Propofol infusion syndrome - a case report

Abstract

The propofol infusion syndrome (PRIS) is a very rare, undesired adverse effect of sedation with propofol that occurs most frequently in children. Despite the fact that a number of fatal cases documented, the syndrome is still relatively unknown. We report the case of a two-year-old boy who was sedated with propofol for 22 hours after surgical resection of a spinal astrocytoma and ultimately died after developing acute rhabdomyolysis with cardiac involvement, severe metabolic acidosis, and acute renal failure. The pathogenesis of PRIS is very probably multifactorial; with various triggering and risk factors being involved to differing extents. A disturbance by propofol of the degradation of free fatty acids resulting in an acute energy deficiency at the cellular level, is considered to be the established cause. In addition, both exogenous and endogenous steroids and/or catecholamines appear to play a role.