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Propofol infusion syndrome.

P C A Kam1, D Cardone

  • 1Department of Anaesthetics, University of Sydney, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia. pkam@usyd.edu.au

Anaesthesia
|June 15, 2007
PubMed
Summary
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Propofol infusion syndrome (PRIS) is a critical condition characterized by bradycardia and metabolic disturbances, often linked to high-dose, long-duration propofol infusions. Early recognition of cardiac signs and predisposing factors is crucial for patient management.

Area of Science:

  • Anesthesiology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Propofol infusion syndrome (PRIS) is a rare but serious adverse event associated with propofol administration.
  • Clinical manifestations include refractory bradycardia, metabolic acidosis, rhabdomyolysis, and hepatic dysfunction.

Purpose of the Study:

  • To summarize the clinical features, proposed mechanisms, predisposing factors, and treatment of PRIS.
  • To highlight early diagnostic signs and management strategies for this critical condition.

Main Methods:

  • Literature review of reported cases of PRIS.
  • Analysis of clinical data, including patient demographics, infusion parameters, and outcomes.
  • Review of proposed pathophysiological mechanisms and predisposing factors.

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Main Results:

  • PRIS is associated with propofol doses > 4 mg.kg(-1).h(-1) for > 48 hours.
  • Reported cases include 61 patients, with significant mortality in both pediatric and adult populations.
  • Early electrocardiogram findings may include right bundle branch block and coved ST elevation in right precordial leads.

Conclusions:

  • PRIS is a complex syndrome with potential mitochondrial dysfunction as a causative factor.
  • Predisposing factors include young age, critical illness, and specific medication/nutritional states.
  • Limited treatment options exist, with extracorporeal methods showing some success; early recognition is key.