title: Use of propofol as an induction agent in the acutely injured patient.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  The mean age was 42, ISS was 13, and GCS was 9.8. The mean dose of propofol was 127 ± 5 mg and the mean dose of etomidate was 21 ± 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, George Washington University School of Medicine and Health Sciences, 2150 Pennsylvania Ave. NW, Suite 6B, Washington, DC, 20037, USA, slzettervall@gmail.com.
authors.forename: S L
authors.initials: SL
authors.lastname: Zettervall
authors.forename: S
authors.initials: S
authors.lastname: Sirajuddin
authors.forename: S
authors.initials: S
authors.lastname: Akst
authors.forename: C
authors.initials: C
authors.lastname: Valdez
authors.forename: C
authors.initials: C
authors.lastname: Golshani
authors.forename: R L
authors.initials: RL
authors.lastname: Amdur
authors.forename: B
authors.initials: B
authors.lastname: Sarani
authors.forename: J R
authors.initials: JR
authors.lastname: Dunne
mesh_terms: D000046:Academic Medical Centers; D000208:Acute Disease; D000328:Adult; D000762:Anesthesia Recovery Period; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D005045:Etomidate / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol; D005045:Etomidate