Survival of propofol infusion syndrome in a head-injured patient.
OBJECTIVE
To describe the clinical progression of an adult patient with traumatic brain injury who survived propofol infusion syndrome.


METHODS
Case report.


METHODS
Tertiary care surgical intensive care unit.


METHODS
A 21-yr-old male with traumatic brain injury was administered high doses of propofol for sedation and intracranial pressure control combined with vasopressor therapy to maintain cerebral perfusion pressure >60 mmHg. He developed a significant metabolic acidosis with a lactic acid level of 10.9 mmol/L.


METHODS
Exploratory laparotomy, discontinuation of propofol infusion.


RESULTS
An exploratory abdominal laparotomy was negative for traumatic injury. During the procedure, the propofol infusion was considered a possible cause and was discontinued. On review, it became apparent that a combination of high-dose propofol and catecholamines were responsible for the lactic acidosis. An echocardiogram revealed severe left ventricular dysfunction and cardiomyopathy, which resolved within 19 days.


CONCLUSIONS
High-dose propofol should be avoided and alternative agents should be instituted for sedation and intracranial pressure management. The use of catecholamine infusions to maintain cerebral perfusion pressure in the setting of a high-dose propofol infusion may be pharmacologically unsound and may be a triggering factor for propofol infusion syndrome. Identification of the syndrome and discontinuation of propofol resulted in complete reversal of symptoms in the case described.
Corbett
Stephanie Mallow
SM
Department of Surgery, Division of Trauma/Critical Care, University of Vermont College of Medicine Burlington, USA.
Moore
Jesse
J
Rebuck
Jill A
JA
Rogers
Frederick B
FB
Greene
Christopher M
CM
D000140:Acidosis, Lactic / Q000139:chemically induced*; D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D001930:Brain Injuries / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D019586:Intracranial Hypertension / Q000517:prevention & control*; D008297:Male; D009638:Norepinephrine / Q000008:administration & dosage / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D018686:Anesthetics, Intravenous; D014662:Vasoconstrictor Agents; D009638:Norepinephrine; D015742:Propofol