2026 Eastern States Conference

Title: Evaluation of propofol safety in critically ill obese adult patients

Authors: Emilia Pieta, PharmD; Rita Jamil, PharmD; Brittany Tyree, PharmD, MS, BCCCP

Objective: Audience members will be able to assess how increasing BMI influences the risk of propofol-associated hemodynamic adverse effects in ICU patients.

Self-Assessment Question: True or False. Propofol used for the maintenance of sedation in the ICU was associated with a higher incidence of the composite outcome of hypotension or bradycardia in obese patients compared to non-obese patients.

Background: Given propofol’s lipophilicity and hemodynamic adverse effects, evaluation of the safety of propofol administered via continuous infusion for sedation in obese (BMI ≥30 kg/m2) versus non-obese (BMI <30 kg/m2) critically ill patients is warranted.

Methods: This single-center, retrospective study at UVA Health University Hospital included adults admitted to the medical ICU that received propofol continuous infusion for sedation for ≥12 hours between January 1, 2022 and May 31, 2025. Exclusions were a diagnosis of COVID-19; concomitant continuous infusion of benzodiazepine, dexmedetomidine, ketamine, or neuromuscular blocking agent; changes in dosing weight strategy during infusion; propofol administration in the operating room; or RASS goal >0 or <-2. The primary composite endpoint was incidence of new hypotension or bradycardia. Secondary safety endpoints included individual components of the composite outcome, peak triglyceride level, ICU length of stay, and in-hospital mortality. Secondary efficacy endpoints included time to first goal RASS, propofol infusion rate at first goal RASS, and incidence of self-extubation. A subgroup analysis was performed comparing patients with BMI 30 to <35 versus BMI ≥35.

Results: A total of 539 patients were screened; 100 patients were included (50 patients in the obese group). Baseline characteristics were similar, except heart failure was more common in obese patients. The incidence of new hypotension or bradycardia occurred in 46 non-obese versus 41 obese patients (p=0.137). Time to first event was 2.5 versus 1 hour (p=0.849). No significant differences were seen in peak triglycerides, ICU length of stay, in-hospital mortality, RASS outcomes, or self-extubation. Subgroup analysis showed higher incidence of new hypotension or bradycardia in BMI ≥35 kg/m2 (n=35) than BMI 30 to <35 kg/m2 (n=15) (26 vs. 15; p=0.043).

Conclusion: No significant difference was observed in the incidence of new hypotension or bradycardia between obese and non-obese patients. Time to first incidence of new hypotension or bradycardia was longer in non-obese patients, despite no significant difference. These results suggest that obesity is not associated with a higher incidence of hemodynamic adverse effects of propofol compared to non-obese patients.