title: Propofol withdrawal syndrome in an adult patient with thermal injury.
abstract: A 48-year-old man with a history of ethanol abuse and bipolar disease fell asleep while smoking in an intoxicated state. The patient received a 30% total body surface area burn involving his face and upper torso that resulted in an inhalation injury. Several attempts at weaning from mechanical ventilation failed due to his extreme agitation, which was unresponsive to benzodiazepines, opiates, and antipsychotic agents. Propofol therapy was begun in combination with valproic acid, fluoxetine, and risperidone to assist in the treatment of his severe agitation associated with the bipolar disease, inhibiting ventilatory weaning. Repeated attempts to discontinue propofol were associated with withdrawal symptoms such as severe agitation, tremors, tachycardia, tachypnea, and hyperpyrexia. His symptoms resolved only after each time the propofol infusion was restarted. The patient received propofol for 95 days for management of his agitation before dying from refractory septic shock and multiple organ failure.
authors.affiliation: Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, 19104-4495, USA. m.cawley@usip.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Cawley
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Guse
authors.forename: Anjali
authors.initials: A
authors.lastname: Laroia
authors.forename: Linwood R
authors.initials: LR
authors.lastname: Haith
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Ackerman
mesh_terms: D001714:Bipolar Disorder / Q000503:physiopathology; D002056:Burns / Q000503:physiopathology; D000431:Ethanol / Q000009:adverse effects; D017809:Fatal Outcome; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000009:adverse effects*; D011595:Psychomotor Agitation / Q000188:drug therapy / Q000209:etiology*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy / Q000209:etiology*
chemical_list: D006993:Hypnotics and Sedatives; D000431:Ethanol; D015742:Propofol