Seems like a questionable allergy, but certainly an easy confrontation to avoid. How hard is it to anesthetize someone without propofol? I am pretty sure I have had several patients who had reasons to avoid propofol over the years, and I simply gave them something else. Ketamine, etomidate, sevoflurane, midazolam, these will anesthetize people easily.
It’s really easy to talk to people and come up with a plan they like.
Why invoke the nocebo effect? From now on, every vague symptom is now going to be from the propofol. Headache? Propofol. Malaise? Propofol. Car won’t start? Propofol. So don’t give propofol.
Edit: Occasionally people do have unusual reactions to propofol. I remember some years ago I was inducing some simple ortho case for which I had planned an LMA. Patient was a muscular male in in his 30s. I injected 200 mg of propofol, and the patient began to have pronounced myclonic jerks. I gave a second 200mg injection, and the patient stiffened, and became pretty rigid, and difficult to ventilate. I pushed some sux and intubated, and called for help. Naturally everything looked completely normal when my partners got there, so I felt a little silly, but it was definitely concerning about a minute earlier. I’ve also noticed a higher frequency of less severe myoclonic activity in response to propofol with chronic alcoholics.
Who knows? Probably benign, but honestly, if someone tattooed “no propofol” on their arm, it’s a bad idea to give propofol.
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