Propofol Related Infusion Syndrome

Propofol Infusion Syndrome (PRIS) represents a rare but potentially fatal complication associated with the administration of propofol, characterized by acute refractory bradycardia progressing to asystole. This clinical state often manifests alongside metabolic acidosis, rhabdomyolysis, hyperkalemia, and cardiac dysfunction. High-risk populations include critically ill patients, particularly those with traumatic brain injuries, severe airway infections, or those receiving high doses of vasopressors and catecholamines. Early indicators such as unexplained lactic acidosis, Brugada-like EKG changes, and tea-colored urine—signaling myoglobinuria—require immediate clinical vigilance. Because PRIS can develop rapidly even after short-term exposure, clinicians must maintain a high index of suspicion. Treatment remains primarily supportive, necessitating the immediate discontinuation of propofol and, in severe cases, the consideration of advanced interventions like hemodialysis or extracorporeal membrane oxygenation (ECMO) to manage refractory cardiovascular collapse.