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A case of propofol toxicity: further evidence for a causal mechanism

Davinia E Withington1, Mary K Decell, Tareq Al Ayed

  • 1Department of Anaesthesia, Montreal Children's Hospital, Montreal, Quebec, Canada. davinia.withington@mcgill.ca

Paediatric Anaesthesia
|May 22, 2004
PubMed

Insights

A 5-month-old boy experienced severe organ failure after propofol sedation for cleft lip repair. Early diagnosis of acylcarnitine metabolism abnormality and charcoal hemoperfusion improved his condition.

Area of Science:

  • Pediatric Anesthesiology
  • Metabolic Disorders
  • Critical Care Medicine

Background:

  • Propofol is a common anesthetic agent used in pediatric procedures.
  • Cleft lip repair is a routine surgical intervention in infants.
  • Metabolic disorders can present with severe complications during anesthesia.

Observation:

  • A 5-month-old boy developed metabolic acidosis, cardiac dysrhythmias, and hepatic/renal failure post-propofol sedation.
  • Escalating doses of propofol and fentanyl were required during the 48-hour post-operative period.
  • Symptoms gradually resolved after propofol discontinuation and charcoal hemoperfusion.

Findings:

  • The infant's condition improved significantly with charcoal hemoperfusion.
  • Investigations revealed an underlying acylcarnitine metabolism abnormality.
  • This metabolic abnormality is similar to a previously reported case.

Implications:

  • This case highlights the potential risk of propofol in infants with undiagnosed metabolic disorders.
  • Acylcarnitine metabolism abnormalities may predispose infants to propofol-induced toxicity.
  • Early recognition and intervention, including charcoal hemoperfusion, can be life-saving.

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