Propofol Infusion Syndrome

Nurs 410

Meaghan Johnson

Stevie Knutson

November 30, 2011

• The student will understand the importance of propofol infusion syndrome by the end of the presentation.
• By the end of the presentation the student will state 3 adverse effects of propofol infusion syndrome
• Students will be able to recognize early symptoms of propofol intoxication

• For induction and maintenance of general anesthesia
• For sedation of adult patients receiving mechanical ventilation

• A rare but potentially lethal complication, resulting from the long term administration of propofol at high doses.
• Characterized by presence of metabolic acidosis, renal failure, rhabdomyolysis, hyperlipidemia, and cardiac dysfunction

Predisposing factors include:

• Young age
• Severe critical illness of CNS/respiratory etiology
• Exogenous catecholamine or glucocorticosteroid administration
• Inadequate carbohydrate intake
• Subclinical mitochondrial disease

• Level III Retrospective, database analysis

• Out of 1139 patients with suspected Propofol Infusion Syndrome, 342 (30%) were fatal.

• The order of frequency of the PRIS associated clinical manifestations were cardiac, followed by hypotension, rhabdomyolysis, hepatic, renal, metabolic acidosis, hypoxia, hyperthermia, and dyslipidemia.

Implications:

• Continuous ECG monitoring
• Awareness of priming factors
• Laboratory monitoring such as ABGs, serum lactate, electrolytes, etc
• Markers of propofol infusion syndrome

Management:

• Early adequate carbohydrate intake
• Hemodialysis and extracorporeal membrane oxygenation
• Combining analgesics with propofol dose
• Sedation Vacation

A 52 year old male patient has been sedated with propofol and ventilated for the previous 30 hours. What are the possible side effects associated with long term propofol administration and what observations would you need to make?

• Young age
• Severe critical illness of CNS/respiratory etiology
• Exogenous catecholamine or glucocorticosteroid administration
• Inadequate carbohydrate intake
• Subclinical mitochondrial disease

What are the side effects that go along with PRIS that, as nurses, we should be aware of?

Answer 3:

• Arrhythmias
• Lactic acidosis
• Hypertriglyceridemia
• Bradycardia
• Respiratory depression

• Unexplained metabolic acidosis
• Hypotension
• Rhabdomyolysis
• Acute renal failure
• Hepatomegaly

Review Question 3:

Research:

Answer 2:

(Fong, Sylvia, Ruthazer, Schumaker, Kcomt, & Devlin, 2008)

Clinical Manifestations of PRIS

Diagnostics of PRIS

• Arrhythmias
• Rhabdomyolysis
• Acute Renal Failure
• Hepatomegaly

• Unexplained metabolic acidosis
• Hypertriglyceridemia
• Hypotension
• Lactic acidosis

Lab Values:

• Serum Creatinine kinase
• Troponin I level
• Myoglobin
• Triglyceride levels
• Serum lactate levels

(Zaccheo & Bucher, 2008)

Research:

References:

• Level III Retrospective cohort analysis
• Review of all cases admitted to the Neuro-ICU over 4-year period
• Three cases of Propofol infusion syndrome noted out of 50 cases
• Two of the cases survived, while one expired after withdrawal from life support.
• Overall, this retrospective article was to be aware of and recognize early signs and symptoms of PRIS.

(Smith, Sinson, & Varelas, 2009)

• Fong, J., Sylvia, L., Ruthazer, R., Schumaker, G., Kcomt, M., & Devlin, J. (2008). Predictors of mortality in patients with suspected propofol infusion syndrome. Critical Care Medicine, 36(8), 2281-2287. DOI:10.1097/CCM.0b013e318180c1eb
• Fullwood, D., & Sargent, S. (2010). An overview of sedation for adult patients in hospital. Nursing Standard, 24(39), 48-56.
• O'Malley, P. (2010). Lethal outcomes: propofol infusion syndrome and propofol abuse. Clinical Nurse Specialist: The Journal For Advanced Nursing Practice, 24(1), 8-10. doi:10.1097/NUR.0b013e3181c5e4cf
• Orsini, J., Nadkarni, A., Chen, J., & Cohen, N. (2009). Propofol infusion syndrome: case report and literature review. American Journal Of Health-System Pharmacy, 66(10), 908-915. doi:10.2146/ajhp070605
• Rajda, C., Dereczyk, D., & Kunkel, P. (2008). Propofol infusion syndrome. Journal Of Trauma Nursing, 15(3), 118-122.
• Smith, H., Sinson, G., & Varelas, P. (2009). Vasopressors and propofol infusion syndrome in severe head trauma. Neurocritical Care, 10(2), 166-172. doi:10.1007/s12028-008-9163-y
• Zaccheo, M., & Bucher, D. (2008). Propofol infusion syndrome: a rare complication with potentially fatal results. Critical Care Nurse, 28(3), 18-27.

Propofol Infusion Syndrome Objectives

Review Question 2

What is Propofol?

Risk Factors for PRIS

What are risk factors for Propofol infusion syndrome?

• "A potent short acting intravenous sedative-hypnotic agent used to induce and maintain anesthesia and to provide continuous sedation in the ICU"

• Rapid onset of action, rapid rate of distribution, dose related hypnotic effect, short elimination half-life

(Orsini, Madkarni, Chen, & Cohen, 2009)

(Zaccheo & Bucher, 2008)

Propofol Infusion Syndrome

Nursing Implications/Management

(Rajda, Dereczyk, & Kunkel, 2008)

What is Propofol used for?

(Zaccheo & Bucher, 2008)

Answer 1:

(Zaccheo & Bucher, 2008)

(Rajda, Dereczyk & Kunkel, 2008)

Propofol Infusion Syndrome

A few common uses include:

• Sedation and maintenance of general anesthesia

• Sedation for patients on mechanical ventilators

Adverse Effects of Propofol

(Orsini, Madkarni, Chen, & Cohen, 2009)

• Respiratory depression
• Pulmonary Edema
• Nausea and Vomiting

• Hypotension
• Bradycardia
• Arrhythmias
• Discoloration of urine
• Postoperative fever

(Fullwood & Sargent, 2010)

(Zaccheo & Bucher, 2008)

Patient/Family Education

Review Question 1:

Teaching should include:

• Medications
• Laboratory tests
• Procedures

(Rajda, Dereczyk, & Kunkel, 2008)

What are a few common uses of Propofol?

Case Study

(Fullwood & Sargent, 2010)