Propofol-related Infusion Syndrome Research Articles

Characterization of Propofol Use For Non-Procedural Sedation in a Pediatric Intensive Care Unit

OBJECTIVE Given the limited literature describing propofol use in pediatric patients, this study aimed to describe the dosing and duration of propofol infusions for non-procedural sedation in the pediatric intensive care unit (PICU). The secondary objectives were to describe the change in concomitant sedative requirements from the 24-hour period before propofol initiation to the 24-hour period after discontinuation of propofol and to review the frequency of adverse events. METHODS This retrospective descriptive cohort study evaluated children 1 month to less than 18 years old who received a continuous infusion of propofol for non-procedural sedation in the PICU between May 2018 and August 2020. RESULTS One hundred thirty propofol infusions representing 127 unique patients (median age, 2.9 years) were included. The median (IQR) propofol infusion duration was 18 (10–28) hours, and the median (IQR) average dose was 4.1 (2.9–5.6) mg/kg/hr. Extubation was attempted in 96 patients (74%) within 24 hours of propofol infusion discontinuation. For patients that remained intubated with continuous sedation, concomitant continuous opioid and midazolam requirements decreased by 20% (p = 0.865) and 43% (p = 0.011), respectively. Patients receiving propofol for over 24 hours experienced the largest percent decrease in concomitant sedation with midazolam. There were no confirmed cases of propofol-related infusion syndrome (PRIS). CONCLUSIONS Durations and doses of propofol infusions for non-procedural sedation vary widely at our institution. Propofol may be beneficial as an adjunct sedative, but prospective studies are needed to further explore the effect of propofol on decreasing the requirements of concomitant opioids and benzodiazepines.

Propofol-related Infusion Syndrome

Propofol-related Infusion Syndrome

70 Propofol Related Infusion Syndrome With Multifactorial Associated Metabolic Acidosis and Rhabdomyolysis

70 Propofol Related Infusion Syndrome With Multifactorial Associated Metabolic Acidosis and Rhabdomyolysis

Propofol Related Infusion Syndrome: A Subtle Adversary

Propofol Related Infusion Syndrome (PRIS) was first described in 1998. It has a strange collection of symptoms, including marked bradycardia, persistent, recalcitrant metabolic acidosis, liver enlargement, rhabdomyolysis, and lipemic blood. We present two recent patients who appeared to have had PRIS. Creatinine kinase seems to be an early detector of PRIS. If PRIS is recognized early, this complex metabolic process seems to be completely reversible.

Management of propofol-related infusion syndrome and discussion of <i>POLG</i> mitochondrial mutation: a case report

Background: Propofol-related infusion syndrome (PRIS) is a known complication of long-term propofol infusion. Providers should be aware of PRIS risk, as early recognition is key to avoiding mortality, which can range from 30% to 60%. The underlying mechanism of PRIS is unknown, but some studies suggest that underlying mitochondrial dysfunction may predispose patients to developing PRIS. Case Report: We present a case of refractory adult-onset epilepsy that was challenging due to a paradoxical response to propofol with worsening brief ictal/interictal rhythmic discharges and complicated by development of PRIS. We aimed to discuss the clinical presentations of PRIS, along with a review of the mitochondrial POLG mutation found in our patient, which has also been described in other case reports of refractory adult-onset epilepsy. Conclusions: We discuss the treatment strategy utilized in hopes of raising awareness of the risks in managing patients with epilepsy who have a potential underlying mitochondrial disorder.

Propofol-Related Infusion Syndrome: A Clinical Review

Propofol-related infusion syndrome (PRIS) is a lethal condition characterized by multiple organ system failures. It can occur due to prolonged administration of propofol (an anesthetic) in mechanically intubated patients. The main presenting features of this condition include cardiovascular dysfunction with particular emphasis on impairment of cardiovascular contractility, metabolic acidosis, lactic acidosis, rhabdomyolysis, hyperkalaemia, lipidaemia, hepatomegaly, acute renal failure, and eventually mortality in most cases. The significant risk factors that predispose one to PRIS are: critical illnesses, increased serum catecholamines, steroid therapy, obesity, young age (significantly below three years), depleted carbohydrate stores in the body, increased serum lipids, and most importantly, heavy or extended dosage of propofol. The primary pathophysiology behind PRIS is the disruption of the mitochondrial respiratory chain that causes inhibition of adenosine triphosphate (ATP)synthesis and cellular hypoxia. Further, excess lipolysis of adipose tissue occurs, especially in critically ill patients where the energy source is lipid breakdown instead of carbohydrates. This process generates excess free fatty acids (FFAs) that cannot undergo adequate beta-oxidation. These FFAs contribute to the clinical pathology of PRIS. It requires prompt management as it is a fatal condition. The clinicians must observe the patient's electrocardiogram (ECG), serum creatine kinase, lipase, amylase, lactate, liver enzymes, and myoglobin levels in urine, under propofol sedation. Doctors should immediately stop propofol infusion upon noticing any abnormality in these parameters. The other essentials of management of various manifestations of PRIS will be discussed in this article, along with a detailed explanation of the condition, its risk factors, diagnosis, pathophysiology, and presenting features. This article aims to make clinicians more aware of the occurrence of this syndrome so that better ways to manage and treat this condition can be formulated in the future.

A CASE REPORT OF PROPOFOL-RELATED INFUSION SYNDROME AFTER LESS THAN 24 HOURS USE

TYPE: Case Report TOPIC: Pharmacotherapeutics INTRODUCTION: Propofol Related Infusion Syndrome (PRIS) typically occurs at infusion rates ≥4 mg/kg/hr and administration ≥48 hours, although there has been reports of occurrence at 2.6 mg/kg/hr for 24 hours. We report a rare case of fatal PRIS at 1.5 mg/kg/hr for 13 hours. This is lowest reported dose and duration of propofol with this syndrome. CASE PRESENTATION: A 62-year-old man with diabetes, hypertension, and hyperlipidemia was admitted for acute hypoxic respiratory failure and septic shock secondary to multifocal pneumonia. Initial labs showed lactic acid 2.2 mmol/L, triglycerides 259 mg/dL, and creatinine 1.1 mg/dL. Patient was started on antibiotics, norepinephrine 15 mcq/min, and propofol 1.5 mg/kg/hr. Three-hours later, the blood pressure dropped. Norepinephrine was increased to 50 mcq/min and vasopressin 0.4 units/min was started. Lactic acid (8.2mmol/L), creatine phosphokinase (1,288 IU/L0), creatinine (5.2 mg/dL), and triglycerides (1,002 mg/dL) were elevated. Propofol was stopped. Patient was started on sodium bicarbonate in D5W. Twelve-hours later, patient became bradycardic and had cardiac arrest. DISCUSSION: PRIS occurs secondary to mitochondrial dysfunction, leading to lactic acidosis, rhabdomyolysis, acute renal failure, and hypertriglyceridemia. This can lead to refractory bradycardia and cardiac arrest. Warning signs are hypotension, metabolic acidosis, and hypertriglyceridemia. Treatment is discontinuation of propofol. Dextrose is given to drive metabolism away from beta-oxidation due to propofol’s inhibitory effects on mitochondrial enzymes. Despite early detection, PRIS mortality rate is 48%. CONCLUSIONS: PRIS can occur at any duration or dose. Further studies are needed to confirm this conclusion. DISCLOSURE: Nothing to declare. KEYWORD: Propofol

Adherence to a Pediatric Continuous Infusion Propofol Policy for Sedation in Mechanically Ventilated Patients: Opportunities for Change and Improvement.

To evaluate adherence to an institutional continuous infusion propofol policy for sedation in mechanically ventilated patients, investigate the rate of propofol-related infusion syndrome (PRIS), and explore areas of improvement to enhance policy compliance and safety. This was a single center, retrospective chart review of patients admitted to a pediatric or cardiac intensive care unit within a large free-standing quaternary care pediatric hospital who received continuous propofol for non-procedural continuous sedation for at least 6 hours between 2014 and 2019. Propofol exposure (dose and duration), laboratory data, and hemodynamic outcomes of patients were evaluated. A total of 104 patients (108 admissions and 133 treatment courses) met inclusion criteria. Policy adherence to propofol dosing and duration limitations were 70% (93/133 courses) and 68% (91/133 courses), respectively. Adherence to all elements of laboratory and hemodynamic monitoring was 23%. Hypotension and bradycardia were common among patients during propofol treatment courses. Except for hypertriglyceridemia, no significant difference in specific laboratory values were detected between patients exposed to greater than 66 mcg/kg/min (4 mg/kg/hr), compared with those exposed to less than 66 mcg/kg/min of propofol. Patients receiving therapy for longer than 48 hours had the highest rates of laboratory values associated with PRIS. No patient in the study cohort met full criteria for PRIS. Adherence to elements of an institutional propofol policy was variable. Improvements in policy adherence may be enhanced by updating policy features, leveraging the electronic medical record order-set, and gaining consensus among key stakeholders.

Successful treatment of propofol-related infusion syndrome in critically ill patient receiving low-dose propofol infusion.

Propofol is widely used to sedate agitated patients in intensive care units. However, it can cause a rare but fatal complication, propofol-related infusion syndrome (PRIS). The pathophysiology of PRIS is not clear, and there is no definitive diagnosis and treatment. We report a successfully treated case of PRIS in a critically ill patient receiving low-dose propofol infusion. A 59-year-old male patient complaining of sudden chest pain repeatedly collapsed in an ambulance and the emergency room, and veno-arterial extracorporeal membrane oxygenation was delivered. He was diagnosed with a total occluded left anterior descending coronary artery in coronary angiography. On day 20, he showed arrhythmia, increased creatinine kinase (CK), and increased CK-MB and troponin I, accompanied by unstable hemodynamic status despite high-dose vasopressors. He was administered propofol for 20 days at an average dose of 1.3 mg/kg/hr owing to issues with agitation and ventilator synchrony. We strongly suspected PRIS and immediately discontinued propofol infusion, and he was successfully treated with aggressive supportive care. PRIS can occur in patients administered propofol for a prolonged period at low doses. Thus, clinicians should use propofol with caution for PRIS and change to alternative sedatives for long-term sedation.

A CASE OF PROPOFOL-RELATED INFUSION SYNDROME IN SARS-COV-2

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Propofol-related infusion syndrome (PRIS) is a rare and serious effect of propofol infusion for sedation in critically ill patients. Though there has been an association seen with higher doses of propofol and prolonged infusion times, usually greater than 24 to 48 hours. CASE PRESENTATION: We present a case of an 86-year-old man with history of bradycardia and an implanted permanent pacemaker who was admitted for acute hypoxic respiratory failure caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Throughout hospital stay, this patient had progressively increasing oxygen requirements with appropriate escalation in level of care to the ICU. Due to increasing hypoxia despite non-invasive ventilation, the patient was intubated on day 4 of hospitalization, placed on vasopressors and started on sedation, which included continuous propofol infusion. On day 6 of hospitalization, the patient developed worsening hypotension requiring increased levels of sedation and significant lab abnormalities compared to labs collected the day prior. The patient was noted to have elevated potassium to 5.8 mmol/L, creatinine elevation to 2.41 mg/dL from 1.36 mg/dL, and elevated AST of 184 U/L and ALT of 95 U/L from normal levels. Lactate was 4.5, and creatinine kinase was 1317. Six hours later, repeat liver function tests revealed AST of 2078 U/L and ALT of 966 U/L. In the setting of sudden onset rhabdomyolysis, acute kidney injury, and lactic acidosis, there was concern for PRIS and propofol was discontinued. After extended discussion with the family, aggressive measures including dialysis were declined, and patient died. Of interest, the patient's pacemaker likely prevented the patient from developing bradycardia, classically seen in PRIS. DISCUSSION: Challenges with sedation of intubated patients with SARS-CoV-2 have been clinically observed and deeper sedation levels have been required to promote ventilator synchrony. Propofol continues to be a first-line sedative in critically ill patients, including SARS-CoV-2 patients. These patients require sedation higher infusion rates compared and are therefore at higher risk. Our patient was maintained on 20mcg/kg/min for 27 hours, then subsequently on 45 mcg/kg/min for 34 hours thereafter. Therefore, our patient was at increased risk of PRIS given propofol infusion at high doses was maintained for longer than 24 hours. Moreover, the concurrent use of vasopressors placed him at increased risk. CONCLUSIONS: Although propofol is recommended as a first-line anesthetic agent in critically ill patients with SARS-CoV-2 requiring sedation, the multiorgan failure resulting from PRIS is potentially fatal. Early recognition is crucial for management, which includes discontinuing propofol infusion and hemodialysis if indicated. REFERENCE #1: Hanidziar D, Bittner EA. Sedation of Mechanically Ventilated COVID-19 Patients: Challenges and Special Considerations. Anesth Analg. 2020;131(1):e40-e41. doi:10.1213/ANE.0000000000004887 REFERENCE #2: Payen JF, Chanques G, Futier E, Velly L, Jaber S, Constantin JM. Sedation for critically ill patients with COVID-19: Which specificities? One size does not fit all. Anaesth Crit Care Pain Med. 2020;39(3):341-343. doi:10.1016/j.accpm.2020.04.010 REFERENCE #3: Yamamoto K. Risk of propofol use for sedation in COVID-19 patient. Anaesthesiology Intensive Therapy. 2020;52(4):354-355. doi:10.5114/ait.2020.100477. DISCLOSURES: No relevant relationships by Sravani Gajjala, source=Web Response No relevant relationships by Oki Ishikawa, source=Web Response No relevant relationships by Stacey Jou, source=Web Response No relevant relationships by Zein Kattih, source=Web Response No relevant relationships by Vinayak Shenoy, source=Web Response

Hemodynamic collapse and severe metabolic acidosis following propofol in the setting of undiagnosed mitochondrial dysfunction: a case report

Anesthetic management of patients with mitochondrial disorders is challenging due to their rare nature, and difficulties to develop evidence–based protocols for general anesthesia. We report a case of a 52–year–old male with hypertension, congenital deafness, optic neuritis, hypogonadism and myotonia, who developed severe refractory hypotension and bradycardia, and intractable severe lactic acidosis during induction of general anesthesia with fentanyl, propofol, and succinylcholine. The surgery had to be postponed and supportive management started. After extensive work–up, the patient was diagnosed with probable mitochondrial dysfunction. Patient returned for surgery under a different anesthetic regimen consisting of ketamine, fentanyl, ephedrine and dexmedetomidine; yielding a successful perioperative course and highlighting potential alternative strategies to manage anesthesia in patients with such disorders. Key words: Mitochondrial Diseases; Propofol Infusion Syndrome; Lactic Acidosis Abbreviations: MD – Mitochondrial disorders; PRIS – Propofol related infusion syndrome; HIPAA – Health Insurance Portability Accountability Act; MAP Mean arterial pressure; NMBAs – Neuromuscular blocking agents. Citation: Kim DW, Hu A, Vaughn D, Rajan GRE. Hemodynamic collapse and severe metabolic acidosis following propofol in the setting of undiagnosed mitochondrial dysfunction: a case report. Anaesth. pain intensive care 2021;25(4):527–531. DOI: 10.35975/apic.v25i4.1587 Received: September 24, 2020. Reviewed: April 1, 2021, Accepted: May 31, 2021

The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019.

Background:Propofol is commonly used to achieve ventilator synchrony in critically ill patients with coronavirus disease 2019 (COVID-19), yet its safety in this patient population is unknown.Objective:To evaluate the safety, in particular the incidence of hypertriglyceridemia, of continuous infusion propofol in patients with COVID-19.Methods:This was a retrospective study at 1 academic medical center and 1 affiliated teaching hospital in New York City. Adult, critically ill patients with COVID-19 who received continuous infusion propofol were included. Patients who received propofol for <12 hours, were transferred from an outside hospital while on mechanical ventilation, or did not have a triglyceride concentration obtained during the infusion were excluded.Results:A total of 252 patients were included. Hypertriglyceridemia (serum triglyceride concentration ≥ 400 mg/dL) occurred in 38.9% of patients after a median cumulative dose of 4307 mg (interquartile range [IQR], 2448-9431 mg). The median time to triglyceride elevation was 3.8 days (IQR, 1.9-9.1 days). In the multivariable regression analysis, obese patients had a significantly greater odds of hypertriglyceridemia (odds ratio = 1.87; 95% CI = 1.10, 3.21). There was no occurrence of acute pancreatitis. The incidence of possible propofol-related infusion syndrome was 3.2%.Conclusion and Relevance:Hypertriglyceridemia occurred frequently in patients with COVID-19 who received propofol but did not lead to acute pancreatitis. Elevated triglyceride concentrations occurred more often and at lower cumulative doses than previously reported in patients without COVID-19. Application of these data may aid in optimal monitoring for serious adverse effects of propofol in patients with COVID-19.

Propofol-related infusion syndrome in a patient with COVID-19 infection

Propofol-infusion syndrome (PRIS) is a life-threating complication of propofol, characterized by cardiac dysrhythmia, congestive heart failure, hyperpotassemia, hyperlipemia, metabolic acidosis, rhabdomyolysis, and myoglobinuria-related renal failure. Risk factors include hypoxia, sepsis, serious cerebral injury, and the administration of high doses of propofol (usually doses &gt;80 μg/kg/min or &gt;5 mg/kg/h for &gt;48 h), but it has been also reported after low-dose, short-term infusions during surgical procedures. Propofol infusion syndrome can occur during anesthesia, even in the absence of higher propofol doses. Despite limited data on PRIS, it has been well described that PRIS is characterized by high anion gap metabolic acidosis. In this article, we present a 42-year-old female patient with novel coronavirus 2019 (COVID-19) pneumonia who underwent mechanical ventilation with propofol infusion and subsequently developed PRIS.

A Rare Case of Combined Rocuronium Induced Malignant Hyperthermia and Propofol-Induced Lactic Acidosis

We report an unusual case of A 64-year-old female received rocuronium and propofol and subsequently developed malignant hyperthermia and particularly propofol-related infusion syndrome.

Propofol Infusion Syndrome: A Life Threatening Condition Blunted by Continuous Renal Replacement Therapy

Propofol is a common intensive care unit anesthetic which was approved by FDA in 1989. It possesses sedative, anxiolytic, and anticonvulsant properties. Case reports of Propofol related infusion syndrome (PRIS) started in early 1990s. Reported signs and symptoms included acute refractory bradycardia, severe metabolic acidosis, cardiovascular collapse, lactic acidosis, rhabdomyolysis, hyperlipidemia, renal failure, and hepatomegaly. It is associated with both high dose cumulative and short-term infusions. This case report highlights the development of PRIS in a patient admitted to the ICU, symptoms of which were assumed to be blunted because of continuous renal replacement therapy support.

A case of propofol related infusion syndrome within the limited dose

A case of propofol related infusion syndrome within the limited dose

A rare case of propofol related infusion syndrome in a neurosurgical patient

Background: For the last three decades propofol has been used in anaesthesia and as a sedation technique. Several reports have warned about its use in higher doses for prolonged durations as it can have severe side effects such as propofol related infusion syndrome (PRIS), which can be fatal.1,2,3 PRIS is a rare and complex clinical condition characterized by severe metabolic acidosis, rhabdomyolysis, cardiac, liver and kidney dysfunction, and lipidemia. In its advanced stage PRIS can lead to severe refractory bradycardia and asystole.4,5 Propofol and remifentanil total intravenous anaesthesia (TIVA) is a popular anaesthesia technique. The target controlled infusion (TCI) gives predicted and controlled drug concentration and has added to the increased use of TIVA. Not much literature is available about the use of propofol and remifentanil TIVA and occurrence of PRIS. We report a case of PRIS in a neurosurgical patient with history of dyslipidemia. Case presentation: A 46-year old man weighing 68 kg, with a known case of hyperlipidemia, presented with decreased hearing on the left side, headache, and perioral numbness. Computerized tomography (CT) of the head showed left cerebropontine angle cystic lesion. His home medications were oral sodium chloride 1200 mg three times daily and pravastatin 20 mg once daily. He was electively scheduled for surgery under general anaesthesia, which lasted for seven hours. He received a TCI with propofol and remifentanil. He remained hemodynamically stable throughout the procedure.Over 7 hours the patient received a total of 3332 mg of 1% propofol, remifentanil TCI 3–4 mcg/ml, ephedrine 18 mg, mannitol 20%–250 ml, pancuronium 16 mg, vecuronium 25 mg, cefazoline 2 g, dexamethasone 16 mg, neostigmine 5 mg, glycopyrolate 1 mg, and labetalol 25 mg. He received 2 liters of crystalloid and one liter of colloid during the surgery. Intra-operative blood sugar remained around 6–7 mmol/L and his central venous pressure was maintained between 8–11 mmHg.His first arterial blood gas showed increasing lactate and metabolic acidosis after two hours of anaesthesia and it continued to rise till the end of surgery. He was extubated and shifted to the surgical intensive care unit (SICU) with a Glasgow Coma Score of 15, spontaneously breathing and with stable hemodynamics. The serum lactate continued to rise in SICU for the first 12 hours and then slowly started to decline (Figure 1). A graph of the trends of carbon dioxide and serum bicarbonate levels is shown in Figure 2. The triglycerides level reached 11.46 (Figure 3), creatine kinase 1852 U/L and myoglobin 474 ng/ml which showed decline within the next 24 hours.He remained hemodynamically stable with adequate urine output. On day one we resumed atorvastatin 20 mg, labetalol prn, bicarbonate infusion. After 24 hours, his lactate levels were normalized and acidosis resolved. The patient was discharged without any complications.Conclusion: Propofol TIVA with TCI is a common anesthesia practice. In a known dyslipidemic patient it will increase the risk for PRIS. In our patient, other risk factors for development of PRIS were higher dose, neurosurgical procedure, and extended duration of propofol infusion. The authors believe it is the first case of PRIS in a dyslipidemic patient undergoing neurosurgery with TIVA.

Survey of Pharmacists Regarding the Use of Propofol Infusions in the PICUs in North America

The objective of this survey was to assess the current use of continuous infusion propofol in PICUs across the United States and Canada. A list of institutions with PICU beds/units was identified through the residency directories available on the American Society of Health-Systems Pharmacists (ASHP) and Canadian Society of Hospital Pharmacists (CHSP) Web sites. A REDCap questionnaire was sent to each identified institution's program director via email. An initial reminder email was sent out 2 weeks later and a second reminder email was sent 4 weeks after the initial request. The survey was closed at 6 weeks. A total of 514 emails were sent to residency program directors, and 50 pharmacists responded to the survey. Of the pharmacists that did respond, 27 (54%) reported using propofol while 23 (46%) did not. Of those that did not, 43.5% reported the FDA boxed warning as the primary reason. Thirty-seven percent of respondents using propofol felt comfortable using a maximum infusion rate of 200 mcg/kg/min. Twenty-nine percent, 25%, and 33% of those who responded as using propofol felt comfortable using this agent for a maximum duration of 24, 48, and 72 hours, respectively. The majority of respondents using propofol did not have a case of propofol-related infusion syndrome. Despite the FDA warning, propofol is used as a continuous infusion (with variable limitations) by a majority of pharmacists in North America. Self-reported incidence of propofol-related infusion syndrome (PRIS) remains low.

The Basic Study of the Mechanism of Propofol-Related Infusion Syndrome Using a Murine Skeletal Muscle Injury Model.

BackgroundThe pathophysiological mechanism of propofol-related infusion syndrome (PRIS) is believed to be due to the injury to the mitochondrial electron transport chain and the resultant metabolic disorders that are caused by both propofol agents and the lipid solvent. However, the mechanisms and causative factors of PRIS have not been fully elucidated.ObjectivesThe aim of this study was to evaluate the possibility of a research model using the culture of differentiated C2C12 cells for fundamental research of PRIS.MethodsFirst, differentiated C2C12 cells were cultured accompanied by several concentrations of chemical reagents of 2,6-diisopropylphenol (2,6 DIP) or dimethyl sulfoxide (DMSO) for 60 hours and the cell death rate was examined by trypan blue staining. Second, The cells were incubated with a commercially available propofol reagent or lipid reagent for 48 hours. The supernatant fluid of the cell culture medium was gathered and the numbers of floating cells were measured by cell counter. To investigate the mitochondrial disorder by the propofol preparation, JC-1, an experiment using fluorescent reagent, was performed for the 48 hours with 100 µg/mL propofol incubation.ResultsThe rate of cell death was increased with elevating concentrations both of chemical reagents of 2,6 DIP group and dimethyl sulfoxide group. The rates of cell death were significantly higher in the 2,6 DIP group than DMSO group. The numbers of floating cells were increased with elevating concentrations both commercially available propofol reagent and lipid reagent groups. The decreased red/green fluorescence ratio by JC-1 staining in the propofol 100µg/mL group proved an attenuated mitochondrial membrane potential.ConclusionsThe dose-dependent cell damage induced by the propofol reagents and a lipid solvent may provide a proposed model as a basic experimental model for further investigations into PRIS.

A follow-up survey of total intravenous anesthesia usage in children in the U.K. and Ireland.

Total intravenous anesthesia usage in children remains relatively unpopular in the UK and Ireland. A postal survey by Hill et al in 2008 indicated that only 26% of Consultants used a propofol infusion at least once a month. Following an increase in teaching and training opportunities in pediatric total intravenous anesthesia in the UK, we repeated the survey among Consultant members of Association of Paediatric Anaesthetists of Great Britain and Ireland and Society for Intravenous Anaesthesia, to see if this had affected total intravenous anesthesia usage in children and how practice may have changed. We used an anonymous online survey sent to Association of Paediatric Anaesthetists of Great Britain and Ireland and Society for Intravenous Anaesthesia members. A total of 291 responses were analyzed. Total intravenous anesthesia was the default method of anesthesia in 8% of respondents and a further 46% used total intravenous anesthesia at least monthly. Overall total intravenous anesthesia usage had increased in the past year in 53%. The main indications were malignant hyperthermia susceptibility, and postoperative nausea and vomiting. Ear/nose/throat surgery was the most popular surgical specialty. The main reasons for not using total intravenous anesthesia were that it was too "fiddly" and lack of confidence in the user. Most respondents used propofol in combination with remifentanil. Over 80% used propofol target-controlled infusion. The potential for propofol-related infusion syndrome concerned many, with 74% limiting infusion duration as a result. Bispectral Index was not used routinely by the majority of anesthetists. Even though most anesthetists did not use total intravenous anesthesia routinely, 98% felt they would be confident to anesthetize an malignant hyperpyrexia-positive patient using the technique. This survey has shown that although total intravenous anesthesia is not the default anesthetic technique for most anesthetists, overall usage in children has more than doubled in the past 10years, with many happy to use it in a wide variety of patients and procedures.