Propofol lipemia mimicking chyle leak during neck dissection.
BACKGROUND
Propofol is an intravenous agent used in anesthesia. Lipemia is an uncommon adverse effect of propofol infusion.


METHODS
A patient undergoing neck dissection for recurrent chordoma had intraoperative lipemia develop after prolonged propofol infusion.


RESULTS
Lipemia gave blood in the surgical field a milky appearance resembling chyle, but no chyle leak was present. Lipemia was confirmed by drawing a sample of blood and leaving it to stand. Layering of the blood with a milky white upper layer was observed. Analysis of a second sample of blood revealed a high lipemic index.


CONCLUSIONS
Lipemia is an uncommon adverse effect of propofol infusion, which may give blood a milky appearance and be confused for a chyle leak in a dissected neck. Identification of lipemia is also important because there is a risk of acute pancreatitis, and it may represent the early stage of propofol infusion syndrome.
Vokes
David E
DE
Department 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
Linskey
Mark E
ME
Armstrong
William B
WB
D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D002913:Chyle; D003937:Diagnosis, Differential; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced* / Q000175:diagnosis*; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects*; D015742:Propofol / Q000009:adverse effects*
D018686:Anesthetics, Intravenous; D015742:Propofol