Propofol infusion syndrome

Abstract

The term PRIS—propofol infusion syndrome— was originally coined by Bray in 1998 to describe the adverse effects associated with the use of propofol in the paediatric population. PRIS was defined as acute refractory bradycardia leading to asystole in the presence of one or more of the following: metabolic acidosis (base excess of 210 mmol litre), rhabdomyolysis or myoglobinuria, lipaemic plasma, or enlarged liver or fatty liver. Although first described in the paediatric population, it has been increasingly reported in adult intensive care patients, particularly in neurointensive care. The safe dose of propofol infusion for sedation in intensive care is considered to be 1–4 mg kg h, but fatal cases of PRIS have been reported after infusion doses as low as 1.9–2.6 mg kg h as well, promoting the idea that genetic factors may have a role to play.