A while back I asked you what drugs you use to induce anaesthesia in critically ill patients. Here are the results. You can see that about 1/4 of you are happy to stick with propofol as long as the patient isn’t hypotensive. In the hypotensive patient there is a big swing to ketamine, most often on it’s own.
My practice is to use ketamine and fentanyl together as the induction agent, with rocuronium as the muscle relaxant. For post intubation sedation I tend to use propofol and fentanyl mainly for institutional reasons. However I always use an opioid heavy cocktail and if hypotension is an issue I just use fentanyl – or add a homeopathic amount of propofol to prevent people from thinking that I’ve forgotten it and adding in a stupid amount.