UMEM Educational Pearls

Title: Propofol Infusion Syndrome

Posted: 11/17/2009 by Evadne Marcolini, MD (Updated: 4/23/2024)
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There is no prospective, randomized study to elucidate propofol’s effect on the critically ill patient. By definition, Propofol Infusion Syndrome (PRIS) has the following characteristics:

acute bradycardia progressing to asystole
lipemic plasma
fatty liver enlargement
metabolic acidosis with negative base excess > 10
rhabdomyolysis or myoglobinuria

It has been thought that PRIS was limited to patients with prolonged use, but we now know that this is not necessarily true.

It has been shown that PRIS is more likely with the following risk factors:

<19 years old
male
received a vasopressor
cardiac manifestations (including Brugada Syndrome)
metabolic acidosis
renal failure
hypotension
rhabdomyolysis
dyslipidemia

The treatment for suspected PRIS is:

Stop infusion
Hemodynamic stabilization
Carbohydrate substitution
Hemodialysis or hemofiltration
ECMO as necessary

References

Fudickar A, Bein B Propofol infusion syndrome: update of clinical manifestation and pathophysiology. Minerva Anestesiologica 2009;75:339-44.

Vernooy K, Delhaas T, et al. Electrocardiographic changes predicting sudden death in propofol-related infusion syndrome. Heart Rhythm 2006;3:131-7