Propofol Infusion Syndrome Associated with Short-Term Large-Dose Infusion During Surgical Anesthesia in an Adult

Abstract

In this case report we describe a case of propofol infusion syndrome in an adult after a short-term infusion of large-dose propofol during a neurosurgical procedure. Large-dose propofol (9 mg.kg(-1).h(-1)) was given for only 3 h during surgery and was followed by a small-dose infusion (2.3 mg.kg(-1).h(-1)) for 20 h postoperatively. The patient had also received large doses of methylprednisolone. He developed a marked lactic acidosis with mild biological signs of renal impairment and rhabdomyolysis but no cardiocirculatory failure. There were no other evident causes of lactic acidosis as documented by laboratory data. We believe this is the first report of reversible lactic acidosis associated with a short duration of large-dose propofol anesthesia.

Propofol infusion syndrome

“…These electrocardiographic changes precede the malignant ventricular arrhythmias that cause sudden cardiac death in these patients. More reports of unexplained early metabolic acidosis developing in patients who were not critically ill on high dose propofol infusions of short duration emerged [13,17,18,39]. A 31-year-old woman received propofol sedation for a radiofrequency ablation procedure for chronic atrial fibrillation [16].…”

Toxicology in the Critical Care Unit

“…Cases in the adult critically ill population have also been reported. 77 The syndrome is usually associated with high doses of continuous propofol administration for prolonged periods (Ͼ 5 mg/kg/h for Ͼ 48 h), but some reports [77][78][79] suggest much shorter exposures. Due to the common use of propofol as a sedative and the nonspecificity of findings associated with this syndrome in the critically ill population, a definite causal relationship has yet to be established.…”

Terlipressine Induced Rhabdomyolysis After Orthotopic Liver Transplantation

“…Recently, fatal cases of PIS at low infusion rates (1.9 -5.1 mg/ kg/h) have been reported [23]. Higher propofol doses during shorter periods of time can also trigger the syndrome [24]. In our case propofol sedation was started after surgery and continued for the first three postoperative days but the doses did not exceed 2 mg/kg/h, being even below the minimal problematic dose [25,26].…”