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Propofol Infusion syndrome: Dx

Propofol infusion syndrome is a rare syndrome typically occurring after over 48 hours of propofol infusions at greater rates than 4 mg/kg/hr (67 ucg/kg/min). Features of the syndrome are acute refractory bradycardia leading to asystole in addition to at least one of the following: metabolic acidosis, rhabdomyolysis, hyperlipidemia, and/or enlarged liver. Also seen are cardiomyopathies, skeletal myopathy, or hyperkalemia.

Risk factors include sepsis, poor DO2, severe brain injury, and high-dose propofol. Originally reported in children but also found to occur in critically-ill adults. Theories include mitochondrial defects and/or toxicity, among others. Increasing lipemia may be an early sign (although this has not been firmly established).

Propofol Infusion Syndrome

  • Who Gets It?: 48 hours of propofol at > 67 ucg/kg/min (4 mg/kg/hr)
  • Cardiac Manifestations: bradycardia/asystole (plus one or more of:), cardiomyopathy
  • Acid/Base: metabolic acidosis (BD > 10 mEq/L)
  • Electrolytes: hyperkalemia
  • Other Organs: rhabdomyolysis, myoglobinuria, enlarged liver, hyperlipidemia