Propofol Infusion Syndrome (PRIS)

Propofol-related Infusion Syndrome is an acute refractory bradycardia leading to asystole and one or more of:

  1. Metabolic acidosis (base deficit > 10 mmol.l(-1))
  2. Rhabdomyolysis
  3. Hyperlipidaemia
  4. Enlarged or fatty liver

Risk Factors:
  • Assosiated with propofol infusions at doses higher than 4 mg/kg/h  for greater than 48 h duration.
  • Young age
  • Low carbohydrate intake
  • Corticosteroids intake
  • Catecholamine infusion

Pathogenesis:

     Unclear, but may be associated with  impaired mitochondrial fatty acid metabolism, mediated by propofol. 

Clinical signs:




  • Hemodynamic instability
  • Requirement of  inotrope support
  • Green urine
  • ECG: right bundle branch block with convex-curved ('coved type') ST elevation in the right praecordial leads (V1 to V3).





  • Blood gases: lactic acidosis; 
  • Electrolytes: hyperkalaemia (in case of rhabdomyolysis, acute kidney failure)
  • Lipaemic serum


    • Treatment:
    • Discontinuation of propofol infusion
    • Haemodialysis and haemoperfusion 
    • Extracorporeal Membrane Oxygenation (ECMO)
    • Carbohydrate infusion (doubtfully)
    • Carnitine supplementation (doubtfully)

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