Propofol Infusion Syndrome

19 Mar

A rare complication of propofol infusion (estimated <1%) with high mortality (upwards of 33%)

 

Risk factors include

  • High doses (>4 mg/kg/hr or >67 mcg/kg/min)
  • Prolonged use (>48 hours)
  • Young age
  • High fat and low carbohydrate intake
  • Inborn errors of mitochondrial fatty acid oxidation
  • Concomitant catecholamine infusion

 

Presentation

  • Bradycardia
  • Severe metabolic acidosis
  • Cardiovascular collapse (EKG appears “brugada-like” with convex-curved ST elevation in V1-V3, also RBBB, arrhythmia, heart block)
  • Rhabdomyolysis
  • Hyperlipidemia
  • Renal failure
  • Hepatomegaly
  • Lipaemic serum (say what??? -> milky white serum due to high fat content- see picture)

lipaemic serum

Treatment

  • Discontinuation of propofol
  • Consider pacing
  • Carnitine supplementation (theoretical benefit)
  • Hemodialysis and ECMO (benefit in a few case reports)
  • Good ol’ fashioned supportive care

 

Submitted by K Estes

 

References:  uptodate.com; lifeinthefastlane.com

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