Propofol infusion syndrome: a systematic review

Abstract

Introduction: propofol infusion syndrome (SIP) is a rare but extremely serious condition that can occur following the administration of high doses (>2-5 mg/kg/h) of propofol for prolonged periods (>48 hours). However, cases of SIP have also been reported after low-dose or short-duration propofol infusion. The condition is characterized by metabolic acidosis, cardiovascular and renal disturbances, rhabdomyolysis, as well as electrocardiographic abnormalities, etc. Objective: to describe the main characteristics, prevention, diagnosis, and management of SIP. Methods: a literature search and selection of articles published in the last 5 years on SIP in critically ill patients were carried out in English, Spanish, and Portuguese. This was done through the Pubmed, TRipDatabase, SciELO, and Google Scholar databases, following the PRISMA methodology. Results: 26 articles were included, which analyzed the definition, general characteristics, epidemiology, risk factors, pathophysiology, clinical manifestations, prevention, and treatment. Conclusions: the literature found reports that SIP is very rare but potentially fatal. The best treatment is prevention and early diagnosis. It is important to be aware that patients receiving propofol infusion are at risk of developing SIP. Therefore, greater monitoring and knowledge of patient clinical profiles is recommended. If SIP is suspected, propofol use should be discontinued and replaced with an alternative hypnotic agent, and management should be initiated. This includes immediate discontinuation of propofol infusion and problem-oriented management, such as hemodialysis, hemodynamic support, and extracorporeal membrane oxygenation in refractory cases. Further research is needed on SIP to obtain more data on its diagnosis, pathophysiology, and incidence.