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Propofol lipemia mimicking chyle leak during neck dissection
David E Vokes1, Mark E Linskey, William B Armstrong
1Department of Otolaryngology-Head & Neck Surgery, University of California Irvine Medical Center, 101 The City Drive South, Building 56, Suite 500, Orange, California 92868, USA. dvokes@uci.edu
Propofol infusion can cause lipemia, a rare side effect that makes blood appear milky. This can be mistaken for a chyle leak during neck surgery.
Area of Science:
- Anesthesiology
- Clinical Chemistry
Background:
- Propofol is a widely used intravenous anesthetic agent.
- Intraoperative lipemia is an uncommon but recognized adverse effect of propofol infusion.
Observation:
- A patient undergoing neck dissection for recurrent chordoma developed intraoperative lipemia during prolonged propofol infusion.
- The patient's blood in the surgical field had a milky appearance, mimicking a chyle leak.
Findings:
- Lipemia was confirmed by observing distinct layering in a blood sample, with a milky white upper layer.
- Laboratory analysis revealed a significantly elevated lipemic index, confirming the presence of lipemia.
Implications:
- Intraoperative lipemia from propofol can be misdiagnosed as a chyle leak in surgical neck dissections.
- Recognizing lipemia is crucial due to potential risks including acute pancreatitis and its possible role as an early sign of propofol infusion syndrome.
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