Neuroimaging of Propofol Infusion Syndrome: A Case Report and Review of Literature

Pernicone, Elizabeth; Watal, Pankaj; Dhar, Deeksha; Hayes, Laura L.; Chandra, Tushar

doi:10.7759/cureus.10583

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…This patient's clinical findings are limited almost exclusively to significant nervous system deficiencies with failed emergence, as well as markedly abnormal brain imaging. This patient's findings on MRI are most consistent with a metabolic process, including those listed in a recent review of PRIS [9]. MRI with Fluidattenuated inversion recovery (FLAIR) sequence revealed significant, symmetric inflammation of the cerebral cortex, particularly parietal, occipital, and posterior temporal lobes.…”

Section: Toxic Brain Edemasupporting

confidence: 69%

Failed Emergence After Pediatric Epilepsy Surgery: Is Propofol-Related Infusion Syndrome to Blame?

Doherty¹,

Gruffi²,

Overby³

2021

Cureus

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Propofol infusion syndrome was first reported in the literature by Bray in 1998. He described a series of fatal outcomes after a presenting constellation of symptoms observed in pediatric patients who had received prolonged propofol infusions. Profound metabolic acidosis and bradycardia are the disease’s hallmark features, which can further develop expeditiously to rhabdomyolysis, renal failure, and heart failure. It has been subsequently theorized that a triggering mechanism or a precipitating factor sets up the progressive physiologic spiral which can ensue. The name of the disease was expanded to Propofol Related Infusion Syndrome (PRIS), as propofol alone was no longer considered the culprit. The disease process is rare and can present with an insidious onset in some cases, causing much speculation of whether there is a proper grasp of the disease entity in its entirety as currently reported. The case discussed in this article depicts an adverse neurologic outcome following a craniotomy for temporal lobectomy in a child with lesional epilepsy. Since there was no obvious causative factor for these findings, PRIS became a diagnosis that was robustly discussed among the involved services.

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Section: Toxic Brain Edemasupporting

confidence: 69%

Failed Emergence After Pediatric Epilepsy Surgery: Is Propofol-Related Infusion Syndrome to Blame?

Doherty¹,

Gruffi²,

Overby³

2021

Cureus

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“…In addition, propofol-induced hyperlactatemia not matching PRIS has been documented in a few other case reports and a limited number of studies [8,9]. The consequences of this isolated hyperlactatemia are less severe than PRIS but have been shown to be associated with prolonged hospitalizations after neurological surgeries, extended intubation, organ failure, and, in some studies, increased mortality [5,10,11]. Although far from being a definitive cause, the relationship between propofol infusion and the patient's hyperlactatemia was supported by a decline in serum lactate after discontinuation of propofol.…”

Section: Discussionmentioning

confidence: 99%

Effective Use of Ketamine-Dexmedetomidine Following Propofol-Induced Hyperlactatemia: A Case Report

Soto-Edwards

Kawamoto

Peters

2022

Cureus

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“…Propofol infusion syndrome manifests as refractory bradycardia and refractory lactic acidosis and is thought to be related to cumulative propofol dose [1,2]. While propofol infusion syndrome has been reported and is associated with significant morbidity and mortality, the actual prevalence of propofol infusion syndrome in pediatric patients is relatively low at approximately 1-4%, particularly considering its ubiquitous use in the perioperative setting [3,4].…”

Section: Introductionmentioning

confidence: 99%

Propofol in the Pediatric Intensive Care Unit, a Safe and Effective Agent in Reducing Pain and Sedation Infusions: A Single-Center Retrospective Study

Uppuluri¹,

Villarreal²,

Dorsey³

et al. 2022

Cureus

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IntroductionPropofol has long been used as an anesthetic agent during pediatric surgery. Its use in pediatric intensive care units has been largely controversial. A beneficial use of propofol is to facilitate weaning of other pain and sedation infusions such as opiates and benzodiazepines. However, some have advocated to not use propofol due to fear of possible adverse effects including propofol infusion syndrome and hemodynamic instability. The purpose of this study was to determine both the safety of propofol infusions in critically ill pediatric patients, as well as the change in the requirement of other pain and sedation infusions by use of a propofol infusion. MethodsSingle-center, retrospective data (January 2011 to January 2020) was obtained manually using a studyspecific data extraction tool created for electronic medical records. The data obtained included variables of interest that measured physiological parameters and pain/sedation infusion (morphine, fentanyl, hydromorphone, midazolam, and dexmedetomidine) rates during three time periods: before propofol initiation, immediately after discontinuation, and four hours after discontinuation. The physiological parameters were then compared to the pain and sedation infusion rates using paired Wilcoxon signed-rank tests. ResultsThere was a total of 33 patients with an average age of 11.1 years who were given a median initial propofol infusion of 50 mcg/kg/min with a peak dose of 75 mcg/kg/min over an average of eight hours. Age had a weak and insignificant correlation with initial rate and duration and a moderate and significant correlation with peak rate and duration. Physiological parameters did not vary at any time point measured. There was a significant reduction in other pain and sedation infusions after discontinuation of propofol. ConclusionPropofol infusions are hemodynamically tolerated and the majority of patients who are on other pain and sedation infusions tolerate complete discontinuation of these infusions following propofol discontinuation.

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Neuroimaging of Propofol Infusion Syndrome: A Case Report and Review of Literature

Cited by 3 publications

References 16 publications

Failed Emergence After Pediatric Epilepsy Surgery: Is Propofol-Related Infusion Syndrome to Blame?

Failed Emergence After Pediatric Epilepsy Surgery: Is Propofol-Related Infusion Syndrome to Blame?

Effective Use of Ketamine-Dexmedetomidine Following Propofol-Induced Hyperlactatemia: A Case Report

Propofol in the Pediatric Intensive Care Unit, a Safe and Effective Agent in Reducing Pain and Sedation Infusions: A Single-Center Retrospective Study

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