Síndrome de infusión por propofol: revisión de tema
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may 24, 2021
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Resumen
El Propofol es un agente anestésico endovenoso usado ampliamente en la inducción y mantenimiento de anestesia, así como en sedación de pacientes en diferentes escenarios. Sus propiedades farmacocinéticas y farmacodinámicas hacen de este un medicamento ideal para el cuidado de pacientes críticos. Algunas de ellas, su rápido inicio de acción y recuperación tras suspender la infusión, además de la presencia de pocos efectos adversos, lo hacen favorable en ciertas condiciones clínicas (descenso de la Presión Intracraneana [PIC] en pacientes con Trauma Cráneo Encefálico [TCE]). Sin embargo, desde hace más de 20 años se han reportado casos en la literatura con respecto a la presencia de signos y síntomas comunes relacionados con la infusión de propofol a dosis mayores de 4 – 5mg/kg/h y por largos periodos de tiempo (>48hrs), como acidosis metabólica, disfunción cardiaca y renal, rabdomiolisis, hipertrigliceridemia e hipercalemia, que en conjunto son conocidos como Síndrome de Infusión de Propofol (SIP). Si bien esta patología es poco frecuente, es potencialmente fatal sin un diagnóstico y tratamiento oportuno. El presente artículo pretende dejar unos puntos claros sobre su fisiopatología, características clínicas, diagnóstico y tratamiento con base en la literatura actual.
Keywords
Propofol, síndrome de infusión de Propofol, mitocondria
References
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3. Krajčová A, Waldauf P, Anděl M, Duška F. Propofol infusion syndrome: A structured review of experimental studies and 153 published case reports. Crit Care. 2015;19(1):1–9.
4. Fallier-Becker P, Vollmer JP, Wolburg H, Haen S, Steiner J, Noell S, et al. Case report: Propofol-related infusion syndrome. Ultrastruct Pathol. 2017;41(1):106–7.
5. Darrouj J, Karma L, Arora R. Cardiovascular manifestations of sedatives and analgesics in the critical care unit. Am J Ther. 2009;16(4):339–53.
6. Caracci B, Aranda F. Propofol infusion syndrome. Rev Chil Anest. 2018;47(3):189–95.
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8. Finsterer J, Frank M. Propofol Is Mitochondrion-Toxic and May Unmask a Mitochondrial Disorder. J Child Neurol. 2016;31(13):1489–94.
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10. Loh NHW, Nair P. Propofol infusion syndrome. Contin Educ Anaesthesia, Crit Care Pain. 2013;13(6):200–2.
11. Diaz JH, Prabhakar A, Urman RD, Kaye AD. Propofol Infusion Syndrome: A Retrospective Analysis at a Level 1 Trauma Center. Crit Care Res Pract. 2014;2014.
12. Fodale V, La Monaca E. Propofol infusion syndrome: An overview of a perplexing disease. Drug Saf. 2008;31(4):293–303.
13. Vollmer JP, Haen S, Wolburg H, Lehmann R, Steiner J, Reddersen S, et al. Propofol Related Infusion Syndrome: Ultrastructural Evidence for a Mitochondrial Disorder. Crit Care Med. 2018;46(1):e91–4.
14. Walli A, Poulsen TD, Dam M, Børglum J. Propofol Infusion Syndrome in Refractory Status Epilepticus: A Case Report and Topical Review. Case Rep Emerg Med. 2016;2016:1–4.
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17. Fong JJ, Sylvia L, Ruthazer R, Schumaker G, Kcomt M, Devlin JW. Predictors of mortality in patients with suspected propofol infusion syndrome. Crit Care Med. 2008;36(8):2281–7.
18. Chidambaran V, Costandi A, D’Mello A. Propofol: A Review of its Role in Pediatric Anesthesia and Sedation. CNS Drugs. 2015;29(7):543–63.
19. Eziefule A, Elshatanoufy S, Thakur M, Rocha F. Propofol-Related Infusion Syndrome in the Peripartum Period. Am J Perinatol Reports. 2016;06(04):e368–71.
20. Barbosa FT. Síndrome da infusão do propofol. Rev Bras Anestesiol. 2007;57(5):539–42.
21. Orsini J, Nadkarni A, Chen J, Cohen N. Propofol infusion syndrome: Case report and literature review. Am J Heal Pharm. 2009;66(10):908–15.
22. Kang TM, Nazario M, Edouard B. Propofol infusion syndrome in critically ill patients. Ann Pharmacother. 2002;36(9):1453–6.
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24. Papaioannou V, Dragoumanis C, Theodorou V, Pneumatikos I. The propofol infusion “syndrome” in intensive care unit: From pathophysiology to prophylaxis and treatment. Acta Anaesthesiol Belg. 2008;59(2):79–86.
25. Jorens PG, Van den Eynden GG. Propofol Infusion Syndrome With Arrhythmia, Myocardial Fat Accumulation and Cardiac Failure. Am J Cardiol [Internet]. 2009;104(8):1160–2. Available from: http://dx.doi.org/10.1016/j.amjcard.2009.05.065
26. Agrawal N, Rao S, Nair R. A death associated with possible propofol infusion syndrome. Indian J Surg. 2013;75(1 SUPPL.):407–8.
27. Vasile B, Rasulo F, Candiani A, Latronico N. The pathophysiology of propofol infusion syndrome: A simple name for a complex syndrome. Intensive Care Med. 2003;29(9):1417–25.
28. Mallow Corbett S, Montoya ID, Moore FA. Propofol-related infusion syndrome in intensive care patients. Pharmacotherapy. 2008;28(2):250–8.
29. Wolf AR, Potter F. Propofol infusion in children: When does an anesthetic tool become an intensive care liability? Paediatr Anaesth. 2004;14(6):435–8.
30. Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol infusion syndrome in adults: A clinical update. Crit Care Res Pract. 2015;2015.
31. Fudickar A, Bein B, Tonner PH. Propofol infusion syndrome in anaesthesia and intensive care medicine. Curr Opin Anaesthesiol. 2006;19(4):404–10.
32. Fodale V, Monaca E La. Propofol infusion syndrome: an overview of a perplexing disease. Fodale V, La Monaca E. Drug Saf. 2008; 31(4):293-303. 2008;31(4):293–303.
33. Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol Infusion Syndrome in Adults : A Clinical Update. 2015;2015.
34. Bray RJ. Propofol infusion syndrome in children. Paediatr Anaesth. 1998;8(6):491–9.
35. Finsterer J, Frank M. Propofol Is Mitochondrion-Toxic and May Unmask a Mitochondrial Disorder. J Child Neurol. 2016;31(13):1489–94.
36. Otterspoor LC, Kalkman CJ, Cremer OL. Update on the propofol infusion syndrome in ICU management of patients with head injury. Curr Opin Anaesthesiol. 2008;21(5):544–51.
37. Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol infusion syndrome in adults: A clinical update. Crit Care Res Pract. 2015;2015.
38. Otterspoor LC, Kalkman CJ, Cremer OL. Update on the propofol infusion syndrome in ICU management of patients with head injury. Curr Opin Anaesthesiol. 2008;21(5):544–51.
39. Mayette M, Gonda J, Hsu JL, Mihm FG. Propofol infusion syndrome resuscitation with extracorporeal life support: A case report and review of the literature. Ann Intensive Care. 2013;3(1):1–6.
2. Robinson JDC, Melman Y, Walsh EP. Cardiac conduction disturbances and ventricular tachycardia after prolonged propofol infusion in an infant. PACE - Pacing Clin Electrophysiol. 2008;31(8):1070–3.
3. Krajčová A, Waldauf P, Anděl M, Duška F. Propofol infusion syndrome: A structured review of experimental studies and 153 published case reports. Crit Care. 2015;19(1):1–9.
4. Fallier-Becker P, Vollmer JP, Wolburg H, Haen S, Steiner J, Noell S, et al. Case report: Propofol-related infusion syndrome. Ultrastruct Pathol. 2017;41(1):106–7.
5. Darrouj J, Karma L, Arora R. Cardiovascular manifestations of sedatives and analgesics in the critical care unit. Am J Ther. 2009;16(4):339–53.
6. Caracci B, Aranda F. Propofol infusion syndrome. Rev Chil Anest. 2018;47(3):189–95.
7. Schroeppel TJ, Fabian TC, Clement LP, Fischer PE, Magnotti LJ, Sharpe JP, et al. Propofol infusion syndrome: A lethal condition in critically injured patients eliminated by a simple screening protocol. Injury [Internet]. 2014;45(1):245–9. Available from: http://dx.doi.org/10.1016/j.injury.2013.05.004
8. Finsterer J, Frank M. Propofol Is Mitochondrion-Toxic and May Unmask a Mitochondrial Disorder. J Child Neurol. 2016;31(13):1489–94.
9. Roberts RJ, Barletta JF, Fong JJ, Schumaker G, Kuper PJ, Papadopoulos S, et al. Incidence of propofol-related infusion syndrome in critically ill adults: A prospective, multicenter study. Crit Care. 2009;13(5):1–10.
10. Loh NHW, Nair P. Propofol infusion syndrome. Contin Educ Anaesthesia, Crit Care Pain. 2013;13(6):200–2.
11. Diaz JH, Prabhakar A, Urman RD, Kaye AD. Propofol Infusion Syndrome: A Retrospective Analysis at a Level 1 Trauma Center. Crit Care Res Pract. 2014;2014.
12. Fodale V, La Monaca E. Propofol infusion syndrome: An overview of a perplexing disease. Drug Saf. 2008;31(4):293–303.
13. Vollmer JP, Haen S, Wolburg H, Lehmann R, Steiner J, Reddersen S, et al. Propofol Related Infusion Syndrome: Ultrastructural Evidence for a Mitochondrial Disorder. Crit Care Med. 2018;46(1):e91–4.
14. Walli A, Poulsen TD, Dam M, Børglum J. Propofol Infusion Syndrome in Refractory Status Epilepticus: A Case Report and Topical Review. Case Rep Emerg Med. 2016;2016:1–4.
15. Fudickar A, Bein B. Propofol infusion syndrome: manifestation and pathophysiology. Minerva Anestesiol. 2009;75(5):339–44.
16. Devlin JW, Roberts RJ. Pharmacology of commonly used analgesics and sedatives in the ICU: Benzodiazepines, propofol, and opioids. Anesthesiol Clin. 2011;29(4):567–85.
17. Fong JJ, Sylvia L, Ruthazer R, Schumaker G, Kcomt M, Devlin JW. Predictors of mortality in patients with suspected propofol infusion syndrome. Crit Care Med. 2008;36(8):2281–7.
18. Chidambaran V, Costandi A, D’Mello A. Propofol: A Review of its Role in Pediatric Anesthesia and Sedation. CNS Drugs. 2015;29(7):543–63.
19. Eziefule A, Elshatanoufy S, Thakur M, Rocha F. Propofol-Related Infusion Syndrome in the Peripartum Period. Am J Perinatol Reports. 2016;06(04):e368–71.
20. Barbosa FT. Síndrome da infusão do propofol. Rev Bras Anestesiol. 2007;57(5):539–42.
21. Orsini J, Nadkarni A, Chen J, Cohen N. Propofol infusion syndrome: Case report and literature review. Am J Heal Pharm. 2009;66(10):908–15.
22. Kang TM, Nazario M, Edouard B. Propofol infusion syndrome in critically ill patients. Ann Pharmacother. 2002;36(9):1453–6.
23. Mijzen EJ, Jacobs B, Aslan A, Rodgers MGG. Propofol infusion syndrome heralded by ECG changes. Neurocrit Care. 2012;17(2):260–4.
24. Papaioannou V, Dragoumanis C, Theodorou V, Pneumatikos I. The propofol infusion “syndrome” in intensive care unit: From pathophysiology to prophylaxis and treatment. Acta Anaesthesiol Belg. 2008;59(2):79–86.
25. Jorens PG, Van den Eynden GG. Propofol Infusion Syndrome With Arrhythmia, Myocardial Fat Accumulation and Cardiac Failure. Am J Cardiol [Internet]. 2009;104(8):1160–2. Available from: http://dx.doi.org/10.1016/j.amjcard.2009.05.065
26. Agrawal N, Rao S, Nair R. A death associated with possible propofol infusion syndrome. Indian J Surg. 2013;75(1 SUPPL.):407–8.
27. Vasile B, Rasulo F, Candiani A, Latronico N. The pathophysiology of propofol infusion syndrome: A simple name for a complex syndrome. Intensive Care Med. 2003;29(9):1417–25.
28. Mallow Corbett S, Montoya ID, Moore FA. Propofol-related infusion syndrome in intensive care patients. Pharmacotherapy. 2008;28(2):250–8.
29. Wolf AR, Potter F. Propofol infusion in children: When does an anesthetic tool become an intensive care liability? Paediatr Anaesth. 2004;14(6):435–8.
30. Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol infusion syndrome in adults: A clinical update. Crit Care Res Pract. 2015;2015.
31. Fudickar A, Bein B, Tonner PH. Propofol infusion syndrome in anaesthesia and intensive care medicine. Curr Opin Anaesthesiol. 2006;19(4):404–10.
32. Fodale V, Monaca E La. Propofol infusion syndrome: an overview of a perplexing disease. Fodale V, La Monaca E. Drug Saf. 2008; 31(4):293-303. 2008;31(4):293–303.
33. Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol Infusion Syndrome in Adults : A Clinical Update. 2015;2015.
34. Bray RJ. Propofol infusion syndrome in children. Paediatr Anaesth. 1998;8(6):491–9.
35. Finsterer J, Frank M. Propofol Is Mitochondrion-Toxic and May Unmask a Mitochondrial Disorder. J Child Neurol. 2016;31(13):1489–94.
36. Otterspoor LC, Kalkman CJ, Cremer OL. Update on the propofol infusion syndrome in ICU management of patients with head injury. Curr Opin Anaesthesiol. 2008;21(5):544–51.
37. Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol infusion syndrome in adults: A clinical update. Crit Care Res Pract. 2015;2015.
38. Otterspoor LC, Kalkman CJ, Cremer OL. Update on the propofol infusion syndrome in ICU management of patients with head injury. Curr Opin Anaesthesiol. 2008;21(5):544–51.
39. Mayette M, Gonda J, Hsu JL, Mihm FG. Propofol infusion syndrome resuscitation with extracorporeal life support: A case report and review of the literature. Ann Intensive Care. 2013;3(1):1–6.
Cómo citar
Tabares Arboleda, M. P., Ávila, L. M., & Londoño Duarte, M. P. (2021). Síndrome de infusión por propofol: revisión de tema. Universitas Medica, 62(2). https://doi.org/10.11144/Javeriana.umed62-2.prop
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Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.