Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Propofol Infusion Associated Metabolic Acidosis in Patients Undergoing Neurosurgical Anesthesia : A Retrospective Study

  • Choi, Yoon Ji (Department of Dental Anesthesiology, Seoul National University Dental Hospital) ;
  • Kim, Min Chul (Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital, Seoul National University) ;
  • Lim, Young Jin (Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University) ;
  • Yoon, Seung Zhoo (Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University) ;
  • Yoon, Suk Min (Department of Anesthesiology and Pain Medicine, College of Medicine, Korea University) ;
  • Yoon, Hei Ryeo (Department of Nutrition, Food Service Management, College of Industrial Science, Kongju National University)
  • Received : 2013.12.09
  • Accepted : 2014.08.16
  • Published : 2014.08.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Propofol and volatile anesthesia have been associated with metabolic acidosis induced by increased lactate. This study was designed to evaluate changes in pH, base excess (BE), and lactate in response to different anesthetic agents and to characterize propofol infusion-associated lactic acidosis. Methods : The medical records of patients undergoing neurosurgical anesthesia between January 2005 and September 2012 were examined. Patients were divided into 2 groups : those who received propofol (total intravenous anesthesia, TIVA) and those who received sevoflurane (balanced inhalation anesthesia, BIA) anesthesia. Propensity analysis was performed (1 : 1 match, n=47), and the characteristics of the patients who developed severe acidosis were recorded. Results : In the matched TIVA and BIA groups, the incidence of metabolic acidosis (11% vs. 13%, p=1) and base excess (p>0.05) were similar. All patients in the TIVA group who developed severe acidosis did so within 4 hours of the initiation of propofol infusion, and these patients improved when propofol was discontinued. Conclusions : The incidence of metabolic acidosis was similar during neurosurgical anesthesia with propofol or sevoflurane. In addition, severe acidosis associated with propofol infusion appears to be reversible when propofol is discontinued.

Keywords

References

  1. Betrosian AP, Papanikoleou M, Frantzeskaki F, Diakalis C, Georgiadis G : Myoglobinemia and propofol infusion. Acta Anaesthesiol Scand 49 : 720, 2005 https://doi.org/10.1111/j.1399-6576.2005.00569.x
  2. Burow BK, Johnson ME, Packer DL : Metabolic acidosis associated with propofol in the absence of other causative factors. Anesthesiology 101 : 239-241, 2004 https://doi.org/10.1097/00000542-200407000-00035
  3. Cravens GT, Packer DL, Johnson ME : Incidence of propofol infusion syndrome during noninvasive radiofrequency ablation for atrial flutter or fibrillation. Anesthesiology 106 : 1134-1138, 2007 https://doi.org/10.1097/01.anes.0000265421.40477.a3
  4. Cremer OL, Moons KG, Bouman EA, Kruijswijk JE, de Smet AM, Kalkman CJ : Long-term propofol infusion and cardiac failure in adult head-injured patients. Lancet 357 : 117-118, 2001 https://doi.org/10.1016/S0140-6736(00)03547-9
  5. De Waele JJ, Hoste E : Propofol infusion syndrome in a patient with sepsis. Anaesth Intensive Care 34 : 676-677, 2006
  6. Fudickar A, Bein B, Tonner PH : Propofol infusion syndrome in anaesthesia and intensive care medicine. Curr Opin Anaesthesiol 19 : 404-410, 2006 https://doi.org/10.1097/01.aco.0000236140.08228.f1
  7. Haase R, Sauer H, Eichler G : Lactic acidosis following short-term propofol infusion may be an early warning of propofol infusion syndrome. J Neurosurg Anesthesiol 17 : 122-123, 2005 https://doi.org/10.1097/01.ana.0000161267.63160.13
  8. Kill C, Leonhardt A, Wulf H : Lacticacidosis after short-term infusion of propofol for anaesthesia in a child with osteogenesis imperfecta. Paediatr Anaesth 13 : 823-826, 2003 https://doi.org/10.1046/j.1460-9592.2003.01114.x
  9. Koch M, De Backer D, Vincent JL : Lactic acidosis : an early marker of propofol infusion syndrome? Intensive Care Med 30 : 522, 2004 https://doi.org/10.1007/s00134-003-2130-3
  10. Liolios A, Guerit JM, Scholtes JL, Raftopoulos C, Hantson P : Propofol infusion syndrome associated with short-term large-dose infusion during surgical anesthesia in an adult. Anesth Analg 100 : 1804-1806, 2005 https://doi.org/10.1213/01.ANE.0000153017.93666.BF
  11. Marinella MA : Lactic acidosis associated with propofol. Chest 109 : 292, 1996 https://doi.org/10.1378/chest.109.1.292
  12. Marsh B, White M, Morton N, Kenny GN : Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth 67 : 41-48, 1991 https://doi.org/10.1093/bja/67.1.41
  13. Otterspoor LC, Kalkman CJ, Cremer OL : Update on the propofol infusion syndrome in ICU management of patients with head injury. Curr Opin Anaesthesiol 21 : 544-551, 2008 https://doi.org/10.1097/ACO.0b013e32830f44fb
  14. Roberts RJ, Barletta JF, Fong JJ, Schumaker G, Kuper PJ, Papadopoulos S, et al. : Incidence of propofol-related infusion syndrome in critically ill adults : a prospective, multicenter study. Crit Care 13 : R169, 2009 https://doi.org/10.1186/cc8145
  15. Rozet I, Tontisirin N, Vavilala MS, Treggiari MM, Lee LA, Lam AM : Prolonged propofol anesthesia is not associated with an increase in blood lactate. Anesth Analg 109 : 1105-1110, 2009 https://doi.org/10.1213/ANE.0b013e3181b5a220
  16. Salengros JC, Velghe-Lenelle CE, Bollens R, Engelman E, Barvais L : Lactic acidosis during propofol-remifentanil anesthesia in an adult. Anesthesiology 101 : 241-243, 2004 https://doi.org/10.1097/00000542-200407000-00036
  17. Ture H, Mercan A, Koner O, Aykac B, Ture U : The effects of propofol infusion on hepatic and pancreatic function and acid-base status in children undergoing craniotomy and receiving phenytoin. Anesth Analg 109 : 366-371, 2009 https://doi.org/10.1213/ane.0b013e3181a89641
  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 29 : 1417-1425, 2003 https://doi.org/10.1007/s00134-003-1905-x
  19. Wolf AR, Potter F : Propofol infusion in children : when does an anesthetic tool become an intensive care liability? Paediatr Anaesth 14 : 435-438, 2004 https://doi.org/10.1111/j.1460-9592.2004.01332.x

Cited by

  1. Safety and efficacy of propofol anesthesia for pediatric target-controlled infusion in children below 3 years of age: a retrospective observational study vol.17, pp.10, 2014, https://doi.org/10.1080/14740338.2018.1524460
  2. Hyperlactatemia After Intracranial Tumor Surgery Does Not Affect 6-Month Survival: A Retrospective Case Series vol.32, pp.1, 2014, https://doi.org/10.1097/ana.0000000000000594