Lactate-to-pyruvate ratio as a marker of propofol infusion syndrome after subarachnoid hemorrhage.
BACKGROUND
Propofol infusion syndrome (PRIS) is a rare but frequently fatal condition. It is characterized by cardiovascular collapse and metabolic derangement due to propofol exposure. The pathophysiology of PRIS is poorly understood, and its study has previously been limited to animal models and clinical observations. We present the first in vivo brain biochemical data in a patient with PRIS.


METHODS
We report the case of a 37-year-old woman with PRIS following aneurysmal subarachnoid hemorrhage who was monitored by cerebral microdialysis (CMD). A CMD catheter was inserted into the brain and provided near real-time monitoring of brain energy-related metabolites, including lactate and pyruvate, during the time period surrounding the diagnosis of PRIS. We recorded propofol exposure, clinical manifestations, and relevant laboratory measurements.


RESULTS
CMD revealed a temporal association between propofol exposure and the cerebral lactate-to-pyruvate ratio (LPR). The LPR increased linearly after propofol was restarted following an off period, and the LPR decreased linearly after propofol was discontinued. Serum lactate correlated with clinical worsening after the onset of PRIS, whereas cerebral LPR correlated with propofol exposure.


CONCLUSIONS
Cerebral LPR may be a sensitive marker of PRIS. Increases in LPR following propofol exposure should alert clinicians to the possibility of PRIS and might prompt early discontinuation of propofol thereby avoiding fatal complications.
Department of Neurosurgery, Hospital of University of Pennsylvania, 3 Silverstein Building, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Jared M
JM
Pisapia
Linda C
LC
Wendell
Monisha A
MA
Kumar
Eric L
EL
Zager
Joshua M
JM
Levine
D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D007262:Infusions, Intravenous; D019344:Lactic Acid / Q000378:metabolism*; D015742:Propofol / Q000009:adverse effects*; D019289:Pyruvic Acid / Q000378:metabolism*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000378:metabolism* / Q000628:therapy*; D013577:Syndrome
D015415:Biomarkers; D006993:Hypnotics and Sedatives; D019344:Lactic Acid; D019289:Pyruvic Acid; D015742:Propofol