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Early Recognition of Electrocardiographic Lambda-Wave ST Elevation during Propofol Infusion Prevents Ventricular Tachyarrhythmia and Cardiac Arrest.

Propofol is a common anesthetic agent with minimal side effects at conventional doses. But prolonged use might cause rare but lethal complications presented in a variety of symptoms like metabolic acidosis, rhabdomyolysis, acute kidney/liver injury and lambda-wave ST elevation (STE) on electrocardiography (ECG). Together these symptoms constitute the propofol infusion syndrome (PRIS) with a mortality rate > 80%. 1 The occurrence of lambda-wave STE during propofol infusion is an early sign preceding ventricular tachyarrhythmia (VT) and cardiac arrest. 2 Here we reported a female who had developed non-sustained VT and a lambda-wave STE in leads V2-6 on ECG after a 9-day long propofol infusion to control her status epilepticus. Early recognition of ECG aberrancy and discontinuation of propofol later reversed the ECG abnormalities and eliminated the VT and cardiac arrest before the full development of PRIS.