{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:10:06Z","timestamp":1756311006979,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,4,16]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:p>A woman in her 40s was transferred to the medical intensive care unit due to severe COVID-19 infection causing respiratory failure. Her respiratory failure worsened rapidly, requiring intubation and continuous sedation with fentanyl and propofol infusions. She required progressive increases in the rates of the propofol infusion, as well as addition of midazolam and cisatracurium due to ventilator dyssynchrony. To support the high sedative doses, norepinephrine was administered as a continuous infusion. She developed atrial fibrillation with rapid ventricular response, with rates ranging between 180 and 200\u2009s which did not respond to intravenous adenosine, metoprolol, synchronised cardioversion or amiodarone. A blood draw revealed lipaemia, and triglyceride levels were noted to be elevated to 2018. The patient developed high-grade fevers up to 105.3 and acute renal failure with severe mixed respiratory and metabolic acidosis, indicating propofol-related infusion syndrome. Propofol was promptly discontinued. An insulin-dextrose infusion was initiated which improved patient\u2019s fevers and hypertriglyceridaemia.<\/jats:p>","DOI":"10.1136\/bcr-2022-252763","type":"journal-article","created":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T11:00:11Z","timestamp":1683198011000},"page":"e252763","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Refractory atrial fibrillation with rapid ventricular response as a heralding sign of propofol infusion syndrome in a patient with COVID-19"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9546-606X","authenticated-orcid":false,"given":"Madiha Naqsh","family":"Siddiqui","sequence":"first","affiliation":[{"name":"Internal medicine, St Joseph Mercy Health System, Ann Arbor, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Henley","sequence":"additional","affiliation":[{"name":"Internal medicine, St Joseph Mercy Health System, Ann Arbor, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bing","family":"Xue","sequence":"additional","affiliation":[{"name":"Critical care\/Pulmonology, St Joseph Mercy Health System, Ann Arbor, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,5,4]]},"reference":[{"key":"2025082708551696000_16.5.e252763.1","first-page":"584","article-title":"Propofol infusion syndrome: a case report","volume":"4","author":"Rewa","year":"2013","journal-title":"J Med Cases"},{"key":"2025082708551696000_16.5.e252763.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2007.05055.x"},{"key":"2025082708551696000_16.5.e252763.3","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.bja.2018.12.025","article-title":"Propofol infusion syndrome: a structured literature review and analysis of published case reports","volume":"122","author":"Hemphill","year":"2019","journal-title":"Br J Anaesth"},{"key":"2025082708551696000_16.5.e252763.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.305.6854.613"},{"key":"2025082708551696000_16.5.e252763.5","first-page":"339","article-title":"Propofol infusion syndrome: update of clinical manifestation and pathophysiology","volume":"75","author":"Fudickar","year":"2009","journal-title":"Minerva Anestesiol"},{"key":"2025082708551696000_16.5.e252763.6","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1016\/S0140-6736(05)75936-5","article-title":"Short-Term propofol infusions in children","volume":"354","author":"Mehta","year":"1999","journal-title":"The Lancet"},{"key":"2025082708551696000_16.5.e252763.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2005.11.005"},{"key":"2025082708551696000_16.5.e252763.8","first-page":"513","article-title":"Target-Controlled infusions of remifentanil and propofol in elderly patients","volume":"37","author":"Xu","year":"2005","journal-title":"Beijing Da Xue Xue Bao Yi Xue Ban"},{"key":"2025082708551696000_16.5.e252763.9","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1111\/pace.12137","article-title":"Profound sedation with propofol modifies atrial fibrillation dynamics","volume":"36","author":"Cervig\u00f3n","year":"2013","journal-title":"Pacing and Clinical Electrophysiology"},{"issue":"Suppl","key":"2025082708551696000_16.5.e252763.10","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.4097\/kjae.2014.67.S.S32","article-title":"Alternating asystole and atrial fibrillation after infusion of propofol and remifentanil with target-controlled infusion","volume":"67","author":"Hwang","year":"2014","journal-title":"Korean J Anesthesiol"},{"key":"2025082708551696000_16.5.e252763.11","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1177\/0310057X0603400516","article-title":"Propofol infusion syndrome in a patient with sepsis","volume":"34","author":"De Waele","year":"2006","journal-title":"Anaesth Intensive Care"},{"key":"2025082708551696000_16.5.e252763.12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S0140-6736(00)03547-9","article-title":"Long-Term propofol infusion and cardiac failure in adult head-injured patients","volume":"357","author":"Cremer","year":"2001","journal-title":"The Lancet"},{"key":"2025082708551696000_16.5.e252763.13","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1097\/FTD.0000000000000073","article-title":"Hypertriglyceridemia, lipemia, and elevated liver enzymes associated with prolonged propofol anesthesia for craniotomy","volume":"36","author":"Bowdle","year":"2014","journal-title":"Ther Drug Monit"},{"key":"2025082708551696000_16.5.e252763.14","unstructured":"M.B. Heard C , Alibrahim O , T. Rotta A . Sedation and analgesia. In: Fuhrman and Zimmerman\u2019s Pediatric Critical Care. 6th ed. Elsevier, 2020."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-252763","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:55:24Z","timestamp":1756310124000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-252763"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5]]},"references-count":14,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,5,4]]},"published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.1136\/bcr-2022-252763"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-252763","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2023,5]]}}}