Our study shows that the decrease in cerebral flow velocities induced by propofol, persisted even after hemodynamic stability was attained after induction doses of propofol. On the contrary etomidate provided stable hemodynamic parameters as well as stable flow velocities.
The Effect of Propofol versus Etomidate Induction on Middle Cerebral Artery Flow Velocities and its Derived Parameters Using Transcranial Doppler Ultrasonography.
Radhika dash et al
We propose that large doses of propofol should be used cautiously in head-injured patients, because there is the potential to increase the injured brain’s vulnerability to secondary insults.
The effects of large-dose propofol on cerebrovascular pressure autoregulation in head-injured patients.
Steiner LA, et al. Anesth Analg. 2003.
I conclude that Etomidate do have upper hand in preserving the cerebral blood flow, while large dose of propofol may cause secondary insult to the traumatic brain.
Worry for high BP can be handle later after intubation by using propofol + fentanyl as sedation.