Propofol
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Lactic acidosis: case report A 43-year-old woman developed severe lactic acidosis after receiving a high-dose propofol infusion during neurosurgery for a perirolandic arteriovenous malformation (AVM). The woman, who underwent a right parietal craniotomy and resection of her AVM, received an infusion of propofol 7 mg/kg/h and remifentanil during the 7-hour procedure. She was transferred to the ICU 1 hour after the surgery and remained on mechanical ventilation; she also received midazolam, fentanyl and valproic acid. Two hours after completion of the surgery, onset of lactic acidosis was detected; pH 7.34, lactic acid 4.1 mmol/L, PaCO2 36mm Hg, bicarbonate 19 mmol/L, base excess –6.4 mmol/L. Blood tests 4 hours later revealed that her lactic acidosis had worsened (pH 7.12, lactic acid 9.9 mmol/L, PaCO2 31mm Hg, bicarbonate 10 mmol/L, base excess –18 mmol/L) and her central venous saturation was 86%. A pulmonary arterial catheter was inserted for haemodynamic monitoring and the woman received IV fluids and norepinephrine [noradrenaline]. Propofol was reintroduced at a dosage of 3.5 mg/kg/h, and the dosage of midazolam was increased, in order to achieve a level of 2 on the Riker’s Sedation-Agitation scale. Subsequent blood analysis revealed a significant worsening of her lactic acidosis: pH 7, lactic acid 8.5 mmol/L with a mixed venous saturation of 80%. She continued to receive supportive treatment during the following hours. Propofol was subsequently suspected as the causative agent for continuation of her lactic acidosis and was withdrawn. Four hours later, her lactic acidosis was improving; pH of 7.53, lactic acid 2.9 mmol/L, PaCO2 24mm Hg. Her lactic acid level had normalised 11 hours after stopping propofol. She remained well and was transferred back to the ICU. Author comment: Our patient combined all the conditions required for a high risk of developing propofol infusion syndrome, since she had undergone major neurosurgery, and had also been given exogenous catecholamines and steroids during surgery and the period immediately following surgery. Romero PC, et al. Severe lactic acidosis caused by propofol infusion. Report of one case. Revista Medica de Chile 136: 88-92, No. 1, Jan 2008 [Spanish; 801080514 summarised from a translation] - Chile
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Reactions 21 Jun 2008 No. 1207
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