Use of propofol as an induction agent in the acutely injured patient

作者：Zettervall S L^*; Sirajuddin S; Akst S; Valdez C; Golshani C; Amdur R L; Sarani B; Dunne J R

来源：European Journal of Trauma and Emergency Surgery, 2015, 41(4): 405-411.

DOI：10.1007/s00068-014-0479-3

• Trauma
• Rapid sequence induction
• Propofol
• Etomidate
• Intubation

Etomidate is a commonly used agent for rapid sequence induction (RSI) in trauma due to its limited hemodynamic effects. Given a recent nationwide shortage of etomidate, alternative induction agents may be required. Propofol is a frequent substitute; however, concern exists regarding its potential hypotensive effects. The study attempts to determine the hemodynamic effects of propofol and etomidate following RSI in trauma bay.
A retrospective study was performed on 76 consecutive trauma patients requiring RSI at a single academic medical center. Patients were stratified by age, gender, mechanism of injury, Injury Severity Score (ISS), and Glasgow Coma Scale (GCS). Pre-induction and post-induction hemodynamic parameters were evaluated, and a multivariate regression analysis was performed.
The mean age was 42, ISS was 13, and GCS was 9.8. The mean dose of propofol was 127 +/- A 5 mg and the mean dose of etomidate was 21 +/- A 6 mg. Patients who received propofol were younger and had a lower ISS. The etomidate group had significantly increased post-induction systolic blood pressure but no difference in mean arterial pressure or heart rate when compared to pre-induction parameters. The propofol group had no significant changes in any post-induction parameter compared to pre-induction parameter.
RSI with propofol did not result in hypotension in our patient population, suggesting that a reduced dose of propofol may represent a reasonable alternative to etomidate in hemodynamically stable trauma patient. Further research is warranted to assess the safety of propofol in the acutely injured patient.

• 出版日期2015-8