Propofol Infusion Syndrome

Aka: Propofol Infusion Syndrome

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II. Epidemiology

  1. ICU patients (most common)
  2. Patients on Backboard in Emergency Department
  3. Children more often affected

III. Risk Factors

  1. Children
  2. Infusion dose >3-4 mg/kg/hour
  3. Infusion duration >12-24 hours (esp. >48 hours)
  4. Risk may be increased in patients with underlying mitochondrial disorders or Muscle disorders

IV. Pathophysiology

  1. Propofol infusion results in mitochondrial respiration arrest (similar to cyanide Poisoning)

V. Risk Factors

  1. Young patients
  2. Sepsis
  3. Concurrent pressor or Glucocorticoid administration

VI. Signs

  1. Metabolic Acidosis
  2. Lactic Acidosis
  3. Rhabdomyolysis
  4. Acute Kidney Injury
  5. Cardiac Failure
  6. Dysrhythmias
    1. Bradycardia
    2. Ventricular Tachycardia
    3. Asystole

VII. Management

  1. Supportive care
  2. Carbohydrate substitution Dialysis and ECMO have been used
  3. Hemodialysis if Acute Renal Failure occurs

VIII. Prognosis

  1. High mortality rate

IX. References

  1. Herbert (2012) EM:RAP 12(1): 3
  2. Claudius in Herbert (2019) EM:Rap 19(4): 12

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