Propofol Infusion Syndrome


A.A. Birkun, A.A. Babanin, M.A. Glotov, A.L. Govdalyuk, P.V. Mel’nychenko, N.Yu. Pylaeva, S.A. Samarin, M.I. Fedosov

Medical Academy named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University, Simferopol

For correspondence: Alexei A. Birkun — Cand. Sci. Med., assistant professor of the chair of anesthesiology-resuscitaion and emergency medicine in Medical Academy named after S.I. Georgievsky of V.I. Vernadsky Crimean Federal University; e-mail:

For citation: Birkun AA, Babanin AA, Glotov MA, Govdalyuk AL, Mel’nychenko PV, Pylaeva NYu, Samarin SA, Fedosov MI. Propofol Infusion Syndrome. Intensive Care Herald. 2016;3:38–42. 

Propofol infusion syndrome (PRIS) is rare but extremely dangerous complication of propofol administration that is characterized by increased mortality level. Pathogenesis of PRIS is represented by the conjunction of intensified lipolysis, disturbances of fatty acid oxidation and impaired mitochondrial respiratory chain function. PRIS typically develops in patients with critical conditions receiving continuous high-dose propofol infusion and presents as lactate acidosis, rhabdomyolysis and acute circulatory failure. For PRIS there is no specific treatment and the prognosis is largely determined by an ability of the clinician to recognize the syndrome early and stop propofol administration. This review provides a modern insight into pathogenesis, clinical presentations, preventive measures and intensive care of the syndrome and is generally intended to raise an alertness and improve understanding of the problem among practicing physicians.

Keywords: propofol infusion syndrome, PRIS, propofol, hyperlipidemia, rhabdomyolysis, acidosis, Brugada syndrome, ECMO

Received: 26.03.2016


  1. Krajcova A., Waldauf P., Andel M., Duska F. Propofol infusion syndrome: a structured review of experimental studies and 153 published case reports. Care. 2015; 19: 398. doi: 10.1186/s13054-015-1112-5.
  2. Справочник Видаль «Лекарственные препараты в России» — описание лекарственных средств. URL: (дата обращения: 18.02.2016). [Spravochnik Vidal’ Lekarstvennye preparaty v Rossii — opisanie lekarstvennykh sredstv. URL: (accessed: 18.02.2016) (In Russ)]
  3. Kotani Y., Shimazawa M., Yoshimura S. et al. The experimental and clinical pharmacology of propofol, an anesthetic agent with neuroprotective properties. CNS Neurosci. Ther. 2008; 14: 95–106. doi: 10.1111/j.1527-3458.2008.00043.x.
  4. Mayette M., Gonda J., Hsu J.L., Mihm F.G. Propofol infusion syndrome resuscitation with extracorporeal life support: a case report and review of the literature. Ann. Intensive Care. 2013; 3(1): 32. doi: 10.1186/2110-5820-3-32.
  5. Mijzen E.J., Jacobs B., Aslan A., Rodgers M.G. Propofol infusion syndrome heralded by ECG changes. Neurocrit. Care. 2012; 17: 260–264. doi: 10.1007/s12028-012-9743-8.
  6. Vanlander A.V., Jorens P.G., Smet J. et al. Inborn oxidative phosphorylation defect as risk factor for propofol infusion syndrome. Acta Anaesthesiol. Scand. 2012; 56: 520–525. doi: 10.1111/j.1399-6576.2011.02628.x.
  7. Levin P.D., Levin V., Weissman C. et al. Therapeutic plasma exchange as treatment for propofol infusion syndrome. J. Clin. Apher. 2015; 30: 311–313. doi: 10.1002/jca.21376.
  8. Bray R.J. Propofol infusion syndrome in children. Paediatric Anaesthesia. 1998; 8: 491-499.
  9. Diaz J.H., Prabhakar A., Urman R.D., Kaye A.D. Propofol infusion syndrome: a retrospective analysis at a level 1 trauma center. Crit. Care Res. Pract. 2014; 2014: 346968. doi: 10.1155/2014/346968.
  10. Mirrakhimov A.E., Voore P., Halytskyy O. et al. Propofol infusion syndrome in adults: a clinical update. Crit. Care Res. Pract. 2015; 2015: 260385. doi: 10.1155/2015/260385.
  11. Roberts R.J., Barletta J.F., Fong J.J. et al. Incidence of propofol-related infusion syndrome in critically ill adults: a prospective, multicenter study. Crit. Care. 2009; 13: R169. doi: 10.1186/cc8145.
  12. Smith H., Sinson G., Varelas P. Vasopressors and propofol infusion syndrome in severe head trauma. Neurocrit Care. 2009; 10: 166–1 doi: 10.1007/s12028-008-9163-y.
  13. Corbett S.M., Montoya I.D., Moore F.A. Propofol-related infusion syndrome in intensive care patients. 2008; 28: 250–258. doi: 10.1592/phco.28.2.250.
  14. Лесной И.И., Черний В.И. Изменение показателей центральной гемодинамики при проведении эпидуральной аналгезии у больных с аналгоседацией и ИВЛ. Український журнал екстремальної медицини імені Г.О. Можаєва. 2012; 13: 49–53. [Lisnyy I.I., Chernyy V.I. The hemodynamic changes during administration of epidural analgesia in patients getting analgosedation and mechanical ventilation. Ukraїns’kii zhurnal ekstremal’noї meditsini іmenіO. Mozhaєva. 2012; 13: 49–53. (In Russ)]
  15. Бабак С.И., Крутой С.В., Злочевский А.Н. Опыт применения препарата Пропофол-Ново в нашей клинике. Медицина неотложных состояний. 2014; 6: 110–112. [Babak S.I., Krutoy S.V., Zlochevsky A.N. Experience of Propofol-Novo application in our clinic. Meditsina neotlozhnykh sostoyanii. 2014; 6: 110–11 (In Russ)]
  16. Черний Т.В., Стецик В.Ю., Черний В.И. Черепно-мозговая травма в аспекте доказательной медицины: обзор актуальных международных рекомендаций. Медицина неотложных состояний. 2014; 5: 16–19. [Cherniy T.V., Stetsik V.Yu., Cherniy V.I. Traumatic brain injury in terms of evidence-based medicine: an overview of current international guidelines Meditsina neotlozhnykh sostoyanii. 2014; 5: 16–19. (In Russ)]
  17. Фесенко У.А. Синдром пропофолової інфузії. Український журнал екстремальної медицини імені Г.О.Можаєва. 2013; 14(4): 129–132. [Fesenko A. Propofol infusion syndrome. Ukraїns’kii zhurnal ekstremal’noї meditsini іmenі G.O. Mozhaєva. 2013; 14(4): 129–132. (In Russ)]
  18. Vasile B., Rasulo F., Candiani A., Latronico N. The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Med. 2003; 29: 1417–1425.
  19. Wolf A., Weir P., Segar P. et al. Impaired fatty acid oxidation in propofol infusion syndrome. Lancet. 2001; 357: 606–607.
  20. Jouven X., Charles M.A., Desnos M., Ducimetiere P. Circulating nonesterified fatty acid level as a predictive risk factor for sudden death in the population. Circulation. 2001; 104: 756–761.
  21. Vanlander A.V., Okun J.G., de Jaeger A. et al. Possible pathogenic mechanism of propofol infusion syndrome involves coenzyme Q. Anesthesiology. 2015; 122: 343–3 doi: 10.1097/ALN.0000000000000484.
  22. Merz T.M., Regli B., Rothen H.-U., Felleiter P. Propofol infusion syndrome — a fatal case at a low infusion rate. Anesth. Analg. 2006; 103: 1050.
  23. Casserly B., O’Mahony E., Timm E.G. et al. Propofol infusion syndrome: an unusual cause of renal failure. Am. J. Kidney Dis. 2004; 44: e98–101.
  24. Myburgh J.A., Upton R.N., Grant C., Martinez A. Epinephrine, norepinephrine and dopamine infusions decrease propofol concentrations during continuous propofol infusion in an ovine model. Intensive Care Med. 2001; 27: 276–282.
  25. Kam P.C., Cardone D. Propofol infusion syndrome. Anaesthesia. 2007; 62: 690–701.
  26. Annen E., Girard T., Urwyler A. Rare, potentially fatal, poorly understood propofol infusion syndrome. Clin. Pract. 2012; 2: e79. doi: 10.4081/cp.2012.e79.
  27. Savard M., Dupre N., Turgeon A.F. et al. Propofol-related infusion syndrome heralding a mitochondrial disease: case report. Neurol 2013; 81: 770–771. doi: 10.1212/WNL.0b013e3182a1aa78.
  28. Vernooy K., Delhaas T., Cremer O.L. Electrocardiographic changes predicting sudden death in propofol-related infusion syndrome. Heart Rhythm. 2006; 3: 131–137.
  29. Timpe E.M., Eichner S.F., Phelps S.J. Propofol-related infusion syndrome in critically ill pediatric patients: coincidence, association, or causation? J. Pediatr. Pharmacol. Ther. 2006; 11: 17–42. doi: 10.5863/1551-6776-11.1.17.
  30. Walsh R.J., Amato A.A. Toxic myopathies. Neurologic Clinics. 2005; 23: 397–428.
  31. Ahlen K., Buckley C.J., Goodale D.B., Pulsford A.H. The ‘propofol infusion syndrome’: the facts, their interpretation and implications for patient care. Eur. J. Anaesthesiol. 2006; 23: 990–998.
  32. Cannon M.L., Glazier S.S., Bauman L.A. Metabolic acidosis, rhabdomyolysis and cardiovascular collapse after prolonged propofol infusion. J. Neurosurg. 2001; 95: 1053–1056.
  33. Parke T.J., Stevens J.E., Rice A.S. et al. Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. 1992; 305: 613–616.
  34. Blum J.M., Brunsvold M.E. Non-acidotic propofol infusion syndrome. Br. J. Anaesth. 2009; 103: 617–618. doi: 10.1093/bja/aep252.
  35. Culp K.E., Augoustides J.G., Ochroch A.E., Milas B.L. Clinical management of cardiogenic shock associated with prolonged propofol infusion. Anesth. Analg. 2004; 99: 221–226.
  36. Guitton C., Gabillet L., Latour P. et al. Propofol Infusion syndrome during refractory status epilepticus in a young adult: successful ECMO resuscitation. Neurocrit. Care. 2011; 15: 139–145. doi: 10.1007/s12028-010-9385-7.
  37. Vitali S., Cronly S. Six days of veno-arterial ECMO rescue therapy for propofol infusion syndrome occuring despite reassuring biochemical markers. Am. J. Respir. Crit. Care Med. 2015; 191: A6222.
  38. Cray S.H., Robinson B.H., Cox P.N. Lactic acidemia and bradyarrhythmia in a child sedated with propofol. Crit. Care Med. 1998; 26: 2087–2092.
  39. Shimony A., Almog Y., Zahger D. Propofol infusion syndrome: a rare cause of multi-organ failure in a man with complicated myocardial infarction. Med. Assoc. J. 2008; 10: 316–317.