Introduction: Patients often receive propofol for sedation and clevidipine for hypertension in the intensive care unit. Both agents are formulated as a lipid emulsion which may increase the risk of hypertriglyceridemia and acute pancreatitis with their coadministration. We aimed to determine the incidence of these adverse effects with their concurrent administration and identify patient risk factors for hypertriglyceridemia. Methods: This was a multi-center retrospective study of adult patients (≥18 years old) receiving concurrent propofol and clevidipine infusions for ≥6 hours. The primary outcome was the frequency of triglyceride level > 400mg/dL and acute pancreatitis. The secondary outcome was risk factors associated with hypertriglyceridemia during concurrent propofol and clevidipine infusions until both infusions had been discontinued. Univariable and multivariable logistic regression analyses were used to assess risk factors of hypertriglyceridemia in patients receiving concurrent propofol and clevidipine infusions. Results: Across 1226 patients, the median duration of infusion overlap was12.4 (IQR 8.3, 22.7) hours. The mean age of the cohort was 59.6 (SD 14.9) and 59.4% were male. Hypertriglyceridemia after initiation of propofol and clevidipine infusion was found in 7.7% (95% CI 6.3 to 9.3%) of the entire cohort. Twenty-six patients (2.1%) had a diagnosis of pancreatitis after initiation of lipid infusions of which 13 cases were potentially or likely infusion related. Based on a multivariable logistic regression of those with a triglyceride level available, risk factors for hypertriglyceridemia included pancreatitis within the past five years (OR 2.77, 95% CI 1.23 to 6.23) and statin use (OR 1.94, 95% CI 1.13 to 3.34). Conclusions: In our cohort of patients receiving concurrent propofol and clevidipine, the frequency of hypertriglyceridemia and acute pancreatitis was low. Further comparative studies are warranted to assess risk of pancreatitis with addition of clevidipine to propofol.
Warfield et al. (Sun,) studied this question.