Propofol Infusion Syndrome: Topic Review
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May 24, 2021
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Abstract
Propofol is an intravenous anaesthetic agent widely used in the induction and maintenance of anaesthesia, as well as in the sedation of patients in various scenarios. Its pharmacokinetic and pharmacodynamic properties make this an ideal medication for the treatment of critical patients. Some of these properties, for instance, its rapid onset of action and recuperation after suspending infusion, in addition to the presence of few adverse effects, make it a favourable choice in certain clinical conditions. Nevertheless, for more than 20 years there have been reported cases in the literature concerning the presence of common signs and symptoms related to the infusion of propofol at doses greater than 4 – 5mg/kg/h and for long periods (>48hrs), such as metabolic acidosis, cardiac and renal dysfunction, rhabdomyolysis, hypertriglyceridemia and hyperkalaemia, which together are known as Propofol Infusion Syndrome (PRIS). Although this pathology is rare, it is potentially fatal without a diagnostic and proper treatment. This article seeks to clear some points about its pathophysiology, clinical features, diagnostic and treatment based on current literature
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References
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2. Robinson JDC, Melman Y, Walsh EP. Cardiac conduction disturbances and ventricular tachycardia after prolonged propofol infusion in an infant. PACE - Pacing Clin Electrophysiol. 2008;31(8):1070–3.
3. Krajčová A, Waldauf P, Anděl M, Duška F. Propofol infusion syndrome: A structured review of experimental studies and 153 published case reports. Crit Care. 2015;19(1):1–9.
4. Fallier-Becker P, Vollmer JP, Wolburg H, Haen S, Steiner J, Noell S, et al. Case report: Propofol-related infusion syndrome. Ultrastruct Pathol. 2017;41(1):106–7.
5. Darrouj J, Karma L, Arora R. Cardiovascular manifestations of sedatives and analgesics in the critical care unit. Am J Ther. 2009;16(4):339–53.
6. Caracci B, Aranda F. Propofol infusion syndrome. Rev Chil Anest. 2018;47(3):189–95.
7. Schroeppel TJ, Fabian TC, Clement LP, Fischer PE, Magnotti LJ, Sharpe JP, et al. Propofol infusion syndrome: A lethal condition in critically injured patients eliminated by a simple screening protocol. Injury [Internet]. 2014;45(1):245–9. Available from: http://dx.doi.org/10.1016/j.injury.2013.05.004
8. Finsterer J, Frank M. Propofol Is Mitochondrion-Toxic and May Unmask a Mitochondrial Disorder. J Child Neurol. 2016;31(13):1489–94.
9. Roberts RJ, Barletta JF, Fong JJ, Schumaker G, Kuper PJ, Papadopoulos S, et al. Incidence of propofol-related infusion syndrome in critically ill adults: A prospective, multicenter study. Crit Care. 2009;13(5):1–10.
10. Loh NHW, Nair P. Propofol infusion syndrome. Contin Educ Anaesthesia, Crit Care Pain. 2013;13(6):200–2.
11. Diaz JH, Prabhakar A, Urman RD, Kaye AD. Propofol Infusion Syndrome: A Retrospective Analysis at a Level 1 Trauma Center. Crit Care Res Pract. 2014;2014.
12. Fodale V, La Monaca E. Propofol infusion syndrome: An overview of a perplexing disease. Drug Saf. 2008;31(4):293–303.
13. Vollmer JP, Haen S, Wolburg H, Lehmann R, Steiner J, Reddersen S, et al. Propofol Related Infusion Syndrome: Ultrastructural Evidence for a Mitochondrial Disorder. Crit Care Med. 2018;46(1):e91–4.
14. Walli A, Poulsen TD, Dam M, Børglum J. Propofol Infusion Syndrome in Refractory Status Epilepticus: A Case Report and Topical Review. Case Rep Emerg Med. 2016;2016:1–4.
15. Fudickar A, Bein B. Propofol infusion syndrome: manifestation and pathophysiology. Minerva Anestesiol. 2009;75(5):339–44.
16. Devlin JW, Roberts RJ. Pharmacology of commonly used analgesics and sedatives in the ICU: Benzodiazepines, propofol, and opioids. Anesthesiol Clin. 2011;29(4):567–85.
17. Fong JJ, Sylvia L, Ruthazer R, Schumaker G, Kcomt M, Devlin JW. Predictors of mortality in patients with suspected propofol infusion syndrome. Crit Care Med. 2008;36(8):2281–7.
18. Chidambaran V, Costandi A, D’Mello A. Propofol: A Review of its Role in Pediatric Anesthesia and Sedation. CNS Drugs. 2015;29(7):543–63.
19. Eziefule A, Elshatanoufy S, Thakur M, Rocha F. Propofol-Related Infusion Syndrome in the Peripartum Period. Am J Perinatol Reports. 2016;06(04):e368–71.
20. Barbosa FT. Síndrome da infusão do propofol. Rev Bras Anestesiol. 2007;57(5):539–42.
21. Orsini J, Nadkarni A, Chen J, Cohen N. Propofol infusion syndrome: Case report and literature review. Am J Heal Pharm. 2009;66(10):908–15.
22. Kang TM, Nazario M, Edouard B. Propofol infusion syndrome in critically ill patients. Ann Pharmacother. 2002;36(9):1453–6.
23. Mijzen EJ, Jacobs B, Aslan A, Rodgers MGG. Propofol infusion syndrome heralded by ECG changes. Neurocrit Care. 2012;17(2):260–4.
24. Papaioannou V, Dragoumanis C, Theodorou V, Pneumatikos I. The propofol infusion “syndrome” in intensive care unit: From pathophysiology to prophylaxis and treatment. Acta Anaesthesiol Belg. 2008;59(2):79–86.
25. Jorens PG, Van den Eynden GG. Propofol Infusion Syndrome With Arrhythmia, Myocardial Fat Accumulation and Cardiac Failure. Am J Cardiol [Internet]. 2009;104(8):1160–2. Available from: http://dx.doi.org/10.1016/j.amjcard.2009.05.065
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27. Vasile B, Rasulo F, Candiani A, Latronico N. The pathophysiology of propofol infusion syndrome: A simple name for a complex syndrome. Intensive Care Med. 2003;29(9):1417–25.
28. Mallow Corbett S, Montoya ID, Moore FA. Propofol-related infusion syndrome in intensive care patients. Pharmacotherapy. 2008;28(2):250–8.
29. Wolf AR, Potter F. Propofol infusion in children: When does an anesthetic tool become an intensive care liability? Paediatr Anaesth. 2004;14(6):435–8.
30. Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol infusion syndrome in adults: A clinical update. Crit Care Res Pract. 2015;2015.
31. Fudickar A, Bein B, Tonner PH. Propofol infusion syndrome in anaesthesia and intensive care medicine. Curr Opin Anaesthesiol. 2006;19(4):404–10.
32. Fodale V, Monaca E La. Propofol infusion syndrome: an overview of a perplexing disease. Fodale V, La Monaca E. Drug Saf. 2008; 31(4):293-303. 2008;31(4):293–303.
33. Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol Infusion Syndrome in Adults : A Clinical Update. 2015;2015.
34. Bray RJ. Propofol infusion syndrome in children. Paediatr Anaesth. 1998;8(6):491–9.
35. Finsterer J, Frank M. Propofol Is Mitochondrion-Toxic and May Unmask a Mitochondrial Disorder. J Child Neurol. 2016;31(13):1489–94.
36. Otterspoor LC, Kalkman CJ, Cremer OL. Update on the propofol infusion syndrome in ICU management of patients with head injury. Curr Opin Anaesthesiol. 2008;21(5):544–51.
37. Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol infusion syndrome in adults: A clinical update. Crit Care Res Pract. 2015;2015.
38. Otterspoor LC, Kalkman CJ, Cremer OL. Update on the propofol infusion syndrome in ICU management of patients with head injury. Curr Opin Anaesthesiol. 2008;21(5):544–51.
39. Mayette M, Gonda J, Hsu JL, Mihm FG. Propofol infusion syndrome resuscitation with extracorporeal life support: A case report and review of the literature. Ann Intensive Care. 2013;3(1):1–6.
2. Robinson JDC, Melman Y, Walsh EP. Cardiac conduction disturbances and ventricular tachycardia after prolonged propofol infusion in an infant. PACE - Pacing Clin Electrophysiol. 2008;31(8):1070–3.
3. Krajčová A, Waldauf P, Anděl M, Duška F. Propofol infusion syndrome: A structured review of experimental studies and 153 published case reports. Crit Care. 2015;19(1):1–9.
4. Fallier-Becker P, Vollmer JP, Wolburg H, Haen S, Steiner J, Noell S, et al. Case report: Propofol-related infusion syndrome. Ultrastruct Pathol. 2017;41(1):106–7.
5. Darrouj J, Karma L, Arora R. Cardiovascular manifestations of sedatives and analgesics in the critical care unit. Am J Ther. 2009;16(4):339–53.
6. Caracci B, Aranda F. Propofol infusion syndrome. Rev Chil Anest. 2018;47(3):189–95.
7. Schroeppel TJ, Fabian TC, Clement LP, Fischer PE, Magnotti LJ, Sharpe JP, et al. Propofol infusion syndrome: A lethal condition in critically injured patients eliminated by a simple screening protocol. Injury [Internet]. 2014;45(1):245–9. Available from: http://dx.doi.org/10.1016/j.injury.2013.05.004
8. Finsterer J, Frank M. Propofol Is Mitochondrion-Toxic and May Unmask a Mitochondrial Disorder. J Child Neurol. 2016;31(13):1489–94.
9. Roberts RJ, Barletta JF, Fong JJ, Schumaker G, Kuper PJ, Papadopoulos S, et al. Incidence of propofol-related infusion syndrome in critically ill adults: A prospective, multicenter study. Crit Care. 2009;13(5):1–10.
10. Loh NHW, Nair P. Propofol infusion syndrome. Contin Educ Anaesthesia, Crit Care Pain. 2013;13(6):200–2.
11. Diaz JH, Prabhakar A, Urman RD, Kaye AD. Propofol Infusion Syndrome: A Retrospective Analysis at a Level 1 Trauma Center. Crit Care Res Pract. 2014;2014.
12. Fodale V, La Monaca E. Propofol infusion syndrome: An overview of a perplexing disease. Drug Saf. 2008;31(4):293–303.
13. Vollmer JP, Haen S, Wolburg H, Lehmann R, Steiner J, Reddersen S, et al. Propofol Related Infusion Syndrome: Ultrastructural Evidence for a Mitochondrial Disorder. Crit Care Med. 2018;46(1):e91–4.
14. Walli A, Poulsen TD, Dam M, Børglum J. Propofol Infusion Syndrome in Refractory Status Epilepticus: A Case Report and Topical Review. Case Rep Emerg Med. 2016;2016:1–4.
15. Fudickar A, Bein B. Propofol infusion syndrome: manifestation and pathophysiology. Minerva Anestesiol. 2009;75(5):339–44.
16. Devlin JW, Roberts RJ. Pharmacology of commonly used analgesics and sedatives in the ICU: Benzodiazepines, propofol, and opioids. Anesthesiol Clin. 2011;29(4):567–85.
17. Fong JJ, Sylvia L, Ruthazer R, Schumaker G, Kcomt M, Devlin JW. Predictors of mortality in patients with suspected propofol infusion syndrome. Crit Care Med. 2008;36(8):2281–7.
18. Chidambaran V, Costandi A, D’Mello A. Propofol: A Review of its Role in Pediatric Anesthesia and Sedation. CNS Drugs. 2015;29(7):543–63.
19. Eziefule A, Elshatanoufy S, Thakur M, Rocha F. Propofol-Related Infusion Syndrome in the Peripartum Period. Am J Perinatol Reports. 2016;06(04):e368–71.
20. Barbosa FT. Síndrome da infusão do propofol. Rev Bras Anestesiol. 2007;57(5):539–42.
21. Orsini J, Nadkarni A, Chen J, Cohen N. Propofol infusion syndrome: Case report and literature review. Am J Heal Pharm. 2009;66(10):908–15.
22. Kang TM, Nazario M, Edouard B. Propofol infusion syndrome in critically ill patients. Ann Pharmacother. 2002;36(9):1453–6.
23. Mijzen EJ, Jacobs B, Aslan A, Rodgers MGG. Propofol infusion syndrome heralded by ECG changes. Neurocrit Care. 2012;17(2):260–4.
24. Papaioannou V, Dragoumanis C, Theodorou V, Pneumatikos I. The propofol infusion “syndrome” in intensive care unit: From pathophysiology to prophylaxis and treatment. Acta Anaesthesiol Belg. 2008;59(2):79–86.
25. Jorens PG, Van den Eynden GG. Propofol Infusion Syndrome With Arrhythmia, Myocardial Fat Accumulation and Cardiac Failure. Am J Cardiol [Internet]. 2009;104(8):1160–2. Available from: http://dx.doi.org/10.1016/j.amjcard.2009.05.065
26. Agrawal N, Rao S, Nair R. A death associated with possible propofol infusion syndrome. Indian J Surg. 2013;75(1 SUPPL.):407–8.
27. Vasile B, Rasulo F, Candiani A, Latronico N. The pathophysiology of propofol infusion syndrome: A simple name for a complex syndrome. Intensive Care Med. 2003;29(9):1417–25.
28. Mallow Corbett S, Montoya ID, Moore FA. Propofol-related infusion syndrome in intensive care patients. Pharmacotherapy. 2008;28(2):250–8.
29. Wolf AR, Potter F. Propofol infusion in children: When does an anesthetic tool become an intensive care liability? Paediatr Anaesth. 2004;14(6):435–8.
30. Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol infusion syndrome in adults: A clinical update. Crit Care Res Pract. 2015;2015.
31. Fudickar A, Bein B, Tonner PH. Propofol infusion syndrome in anaesthesia and intensive care medicine. Curr Opin Anaesthesiol. 2006;19(4):404–10.
32. Fodale V, Monaca E La. Propofol infusion syndrome: an overview of a perplexing disease. Fodale V, La Monaca E. Drug Saf. 2008; 31(4):293-303. 2008;31(4):293–303.
33. Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol Infusion Syndrome in Adults : A Clinical Update. 2015;2015.
34. Bray RJ. Propofol infusion syndrome in children. Paediatr Anaesth. 1998;8(6):491–9.
35. Finsterer J, Frank M. Propofol Is Mitochondrion-Toxic and May Unmask a Mitochondrial Disorder. J Child Neurol. 2016;31(13):1489–94.
36. Otterspoor LC, Kalkman CJ, Cremer OL. Update on the propofol infusion syndrome in ICU management of patients with head injury. Curr Opin Anaesthesiol. 2008;21(5):544–51.
37. Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol infusion syndrome in adults: A clinical update. Crit Care Res Pract. 2015;2015.
38. Otterspoor LC, Kalkman CJ, Cremer OL. Update on the propofol infusion syndrome in ICU management of patients with head injury. Curr Opin Anaesthesiol. 2008;21(5):544–51.
39. Mayette M, Gonda J, Hsu JL, Mihm FG. Propofol infusion syndrome resuscitation with extracorporeal life support: A case report and review of the literature. Ann Intensive Care. 2013;3(1):1–6.
How to Cite
Tabares Arboleda, M. P., Ávila, L. M., & Londoño Duarte, M. P. (2021). Propofol Infusion Syndrome: Topic Review. Universitas Medica, 62(2). https://doi.org/10.11144/Javeriana.umed62-2.prop
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Short Reviews
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