Lactic acidemia and bradyarrhythmia in a child sedated with propofol

Objectives: To describe a severe adverse reaction in a child who received a n infusion of propofol for sedation in the intensive care unit (ICU). To de scribe the management and further investigation of this patient and review similar published reports. Design: Case report and literature review. Setting: Community hospital ICU and tertiary pediatric ICU. Patient: Infant with upper respiratory obstruction secondary to an esophage al foreign body who required tracheal intubation and mechanical ventilation . Interventions: Conventional cardiovascular and respiratory support. Continu ous veno-venous hemofiltration (CVVH) and plasmapheresis. Measurements and Main Results: The patient received a propofol infusion at a mean rate of 10 mg/kg/hr for 50.5 hrs. He developed lipemia and green uri ne and subsequently, a progressive severe lactic acidemia and bradyarrhythm ias unresponsive to conventional treatment. These abnormalities resolved wi th CVVH. He was encephalopathic and developed liver and muscle necrosis his tologically compatible with a toxic insult. Examination of homogenized musc le tissue demonstrated a reduction in cytochrome C oxidase activity. There was no evidence of systemic infection or underlying metabolic disease. He e ventually recovered completely. Conclusion: Propofol has been associated with severe adverse reactions in c hildren receiving intensive care, The biochemical and histologic abnormalit ies described in this patient may guide further investigation. We advise ag ainst prolonged use of propofol for sedation in children.