Propofol. Complicaciones

Síndrome de infusión por propofol: Actualización de sus manifestaciones clínicas y su patofisiología. Propofol infusion syndrome: update of clinical manifestation and pathophysiology. Fudickar A, Bein B. Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany. fudickar@anaesthesie.uni-kiel.de Minerva Anestesiol. 2009 May;75(5):339-44. Abstract Propofol infusion syndrome (PRIS) is defined as acute bradycardia progressing to asystole combined with lipemic plasma, fatty liver enlargement, metabolic acidosis with negative base excess >10 mmol l(-1), rhabdomyolysis or myoglobinuria associated with propofol infusion. The purpose of this review was to provide a new update of reported case reports and to describe recent retrospective studies and animal research relevant for the pathophysiology and clinical presentation of PRIS. New case reports of PRIS have confirmed previously identified risk factors, and have also further revealed the incidence of PRIS in patients previously not estimated to be at risk for this syndrome. Retrospective studies contributed new evidence to the incidence of PRIS and development of PRIS even at propofol doses commonly used for surgical anesthesia. An animal study confirmed potential pathophysiological pathways and showed new organ manifestations possibly associated with propofol infusion. Further clinical and experimental evidence has confirmed the existence of PRIS as a rare but highly lethal complication of propofol use not limited to prolonged use of propofol. PRIS has to be kept in mind if propofol is used for anesthesia or sedation. Recommendations for the limitation of propofol use have to be adhered to. Early warning signs must prompt immediate cessation of propofol infusion and adequate treatment   Artí­culo en PDF Dolor con la inyección de la microemulsión de propofol Pain on injection with microemulsion propofol Ji-Yeon Sim, Soo-Han Lee, Do-Yang Park, Jin-Ah Jung, Kyoung-Ho Ki, Dong-Ho Lee and Gyu-Jeong Noh British Journal of Clinical Pharmacology 2009;67:316-325, Abstract WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT. Aqueous free propofol in lipid emulsion elicits pain. No data on the incidence and severity of injection pain for Aquafol™ (Daewon Pharmaceutical Co., Ltd, Seoul, Korea), a lipid-free microemulsion propofol, are available. Two hypotheses involving plasma bradykinin generation have been proposed to explain propofol-induced pain; one implicates aqueous free propofol, the other implicates the lipid solvent. WHAT THIS STUDY ADDS. Microemulsion propofol produces more frequent and severe pain on injection, an effect that may be attributable to the high concentration of aqueous free propofol. There was no evidence that plasma bradykinin generation caused propofol-induced pain. In addition, agents known to prevent propofol-induced pain did not decrease aqueous free propofol concentrations. AIMS. To evaluate the incidence and severity of injection pain caused by microemulsion propofol and lipid emulsion propofol in relation to plasma bradykinin generation and aqueous free propofol concentrations. METHODS. Injection pain was evaluated in 147 patients. Aqueous free propofol concentrations in each formulation, and in formulation mixtures containing agents that reduce propofol-induced pain, were measured by high-performance liquid chromatography. Plasma bradykinin concentrations in both formulations and in their components mixed with blood sampled from six volunteers were measured by radioimmunoassays. Injection pain caused by 8% polyethylene glycol 660 hydroxystearate (PEG660 HS) was evaluated in another 10 volunteers. RESULTS. The incidence of injection pain [visual analogue scale (VAS) >30 mm] caused by microemulsion and lipid emulsion propofol was 69.7 and 42.3% (P < 0.001), respectively. The median VAS scores for microemulsion and lipid emulsion propofol were 59 and 24 mm, respectively (95% confidence interval for the difference 12.5, 40.0). The aqueous free propofol concentration of microemulsion propofol was seven times higher than that of lipid emulsion propofol. Agents that reduce injection pain did not affect aqueous free propofol concentrations. Microemulsion propofol and 8% PEG660 HS enhanced plasma bradykinin generation, whereas lipid emulsion propofol and lipid solvent did not. PEG660 HS did not cause injection pain. CONCLUSIONS. Higher aqueous free propofol concentrations of microemulsion propofol produce more frequent and severe pain. The plasma kallikrein-kinin system may not be involved, and the agents that reduce injection pain may not act by decreasing aqueous free propofol concentrations. Lea el artí­culo completo en PDF Encuesta sobre el abuso de propofol en programas académicos de anestesia A Survey of Propofol Abuse in Academic Anesthesia Programs Paul E. Wischmeyer, Bradley R. Johnson, Joel E. Wilson, Colleen Dingmann, RN, Heidi M. Bachman, Evan Roller, Zung Vu Tran, Thomas K. Henthorn. Anesth Analg 2007;105:1066 -71. BACKGROUND: Although propofol has not traditionally been considered a drug of abuse, subanesthetic doses may have an abuse potential. We used this survey to assess prevalence and outcome of propofol abuse in academic anesthesiology programs. METHODS: E-mail surveys were sent to the 126 academic anesthesiology training programs in the United States. RESULTS: The survey response rate was 100%. One or more incidents of propofol abuse or diversion in the past 10 yr were reported by 18% of departments. The observed incidence of propofol abuse was 10 per 10,000 anesthesia providers per decade, a fivefold increase from previous surveys of propofol abuse (P 0.005). Of the 25 reported individuals abusing propofol, 7 died as a result of the propofol abuse (28%), 6 of whom were residents. There was no established system to control or monitor propofol as is done with opioids at 71% of programs. There was an association between lack of control of propofol (e.g., pharmacy accounting) at the time of abuse and incidence of abuse at the program (P 0.048).  CONCLUSIONS: Propofol abuse in academic anesthesiology likely has increased over the last 10 yr. Much of the mortality is in residents. Most programs have no pharmacy accounting or control of propofol stocks. This may be of concern, given that all programs reporting deaths from propofol abuse were centers in which there was no pharmacy accounting for the drug. Lea este artículo en este enlace: http://www.anesthesia-analgesia.org/content/105/4/1066.full.pdf

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