PRIS and steroids

Q: The addition of steroids to a patient who is on propofol infusion will  _____________ the risk of propofol infusion syndrome. (select one)

A) decreases

B) increases

Answer: B

Propofol when combined with steroids, acts as a triggering factor for propofol infusion syndrome. 

An improper unsterile handling of propofol may increase the infection rate, though not associated with steroid. Steroid may independently increase the rate of infection.

When continued at rates higher than 5 mg/kg/h for more than 48 hours, propofol may cause rhabdomyolysis, acute renal failure, metabolic acidosis, hyperkalemia, bradycadia, arrhythmia and hyperthermia. Mortality is very high at more than 80%. Syndrome is called 'propofol infusion syndrome' or PRIS. It should be noted that PRIS has been reported even at lower dose or in less than 48 hours time. 

Propofol may turn color of urine green. It is a benign effect of Propofol. Recognition of this side effect is important as it averts unnecessary workup and limits medical expenditures.

#pharmacology

References: 

1. 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 Sep;29(9):1417-25. doi: 10.1007/s00134-003-1905-x. Epub 2003 Aug 6. PMID: 12904852.

2. Merz TM, Regli B, Rothen HU, Felleiter P. Propofol infusion syndrome--a fatal case at a low infusion rate. Anesth Analg. 2006 Oct;103(4):1050. doi: 10.1213/01.ane.0000239080.82501.c7. PMID: 17000843.

3. Liolios A, Guérit 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. 2005 Jun;100(6):1804-1806. doi: 10.1213/01.ANE.0000153017.93666.BF. PMID: 15920217.

4. Singh A, Anjankar AP. Propofol-Related Infusion Syndrome: A Clinical Review. Cureus. 2022 Oct 17;14(10):e30383. doi: 10.7759/cureus.30383. PMID: 36407194; PMCID: PMC9671386.