Zhang Haibo, Liu Yezu, Liu Minlong, Li Bing, Li Haima
Department of Critical Medicine, Xi'an Daxing Hospital, Yan'an University, Shaanxi, People's Republic of China.
Department of Neurosurgery, Peking University People's Hospital, Peking University, Beijing, People's Republic of China.
SAGE Open Med Case Rep. 2025 Aug 19;13:2050313X251359394. doi: 10.1177/2050313X251359394. eCollection 2025.
Propofol is a commonly used sedative for the induction of clinical anesthesia and sedation maintenance in intensive care unit patients. However, in a minority of patients, prolonged infusion of propofol may cause metabolic acidosis, electrocardiographic abnormalities, arrhythmias, and rhabdomyolysis, a condition known as propofol-related infusion syndrome. If not promptly identified and managed, propofol-related infusion syndrome can be fatal. Propofol-related infusion syndrome typically occurs in critically ill patients in the intensive care unit and is less common in clinical surgical anesthesia. We herein report a case of a patient with hematospermia who developed propofol-related infusion syndrome perioperatively, receiving a large amount of propofol infusion in a short time due to agitation during anesthesia recovery. Arterial blood gas analysis indicated persistently increasing lactic acid and unresolving metabolic acidosis, leading to the patient's transfer to the intensive care unit for further treatment. During intensive care unit treatment, the patient received continuous propofol infusion for sedation, with doses reaching up to 10 μg/kg/min, and a total infusion duration of ~8 h. We highly suspected propofol-related infusion syndrome and discontinued propofol. The patient successfully recovered after continuous renal replacement therapy. Propofol-related infusion syndrome can occur in non-critically ill patients receiving short-term propofol; hence, caution is warranted when using this drug. Early blood purification therapy is recommended for a better recovery from propofol-related infusion syndrome, and alternative sedatives should be considered as needed.
丙泊酚是一种常用的镇静剂，用于诱导临床麻醉以及维持重症监护病房患者的镇静状态。然而，在少数患者中，长时间输注丙泊酚可能会导致代谢性酸中毒、心电图异常、心律失常和横纹肌溶解，这种情况被称为丙泊酚相关输注综合征。如果不能及时识别和处理，丙泊酚相关输注综合征可能会致命。丙泊酚相关输注综合征通常发生在重症监护病房的危重病患者中，在临床手术麻醉中较少见。我们在此报告一例血精患者，其在围手术期发生了丙泊酚相关输注综合征，由于麻醉恢复期间躁动，在短时间内接受了大量丙泊酚输注。动脉血气分析显示乳酸持续升高且代谢性酸中毒未缓解，导致患者被转至重症监护病房进行进一步治疗。在重症监护病房治疗期间，患者接受持续丙泊酚输注以维持镇静，剂量高达10μg/kg/min，总输注时间约8小时。我们高度怀疑为丙泊酚相关输注综合征并停用了丙泊酚。患者在接受持续肾脏替代治疗后成功康复。丙泊酚相关输注综合征可发生在接受短期丙泊酚治疗的非危重病患者中；因此，使用该药物时需谨慎。建议早期进行血液净化治疗以更好地从丙泊酚相关输注综合征中恢复，并应根据需要考虑使用其他镇静剂。
