Propofol lipemia mimicking chyle leak during neck dissection

Abstract

Propofol is an intravenous agent used in anesthesia. Lipemia is an uncommon adverse effect of propofol infusion. A patient undergoing neck dissection for recurrent chordoma had intraoperative lipemia develop after prolonged propofol infusion. Lipemia gave blood in the surgical field a milky appearance resembling chyle, but no chyle leak was present. Lipemia was confirmed by drawing a sample of blood and leaving it to stand. Layering of the blood with a milky white upper layer was observed. Analysis of a second sample of blood revealed a high lipemic index. Lipemia is an uncommon adverse effect of propofol infusion, which may give blood a milky appearance and be confused for a chyle leak in a dissected neck. Identification of lipemia is also important because there is a risk of acute pancreatitis, and it may represent the early stage of propofol infusion syndrome.