TY - JOUR
T1 - Propofol infusion syndrome in patients with refractory status epilepticus
T2 - An 11-year clinical experience
AU - Iyer, Vivek N.
AU - Hoel, Rebecca
AU - Rabinstein, Alejandro A.
N1 - Funding Information:
Supported, in part, by grant 1 UL1 RR024150 from the National Center for Research Resources (NCRR), a component of the U.S. National Institutes of Health (NIH), and the NIH Roadmap for Medical Research. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the NCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov/ . Information on Reengineering the Clinical Research Enterprise can be obtained from: http://nihroadmap.nih.gov .
PY - 2009/12
Y1 - 2009/12
N2 - Objective: Propofol is a sedative, anesthetic, and antiepileptic agent that is frequently used in patients with refractory status epilepticus. Propofol infusion syndrome 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 refractory status epilepticus. Design: Retrospective study with outcome assessment. Setting: Intensive care units at Mayo Clinic. Patients: Intensive care unit admissions with refractory status epilepticus. Interventions: None. Measurements and main results: A computer-assisted search identified 41 consecutive patients from January 1997 to September 2008 admitted to our intensive care unit with refractory status epilepticus, defined by the need for continuous intravenous infusion of anesthetic agents to control seizures. Propofol infusion syndrome was defined per previously published criteria. The study population consisted of 24 males and 17 females with a median age of 51 yrs (range, 0.25-80). Propofol was used in 31 (76%) of these patients (propofol group), and other agents like midazolam, lorazepam, and pentobarbital were used in the other ten (24%) patients (nonpropofol group). Median hospital (12 days; range, 2-112) and intensive care unit length of stay (9 days; range, 2-95) did not differ among the two groups. Propofol was used for a median of 63 hrs (range, 2-391) with a median cumulative dosage of 12,750 mg (range, 336-57,545). The median peak infusion rate was 67 μg/kg/min (range, 19-200). There were three sudden unexplained cardiorespiratory arrests in the propofol group (3 of 31, 10%), of which two were fatal. These three patients were aged 37, 46, and 55 yrs and had no prior cardiopulmonary disease. Eleven additional patients (11 of 31, 35%) had non-life-threatening features of propofol infusion syndrome. There were no such events noted in the nonpropofol group. Conclusions: The prolonged use of large doses of propofol to treat refractory status epilepticus was associated with significant mortality and morbidity.
AB - Objective: Propofol is a sedative, anesthetic, and antiepileptic agent that is frequently used in patients with refractory status epilepticus. Propofol infusion syndrome 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 refractory status epilepticus. Design: Retrospective study with outcome assessment. Setting: Intensive care units at Mayo Clinic. Patients: Intensive care unit admissions with refractory status epilepticus. Interventions: None. Measurements and main results: A computer-assisted search identified 41 consecutive patients from January 1997 to September 2008 admitted to our intensive care unit with refractory status epilepticus, defined by the need for continuous intravenous infusion of anesthetic agents to control seizures. Propofol infusion syndrome was defined per previously published criteria. The study population consisted of 24 males and 17 females with a median age of 51 yrs (range, 0.25-80). Propofol was used in 31 (76%) of these patients (propofol group), and other agents like midazolam, lorazepam, and pentobarbital were used in the other ten (24%) patients (nonpropofol group). Median hospital (12 days; range, 2-112) and intensive care unit length of stay (9 days; range, 2-95) did not differ among the two groups. Propofol was used for a median of 63 hrs (range, 2-391) with a median cumulative dosage of 12,750 mg (range, 336-57,545). The median peak infusion rate was 67 μg/kg/min (range, 19-200). There were three sudden unexplained cardiorespiratory arrests in the propofol group (3 of 31, 10%), of which two were fatal. These three patients were aged 37, 46, and 55 yrs and had no prior cardiopulmonary disease. Eleven additional patients (11 of 31, 35%) had non-life-threatening features of propofol infusion syndrome. There were no such events noted in the nonpropofol group. Conclusions: The prolonged use of large doses of propofol to treat refractory status epilepticus was associated with significant mortality and morbidity.
KW - Intensive care unit
KW - Mortality
KW - Propofol infusion syndrome
KW - Refractory status epilepticus
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UR - http://www.scopus.com/inward/citedby.url?scp=73349137319&partnerID=8YFLogxK
U2 - 10.1097/CCM.0b013e3181b08ac7
DO - 10.1097/CCM.0b013e3181b08ac7
M3 - Article
C2 - 19661801
AN - SCOPUS:73349137319
SN - 0090-3493
VL - 37
SP - 3024
EP - 3030
JO - Critical care medicine
JF - Critical care medicine
IS - 12
ER -