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Propofol Infusion Syndrome (PRIS)

5/18/2015

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Propofol basics:
  • Short acting, intravenous general anesthetic
  • Sedation dose typically 0.3-4 mg/kg/hr
  • Anesthesia dose 4-12 mg/kg/hr
  • Rapid onset and short duration
  • Propofol infusion syndrome first described in 1990
 
Mechanism PRIS:
  • Propofol inhibits transport of fatty acids into the mitochondria and inhibits electron transport chain causing build up of fatty acid metabolites and decreased ATP
  • Made worse by a patient who is critically ill, has depleted carbohydrate stores, and thus relies on fatty acid breakdown for energy
 
Clinical features:
  • Metabolic acidosis
  • Cardiovascular collapse: Hypotension, treatment resistant bradycardia, and Brugada pattern on EKG
  • Rhabdomyolysis/acute renal failure
  • Elevated triglycerides
  • Hepatomegaly
  • Elevated lactate
  • 30% mortality
 
Risk factors:
  • Younger age (think higher doses propofol and less carbohydrate stores)
  • People on high doses/long duration of propofol
  • Exogenous glucocorticoids and vasopressors
 
Prevention:
  • Limit propofol to 4 mg/kg/hr for less than 48 hours
  • Note: cases of PRIS have still been described even with short duration/doses of propofol
  • Consider screening high risk patients with lactate, CPK, EKG, or triglycerides
 
Treatment:
  • Stop the propofol
  • Provide carbohydrates
  • Hemodialysis for acidosis
  • ECMO if all else fails
 
References:
Diedrick, D, Brown D. Propofol Infusion Syndrome in the ICU. Journal of  Intensive Care Medicine. 2011; 26 (2) 59-72. .
 
Rosen DJ, Nicoara A, Koshy N, Wedderburn RV. Too much of a good thing? Tracing the history of the propofol infusion syndrome.  J Trauma. 2007;63(2):443-447.
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  • Prospective Applicants
    • 2020 MATCH
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    • Our Curriculum
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    • Our Fellowships
    • Program Leadership
    • Explore Charlotte
    • Official Site
  • ROTATING STUDENTS
    • Prospective Visiting Students
    • UNC Students
    • Healthcare Disparities Externship
    • Current Students
  • Current Residents
    • FlashPoint
    • Airway Lecture!
    • PGY - 1
    • PGY - 2
    • PGY - 3
    • Simulation Reading
    • Blogs >
      • EM GuideWire
      • CMC ECG Masters
      • Core Concepts
      • #FOAMed
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
    • Resident Wellness
    • Resident Research
  • Top 20
  • Chiefs Corner
    • Schedules >
      • Conference/Flashpoint
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