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Suspected propofol infusion syndrome during normal targeted propofol concentration
Taku Ichikawa1, Keiko Okuyama1, Kotoe Kamata2,3
1Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan.
Journal of Anesthesia
|March 31, 2020
Summary
Propofol infusion syndrome (PRIS) pathophysiology is unclear. This case report details a suspected PRIS event with a measured propofol concentration 12 times higher than predicted, leading to severe acidosis.
Area of Science:
- Anesthesiology
- Pharmacology
- Critical Care Medicine
Background:
- Propofol infusion syndrome (PRIS) is a potentially fatal condition with unknown pathophysiology and risk factors.
- A clear definition and understanding of PRIS are lacking, despite reported cases in pediatric and adult populations.
- The actual propofol plasma concentration (Cp) in suspected PRIS cases has not been previously clarified.
Purpose of the Study:
- To describe the first suspected case of PRIS with measured propofol plasma concentration.
- To investigate potential triggering factors for PRIS, such as propofol clearance.
- To correlate clinical manifestations with propofol levels and metabolic disturbances.
Main Methods:
- Clinical case report of a patient undergoing surgical anesthesia with target-controlled infusion of propofol.
- Measurement of propofol plasma concentration (Cp) after prolonged infusion.
- Monitoring of vital signs, acid-base balance, and liver/renal function.
Main Results:
- A suspected PRIS case was identified with a propofol Cp of 7.2 µg/mL, 12 times higher than the predicted 0.6 µg/mL after 226 minutes of infusion.
- The patient exhibited progressive hypercapnia, tachycardia, and severe lactic acidosis.
- Slightly elevated liver enzymes suggested minimal liver damage, while renal impairment occurred concurrently with acidosis.
Conclusions:
- Low or delayed propofol clearance may be a triggering factor for severe lactic acidosis in PRIS.
- This case highlights the importance of monitoring propofol levels and metabolic status in patients at risk for PRIS.
- Further research is needed to elucidate the pathophysiology and establish a definition for PRIS.
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