Propofol infusion syndrome in a super morbidly obese patient (BMI = 75)
Date
2011-01Author
Ramaiah, Ramesh
Lollo, Loreto
Brannan, Douglas
Bhananker, Sanjay
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Propofol infusion syndrome (PRIS) is a rare but often fatal complication as a result of large doses of propofol
infusion (4–5 mg/kg/hr) for a prolonged period (>48 h). It has been reported in both children and adults.
Besides large doses of propofol infusion, the risk factors include young age, acute neurological injury, low
carbohydrate and high fat intake, exogenous administration of corticosteroid and catecholamine, critical
illness, and inborn errors of mitochondrial fatty acid oxidation. PRIS manifestation include presence of
metabolic acidosis with a base deficit of more than 10 mmol/l at least on one occasion, rhabdomyolysis or
myoglobinuria, acute renal failure, sudden onset of bradycardia resistant to treatment, myocardial failure, and
lipemic plasma. The pathophysiology of PRIS may be either direct mitochondrial respiratory chain inhibition
or impaired mitochondrial fatty acid metabolism mediated by propofol. We report a case of supermorbidly
obese patient who received propofol infusion by total body weight instead of actual body weight and
developed PRIS.