Journal: Acta Anaesthesiol Scand 52(7):1015-1017, 2008. 13 References
Reprint: Department of Anesthesiology and Reanimation, Trakya University Faculty of Medicine, 22030 Edirne, Turkey (MT Inal, MD)
Faculty Disclosure: Abstracted by S. Ouellette, who has nothing to disclose.
Propofol is an ultrashort-acting IV hypnotic and sedative formulated in lipid solution. It is also used as an anesthetic. Side effects are mild although hypotension, respiratory depression, apnea and pain during injection have been noted. Pulmonary edema associated with propofol injection is rare but this report describes late-onset pulmonary edema due to propofol. The complication occurred during the administration of propofol during a cesarean section and while in the intensive care unit. The skin test demonstrated strong positive wheal and flare reaction to propofol. The patient was treated successfully with mechanical ventilatory support.
The major reason for pulmonary edema during anesthesia is membrane edema due to a leaky alveolar capillary membrane and low filling pressures. The worsening of the patient's condition in ICU after administration of propofol and rocuronium made providers consider the relationship between pulmonary edema and these drugs. The skin tests performed for fentanyl and rocuronium were all negative, while propofol demonstrated strong positive wheal and flare reactions. It was thought that the pulmonary edema was due to administration of propofol.
The pathogenesis of pulmonary edema associated with propofol remains unclear but anaphylactoid reaction is the most frequently postulated etiology. Propofol contains a diisopropyl chain and a phenol group and both have the potential to cause an allergic reaction. The anaphylactoid reaction may increase vascular permeability and result in acute pulmonary edema. Anaphylaxis is generally an unanticipated severe allergic reaction, often explosive in onset, that can occur during the perioperative period. Cardiovascular symptoms and bronchospasm are the most common clinical features. The clinical manifestations of anaphylaxis are derived from the acute release of mediators from mast cells and basophils.
Anaphylaxis usually occurs seconds to minutes after exposure to the relevant antigen. Late onset anaphylaxis also occurs. The incidence of prolonged response is unknown but may be common. A case in the US demonstrated that anaphylaxis may occur 3 days after antigen delivery. In this case, pulmonary edema occurred 30 minutes after administration of propofol. |
