Acute pancreatitis associated with intravenous administration of propofol

Evaluation of causality in a systematic review of the literature

Samir Haffar, Ravinder Jeet Kaur, Sushil Kumar Garg, Joseph A. Hyder, Mohammad H Murad, Barham K. Abu Dayyeh, Fateh Bazerbachi

Research output: Contribution to journalReview article

Abstract

Acute pancreatitis (AP) associated with intravenous administration of propofol has been described with unknown causal relation. We therefore assessed this causality in a systematic review. Multiple databases were searched on 16 August 2017; studies were appraised and selected by two reviewers based on a priori criteria. Propofol causality was evaluated with the Naranjo scale and Badalov classification. We identified 18 studies from 11 countries with a total of 21 patients, and the majority had adequate methodological quality. The median age was 35 years (range, 4-77) and 10 (48%) were males. Overall, propofol was administrated in 8 patients as sedative along with induction/maintenance of anesthesia in 13 patients; median dose was 200 mg, with intermediate latency (1-30 days) in 14 (67%). Serum triglycerides were >1000 mg/dL in four patients. Severe AP was observed in four patients (19%). AP recurrence occurred in one out of two patients who underwent rechallenge. Mortality related to AP was 3/21(14%). Propofol was the probable cause of AP according to the Naranjo scale in 19 patients (89%). Propofol-induced AP has a probable causal relation and evidence supports Badalov class Ib. Hypertriglyceridemia is not the only mechanism by which propofol illicit AP. Propofol-induced AP was severe in 19% of patients with a mortality rate related to AP of 14%. Future research is needed to delineate whether this risk is higher if combined with other procedures that portend inherent risk of pancreatitis such as endoscopic retrograde cholangiopancreatography.

Original languageEnglish (US)
Pages (from-to)13-23
Number of pages11
JournalGastroenterology Report
Volume7
Issue number1
DOIs
StatePublished - Feb 1 2019

Fingerprint

Propofol
Causality
Pancreatitis
Intravenous Administration
Mortality
Hypertriglyceridemia
Endoscopic Retrograde Cholangiopancreatography
Hypnotics and Sedatives
Triglycerides
Anesthesia
Maintenance
Databases
Recurrence

Keywords

  • Acute pancreatitis
  • Drug-induced pancreatitis
  • Propofol
  • Systematic review

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Acute pancreatitis associated with intravenous administration of propofol : Evaluation of causality in a systematic review of the literature. / Haffar, Samir; Kaur, Ravinder Jeet; Garg, Sushil Kumar; Hyder, Joseph A.; Murad, Mohammad H; Abu Dayyeh, Barham K.; Bazerbachi, Fateh.

In: Gastroenterology Report, Vol. 7, No. 1, 01.02.2019, p. 13-23.

Research output: Contribution to journalReview article

Haffar, Samir ; Kaur, Ravinder Jeet ; Garg, Sushil Kumar ; Hyder, Joseph A. ; Murad, Mohammad H ; Abu Dayyeh, Barham K. ; Bazerbachi, Fateh. / Acute pancreatitis associated with intravenous administration of propofol : Evaluation of causality in a systematic review of the literature. In: Gastroenterology Report. 2019 ; Vol. 7, No. 1. pp. 13-23.
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abstract = "Acute pancreatitis (AP) associated with intravenous administration of propofol has been described with unknown causal relation. We therefore assessed this causality in a systematic review. Multiple databases were searched on 16 August 2017; studies were appraised and selected by two reviewers based on a priori criteria. Propofol causality was evaluated with the Naranjo scale and Badalov classification. We identified 18 studies from 11 countries with a total of 21 patients, and the majority had adequate methodological quality. The median age was 35 years (range, 4-77) and 10 (48{\%}) were males. Overall, propofol was administrated in 8 patients as sedative along with induction/maintenance of anesthesia in 13 patients; median dose was 200 mg, with intermediate latency (1-30 days) in 14 (67{\%}). Serum triglycerides were >1000 mg/dL in four patients. Severe AP was observed in four patients (19{\%}). AP recurrence occurred in one out of two patients who underwent rechallenge. Mortality related to AP was 3/21(14{\%}). Propofol was the probable cause of AP according to the Naranjo scale in 19 patients (89{\%}). Propofol-induced AP has a probable causal relation and evidence supports Badalov class Ib. Hypertriglyceridemia is not the only mechanism by which propofol illicit AP. Propofol-induced AP was severe in 19{\%} of patients with a mortality rate related to AP of 14{\%}. Future research is needed to delineate whether this risk is higher if combined with other procedures that portend inherent risk of pancreatitis such as endoscopic retrograde cholangiopancreatography.",
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