Recommended Citation
Hussain H, Knezevic N. Propofol-induced green discoloration of breast milk: A case report. Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Presentation Notes
Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Abstract
Introduction: Propofol is a widely used intravenous sedative-hypnotic agent, known for its rapid onset, and is commonly used for the induction and maintenance of general anesthesia and sedation. Propofol is extensively metabolized in the liver into water-soluble metabolites that are excreted by the kidneys. Propofol has been associated with the green discoloration of urine, breast milk, and other bodily fluids. Although the exact mechanism remains to be elucidated, it is thought to be related to the phenolic derivatives of propofol. Here we present a case of a 27-year-old breastfeeding mother producing green-colored breast milk following propofol induction for laparoscopic cholecystectomy. Case Presentation: A 27-year-old G3P2012 female presented with a one-day history of severe (9/10) right upper quadrant pain, nausea, and decreased appetite. She was actively breastfeeding her seven-month-old child without issues. Her medical history was unremarkable except for a prior Cesarean delivery under spinal anesthesia. She took no prescribed medications, reported daily multivitamin use, and had no allergies or substance use. On exam, she had right upper quadrant tenderness without peritonitis. Labs showed elevated transaminases and hyperbilirubinemia. She was diagnosed with acute cholecystitis and underwent an uncomplicated robotic cholecystectomy under general anesthesia, receiving propofol, succinylcholine, lidocaine and fentanyl on induction. On post-op day 1, while pumping for the first time, she noticed a blue-green discoloration of her breast milk, prompting an anesthesia consult. Active medications included enoxaparin, ondansetron, tramadol, polyethylene glycol, and ketorolac. Given the timing and medication review, propofol was identified as the likely cause. The discoloration resolved within 24 hours, and she was reassured it was safe to resume breastfeeding. She was discharged home on post-op day 3 in stable condition. Conclusion: This case highlights an uncommon side effect of propofol administration in breastfeeding mothers. Clinicians should be aware of this rare side effect of propofol. While the exact mechanism remains unclear, propofol’s lipophilic nature and its metabolic byproducts may contribute to transient breast milk discoloration. Risks to the infant are currently unknown, therefore we recommend temporarily halting administration of breast milk for at least 48 hours or until resolution of the discoloration. There have been a limited number of case reports where attempts to analyze breast milk sample for propofol metabolites were made, but with no evidence of metabolites present. Further studies are warranted to further evaluate other potential chromophoric derivatives of propofol in breast milk. 1. Rainone, Anthony et al. (2018) The Canadian Journal of Hospital Pharmacy 71: 389-391. 2. Bulut, Ozgulet et al (2021) Journal of Paediatrics and Child Health 57 153-154. 3. Birkholz, Torsten, et al. (2009) Anesthesiology 1168–1169
Type
Oral/Podium Presentation
Affiliations
Advocate Illinois Masonic Medical Center