Propofol infusion syndrome

Background

  • PRIS = propofol infusion syndrome
  • Refractory bradycardia and cardiovascular collapse
  • Poorly understood mechanism
  • Risk factors
    • High doses of (> 4mg/kg/hr or 67 mcg/kg/min)
    • Long duration (> 48 hrs)
    • Younger age (PRIS first recognized in pediatric population)
    • Critical illness
    • Malnutrition
    • Liver disease
    • Carnitine deficiency
    • Mitochondrial disease
    • Catecholamine, vasopressor infusion
    • Corticosteroid infusion

Clinical Features

Evaluation

  • Serum lipids (TGs, cholesterol)
  • BMP, Cr
  • CK, potassium, urinary myoglobin
  • Lactate, ABG
  • Propofol levels if available
  • ECG
    • Brugada like pattern, coved-type
    • RBBB
    • Heart block

Management

  • Immediate discontinuation of propofol infusion
  • Treatment of rhabdomyolysis, to include renal replacement therapy
  • Hemodynamic support, cardiac pacing
  • L-carnitine supplementation
  • Carbohydrate administration at 6-8mg/kg/min
  • Hemodialysis
  • ECMO in refractory cases

References

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