OBJECTIVE: To report a case of propofol related infusion syndrome associated with low doses propofol administration in a young adult with head injury.

CASE SUMMARY: A previously healthy 24-year-old male patient with severe traumatic head injury was admitted to a neurosurgery intensive care unit after craniotomy. He was given a continuous infusion (1.5–2.3 mg/kg/h) of propofol for sedation and intracranial pressure control. After infusion, bradycardia, metabolic acidosis, hyperkalemia, rhabdomyolysis, and acute renal failure developed. The patient died of refractory cardiac dysrhythmia after approximately 72 hours of propofol administration.

DISCUSSION: The clinical features of propofol related infusion syndrome (PRIS) are characterized by severe metabolic acidosis, rhabdomyolysis, myoglobinuria, hyperkalemia, lipemia, renal failure, hepatomegaly, cardiac arrhythmias, and myocardial failure. The possible theories include abnormal mitochondrial gene mutations, inhibition of enzymes in the mitochondrial respiratory chain, impaired fatty acid oxidation. Associated risk factors included high doses and prolonged use, children, head injury or respiratory failure, combined glucocorticoids or catecholamines and carbohydrate intake. Based on the Naranjo adverse reaction probability scale criteria, propofol was the most probable cause of death in the patient (score of 5).

CONCLUSION: Although PRIS developed in a sedative patient after a high-dose and prolonged infusion of propofol. Clinical should be aware of this syndrome in adults with prolonged infusion of low-dose propofol and combined catecholamines

 

案例說明：一位24歲健康男性，因嚴重頭部外傷，手術後住進神經外科加護病房，使用低劑量1.5-2.3 mg/kg/hr propofol輸注，作為鎮靜劑及控制其顱內壓上升，72小時後案例出現心跳徐緩、代謝性酸中毒、高血鉀、橫紋肌溶解症、急性腎衰竭及心律不整死亡。

討論：Propofol引起的輸注症候群(PRIS)的特徵為代謝性酸中毒、橫紋肌溶解症、肌蛋白尿、高血鉀、高血酯症、腎衰竭、肝腫大、心律不整及心臟衰竭等。機轉可能與脂肪酸代謝異常引起週邊或心肌損傷，或因粒腺體基因異常突變或其粒腺體呼吸鏈異常，而無法利用脂肪酸產生能量所導致。相關危險因子包括高劑量且長時間使用、兒童、頭部外傷或呼吸衰竭、給予類固醇或兒茶酚胺及碳水化合物攝取等。依據Naranjo不良反應與藥物相關性之評估，本案例PRIS是極有可能。