Propofol infusion syndrome in critically ill patients.
OBJECTIVE
To describe the clinical presentation of propofol infusion syndrome in critically ill adults.


METHODS
Clinical literature was accessed through MEDLINE (1966 - March 2001). Key search terms included Diprivan, propofol, and propofol infusion syndrome. Case reports and small case series evaluating the use and toxicity of propofol in sedating critically ill adults were reviewed.


RESULTS
The association between propofol infusion syndrome and death in children secondary to myocardial failure is well documented. However, few data are available regarding the syndrome in critically ill adults. Based on a review of those data, it appears that propofol infusion syndrome can occur in both children and adults. Common clinical features of propofol infusion syndrome may include hyperkalemia, hepatomegaly, lipemia, metabolic acidosis, myocardial failure, and rhabdomyolysis. Although the premise has not been proven, recent published cases appear to demonstrate an association between propofol infusion and death secondary to myocardial failure.


CONCLUSIONS
Until further safety data become available, caution should be exercised when using high-dose (>5 mg/kg/h) and long-term (>48 h) propofol infusion in sedating critically ill adults.
Department of Pharmacy, Christiana Care Health Services, 4755 Ogletown-Stanton Rd., Newark, DE 19718-0001, USA. tkang@christianacare.org
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Kang
D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D002303:Cardiac Output, Low / Q000139:chemically induced* / Q000401:mortality; D002648:Child; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality; D006801:Humans; D007262:Infusions, Intravenous; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*
D018686:Anesthetics, Intravenous; D015742:Propofol