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Propofol infusion syndrome heralded by ECG changes
Elsbeth J Mijzen1, Bram Jacobs, Adnan Aslan
1Department of Intensive Care, University of Groningen, University Medical Centrum Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. ejmijzen@gmail.com
Insights
Propofol infusion syndrome (PRIS) is a lethal complication of propofol sedation. Reversed T-waves on ECG may signal early PRIS development in patients with traumatic brain injury (TBI).
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.
Background:
Propofol infusion syndrome (PRIS) is well known, often associated with, lethal complication of sedation with propofol. PRIS seems to be associated with young age, traumatic brain injury (TBI), higher cumulative doses of propofol, and the concomitant use of catecholamines. Known manifestations of PRIS are metabolic acidosis, rhabdomyolysis, and cardiac failure. While fatal PRIS can occur suddenly and rapidly, there is no sensitive test or early warning sign, and the only preventive measure is to limit propofol dosage and its duration.
Methods:
DESCRIPTION OF A SINGLE CASE: A case report was used for investigation purposes of this study.
Results:
We report the case study of a young patient with severe TBI, receiving propofol sedation because of high intracranial pressure. Seven days after the trauma, the patient developed metabolic acidosis and refractory circulatory shock, probably caused by PRIS. Reversal of T-waves was seen on the electrocardiogram (ECG) 29 h before circulation failure occurred. In the absence of other signs of cardiac dysfunction or ischemia, these reversed T-waves probably represent an early warning sign of developing PRIS.
Conclusion:
From the findings of this study, we conclude that meticulous observation and analysis of the ECG during propofol sedation might result in earlier recognition of developing PRIS.
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