CASE REPORT article
Front. Anesthesiol.
Sec. General Pharmacology and Pharmacokinetics
Reversible Propofol Resistance in a Pediatric Patient with Chemotherapy-Induced Hypertriglyceridemia: A Case Report
Provisionally accepted
- Medical University of South Carolina, Charleston, United States
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We report the case of a 10-year-old female with high-risk B-cell acute lymphoblastic leukemia who exhibited transient resistance to propofol. She was found to have milky appearing serum and bone marrow aspirate, markedly elevated triglycerides, while being recently treated with calaspargase pegol and dexamethasone during induction chemotherapy. Despite previously normal anesthetic responses, the patient required a markedly increased propofol dose (28 mg/kg)—over five times the range of her previous anesthetics (4.5-5.2 mg/kg)—to achieve adequate sedation for her bone marrow aspiration and biopsy. Ultimately, normal propofol sensitivity returned after triglyceride normalization. This case highlights chemotherapy-induced hypertriglyceridemia as a reversible cause of anesthetic resistance and emphasizes the consideration of lipid levels when an unusual response to routine anesthetic administration occurs.
Keywords: Propofol, Leukemia, Hypertriglyceridemia, sedation, Lipid
Received: 15 Oct 2025; Accepted: 14 Nov 2025.
Copyright: © 2025 McCoy, Rovner, Greenlaw, Ferrante, Eason and Heine. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Nicole McCoy, mccoyn@musc.edu
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