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| No. 40 | 
Jun 14, 2007, 08:43 AM
 Re: propofol infusion syndrome
I have yet to see this but we don't use more than 50 mg/hr, with an order 100 mg/hr. If in the usual unit vented scenerio, 50 mg/hr isn't working, you need a second agent, versed, fentanyl, morphine, dilaudid prn or scheduled.
My pt. last night just off paralytics was writing his needs on paper on 50 mg/hr of Diprovan. He wasn't sedated, just wasn't trying to stand in the bed while intubated like a few days ago.
 | | Advertisement Sponsored Links | | | | No. 42 |
Sep 15, 2007, 09:19 AM
Re: propofol infusion syndrome
Doesn't matter if one is a nurse when bringing important legit info that anyone infusing this drug must be aware: the pathophysiology of propofol infusion syndrome a simple name for a complex syndrome.
Propofol infusion syndrome (PRIS) is a rare and often fatal syndrome described in critically ill children undergoing long-term propofol infusion at high doses. Recently several cases have been reported in adults, too. The main features of the syndrome consist of cardiac failure, rhabdomyolysis, severe metabolic acidosis and renal failure. To date 21 paediatric cases and 14 adult cases have been described. These latter were mostly patients with acute neurological illnesses or acute inflammatory diseases complicated by severe infections or even sepsis, and receiving catecholamines and/or steroids in addition to propofol. Central nervous system activation with production of catecholamines and glucocorticoids, and systemic inflammation with cytokine production are priming factors for cardiac and peripheral muscle dysfunction. High-dose propofol, but also supportive treatments with catecholamines and corticosteroids, act as triggering factors. At the subcellular level, propofol impairs free fatty acid utilisation and mitochondrial activity. Imbalance between energy demand and utilisation is a key pathogenetic mechanism, which may lead to cardiac and peripheral muscle necrosis.Propofol infusion syndrome is multifactorial, and propofol, particularly when combined with catecholamines and/or steroids, acts as a triggering factor. The syndrome can be lethal and we suggest caution when using prolonged (>48 h) propofol sedation at doses higher than 5 mg/kg per h, particularly in patients with acute neurological or inflammatory illnesses. In these cases, alternative sedative agents should be considered. If unsuitable, strict monitoring of signs of myocytolysis is advisable.
PMID: 12904852 [PubMed - indexed for MEDLINE] HIGH-DOSE PROPOFOL INFUSIONS FOR REFRACTORY INTRACRANIAL HYPERTENSION | | No. 44 |
Sep 18, 2007, 03:44 PM
Re: propofol infusion syndrome
I had a twenty year old patient a year ago that went to or for a routine something or other and unexpectedly developed severe lactic acidosis. Took away the propofol and *poof* miraculous recovery from the acidosis.
| | No. 45 |
Sep 20, 2007, 09:58 AM
Re: propofol infusion syndrome Originally Posted by cpillow  I had a twenty year old patient a year ago that went to or for a routine something or other and unexpectedly developed severe lactic acidosis. Took away the propofol and *poof* miraculous recovery from the acidosis.
Lactic acidosis can be caused by many different factors. A short procedure with Propofol should not have been the cause unless you had an unusual reaction. Most often lactic acidosis is caused by poor tissue perfusion. In some people propofol can cause hypotension. If this occurred in your case it could be the culprit. If not, then it's highly unlikely to be the source of your problem.
| | No. 46 |
Sep 20, 2007, 09:26 PM
Re: propofol infusion syndrome Originally Posted by NRSKarenRN Doesn't matter if one is a nurse when bringing important legit info that anyone infusing this drug must be aware: the pathophysiology of propofol infusion syndrome a simple name for a complex syndrome.
Propofol infusion syndrome (PRIS) is a rare and often fatal syndrome described in critically ill children undergoing long-term propofol infusion at high doses. Recently several cases have been reported in adults, too. The main features of the syndrome consist of cardiac failure, rhabdomyolysis, severe metabolic acidosis and renal failure. To date 21 paediatric cases and 14 adult cases have been described. These latter were mostly patients with acute neurological illnesses or acute inflammatory diseases complicated by severe infections or even sepsis, and receiving catecholamines and/or steroids in addition to propofol. Central nervous system activation with production of catecholamines and glucocorticoids, and systemic inflammation with cytokine production are priming factors for cardiac and peripheral muscle dysfunction. High-dose propofol, but also supportive treatments with catecholamines and corticosteroids, act as triggering factors. At the subcellular level, propofol impairs free fatty acid utilisation and mitochondrial activity. Imbalance between energy demand and utilisation is a key pathogenetic mechanism, which may lead to cardiac and peripheral muscle necrosis.Propofol infusion syndrome is multifactorial, and propofol, particularly when combined with catecholamines and/or steroids, acts as a triggering factor. The syndrome can be lethal and we suggest caution when using prolonged (>48 h) propofol sedation at doses higher than 5 mg/kg per h, particularly in patients with acute neurological or inflammatory illnesses. In these cases, alternative sedative agents should be considered. If unsuitable, strict monitoring of signs of myocytolysis is advisable.
PMID: 12904852 [PubMed - indexed for MEDLINE] HIGH-DOSE PROPOFOL INFUSIONS FOR REFRACTORY INTRACRANIAL HYPERTENSION
Um, well personally I do take information from medical professionals a little more seriously than someone seeking to discredit a drug with who knows what motives and educational background. Last I checked this was a website for nurses, no? I am aware that PIS is an issue in pediatrics, NO-ONE is denying that. But however in 3+ yrs of working as a critical RN I have never seen PIS in adults. I HAVE seen greater problems with Versed drips. Dex is too expensive. I have never met a single nurse who has had an adult pt with PIS. Furthermore every anesthesiologist and CRNA I've asked about it feels the same way. The reason the subject irritates me is that some ignorant resident reads somewhere that there is some minor incidence of PIS and takes a so sick they're not going to make it patient off propofol and an opiate (which was sedating them humanely and therapeutically) and puts them on versed and fentanyl or versed and morphine drip and the pt is not humanely sedated because the versed just isn't as effective.
I mean if you're going to take aim at a drug, pick one with a much higher morbidity/mortality profile, such as coumadin, digoxin or even tylenol for that matter. When you can site a long term study that shows statistically significant poorer outcomes in patients who had been on propofol vs. other commonly used sedatives in adults, then I'll listen.
| | No. 47 |
Sep 20, 2007, 10:49 PM
Re: propofol infusion syndrome
not to rain on anyones parade but we use diprovan extensively and i mean many times greater than 50mcgs/kg for long trips as long as 10-15 days. none of us have seen anytype of syndrome.
| | No. 48 |
Sep 21, 2007, 08:36 AM
Re: propofol infusion syndrome Originally Posted by BULLYDAWGRN not to rain on anyones parade but we use diprovan extensively and i mean many times greater than 50mcgs/kg for long trips as long as 10-15 days. none of us have seen anytype of syndrome.
May I say that diprovan is a great drug! Like anything else, it has side effects, but when push come to shove, it works like a charm. I went to the National Teaching Conference in New Orleans a few years ago and Wayne Brady did the funniest skit and song on diprovan! Was anyone there?
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