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Propofol infusion syndrome: Case report and literature review

Articlein American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists 66(10):908-15 ·  June 2009with58 Reads

DOI: 10.2146/ajhp070605 · Source: PubMed

Jose Orsini
Jose Orsini

Abhijeet Nadkarni
Abhijeet Nadkarni

Julie Chen
Julie Chen

Nina Cohen
Nina Cohen

Abstract
A case of propofol infusion syndrome in a patient with respiratory failure and sepsis is reported.
A 36-year-old Hispanic woman was admitted to the medical intensive care unit for treatment of respiratory failure and sepsis, likely secondary to pneumonia. Her medical history included human immunodeficiency virus infection and chronic hepatitis C virus infection. She was intubated and placed on mechanical ventilation. Empirical i.v. antimicrobial therapy was initiated with vancomycin, moxifloxacin, piperacillin-tazobactam, trimethoprim-sulfamethoxazole, and micafungin, along with corticosteroids and vasopressors. Propofol 1.5 mg/kg per hour i.v. and midazolam i.v. were initiated for sedation, but the dosages of both propofol and midazolam needed to be increased due to persistent agitation. On hospital day 7, the patient developed a morbilliform rash on her neck, shoulders, and chest and multiple abnormal laboratory test values, including elevated levels of alanine transaminase, aspartate transaminase, amylase, lipase, creatine kinase, and triglycerides. Serial electrocardiograms revealed sinus tachycardia. Computed tomography of the abdomen showed hepatomegaly with fatty infiltration of the liver, no gallstones, and a normal pancreas. I.V. phenobarbital was added for sedation, and propofol was tapered and discontinued on the same day. The patient responded adequately to phenobarbital maintenance therapy and was eventually weaned off all other sedatives. The patient's laboratory test values returned to normal within 72 hours after discontinuation of the propofol infusion, and the rash and tachycardia resolved.
Propofol infusion syndrome developed in a patient with respiratory failure and sepsis after a prolonged infusion of high-dose propofol.

Do you want to read the rest of this article ?

  • … This may be the result of cumulative toxicity, with reports coming after high-dose infusions as well as after prolonged administration [20] . Risk factors for the PIS include: large cumulative doses, young age, acute neurological injury, low carbohydrate intake, high fat intake or inadequate clearance, exogenous catecholamine or corticosteroid infusion , critical illness and inborn errors of mitochondrial fatty acid oxidation [21]. Current guidelines for maximal propofol dosage suggested < 4 mg/kg//h for a duration of up to 48 h [22] . …
    … PIS is similar to the inherited mitochondrial myopathies, often clinically silent until a metabolic stress is encountered, when the body comes to rely on fat rather than carbohydrate for its energy requirements [27]. Although low glycogen stores may have existed in this severely wasted patient, a normal carbohydrate intake of 3.5 g/kg/day was assured [21]. Nothing is known about inborn errors of mitochondrial fatty acid oxidation in the recipient or in the transplanted liver. …
    Terlipressine Induced Rhabdomyolysis After Orthotopic Liver Transplantation
    Article
    • Jan 2014
    • J Med Cases
    • Eid

  • … [289] Propofol infusion syndrome (PRIS) is a rare complication of propofol administration. [290,291] Although its pathophysiology is incompletely understood, this potentially fatal syndrome may result from mitochondrial respiratory chain dys- function. [290,292,293] Risk factors for PRIS include propofol infusion rates >5 mg/kg/h for >48 hours, utilization of higher concentrations (2% vs 1%) of propofol, young age, critical illness, high fat and low carbohydrate intake, inborn errors of mitochondrial fatty acid oxidation and concomitant catecholamine infusion or steroid ther- apy.290291292293294295 …
    … [290,291] Although its pathophysiology is incompletely understood, this potentially fatal syndrome may result from mitochondrial respiratory chain dys- function. [290,292,293] Risk factors for PRIS include propofol infusion rates >5 mg/kg/h for >48 hours, utilization of higher concentrations (2% vs 1%) of propofol, young age, critical illness, high fat and low carbohydrate intake, inborn errors of mitochondrial fatty acid oxidation and concomitant catecholamine infusion or steroid ther- apy.290291292293294295 While usually observed in patients receiving high doses of propofol for prolonged periods of time, it may also occur after a short infusion and/or with low doses.296297298 …
    Sedation for Critically Ill or Injured Adults in the Intensive Care Unit
    Article
    Full-text available
    • Oct 2012
    • DRUGS
    • Derek J Roberts

      Derek J Roberts

    • Babar Haroon
    • Richard I Hall

      Richard I Hall

  • … Studies on amitriptyline [4,18,28,31,33,34,54,55], carbamazepine [28,30,31,36,37], tramadol [22,46,[56][57][58][59] and trazodone [47][48][49][60][61][62][63] related deaths and PMR have frequently been reported. Propofol related deaths [64][65][66][67][68][69] have frequently been reported, but studies on PMR of propofol have not been reported. As for diclofenac, drug-related fatalities and PMR have rarely been reported and research about PMR of proxyphylline has not been reported. …
    Evaluation of postmortem redistribution phenomena for commonly encountered drugs
    Article
    • Jan 2012
    • Eunyoung Han

      Eunyoung Han

    • Eunmi Kim

      Eunmi Kim

    • Hyojeong Hong
    • Sujin Jeong
    • Sangki Lee

      Sangki Lee

  • … This in turn could be counterproductive by promoting overfeeding , as well as by limiting the amount of fish-oil-based lipids that can be administered. Other associated risks of high-dose propofol infusion include the following: increased potential for developing hyperlipidemia, adverse effects of parenteral soy-based lipids in ICU patients, and the propofol-infusion syndrome [46,48,57]. No rec, no recommendation; IPS, inherent in protein source; ARG, arginine; GLA, gamma-linolenic acid; MCT, medium-chain triglycerides …
    Immunonutrition and critical illness: An update
    Article
    • Apr 2010
    • NUTRITION
    • Barry A Mizock

      Barry A Mizock

  • … Ipnotico molto potente ad azione ultrarapida (inizia ad agire in 40 secondi circa dall'iniezione endovenosa con cessazione dell'effetto in una decina di minuti dalla fine della somministrazione), agisce potenziando la trasmissione inibitoria GABAergica a livello del sistema nervoso centrale. Quando infuso rapidamente, provoca depressione respiratoria con apnea e arresto respiratorio, mentre se somministrato lentamente (orientativamente 1-2 mg/kg in 2-3 minuti nel bambino sopra l'anno, 0,5-1 mg/kg nel lattante) permette di mantenere la respirazione spontanea e lo stato di sedazione viene assicurato per tutto il tempo necessario alla procedura con successivi boli di 0,5 mg/kg (oppure utilizzando l'infusione continua, controindicata sotto i 3 anni per il rischio associato di propofol infusion syndrome, caratterizzata da acidosi metabolica, iperlipemia, iperkaliemia e arresto cardiaco ) [13]. …
    Procedural sedation 2010: The drugs
    Article
    Full-text available
    • Jan 2010
    • L. Badina

      L. Badina

    • M. Minute

      M. Minute

    • E. Barbi

      E. Barbi

  • Aquagenic urticaria in 2 adolescents
    Article
    Full-text available
    • Jan 2010
    • J INVEST ALLERG CLIN
    • S T Yavuz

      S T Yavuz

    • U M Sahiner

      U M Sahiner

    • A Tuncer
    • C Sackesen

      C Sackesen

  • Fixed drug eruption due to propofol after an intradermal test
    Article
    • Jan 2010
    • J INVEST ALLERG CLIN
    • J Domínguez-Ortega
    • B Rodríguez-Jiménez

      B Rodríguez-Jiménez

    • C González-Herrada
    • L El-Bouayadi
    • J M González

  • m-Azipropofol (AziPm) a Photoactive Analogue of the Intravenous General Anesthetic Propofol
    Article
    • Aug 2010
    • J Med Chem
    • Michael A Hall
    • Jin Xi
    • Chong Lor
    • Shuiping Dai
    • Roderic G Eckenhoff

  • Dexmedetomidine Use in Pediatric Airway Reconstruction
    Article
    Full-text available
    • Feb 2011
    • OTOLARYNG HEAD NECK
    • Amanda L Silver
    • Phoebe Yager
    • Prashant Purohit

      Prashant Purohit

    • Natan Noviski

      Natan Noviski

    • Christopher J Hartnick

  • Propofol Abuse
    Article
    • Sep 2011
    • Ethan O Bryson

      Ethan O Bryson

    • Elizabeth A.M. Frost

      Elizabeth A.M. Frost

Recommended publications

Discover more publications, questions and projects in Propofol

Article
Propofol-Related Infusion Syndrome in Intensive Care Patients
March 2008 · Pharmacotherapy
    The Institute of Medicine has identified adverse drug events as factors that significantly contribute to increased patient morbidity and mortality. As critically ill patients receive numerous drugs to treat a multitude of complicated health problems, they are at high risk for adverse drug events. Sedation is often a key requirement for the optimal management of critical illness, and propofol,… [Show full abstract]
    Read more
    Article
    [Propofol infusion syndrome]
    January 2010 · Annales francaises d'anesthesie et de reanimation
      OBJECTIVE:
      Propofol is commonly used for sedation of children or adult patients in intensive care unit as an alternative to benzodiazepines for the long-term sedation of mechanically ventiled patient. However, the life-threatening complication of propofol-infusion syndrome (PRIS) may in some case occur. The objective of this article is to review the clinical features, physiopathology and… [Show full abstract]
      Read more
      Article
      Analytic Reviews: Propofol Infusion Syndrome in the ICU
      April 2011 · Journal of Intensive Care Medicine
        Propofol is an alkylphenol derivative named 2, 6, diisopropylphenol and is a potent intravenous short-acting hypnotic agent. It is commonly used as sedation, as well as an anesthetic agent in both pediatric and adult patient populations. There have been numerous case reports describing a constellation of findings including metabolic derangements and organ system failures known collectively as… [Show full abstract]
        Read more
        Article
        Le syndrome de perfusion du propofol
        May 2010 · Annales francaises d'anesthesie et de reanimation
          Objective
          Propofol is commonly used for sedation of children or adult patients in intensive care unit as an alternative to benzodiazepines for the long-term sedation of mechanically ventiled patient. However, the life-threatening complication of propofol-infusion syndrome (PRIS) may in some case occur. The objective of this article is to review the clinical features, physiopathology and… [Show full abstract]
          Read more

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          26 References

          Propofol infusion syndrome: Case report and literature review

          Articlein American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists 66(10):908-15 ·  June 2009with58 Reads

          DOI: 10.2146/ajhp070605 · Source: PubMed

          Jose Orsini
          Jose Orsini

          Abhijeet Nadkarni
          Abhijeet Nadkarni

          Julie Chen
          Julie Chen

          Nina Cohen
          Nina Cohen

          Abstract
          A case of propofol infusion syndrome in a patient with respiratory failure and sepsis is reported.
          A 36-year-old Hispanic woman was admitted to the medical intensive care unit for treatment of respiratory failure and sepsis, likely secondary to pneumonia. Her medical history included human immunodeficiency virus infection and chronic hepatitis C virus infection. She was intubated and placed on mechanical ventilation. Empirical i.v. antimicrobial therapy was initiated with vancomycin, moxifloxacin, piperacillin-tazobactam, trimethoprim-sulfamethoxazole, and micafungin, along with corticosteroids and vasopressors. Propofol 1.5 mg/kg per hour i.v. and midazolam i.v. were initiated for sedation, but the dosages of both propofol and midazolam needed to be increased due to persistent agitation. On hospital day 7, the patient developed a morbilliform rash on her neck, shoulders, and chest and multiple abnormal laboratory test values, including elevated levels of alanine transaminase, aspartate transaminase, amylase, lipase, creatine kinase, and triglycerides. Serial electrocardiograms revealed sinus tachycardia. Computed tomography of the abdomen showed hepatomegaly with fatty infiltration of the liver, no gallstones, and a normal pancreas. I.V. phenobarbital was added for sedation, and propofol was tapered and discontinued on the same day. The patient responded adequately to phenobarbital maintenance therapy and was eventually weaned off all other sedatives. The patient's laboratory test values returned to normal within 72 hours after discontinuation of the propofol infusion, and the rash and tachycardia resolved.
          Propofol infusion syndrome developed in a patient with respiratory failure and sepsis after a prolonged infusion of high-dose propofol.

          Do you want to read the rest of this article ?

          • … This may be the result of cumulative toxicity, with reports coming after high-dose infusions as well as after prolonged administration [20] . Risk factors for the PIS include: large cumulative doses, young age, acute neurological injury, low carbohydrate intake, high fat intake or inadequate clearance, exogenous catecholamine or corticosteroid infusion , critical illness and inborn errors of mitochondrial fatty acid oxidation [21]. Current guidelines for maximal propofol dosage suggested < 4 mg/kg//h for a duration of up to 48 h [22] . …
            … PIS is similar to the inherited mitochondrial myopathies, often clinically silent until a metabolic stress is encountered, when the body comes to rely on fat rather than carbohydrate for its energy requirements [27]. Although low glycogen stores may have existed in this severely wasted patient, a normal carbohydrate intake of 3.5 g/kg/day was assured [21]. Nothing is known about inborn errors of mitochondrial fatty acid oxidation in the recipient or in the transplanted liver. …
            Terlipressine Induced Rhabdomyolysis After Orthotopic Liver Transplantation
            Article
            • Jan 2014
            • J Med Cases
            • Eid

          • … [289] Propofol infusion syndrome (PRIS) is a rare complication of propofol administration. [290,291] Although its pathophysiology is incompletely understood, this potentially fatal syndrome may result from mitochondrial respiratory chain dys- function. [290,292,293] Risk factors for PRIS include propofol infusion rates >5 mg/kg/h for >48 hours, utilization of higher concentrations (2% vs 1%) of propofol, young age, critical illness, high fat and low carbohydrate intake, inborn errors of mitochondrial fatty acid oxidation and concomitant catecholamine infusion or steroid ther- apy.290291292293294295 …
            … [290,291] Although its pathophysiology is incompletely understood, this potentially fatal syndrome may result from mitochondrial respiratory chain dys- function. [290,292,293] Risk factors for PRIS include propofol infusion rates >5 mg/kg/h for >48 hours, utilization of higher concentrations (2% vs 1%) of propofol, young age, critical illness, high fat and low carbohydrate intake, inborn errors of mitochondrial fatty acid oxidation and concomitant catecholamine infusion or steroid ther- apy.290291292293294295 While usually observed in patients receiving high doses of propofol for prolonged periods of time, it may also occur after a short infusion and/or with low doses.296297298 …
            Sedation for Critically Ill or Injured Adults in the Intensive Care Unit
            Article
            Full-text available
            • Oct 2012
            • DRUGS
            • Derek J Roberts

              Derek J Roberts

            • Babar Haroon
            • Richard I Hall

              Richard I Hall

          • … Studies on amitriptyline [4,18,28,31,33,34,54,55], carbamazepine [28,30,31,36,37], tramadol [22,46,[56][57][58][59] and trazodone [47][48][49][60][61][62][63] related deaths and PMR have frequently been reported. Propofol related deaths [64][65][66][67][68][69] have frequently been reported, but studies on PMR of propofol have not been reported. As for diclofenac, drug-related fatalities and PMR have rarely been reported and research about PMR of proxyphylline has not been reported. …
            Evaluation of postmortem redistribution phenomena for commonly encountered drugs
            Article
            • Jan 2012
            • Eunyoung Han

              Eunyoung Han

            • Eunmi Kim

              Eunmi Kim

            • Hyojeong Hong
            • Sujin Jeong
            • Sangki Lee

              Sangki Lee

          • … This in turn could be counterproductive by promoting overfeeding , as well as by limiting the amount of fish-oil-based lipids that can be administered. Other associated risks of high-dose propofol infusion include the following: increased potential for developing hyperlipidemia, adverse effects of parenteral soy-based lipids in ICU patients, and the propofol-infusion syndrome [46,48,57]. No rec, no recommendation; IPS, inherent in protein source; ARG, arginine; GLA, gamma-linolenic acid; MCT, medium-chain triglycerides …
            Immunonutrition and critical illness: An update
            Article
            • Apr 2010
            • NUTRITION
            • Barry A Mizock

              Barry A Mizock

          • … Ipnotico molto potente ad azione ultrarapida (inizia ad agire in 40 secondi circa dall'iniezione endovenosa con cessazione dell'effetto in una decina di minuti dalla fine della somministrazione), agisce potenziando la trasmissione inibitoria GABAergica a livello del sistema nervoso centrale. Quando infuso rapidamente, provoca depressione respiratoria con apnea e arresto respiratorio, mentre se somministrato lentamente (orientativamente 1-2 mg/kg in 2-3 minuti nel bambino sopra l'anno, 0,5-1 mg/kg nel lattante) permette di mantenere la respirazione spontanea e lo stato di sedazione viene assicurato per tutto il tempo necessario alla procedura con successivi boli di 0,5 mg/kg (oppure utilizzando l'infusione continua, controindicata sotto i 3 anni per il rischio associato di propofol infusion syndrome, caratterizzata da acidosi metabolica, iperlipemia, iperkaliemia e arresto cardiaco ) [13]. …
            Procedural sedation 2010: The drugs
            Article
            Full-text available
            • Jan 2010
            • L. Badina

              L. Badina

            • M. Minute

              M. Minute

            • E. Barbi

              E. Barbi

          • Aquagenic urticaria in 2 adolescents
            Article
            Full-text available
            • Jan 2010
            • J INVEST ALLERG CLIN
            • S T Yavuz

              S T Yavuz

            • U M Sahiner

              U M Sahiner

            • A Tuncer
            • C Sackesen

              C Sackesen

          • Fixed drug eruption due to propofol after an intradermal test
            Article
            • Jan 2010
            • J INVEST ALLERG CLIN
            • J Domínguez-Ortega
            • B Rodríguez-Jiménez

              B Rodríguez-Jiménez

            • C González-Herrada
            • L El-Bouayadi
            • J M González

          • m-Azipropofol (AziPm) a Photoactive Analogue of the Intravenous General Anesthetic Propofol
            Article
            • Aug 2010
            • J Med Chem
            • Michael A Hall
            • Jin Xi
            • Chong Lor
            • Shuiping Dai
            • Roderic G Eckenhoff

          • Dexmedetomidine Use in Pediatric Airway Reconstruction
            Article
            Full-text available
            • Feb 2011
            • OTOLARYNG HEAD NECK
            • Amanda L Silver
            • Phoebe Yager
            • Prashant Purohit

              Prashant Purohit

            • Natan Noviski

              Natan Noviski

            • Christopher J Hartnick

          • Propofol Abuse
            Article
            • Sep 2011
            • Ethan O Bryson

              Ethan O Bryson

            • Elizabeth A.M. Frost

              Elizabeth A.M. Frost

          Recommended publications

          Discover more publications, questions and projects in Propofol

          Article
          Propofol-Related Infusion Syndrome in Intensive Care Patients
          March 2008 · Pharmacotherapy
            The Institute of Medicine has identified adverse drug events as factors that significantly contribute to increased patient morbidity and mortality. As critically ill patients receive numerous drugs to treat a multitude of complicated health problems, they are at high risk for adverse drug events. Sedation is often a key requirement for the optimal management of critical illness, and propofol,… [Show full abstract]
            Read more
            Article
            [Propofol infusion syndrome]
            January 2010 · Annales francaises d'anesthesie et de reanimation
              OBJECTIVE:
              Propofol is commonly used for sedation of children or adult patients in intensive care unit as an alternative to benzodiazepines for the long-term sedation of mechanically ventiled patient. However, the life-threatening complication of propofol-infusion syndrome (PRIS) may in some case occur. The objective of this article is to review the clinical features, physiopathology and… [Show full abstract]
              Read more
              Article
              Analytic Reviews: Propofol Infusion Syndrome in the ICU
              April 2011 · Journal of Intensive Care Medicine
                Propofol is an alkylphenol derivative named 2, 6, diisopropylphenol and is a potent intravenous short-acting hypnotic agent. It is commonly used as sedation, as well as an anesthetic agent in both pediatric and adult patient populations. There have been numerous case reports describing a constellation of findings including metabolic derangements and organ system failures known collectively as… [Show full abstract]
                Read more
                Article
                Le syndrome de perfusion du propofol
                May 2010 · Annales francaises d'anesthesie et de reanimation
                  Objective
                  Propofol is commonly used for sedation of children or adult patients in intensive care unit as an alternative to benzodiazepines for the long-term sedation of mechanically ventiled patient. However, the life-threatening complication of propofol-infusion syndrome (PRIS) may in some case occur. The objective of this article is to review the clinical features, physiopathology and… [Show full abstract]
                  Read more

                  Discover more

                  About
                  News
                  Company
                  Careers
                  Support
                  Help center
                  FAQ
                  Business solutions
                  Recruiting
                  Advertising
                  © ResearchGate 2018 . All rights reserved.
                  • Imprint
                  • Terms
                  • Privacy

                  or

                  Discover by subject area

                  Join for free
                  Log in

                  For full functionality of ResearchGate it is necessary to enable JavaScript.
                  Here are the
                  instructions how to enable JavaScript in your web browser .


                  See all ›

                  22 Citations

                  See all ›

                  26 References

                  Propofol infusion syndrome: Case report and literature review

                  Articlein American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists 66(10):908-15 ·  June 2009with58 Reads

                  DOI: 10.2146/ajhp070605 · Source: PubMed

                  Jose Orsini
                  Jose Orsini

                  Abhijeet Nadkarni
                  Abhijeet Nadkarni

                  Julie Chen
                  Julie Chen

                  Nina Cohen
                  Nina Cohen

                  Abstract
                  A case of propofol infusion syndrome in a patient with respiratory failure and sepsis is reported.
                  A 36-year-old Hispanic woman was admitted to the medical intensive care unit for treatment of respiratory failure and sepsis, likely secondary to pneumonia. Her medical history included human immunodeficiency virus infection and chronic hepatitis C virus infection. She was intubated and placed on mechanical ventilation. Empirical i.v. antimicrobial therapy was initiated with vancomycin, moxifloxacin, piperacillin-tazobactam, trimethoprim-sulfamethoxazole, and micafungin, along with corticosteroids and vasopressors. Propofol 1.5 mg/kg per hour i.v. and midazolam i.v. were initiated for sedation, but the dosages of both propofol and midazolam needed to be increased due to persistent agitation. On hospital day 7, the patient developed a morbilliform rash on her neck, shoulders, and chest and multiple abnormal laboratory test values, including elevated levels of alanine transaminase, aspartate transaminase, amylase, lipase, creatine kinase, and triglycerides. Serial electrocardiograms revealed sinus tachycardia. Computed tomography of the abdomen showed hepatomegaly with fatty infiltration of the liver, no gallstones, and a normal pancreas. I.V. phenobarbital was added for sedation, and propofol was tapered and discontinued on the same day. The patient responded adequately to phenobarbital maintenance therapy and was eventually weaned off all other sedatives. The patient's laboratory test values returned to normal within 72 hours after discontinuation of the propofol infusion, and the rash and tachycardia resolved.
                  Propofol infusion syndrome developed in a patient with respiratory failure and sepsis after a prolonged infusion of high-dose propofol.

                  Do you want to read the rest of this article ?

                  • … This may be the result of cumulative toxicity, with reports coming after high-dose infusions as well as after prolonged administration [20] . Risk factors for the PIS include: large cumulative doses, young age, acute neurological injury, low carbohydrate intake, high fat intake or inadequate clearance, exogenous catecholamine or corticosteroid infusion , critical illness and inborn errors of mitochondrial fatty acid oxidation [21]. Current guidelines for maximal propofol dosage suggested < 4 mg/kg//h for a duration of up to 48 h [22] . …
                    … PIS is similar to the inherited mitochondrial myopathies, often clinically silent until a metabolic stress is encountered, when the body comes to rely on fat rather than carbohydrate for its energy requirements [27]. Although low glycogen stores may have existed in this severely wasted patient, a normal carbohydrate intake of 3.5 g/kg/day was assured [21]. Nothing is known about inborn errors of mitochondrial fatty acid oxidation in the recipient or in the transplanted liver. …
                    Terlipressine Induced Rhabdomyolysis After Orthotopic Liver Transplantation
                    Article
                    • Jan 2014
                    • J Med Cases
                    • Eid

                  • … [289] Propofol infusion syndrome (PRIS) is a rare complication of propofol administration. [290,291] Although its pathophysiology is incompletely understood, this potentially fatal syndrome may result from mitochondrial respiratory chain dys- function. [290,292,293] Risk factors for PRIS include propofol infusion rates >5 mg/kg/h for >48 hours, utilization of higher concentrations (2% vs 1%) of propofol, young age, critical illness, high fat and low carbohydrate intake, inborn errors of mitochondrial fatty acid oxidation and concomitant catecholamine infusion or steroid ther- apy.290291292293294295 …
                    … [290,291] Although its pathophysiology is incompletely understood, this potentially fatal syndrome may result from mitochondrial respiratory chain dys- function. [290,292,293] Risk factors for PRIS include propofol infusion rates >5 mg/kg/h for >48 hours, utilization of higher concentrations (2% vs 1%) of propofol, young age, critical illness, high fat and low carbohydrate intake, inborn errors of mitochondrial fatty acid oxidation and concomitant catecholamine infusion or steroid ther- apy.290291292293294295 While usually observed in patients receiving high doses of propofol for prolonged periods of time, it may also occur after a short infusion and/or with low doses.296297298 …
                    Sedation for Critically Ill or Injured Adults in the Intensive Care Unit
                    Article
                    Full-text available
                    • Oct 2012
                    • DRUGS
                    • Derek J Roberts

                      Derek J Roberts

                    • Babar Haroon
                    • Richard I Hall

                      Richard I Hall

                  • … Studies on amitriptyline [4,18,28,31,33,34,54,55], carbamazepine [28,30,31,36,37], tramadol [22,46,[56][57][58][59] and trazodone [47][48][49][60][61][62][63] related deaths and PMR have frequently been reported. Propofol related deaths [64][65][66][67][68][69] have frequently been reported, but studies on PMR of propofol have not been reported. As for diclofenac, drug-related fatalities and PMR have rarely been reported and research about PMR of proxyphylline has not been reported. …
                    Evaluation of postmortem redistribution phenomena for commonly encountered drugs
                    Article
                    • Jan 2012
                    • Eunyoung Han

                      Eunyoung Han

                    • Eunmi Kim

                      Eunmi Kim

                    • Hyojeong Hong
                    • Sujin Jeong
                    • Sangki Lee

                      Sangki Lee

                  • … This in turn could be counterproductive by promoting overfeeding , as well as by limiting the amount of fish-oil-based lipids that can be administered. Other associated risks of high-dose propofol infusion include the following: increased potential for developing hyperlipidemia, adverse effects of parenteral soy-based lipids in ICU patients, and the propofol-infusion syndrome [46,48,57]. No rec, no recommendation; IPS, inherent in protein source; ARG, arginine; GLA, gamma-linolenic acid; MCT, medium-chain triglycerides …
                    Immunonutrition and critical illness: An update
                    Article
                    • Apr 2010
                    • NUTRITION
                    • Barry A Mizock

                      Barry A Mizock

                  • … Ipnotico molto potente ad azione ultrarapida (inizia ad agire in 40 secondi circa dall'iniezione endovenosa con cessazione dell'effetto in una decina di minuti dalla fine della somministrazione), agisce potenziando la trasmissione inibitoria GABAergica a livello del sistema nervoso centrale. Quando infuso rapidamente, provoca depressione respiratoria con apnea e arresto respiratorio, mentre se somministrato lentamente (orientativamente 1-2 mg/kg in 2-3 minuti nel bambino sopra l'anno, 0,5-1 mg/kg nel lattante) permette di mantenere la respirazione spontanea e lo stato di sedazione viene assicurato per tutto il tempo necessario alla procedura con successivi boli di 0,5 mg/kg (oppure utilizzando l'infusione continua, controindicata sotto i 3 anni per il rischio associato di propofol infusion syndrome, caratterizzata da acidosi metabolica, iperlipemia, iperkaliemia e arresto cardiaco ) [13]. …
                    Procedural sedation 2010: The drugs
                    Article
                    Full-text available
                    • Jan 2010
                    • L. Badina

                      L. Badina

                    • M. Minute

                      M. Minute

                    • E. Barbi

                      E. Barbi

                  • Aquagenic urticaria in 2 adolescents
                    Article
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                          26 References

                          Propofol infusion syndrome: Case report and literature review

                          Articlein American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists 66(10):908-15 ·  June 2009with58 Reads

                          DOI: 10.2146/ajhp070605 · Source: PubMed

                          Jose Orsini
                          Jose Orsini

                          Abhijeet Nadkarni
                          Abhijeet Nadkarni

                          Julie Chen
                          Julie Chen

                          Nina Cohen
                          Nina Cohen

                          Abstract
                          A case of propofol infusion syndrome in a patient with respiratory failure and sepsis is reported.
                          A 36-year-old Hispanic woman was admitted to the medical intensive care unit for treatment of respiratory failure and sepsis, likely secondary to pneumonia. Her medical history included human immunodeficiency virus infection and chronic hepatitis C virus infection. She was intubated and placed on mechanical ventilation. Empirical i.v. antimicrobial therapy was initiated with vancomycin, moxifloxacin, piperacillin-tazobactam, trimethoprim-sulfamethoxazole, and micafungin, along with corticosteroids and vasopressors. Propofol 1.5 mg/kg per hour i.v. and midazolam i.v. were initiated for sedation, but the dosages of both propofol and midazolam needed to be increased due to persistent agitation. On hospital day 7, the patient developed a morbilliform rash on her neck, shoulders, and chest and multiple abnormal laboratory test values, including elevated levels of alanine transaminase, aspartate transaminase, amylase, lipase, creatine kinase, and triglycerides. Serial electrocardiograms revealed sinus tachycardia. Computed tomography of the abdomen showed hepatomegaly with fatty infiltration of the liver, no gallstones, and a normal pancreas. I.V. phenobarbital was added for sedation, and propofol was tapered and discontinued on the same day. The patient responded adequately to phenobarbital maintenance therapy and was eventually weaned off all other sedatives. The patient's laboratory test values returned to normal within 72 hours after discontinuation of the propofol infusion, and the rash and tachycardia resolved.
                          Propofol infusion syndrome developed in a patient with respiratory failure and sepsis after a prolonged infusion of high-dose propofol.

                          Do you want to read the rest of this article ?

                          • … This may be the result of cumulative toxicity, with reports coming after high-dose infusions as well as after prolonged administration [20] . Risk factors for the PIS include: large cumulative doses, young age, acute neurological injury, low carbohydrate intake, high fat intake or inadequate clearance, exogenous catecholamine or corticosteroid infusion , critical illness and inborn errors of mitochondrial fatty acid oxidation [21]. Current guidelines for maximal propofol dosage suggested < 4 mg/kg//h for a duration of up to 48 h [22] . …
                            … PIS is similar to the inherited mitochondrial myopathies, often clinically silent until a metabolic stress is encountered, when the body comes to rely on fat rather than carbohydrate for its energy requirements [27]. Although low glycogen stores may have existed in this severely wasted patient, a normal carbohydrate intake of 3.5 g/kg/day was assured [21]. Nothing is known about inborn errors of mitochondrial fatty acid oxidation in the recipient or in the transplanted liver. …
                            Terlipressine Induced Rhabdomyolysis After Orthotopic Liver Transplantation
                            Article
                            • Jan 2014
                            • J Med Cases
                            • Eid

                          • … [289] Propofol infusion syndrome (PRIS) is a rare complication of propofol administration. [290,291] Although its pathophysiology is incompletely understood, this potentially fatal syndrome may result from mitochondrial respiratory chain dys- function. [290,292,293] Risk factors for PRIS include propofol infusion rates >5 mg/kg/h for >48 hours, utilization of higher concentrations (2% vs 1%) of propofol, young age, critical illness, high fat and low carbohydrate intake, inborn errors of mitochondrial fatty acid oxidation and concomitant catecholamine infusion or steroid ther- apy.290291292293294295 …
                            … [290,291] Although its pathophysiology is incompletely understood, this potentially fatal syndrome may result from mitochondrial respiratory chain dys- function. [290,292,293] Risk factors for PRIS include propofol infusion rates >5 mg/kg/h for >48 hours, utilization of higher concentrations (2% vs 1%) of propofol, young age, critical illness, high fat and low carbohydrate intake, inborn errors of mitochondrial fatty acid oxidation and concomitant catecholamine infusion or steroid ther- apy.290291292293294295 While usually observed in patients receiving high doses of propofol for prolonged periods of time, it may also occur after a short infusion and/or with low doses.296297298 …
                            Sedation for Critically Ill or Injured Adults in the Intensive Care Unit
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                            Full-text available
                            • Oct 2012
                            • DRUGS
                            • Derek J Roberts

                              Derek J Roberts

                            • Babar Haroon
                            • Richard I Hall

                              Richard I Hall

                          • … Studies on amitriptyline [4,18,28,31,33,34,54,55], carbamazepine [28,30,31,36,37], tramadol [22,46,[56][57][58][59] and trazodone [47][48][49][60][61][62][63] related deaths and PMR have frequently been reported. Propofol related deaths [64][65][66][67][68][69] have frequently been reported, but studies on PMR of propofol have not been reported. As for diclofenac, drug-related fatalities and PMR have rarely been reported and research about PMR of proxyphylline has not been reported. …
                            Evaluation of postmortem redistribution phenomena for commonly encountered drugs
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                          • … This in turn could be counterproductive by promoting overfeeding , as well as by limiting the amount of fish-oil-based lipids that can be administered. Other associated risks of high-dose propofol infusion include the following: increased potential for developing hyperlipidemia, adverse effects of parenteral soy-based lipids in ICU patients, and the propofol-infusion syndrome [46,48,57]. No rec, no recommendation; IPS, inherent in protein source; ARG, arginine; GLA, gamma-linolenic acid; MCT, medium-chain triglycerides …
                            Immunonutrition and critical illness: An update
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                            • Apr 2010
                            • NUTRITION
                            • Barry A Mizock

                              Barry A Mizock

                          • … Ipnotico molto potente ad azione ultrarapida (inizia ad agire in 40 secondi circa dall'iniezione endovenosa con cessazione dell'effetto in una decina di minuti dalla fine della somministrazione), agisce potenziando la trasmissione inibitoria GABAergica a livello del sistema nervoso centrale. Quando infuso rapidamente, provoca depressione respiratoria con apnea e arresto respiratorio, mentre se somministrato lentamente (orientativamente 1-2 mg/kg in 2-3 minuti nel bambino sopra l'anno, 0,5-1 mg/kg nel lattante) permette di mantenere la respirazione spontanea e lo stato di sedazione viene assicurato per tutto il tempo necessario alla procedura con successivi boli di 0,5 mg/kg (oppure utilizzando l'infusione continua, controindicata sotto i 3 anni per il rischio associato di propofol infusion syndrome, caratterizzata da acidosi metabolica, iperlipemia, iperkaliemia e arresto cardiaco ) [13]. …
                            Procedural sedation 2010: The drugs
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                            Article
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                            • J INVEST ALLERG CLIN
                            • J Domínguez-Ortega
                            • B Rodríguez-Jiménez

                              B Rodríguez-Jiménez

                            • C González-Herrada
                            • L El-Bouayadi
                            • J M González

                          • m-Azipropofol (AziPm) a Photoactive Analogue of the Intravenous General Anesthetic Propofol
                            Article
                            • Aug 2010
                            • J Med Chem
                            • Michael A Hall
                            • Jin Xi
                            • Chong Lor
                            • Shuiping Dai
                            • Roderic G Eckenhoff

                          • Dexmedetomidine Use in Pediatric Airway Reconstruction
                            Article
                            Full-text available
                            • Feb 2011
                            • OTOLARYNG HEAD NECK
                            • Amanda L Silver
                            • Phoebe Yager
                            • Prashant Purohit

                              Prashant Purohit

                            • Natan Noviski

                              Natan Noviski

                            • Christopher J Hartnick

                          • Propofol Abuse
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                            • Sep 2011
                            • Ethan O Bryson

                              Ethan O Bryson

                            • Elizabeth A.M. Frost

                              Elizabeth A.M. Frost

                          Recommended publications

                          Discover more publications, questions and projects in Propofol

                          Article
                          Propofol-Related Infusion Syndrome in Intensive Care Patients
                          March 2008 · Pharmacotherapy
                            The Institute of Medicine has identified adverse drug events as factors that significantly contribute to increased patient morbidity and mortality. As critically ill patients receive numerous drugs to treat a multitude of complicated health problems, they are at high risk for adverse drug events. Sedation is often a key requirement for the optimal management of critical illness, and propofol,… [Show full abstract]
                            Read more
                            Article
                            [Propofol infusion syndrome]
                            January 2010 · Annales francaises d'anesthesie et de reanimation
                              OBJECTIVE:
                              Propofol is commonly used for sedation of children or adult patients in intensive care unit as an alternative to benzodiazepines for the long-term sedation of mechanically ventiled patient. However, the life-threatening complication of propofol-infusion syndrome (PRIS) may in some case occur. The objective of this article is to review the clinical features, physiopathology and… [Show full abstract]
                              Read more
                              Article
                              Analytic Reviews: Propofol Infusion Syndrome in the ICU
                              April 2011 · Journal of Intensive Care Medicine
                                Propofol is an alkylphenol derivative named 2, 6, diisopropylphenol and is a potent intravenous short-acting hypnotic agent. It is commonly used as sedation, as well as an anesthetic agent in both pediatric and adult patient populations. There have been numerous case reports describing a constellation of findings including metabolic derangements and organ system failures known collectively as… [Show full abstract]
                                Read more
                                Article
                                Le syndrome de perfusion du propofol
                                May 2010 · Annales francaises d'anesthesie et de reanimation
                                  Objective
                                  Propofol is commonly used for sedation of children or adult patients in intensive care unit as an alternative to benzodiazepines for the long-term sedation of mechanically ventiled patient. However, the life-threatening complication of propofol-infusion syndrome (PRIS) may in some case occur. The objective of this article is to review the clinical features, physiopathology and… [Show full abstract]
                                  Read more

                                  Discover more

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