Key Principles
- Prompt removal of propofol infusion
- Aggressive supportive care
- Consideration of haemodfiltration or plasma exchange
- VA ECMO in refractory cases
Initial Resuscitation & Supportive Care
- Management almost entirely supportive
- Stop the propofol and use alternative sedation
- Pacing and atropine - may be useless (the bradycardia is refractory)
- Vasopressors and inotropes - usually ineffective
- VA ECMO is the only answer if circulatory collapse with bradycardia has developed
- Nutrition with a satisfactory amount of carbohydrate to reduce the use of fat for metabolism
- Treatment of rhabdomyolysis
Specific Management
Enhanced Elimination
- Stop the Propofol infusion!
- Haemodialysis - wash out propofol and its toxic metabolites
- Plasma exchange may be required
Specific Management
- Carnitine - anecdotal