Propofol-Related Infusion Syndrome in a Child With Refractory Status Epilepticus: Successful Resuscitation With Veno-Arterial Extracorporeal Membrane Oxygenation, Continuous Renal Replacement Therapy, and Therapeutic Plasma Exchange

Joshua Calvano; Matthew R Paluska; Arthur J Armijo; Timothy R Petersen; Codruta Soneru; Alia Broman; Gloria Lopez-Hernandez

doi:10.7759/cureus.47866

Propofol-Related Infusion Syndrome in a Child With Refractory Status Epilepticus: Successful Resuscitation With Veno-Arterial Extracorporeal Membrane Oxygenation, Continuous Renal Replacement Therapy, and Therapeutic Plasma Exchange

Cureus. 2023 Oct 28;15(10):e47866. doi: 10.7759/cureus.47866. eCollection 2023 Oct.

Authors

Joshua Calvano¹, Matthew R Paluska², Arthur J Armijo³, Timothy R Petersen^{4

1

5}, Codruta Soneru¹, Alia Broman⁶, Gloria Lopez-Hernandez⁷

Affiliations

¹ Department of Anesthesiology and Critical Care, University of New Mexico School of Medicine, Albuquerque, USA.
² Department of Anesthesiology, Rocky Vista University College of Osteopathic Medicine, Englewood, USA.
³ Department of Graduate Medical Education, Healthcare Corporation of America/HealthOne, Lone Tree, USA.
⁴ Department of Graduate Medical Education, University of New Mexico School of Medicine, Albuquerque, USA.
⁵ Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, USA.
⁶ Department of Pediatrics, University of Colorado School of Medicine, Denver Health Medical Center, Denver, USA.
⁷ Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, USA.

Abstract

Propofol is used for sedation, anxiolysis, anesthesia induction, and as an anticonvulsant. In cases of refractory status epilepticus (RSE), propofol is more efficient than barbiturates. We present a case of a 3-year-old female with RSE who developed propofol-related infusion syndrome (PRIS) despite low dosage after failed attempts with multiple anti-epileptic drips and bolus therapies. Careful consideration must be made before initiating propofol administration for RSE. We discuss our PRIS treatment approach with extracorporeal membrane oxygenation, therapeutic plasma exchange, and continuous renal replacement therapy leading to our patient recovering to baseline and being discharged home from the hospital.

Keywords: continuous renal replacement therapy (crrt); propofol infusion syndrome; refractory status epilepticus; therapeutic plasma exchange (tpe); va-ecmo.

Publication types

Case Reports