Lactic acidemia and bradyarrhythmia in a child sedated with propofol

• Published in: Critical care medicine Vol. 26; no. 12; pp. 2087 - 2092
• Main Authors: Cray, Steven H, Robinson, Brian H, Cox, Peter N
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Williams & Wilkins 01-12-1998; Lippincott
• Subjects: Acidosis, Lactic - chemically induced; Acidosis, Lactic - diagnosis; Acidosis, Lactic - metabolism; Biological and medical sciences; Bradycardia - chemically induced; Bradycardia - diagnosis; Bradycardia - metabolism; Conscious Sedation - adverse effects; Drug toxicity and drugs side effects treatment; Fatty Liver - chemically induced; Fatty Liver - pathology; Humans; Hyperlipidemias - chemically induced; Hypnotics and Sedatives - adverse effects; Infant; Infusions, Intravenous; Male; Medical sciences; Muscular Diseases - chemically induced; Muscular Diseases - pathology; Necrosis; Oliguria - chemically induced; Pharmacology. Drug treatments; Propofol - adverse effects; Respiration, Artificial; Toxicity: nervous system and muscle; Human; Intensive care; Arrhythmia; Toxicity; Cardiovascular disease; Acid base balance disorder; Sedation; Excitability disorder; Case study; Metabolic disorder; Bradycardia; Chemotherapy; Treatment; General anesthetic; Heart disease; Complication; Lactic acid; Propofol; Acidosis; Child; Metabolic acidosis; Bibliographic review
• ISSN: 0090-3493; 1530-0293
• DOI: 10.1097/00003246-199812000-00046

OBJECTIVESTo describe a severe adverse reaction in a child who received an infusion of propofol for sedation in the intensive care unit (ICU). To describe the management and further investigation of this patient and review similar published reports.
DESIGNCase report and literature review.
SETTINGCommunity hospital ICU and tertiary pediatric ICU.
PATIENTInfant with upper respiratory obstruction secondary to an esophageal foreign body who required tracheal intubation and mechanical ventilation.
INTERVENTIONSConventional cardiovascular and respiratory support. Continuous veno-venous hemofiltration (CVVH) and plasmapheresis.
MEASUREMENTS AND MAIN RESULTSThe patient received a propofol infusion at a mean rate of 10 mg/kg/hr for 50.5 hrs. He developed lipemia and green urine and subsequently, a progressive severe lactic acidemia and bradyarrhythmias unresponsive to conventional treatment. These abnormalities resolved with CVVH. He was encephalopathic and developed liver and muscle necrosis histologically compatible with a toxic insult. Examination of homogenized muscle tissue demonstrated a reduction in cytochrome C oxidase activity. There was no evidence of systemic infection or underlying metabolic disease. He eventually recovered completely.
CONCLUSIONPropofol has been associated with severe adverse reactions in children receiving intensive care. The biochemical and histologic abnormalities described in this patient may guide further investigation. We advise against prolonged use of propofol for sedation in children. (Crit Care Med 1998; 26:2087-2092)