Propofol infusion syndrome in patients with refractory status epilepticus: An 11-year clinical experience

Vivek N. Iyer, Rebecca Hoel, Alejandro Rabinstein

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)3024-3030
Number of pages7
JournalCritical Care Medicine
Volume37
Issue number12
DOIs
StatePublished - Jan 1 2009

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Status Epilepticus
Propofol
Intensive Care Units
Anesthetics
Intravenous Anesthetics
Lorazepam
Propofol Infusion Syndrome
Midazolam
Pentobarbital
Hypnotics and Sedatives
Intravenous Infusions
Anticonvulsants
Length of Stay
Patient Care
Seizures
Retrospective Studies
Outcome Assessment (Health Care)
Morbidity
Mortality

Keywords

  • Intensive care unit
  • Mortality
  • Propofol infusion syndrome
  • Refractory status epilepticus

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Propofol infusion syndrome in patients with refractory status epilepticus : An 11-year clinical experience. / Iyer, Vivek N.; Hoel, Rebecca; Rabinstein, Alejandro.

In: Critical Care Medicine, Vol. 37, No. 12, 01.01.2009, p. 3024-3030.

Research output: Contribution to journalArticle

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abstract = "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.",
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AU - Hoel, Rebecca

AU - Rabinstein, Alejandro

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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.

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KW - Mortality

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KW - Refractory status epilepticus

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