Patient Safety Matters with Use of Propofol in Critically Ill Patients

ABSTRACT: Despite its tendency to produce hypotension, propofol is used widely to induce general anesthesia and to facilitate endotracheal intubation in critically ill patients. Both dose reduction and routine co-administration of vasopressors have been used to offset this unfavorable hemodynamic effect in this subset of individuals. There are potential problems associated with each of these corrective measures, however, and criticism of other intravenous hypnotics used for this purpose—particularly etomidate—may be unwarranted. Choice of the appropriate pharmacology to induce anesthesia to assist with intubation should likely be based on individual clinical assessment, together with an understanding of the drug profile and realistic adverse effects.