Síndrome da infusão do propofol: artigo de revisão narrativa/ Propofol infusion syndrome: a narrative review

Rodrigo Andrade de Lima, Karolliny Correa Barauna, Rafaela Brasil e Silva Nunes

Abstract


Dado o uso cotidiano do propofol na prática anestésica, estudar seus efeitos adversos é imprescindível. Nesse contexto, a síndrome da infusão do propofol é um evento adverso possível e de alta relevância. O cenário nacional de publicações a respeito da temática carece de profundidade e este artigo objetiva fornecer uma revisão narrativa com recomendações e considerações atualizadas com égide na medicina baseada em evidências.  É um estudo qualitativo de revisão narrativa, constituído por uma análise ampla da literatura, incluindo artigos de 1996 a 2019. Os termos utilizados para a estratégia de busca foram: “síndrome da infusão do propofol” e “PRIS”. O propofol é um medicamento frequentemente utilizado. A administração de doses tóxicas pode cursar com eventos deletérios, como a síndrome da infusão do propofol, uma condição rara e potencialmente fatal, que ocorre geralmente com infusões prolongadas (>48h) e em altas doses (>5 mg/kg/hora) de propofol. As manifestações clínicas mais prevalentes são acidose metabólica de início recente e disfunção cardíaca. Importantes fatores etiológicos são: baixos níveis de carboidratos, uso de glicocorticoides e administração de vasopressores por via intravenosa. A dosagem sérica de creatina quinase, por sua vez, pode ser utilizada para triagem, pois é capaz de detectar pacientes de alto risco. É imperativo para o tratamento interromper a infusão da droga e estabilizar o paciente hemodinamicamente, devendo-se direcionar tratamento individualizado para cada manifestação clínica e laboratorial. Por fim, a medida preventiva mais importante é evitar taxas de infusão de propofol de mais de 5 mg/kg/hora por mais de 48 horas. As características farmacológicas do propofol fazem dele um medicamento muito importante no cenário atual da anestesiologia. O estudo mostrou que a prevalência dessa síndrome é baixa, mas que esta deve ser sempre lembrada pois é condição com elevada taxa de mortalidade. Um tratamento rápido deve ser oferecido de maneira a atingir a estabilidade hemodinâmica; e fazer uma história completa do paciente antes de iniciar uma infusão de propofol é imprescindível, pois alternativas com outro sedativo podem ser consideradas no ato anestésico. 


Keywords


síndrome da infusão do propofol, revisão da literatura

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DOI: https://doi.org/10.34117/bjdv6n3-287

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