Vasopressors and Propofol Infusion Syndrome in Severe Head Trauma

Smith, Heidi; Sinson, Grant; Varelas, Panayiotis N.

doi:10.1007/s12028-008-9163-y

Cited by 25 publications

(15 citation statements)

References 39 publications

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“…The combination of a high dose of propofol with vasopressor use, and high endogenous levels of catecholamines in the myocardium, may increase the risk for developing PRIS in patients with severe head trauma [7]. During stress metabolism, catecholamines serve as a major trigger for lipolysis, leading to accumulation of free-fatty acids, which is another risk factor for developing PRIS [5].…”

Section: Discussionmentioning

confidence: 99%

“…The pathophysiology is poorly understood but clinical manifestations include cardiac failure, hypotension, metabolic acidosis, renal failure, and rhabdomyolysis [4,5]. Occurrence is generally associated with higher propofol dosages (N 4 mg/kg/hr), prolonged application (N 48 hrs), and in patients with neurological or neurosurgical diseases [2,6,7]. A case of fatal PRIS in a patient receiving the drug at a moderate dosage is presented.…”

Section: Introductionmentioning

confidence: 99%

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Propofol-related infusion syndrome induced by “moderate dosage” in a patient with severe head trauma

Annecke

Conzen

Ney

2012

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Propofol-related infusion syndrome induced by “moderate dosage” in a patient with severe head trauma

Annecke

Conzen

Ney

2012

Journal of Clinical Anesthesia

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“…16 Vasopressors. In their review of neurological ICU patients, Smith and colleagues 17 reported a relationship between the use of vasopressors and the development of propofol infusion syndrome. They suggested that this effect could be caused by the action of propofol and vasopressors on the heart.…”

Section: Risk Factorsmentioning

confidence: 99%

Propofol infusion syndrome: a structured literature review and analysis of published case reports

Hemphill

McMenamin

Bellamy

et al. 2019

British Journal of Anaesthesia

225

182

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Propofol infusion syndrome is a rare, potentially fatal condition first described in children in the 1990s and later reported in adults. We provide a narrative review of what is currently known about propofol infusion syndrome, including a structured analysis of all published case reports; child and adult cases were analysed separately as propofol is no longer used for long-term sedation in children. The review contains an update on current knowledge of the pathophysiology of this condition along with recommendations for its diagnosis, prevention, and management. We reviewed 108 publications documenting 168 cases of propofol infusion syndrome. We evaluated clinical features and analysed factors influencing mortality in child and adult cases using separate multivariate analysis models. We used separate multiple linear regression models to analyse relationships between cumulative dose of propofol and the number of features seen and organ systems involved. Lipidaemia, fever, and hepatomegaly occurred more frequently in children than in adults, whilst rhabdomyolysis and hyperkalaemia were more frequent in adults. Mortality from propofol infusion syndrome is independently associated with fever and hepatomegaly in children, and electrocardiogram changes, hypotension, hyperkalaemia, traumatic brain injury, and a mean propofol infusion rate >5 mg kg À1 h À1 in adults. The cumulative dose of propofol was associated with an increased number of clinical features and the number of organ systems involved in adult cases only. Clinicians should consider propofol infusion syndrome in cases of unexplained metabolic acidosis, ECG changes, and rhabdomyolysis. We recommend early consideration of continuous haemofiltration in the management of propofol infusion syndrome.

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“…Arrhythmias including atrial fibrillation, bradycardia, bundle branch block, ventricular tachycardia and asystole have also been reported ( Table 2) [17]. The incidence of PRIS is unknown as no formal registry exists to record patients who develop the syndrome, but since the first case reports in 1992, more than 35 children and approximately 40 adults have demonstrated signs and symptoms suggestive of PRIS [18][19][20][21][22][23][24][25]. Following discontinuation of the propofol infusion, treatment of the syndrome is primarily supportive and the associated mortality is high.…”

Section: Propofolmentioning

confidence: 99%

Optimizing Sustained Use of Sedation in Mechanically Ventilated Patients: Focus on Safety

Arnold¹,

Hollands²,

Skrupky³

et al. 2010

CDS

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Optimizing sustained use of ICU sedation in mechanically ventilated patients requires careful consideration of drug-specific characteristics (E.G. pharmacokinetics), consideration of potential adverse effects in susceptible patients, and utilization of sedation-minimizing strategies. In the era of anxiolytic dosing protocols adjusted to specific patient behaviors as defined by sedation scales in conjunction with daily interruption, midazolam is a reasonable option for long-term sedation. Propofol is an appealing agent for ICU sedation due to it's pharmacokinetic profile and a reduced propensity to result in prolonged sedation. However, care should be taken to monitor for potential devastating adverse effects including hypertriglyceridemia and propofol-related infusion syndrome (PRIS). Dexmedetomidine unreliably provides adequate sedation at doses currently approved by the FDA, though upward titration of dexmedetomidine coupled with rescue benzodiazepines and/or fentanyl appears to be safe and comparable to benzodiazepines in the achievement of light to moderate Richmond Agitation Sedation Scale (RASS) goals. Clinicians should closely monitor patients receiving dexmedetomidine for hemodynamic-altering bradycardia. Strategies that promote frequent patient assessment with corresponding sedative dose minimization have demonstrated the benefits of limiting oversedation. Implementation of a sedation protocol requires careful consideration of ICU resources and staffing such that efforts made are sustainable and will be safe and effective for the patient population affected.

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Vasopressors and Propofol Infusion Syndrome in Severe Head Trauma

Abstract: Awareness and early recognition of PRIS in critically ill neurosurgical patients on vasopressors and daily screening for creatine kinase elevation, unexplained acidosis, or electrocardiographic changes may reduce the incidence and case-fatality.

Cited by 25 publications

References 39 publications

Propofol-related infusion syndrome induced by “moderate dosage” in a patient with severe head trauma

Propofol-related infusion syndrome induced by “moderate dosage” in a patient with severe head trauma

Propofol infusion syndrome: a structured literature review and analysis of published case reports

Optimizing Sustained Use of Sedation in Mechanically Ventilated Patients: Focus on Safety

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