Propofol infusion syndrome: Difference between revisions
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==Background== | ==Background== | ||
*PRIS = propofol infusion syndrome | *PRIS = [[propofol]] infusion syndrome | ||
*Refractory bradycardia and cardiovascular collapse | *Refractory [[bradycardia]] and [[hypotension|cardiovascular collapse]] | ||
*Poorly understood mechanism | *Poorly understood mechanism | ||
*Risk factors | *Risk factors | ||
**High doses of (> | **High doses of (> 4mg/kg/hr or 67 mcg/kg/min) | ||
**Long duration (> 48 hrs) | **Long duration (> 48 hrs) | ||
**Younger age (PRIS first recognized in pediatric population) | **Younger age (PRIS first recognized in pediatric population) | ||
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==Clinical Features== | ==Clinical Features== | ||
*Elevated AG metabolic acidosis | *Elevated [[anion gap acidosis|AG metabolic acidosis]] | ||
*Hypotension | *[[Hypotension]] | ||
*Bradycardia | *[[Bradycardia]] | ||
*[[Rhabdomyolysis]] | *[[Rhabdomyolysis]] | ||
*[[Hyperkalemia]] | *[[Hyperkalemia]] | ||
*AKI | *[[AKI]] | ||
*Hyperlipidemia | *Hyperlipidemia | ||
*Transaminitis, fatty liver | *Transaminitis, fatty liver | ||
== | ==Evaluation== | ||
*Serum lipids (TGs, cholesterol) | *Serum lipids (TGs, cholesterol) | ||
*BMP, Cr | *BMP, Cr | ||
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*Lactate, ABG | *Lactate, ABG | ||
*Propofol levels if available | *Propofol levels if available | ||
*ECG | *[[ECG]] | ||
**[[Brugada]] like pattern, coved-type | **[[Brugada]] like pattern, coved-type | ||
**RBBB | **[[RBBB]] | ||
**Heart block | **[[Heart block]] | ||
==Management== | ==Management== | ||
*Immediate | *Immediate discontinuation of propofol infusion | ||
*Treatment of rhabdomyolysis, to include renal replacement therapy | *Treatment of [[rhabdomyolysis]], to include renal replacement therapy | ||
*Hemodynamic support, cardiac pacing | *Hemodynamic support, cardiac [[pacing]] | ||
*L-carnitine supplementation | *[[L-carnitine]] supplementation | ||
*Carbohydrate administration at 6- | *Carbohydrate administration at 6-8mg/kg/min | ||
*Hemodialysis | *[[Hemodialysis]] | ||
*ECMO in refractory cases | *[[ECMO]] in refractory cases | ||
==References== | ==References== | ||
Latest revision as of 03:19, 21 February 2021
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 discontinuation 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