(a) List the risk factors for and the clinical and laboratory findings of propofol infusion syndrome.
(b) Outline your management of a patient with suspected propofol infusion syndrome.
(a) List the risk factors for and the clinical and laboratory findings of propofol infusion syndrome.
Risk Factors
Large doses (> 4mg/kg/hr for > 48 hours in adults): typically, but not always, large dose, long time
Younger age
Acute neurological injury
Low carbohydrate intake
Catecholamine and/or corticosteroid infusion
Clinical and laboratory findings Unexplained lactic acidosis Increasing inotrope support
(Lipaemic serum, propofol levels / chromatography (if available??))
Brugada-like ECG abnormalities (Coved-type = convex-curved ST elevation in V1-
3)
(Green urine)
Cardiovascular collapse, reflected in PICCO / PAC / ECHO Rhabdomyolysis, high CK, hyperkalaemia
Arrhythmia / heart block
Renal failure
(b) Outline your management of a patient with suspected propofol infusion syndrome.
Management:
High index of suspicion
Discontinue immediately
Monitor for early warning signs: lactate, CK, Urine myoglobin, ECG Standard cardio-respiratory support
Consider pacing (bradycardia often resistant to high dose CA and pacing)
Adequate carbohydrate intake (6-8mg/kg/min)
Carnitine supplementation: theoretical benefit
Haemodialysis and haemoperfusion, used, unproven benefit
ECMO: 2 case reports, readily reversible pathology
Propofol infusion syndrome is discussed elsewhere.
It is well covered in an article by Prof Kam.
Pathophysiology of propofol infusion syndrome
a) Risk factors for propofol infusion syndrome
Clinical features and laboratory findings in propofol infusion syndrome
Management of propofol infusion syndrome
Enhanced elimination
Specific antidote
Supportive care
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Vasile, Beatrice, et al. "The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome." Intensive care medicine 29.9 (2003): 1417-1425.
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