PURPOSE: Propofol is a widely used sedative, anesthetic and antiepileptic agent that is frequently used in patients with refractory status epilepticus (RSE). Propofol Infusion Syndrome (PRIS) is a feared complication of propofol use especially at high infusion rates for prolonged periods. The present study describes the use of propofol and its associated complications in patients with RSE.
METHODS: A computer-assisted database search identified 39 consecutive patients from 1997 to 2007 admitted to our ICU with RSE; defined by the need for continuous IV infusion of anesthetic agents to control seizures. PRIS was defined by the unexplained presence of >= 1 of the following: metabolic acidosis; rhabdomyolysis; bradycardia and cardiac arrest.
RESULTS: The 39 patients consisted of 24 males and 15 females with a median age of 54 years (range, 9 to 80). Anesthetic agents were infused for a median duration of 6 days (range, 1–55). Propofol was used in 32 (82%) of these patients (Group A) and other agents like versed and pentobarbitol were used in the other 7 (18%) patients (Group B). Median hospital (12 days, range: 2–112) and ICU length of stay (LOS) (9 days, range: 2–95) did not differ amongst the two groups. Propofol was used for a median of 63 hrs (range, 2–391) with a median cumulative dosage of 12750 mg (range, 336 -57545). The median peak infusion rate was 67 mcg/kg/min (range, 19–200). Bradycardia occurred in 7 patients in Group A but in only 1 patient in Group B. There were 3 sudden unexplained cardio-respiratory arrests in Group A (3/32, 10%), of which two were fatal. These 3 patients were aged between 35–55 years with no prior cardio-pulmonary disease. No similar events were noted in Group B.
CONCLUSION: The use of propofol to treat RSE was associated with significant mortality and morbidity. No obvious benefits in terms of seizure control, Hospital LOS or ICU LOS were discernable for patients given propofol.
CLINICAL IMPLICATIONS: Propofol should be used with extreme caution in patients with RSE.
DISCLOSURE: Vivek Iyer, None.