- (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
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.