Propofol infusion syndrome

Definition

• A life-threatening condition characterised by acute refractory bradycardia progressing to asystole with one or more of:
  • Metabolic acidosis
  • Rhabdomyolysis
  • Hyperlipidaemia
  • Enlarged or fatty liver

Pathophysiology

• Unknown

Risk Factors

• Propofol infusion >4mg/kg/h x48h
• Younger age
• Acute neurological injury
• Low carbohydrate intake
• Concurrent catecholamine infusion
• Concurrent corticosteroids infusion

Investigations

• Laboratory
  • ABG showing metabolic acidosis
  • Lactate, elevated without other cause
  • Electrolytes, for hyperkalemia
  • Creatinine and CK, for renal failure and rhabdomyolysis
• Other
  • EKG, showing a Brugada pattern, RBBB, arrhythmia, or heart block

Management

• Stop propofol infusion
• Supportive care