Propofol Infusion Syndrome: A Case Report

Oleksa Rewa, John Muscedere

Abstract


Propofol is an ultra-short acting intravenous sedative/hypnotic agent commonly used for sedation in the intensive care unit (ICU) and operating room (OR). Up until recently, no severe systemic side effects were apparent but more recently severe and potentially lethal side effects have been sporadically reported and termed propofol-infusion syndrome (PRIS). Herein we describe a case of a 23 years old previously healthy male admitted to the ICU secondary to trauma. Due to excessive agitation and failure of other agents, he was sedated on high dose propofol (> 100 µg/Kg/min) for several days. Following this he developed rhabdomyolysis, worsening renal failure, hyperkalemia, refractory acidosis, and eventually expired secondary to cardiovascular collapse. PRIS was attributed as the cause of death. Since its introduction in the 1980s propofol has been widely used for sedation in the ICU. PRIS has become an increasingly recognized phenomenon where propofol infusions have been used for prolonged periods of time. It is characterized by progressive rhabdomyolysis, renal failure, hyperkalemia, metabolic acidosis, Brugada-like pattern changes on ECG, cardiovascular collapse and finally death, all characteristics present in our patient. Several important risk factors for this condition exist such as prolonged propofol infusion, young age, head trauma, airway infection, increased catecholamine and glucocorticoid levels and malnutrition. The mechanism of PRIS remains incompletely understood but it is thought to be due to mitochondrial dysfunction with propofol serving to uncouple the respiratory chain; as such treatment involves stopping the medication and supportive care. In the vast majority of patients, propofol is safe with few side effects but given its potential for lethal complications heightened vigilance is required for its continued use. In particular, to minimize the potential for the development of PRIS, dose limitations and daily re-evaluation as to the necessity of its continued use are required. Further, PRIS must be considered when patients develop unexplained organ dysfunction with metabolic acidosis, increased creatinine phosphokinase and hemodynamic instability. Awareness of the early clinical manifestations of PRIS leading to prompt termination of propofol infusion and appropriate supportive care may improve its outcome if it does develop.



J Med Cases. 2013;4(9):584-587
doi: https://doi.org/10.4021/jmc1269w

Keywords


Propofol infusion; Syndrome; Trauma

Full Text: HTML PDF
 

Browse  Journals  

     

Journal of clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 

 

 

 

Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.            
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.journalmc.org   editorial contact: editor@journalmc.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.