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Case Report

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Suspected chyle leak during complex spine surgery A unique case of propofol infusion resulting in lipid emulsion pooling in the surgical field

  • CHARLES THOMAS WASS1
  • TONY ROCCISANO1
  • STEPHEN DAVID CASSIVI1
  • MARK BENEDICT DEKUTOSKI1
  • MICHAEL JOHN BROWN1

1,Departments of Orthopedic Surgery Thoracic Surgery and Anesthesiology Mayo College of Medicine Mayo Clinic

DOI: 10.22514/SV81.052013.10 Vol.8,Issue 1,May 2013 pp.56-58

Published: 01 May 2013

*Corresponding Author(s): CHARLES THOMAS WASS E-mail: wass.thomas@mayo.edu

Abstract

The authors report a case of propofol infusion being mistaken for chyle during a two stage thoracic spinal fusion. Propofol is commonly used during spine surgery to facilitate neuromonitoring and there are no reported cases of these observations in the spine literature. We describe the positioning, timing, and treatment in a patient that required prolonged care to rule out a chylothorax. Chyle and the pharmacologic and physiologic effects of propofol are discussed. This review outlines our reasoning and steps used to rule out a chyle leak in the setting of propofol-based anesthesia.

Keywords

chest tube, chylothorax, motor evoked potential monitoring, neuromonitoring, propofol infusion syndrome, PRIS, thoracic duct, tho-racotomy, total intravenous anesthe-sia, TIVA 

Cite and Share

CHARLES THOMAS WASS,TONY ROCCISANO,STEPHEN DAVID CASSIVI,MARK BENEDICT DEKUTOSKI,MICHAEL JOHN BROWN. Suspected chyle leak during complex spine surgery A unique case of propofol infusion resulting in lipid emulsion pooling in the surgical field. Signa Vitae. 2013. 8(1);56-58.

References

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2. Sloan TB, Heyer EJ. Anesthesia for intraoperative neurophysiologic monitoring of the spinal cord. J Clin Neurophysiol 2002:19(5);430-43.

3. Zhou HH, Zhu C. Comparison of isoflurane effects on motor evoked potential and F wave. Anesthesiology 2000:93(1);32-8.

4. Vokes DE, Linskey ME, Armstrong WB. Propofol lipemia mimicking chyle leak during neck dissection. Head Neck 2006:28(12);1147-9.

5. Reves JG, Glass PS, Lubarsky DA, McEvoy MD, Martinez-Ruiz R. Intravenous anesthetics. In: Miller RD, editor. Miller’s Anesthesia. Phi-ladelphia; Churchill Livingstone Elsevier: 2010. p. 719-68.

6. Ahlen K, Buckley CJ, Goodale DB, Pulsford AH. The “propofol infusion syndrome’: the facts, their interpretation and implications for patient care. Eur J Anaesthesiol 2006:23;990-8.

7. Fudickar A, Bein B. Propofol infusion syndrome: update of clinical manifestation and pathophysiology. Minerva Anestesiol 2009:75;339-44.

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