Abstract
A 6-year-old girl was admitted to the pediatric ward because of her behavioral abnormalities such as “diurnal sleepnessnocturnal irritation” rhythm, choreic movements and generalized muscle rigidity. Several medicines including diazepam and phenytoin were given for her convulsive attack. On the 11th hospital day, she was transferred to the ICU, because of progressive disturbance of consciousness, hyperthermia (42°C), hyper- “creatinine phosphkinase (CPK)” -emia and anuria. The patient was suspected as neuroleptic malignant syndrome.
Forced cooling, administration of dantrolene, continuous hemofiltration, and plasma exchange were performed. On the 15th day, the CPK concentration decreased from 312, 480U·l-1 on the day of ICU admission to 38, 880U·l-1. Continuous propofol infusion (3mg·kg·hr-1) was started on the 15th day to facilitate mechanical ventilation and finally stopped on the 27th day becaus of the suspicion that propofol was attributable to lasting hyper- “CPK” -emia in the range between 4, 000 and 8, 000U·l-1. The CPK concentrations remarkably decreased after the cessation of propofol to less than 1, 000U·l-1 on the 30th day and kept decreasing. We suggest that propofol should not be used for sedation in children even within the recommended dosage because of the possible contribution of rhabdomyolysis.
