Propofol infusion syndrome

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD's medical weight loss NYC, sleep center NYC
Philadelphia medical weight loss and Philadelphia sleep clinics

Propofol infusion syndrome
Chemical structure of propofol
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

Chemical structure of propofol

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

See also

• Propofol
• Anesthesia
• Rhabdomyolysis
• Metabolic acidosis