propofol infusion syndrome

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Propofol should not be used for long term sedation. Few people know of this deadly drug reaction

Many Europen countries know the truth about this very unpredicable drug.It's time to open honest discusion about it's shortcommings here.

Specializes in Critical Care, Cardiothoracics, VADs.

I hadn't heard of it either, but I echo the sentiment that it seems extraordinarily rare! As a SICU nurse I called Diprivan "vitamin D" and loved it (in my patients!!). Quick and easy to titrate, short half life, effective sedation. Every treatment and drug has a risk/benefit profile, and I have not seen any data to convince me that this is anything other than a rarely observed phenomenon in a highly specific patient group.

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Specializes in Med-Surg Nursing.

At the previous ICU I worked at, we had a pt die from Propofol infusion syndrome. It's very RARE!!! Problem was the Dr never monitored pt's triglyceride level while this drug was running and pt was on high dose for increased ICP's per NeuroSurgeon. After that episode, tthe sedation policy was revamped. At the current ICU I work at(it's in the same town), we do not use propofol sedation because of the aforementioned incident.

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this is a recent case report of the syndrome involving a short term dose of propofol http://www.anesthesia-analgesia.org/cgi/content/abstract/100/6/1804

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Wow! I've never heard of this Propofol syndrome either!! We use it a lot and I would like to learn more about it. Anyone with info in the form of an article would you please post it for all of us to benefit from,please?

Thank you!

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Gwenith, Just a thanks for your sites on another post but my impression was that the "milk of human kindness" or diprivan / propofol was well known for patients rapidly developing a need for a greater dose to achieve the same effect tachyphalaxis (I think that is the spelling). My biggest beef with the stuff is that many people forget that it is a lipid so they don't reduce the dosage of intralipids when the patient is on TPN which can lead to high blood lipids but also fat overload syndrome, which I am told is rare but nasty.

info below from: Data Sheet

Fat overload syndrome

An impaired capacity to eliminate fat may lead to the fat overload syndrome. This may occur as a result of overdosages, but also at recommended rates of infusion, in association with a sudden change in the patient's clinical condition resulting in severe renal or hepatic impairment.

The fat overload syndrome is characterised by hyperlipaemia, fever, fat infiltration, hepatomegaly, splenomegaly, anaemia, leucopenia, thrombocytopenia, blood coagulation disorders and coma. These changes are invariably reversible on discontinuation of the fat infusion.

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Specializes in ICU.
info below from: Data Sheet

Fat overload syndrome

An impaired capacity to eliminate fat may lead to the fat overload syndrome. This may occur as a result of overdosages, but also at recommended rates of infusion, in association with a sudden change in the patient's clinical condition resulting in severe renal or hepatic impairment.

The fat overload syndrome is characterised by hyperlipaemia, fever, fat infiltration, hepatomegaly, splenomegaly, anaemia, leucopenia, thrombocytopenia, blood coagulation disorders and coma. These changes are invariably reversible on discontinuation of the fat infusion.

Do you have any information that propofol infusion syndrome is the same as fat overload syndrome?

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I have never heard of this Propofol Infusion Syndrome till now. I've had pts who are on this gtt for weeks off and on. To me, pts on propofol wake up easily than any other drugs. Some common side effects of the drug are cardiac suppresion and high fat content and therefore not recommended for someone who has active pancreatitis.

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Specializes in Neuro ICU and Med Surg.

Had a pt yesterday who was taken off propofol, due to propofol induced pancreatitis, and green urine (a ugly green too). Pt was having issues with DIC also. BUT this was the only thing that worked to decrease her ICP. After d/c the drip her ICP was in the 30-40 range all day with paramaters to keep less than 30. Versed and Fentanyl gtt's didn't work, mannitol didn't work either. I have today off so I have no idea what they did for her. So I can see why the drug is only for short term sedation.

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Had a pt yesterday who was taken off propofol, due to propofol induced pancreatitis, and green urine (a ugly green too). Pt was having issues with DIC also. BUT this was the only thing that worked to decrease her ICP. After d/c the drip her ICP was in the 30-40 range all day with paramaters to keep less than 30. Versed and Fentanyl gtt's didn't work, mannitol didn't work either. I have today off so I have no idea what they did for her. So I can see why the drug is only for short term sedation.

Have they tried Barbituate coma yet. This would help reduce icp.

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Specializes in Neuro ICU and Med Surg.

I am hoping that when I go in to work tomorrow morning that the intensivest team has tried this. I told 3 residents about the ICP not going down and that we were maxed out on paramaters for versed fentanyl gtt and also given mannitol and I ended up with orders for nicardipine. Worked well for BP but not ICP. I was going to suggest but it seemed like the residents were ignoring me. I am new to the ICU (have been medsurg for 5 yrs) and afraid to be too vocal. I just hope that they did something. It has been 3 days since last CT and pt CT after crani looked worse than before crani. Pt too unstable to travel since issues with DIC. I will see what happnes in the morning.

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I have a question about using Diprivan off label for seizure suppression? I work in CCU and we had a pt that became hypotensive (sbp 50's). She was on continuous EEG monitoring, which we normally do not see in CCU. We normally turn off the Diprivan drip and call the physician if pt becomes hypotensive. We have critical care docs that are the primary, so I called the doc on call, updated him on events/condition and told him the Diprivan had been turned off. The pt was end stage renal on dialysis and Levo at the time. We started an Epi drip as per order. Her sbp temporarily increased 80-90's then dropped again. Further orders from physician was fluid bolus and cardiology consult in AM (d/t brady heart rate and widening of QRS). We also did 12 lead EKG. I also had the house officer come by to update her. This all happened around 3am.

Family was notified, they came in and decided at 7am to change code status to DNRCCA. When the neurologist came in that morning, he was irate that Diprivan had been turned off. He stated that it should not have been turned off because it was for seizure suppression.

Has anyone had any experience with this off label use of Diprivan? Thank you!!!;)

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