Propofol-related Infusion Syndrome is an acute refractory bradycardia leading to asystole and one or more of:
- Metabolic acidosis (base deficit > 10 mmol.l(-1))
- Rhabdomyolysis
- Hyperlipidaemia
- 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)
