Long-term propofol infusion and cardiac failure in adult head-injured patients

Five adult patients with head injuries inexplicably had fatal cardiac arres ts in our neurosurgical intensive-care unit after the introduction of a sed ation formulation containing an increased concentration of propofol. To exa mine the possible relation further, we did a retrospective cohort analysis of head-injured adults admitted to our unit between 1996 and 1999 who were sedated and mechanically ventilated. 67 patients met the inclusion criteria , of whom seven were judged to have died from propofol-infusion syndrome. T he odds ratio for the occurrence of the syndrome was 1.93 (95% CI 1.12-3.32 , p=0.018) for every mg/kg per h increase in mean propofol dose above 5 mg/ kg per h. We suggest that propofol infusion at rates higher than 5 mg/kg pe r h should be discouraged for long-term sedation in the intensive-care unit .