Department of Anesthesiology, Tokyo Women's Medical University, Tokyo, Japan.
Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
J Anesth. 2020 Aug;34(4):619-623. doi: 10.1007/s00540-020-02773-z. Epub 2020 Mar 28.
To this day, the pathophysiology and risk factors of propofol infusion syndrome (PRIS) remain unknown. Moreover, there is no widely accepted definition of PRIS, even though it is a potentially fatal condition. While many suspected cases of PRIS have been reported in both pediatric and adult populations, the actual propofol plasma concentration (Cp) has never been clarified. In this clinical report, we described the first suspected PRIS case in which the propofol Cp was measured 25 min after 226 min of propofol infusion (7.2 µg/mL), which was 12 times higher than the predicted value (0.6 µg/mL). In the presented case, we observed gradually progressive uncontrollable hypercapnia and tachycardia, followed by severe lactic acidosis during surgical anesthesia based on the target-controlled infusion of propofol. Levels of liver enzymes were slightly elevated which suggests little or no liver damage though propofol is mainly metabolized by the liver. Meanwhile, renal impairment, a common secondary feature of PRIS, occurred concomitantly when hypercapnia and metabolic acidosis were manifested. In this case, low or delayed propofol clearance might have been a triggering factor causing severe lactic acidosis.
时至今日，丙泊酚输注综合征（PRIS）的病理生理学和危险因素仍不清楚。此外，尽管 PRIS 是一种潜在致命的疾病，但它甚至没有一个被广泛接受的定义。虽然在儿科和成人人群中都报告了许多疑似 PRIS 的病例，但丙泊酚的实际血浆浓度（Cp）从未得到澄清。在本临床报告中，我们描述了首例疑似 PRIS 病例，该病例在丙泊酚输注 226 分钟后 25 分钟测量丙泊酚 Cp（7.2µg/mL），是预测值（0.6µg/mL）的 12 倍。在本例中，我们观察到在基于丙泊酚靶控输注的手术麻醉期间，逐渐出现无法控制的高碳酸血症和心动过速，随后出现严重的乳酸性酸中毒。肝酶水平略有升高，这表明丙泊酚主要在肝脏中代谢，尽管可能有轻微或没有肝损伤。同时，当出现高碳酸血症和代谢性酸中毒时，PRIS 的常见次要特征之一——肾功能损害也同时发生。在这种情况下，丙泊酚清除率低或延迟可能是导致严重乳酸性酸中毒的触发因素。
