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Propofol is the induction agent of choice for urgent intubations with UK physicians


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 [14]. 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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Rooney, K., Jackson, R., Binks, A. et al. Propofol is the induction agent of choice for urgent intubations with UK physicians. Crit Care 15 (Suppl 1), P153 (2011).

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  • Ketamine
  • Tracheal Intubation
  • Historical Control
  • Etomidate
  • European Centre