Abstracts

Propofol is increasingly more popular for the treatment of status epilepticus due to the short half-life and ease of use. In children a rare but serious complication with acidosis and rhabdomyolysis has been reported. Propofol infusion syndrome in children includes cardiac and renal failure, rhabdomyolysis and severe metabolic acidosis. In children prolonged use ([gt]48 hours) and doses above 5 mg/kg/hr have been associated with propofol infusion syndrome. We report an adult case of status epilepticus treated with propofol. The patient died of propofol infusion syndrome as a consequence. A 36 years old women with intractable, localization related epilepsy was admitted due to non-convulsive status epilepticus. The patient was chronically treated with topiramate. Two weeks prior she had delivered a healthy girl after a complicated pregnancy. The patient required intubation after administration of benzodiazepines. Propofol was administered for intubation. While on propofol the patient continued to have motor activity and epileptiform EEG changes. Propofol was increased but the patient was never treated with higher doses than 5mg/kg/hr. With the addition of phenobarbital and valproic acid, status epilepticus was eventually controlled. The patient remained in a burst suppression pattern on EEG. Propofol was reduced to sedative doses, but 48 hours after admission the patient developed severe rhabdomyolysis, renal failure, lactic acidosis and cardiomyopathy. Despite several attempts of cardioversion the patient died of bradyarrhythmia on the fourth day after admission. Propofol infusion syndrome with rhabdomyolysis, renal failure, lactic acidosis and bradyarrhythmias does not only occur in children but also occurs in adults. It can be a deadly complication of the treatment of status epilepticus. Caution should be used if prolonged propofol infusion is required for status epilepticus. Patients should be monitored for signs of myolysis and acidosis.