Propofol is widely used in critically ill ED patients. Although rare, propofol infusion syndrome (PRIS) has been reported/described, and is something to keep in mind when administering this drug. What are the clinical features and risk factors for PRIS? What is the earliest sign of cardiac instability?
Intially discussed primarily in the pediatric community and literature, there are now several reports and discussions of PRIS in adults. Commonly noted clinical features include: acute refractory bradycardia leading to asystole, in the presence of metabolic acidosis, rhabdomyolysis, and hyperlipidemia.
RISK FACTORS: CNS or pulmonary illness, young age, and exogenous catecholamine/glucocorticoid administration. There is also an association with PRIS and infusions at doses > 4 mg/kg/hr for > 48 hr duration.
EARLY SIGN OF CARDIAC INSTABILITY: Development of RBBB and convex-curved ST elevation in the R precordial leads (V1-V3), not dissimilar to Brugada. So…do an EKG if you are concerned!
Source: (THERE ARE A FEW COPIES OF THIS ARTICLE IN THE SINAI RESIDENT ROOM):
Review Article: Kam P and Cardone D. Propofol infusion syndrome. Anesthesia (2007). 62: 690-701.