Hülya ÇELEBİ, Nur CANDAN, Berrin GÜNAYDIN

Profol infüzyon sendromu

Bu derlemede metabolik asidoz, hayatı tehdit eden disritmiler, kalp yetmezliği, rabdomiyoliz ve renal yetmezlikle karakterize olan propofolün yüksek doz ve uzun süre kullanımıyla ilişkili Propofol infüzyon Sendromu; 1990-2006 tarihleri arasında yayınlanan olgular, derlemeler, denetleyici merkezlerin ve üretici firmanın görüşleri incelenerek sunuldu. Propofolün anestezi dışında gittikçe genişleyen kullanım alanları nedeniyle karşılaşılan bu sorunun sebebi tam olarak anlaşılana kadar çocuk ve erişkin yoğun bakım hastalarının sedasyonunda uzun süreli infüzyon şeklinde kullanılmasının sakıncalı olabileceğine dikkat çekilmek istendi.

Profol infusion syndrome

This review presents the propofol infusion syndrome related to high doses and long term propofol use, which is characterized by metabolic acidosis, life-threatening dysrhythmias, heart failure, rhabdomyolysis and renal failure. Case reports, reviews published between 1990 and 2006, and the reports of the regulatory centers and manufacturers were examined within the scope of this study. Due to widespread use of propofol in the non-anesthetic field, we suggest the cautious use of long term propofol for sedation in children and adults until the pathophysiology is clarified.

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1. Short TG, Young Y. Toxicity of intravenous anaesthetics. Best Pract Res Clin Anaesthesiol 2003; 17: 77-89.
2. Side Effects Committee Notice: Propofol (Diprivan) side effects. Ugeskrift for Laeger 1990; 152/16: 1176.
3. Parke TJ, Stevens JE, Rice AS ve ark. Metabolic acidosis and fa- tal myocardial failure after propofol infusion in children: five case reports. BMJ 1992; 305: 613-6.
4. Perrier ND, Baerga-VarelaY, Murray MJ. Death related to propofol use in an adult patient. Crit Care Med 2000; 28: 3071-4.
5. Rodgers EM. Diprivan intensive care sedation in children. Br J Anaesth 1991; 67: 505.
6. Edwards KG, Arnold BD. Propofol infusion in children. BMJ 1992; 305: 952.
7. Reed MD, Blumer JL. Propofol bashing: the time to stop is now! Crit Care Med 1996; 24: 175-6.
8. Pepperman ML, Macrae D. A comparison of propofol and other sedative use in paediatric intensive care in the United Kingdom. Paediatr Anaesth 1997; 7: 143-53.
9. Martin PH, Murthy BVS, Petros AJ. Metabolic, biochemical and haemodynamic effects of infusion of propofol for long-term sedation of children undergoing intensive care. Br J Anaesth 1997; 79: 276-9.
10. Hatch DJ. Propofol in paediatric intensive care. Br J Anaesth 1997; 79: 274-5.
11. US Food and Drug Administrations Center for Drug Evaluation and Research (Anesthetic and Life Support Committee): ICI’ Diprivan (propofol) anesthetic has no link to pediatric deaths in ICUs. FDA Reports 1992; 54: 14.
12. Murdoch SD, Cohen AT. Propofol-infusion syndrome in children. Lancet 1999; 353: 2074-5.
13. Festa M, Bowra J, Schell D. Use of propofol infusion in Australian and New Zealand paediatric intensive care units. Anaesth Int Care 2002; 30: 786-93.
14. Bray RJ. Propofol infusion syndrome in children. Paediatr Anaesth 1998; 8: 491-9.
15. Cray SH, Robinson BH, Cox PN. Lactic academia and brad- yarrythmia in a child sedated with propofol. Crit Care Med 1998; 26: 2087-92.
16. Wolf A, Weir P, Segar P, Stone J, Shield J. Impaired fatty acid oxidation in propofol infusion syndrome. Lancet 2001; 357: 606-7.
17. Culp EK, Augoustides JG, Ochroch AE, Milas BL. Clinical Management of Cardiogenic Shock Associated with Prolonged Propofol Infusion. Anesth Analg 2004; 99: 221-6.
18. Holzki J, Aring C, Gillor A. Death after re-exposure to propofol in 3-year-old child: a case report. Pediatr Anesth 2004; 14: 265-70.
19. Withington DE, Decell MK, Al Ayed T. A case of propofol toxicity: further evidence for casual mechanism. Pediatr Anesth 2004; 4: 505-8.
20. Koch M, De Backer D, Vincent JL. Lactic acidosis: An early marker of propofol infusion syndrome? Intensive Care Med 2004; 30: 522.
21. Kill C, Leonhardt A, Wulf H. Lactic acidosis after short term infusion of propofol for anaesthesia in a child with osteogenesis imperfecta. Paediatr Anaesth. 2003; 13: 823-6.
22. Haase R, Sauer H, Eichler G. Lactic acidosis following short–term propofol infusion may be an early warning of propofol infusion syndrome. J Neurosurg Anesthesiol 2005; 17: 122-3.
23. Ozlu O, Ozkara HA, Eris S, Ocal T.. Propofol anaesthesia and metabolic acidosis in children. Paediatr Anaesth 2003; 13: 53-7.
24. Stelow EB, Johari VP, Smith SA, Crosson JT, Apple FS. Propofol-associated rhabdomyolysis with cardiac involvement in adults: chemical and anatomic findings. Clin Chem 2000; 46: 577-81.
25. Cremer OL, Moons KG, Bouman EA, Kruijswijk JE, de Smet AM, Kalkman CJ. Long term propofol infusion and cardiac failure in adult head-injured patients. Lancet 2001; 357: 117-8.
26. Menon DK, Matta BF, Gupta AK, Swami A. Propofol use in head-injury patients. Lancet 2001; 357: 1708-9.
27. Myburgh JA, Upton RN. Propofol use in head-injury patients. Lancet 2001; 357: 1709.
28. Myburgh JA, Upton RN, Grant C, Martinez A. Epinephrine, norepinephrine and dopamine infusions decrease propofol concentrations during continuous propofol infusion in an ovine model. Intensive Care Med 2001; 27: 276-82.
29. Ernest D, French C. Propofol infusion syndrome – report of an adult fatality. Anaesth Int Care 2003; 31: 316-9.
30. Eriksen J, Povey HM. A case of suspected non-neurosurgical fatal propofol infusion syndrome. Acta Anaesthesiol Scand 2006; 50: 117-9.
31. Liolios A, Guerit JM, Scholtes JL, Raftopoulos C, Hantson P. Propofol infusion syndrome associated with short-term large-dose infusion during surgical anesthesia in an adult. Anesth Analg 2005; 100: 1804-6.
32. Chukwuemeka A, Ko R, Ralph-Edwards A. Short-term low-dose propofol anaesthesia associated with severe metabolic acidosis. Anaesth Intensive Care 2006; 34: 651-5.
33. Vasile B, Rasulo F, Candiani A, Latronico N. The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Med 2003; 29: 1417-25.
34. Gempeler F, Elston AC, Thompson SP, Park GR. Propofol and Intralipid cause creaming of serum from critically ill patients. Anaesthesia 1994; 49: 17-20.
35. El-Ebiary M, Torres A, Ramirez J, Xaubet A, Rodriguez-Roisin R. Lipid deposition during long-term infusion of propofol. Crit Care Med 1995; 23: 1928-30.
36. Branca D, Roberti MS, Lorenzin P, Vincenti E, Scutari G. Influence of the anaesthetic 2,6-diisopropylphenol on the oxidative phosphorylation of isolated rat liver mitochondria. Biochem Pharmacol 1991; 42: 87-90.
37. Schenkman KA, Yan S. Propofol impairment of mitochondrial respiration in isolated perfused guinea pig hearts determined by reflectance spectroscopy. Crit Care Med 2000; 28: 172-7.
38. Samuels MA, Southern JF. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. A 26-year old woman with cardiomyopathy, multiple strokes, and an adrenal mass. Case 15. N Eng J Med 1988; 318: 970-81.
39. Mitch WE, Goldberg AL. Mechanisms of muscle wasting. The role of the ubiquitin-ptoteasome pathway. New Engl J Med 1996; 335: 1897-905.
40. Turner A, Tsamitros M, Bellomo R. Myocardial cell injury in septic shock. Crit Care Med 1999; 27: 1775-80.
41. Oppenheimer SM, Wilson JX, Guiraudon C, Cechetto DF. Insular cortex stimulation produces lethal cardiac arrhythmias: a mechanism of sudden death. Brain Res 1991; 550: 115-21.
42. Uezono S, Hotta Y, Takakuwa Y, Ozaki M. Acquired carnitine deficiency: a clinical model for propofol infusion syndrome? Anesthesiology 2005; 103: 909.
43. Vernooy K, Delhaas T, Cremer OL ve ark. Electrocardiographic changes predicting sudden death in propofol-related infusion syndrome. Heart Rhythm 2006; 3: 131-7.
44. Enting D, Ligtenberg JJM, Aarts LPHJ, Zijlstra JG. Total suppression of cerebral activity by thiopental mimicking propofol infusion syndrome: a fatal common pathway? Anesth Analg 2005; 100: 1864-5.
45. Hermanns H, Lipfert P, Ladda S, Stevens MF. Propofol infusion syndrome during anaesthesia for scoliosis surgery in an adolescent with neonatal progeroid syndrome. Acta Anaesthesiol Scand 2006; 50: 392-4.
46. Salengros J-C, Velghe-Lenelle C-E, Bollens R, Engelman E, Barvais L. Lactic acidosis during propofol-remifentanil anesthesia in an adult. Anesthesiology 2004; 101: 241-3.
47. Crozier TA. The ‘propofol infusion syndrome’: myth or menace? Eur J Anaesthesiol 2006; 23: 987-9.
48. Ahlen K, Buckley CJ, Goodale DB, Pulsford AH. The ‘propofol infusion syndrome’: the facts, their interpretation and implications for patient care. Eur J Anaesthesiol 2006; 23: 990-8.
49. Wolf AR, Potter F. Propofol infusion in children: when does an anesthetic tool become an intensive care liability? Pediatr Anesth 2004; 14: 435-8.
50. FDA issues warning on propofol (Diprivan) CMAJ 2001; 164: 1608.
51. Task Force of American College of Critical Care Medicine of The Society of Critical Care Medicine. Clinical Practical Guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002; 30: 119-41.
52. The FDA Warning Against Prolonged Sedation in Children (Remains Warranted) Pediatrics 2003; 112: 1002-3.
53. Wooltorton E. Propofol: contraindicated for sedation of pediatric intensive care patients. (Practice Health and Drug Alerts) CMAJ 2002; 167: 507.