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Propofol and Hypertriglyceridaemia — FRCA Final MCQ

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ModerateIntensive Care MedicinePropofol and HypertriglyceridaemiaFRCA Final

A 45-year-old mechanically ventilated man (80 kg) with acute pancreatitis is sedated on the ICU with a propofol 1% infusion at 20 ml/h. Routine monitoring shows his serum triglyceride concentration has risen to 15 mmol/L. The sedation target is RASS −2, which he currently meets. He is haemodynamically stable and in sinus rhythm at 78 beats/min, with no atrioventricular block. Which is the most appropriate immediate change to his sedation?

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Correct answer: A — Stop propofol and start dexmedetomidine

Propofol 1% delivers approximately 0.1 g of fat per ml. Its UK SmPC requires lipid monitoring in patients at risk of fat overload and appropriate adjustment when fat is inadequately cleared. With triglycerides of 15 mmol/L and concurrent acute pancreatitis, continuing an avoidable lipid emulsion is inappropriate; propofol should be stopped. Dexmedetomidine is licensed for adult ICU sedation at RASS 0 to −3, matching the RASS −2 target. The stem excludes hypotension, bradycardia and atrioventricular block, making it a suitable replacement. The dexmedetomidine mortality signal in younger ICU patients was associated particularly with early high-dose deep sedation and was not detected with light sedation. A and B continue full lipid exposure, D still supplies 24 g/day, and E neither removes the lipid source nor provides sufficiently rapid treatment of this immediate problem.

Reference: electronic Medicines Compendium. Propofol 10 mg/ml (1%) emulsion for injection or infusion — Summary of Product Characteristics, sections 4.2 and 4.4; updated 3 November 2025. https://www.medicines.org.uk/emc/product/5492/smpc