Propofol infusion syndrome (PRIS) is a rare but lethal complication. Which combination of features should trigger immediate suspicion of PRIS?

• A Hypoglycaemia, hypertension, and thrombocytopenia after short propofol infusion
• B Hyperthermia, muscle rigidity, and autonomic instability in young males
• C Bradycardia and hypotension at standard induction doses
• D Metabolic acidosis with high anion gap, rhabdomyolysis, hyperlipidaemia, cardiac failure (new RBBB or ST elevation), and hepatomegaly in ICU patients on high-dose propofol (>4–5 mg/kg/hr for >48 hours) ✓

Explanation

Propofol infusion syndrome manifests with metabolic acidosis (high anion gap due to lactate + ketone bodies), rhabdomyolysis (myoglobinaemia), hypertriglyceridaemia, hepatomegaly/hepatic failure, and cardiac failure (characteristic ECG pattern: new right bundle branch block, ST elevation mimicking Brugada pattern). It results from propofol impairing mitochondrial respiratory chain complexes (I and II) and fatty acid oxidation, causing cellular energy failure. Risk factors: >4 mg/kg/hr, duration >48 hours, concomitant catecholamines/corticosteroids, and carbohydrate depletion. Management: stop propofol immediately and switch to alternative sedation.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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