Cray S H, Robinson B H, Cox P N
Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
Crit Care Med. 1998 Dec;26(12):2087-92. doi: 10.1097/00003246-199812000-00046.
To describe a severe adverse reaction in a child who received an infusion of propofol for sedation in the intensive care unit (ICU). To describe the management and further investigation of this patient and review similar published reports.
Case report and literature review.
Community hospital ICU and tertiary pediatric ICU.
Infant with upper respiratory obstruction secondary to an esophageal foreign body who required tracheal intubation and mechanical ventilation.
Conventional cardiovascular and respiratory support. Continuous veno-venous hemofiltration (CVVH) and plasmapheresis.
The patient received a propofol infusion at a mean rate of 10 mg/kg/hr for 50.5 hrs. He developed lipemia and green urine and subsequently, a progressive severe lactic acidemia and bradyarrhythmias unresponsive to conventional treatment. These abnormalities resolved with CVVH. He was encephalopathic and developed liver and muscle necrosis histologically compatible with a toxic insult. Examination of homogenized muscle tissue demonstrated a reduction in cytochrome C oxidase activity. There was no evidence of systemic infection or underlying metabolic disease. He eventually recovered completely.
Propofol has been associated with severe adverse reactions in children receiving intensive care. The biochemical and histologic abnormalities described in this patient may guide further investigation. We advise against prolonged use of propofol for sedation in children.
描述一名在重症监护病房（ICU）接受丙泊酚输注镇静的儿童发生的严重不良反应。描述该患者的处理及进一步检查情况，并回顾已发表的类似报告。
病例报告及文献综述。
社区医院ICU及三级儿科ICU。
因食管异物继发上呼吸道梗阻的婴儿，需要气管插管及机械通气。
常规心血管及呼吸支持。持续静脉-静脉血液滤过（CVVH）及血浆置换。
患者接受丙泊酚输注，平均速率为10mg/kg/hr，持续50.5小时。他出现了脂血症和绿色尿液，随后出现进行性严重乳酸血症及对常规治疗无反应的缓慢性心律失常。这些异常通过CVVH得以缓解。他出现脑病，组织学检查显示肝脏和肌肉坏死，与毒性损伤相符。对匀浆肌肉组织的检查显示细胞色素C氧化酶活性降低。无全身感染或潜在代谢疾病的证据。他最终完全康复。
丙泊酚与接受重症监护的儿童严重不良反应有关。该患者所描述的生化及组织学异常可能为进一步研究提供指导。我们建议避免在儿童中长时间使用丙泊酚进行镇静。
