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Propofol is generally a well-tolerated sedative / amnestic but occasionally it can lead to the propofol infusion syndrome (PRIS); a metabolic disorder causing end-organ dysfunction.
Suspect PRIS in patients with increasing lactate levels, worsening metabolic acidosis, worsening renal function, increased triglyceride levels, or creatinine kinase levels. End-organ effects include:
- Myocardial dysfunction / Arrhythmias
- Rhabdomyolysis
- Acute renal failure
The true incidence of PRIS is unknown, however, certain risk factors have been identified:
- Doses >4-5mg/kg/hour
- <18 years of age
- Critically-ill patients; especially receiving vasopressors or steroids
- History of mitochondrial disorders
- Infusions >48 hours
Prevent PRIS by using adequate analgesia (with morphine or fentanyl) post-intubation, which may reduce the overall dosage of propofol ultimately reducing the risk.
If PRIS develops, stop propofol and provide supportive care; IV fluids, ensuring good urine output, adequate oxygenation, dialysis (if indicated), vasopressor and inotropic support.
References
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