Propofol is a short-acting intravenous general anesthetic from the group of narcotics and traded one of them under the name Diprivan. It can be used in the induction and maintenance of general anesthesia and the sedation of ventilated patients in intensive care units. Propofol is also commonly used in veterinary medicine.
Definition and risk factors
This is an intravenous, rapid-acting anesthetic agent that can be used for the induction and maintenance of general anesthesia as well as for sedation in the Intensive Care Unit and for the anesthetic sedation of short-term procedures and in addition locoregional anesthesia.
In some patients, the use of this medication for sedation in intensive care units may be associated with a combination of metabolic disorders and organ failure, characteristic of propofol infusion syndrome and which can lead to death.
The propofol infusion syndrome may manifest as the following events: metabolic acidosis, rhabdomyolysis, hyperkalaemia, hepatomegaly, renal failure, hyperlipidemia, cardiac arrhythmia, Brugada syndrome (ST segment elevation ECG with domed appearance), rapidly progressing heart failure usually unresponsive to treatment with an inotropic agent. In the literature, severe brain damage (basal ganglia) has also been reported concomitantly with metabolic syndrome in one patient after only 3 hours of surgery under intravenous anesthesia with it.
Several risk factors have been identified to date: young age (this medication is contraindicated in patients under 16 years of age for continuous sedation in the Intensive Care Unit), reduction in carbohydrate intake (perioperative fasting), co-administration of metformin, decreased tissue oxygen supply, severe neurological injury and / or sepsis, high doses of one or more of the following pharmacological agents – vasoconstrictors, steroids, inotropic agents or use of propofol at higher doses at 4 mg / kg / h for more than 48 h. Sometimes propofol infusion syndrome can be indicative of mitochondrial disease.
Diagnosis, monitoring and measures to be taken
The diagnosis of propofol infusion syndrome can sometimes be difficult to make, especially since the data in the literature show that this syndrome can also be observed during the use of propofol for a short time including during anesthesia. of a few hours. The clinical manifestations of this syndrome are sometimes nonspecific. Therefore, faced with hemodynamic degradation or the appearance of metabolic (lactic) acidosis not explained by the clinical situation in a patient treated with propofol, it is important to mention a propofol infusion syndrome.
When a propofol infusion syndrome is suspected, it is necessary to stop the propofol as soon as possible and use another sedative treatment.
In the majority of cases, when the propofol infusion syndrome is identified early and the propofol is stopped immediately, the outcome is favorable.
On the other hand, monitoring measures can be put in place, in particular in the event of prolonged or high dose infusion, to detect the occurrence of this syndrome such as ECG (Electrocardiography) monitoring, production of arterial blood gases with dosage of lactates, dosage of CPKs (Creatine kinase: enzymes produced from various tissues in the body) and triglyceride (a type of fat found in the blood) tests.
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