Papaioannou V, Dragoumanis C, Theodorou V, Pneumatikos I
Department of Critical Care Medicine, Democritus University of Thrace, Alexandroupolis Teaching Hospital, Greece.
Acta Anaesthesiol Belg. 2008;59(2):79-86.
Propofol is a short-acting intravenous anesthetic agent widely used for sedation in anesthesia and intensive care. However, during the last 15 years there have been quite a lot of publications reporting unexplained deaths among pediatric and adult critically ill patients. These cases shared common symptoms and signs unrelated with initial admission diagnosis and were under long-term propofol infusion at high doses. A new syndrome called 'propofol infusion syndrome' was defined, including cardiovascular instability, metabolic acidosis, hyperkalaemia and rhabdomyolysis, with no evidence for other known causes of myocardial failure. One common denominator in these patients was the presence of hypoxia and tissue hypoperfusion. It seems that during states of increased metabolic demand, the reduced energy production related to an inhibitory propofol action at the level of mitochondrial oxidative phosphorylation and lipid metabolism may lead to the manifestation of the syndrome. Furthermore, cases of early toxicity due to failure in cellular energy production with development of lactic acidosis have been also described during anesthesia. For the above reasons, recommendations for the limitation of propofol use have been devised by various institutions, whereas physicians need to be cautious when using prolonged propofol sedation and alert for early signs of toxicity.
丙泊酚是一种短效静脉麻醉剂，广泛用于麻醉和重症监护中的镇静。然而，在过去15年里，有相当多的出版物报道了儿科和成人重症患者中不明原因的死亡。这些病例具有与初始入院诊断无关的共同症状和体征，并且长期接受高剂量丙泊酚输注。一种名为“丙泊酚输注综合征”的新综合征被定义，包括心血管不稳定、代谢性酸中毒、高钾血症和横纹肌溶解，且没有其他已知心肌衰竭原因的证据。这些患者的一个共同特征是存在缺氧和组织灌注不足。在代谢需求增加的状态下，与丙泊酚在线粒体氧化磷酸化和脂质代谢水平的抑制作用相关的能量产生减少，可能导致该综合征的表现。此外，麻醉期间也描述了因细胞能量产生失败和乳酸酸中毒发展而导致的早期毒性病例。基于上述原因，各机构已制定了限制丙泊酚使用的建议，而医生在使用丙泊酚进行长时间镇静时需要谨慎，并警惕毒性的早期迹象。
