1. Curr Opin Anaesthesiol. 2008 Oct;21(5):544-51.
Update on the propofol infusion syndrome in ICU management of patients with head
Otterspoor LC, Kalkman CJ, Cremer OL.
Department of Intensive Care, University Medical Centre Utrecht, Utrecht, The
PURPOSE OF REVIEW: The propofol infusion syndrome is a rare condition
characterized by the occurrence of lactic acidosis, rhabdomyolysis and
cardiovascular collapse following high-dose propofol infusion over prolonged
periods of time. Patients with traumatic brain injury are particularly at risk of
developing this complication because large doses of propofol are commonly used to
control intracranial pressure, whereas vasopressors are administered to augment
cerebral perfusion pressure. In this review, we provide an update on the
literature with particular emphasis on patients with traumatic brain injury.
RECENT FINDINGS: Several new case reports and reviews, as well as a number of
experiments, have contributed significantly to our increased understanding of the
cause of the syndrome. At the basis of the syndrome lies an imbalance between
energy utilization and demand resulting in cell dysfunction, and ultimately
necrosis of cardiac and peripheral muscle cells. Uncertainty remains whether a
genetic susceptibility exists. Nonetheless, the growing number of case reports
has made it possible to identify several risk factors. SUMMARY: Propofol infusion
syndrome is a rare but frequently lethal complication of propofol use. In
patients with risk factors, such as traumatic brain injury, it is suggested that
an infusion rate of 4 mg/kg per hour should not be exceeded. Early warning signs
include unexplained lactic acidosis, lipemia and Brugada-like ECG changes. When
these occur, propofol infusion should be discontinued immediately.
PMID: 18784477 [PubMed - indexed for MEDLINE]