The 2018 ACC/AHA classifies moderate hypertriglyceridemia as 150-499 mg/dL and severe hypertriglyceridemia as 500 mg/dL or more. Hyper-triglyceridemia is a risk factor for pancreatitis.14 Devlin et al performed a retrospective review of 159 adult patients in intensive care unit who received propofol for 24 hours or longer and had at least 1 serum triglyceride concentration. 4 Propofol has been speculated to cause pancreatitis by this mechanism. Allergic complications, which may include bronchospasm, have been reported with the formulation containing metabisulfite. Mackenzie N, Grant IS. Acute pancreatitis associated with intravenous administration of propofol: evaluation of causality in a systematic review of the literature. National Library of Medicine doi: 10.1097/CCE.0000000000000330. However, it is not clear whether this relationship (if any) is dose-related or idiosyncratic. Propofol is a short-acting anesthetic used to induce sedation in various ambulatory and inpatient surgical procedures. Serum triglyceride concentrations should be routinely monitored in these patients. Propofol is administered as a fat emulsion and has been shown to increase triglyceride levels when given as a prolonged infusion. Bethesda, MD 20894, Copyright Hypertriglyceridemia more than 1000 mg/dl was documented at time of acute pancreatitis in reports of propofol-pancreatitis; however, in other propofol, pancreatitis was documented in absence of hypertriglyceridemia . Unable to load your collection due to an error, Unable to load your delegates due to an error. US$ 39.95. Case description . report the occurrence of pancreatitis, a rare complication of propofol, in a 22-year-old man who underwent an uncomplicated esophagogastroduodenoscopy under sedation with IV propofol. Accessibility Hypertriglyceridemia and hypertriglyceridemia-associated pancreatitis are often seen in intensive care patients receiving propofol. Propofol-related infusion syndrome in intensive care patients. Propofol-related pancreatitis has been attributed to developed hypertriglyceridemia, a traditional etiology for acute pancreatitis . eCollection 2021 Jan. Kenes MT, McSparron JI, Marshall VD, Renius K, Hyzy RC. eCollection 2020 Dec. Subsequently, he presented to the ER with severe epigastric pain and vomiting and his condition was seen to deteriorate. The remaining three recommendations build on this. Postgrad Med J. Areas of uncertainty: There are several case reports in the literature that have shown an association between propofol and pancreatitis. Case Presentation: A 45-year-old woman with type 2 diabetes mellitus (DM) and dyslipidemia presented with a 2-day history of nausea, vomiting, and epigastric pain. Subscribe to journal. eCollection 2020 Dec. Corrado MJ, Kovacevic MP, Dube KM, Lupi KE, Szumita PM, DeGrado JR. Crit Care Explor. The median time from the start of propofol therapy to identification of hypertriglyceridemia was 54 hours (range 14-319 hrs). In addition to general anesthesia, it is used to sedate patients undergoing mechanical ventilation or short procedures such as endoscopy, transesophageal echocardiogram, and abscess drainage. In addition, alternative sedation strategies should be considered when hypertriglyceridemia is … Propofol has a remarkable safety profile. Propofol-Associated Hypertriglyceridemia in Coronavirus Disease 2019 Versus Noncoronavirus Disease 2019 Acute Respiratory Distress Syndrome. 2019 Feb;7(1):13-23. doi: 10.1093/gastro/goy038. Pancreatitis developed in three (10%) of the 29 patients with hypertriglyceridemia. Pharmacotherapy. ● In patients with very high triglyceride levels (above 1000 mg/dL [11.3 mmol/L]), pancreatitis may develop [ 112 ]. Case reports suggesting propofol-induced pancreatitis have reported serum triglyceride values as high as 1000 mg/dl (9). 2 Estrogen, vitamin A, and fat emulsions in total parenteral nutrition cause pancreatitis indirectly by inducing hypertriglyceridemia. triglyceride has also been reported with prolonged infusions of propofol1,5. US$ 199 . Systematic review of hypertriglyceridemia-induced acute pancreatitis: A more virulent etiology? Epub 2018 Nov 6. The patient's nurse subsequently noted acute hemiplegia of the right side. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. None of the patients in the three groups developed any feature suggestive of acute pancreatitis in the postoperative period. 2020 Oct 23;11:593931. doi: 10.3389/fendo.2020.593931. Serum triglyceride levels should be monitored during propofol use to avoid hypertriglyceridemia and pancreatitis. 2008 Jul-Aug;27(7-8):617-22. doi: 10.1016/j.annfar.2008.05.010. The patient's nurse subsequently noted acute hemiplegia of the right side. Propofol (“Diprivan”) by intravenous infusion with nitrous oxide: dose requirements and haemodynamic effects. Fahy LT, Van Mourik GA, Utting JE. Serum triglyceride concentrations should be routinely monitored in these patients. We report a case of propofol induced acute pancreatitis in an intensive care patient without elevation of serum triglyceride levels. At the time when hypertriglyceridemia was detected, the median infusion rate of propofol was 50 microg/kg/minute (range 5-110 microg/kg/min). eCollection 2021. Medical and surgical intensive care units. Comparison of propofol with methohexitone in the provision of anaesthesia for surgery under regional blockade. Parekh, Akarsh et al. • Hypertriglyceridemia: Because propofol is formulated within a 10% fat emulsion, hypertriglyceridemia is an expected side effect. Serum triglyceride concentrations should be routinely monitored in these patients. Study objectives: Hypertriglyceridemia and related pancreatitis due to the use of lipid emulsions such as propofol has been documented, but less is known about the additive adverse effects of propofol and clevidipine lipid emulsions in the literature. The effects of propofol on serum lipid concentrations remain controversial. Price includes VAT for USA. 1995;33:131–154. Pharmacokinetics of propofol (diprivan) in elderly patients. Br J Anaesth. In addition, alternative sedation strategies should be considered when hypertriglycer …. Data sources: trauma, sepsis, or pancreatitis. 8600 Rockville Pike Some cases of acute pancreatitis have also been reported following a single dose of propofol4,6. Because hypertriglyceridemia is a known cause of pancreatitis, the possibility that pancreatitis could occur due to hypertriglyceridemia induced by propofol must be addressed. Masica AL, Girard TD, Wilkinson GR, Thomason JW, Truman Pun B, Nair UB, Light RW, Canonico AE, Dunn J, Pandharipande P, Shintani AK, Ely EW. The diagnosis of drug-induced pancreatitis is often a clinical challenge and it can be suspected when a culprit drug has been ingested after excluding common etiologies of acute pancreatitis (AP), such as gallstones, alcohol ingestion and hypertriglyceridemia, in addition to other less common etiologies [1]. 2021 Jan 11;3(1):e0330. National Library of Medicine 4 Propofol has been speculated to cause pancreatitis by this mechanism. Two years earlier, she had an episode of pancreatitis secondary to hypertriglyceridemia (HTG; 1120 mg/dL), which was treated with gemfibrozil and atorvastatin. eCollection 2020. Because hypertriglyceridemia is a known cause of pancreatitis, the possibility that pancreatitis could occur due to hypertriglyceridemia induced by propofol must be addressed. We gathered articles on previously documented case reports and up-to-date studies on propofol-induced pancreatitis by searching databases such as PubMed and Google Scholar. However, if the attack occurs late in the third trimester, delivery is usually advocated, as this will cause an immediate decrease in the triglyceride level. New Haven, CT, USA ABSTRACT Context Propofol can cause acute pancreatitis related to hypertriglyceridemia, however, other mechanisms may also exist. The Incidence of Propofol-Induced Hypertriglyceridemia and Identification of Associated Risk Factors. We conclude that even short‐term propofol administration with standard doses of propofol may have a significant effect on serum triglyceride and pancreatic enzyme levels in children. While the statin group of drugs have been used more widely in children and noted to reduce triglyceride levels, case reports suggest pancreatitis may occur as a rare adverse effect.4In view of the risk of pancreatitis, statins were not considered for treatment. A less known but serious complication is acute pancreatitis. If the cause of acute pancreatitis is due to triglycerides, certain medications and dietary modifications can be used to help prevent recurrent attacks. Crit Care Explor. 2016 Jul-Aug;16(4):469-76. doi: 10.1016/j.pan.2016.02.011. doi: 10.1097/CCE.0000000000000282. Drug-induced hypertriglyceridemia is another important cause for acute pancreatitis. At present, it is not clear whether the elevation of enzymes and triglycerides following propofol 2007 Mar;27(3):351-9. doi: 10.1592/phco.27.3.351. Propofol was discontinued within 24 hours of detecting the hypertriglyceridemia 84% of the time. Propofol is used for conscious sedation in di… Serum triglyceride concentrations should be routinely monitored in these patients. The diagnosis of hypertriglyceridemic pancreatitis is based upon an elevated triglyceride level (typically >1,000 mg/dL) and exclusion of other likely causes. Setting: Prevention and treatment information (HHS). Areas of uncertainty: Evaluation of Hypertriglyceridemia in Critically Ill Patients With Coronavirus Disease 2019 Receiving Propofol. Hypertriglyceridemia and related pancreatitis due to the use of lipid emulsions such as propofol has been documented, but less is known about the additive adverse effects of propofol and clevidipine lipid emulsions in the literature. An insulin drip was started for treatment of suspected propofol-induced hypertriglyceridemia and pancreatitis; propofol was discontinued. Hypertriglyceridemia and hypertriglyceridemia‐associated pancreatitis are often seen in intensive care patients receiving propofol. The mechanism of drug-induced pancreatitis includes hypersensitivity (to azathioprine or mercaptopurine, among others) or direct toxic injury (from pentamidine or valproate, among others). Hypertriglyceridemia and hypertriglyceridemia-associated pancreatitis are often seen in intensive care patients receiving propofol. Hypertriglyceridemia and massive rhabdomyolysis in a patient with disseminated legionella. Future research is needed to delineate whether this risk is higher if combined with other procedures that portend inherent risk of pancreatitis such as endoscopic retrograde cholangiopancreatography. Privacy, Help Acute pancreatitis after anesthesia with propofol in a child with glycogen storage disease type IA. Context Propofol can cause acute pancreatitis related to hypertriglyceridemia, however, other mechanisms may also exist. 1985;61(suppl 3):76–79. Case report A 71-year-old male on propofol infusion in the intensive care setting, developed acute pancreatitis as confirmed Serum triglyceride concentrations should be routinely monitored in these patients. Various case reports have indicated a possible relationship between propofol and pancreatitis. Little is known about drug‐induced pancreatitis, although it is reported to … The risk of developing acute pancreatitis is approximately 5 percent with TG > 1000mg/dL and 10-20 percent with TG > 2000mg/dL. A Comprehensive Update on the Chylomicronemia Syndrome. The mechanism of propofol-induced pancreatitis remains unknown. doi: 10.14309/crj.0000000000000528. Hypertriglyceridemia is not the only mechanism by which propofol illicit AP. While this is not established, it is quite clear that the risk of pancreatitis increases with higher serum triglyceride (TG) levels. Conclusions: 2008 Feb;28(2):250-8. doi: 10.1592/phco.28.2.250. 7 In addition, there are reports of a link between propofol use and the occurrence of acute pancreatitis in humans. It is a US Food and Drug Administration approved lipid-based intravenous hypnotic agent, which has been used clinically for the induction and maintenance of anesthesia for over 3 decades. Propofol is administered as a fat emulsion, and it has a fat content very similar to 10% fat emulsion in total parenteral nutrition solution (100 mg/mL soybean oil, 22.5 mg/mL glycerol, and 12 mg/mL egg lecithin). The ESC/EAS guideline classifies levels as more than ~880 mg/dL (~10 mmol/L) as requiring … Retrospective analysis. Epub 2008 Jun 26. Hypertriglyceridemia Independent Propofol-Induced Pancreatitis Thiruvengadam Muniraj, Harry R Aslanian Section of Digestive Diseases, Yale University School of Medicine. Non-contrast head CTs were negative for infarct at that time and 3 days later. One hundred and fifty patients, aged 18 to 60 years, belonging to ASA physical status I and II, undergoing non-abdominal surgery were divided into three groups. acute pancreatitis; hypertriglyceridemia; propofol; drug-induced pancreatitis; Access options Buy single article. Hypertriglyceridemia and pancreatitis are uncommon complications. Pancreatitis developed in three (10%) of the 29 patients with hypertriglyceridemia. In this review, we will discuss the proposed mechanisms of AP secondary to propofol, a number of reported cases, studies conducted, and treatment strategies. One hundred fifty-nine adult intensive care patients administered propofol for 24 hours or longer and who had at least one serum triglyceride concentration. Propofol has been a widely used medication since its recognition by the US Food and Drug Administration in 1989 [1], and it has become a popular anesthetic agent. 2020 Dec 16;2(12):e0303. Due to the low capacity of cats’ liver in glucuronidation, some concerns have been raised regarding the consequence of hypertriglyceridemia in this species. Propofol infusion syndrome in patients with refractory status epilepticus: an 11-year clinical experience. Kovacevic MP, Dube KM, Lupi KE, Szumita PM, DeGrado JR. Crit Care Explor. Gottardis et al. A comparison of the induction characteristics of thiopentone and propofol (2,6-diisopropyl phenol). To characterize the frequency, severity, risk factors, and clinician response to propofol-associated hypertriglyceridemia and hypertriglyceridemia-associated pancreatitis. Hypertriglyceridemia more than 1000 mg/dl was documented at time of acute pancreatitis in reports of propofol-pancreatitis; however, in other propofol, pancreatitis was documented in absence of hypertriglyceridemia [ 9 ]. Therefore, a prospective study was conducted to evaluate the effect of different doses of propofol on postoperative pancreatic enzymes and serum triglyceride levels. We conclude that even short‐term propofol administration with standard doses of propofol may have a significant effect on serum triglyceride and pancreatic enzyme levels in children. Although induction of hypertriglyce-ridaemia has been described and is therefore a suspected mechanism, it seems unlikely that short-term administra- tion of propofol could raise serum lipid levels as much as to induce pancreatitis. 2007 Sep;5(3):218-31. doi: 10.1016/j.amjopharm.2007.10.005. Patients who develop hypertriglyceridemia (eg, ≥400 mg/dL) are at risk of developing pancreatitis. Propofol-induced AP was severe in 19% of patients with a mortality rate related to AP of 14%. Careers. Instant access to the full article PDF. Design: Clipboard, Search History, and several other advanced features are temporarily unavailable. Pancreatitis developed in three (10%) of the 29 patients with hypertriglyceridemia. The hypertriglyceridemia leads to increased lipase levels in pancreatic capillaries, which leads to the inflammatory cycle. 6, 8, 9 This population may be more prone to hypertriglyceridemia development with propofol use given the metabolic activities of IL‐6 and may warrant more frequent monitoring. Non-contrast head CTs were negative for infarct at that time and 3 days later. Propofol-Associated Hypertriglyceridemia in Coronavirus Disease 2019 Versus Noncoronavirus Disease 2019 Acute Respiratory Distress Syndrome. Please enable it to take advantage of the complete set of features! Kovacevic MP, Dube KM, Lupi KE, Szumita PM, DeGrado JR. Crit Care Explor. Careers. The effect of some drugs is mild and of little clinical significance, whereas others can cause severe hyperlipidemia and acute complications such as pancreatitis. Epub 2016 Mar 3. Adjunctive dexmedetomidine therapy in the intensive care unit: a retrospective assessment of impact on sedative and analgesic requirements, levels of sedation and analgesia, and ventilatory and hemodynamic parameters. In addition, alternative sedation strategies should be considered when hypertriglyceridemia is … Please enable it to take advantage of the complete set of features! JOP. Evaluation of Hypertriglyceridemia in Critically Ill Patients With Coronavirus Disease 2019 Receiving Propofol. These findings indicate that propofol administration at recommended doses does not produce dose-related increases in pancreatic enzyme and triglyceride … indirectly by inducing hypertriglyceridemia.4Propofol has been speculated to cause pancreatitis by this mechanism. Various case reports have indicated a possible relationship between propofol and pancreatitis. Pharmacotherapy. doi: 10.1097/CCE.0000000000000282. Clinical sedation scores as indicators of sedative and analgesic drug exposure in intensive care unit patients. Clinicians should be aware of the association between propofol and pancreatitis, and any patient presenting with abdominal pain after propofol infusion should be evaluated for AP and treated promptly to avoid complications. Int Anesthesiol Clin. Serum triglyceride levels should be obtained prior to initiation of therapy and every 3 to 7 days thereafter. "While the risk of acute pancreatitis in the general population is about 0.5 to 1 percent, and about 5 percent in people with alcoholism, the risk increases to 10 percent in those with serum TG above 1,000 mg/dL. Conclusion: An infrequent but serious complication of propofol is acute pancreatitis (AP), with potentially significant morbidity and possible mortality. Hence, acute pancreatitis inferred to propofol could have many mechanisms. Subscription will auto renew annually. doi: 10.1097/CCE.0000000000000330. Little is known about drug‐induced pancreatitis, although it is reported to … Accessibility Bethesda, MD 20894, Copyright The mechanism of drug‐induced pancreatitis include hypersensitivity, direct toxic injury or indirectly by inducing hypertriglyceridemia. 2012 Jul 10;13(4):451-3. doi: 10.6092/1590-8577/822. 2021 Jan 19;8(1):e00528. Discussion: Hypertriglyceridemia is the third most common cause of acute pancreatitis after alcohol and gallstone. However, it is not clear whether this relationship (if any) is dose-related or idiosyncratic. The maximum values of serum triglyceride observed in our study in groups I, II and III were 117, 98 and 145 mg/dl respectively and all values were well within the normal limits (Table 3). Based on previous studies and case reports, we suggest that propofol should be added to a list of drugs having a direct association with AP. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. The median maximum serum triglyceride concentration was 696 mg/dl (range 403-1737 mg/dl). Carr RA, Rejowski BJ, Cote GA, Pitt HA, Zyromski NJ. CONCLUSION: Hypertriglyceridemia and hypertriglyceridemia-associated pancreatitis are often seen in intensive care patients receiving propofol. Propofol has been speculated to cause pancreatitis by this mechanism. The patient suffered her first episode of acute pancreatitis with acute abdominal pain at age 12 years, following an infusion of Propofol, which was prescribed for anaesthesia for brain MRI. Conclusion. Her family history was significant for hyperlipidemia and type 2020 Nov 30;2(12):e0282. Haffar S, Kaur RJ, Garg SK, Hyder JA, Murad MH, Abu Dayyeh BK, Bazerbachi F. Gastroenterol Rep (Oxf). 1985;57:1167–1172. doi: 10.1097/CCE.0000000000000303. Unable to load your collection due to an error, Unable to load your delegates due to an error. Modest triglyceride elevation is noted with use of non-selective β blockers such as atenolol, propranolol, and metoprolol,62 63 especially in people with underlying hypertriglyceridemia,64 but not with the selective β adrenergic blocker … 2021 Jan 11;3(1):e0330. [2] The effects of propofol on serum lipid concentrations remain controversial. In addition, this formulation has been demonstrated to result in the generation of oxygen free radicals. Propofol-Induced Pancreatitis* Recurrence of Pancreatitis After Rechallenge Ananth N. Kumar, MD; David E. Schwartz, MD, FCCP; and Kaiser G. Lim, MD We report a case of pancreatitis, which occurred while the patient was on a propofol drip and then recurred after resolution following an inadvertent rechallenge with propofol. FOIA This site needs JavaScript to work properly. An insulin drip was started for treatment of suspected propofol-induced hypertriglyceridemia and pancreatitis; propofol was discontinued. The class I recommendation first identifies a population 20 years of age or older who have moderate hypertriglyceridemia defined as fasting or nonfasting triglycerides (TG) 175-499 mg/dL (1.9-5.6 mmol/L) and advises searching for and treating secondary factors (see Table 1). Context Propofol can cause acute pancreatitis related to hypertriglyceridemia, however, other mechanisms may also exist. Hypertriglyceridemia and pancreatitis are uncommon complications. Therefore, a prospective study was conducted to evaluate the effect of different doses of propofol on postoperative pancreatic enzymes and serum triglyceride levels. Patients: The mechanism of drug-induced pancreatitis includes hypersensitivity (to azathioprine or mercaptopurine, among others) or direct toxic injury (from pentamidine or valproate, among others). There are several case reports in the literature that have shown an association between propofol and pancreatitis. The exact mechanism behind propofol-induced pancreatitis is not fully understood, but proposed mechanisms include hypertriglyceridemia (HTG), hypersensitivity, or direct pancreatic toxicity of the drug. Triggering factors are concurrent use of catecholamines and corticosteroids. Patient records were reviewed to identify the frequency of hypertriglyceridemia (serum triglyceride concentration > or = 400 mg/dl) and pancreatitis (amylase concentration > or = 125 IU/L, lipase concentration > or = 60 IU/L, and abdominal computed tomography scan or clinical examination findings consistent with pancreatitis). Compared with those who did not develop hypertriglyceridemia, patients who developed hypertriglyceridemia were older, had a longer intensive care unit stay, and received propofol for a longer duration; they were also more likely to be admitted to the medical versus the surgical intensive care unit. Therefore, a prospective study was conducted to evaluate the effect of different doses of propofol on postoperative pancreatic enzymes and serum triglyceride levels. 1988;60:146–150. doi: 10.1097/CCE.0000000000000303. 2006 Jun;16(6):680-3. doi: 10.1111/j.1460-9592.2005.01833.x. Hypertriglyceridemia and hypertriglyceridemia-associated pancreatitis are often seen in intensive care patients receiving propofol. Would you like email updates of new search results? Case report A 71-year-old male on propofol infusion in the intensive care setting, developed acute pancreatitis as confirmed biochemically and by imaging. While propofol is known to increase TGs secondary to the lipid emulsion vehicle, this effect is typically seen 2.25 to 7 days after initiating therapy with normalization occurring within 72 hours. The risk of acute pancreatitis increases progressively with increasing levels of serum triglycerides over 500 mg/dL, with a sharp increase at levels over 1,000 mg/dL (2, 3). Kirkpatrick T, Cockshott ID, Douglas EJ, et al. Of the 159 patients, 29 (18%) developed hypertriglyceridemia; six (21%) of the 29 had a serum triglyceride concentration of 1000 mg/dl or greater.
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