Early propofol infusion syndrome following cerebral angiographic embolization for giant aneurysm repair. Case report.

Abstract

The authors report a case of short-term high-dose propofol-related metabolic acidosis in a 3-year-old girl. The patient initially presented at another institution with left fourth cranial nerve palsy, and examination revealed a large, wide-necked 19 x 22 x 17-mm aneurysm in the left internal carotid artery. She had undergone three previous unsuccessful attempts at endovascular coil embolization, which were complicated by repeated coil protrusions into the parent vessel. During angiography and a balloon occlusion test (BOT) 80 mg propofol was given for 3 hours followed by 200 microg/kg/min for another 4 hours. The 20-minute BOT was well tolerated, and the aneurysm was occluded with stent-assisted coil embolization. Following the procedure the patient developed severe acidosis, hypotension, tachycardia, and signs of cardiac failure. On postoperative Day 3 her metabolic acidosis resolved, and she was weaned off sedatives. She continued to improve and was discharged from the hospital on postoperative Day 7. The metabolic acidosis and hypotension were thought to be due to propofol-related infusion syndrome.