Propofol infusion syndrome in a super morbidly obese patient (BMI = 75)

Area of Science:

• Anesthesiology
• Intensive Care Medicine
• Clinical Pharmacology

Background:

• Propofol infusion syndrome (PRIS) is a rare but serious complication associated with prolonged, high-dose propofol administration.
• Risk factors include young age, critical illness, and certain metabolic conditions.
• PRIS presents with metabolic acidosis, rhabdomyolysis, renal and myocardial failure, and bradycardia.

Observation:

• PRIS is typically seen with doses of 4-5 mg/kg/hr for over 48 hours.
• Pathophysiology involves direct mitochondrial respiratory chain inhibition or impaired fatty acid metabolism.
• A supermorbidly obese patient developed PRIS.

Findings:

• The patient received propofol based on total body weight, not ideal or actual body weight.
• This dosing error likely contributed to the excessive propofol exposure leading to PRIS.
• This case underscores the importance of accurate weight-based dosing in obese patients.

Implications:

• Accurate weight-based dosing of propofol is crucial, especially in supermorbidly obese patients.
• Clinicians should be vigilant for PRIS in high-risk patients and with potential dosing errors.
• This case highlights the need for revised dosing protocols for propofol in extreme obesity.