Episode 932: Induction Agent Hypotension

Emergency Medical Minute

Contributor: Aaron Lessen MD

Educational Pearls:

• Induction agent selection during rapid sequence intubation involves accounting for hemodynamic stability in the post-intubation setting

• Many emergency departments use ketamine or etomidate

• A recent study sought to explore the rates of post-induction hypotension of ketamine compared with propofol

  • Single center retrospective cohort study of patients between 2018-2021

• Ketamine and propofol were both significantly associated with post-induction hypotension

  • Ketamine adjusted odds ratio = 4.50

  • Propofol adjusted odds ratio = 4.88

  • 50% of patients became hypotensive after induction with either propofol or ketamine

• These findings suggest post-induction hypotension is mainly due to sympatholysis rather than the choice of agent itself

References

1. Tamsett Z, Douglas N, King C, et al. Does the choice of induction agent in rapid sequence intubation in the emergency department influence the incidence of post-induction hypotension?. Emerg Med Australas. 2024;36(3):340-347. doi:10.1111/1742-6723.14355

Summarized & Edited by Jorge Chalit, OMS3

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