How do you diagnose PRIS?

How do you diagnose PRIS?

A presumptive diagnosis of PRIS includes rhabdomyolysis, hyperkalemia, hyperlipidemia, and acute renal failure in adults receiving high-dose propofol infusions (>4 mg/kg/h) for prolonged (>48 hours) periods.

Does propofol increase CK?

In our experience, increasing CK levels after 24–48 h of propofol infusion should raise the suspicion of PRIS in the absence of any other muscular pathologies. Renal failure often occurs and it is thought to be related to myoglobinuria.

When should propofol triglycerides be checked?

Propofol is considered a first-line sedative at our institution in mechanically ventilated patients who require continuous sedation. The maximum dose allowed in the ICU is 83 µg/kg/min, and it is recommended to monitor triglyceride levels every 48–72 hours for patients requiring prolonged infusions.

What can I monitor with propofol?

During the administration of propofol, patients should be monitored without interruption to assess level of consciousness, and to identify early signs of hypotension, bradycardia, apnea, airway obstruction and/or oxygen desaturation.

Can propofol cause rhabdomyolysis?

Propofol, a central-acting sedative agent, has been implicated in the development of rhabdomyolysis in children. We describe two adults who developed rhabdomyolysis after receiving high rates of propofol infusion.

Does propofol cause metabolic acidosis?

In conclusion, propofol infusion may be a leading cause of metabolic acidosis in patients receiving neurosurgical anesthesia. However, volatile anesthesia also may have a similar effect on metabolic acidosis. Assessment of the effects of propofol on metabolic acidosis requires prospective controlled trials.

What biochemical parameters should be checked when a patient is receiving propofol?

The following parameters should be monitored for all patients receiving propofol: pulse oximetry, blood pressure, and electrocardiography and heart rate.

Does propofol cause hypertriglyceridemia?

Due to its formulation, propofol has been associated with an increased risk of developing hypertriglyceridemia (2). Although propofol-induced pancreatitis may occur independent of elevated triglyceride levels, hypertriglyceridemia is a risk factor for pancreatitis (4–6).

What should you assess before giving propofol?

All patients receiving propofol MUST be monitored for:

  1. Vital signs.
  2. Neurologic function.
  3. Cardiac and Respiratory Rate.
  4. S & S of bacterial sepsis (Fever, Chills & Body aches)

What is propofol infusion syndrome?

Propofol-related infusion syndrome (PRIS) is a rare yet often fatal syndrome that has been observed in critically ill patients receiving propofol for sedation. PRIS is charac- terized by severe unexplained metabolic acidosis, arrhythmias, acute renal failure, rhabdomyolysis, hyperkalemia, and cardiovascular collapse.

Why does propofol cause metabolic acidosis?

Objective. Propofol and volatile anesthesia have been associated with metabolic acidosis induced by increased lactate.

What are the risk factors for propofol infusion syndrome?

Certain risk factors for the development of propofol infusion syndrome are described, such as appropriate propofol doses and durations of administration, carbohydrate depletion, severe illness, and concomitant administration of catecholamines and glucocorticosteroids.

How many ECGs are done for propofol infusions?

The triglyceride level was ≥2.2 mmol/l (very high) on first testing in 75% of patients. All patients had a 12-lead ECG done on admission. Seventeen of 25 (68%) had a further ECG performed whilst on continuous propofol infusion (45% in 2011). Additional ECGs were done in 13/17 patients (zero in 2011).

How long should a patient be on propofol?

In patients who required propofol sedation for 4 days or more, we prospectively monitored: frequency of performing lipid profile and 12-lead ECG; and frequency of co-administration of a propofol-sparing agent. We collected data from 25 patients. The duration of propofol infusion was 4 to 15 days (mean 8.5 days).

What should the triglyceride level be for propofol?

The triglyceride level was ≥2.2 mmol/l (very high) on first testing in 75% of patients. All patients had a 12-lead ECG done on admission. Seventeen of 25 (68%) had a further ECG performed whilst on continuous propofol infusion (45% in 2011).