Metabolic acidosis associated with propofol in the absence of other causative factors.

PROPOFOL is commonly used for intensive care unit sedation and prolonged procedures in the adult population where both deep sedation and quick emergence are required. Several recent reports have described a “propofol infusion syndrome,” occurring in both pediatric and adult patients receiving prolonged high-dose infusions of propofol ( 75 g · kg 1 · min 1 24 h). The syndrome is characterized as a severe metabolic acidosis, sometimes associated with myocardial dysfunction, rhabdomyolysis, or death. Although some reports have documented high anion gap, lactic acidosis, others have documented only a metabolic acidosis without further characterization. All cases of propofol infusion syndrome reported thus far have occurred in critically ill patients receiving multiple other drugs, creating some controversy as to whether propofol alone was its cause. We now report a case of metabolic acidosis, without ventilatory depression or hypoxia, in an otherwise healthy patient receiving propofol as the sole anesthetic agent during an ablation for atrial fibrillation. Approval for this case review was obtained from the institutional review board of the Mayo Clinic College of Medicine.