title: Hypertriglyceridemia, lipemia, and elevated liver enzymes associated with prolonged propofol anesthesia for craniotomy.
abstract: : Lipemic blood was noted in the surgical field by a neurosurgeon after 12.5 hours of anesthesia consisting of infusions of propofol (total dose, 14,956 mcg) and remifentanil (total dose, 25,091 mcg). For most of that time, the rate of propofol was 120-160 mcg·kg-1·min-1 and never exceeded 160 mcg·kg-1·min-1. Lipemia was confirmed by allowing a sample of the patient's blood to settle in a syringe. The triglyceride concentration was 15.8 mmol/L. There was no metabolic acidosis or other indications of propofol infusion syndrome. Postoperatively, liver enzymes were elevated (peak aspartate aminotransferase, 420 units/L) but returned to nearly normal within 5 days. The patient recovered from surgery uneventfully. Reports of intraoperative lipemia during propofol anesthesia are very rare but raise concerns about the safety of prolonged propofol infusion.
authors.affiliation: Departments of *Anesthesiology; and †Neurological Surgery, University of Washington, Seattle.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bowdle
authors.forename: Philippe
authors.initials: P
authors.lastname: Richebe
authors.forename: Lorri
authors.initials: L
authors.lastname: Lee
authors.forename: Robert
authors.initials: R
authors.lastname: Rostomily
authors.forename: Patrik
authors.initials: P
authors.lastname: Gabikian
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D001219:Aspartate Aminotransferases / Q000097:blood; D003399:Craniotomy; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000139:chemically induced*; D015228:Hypertriglyceridemia / Q000139:chemically induced*; D008099:Liver / Q000201:enzymology*; D009464:Neuroma, Acoustic / Q000601:surgery; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D018686:Anesthetics, Intravenous; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D015742:Propofol