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Propofol infusion syndrome
From WikEM
Background
- PRIS = propofol infusion syndrome
- Refractory bradycardia and cardiovascular collapse
- Poorly understood mechanism
- Risk factors
- High doses of (> 4mg/kg/hr or 67 mcg/kg/min)
- Long duration (> 48 hrs)
- Younger age (PRIS first recognized in pediatric population)
- Critical illness
- Malnutrition
- Liver disease
- Carnitine deficiency
- Mitochondrial disease
- Catecholamine, vasopressor infusion
- Corticosteroid infusion
Clinical Features
- Elevated AG metabolic acidosis
- Hypotension
- Bradycardia
- Rhabdomyolysis
- Hyperkalemia
- AKI
- Hyperlipidemia
- Transaminitis, fatty liver
Evaluation
- Serum lipids (TGs, cholesterol)
- BMP, Cr
- CK, potassium, urinary myoglobin
- Lactate, ABG
- Propofol levels if available
- ECG
- Brugada like pattern, coved-type
- RBBB
- Heart block
Management
- Immediate discharge of propofol infusion
- Treatment of rhabdomyolysis, to include renal replacement therapy
- Hemodynamic support, cardiac pacing
- L-carnitine supplementation
- Carbohydrate administration at 6-8mg/kg/min
- Hemodialysis
- ECMO in refractory cases
