Rhabdomyolysis propofol

Benzodiazepines can be used to control agitation. Avoid phenothiazines due to possible hypotension. Animals may need to be heavily sedated so they do not injure themselves or others. Control seizures with a benzodiazepine, pheno-barbital, or propofol. Rhabdomyolysis can occur if agitation or seizures are not controlled. 

Propofol infusion syndrome has been described and may result in severe metabolic acidosis, cardiac dysrhythmias, cardiovascular collapse, rhabdomyolysis, and death. The risk may be increased with concomitant catecholamine infusions or when the dose exceeds... 

Propofol (Diprivan) Not recommended due to adverse events (e.g., rhabdomyolysis)... 

Rhabdomyolysis is the destruction of skeletal muscle tissues and may be associated with lipid-regulating drugs such as the fibrates and the statins. The risk of this side-effect is increased in patients with renal impairment and with hypothyroidism. Rhabdomyolysis may also occur with nicotinic acid, the antipsychotic aripiprazole, and the anaesthetic propofol. 

Propofol infusion syndrome is a syndrome of cardiac failure (bradycardia, hypotension, low cardiac output), metabolic acidosis, and rhabdomyolysis, first described in children receiving high-dose propofol infusions for more than 48 hours. 

Propofol infusion syndrome can present with one component only, such as lactic acidosis (954) or rhabdomyolysis (955) (see below). It has been suggested that patients who are susceptible to metabolic acidosis or rhabdomyolysis after propofol administration may have subclinical forms of mitochondrial diseases that affect either the respiratory chain complex or fatty acid oxidation (956). In order to minimize the development of propofol infusion syndrome as a potentially lethal complication, a maximum dose of 3 mg/kg/hour has been recommended for sedation in intensive care patients. 

A 10-year-old child had status epilepticus controlled with a combination of valproate, oxcarbazepine, and 48 hours of propofol infusion in a dose of 5.5 mg/kg/ hour. After weaning from propofol, a classic ketogenic diet was instituted in an attempt to provide long-term control of the seizures. A day later status epilepticus recurred and propofol was restarted at a rate of 6-9 mg/ kg/hour to suppress seizure activity (the diet, valproate, and oxcarbazepine were also continued). Shortly thereafter, he developed the classical constellation of malignant ventricular arrhythmias, hyperlipidemia, rhabdomyolysis, lactic acidosis, and biventricular cardiac failure. He did not survive. 

There have been several reports of lactic acidosis with and without rhabdomyolysis after propofol infusion, and two fatal cases have been reported (964). 

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. 

Lactic acidosis and rhabdomyolysis have been reported in a child receiving an infusion of propofol for sedation in an intensive care unit (965). 

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

Rhabdomyolysis has been reported in two patients receiving propofol for sedation while being ventilated for severe asthma (69). 

A 47-year-old woman had an infusion of propofol 200 micrograms/kg/minute for 4 days. On day 2 she developed hematuria, and laboratory investigations showed renal insufficiency with hyperkalemic metabolic acidosis. She died as a result of rhabdomyolysis with cardiac involvement. 

Although in none of these cases was a definitive link between propofol and the pathology established, the authors pointed out that several other cases have been reported, especially in children. Clinicians should be more aware that propofol may cause rhabdomyolysis, which appears to occur particularly at high doses. 

The propofol-infusion syndrome consists of a metabolic acidosis, rhabdomyolysis, and cardiovascular collapse. It occurs after prolonged infusion of propofol (over 48 hours) and has generally been reported in children, but also occasionally in adults. 

Stelow EB, Johari VP, Smith SA, Crosson JT, Apple FS. Propofol-associated rhabdomyolysis with cardiac involvement in adults chemical and anatomic findings. Clin Chem 2000 46(4) 577-81. 

Cannon ML, Glazier SS, Bauman LA. Metabolic acidosis, rhabdomyolysis, and cardiovascular collapse after prolonged propofol infusion. J Neurosurg 2001 95(6) 1053-6. 

D. Propofol infusion syndrome, a condition of metabolic (lactic) acidosis, renal failure, rhabdomyolysis, and cardiovascular collapse, has been reported after prolonged hIgh-dose infusion in both pediatric and adult populations. 

Metabolism The propofol infusion syndrome has been predominantly reported anecdotally. Now the incidence has been assessed in a prospective, multicenter, observational study in 1017 patients who received propofol for at least 24 hours [41 ]. The syndrome was defined as a metabolic acidosis plus cardiac dysfunction plus one or more of rhabdomyolysis, hypertriglyceridemia, and renal failure. The criteria were satisfied in 11 patients (1.1%) 2 developed 3 criteria within 24 hours of propofol infusion and 10 developed three criteria within 3 days. Susceptibility factors were identified 10 of the 11 patients... 

Propofol infusion syndrome Propofol infusion syndrome has been reported in children and adults after short-term high-dose propofol. It presents with variations of severe metabolic acidosis, rhabdomyolysis, myoglobinuria, cardiac failure, and death. The pathophysiology is unknown, but genetic predisposition, mitochondrial inhibition, and increases in serum free fatty acids are believed to play a role. Catecholamines and corticosteroids may act as triggering agents. 

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... 

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