| Síndrome de infusión de propofol en un paciente súper obeso (IMC 75) |
Propofol infusion syndrome in a super morbidly obese patient (BMI = 75).
Ramaiah R, Lollo L, Brannan D, Bhananker SM.
Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, USA.
Int J Crit Illn Inj Sci. 2011 Jan;1(1):84-6
Abstract
Propofol infusion syndrome (PRIS) is a rare but often fatal complication as a result of large doses of propofol infusion (4-5 mg/kg/hr) for a prolonged period (>48 h). It has been reported in both children and adults. Besides large doses of propofol infusion, the risk factors include young age, acute neurological injury, low carbohydrate and high fat intake, exogenous administration of corticosteroid and catecholamine, critical illness, and inborn errors of mitochondrial fatty acid oxidation. PRIS manifestation include presence of metabolic acidosis with a base deficit of more than 10 mmol/l at least on one occasion, rhabdomyolysis or myoglobinuria, acute renal failure, sudden onset of bradycardia resistant to treatment, myocardial failure, and lipemic plasma. The pathophysiology of PRIS may be either direct mitochondrial respiratory chain inhibition or impaired mitochondrial fatty acid metabolism mediated by propofol. We report a case of supermorbidly obese patient who received propofol infusion by total body weight instead of actual body weight and developed PRIS.
http://www.ijciis.org/article.asp?issn=2229-5151;year=2011;volume=1;issue=1;spage=84;epage=86;aulast=Ramaiah
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| El síndrome de la infusión de propofol: la evidencia más sorprendente de una enfermedad compleja y mal caracterizada. |
The propofol infusion syndrome: more puzzling evidence on a complex and poorly characterized disorder.
Cremer OL.
Department of Intensive Care, University Medical Centre Utrecht, CX Utrecht, The Netherlands. o.l.cremer@umcutrecht.nl
Crit Care. 2009;13(6):1012. Epub 2009 Dec 7.
Abstract
The propofol infusion syndrome is a potentially devastating cardiovascular and metabolic derangement that has been described in both pediatric and adult patients sedated with propofol. Despite a large number of case reports that have appeared in the literature since 1992, the precise clinical features and pathophysiology of this disorder remain uncertain. Historically, the syndrome has been characterized by the occurrence of lactic acidosis, rhabdomyolysis, and circulatory collapse after several days of high-dose propofol infusion. The affected patients were typically young and critically ill, and the reported mortality was high. More recently, a number of atypical cases have been reported with favorable outcomes. These occurred after short-term or lower-dose infusions in noncritically ill patients in whom generally only a subset of the classical syndrome features was observed. It remains unclear whether these reports reflect true propofol infusion syndrome detected at an earlier and more salvageable stage, or mere associations with the use of sedative agents in general. Without better information on the true incidence of the propofol infusion syndrome, clinical guidelines on the safe use of this drug remain unsupported by good evidence.
http://ccforum.com/content/pdf/cc8177.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811905/pdf/cc8177.pdf |
| Incidencia del síndrome relacionado a infusión de propofol en adultos graves: estudio prospectivo, multicéntrico |
Incidence of propofol-related infusion syndrome in critically ill adults: a prospective, multicenter study.
Roberts RJ, Barletta JF, Fong JJ, Schumaker G, Kuper PJ, Papadopoulos S, Yogaratnam D, Kendall E, Xamplas R, Gerlach AT, Szumita PM, Anger KE, Arpino PA, Voils SA, Grgurich P, Ruthazer R, Devlin JW.
Department of Pharmacy, Tufts Medical Center, Boston, MA 02111, USA.rroberts@tuftsmedicalcenter.org
Crit Care. 2009;13(5):R169. Epub 2009 Oct 29.
Abstract
INTRODUCTION: While propofol is associated with an infusion syndrome (PRIS) that may cause death, the incidence of PRIS is unknown. Determining the incidence of PRIS and the frequency of PRIS-related clinical manifestations are key steps prior to the completion of any controlled studies investigating PRIS. This prospective, multicenter study sought to determine the incidence of PRIS and PRIS-related clinical manifestations in a large cohort of critically ill adults prescribed propofol. METHODS: Critically ill adults from 11 academic medical centers administered an infusion of propofol for [>or=] 24 hours were monitored at baseline and then on a daily basis until propofol was discontinued for the presence of 11 different PRIS-associated clinical manifestations and risk factors derived from 83 published case reports of PRIS. RESULTS: Among 1017 patients [medical (35%), neurosurgical (25%)], PRIS (defined as metabolic acidosis plus cardiac dysfunction and [>or=] 1 of: rhabdomyolysis, hypertriglyceridemia or renal failure occurring after the start of propofol therapy) developed in 11 (1.1%) patients an average of 3 (1-6) [median (range)] days after the start of propofol. While most (91%) of the patients who developed PRIS were receiving a vasopressor (80% initiated after the start of propofol therapy), few received a propofol dose >83 mcg/kg/min (18%) or died (18%). Compared to the 1006 patients who did not develop PRIS, the APACHE II score (25 +/- 6 vs 20 +/- 7, P = 0.01) was greater in patients with PRIS but both the duration of propofol use (P = 0.43) and ICU length of stay (P = 0.82) were similar. CONCLUSIONS: Despite using a conservative definition for PRIS, and only considering new-onset PRIS clinical manifestations, the incidence of PRIS slightly exceeds 1%. Future controlled studies focusing on evaluating whether propofol manifests the derangements of critical illness more frequently than other sedatives will need to be large. These studies should also investigate the mechanism(s) and risk factors for PRIS.
http://ccforum.com/content/pdf/cc8145.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784401/pdf/cc8145.pdf |
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