Rapid Sequence Intubation (RSI) Masterclass Rapid Sequence Intubation (RSI): Propofol For RSI

Lesson 8 of 16

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Rapid Sequence Intubation (RSI): Propofol For RSI

Mechanism of Action

Propofol is a highly lipid-soluble, phenolic derivative, which is a GABA agonist and is used as an induction agent for RSI.

Dose

1.5-2 mg/kg IV

Onset

~10-50 seconds

Duration

3-10 minutes

Adverse effects

Hypotension
Bradycardia

Propofol Impact on Hemodynamics

Blood Pressure (BP)	Heart Rate (HR)	Cardiac Output (CO)	Intracranial Pressure (ICP)
↓ Decreased	↓ Decreased	↓ Decreased	↓ Decreased

Literature Review

Author, year	Design/ sample size	Intervention & Comparison	Outcome
Dietrich, 2018	Retrospective review/ n=83	Propofol vs Non-propofol (etomidate or midazolam)	↑ post-intubation hypotension with propofol OR 3.64 (95% CI 1.16-13.24) Similar rates of hypotension were seen among patients who received ≤2 mg/kg and those receiving >2 mg/kg No significant differences between groups in-hospital length of stay or mortality
Bruder, 2015	Cochrane Review	Etomidate Midazolam Propofol Ketamine	There was no difference in mortality, hospital LOS, duration of ventilation, and duration of vasopressors Etomidate associated with ↑ ACTH and ↓ in cortisol level

ACHT= Adrenocorticotropic hormone; GCS= Glasgow Coma; HR= Heart Rate; MAP= Mean Arterial Pressure; RCT= Randomized Controlled Trial; Scale; SOFA= Sequential Organ Failure Assessment;

Comments by ED Physician Attendings

Pro’s	Con’s
“Due to vasodilatory and anti-epileptic properties, propofol is most useful in hypertensive head bleeds and patients with status epilepticus those with enough BP to work with but titrate 10 mg at a time”	“Hypotension and bradycardia should be noted, especially in trauma patients”

Comment

Propofol can reduce SBP by 20-25% for induction