Propofol infusion syndrome heralded by ECG changes.

Area of Science:

• Critical care medicine
• Neurology
• Pharmacology

Background:

• Propofol infusion syndrome (PRIS) is a known, potentially fatal complication of propofol sedation.
• PRIS is associated with young age, traumatic brain injury (TBI), high cumulative propofol doses, and catecholamine use.
• Metabolic acidosis, rhabdomyolysis, and cardiac failure are characteristic manifestations of PRIS.

Observation:

• A case report details a young patient with severe TBI receiving propofol for intracranial pressure management.
• The patient developed metabolic acidosis and refractory circulatory shock seven days post-trauma, suspected to be PRIS.
• Electrocardiogram (ECG) showed reversed T-waves 29 hours prior to circulatory failure.

Findings:

• Reversed T-waves on ECG, in the absence of other cardiac abnormalities, may serve as an early indicator of developing PRIS.
• This finding suggests a potential non-invasive marker for early PRIS detection.
• The case highlights the importance of continuous ECG monitoring during propofol sedation.

Implications:

• Meticulous ECG analysis during propofol sedation could enable earlier recognition of PRIS.
• Early detection may allow for timely intervention and potentially improve patient outcomes.
• Further research is warranted to validate reversed T-waves as a reliable early warning sign for PRIS.