Propofol Infusion Syndrome
Propofol is an intravenous anesthetic that is commonly used for sedation when rapid onset and awakening are desired. Propofol modulates hypothalamic sleep pathways by activating central gamma-aminobutyric acid receptors in the central nervous system.
Propofol is insoluble in water so it is prepared as a lipid emulsion consisting of soybean oil, egg lecithin and glycerol. Propofol is administered by continuous infusion in the ICU. During administration, routine biochemical monitoring is recommended to detect the onset of the propofol infusion syndrome (PRIS), which is a rare complication. PRIS usually occurs after infusion of high doses for more than 48 hours. Clinical features include refractory bradycardia, severe metabolic acidosis, cardiovascular collapse, rhabdomyolysis, hypertriglyceridemia, renal failure and hepatomegaly.
Recommended laboratory tests include anion gap, triglycerides, creatine kinase, myoglobin, creatinine, troponin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Plasma samples have a strawberry milk appearance.
References
Kam PC and Cardone D. Propofol Infusion Syndrome. Anaesthesia 2007;62:690
Mirrakhimov AE et al. Propofol Infusion Syndrome in adults: a clinical update. Crit Care Res Pract 2015;260:385.
Hemphill S et al. Propofol Infusion Syndrome: a structure literature review and analysis of published case reports. Br J Anaesth 2019;122:448.
