Anesthetic Induction with Etomidate, Rather than Propofol, Is Associated with Increased 30-Day Mortality and Cardiovascular Morbidity After Noncardiac Surgery

Design

Propensity score-matched cohort study

N= 7,377

Objective

To evaluate if patients induced with etomidate suffer greater mortality and morbidity than comparable patients induced with propofol for noncardiac surgeries 

Study Groups

Etomidate (N= 2,144)

Propofol (N= 5,233)

Inclusion Criteria

American Society of Anesthesiologists (ASA) physical status III and IV adults having noncardiac surgery under general anesthesia, with or without regional anesthesia, requiring at least 1 night of postoperative hospitalization

Exclusion Criteria

Received propofol, thiopental, etomidate, or ketamine at any other time during anesthesia

Methods

Eligible patients received anesthetic induction with propofol, thiopental, etomidate, or ketamine, and those receiving etomidate were matched to a maximum of 3 patients who received propofol using propensity score matching based on surgery types. Imbalanced covariables between the two groups after propensity score matching were adjusted for in all analyses.

Duration

Between January 6, 2005, and December 31, 2009

Outcome Measures

Primary: 30-day mortality, any major in-hospital cardiovascular morbidity, and any major in-hospital infectious morbidity

Secondary: intraoperative vasopressor use, duration of hospitalization, dose effect of etomidate on primary outcomes

Baseline Characteristics

Etomidate (N= 2,144)

Propofol (N= 5,233)

Age, years

Female

White

Hypothalamic pituitary adrenal disorder

ASA status, IV (vs III)

2

Surgical characteristics 

Emergent

Intraoperative steroid

Regional anesthesia

Duration, h

19% 

20% 

7%

4

14%

19%

7%

4

Observed dose (interquartile range [IQR]), mg/kg

ASA status, Charlson comorbidity score, and emergent surgery were still slightly imbalanced between the etomidate and propofol patients after propensity score matching. 

Results

Endpoint

Etomidate (N= 2,144)

Odds ratio (98.3% confidence interval; etomidate/propofol); p-value*

Primary outcome

30-d mortality

Cardiovascular morbidity

Infectious morbidity

139 (6.5%)

163 (7.6%)

191 (8.9%)

135 (2.5%)

254 (4.9%)

437 (8.4%)

2.49 (1.85 to 3.35); < 0.001

1.51 (1.17 to 1.94); < 0.001

1.00 (0.80 to 1.25); 0.99

Etomidate (N= 2,144)

Secondary outcome

Intraoperative vasopressor use

Length of hospital stay, d (IQR)

1,595 (74.4%)

7 (3, 13)

3,988 (76.2%)

6 (2, 11)

0.92 (0.82 to 1.03); 0.16

hazard ratio 0.82 (0.78 to 0.87); < 0.001

No “dose effect” of etomidate was found on any of the primary outcomes. 

Adverse Events

Study Author Conclusions

Etomidate was associated with a substantially increased risk for 30-day mortality, cardiovascular morbidity, and prolonged hospital stay. The conclusions, especially on 30-day mortality, are robust to a strong unmeasured binary confounding variable. Although the study showed only an association between etomidate use and worse patients' outcomes but not a causal relationship, clinicians should use etomidate judiciously, considering that improved hemodynamic stability at induction may be accompanied by substantially worse longer-term outcomes.

InpharmD Researcher Critique

Ketamine/propofol admixture vs etomidate for intubation in the critically ill: KEEP PACE Randomized clinical trial

Design

Randomized, parallel-group, triple-blind, single-center, controlled trial

N= 152

Objective

To determine if an admixture of ketamine and propofol for emergent endotracheal intubation in critically ill patients was superior to etomidate

Study Groups

Etomidate (n= 73)

Ketamine/propofol (n= 79)

Inclusion Criteria

Aged ≥18 years; admitted to one of three ICUs (medical, surgical, and oncologic/transplant); required emergent intubation

Exclusion Criteria

Intubation for cardiac arrest; intracranial pathology with known/suspected elevation in intracranial pressure; chronic opioid dependence; bipolar and/or schizophrenia disorder; egg allergy; contraindications to fentanyl, midazolam, ketamine, propofol, or etomidate; body weight >140 kg or <30 kg; continuous infusions of propofol, midazolam, lorazepam, fentanyl, or dexmedetomidine in the previous 24 hours; procedural intubation

Methods

Intensive care unit patients who needed to undergo emergent intubation were randomized 1:1 to receive a ketamine/propofol admixture or etomidate for sedation. While the trial intervention was nonblinded, the allocation concealment was blinded to the team. Additionally, the patients and outcomes assessors were also blinded.

Patients randomized to ketamine/propofol received equal amounts (in mg/kg) of ketamine and propofol drawn into a single syringe. The admixture was administered based on the patient's actual (current) body weight. An initial dose of 1 mg/kg (0.5 mg/kg of ketamine and propofol each) was the standard intravenous induction dose, with a second dose available as a rescue.

Etomidate was given as an induction dose of 0.15 mg/kg of actual body weight, with a second 0.15 mg/kg dose available as a rescue.

Both study arms also received a 50 mcg bolus of fentanyl to blunt the hemodynamic response. The use of benzodiazepines, additional opioids, neuromuscular blocking agents, and sedation following intubation was up to the description of the treating team.

Duration

2014 to 2017

Outcome Measures

Primary: change in mean arterial pressure (MAP) from baseline (from 1 minute before drug administration to 5 minutes after administration)

Secondary: change in MAP at 10 and 15 minutes after drug administration; new-onset vasopressor use; narcotic use

Baseline Characteristics

Etomidate (n= 73)

Ketamine/propofol (n= 79)

Age, years

Male

Body mass index, kg/m²

APACHE III score

Acute kidney injury

Reason for intubation

Airway protection

Acute respiratory failure

Neurologic

Shock

Other

33%

58%

4%

3%

3%

24%

68%

1%

5%

1%

Results

Etomidate (n= 73)

Ketamine/propofol (n= 79)

p-value

Mean arterial pressure, mm Hg

Baseline

After 5 minutes

After 10 minutes

After 15 minutes

82.8 ± 17.9

81.7 ± 17.2

81.9 ± 20.0

79.1 ± 19.5

80.9 ± 13.3

77.6 ± 15.4

75.3 ± 20.3

75.5 ± 18.1

-

0.385

0.241

0.802

Additional medications during intubation

Additional propofol (dose)

Fentanyl (dose)

Midazolam

Rocuronium

Succinylcholine

Vecuronium

3% (80 ± 28.28 mg)

99% (60.76 ± 29.91 mcg)

45%

38%

53%

0

5% (32.50 ± 9.57 mg)

99% (62.53 ± 35.10 mcg)

34%

33%

61%

1%

0.683

1.00

0.186

0.502

0.413

1.00

Total narcotic use, morphine mg equivalents (IQR)

140 (26 to 269)

131 (39 to 287)

0.545

Adrenal insufficiency

After 3-5 hours

After 23-25 hours

13/16 (81%)

9/15 (60%)

5/13 (38%)

6/15 (40%)

0.027

0.467

New onset delirium

13%

6%

0.233

Hospital mortality

36%

32%

0.605

Adverse Events

One severe hypotension occurred within 3 minutes in the ketamine/propofol group, and one life-threatening hypotension occurred within 3 minutes in the etomidate group.

Two episodes of severe hypertension occurred within 5 minutes (196/109 mm Hg) and 15 minutes (175/85 mm Hg) in the etomidate group.

Two cardiac arrests occurred with ketamine/propofol.

Study Author Conclusions

InpharmD Researcher Critique

This was a randomized, single-center study conducted at the Mayo Clinic with non-controlled co-interventions that may have affected hemodynamics and study outcomes. While the trial intervention was nonblinded, the outcomes and group allocation were blinded to everyone involved, including the data assessors. Baseline cortisol levels were not obtained, and only a small number of patients had their cortisol levels monitored after medication administration to assess for adrenal insufficiency.

Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial

Design

Prospective, randomized, controlled, single-blind (caregiver) trial

N= 469

Objective

To compare early and 28-day morbidity after a single dose of etomidate or ketamine used for emergency endotracheal intubation of critically ill patients

Study Groups

Etomidate (n= 234)

Ketamine (n= 235)

Inclusion Criteria

Patients who were 18 years or older and who needed sedation for emergency intubation

Exclusion Criteria

Cardiac arrest; contraindications to succinylcholine, ketamine, or etomidate; or known pregnancy; discharged alive from the intensive care unit within 3 days; died before reaching the hospital 

Methods

Eligible patients were randomized (1:1) to receive either etomidate administered as a 0.3 mg/kg intravenous (IV) bolus or ketamine administered as a 2 mg/kg IV bolus. Only the emergency physician enrolling patients was aware of the group assignment. 

Succinylcholine was given immediately after the sedative as a 1 mg/kg IV bolus. After confirmation of intubation and tube placement, continuous sedation was initiated by use of a standardized protocol with midazolam (0.1 mg/kg/h) combined with fentanyl (2–5 μg/kg/h) or sufentanil (0.2–0.5 μg/kg/h).

Duration

From April 25, 2007, to February 27, 2008

Outcome Measures

Primary: maximum SOFA score during the first 3 days in the intensive care unit (ICU)

Secondary: Δ-SOFA score (maximum score minus admission score), 28-day all-cause mortality, days free from ICU, organ support-free days (mechanical ventilation and vasopressor) during the 28-day follow-up

Baseline Characteristics

Etomidate (n= 234)

Ketamine (n= 235)

Age, years

Male

Weight, kg

Activity limitation*

A

B

C

D

Missing

142 (61%)

54 (23%)

24 (10%)

11 (5%)

3 (1%)

138 (59%)

58 (25%)

29 (12%)

10 (4%)

0

McCabe classification†

1

2

3

Missing

160 (68%)

59 (25%)

12 (5%)

3 (1%)

162 (69%)

55 (23%)

18 (8%)

0

Reasons for emergency intubation

Comatose

Shock

Acute respiratory failure

Other

162 (69%)

31 (13%)

37 (16%)

4 (2%)

162 (69%)

26 (11%)

41 (17%)

6 (3%)

Disease severity at inclusion

Temperature, °C

Heart rate, beats/min

Systolic blood pressure, mmHg

Diastolic blood pressure, mmHg

SpO2, %

Glasgow coma scale (median [range])

36.4 ± 1.6

98 ± 27

132 ± 38

78 ± 23

93 ± 10

6 (3–15)

36.4 ± 1.7

97 ± 29

128 ± 32

75 ± 19

93 ± 9

7 (3–15)

Simplified acute physiology score II

Final diagnosis

Trauma

Sepsis

Other

57 (24%)

41 (18%)

136 (58%)

47 (20%)

35 (15%)

153 (65%)

*Activity levels were defined as follows (Knaus chronic health status score): A, previous good health, no functional limitations; B, mild to moderate limitation of activity because of a chronic medical problem; C, chronic disease producing serious but not incapacitating limitation of activity; and D, severe restriction of activity due to disease, including people bedridden or institutionalized because of illness. †McCabe classification: 1, non-fatal disease; 2, ultimately fatal disease; and 3, rapidly fatal disease.

Results

Endpoint

Etomidate (n= 234)

Ketamine (n= 235)

Difference (95% confidence interval)

p-value

SOFA_max score

Δ-SOFA (median [IQR])*

28-day mortality (n [%, 95% CI])

Mechanical ventilation-free days at day 28 (median [IQR])

42 (18%, 13 to 23)

2 ± 1

Catecholamine support (n [%, 95% CI])

Catecholamine-free days (until day 28; median [IQR])

ICU-free days at day 28 (median [IQR])

Glasgow outcome score (median [IQR])

SOFA_max=the maximum value of the sequential organ failure assessment (SOFA) score during the first 3 days in intensive care; *Δ-SOFA= SOFA_max–SOFA (admission)

Adverse Events

No serious adverse events with either study drug

Study Author Conclusions

Our results show that ketamine is a safe and valuable alternative to etomidate for endotracheal intubation in critically ill patients, and should be considered in those with sepsis.

InpharmD Researcher Critique

Per the study authors, the maximum SOFA score, though a surrogate marker, is considered clinically appropriate as the primary endpoint. Given the small sample size allotted to patients with sepsis, the study may lack sufficient power to show a significant increase in morbidity related to the use of etomidate in patients with sepsis, leading to a type-II error.

Randomized Clinical Trial of Etomidate Versus Propofol for Procedural Sedation in the Emergency Department

Design

Randomized, non-blinded, prospective trial

N= 214

Objective

Study Groups

Etomidate (n= 105)

Propofol (n= 109)

Inclusion Criteria

Exclusion Criteria

American Society of Anesthesiologists (ASA) Physical Assessment Score > 2, known hypersensitivity to either medication, pregnancy, clinical evidence of intoxication prior to start of procedure

Methods

Patients were randomized to receive either propofol 1 mg/kg bolus followed by 0.5 mg/kg every 3 minutes as needed for sedation or etomidate 0.1 mg/kg followed by 0.05 mg/kg every 3 to 5 minutes as needed. Neither group was blinded to treatment. The use of supplemental oxygen was at the discretion of the physician.

Duration

Outcome Measures

Subclinical respiratory depression (defined as change from baseline nasal end-tidal CO2 [ETCO2] of > 10 mmHg, oxygen saturation < 92%, or airway obstruction with cessation of gas exchange)

Absolute change in ETCO2 from baseline

Report of pain during procedure, recall of procedure, and satisfaction with procedure (measured using 100-mm visual analog scales. A score of 100 indicates highest pain and remembrance of procedure while greatest satisfaction is scored at 0)

Baseline Characteristics

Etomidate (n= 105)

Propofol n= 109)

Age, years

Weight, kg

ASA physical status score of 1

Initial systolic blood pressure, mmHg

Initial ETCO2, mmHg

Initial oxygen saturation, %

Preprocedural supplemental oxygen use

Number of doses of sedative (range)

Total time of procedure, min

Results

Endpoint

Etomidate (n= 105)

Propofol n= 109)

Difference (95% confidence interval [CI])

First dose, mg/kg

Total dose, mg/kg

0.15

0.26

0.99

1.86

--

Subclinical respiratory depression detected

34.3%

42.2%

-7.9% (-20.9% to 5.1)

Presence of myoclonus

20%

1.8

18.2 (10.1 to 26.2)

Absolute change in ETCO2 from baseline, mmHg (range, standard deviation [SD])

10.0 (1-29, ±6.1)

11.5 (5-34, ±8.1)

-1.5 (-3.4 to 0.5)

Report of pain during procedure (100-mm)

Report of recall of procedure (100-mm)

Satisfaction with procedure (100-mm)

18.3

23.9

9.8

16.2

16.1

10.3

2.1

7.8

-0.4

Study Author Conclusions

InpharmD Researcher Critique

Comparison of Etomidate and Ketamine for Induction during Rapid Sequence Intubation of Adult Trauma Patients

Design

Single-center, retrospective analysis

N= 968

Objective

To compare clinical outcomes among those induced with etomidate and ketamine for adult trauma patients emergently intubated

Study Groups

Etomidate (n= 526)

Ketamine (n= 442)

Inclusion Criteria

Age ≥ 18 years, presenting with acute trauma, intubated in the emergency department (ED) using either etomidate or ketamine for rapid sequence intubation (RSI) induction

Exclusion Criteria

Not explicitly specified

Methods

Two separate analyses were conducted. The primary analysis was a comparison of patients receiving ketamine or etomidate, regardless of which agent was the standard RSI on-protocol induction agent at the time of intubation. The secondary analysis was a quasi-experimental analysis that assessed the impact of the RSI protocol change from etomidate to ketamine in which patients intubated after the induction agent protocol switch in December 2012 (ketamine period) were compared to those intubated before the protocol switch (etomidate period), regardless of the induction agent received.

Adult trauma patients were intubated by emergency physicians using a standardized clinical protocol. Recommended induction doses were 0.3 mg/kg for etomidate and 1-2 mg/kg for ketamine. Succinylcholine was the standard on-protocol RSI paralytic throughout the study period. All treatment decisions were made by treating clinicians independent of the study. Treating clinicians had the ability to select an off-protocol induction agent based on clinical discretion.

Duration

Study period: January 1, 2011, to December 31, 2014

Protocol switch: December 2012

Outcome Measures

Primary: hospital mortality (death in the ED or during the index hospitalization following RSI in the ED)

Secondary: intensive care unit (ICU)-free days, ventilator-free days, vasopressor-free days, units of packed red blood cells (PRBCs) transfused in the first 48 hours, hospital-acquired sepsis to day 28, time to hospital discharge, hazard of hospital death, peri-intubation outcomes

Baseline Characteristics

Etomidate (n= 526)

Ketamine (n= 442)

Age, years

Female

White

Patient characteristics at ED presentation, median (interquartile range [IQR])

Glasgow Coma Scale

Systolic blood pressure, mmHg

Diastolic blood pressure, mmHg

Heart rate, beats/min

Respiratory rate, breaths/min

13 (7 to 15)

130 (107 to 150)

80 (64 to 90)

103 (83 to 119)

20 (16 to 24)

12 (5 to 15)

122 (100 to 143)

80 (62 to 90)

103 (88 to 120)

19 (16 to 24)

Injury severity score, median (IQR)

22 (13 to 33)

22 (13 to 29)

APACHE II score, median (IQR)

22 (17 to 27)

21 (16 to 26)

Systolic blood pressure < 100 mmHg on presentation

117 (22.2%)

121 (27.4%)

Results

Endpoint

Etomidate (n= 526)

Ketamine (n= 442)

Adjusted odds ratio (95% confidence interval [CI]; etomidate referent)

Hospital mortality

ICU-free days to day 28, median (IQR)

Ventilator-free days to day 28, median (IQR)

Vasopressor-free days to day 28, median (IQR)

PRBC units transfused to 48 hours, median (IQR)

Hospital-acquired sepsis

Median time to hospital discharge, days (IQR)

Hazard of hospital death

Peri-intubation outcomes were similar between groups, including first-pass intubation success, need for rescue surgical airway, and peri-intubation cardiac arrest.

In the secondary analysis, unadjusted hospital mortality was 17.3% during the etomidate period and 20.7% during the ketamine period (absolute risk difference 3.4%; 95% CI -1.8% to 8.6%). In segmented regression analysis, there was no significant trend in-hospital mortality during the etomidate period (-0.4% absolute change per bimonth; 95% CI -1.8 to 1.0%), and no significant change in hospital mortality immediately associated with the protocol switch from etomidate to ketamine (1.2% absolute change; 95% CI -11.3% to 13.6%). Hospital mortality trends in the ketamine and etomidate periods did not significantly differ from one another (1.1% absolute change; 95% CI -0.8% to 3.1%).

Adverse Events

Study Author Conclusions

In this analysis spanning an institutional protocol switch from etomidate to ketamine as the standard RSI induction agent for adult trauma patients, patient-centered outcomes were similar for patients who received etomidate and ketamine.

InpharmD Researcher Critique

Due to the protocol switch, the primary analysis was based on non-concurrent cohorts and is potentially susceptible to temporal changes in practice or types of patients. Despite this, the study is fairly robust in design and procedures.

A Comparison of Etomidate, Ketamine, and Methohexital in Emergency Department Rapid Sequence Intubation

Design

Retrospective, single-center, observational study

N= 82

Objective

Study Groups

Etomidate (n= 47)

Ketamine (n= 9)

Methohexital (n= 26)

Inclusion Criteria

Aged≥18 years; intubated in the ED with etomidate from March 1 to May 24, 2012, or with ketamine or methohexital from May 25 to August 31, 2012 (during the period of etomidate shortage)

Exclusion Criteria

Contraindications to any of the induction agents or any intubation performed by the hospital's difficult airway response team or anesthesiology

Methods

Eligible patients were recognized from electronic health record reviews of mostly nursing documentation and included for analysis. The ED attending physician's section of the RSI procedure note was used for any missing information. 

Changes in vital signs were measured within 15 mins before and after RSI, and incidence of new-onset seizure was assessed within 15 min of induction agent administration in a patient without a history of seizures.

Duration

March 1 to August 31, 2012

Outcome Measures

Rate of successful first-attempt intubation, total number of intubation attempts, time to intubation, change in vital signs, new-onset seizures, and RSI complications (airway trauma, dental trauma, aspiration, and esophageal intubation)

Baseline Characteristics

Etomidate (n= 47)

Ketamine (n= 9)

Methohexital (n= 26)

Age, years

Female

Race

White 

African American

44.7%

42.6%

11.1%

77.8%

46.2%

30.8%

Past medical history

Hypertension

Asthma/COPD

Seizure disorder

Coronary artery disease

51.1%

31.1%

13.3%

10.9% 

55.6%

22.2%

1.1%

33.3%

53.8%

23.1%

11.5%

19.2% 

Vital signs

Systolic blood pressure, mmHg

Heart rate, beats per minute 

135.9 ± 42.0

99 ± 29.5

106.3 ± 46.5

98 ± 27.4

141.3 ± 34.6

97.5 ± 18.5

Intubation reason

Respiratory distress

Altered mental status

Trauma

Status epilepticus

Other

36.2%

23.4%

17.0%

8.5%

14.9%

55.6%

11.1%

22.2%

11.1%

0

19.2%

34.6%

30.8%

7.7%

7.7%

Premedication

Lidocaine

Fentanyl

Defasciculating NMBA

4.3%

2.1%

0

0

0

0 

11.5%

23.1%

7.7% 

Paralytic

Succinylcholine

Rocuronium

59.6%

40.4% 

100%

0

92.3%

7.7%

Medication dose, mg/kg

Succinylcholine

Rocuronium

Induction agent

1.4 ± 0.2

1 ± 0.2

0.3 ± 0.1

1.4 ± 0.4

--

1.2 ± 0.4

1.2 ± 0.2

1.1 ± 0.3

1.2 ± 0.2

NMBA = neuromuscular blocking agent; COPD = chronic obstructive pulmonary disease

Results

Endpoint

Etomidate (n= 47)

Ketamine (n= 9)

Successful intubation on the first attempt

Time to intubation, min

Total number of intubation attempts

Change in systolic blood pressure, mmHg

Change in heart rate, beats/min

Aspiration

Dental trauma, airway trauma, esophageal intubation, and new-onset seizures did not occur in any patients.

Adverse Events

Not disclosed

Study Author Conclusions

Methohexital and etomidate had similar rates of successful intubation on the first attempt and seemed to be more effective than ketamine. Etomidate may reduce the need for three or more intubation attempts. Larger, prospective studies are needed to determine if ketamine or methohexital is more effective than etomidate for RSI.

InpharmD Researcher Critique

The study is limited by its retrospective, single-center design and small sample size, making it difficult to determine the significance of differences between groups due to the lack of adequate power. Nursing notes on the electronic health record may have been confounded by recall bias. 

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

Design

Retrospective analysis 

N= 76

Objective

To determine the hemodynamic effects of propofol and etomidate following rapid sequence induction (RSI) in trauma bay

Study Groups

Propofol (n= 57)

Etomidate (n= 19)

Inclusion Criteria

Critically injured patients requiring emergent intubation in the trauma bay at a single academic medical center

Exclusion Criteria

Patients under 16 years of age, arrived intubated, were intubated in the trauma bay without the use of induction agents, received vasopressor prior to intubation, or lacked documentation of pre- and post-induction hemodynamic parameters

Methods

Data were retrospectively collected from the trauma flow sheet. Eligible patients were stratified by age, gender, mechanism of injury, Injury Severity Score (ISS), and Glasgow Coma Scale (GCS).

Duration

From October 2011 to September 2012

Outcome Measures

Multivariate adjusted means for hemodynamic outcomes before and after induction 

Baseline Characteristics

Propofol (n= 57)

Etomidate (n= 19)

Age, years

Male

Injury Severity Score

Admission GCS

Traumatic brain injury

Blunt injury

Mortality

Indication for intubation

Altered mental status

Combative

Respiratory distress

Other

61%

23%

7%

5%

58%

32%

11%

0%

0.80

0.54

0.64

0.57

Given dose, mg

127 ± 5 

Results

Endpoint

Propofol (n= 57)

Etomidate (n= 19)

Mean arterial pressure (95% confidence interval [CI]), mmHg

Pre-induction

Post-induction

p-value

95 (90–100)

94 (89–99)

0.57

101 (89–114)

106 (94–118)

0.26

Systolic blood pressure (95% CI) , mmHg

Pre-induction

Post-induction

p-value

131 (125–138)

131 (124–138)

0.87

139 (119–158)

152 (133–171)

0.02

Heart rate (95% CI), beats/minute

Pre-induction

Post-induction

p-value

98 (90–106)

101 (94–108)

0.17 

98 (86–109)

92 (80–103)

0.11

Adverse Events

Common Adverse Events: Not disclosed 

Serious Adverse Events: Not disclosed 

Percentage that Discontinued due to Adverse Events: Not disclosed 

Study Author 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.

InpharmD Researcher Critique

The study is subject to the limitations inherent to a retrospective analysis. This study rather measures the intra-difference between pre- and post-induction within either propofol or etomidate than the inter-difference between propofol and etomidate.  Furthermore, the study did not address the amount of fluid resuscitation or blood transfusion, thus, lacking the control for the effect or amount of resuscitation received by included patients.