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Etomidate in haemodynamic instability — FRCA Primary MCQ

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HardPharmacologyEtomidate in haemodynamic instabilityFRCA Primary

A 79-year-old woman requires induction for fractured neck of femur surgery. She is frail, hypovolaemic and has severe aortic stenosis. Which intravenous induction approach is most appropriate?

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Correct answer: C — Large bolus propofol to deepen anaesthesia rapidly

Etomidate causes relative cardiovascular stability compared with propofol or thiopental and is often chosen for haemodynamically fragile patients, although adrenal suppression is recognised. A large propofol bolus is likely to cause marked hypotension in severe aortic stenosis and hypovolaemia. Ketamine may preserve pressure but tachycardia can be problematic in fixed outflow obstruction. The key point is titration and preparation for vasopressor support.

Reference: RCoA Primary FRCA Syllabus 2026; Peck, Hill & Williams Pharmacology for Anaesthesia