Propofol infusion syndrome: a structured literature review and analysis of published case reports

Abstract

Propofol infusion syndrome is a rare, potentially fatal condition first described in children in the 1990s and later reported in adults. We provide a narrative review of what is currently known about propofol infusion syndrome, including a structured analysis of all published case reports; child and adult cases were analysed separately as propofol is no longer used for long-term sedation in children. The review contains an update on current knowledge of the pathophysiology of this condition along with recommendations for its diagnosis, prevention, and management. We reviewed 108 publications documenting 168 cases of propofol infusion syndrome. We evaluated clinical features and analysed factors influencing mortality in child and adult cases using separate multivariate analysis models. We used separate multiple linear regression models to analyse relationships between cumulative dose of propofol and the number of features seen and organ systems involved. Lipidaemia, fever, and hepatomegaly occurred more frequently in children than in adults, whilst rhabdomyolysis and hyperkalaemia were more frequent in adults. Mortality from propofol infusion syndrome is independently associated with fever and hepatomegaly in children, and electrocardiogram changes, hypotension, hyperkalaemia, traumatic brain injury, and a mean propofol infusion rate >5 mg kg À1 h À1 in adults. The cumulative dose of propofol was associated with an increased number of clinical features and the number of organ systems involved in adult cases only. Clinicians should consider propofol infusion syndrome in cases of unexplained metabolic acidosis, ECG changes, and rhabdomyolysis. We recommend early consideration of continuous haemofiltration in the management of propofol infusion syndrome.

A fatal adverse event upon adenotonsillectomy in a child. Are Brugada syndrome and propofol real accomplices?

“…Finally, we did not include propofol infusion syndrome in the structured imputability analysis, since one dose of propofol was administered. 8,9 Concluding, we also support a 12-lead preoperative screening, in a subset of children. Nevertheless, the conclusion of "a small risk of fatal ventricular arrhythmias in the postoperative period in patients who receive propofol anaesthesia" is not confirmed by prospective clinical trials.…”

The preclinical pharmacological study on HX0969W, a novel water-soluble pro-drug of propofol, in rats

“…Propofol has been the most widely used intravenous anesthetic in clinical practices due to its rapid onset and recovery from sedation (Hemphill et al, 2019). However, the pharmacokinetic features of HX0969W, including a longer MRT and t 1/2 , and a larger AUC, have superseded the advantages of propofol.…”

“…General anesthesia is a combination of drugs, including sedative-hypnotic agents, analgesics, or muscle relaxants, which put the patients in a sleep-like state before surgery or other medical examinations. Propofol is the most widely used intravenous sedativehypnotic anesthetic in clinical practice (Hemphill et al, 2019). However, many serious side effects have been related to its lipid emulsion formations, such as emulsion instability, injection pain, hyperlipidemia, infection, fat metabolism disorder, and propofol-related infusion syndrome (Diaz et al, 2014;Lee et al, 2014;Mirrakhimov et al, 2015;Pestana, Garcia-de Lorenzo & Madero, 1996;Prankerd & Stella, 1990;Singh, Jindal & Singh, 2011;Wachowski et al, 1999;Wolf et al, 2001;Zhou et al, 2015).…”

Peer Review #2 of "The preclinical pharmacological study on HX0969W, a novel water-soluble pro-drug of propofol, in rats (v0.1)"

“…General anesthesia is a combination of drugs, including sedative-hypnotic agents, analgesics, or muscle relaxants, which put the patients in a sleep-like state before surgery or other medical examinations. Propofol is the most widely used intravenous sedative-hypnotic anesthetic in clinical practice (Hemphill et al 2019). However, many serious side effects have been related to its lipid emulsion formations, such as emulsion instability, injection pain, hyperlipidemia, infection, fat metabolism disorder, and propofol-related infusion syndrome (Diaz et al 2014;Lee et al 2014;Mirrakhimov et al 2015;Pestana et al 1996;Prankerd & Stella 1990;Singh et al 2011;Wachowski et al 1999;Wolf et al 2001;Zhou et al 2015).…”