- (a) List the risk factors for and the clinical and laboratory findings of propofol infusion syndrome.
- (b) Outline your management of a patient with suspected propofol infusion syndrome.
Answer and interpretation
(a) List the risk factors for and the clinical and laboratory findings of propofol infusion syndrome.
- Large doses (> 4mg/kg/hr for > 48 hours in adults): typically, but not always, large dose, long time
- Younger age
- Acute neurological injury
- Low carbohydrate intake
- Catecholamine and/or corticosteroid infusion
Clinical and laboratory findings
- Unexplained lactic acidosis
- Increasing inotrope support
- (Lipaemic serum, propofol levels / chromatography (if available??))
- Brugada-like ECG abnormalities (Coved-type = convex-curved ST elevation in V1- 3)
- (Green urine)
- Cardiovascular collapse, reflected in PICCO / PAC / ECHO
- Rhabdomyolysis, high CK, hyperkalaemia
- Arrhythmia / heart block
- Renal failure
(b) Outline your management of a patient with suspected propofol infusion syndrome.
- High index of suspicion
- Discontinue immediately
- Monitor for early warning signs: lactate, CK, Urine myoglobin, ECG
- Standard cardio-respiratory support
- Consider pacing (bradycardia often resistant to high dose CA and pacing)
- Adequate carbohydrate intake (6-8mg/kg/min)
- Carnitine supplementation: theoretical benefit
- Haemodialysis and haemoperfusion, used, unproven benefit
- ECMO: 2 case reports, readily reversible pathology