Propofol Infusion Syndrome
Rare and potentially fatal complication of prolonged high-dose propofol use, characterised by:
- Severe metabolic acidosis
- Bradycardia → asystole
- Cardiac failure
- Rhabdomyolysis
Epidemiology and Risk Factors
Risk factors:
- Drug
- Propofol infusion >4mg/kg/hr for >48 hours
- Catecholamines
- Nutrition
- Carnitine deficiency
- ↓ Carbohydrate intake
↑ Lipolysis to meet energy needs, with subsequent ↑ in free fatty acids.
- Pathology
- TBI
Pathophysiology
Uncertain, favoured to be:
- Propofol inhibition of coenzyme Q and cytochrome C
- Subsequent failure of ATP production and the electron transport chain
- Lactate production
Aetiology
Clinical Features
- ↓ HR
- Severe HAGMA
BE <-10, due to:- Lactataemia
- ↑ Free fatty acids
- Hyperlipidaemia
- Hepatomegaly
- Rhabdomyolysis
Assessment
History:
Exam:
Investigations
Bedside:
Laboratory:
Imaging:
Other:
Diagnostic Approach and DDx
Management
- Stop propofol
- RRT
- Consider plasma exchange
Resuscitation:
- C
- Consider pacing and inotropes
Typically refractory. - Early consideration of mechanical support
- Consider pacing and inotropes
Specific therapy:
- Pharmacological
- Cease propofol
- Procedural
- Physical
Supportive care:
- F
- RRT
- H
- Plasma exchange
Disposition:
Preventative:
Marginal and Ineffective Therapies
Anaesthetic Considerations
Complications
Prognosis
Key Studies
References
- Kam PCA, Cardone D. Propofol infusion syndrome. Anaesthesia. 2007;62(7):690-701. doi:10.1111/j.1365-2044.2007.05055.x