Hypotension associated with propofol in trauma patients in the emergency department

Purpose: Propofol is commonly used in mechanically ventilated trauma patients after intubation in the emergency department.  The purpose of this study was to determine the incidence of hypotension and identify predictors of hypotension associated with propofol in this setting.

Methods: This was a retrospective cohort study conducted between June 24^th, 2010 and December 1^st, 2011. Consecutive adult trauma patients who were initiated on a propofol infusion in the emergency department during this time frame were included.  Patients were excluded if they had baseline hypotension (systolic blood pressure <90 mm Hg or on a vasopressor) prior to propofol initiation.  The incidence of subsequent hypotension was determined prior to patient transfer. A multivariate logistic regression analysis was performed to identify predictors of hypotension. 

Results: A total of 200 patients were included in the final analyses.  Of these, 32 (16%) developed hypotension in the emergency department. In the multivariate analysis, increasing patient age (odds ratio 1.035, 95% CI 1.007 to 1.064, p=0.014) and weight (odds ratio 1.026, 95% CI 1.003 to 1.048, p=0.025) were associated with more hypotension. The risk of hypotension also increased with lower baseline blood pressure (odds ratio 0.953, 95% CI 0.932 to 0.975, p<0.001). Other variables such as sex, race propofol infusion rates, and use of analgesia was not predictive of hypotension.

Conclusion: Increasing age and weight, and lower baseline blood pressure is associated with a higher risk of hypotension in trauma patients treated with propofol infusions in the emergency department.