Skip to main content

Propofol ,the unsafe aspects




Propofol infusion syndrome is characterized by severe lactic acidosis, rhabdomyolysis and lipidemia which can lead to cardiovascular collapse.


The suggested dose and duration to avoid propofol infusion syndrome in healthy patients is > 4 mg/kg/h over 48 hours.

The syndrome may occur with smaller doses and duration in children with  Mitochondrial diseases.The syndrome may occur with smaller doses and duration in children with underlying disorders (200 mcg/k/min over 150 min in a 7 y.o.)

Mitochondrial diseases affect ATP production and present as clinical disorders of skeletal muscle, brain and heart.

Propofol has several negative effects on mitochondrial ATP production which include:
 1) inhibition of enzyme activity of electron transport complex
2) inhibition of carnitine palmitoyl transferase 
 3) inhibition of

These depressant mitochondrial effects may account for proposal infusion syndrome occurring in these susceptible
patients.
Mitochondrial disorders have an incidence of one in 4000.

Also there are many case reports of anaphylaxis due to propofol in patients allergic to soya bean oil,or peanuts.


Faraq E, et al. Metabolic acidosis due to propofol infusion. Anesthesiology 2005;102:697-8.

Kill C, et al. Lacticacidosis after short-term infusion of propofol for anaesthesia in a child with
osteogenesis imperfecta. Paed Anaesth 2003;13:823-6.

Driesen J, et al. Anesthesia-related morbidity and mortality after surgery for muscle biopsy in children
with mitochondrial defects. Ped Anesth 2007;17:16-21.β-oxidation.
Labels:

Comments

Post a Comment

Popular posts from this blog

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...
Post a Comment
Read more

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients     Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...
1 comment
Read more

Lumbar and thoracic epidural in Pediatrics-Technical aspect

The midline approach is most commonly used. The ligamentum   flavum is considerably thinner and less dense in infants than in older children and adults. This makes recognition of engagement in the ligament more difficult and requires both extra care and slower, more deliberate passage of the needle to avoid subarachnoid puncture. The angle of approach to the epidural space is slightly more perpendicular to the plane of the back than in older children and adults, owing to the orientation of the spinous   processes in infants and small children. The loss of resistance technique should be used, but only with saline, not air. There are several reports of venous air embolism in infants and children when air was used to test for loss of resistance Use a short (5 cm) 18-gauge Tuohy needle and a 20- or 21-gauge catheter in infants and children. Epidural kits specifically for infants and children are available Maximum of 0.4 mg/kg/hr of bupivacaine after the initial block is estab...
Post a Comment
Read more