Propofol Infusion Syndrome

Specialties MICU

Published

I thought those of you on this forum would appreciate this recent abstract. It is making me rethink propofol infusion on long surgical cases. My sense is that the FDA will be looking closely at this issue.

Yoga CRNA

1: Anaesthesist. 2004 Sep 23 [Epub ahead of print]

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[Propofol infusion syndrome]

[Article in German]

Motsch J, Roggenbach J.

Klinik fur Anasthesiologie, Universitatsklinikum Heidelberg.

Propofol infusion syndrome has not only been observed in patients undergoing long-term sedation with propofol, but also during propofol anesthesia lasting 5 h. It has been assumed that the pathophysiologic cause is propofol's impairment of oxidation of fatty acid chains and inhibition of oxidative phosphorylation in the mitochondria, leading to lactate acidosis and muscular necrosis. It has been postulated that propofol might act as a trigger substrate in the presence of priming factors. Severe diseases in which the patient has been exposed to high catecholamine and cortisol levels have been identified as trigger substrates. Once the development of propofol infusion syndrome is suspected, propofol infusion has to be stopped immediately and specific therapeutic measures initiated, including cardiocirculatory stabilization and correction of metabolic acidosis. To increase elimination of propofol and its potential toxic metabolites, hemodialysis or hemofiltration are recommended. Due to its possible fatal side effects, the use of propofol for long-term sedation in critically ill patients should be reconsidered. In cases of unexplained lactate acidosis occurring during continuous propofol infusion, propofol infusion syndrome must be taken into consideration.

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are there any reactions related to short term infusion with ketamine for iv sedation?

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Propofol with ketamine is a very nice sedation technique with a number of caveats. The person administering it should be an anesthesia professional, not an RN with some extra training. The doses of ketamine should be carefully calculated to minimize the side effects. A benzodiazepine should be administered before the ketamine is given. The technique should include "titration to effect" and not based on a recipe card approach. The last thing to remember is--it is not a general anesthetic and so the patient should be light enough to have protective airway reflexes in tact. Post-op recovery should be in a quiet area with minimal stimulation.

By the way, I have seen several patients vomit and aspirate with this technique, so have oxygen, positive pressure and suction handy.

Yoga CRNA

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