Hypoxia propofol

Two men, aged 7 and 17 years, presented with refractory status epilepticus. Both were treated with high-dose propofol infusions to achieve burst suppression on the electroencephalogram. During the second day of propofol infusion there was progressive severe lactic acidosis, hypoxia, pyrexia, and rhabdomyolysis, followed by hypotension, bradydysrhythmias, and renal dysfunction, leading to death. The total doses of propofol were 1275 mg/ kg over 2.7 days and 482 mg/kg over 2 days. 

Hanna JP, Ramundo ML. Rhabdomyolysis and hypoxia associated with prolonged propofol infusion in children. Neurology 1998 50(l) 301-3. 

Patients with fixed cardiac output, e.g. with aorhc stenosis or constrictive pericarditis, are at special risk from reduced cardiac output with drugs that depress the myocardium and vasomotor centre, for they cannot compensate. Induction with propofol or thiopental is particularly liable to cause hypotension in these patients. Hypoxia is obviously harmful. Skilled technique rather than choice of drugs on pharmacological grounds is the important factor. 

In an analysis of 1139 patients with suspected propofol infusion syndrome in adults (mean age 52 years) and children (mean age 9 years), the presenting symptoms included cardiac (43%), hypotension (34%), rhabdomyolysis (27%), hepatic (24%), renal (24%), metabolic acidosis (20%), hypoxia (18%), and hyperthermia (12%) [74 ]. Propofol infusion ranges exceeded 5 mg/kg/hour in 129 cases in which the dose was reported. Regrettably, two important variables with respect to the propofol infusion syndrome, dosage and timing of propofol infusion, were not recorded in about 90% of papers. Multivariate logistic regression analysis identified... 

RESPIRATORY Use of remifentanyl in a combination with propofol for sedation and analgesia prior to bronchoscopy was associated with a greater incidence of hypoxia when compared to propofol and dexmedetomidate despite the lack of difference in the degree of sedation between the two groups [68 ]. 

The use of propofol to provide safe procedural sedation in the emergency department is again reported [72 ]. A retrospective review of 215 adult patients receiving propofol procedural sedation between June 2005 and December 2010 reported adverse event rate occurring in 10/215 (4.65%) patients with the most frequent events being hypotension in 5/215 (2.33%). Brief hypoxia occurred in 3/215 (1.4%) patients, two patients (0.93%) required airway opening manoeuvres, and two patients (0.93%) required bag valve mask assisted ventilation. 

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