PMID- 36407194
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221122
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 14
IP  - 10
DP  - 2022 Oct
TI  - Propofol-Related Infusion Syndrome: A Clinical Review.
PG  - e30383
LID - 10.7759/cureus.30383 [doi]
LID - e30383
AB  - Propofol-related infusion syndrome (PRIS) is a lethal condition characterized by 
      multiple organ system failures. It can occur due to prolonged administration of 
      propofol (an anesthetic) in mechanically intubated patients. The main presenting 
      features of this condition include cardiovascular dysfunction with particular 
      emphasis on impairment of cardiovascular contractility, metabolic acidosis, 
      lactic acidosis, rhabdomyolysis, hyperkalaemia, lipidaemia, hepatomegaly, acute 
      renal failure, and eventually mortality in most cases. The significant risk 
      factors that predispose one to PRIS are: critical illnesses, increased serum 
      catecholamines, steroid therapy, obesity, young age (significantly below three 
      years), depleted carbohydrate stores in the body, increased serum lipids, and 
      most importantly, heavy or extended dosage of propofol. The primary 
      pathophysiology behind PRIS is the disruption of the mitochondrial respiratory 
      chain that causes inhibition of adenosine triphosphate (ATP) synthesis and 
      cellular hypoxia. Further, excess lipolysis of adipose tissue occurs, especially 
      in critically ill patients where the energy source is lipid breakdown instead of 
      carbohydrates. This process generates excess free fatty acids (FFAs) that cannot 
      undergo adequate beta-oxidation. These FFAs contribute to the clinical pathology 
      of PRIS. It requires prompt management as it is a fatal condition. The clinicians 
      must observe the patient's electrocardiogram (ECG), serum creatine kinase, 
      lipase, amylase, lactate, liver enzymes, and myoglobin levels in urine, under 
      propofol sedation. Doctors should immediately stop propofol infusion upon 
      noticing any abnormality in these parameters. The other essentials of management 
      of various manifestations of PRIS will be discussed in this article, along with a 
      detailed explanation of the condition, its risk factors, diagnosis, 
      pathophysiology, and presenting features. This article aims to make clinicians 
      more aware of the occurrence of this syndrome so that better ways to manage and 
      treat this condition can be formulated in the future.
CI  - Copyright (c) 2022, Singh et al.
FAU - Singh, Aayushi
AU  - Singh A
AD  - Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of 
      Medical Sciences, Wardha, IND.
FAU - Anjankar, Ashish P
AU  - Anjankar AP
AD  - Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical 
      Sciences, Wardha, IND.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20221017
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9671386
OTO - NOTNLM
OT  - beta-oxidation
OT  - catecholamines
OT  - cellular hypoxia
OT  - creatine kinase
OT  - critical illness
OT  - ecg
OT  - mitochondrial respiratory chain
OT  - myoglobin
OT  - propofol infusion syndrome
OT  - steroids
COIS- The authors have declared that no competing interests exist.
EDAT- 2022/11/22 06:00
MHDA- 2022/11/22 06:01
PMCR- 2022/10/17
CRDT- 2022/11/21 04:29
PHST- 2022/09/16 00:00 [received]
PHST- 2022/10/17 00:00 [accepted]
PHST- 2022/11/21 04:29 [entrez]
PHST- 2022/11/22 06:00 [pubmed]
PHST- 2022/11/22 06:01 [medline]
PHST- 2022/10/17 00:00 [pmc-release]
AID - 10.7759/cureus.30383 [doi]
PST - epublish
SO  - Cureus. 2022 Oct 17;14(10):e30383. doi: 10.7759/cureus.30383. eCollection 2022 
      Oct.