Propofol infusion syndrome: Difference between revisions
From WikiMD's Wellness Encyclopedia
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{{Infobox medical condition | |||
[[File:Propofol.svg|thumb| | | name = Propofol infusion syndrome | ||
| image = [[File:Propofol.svg|left|thumb|Chemical structure of propofol]] | |||
| caption = Chemical structure of propofol | |||
| field = [[Anesthesiology]] | |||
| symptoms = [[Metabolic acidosis]], [[rhabdomyolysis]], [[hyperkalemia]], [[cardiac arrhythmia]], [[heart failure]], [[renal failure]] | |||
| complications = [[Cardiac arrest]], [[multi-organ failure]] | |||
| onset = Typically after prolonged high-dose [[propofol]] infusion | |||
| duration = Variable, depending on intervention | |||
| causes = High-dose [[propofol]] infusion | |||
| risks = [[Critical illness]], [[pediatric]] patients, [[neurological injury]] | |||
| diagnosis = Clinical evaluation, laboratory tests | |||
| differential = [[Malignant hyperthermia]], [[neuroleptic malignant syndrome]], [[sepsis]] | |||
| prevention = Limiting dose and duration of [[propofol]] infusion | |||
| treatment = Discontinuation of [[propofol]], supportive care, [[hemodialysis]] | |||
| prognosis = Variable, can be fatal if not recognized and treated promptly | |||
| frequency = Rare | |||
}} | |||
'''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. | '''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 == | == 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. | 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 == | == Clinical Features == | ||
Patients with PRIS may present with a variety of symptoms, including: | Patients with PRIS may present with a variety of symptoms, including: | ||
* Severe metabolic acidosis | * Severe metabolic acidosis | ||
* Cardiac arrhythmias or cardiac failure | * Cardiac arrhythmias or cardiac failure | ||
| Line 19: | Line 29: | ||
* Hyperkalemia | * Hyperkalemia | ||
* Lipemia | * Lipemia | ||
The onset of symptoms can be rapid, and the condition can progress quickly to life-threatening complications. | The onset of symptoms can be rapid, and the condition can progress quickly to life-threatening complications. | ||
== Risk Factors == | == Risk Factors == | ||
Several risk factors have been identified for the development of PRIS, including: | Several risk factors have been identified for the development of PRIS, including: | ||
* High-dose propofol infusion (>4 mg/kg/hr) | * High-dose propofol infusion (>4 mg/kg/hr) | ||
* Prolonged duration of propofol administration (>48 hours) | * Prolonged duration of propofol administration (>48 hours) | ||
* Critical illness, particularly in pediatric patients | * Critical illness, particularly in pediatric patients | ||
* Concomitant use of catecholamines or corticosteroids | * Concomitant use of catecholamines or corticosteroids | ||
== Management == | == Management == | ||
The primary treatment for PRIS is the immediate discontinuation of propofol. Supportive care is crucial and may include: | The primary treatment for PRIS is the immediate discontinuation of propofol. Supportive care is crucial and may include: | ||
* Correction of metabolic acidosis with bicarbonate | * Correction of metabolic acidosis with bicarbonate | ||
* Hemodynamic support with vasopressors | * Hemodynamic support with vasopressors | ||
* Renal replacement therapy in cases of renal failure | * Renal replacement therapy in cases of renal failure | ||
* Monitoring and management of electrolyte imbalances | * Monitoring and management of electrolyte imbalances | ||
Early recognition and intervention are essential to improve outcomes in patients with PRIS. | Early recognition and intervention are essential to improve outcomes in patients with PRIS. | ||
== Prevention == | == Prevention == | ||
To prevent PRIS, it is recommended to: | To prevent PRIS, it is recommended to: | ||
* Use the lowest effective dose of propofol | * Use the lowest effective dose of propofol | ||
* Limit the duration of propofol infusion | * Limit the duration of propofol infusion | ||
* Monitor patients closely for early signs of PRIS | * Monitor patients closely for early signs of PRIS | ||
== See also == | |||
== | |||
* [[Propofol]] | * [[Propofol]] | ||
* [[Anesthesia]] | * [[Anesthesia]] | ||
* [[Rhabdomyolysis]] | * [[Rhabdomyolysis]] | ||
* [[Metabolic acidosis]] | * [[Metabolic acidosis]] | ||
[[Category:Anesthesia]] | [[Category:Anesthesia]] | ||
[[Category:Medical syndromes]] | [[Category:Medical syndromes]] | ||
Revision as of 15:22, 8 April 2025
Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC
| Propofol infusion syndrome | |
|---|---|
 | |
| Synonyms | N/A |
| Pronounce | N/A |
| Specialty | N/A |
| Symptoms | Metabolic acidosis, rhabdomyolysis, hyperkalemia, cardiac arrhythmia, heart failure, renal failure |
| Complications | Cardiac arrest, multi-organ failure |
| Onset | Typically after prolonged high-dose propofol infusion |
| Duration | Variable, depending on intervention |
| Types | N/A |
| Causes | High-dose propofol infusion |
| Risks | Critical illness, pediatric patients, neurological injury |
| Diagnosis | Clinical evaluation, laboratory tests |
| Differential diagnosis | Malignant hyperthermia, neuroleptic malignant syndrome, sepsis |
| Prevention | Limiting dose and duration of propofol infusion |
| Treatment | Discontinuation of propofol, supportive care, hemodialysis |
| Medication | N/A |
| Prognosis | Variable, can be fatal if not recognized and treated promptly |
| Frequency | Rare |
| Deaths | N/A |
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
