2003 OPEN FORUM Abstracts
The Use of Propofol as a means of Sedation for Intubation in the Critically Ill Patient: Our Experience.
Tate Bennett, RRT; John Davies, MA RRT; Joann Latour, PharmD; Joe Govert, MD; Neil MacIntyre, MD. Duke University Medical Center, Durham, NC
INTRODUCTION: Studies suggest that the use of Propofol decreases pharyngeal and laryngeal reactivity and muscle tone enough to allow tracheal intubation. Hypotension is a know side effect of propofol post intubation. We developed a sedation protocol for intubation using Propofol and monitored its effectiveness and incidence of hypotension.
Methods: The protocol required adequate IV access with pre-mixed dopamine (800mg/250mls) at the bedside. Propofol 40 mg IV with additional 20-40 mg boluses every 1 minute up to a maximum of 2 mg/kg was used to achieve adequate sedation prior to intubation. We monitored blood pressure immediately before intubation, immediately after intubation, 5 minutes after intubation, and 15 minutes after intubation. We also monitored the amount of drug required and vasopressor use in 46 patients.
RESULTS: Mild hypotension was observed when Propofol was used for sedation. The maximum drop in blood pressure was seen 5 minutes post intubation in the > 80 mg group (-15%). Lower doses of Propofol were associated with a lesser degree of hypotension. No patients experience life threatening hypotension. Vasopressor use was required in only 24% of both dose dose groups.
|Amount of Propofol||Mean BP Immediately After Intubation||Mean BP 5 Minutes post Intubation||Mean BP 15 Minutes Post Intubation||Vasopressor Use Required|
|0 - 80 mg (52 + 32)||-9%||-5%||-6%||7/29 = 24%|
|> 80 mg (135 + 125)||-13%||-15%||-14%||4/17 = 24%|
|Total (83 + 177)||-9%||-8%||-9%||11/46 = 24%|
CONCLUSION: The use of propofol as a sedating agent for endotracheal intubation is associated with mild hypotension. However, because the effect was mild, we deemed our protocol effective and safe.