A 9-year-old child sedated with propofol 4 mg/kg/hour for five days after head injury develops worsening metabolic acidosis, rhabdomyolysis with creatine kinase above 10,000 U/L, and new ventricular arrhythmias. The most appropriate immediate step is:

• A Continue propofol and add sodium bicarbonate infusion
• B Give dantrolene 2.5 mg/kg intravenously
• C Start haemodialysis without changing the sedation
• D Stop propofol immediately and switch to an alternative sedative ✓

Explanation

This is propofol infusion syndrome: prolonged high-dose propofol (>4 mg/kg/h for more than 48 hours), especially in children, causes impaired mitochondrial fatty acid oxidation leading to lactic acidosis, rhabdomyolysis, renal failure, arrhythmia and death. The definitive step is immediate cessation of propofol and supportive care; dialysis and bicarbonate treat consequences but do not remove the cause. Dantrolene treats malignant hyperthermia, which presents with hypercarbia and rigidity during anaesthesia rather than after days of ICU sedation.

Reference: Miller's Anesthesia, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.