Propofol infusion syndrome: Difference between revisions

Revision as of 11:16, 15 February 2025

Propofol Infusion Syndrome

Propofol infusion syndrome (PRIS) is a rare but serious condition associated with the prolonged use of the anesthetic drug propofol. It is characterized by a combination of metabolic acidosis, cardiac failure, rhabdomyolysis, and renal failure. PRIS is most commonly observed in critically ill patients, particularly those receiving high doses of propofol for extended periods.

Pathophysiology

The exact mechanism of PRIS is not fully understood, but it is believed to involve mitochondrial dysfunction and impaired fatty acid oxidation. Propofol may interfere with the electron transport chain in mitochondria, leading to decreased adenosine triphosphate (ATP) production and increased lactate levels. This can result in metabolic acidosis and muscle breakdown, contributing to the clinical manifestations of the syndrome.

Clinical Features

Patients with PRIS may present with a variety of symptoms, including:

Severe metabolic acidosis
Cardiac arrhythmias or cardiac failure
Rhabdomyolysis, leading to elevated creatine kinase levels
Renal failure
Hyperkalemia
Lipemia

The onset of symptoms can be rapid, and the condition can progress quickly to life-threatening complications.

Risk Factors

Several risk factors have been identified for the development of PRIS, including:

High-dose propofol infusion (>4 mg/kg/hr)
Prolonged duration of propofol administration (>48 hours)
Critical illness, particularly in pediatric patients
Concomitant use of catecholamines or corticosteroids

Management

The primary treatment for PRIS is the immediate discontinuation of propofol. Supportive care is crucial and may include:

Correction of metabolic acidosis with bicarbonate
Hemodynamic support with vasopressors
Renal replacement therapy in cases of renal failure
Monitoring and management of electrolyte imbalances

Early recognition and intervention are essential to improve outcomes in patients with PRIS.

Prevention

To prevent PRIS, it is recommended to:

Use the lowest effective dose of propofol
Limit the duration of propofol infusion
Monitor patients closely for early signs of PRIS

Related Pages

@@ Line 1: / Line 1: @@
-'''Propofol Infusion Syndrome''' (PIS) is a rare, but potentially fatal, medical condition that can occur in patients receiving large doses of the anesthetic drug [[propofol]] for an extended period of time.
+== Propofol Infusion Syndrome ==
-== Symptoms ==
+[[File:Propofol.svg|thumb|right|Chemical structure of propofol]]
-The syndrome is characterized by a sudden onset of rapid heart rate, high levels of acid in the blood ([[metabolic acidosis]]), muscle breakdown ([[rhabdomyolysis]]), and failure of the heart to pump enough blood ([[cardiac failure]]). Other symptoms may include high levels of potassium in the blood ([[hyperkalemia]]), high levels of fat in the blood ([[hyperlipidemia]]), and kidney failure ([[renal failure]]).
-== Causes ==
+'''Propofol infusion syndrome''' (PRIS) is a rare but serious condition associated with the prolonged use of the [[anesthetic]] drug [[propofol]]. It is characterized by a combination of metabolic acidosis, cardiac failure, rhabdomyolysis, and renal failure. PRIS is most commonly observed in critically ill patients, particularly those receiving high doses of propofol for extended periods.
-The exact cause of PIS is unknown, but it is thought to be related to the way propofol affects the body's metabolism. Propofol is a powerful sedative and anesthetic that is commonly used in intensive care units (ICUs) to sedate patients who are on a ventilator. It is also used for general anesthesia during surgery.
-== Diagnosis ==
+== Pathophysiology ==
-Diagnosis of PIS is based on the presence of the characteristic symptoms in a patient who has been receiving propofol. There is no specific test for PIS, but blood tests may show high levels of acid, potassium, and fat in the blood.
-== Treatment ==
+The exact mechanism of PRIS is not fully understood, but it is believed to involve mitochondrial dysfunction and impaired fatty acid oxidation. Propofol may interfere with the electron transport chain in mitochondria, leading to decreased [[adenosine triphosphate]] (ATP) production and increased lactate levels. This can result in metabolic acidosis and muscle breakdown, contributing to the clinical manifestations of the syndrome.
-Treatment of PIS involves discontinuing the use of propofol and providing supportive care. This may include medications to treat the symptoms, dialysis to remove toxins from the blood, and mechanical ventilation to support breathing.
+== Clinical Features ==
+Patients with PRIS may present with a variety of symptoms, including:
+* Severe metabolic acidosis
+* Cardiac arrhythmias or cardiac failure
+* Rhabdomyolysis, leading to elevated creatine kinase levels
+* Renal failure
+* Hyperkalemia
+* Lipemia
+The onset of symptoms can be rapid, and the condition can progress quickly to life-threatening complications.
+== Risk Factors ==
+Several risk factors have been identified for the development of PRIS, including:
+* High-dose propofol infusion (>4 mg/kg/hr)
+* Prolonged duration of propofol administration (>48 hours)
+* Critical illness, particularly in pediatric patients
+* Concomitant use of catecholamines or corticosteroids
+== Management ==
+The primary treatment for PRIS is the immediate discontinuation of propofol. Supportive care is crucial and may include:
+* Correction of metabolic acidosis with bicarbonate
+* Hemodynamic support with vasopressors
+* Renal replacement therapy in cases of renal failure
+* Monitoring and management of electrolyte imbalances
+Early recognition and intervention are essential to improve outcomes in patients with PRIS.
 == Prevention ==
-Prevention of PIS involves careful monitoring of patients who are receiving propofol, especially those who are receiving high doses for an extended period of time.
-== See also ==
+To prevent PRIS, it is recommended to:
+* Use the lowest effective dose of propofol
+* Limit the duration of propofol infusion
+* Monitor patients closely for early signs of PRIS
+== Related Pages ==
 * [[Propofol]]
-* [[Intensive care unit]]
+* [[Anesthesia]]
+* [[Rhabdomyolysis]]
 * [[Metabolic acidosis]]
-* [[Rhabdomyolysis]]
-* [[Cardiac failure]]
-* [[Hyperkalemia]]
-* [[Hyperlipidemia]]
-* [[Renal failure]]
-[[Category:Medical conditions]]
 [[Category:Anesthesia]]
-[[Category:Intensive care medicine]]
+[[Category:Medical syndromes]]
-{{stub}}