[Propofol infusion syndrome]

Area of Science:

• Critical Care Medicine
• Pharmacology
• Biochemistry

Context:

• Propofol is a widely used sedative in intensive care units (ICUs) for both pediatric and adult patients.
• It serves as an alternative to benzodiazepines for long-term sedation in mechanically ventilated patients.
• However, propofol use is associated with the risk of developing propofol infusion syndrome (PRIS).

Purpose:

• To review the clinical manifestations, underlying pathophysiology, and management strategies for propofol infusion syndrome (PRIS).
• To highlight the importance of early identification and intervention for this potentially lethal complication.

Summary:

• Propofol infusion syndrome (PRIS) is a rare, potentially fatal complication characterized by arrhythmias, metabolic acidosis, lipemia, and rhabdomyolysis.
• While classically associated with prolonged infusions (>48 hours) at high doses (>4 mg/kg/hr), PRIS can occur with lower doses and shorter durations.
• Mitochondrial respiratory chain dysfunction and genetic factors are implicated in PRIS pathophysiology, with steroids, vasopressors, and low carbohydrate intake acting as potential triggers.

Impact:

• Early recognition of PRIS significantly improves patient outcomes.
• Discontinuation of propofol infusion and consideration of alternative sedatives are recommended for susceptible patients.
• Monitoring for arrhythmias and serum triglyceridemia levels is advised during prolonged propofol sedation.