Poster presentation | Open | Published:
Propofol is the induction agent of choice for urgent intubations with UK physicians
Critical Carevolume 15, Article number: P153 (2011)
We performed a multicentre, prospective, observational study across nine hospitals in the Severn Deanery (UK). Choice of induction agents for out-of-theatre intubations was compared against historical controls.
Data were collected prospectively on all out-of-theatre tracheal intubations occurring within the region during a 1-month period. We included all intubations performed outside areas normally used for elective or emergency surgery. Neonates and cardiac arrests were excluded from analysis. Data were collected locally using a standardised proforma and centrally collated. All intubations were performed according to the preference of the treating team.
Hypnotics were used for 164 out-of-theatre intubations. Seventy-six per cent of intubations were accomplished by the use of propofol. Propofol was more likely to cause hypotension than other hypnotics (27.4% vs. 14.3%). Use of alternatives increased with seniority of the intubator. Consultants and senior trainees were less likely to use propofol than junior trainees (73% vs. 93%). Etomidate was not used at all. Previous studies from North American and European centres demonstrate greater use of alternative induction agents, particularly etomidate and ketamine [1–4]. UK practice has also changed over time, comparing our study with historical controls [5, 6].
There is significant geographical variation in choice of induction agent for critically ill patients. There has been an increase in the use of propofol amongst UK physicians over the past 7 years. Choice of hypnotic agent has a significant impact on physiological stability and out-of-theatre intubations are commonly performed in emergent circumstances on unstable patients. This study raises concerns that UK physicians choose induction agents based on familiarity rather than the pharmacodynamic profile.
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