Propofol-Related Infusion Syndrome in the Peripartum Period

Abstract

Background Propofol is a widely known, commonly used drug. Complications can occur with the use of this drug, including propofol-related infusion syndrome (PRIS). PRIS, in the obstetric population, has not been documented; however, we report a case of a patient who developed PRIS after an emergent cesarean delivery of a preterm infant.

Case Study A 35-year-old multigravida woman presented complaining of leakage of fluid and decreased fetal movement. Her pregnancy was complicated by methadone maintenance therapy due to a history of opioid abuse. Complications after admission for prolonged monitoring and a prolonged fetal heart tone deceleration was noted with no recovery despite intrauterine resuscitation. An emergent cesarean delivery was performed using general anesthesia and endotracheal intubation after which she developed aspiration pneumonia. She was admitted to the intensive care unit and reintubation and sedation were required secondary to respiratory distress. Sedation was achieved using propofol infusion. She subsequently developed changes in her electrocardiogram, an increase of her serum creatinine, creatinine protein kinase, lipase, amylase, and triglycerides, making the diagnosis of PRIS.

Conclusion PRIS should be included in the differential diagnosis of intubated or postoperative patients in the obstetric population.

Keywords

PRIS - infusion syndrome - pregnancy - obstetrics

• References

• 1 Orsini J, Nadkarni A, Chen J, Cohen N. Propofol infusion syndrome: case report and literature review. Am J Health Syst Pharm 2009; 66 (10) 908-915
• 2 Bray RJ. Propofol infusion syndrome in children. Paediatr Anaesth 1998; 8 (6) 491-499
• 3 Wong JM. Propofol infusion syndrome. Am J Ther 2010; 17 (5) 487-491
• 4 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; 201: 346968
• 5 Roberts RJ, Barletta JF, Fong JJ , et al. Incidence of propofol-related infusion syndrome in critically ill adults: a prospective, multicenter study. Crit Care 2009; 13 (5) R169
• 6 Imam TH. Propofol-related infusion syndrome: role of propofol in medical complications of sedated critical care patients. Perm J 2013; 17 (2) 85-87
• 7 Chukwuemeka A, Ko R, Ralph-Edwards A. Short-term low-dose propofol anaesthesia associated with severe metabolic acidosis. Anaesth Intensive Care 2006; 34 (5) 651-655
• 8 Savard M, Dupré N, Turgeon AF, Desbiens R, Langevin S, Brunet D. Propofol-related infusion syndrome heralding a mitochondrial disease: case report. Neurology 2013; 81 (8) 770-771
• 9 Vanlander AV, Jorens PG, Smet J , et al. Inborn oxidative phosphorylation defect as risk factor for propofol infusion syndrome. Acta Anaesthesiol Scand 2012; 56 (4) 520-525