Which intravenous anesthetic is commonly associated with pain on injection and can cause severe hypotension in the elderly?

Which intravenous anesthetic is commonly associated with pain on injection and can cause severe hypotension in the elderly?

• A. Thiopental
• B. Diazepam
• C. Etomidate
• D. Propofol

Answer: (D)

Propofol is the intravenous anesthetic most linked with pain on injection and with significant blood pressure drops, especially in the elderly. The injection pain comes from irritation of the peripheral veins by the drug’s lipid emulsion and the rapid entry into the venous system, producing a burning sensation for many patients. At the same time, propofol causes marked vasodilation and a decrease in systemic vascular resistance, along with some reduction in cardiac preload and output. In older patients, reduced vascular smooth muscle tone and diminished autonomic reflexes mean they can’t compensate as well, so the same dose leads to a more pronounced and potentially dangerous hypotensive response. While other agents may cause hypotension or injection discomfort, propofol’s combination of prominent injection pain and notable, dose-dependent hypotension in the elderly makes it the classic match for this scenario.

Propofol is the intravenous anesthetic most linked with pain on injection and with significant blood pressure drops, especially in the elderly. The injection pain comes from irritation of the peripheral veins by the drug’s lipid emulsion and the rapid entry into the venous system, producing a burning sensation for many patients. At the same time, propofol causes marked vasodilation and a decrease in systemic vascular resistance, along with some reduction in cardiac preload and output. In older patients, reduced vascular smooth muscle tone and diminished autonomic reflexes mean they can’t compensate as well, so the same dose leads to a more pronounced and potentially dangerous hypotensive response. While other agents may cause hypotension or injection discomfort, propofol’s combination of prominent injection pain and notable, dose-dependent hypotension in the elderly makes it the classic match for this scenario.