This patient is hemodynamically unstable (ie, hypotensive, tachycardic).  Prior to operative intervention, anesthesia must be induced.  Three medications are commonly used because of their rapid onset of action and short duration of effect:

• Propofol:  A highly lipophilic GABA agonist that has the advantage of reducing airway resistance.  Disadvantages include vasodilation, which can result in hypotension and an increase in serum triglycerides and lipase (Choice B).

• Etomidate:  A GABA agonist that has the advantage of being the most hemodynamically neutral.  It does not cause changes in heart rate, blood pressure, or cardiac output.  However, it inhibits cortisol synthesis, which can lead to adrenocortical suppression that is typically reversible.  Because of this, etomidate is often avoided in patients with septic shock, and it should not be used as maintenance of sedation after induction (Choices C and E).

• Ketamine:  An N-methyl-d-aspartate antagonist that is similar to PCP, it preserves the respiratory drive during induction of anesthesia.  Ketamine also provides an analgesic effect.  It stimulates the release of catecholamines, which can cause bronchodilation but also increase heart rate, myocardial contractility, and cerebral blood flow.

In hypotensive patients, anesthesia is often induced with either a hemodynamically neutral agent (etomidate) or one that may improve hemodynamics due to catecholamine release (ketamine).

(Choice A)  In contrast to ketamine, neither propofol nor etomidate provide an analgesic effect.

Educational objective:
Etomidate, a GABA agonist, is often used for anesthesia induction to provide sedation and amnesia.  It is hemodynamically neutral, but it can result in transient adrenocortical suppression because it inhibits cortisol synthesis.