• PDF / 170,637 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 1 Downloads / 210 Views

DOWNLOAD

REPORT

---

1 S

Propofol infusion syndrome: case report A 57-year-old man developed propofol infusion syndrome during treatment with propofol. Additionally, he received norepinephrine, which also contributed to the development of propofol infusion syndrome [specific routes and duration of treatments to reaction onset not stated]. The man, who had severe triple-vessel coronary artery disease, underwent emergent aortic valve replacement and multivessel coronary artery bypass grafting (CABG). During the surgery, he developed hypoxemic respiratory failure and cardiogenic shock necessitating central venoarterial extracorporeal membrane oxygenation (VA-ECMO). Within one week, his oxygenation and haemodynamic status improved, allowing decannulation of VA-ECMO. One day later, he developed acute kidney injury, frequent ventricular and supraventricular arrhythmias, severe hyperkalaemia, lactic acidosis and metabolic acidosis. He received vasoactive support with low-dose norepinephrine 0.03 mg/kg/min and vasopressin. His overall vasoactive-inotropic support (VIS) score increased from 1.6 to 13.5 in the subsequent 24 to 48h. At the time, his lab tests revealed elevated levels of triglycerides, lactic acid, AST and ALT. His creatine kinase was found to be 39 U/L. He also underwent continuous renal replacement therapy (CRRT). His hyperkalaemia and lactic acidosis was out of proportion to kidney injury and cardiac function, respectively. Subsequently, a CRRT filter clogged with lipoidal blood due to hypertriglyceridaemia. At this time, he had been maintained on infusion of propofol with average dose of 50 µg/kg/min for 8 days. After decannulation, the propofol dose was not reduced due to hypoxemia and ventilator synchrony necessitating chemical paralysis. Based on clinical presentation, a suspicion of propofol infusion syndrome was made. The man’s propofol was therefore immediately discontinued. Over the following hours, his haemodynamic status and aforementioned lab values improved. In the following days, he was weaned from the mechanical ventilation, and his vasoactive infusions were stopped. His kidney function gradually improved requiring intermittent haemodialysis for another 2 weeks. Lal A, et al. Consider Heightened Awareness of Propofol Infusion Syndrome after Extracorporeal Membrane Oxygenation (ECMO) Decannulation. Journal of Cardiothoracic 803498369 and Vascular Anesthesia 34: 2174-2177, No. 8, Aug 2020. Available from: URL: http://doi.org/10.1053/j.jvca.2019.12.019

0114-9954/20/1819-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

Reactions 29 Aug 2020 No. 1819