Propofol
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Fatal propofol-related infusion syndrome: case report A 36-year-old woman developed fatal propofol-related infusion syndrome after receiving propofol for sedation. The woman presented with severe head trauma, including an open skull fracture, multiple complex facial fractures, a subarachnoid haemorrhage and an intraparenchymal haematoma. She was transferred to an ICU, where she received sedation with midazolam, fentanyl and an infusion of propofol, with a maximum dosage of 2.8 mg/kg/h. She also received norepinephrine [noradrenaline] for increased intracranial pressure. Seven days after admission, she had an increased requirement for norepinephrine and a creatine kinase level of 701 U/L. Over the following hours, her circulatory function deteriorated, with the development of a Brugada syndrome-like pattern on ECG. She went into shock, with metabolic acidosis, hyperphosphataemia, hyperkalaemia. Her lactate and creatine kinase levels increased to 4.9 mmol/L and 1809 U/L, respectively. Norepinephrine was increased, and the woman received dobutamine. Propofol was withdrawn, and she commenced haemofiltration for acidosis and hyperkalaemia. Her cardiac function continued to deteriorate, with intermittent periods of ventricular tachycardia, followed by bradyarrhythmia. She received epinephrine [adrenaline] and vasopressin, and underwent placement of a sheath for pacer wire introduction. However, she had multiple episodes of temporary pulseless electrical activity, requiring resuscitation. She received aggressive therapy; however, after a prolonged period of pulseless electrical activity, she could not be resuscitated. An autopsy was not performed. Annecke T, et al. Propofol-related infusion syndrome induced by "moderate dosage" in a patient with severe head trauma. Journal of Clinical Anesthesia 24: 51-54, No. 1, Feb 2012. Available from: URL: http://dx.doi.org/10.1016/ 803069056 j.jclinane.2011.03.008 - Germany
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Reactions 14 Apr 2012 No. 1397
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