Journal of Experimental & Clinical Medicine
Volume 2, Issue 4 , Pages 192-195, August 2010

Propofol Infusion Syndrome Leads to Severe Right Heart Injury and Lethal Arrhythmias

  • Yuan-Teng Tseng

      Affiliations

    • Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Medical University–Shuang Ho Hospital, Taipei, Taiwan
    • ,
  • Wen-Rui Hao

      Affiliations

    • Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Medical University–Shuang Ho Hospital, Taipei, Taiwan
    • ,
  • Ju-Chi Liu

      Affiliations

    • Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Medical University–Shuang Ho Hospital, Taipei, Taiwan
    • ,
  • Ming-Hsiung Hsieh

      Affiliations

    • Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Medical University–Wan Fang Hospital, Taipei, Taiwan
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    • Corresponding Author InformationCorresponding author. Division of Cardiovascular Medicine, Taipei Medical University–Wan Fang Hospital, 111, Section 3, Hsing Long Road, Taipei 116, Taiwan

Received 29 September 2009; received in revised form 30 March 2010; accepted 28 April 2010.

Article Outline

Propofol-related infusion syndrome (PRIS) has a high mortality with myocardial failure and dysrhythmias. However, there is no detailed description of the serial cardiac conditions presenting during the critical and recovery periods during PRIS. We report the case of a 24-year-old man with a traumatic head injury who developed PRIS after propofol infusion. Cyanosis, hypotension, neck vein distension, cardiac arrest and ventricular tachycardia occurred. The patient survived PRIS by prompt cessation of propofol, the use of inotropic agents, and short-term hemofiltration. A timely Holter electrocardiogram (ECG) recording, serial echocardiograms and 12-lead ECGs revealed isolated right heart failure, sequential bradycardia, arrest, left bundle branch block-like ventricular tachycardia, and varied coved-type ST elevation in the right precordial leads. All these clinical abnormalities (symptoms, echocardiograms, and ECGs) subsided within a few hours after treatment. The patient was eventually discharged with clear consciousness and without any cardiopulmonary sequelae. Our cardiac survey implied that in PRIS, the right heart is severely injured, both mechanically and electrophysiologically. Injured right hearts can completely and rapidly recover if recognition and treatment are timely.

Key Words:  cardiac arrest , coved-type ST elevation , heart failure , propofol , ventricular arrhythmia

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Parke TJ, Stevens JE, Rice AS, Greenaway CL, Bray RJ, Smith PJ, et al  Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports . BMJ . 1992;305:613–616
  2. Bray RJ . Propofol infusion syndrome in children . Paediatr Anaesth . 1998;8:491–499
  3. Corbett SM , Montoya ID , Moore FA . Propofol-related infusion syndrome in intensive care patients . Pharmacotherapy . 2008;28:250–258
  4. Kam PC , Cardone D . Propofol infusion syndrome . Anaesthesia . 2007;62:690–701
  5. 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;357:117–118
  6. 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;23:990–998
  7. Vernooy K, Delhaas T, Cremer OL, Di Diego JM, Oliva A, Timmermans C, et al  Electrocardiographic changes predicting sudden death in propofol-related infusion syndrome . Heart Rhythm . 2006;3:131–137
  8. 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;29:1417–1425
  9. Wessel N , Schirdewan A . Toward a prediction of sudden death in propofol-related infusion syndrome . Heart Rhythm . 2006;3:138–139
  10. Perrier ND , Baerga-Varela Y , Murray MJ . Death related to propofol use in an adult patient . Crit Care Med . 2000;28:3071–3074
  11. Corbett SM , Moore J , Rebuck JA , Rogers FB , Greene CM . Survival of propofol infusion syndrome in a head-injured patient . Crit Care Med . 2006;34:2479–2483
  12. Yan GX , Antzelevitch C . Cellular basis for the Brugada syndrome and other mechanisms of arrhythmogenesis associated with ST-segment elevation . Circulation . 1999;100:1660–1666

PII: S1878-3317(10)60030-7

doi:10.1016/S1878-3317(10)60030-7

Journal of Experimental & Clinical Medicine
Volume 2, Issue 4 , Pages 192-195, August 2010

Article Tools