- Likely to be a combination of mitochondrial respiratory chain inhibition and impaired mitochondrial fatty acid metabolism
- Combination predisposes to intracellular dysfunction and apoptosis
- In addition propofol is a direct myocardial depressant
Respiratory chain Inhibition
- Inhibition by propofol of coenzyme Q and Cytochrome C
- Results in a failure of the electron transport chain, oxidative phosphorylation and ATP production
- Metabolism becomes increasingly anaerobic with massive lactate being production
Impairment of Fatty Acid Metabolism
- Conversion of FFAs to acetyl-CoA is blocked
- Thus no ATP is produced by lipolysis.
- FFA accumulate in blood stream contributing to the acidosis directly
- FFA accumulate in tissues leading to cardiac and skeletal myocyte ischaemia and necrosis