Propofol-related infusion syndrome (PRIS) - a review

Propofol related infusion syndrome (PRIS) is a rare and controversial clinical entity that was described in patients who got this sedative drug for long periods of time, mainly in the critical care environment, and very often in doses larger than those recommended by literature. Initially it was described in children, but soon some cases of adult patients in critical condition were published. Acute neurological conditions such as head trauma or status epilepticus are among those clinical situations that predispose to PRIS development. PRIS is characterized by severe clinical and laboratory signs, such as bradycardia, cardiac failure, hypotension not responding to vasopressors, lactic acidosis, and signs of rhabdomyolysis. It seems that administration of propofol in large doses and for long duration has a pathological influence on mitochondrial activity, but disturbances in lipid metabolism and free fatty utilization have also been incriminated as being part of the pathophysiological explanation of the syndrome. The article presents the main prophylactic measures to be taken when propofol is administered in large doses and for long periods of time, as well as proposals for management of PRIS. Since a good part of the literature questions even the existence of the syndrome, the article presents some data regarding this controversy and proposes a very careful approach to every case in which PRIS is suspected.