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There is no prospective, randomized study to elucidate propofol’s effect on the critically ill patient. By definition, Propofol Infusion Syndrome (PRIS) has the following characteristics:
- acute bradycardia progressing to asystole
- lipemic plasma
- fatty liver enlargement
- metabolic acidosis with negative base excess > 10
- rhabdomyolysis or myoglobinuria
It has been thought that PRIS was limited to patients with prolonged use, but we now know that this is not necessarily true.
It has been shown that PRIS is more likely with the following risk factors:
- <19 years old
- male
- received a vasopressor
- cardiac manifestations (including Brugada Syndrome)
- metabolic acidosis
- renal failure
- hypotension
- rhabdomyolysis
- dyslipidemia
The treatment for suspected PRIS is:
- Stop infusion
- Hemodynamic stabilization
- Carbohydrate substitution
- Hemodialysis or hemofiltration
- ECMO as necessary
References
Fudickar A, Bein B Propofol infusion syndrome: update of clinical manifestation and pathophysiology. Minerva Anestesiologica 2009;75:339-44.
Vernooy K, Delhaas T, et al. Electrocardiographic changes predicting sudden death in propofol-related infusion syndrome. Heart Rhythm 2006;3:131-7