Propofol and Intralipid cause creaming of serum from critically ill patients

Gempeler, Fritz E.; Elston, A.; Thompson, S; Park, G. R.

doi:10.1111/j.1365-2044.1994.tb03305.x

Cited by 14 publications

(8 citation statements)

References 13 publications

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“…It is possible that the lipaemia, metabolic acidosis and liver changes are just manifestations of lipid infusion in critically ill children. Propofol has been shown to produce ‘creaming’ of serum taken from 74% of critically ill adults, particularly those with pulmonary disease ( 51). A metabolic acidosis is not uncommon in seriously ill children and might also be caused by lipid microembolization ( 52).…”

Section: Introductionmentioning

confidence: 99%

Propofol infusion syndrome in children

1998

Pediatric Anesthesia

499

204

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The use of propofol infusions to sedate children in intensive care units has decreased after reports of deaths from myocardial failure. More recently it has been suggested that propofol might have been prematurely condemned. Information about 18 children who had received propofol infusions and suffered serious unwanted effects was used to define their common features. Three of the deaths occurred in one intensive care unit where propofol infusions had been used between 1987 and 1993. During this period 44 children with respiratory tract infections had been admitted to this unit and sedated for at least 48 h. Nine had received long-term (> 48 h), high-dose (> 4 mg.kg-1.h-1) propofol infusions and three had developed progressive myocardial failure and died. There was a significant association between receiving a long-term, high-dose propofol infusion and developing progressive myocardial failure (Fisher's Exact Test, two-tailed hypothesis, P = 0.0128) although a causative relationship could not be proved.

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Section: Introductionmentioning

confidence: 99%

Propofol infusion syndrome in children

1998

Pediatric Anesthesia

499

204

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“…Layering out of fat emulsion from the circulating blood has been shown to occur in hemofiltration studies, but, to our knowledge, no in vivo studies have been conducted to assess the effect during neonatal ECMO. 5 Although the clinical impact of fat emulsion accumulation in ECMO is not yet known, abnormal agglutination of fat emulsion in the blood of critically ill patients has been found to result in disruption of normal blood flow. [5][6][7] Infusion of fat emulsion has also been associated with decreased production of tissue plasminogen activator, potentially increasing patients' risk for thrombus formation.…”

Section: Discussionmentioning

confidence: 99%

“…5 Although the clinical impact of fat emulsion accumulation in ECMO is not yet known, abnormal agglutination of fat emulsion in the blood of critically ill patients has been found to result in disruption of normal blood flow. [5][6][7] Infusion of fat emulsion has also been associated with decreased production of tissue plasminogen activator, potentially increasing patients' risk for thrombus formation. 8 Determining the impact of fat emulsion on clot formation in ECMO is difficult, as the procedure itself carries a significant risk for thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Methods for Intravenous Infusion of Fat Emulsion During Extracorporeal Membrane Oxygenation

Buck¹,

Wooldridge²,

Ksenich

2005

Pharmacotherapy

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Although both methods were associated with layering out, agglutination, and clot formation, these effects occurred more frequently with administration into the ECMO circuit, particularly in areas of stasis. This may result in disruption of normal ECMO blood flow and impaired delivery of calories. Fat emulsion should therefore be administered through separate intravenous access during ECMO whenever possible.

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“…Any effect of propofol on β ‐oxidation will be compounded by delivery of an excessive fat load. It has also been suggested that an excessive fat load in the plasma, may lead to the formation of lipid plugs in the microvasculature leading to organ ischemia (18). The second issue concerns the provision of an adequate carbohydrate intake.…”

Section: Mean Propofol Infusion Rate Carbohydrate Intake and Plasma mentioning

confidence: 99%