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Propofol cardiovascular effects — FRCA Primary MCQ

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EasyPharmacologyPropofol cardiovascular effectsFRCA Primary

A fit adult becomes hypotensive shortly after induction with propofol for elective surgery. Heart rate is unchanged and there is no rash or wheeze. What is the most likely explanation?

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Correct answer: A — Reduced systemic vascular resistance

Propofol commonly causes hypotension by vasodilatation, reduced sympathetic tone and some myocardial depression. Histamine-mediated bronchospasm would suggest an allergic or pseudoallergic mechanism, which is not supported by the observations. Adrenal suppression is characteristic of etomidate, and sodium channel blockade is more relevant to local anaesthetic toxicity. Slow titration and attention to volume status reduce this predictable effect.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care