Propofol Induction Dose — FRCA Primary MCQ

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HardPharmacology - Intravenous AnaestheticsPropofol Induction DoseFRCA Primary

A ventilated patient with traumatic brain injury receives a high-dose propofol infusion for several days. New lactic acidosis, rising creatine kinase, hyperkalaemia, a Brugada-like ECG pattern and refractory cardiac failure develop. What is the most likely diagnosis?

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Correct answer: D — Propofol infusion syndrome

The best answer is “Propofol infusion syndrome”. The constellation of otherwise unexplained metabolic acidosis, rhabdomyolysis, hyperkalaemia, Brugada-type ECG change and rapidly progressive cardiac failure during prolonged high-dose propofol is characteristic of propofol infusion syndrome. Malignant hyperthermia is linked to triggering anaesthetics and hypermetabolism; the other choices do not explain the exposure-specific cardiac and skeletal-muscle phenotype.

Reference: Propofol 1% emulsion for injection or infusion, UK SmPC: https://www.medicines.org.uk/emc/product/15152/smpc; Royal College of Anaesthetists, Primary FRCA syllabus v2.2: https://www.rcoa.ac.uk/sites/default/files/documents/2026-01/Primary-FRCA-Syllabus.pdf