Pancreatitis is common among patients with primary or secondary hypertriglyceridemia. Monitor Triglycerides To Avoid Propofol Infusion Syndrome May 12, 2015 by Dr. Clemens Leave a Comment It is disturbingly common, dangerously lethal and difficult to diagnose, yet propofol-related infusion syndrome (PRIS) may be detected before it happens, given proper vigilance by anesthesiologists. Medications including propofol, valproic acid, protease inhibitors, thiazides, olanzapine, mirtazapine, estrogen-containing oral contraceptives, tamoxifen, clomiphene, and isotretinoin (Scherer 2014) Identifying the cause of hypertriglyceridemia generally isn't critical for management. Propofol mechanism of action. The mechanism for propofol-induced pancreatitis is largely unknown, but hypertriglyceridemia and defects in lipid metabolism have been proposed.116Gottardis et al. Propofol, marketed as Diprivan, among other names, is a short-acting medication that results in a decreased level of consciousness and a lack of memory for events. Like most intravenous anesthetics, Propofol works by increasing GABA-mediated inhibatory tone in the CNS. Its uses include the starting and maintenance of general anesthesia, sedation for mechanically ventilated adults, and procedural sedation. It is also used for status epilepticus if other medications have not worked. Propofol infusion syndrome (PRIS) is a rare syndrome which affects patients undergoing long-term treatment with high doses of the anaesthetic and sedative drug propofol.It can lead to cardiac failure, rhabdomyolysis, metabolic acidosis, and kidney failure, and is often fatal. t has been suggested that long-medium chain triglyceride (LCT/MCT) emulsive propofol causes less injection pain than long chain triglyceride (LCT) emulsive propofol because of the decreased propofol concentration in the aqueous phase. It is known that propofol, a lipid‐based formula, can cause hypertriglyceridaemia, a phenomenon that was also demonstrated by this study. To identify the mechanism for reduced pain with LCT/MCT propofol, injection pain, bradykinin generation and complement activation with use of both propofol products were compared. Propofol has probably the commonly used intravenous anesthetic and is most frequently used for the induction of anesthesia. Propofol infusions for sedation should not exceed 4 mg kg −1 h −1 and routine monitoring of CK and triglycerides should be performed for the at-risk population. This mechanism does not explain the recurrence of pancreatitis in our patient because there was only a small increase in serum triglyceride levels (380 mg/dL) on rechallenge with propofol. Definition. We postulate that there may be more than one mechanism for propofol-induced pancreatitis. While propofol is known to increase TGs secondary to the lipid emulsion vehicle, this effect is typically seen 2.25 to 7 days after initiating therapy with normalization occurring within 72 hours. The term PRIS—propofol infusion syndrome—was originally coined by Bray in 1998 to describe the adverse effects associated with the use of propofol in the paediatric population. Hydrolysis of triglycerides in the pancreas leads to unbound fatty acids in high concentrations. Patients at risk of hyperlipidemia should be monitored for increases in serum triglycerides or serum turbidity. A proposed mechanism of hypertriglyceridaemia‐induced pancreatitis is as follows. Alternatively, LCT propofol generates bradykinin causing the injection pain and activates complement, but these effects when using LCT/MCT propofol have not … Since Propofol injectable emulsion is formulated in an oil-in-water emulsion, elevations in serum triglycerides may occur when Propofol is administered for extended periods of time.
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