Propofol remains a cornerstone sedative for mechanically ventilated critically ill patients and is supported by PADIS guidelines and favored for its rapid onset, titratability, and limited side effects. However, its use in hemodynamically unstable patients remains a persistent clinical dilemma. In this episode of the Society of Critical Care Medicine (SCCM) Podcast, host Kyle Enfield, MD, is joined by Scott Benken, PharmD, MHPE, BCCCP, and Nathan Smischney, MD, MS, to explore the risks, benefits, and evolving evidence surrounding propofol use in this high-risk population.  

The discussion examines the physiologic basis of propofol-associated hypotension and how that can manifest in different patients, such as those with sepsis and septic shock. Patient selection and real-time assessment of hemodynamic trends are essential. Additional considerations include the recognition of and monitoring for propofol infusion syndrome, a rare but life-threatening complication.  

The episode also explores alternative drugs such as dexmedetomidine and ketamine, highlighting the benefits and risks of each. Emerging strategies are discussed, including a ketamine-propofol combination called ketafol and its utility in balancing sedation and hemodynamic stability. 

Listeners will gain expert insights into propofol use in the ICU and a deeper understanding of patient-centered approaches to sedation. 

Resources referenced in this episode: