Propofol is generally a well-tolerated sedative / amnestic but occasionally it can lead to the propofol infusion syndrome (PRIS); a metabolic disorder causing end-organ dysfunction.
Suspect PRIS in patients with increasing lactate levels, worsening metabolic acidosis, worsening renal function, increased triglyceride levels, or creatinine kinase levels. End-organ effects include:
Myocardial dysfunction / Arrhythmias
Rhabdomyolysis
Acute renal failure
The true incidence of PRIS is unknown, however, certain risk factors have been identified:
Doses >4-5mg/kg/hour
<18 years of age
Critically-ill patients; especially receiving vasopressors or steroids
History of mitochondrial disorders
Infusions >48 hours
Prevent PRIS by using adequate analgesia (with morphine or fentanyl) post-intubation, which may reduce the overall dosage of propofol ultimately reducing the risk.
If PRIS develops, stop propofol and provide supportive care; IV fluids, ensuring good urine output, adequate oxygenation, dialysis (if indicated), vasopressor and inotropic support.
References
Follow me on Twitter (@criticalcarenow) or Google+ (+criticalcarenow)
