Lesson 8 of 16
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Rapid Sequence Intubation (RSI): Propofol For RSI

Mechanism of Action

Propofol is a highly lipid-soluble, phenolic derivative, which is a GABA agonist and is used as an induction agent for RSI.


  • 1.5-2 mg/kg IV


~10-50 seconds


  • 3-10 minutes

Adverse effects

  • Hypotension
  • Bradycardia

Propofol Impact on Hemodynamics

Blood Pressure (BP) Heart Rate (HR) Cardiac Output (CO)Intracranial Pressure (ICP)
↓ Decreased ↓ Decreased ↓ Decreased ↓ Decreased

Literature Review

Author, year Design/ sample size Intervention & ComparisonOutcome
Dietrich, 2018Retrospective review/ n=83 Propofol
Non-propofol (etomidate or midazolam)
↑ post-intubation hypotension with propofol OR 3.64 (95% CI 1.16-13.24)

Similar rates of hypotension were seen among
patients who received ≤2 mg/kg and those receiving >2 mg/kg

No significant differences between groups in-hospital length of stay or mortality
Bruder, 2015Cochrane ReviewEtomidate
There was no difference in mortality, hospital LOS, duration of ventilation, and duration of vasopressors

Etomidate associated with ↑ ACTH and ↓ in cortisol level
ACHT= Adrenocorticotropic hormone; GCS= Glasgow Coma; HR= Heart Rate; MAP= Mean Arterial Pressure; RCT= Randomized Controlled Trial; Scale; SOFA= Sequential Organ Failure Assessment;

Comments by ED Physician Attendings

“Due to vasodilatory and anti-epileptic properties, propofol is most useful in hypertensive head bleeds and patients with status epilepticus those with enough BP to work with but titrate 10 mg at a time”“Hypotension and bradycardia should be noted, especially in trauma patients”


  • Propofol can reduce SBP by 20-25% for induction