Propofol Dose-Finding to Reach Optimal Effect for (Semi-)Elective Intubation in Neonates

Smits, Anne; Thewissen, Liesbeth; Caicedo, Alexander; Naulaers, Gunnar; Allegaert, Karel

doi:10.1016/j.jpeds.2016.07.049

Cited by 65 publications

(101 citation statements)

References 33 publications

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“…Therefore, lower values of starting propofol dose were used, as indicated in Table 1. More specifically, administered dose ranges from 0.5 to 4.5 mg·kg −1 [6]. In general, the oldest neonates were sedated using higher propofol doses compared to the youngest neonates, as can be observed from Table 1.…”

Section: Datasetmentioning

confidence: 99%

“…The dataset used in the present analysis was collected as part of a study on propofol dose selection by Smits et al [6]. In the study, 50 neonates were sedated using propofol as part of an endotracheal intubation procedure.…”

Section: Datasetmentioning

confidence: 99%

“…For details regarding the composition of the patient groups, the PNA of the patients, and the doses of propofol administered to the subjects of each group, see Table 1. More information 2 Complexity about the clinical characteristics of the subjects can be found in the original paper by Smits et al [6]. Practices on propofol dosing, particularly in highly vulnerable premature neonates, are not standardized and vary between different NICUs.…”

Section: Datasetmentioning

confidence: 99%

“…Propofol (2,6 diisopropylphenol) is a short-acting anesthetic: it has a rapid onset of action and is generally short in duration. In neonates, however, it is documented that clinical recovery takes time [6]. In clinical practice, propofol is administered to the neonates as a single intravenous (IV) bolus.…”

Section: Introductionmentioning

confidence: 99%

“…In clinical practice, propofol is administered to the neonates as a single intravenous (IV) bolus. Propofol administration is frequently associated with a decrease in MABP in neonates [6][7][8][9][10][11], children [12], and adults [13][14][15]. Propofol distributes into the central nervous system and fat tissue immediately after intravenous dosing, which explains the rapid onset of this anesthetic drug.…”

Section: Introductionmentioning

confidence: 99%

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Using Graph Theory to Assess the Interaction between Cerebral Function, Brain Hemodynamics, and Systemic Variables in Premature Infants

et al. 2018

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Graphs can be used to describe a great variety of real-world situations and have therefore been used extensively in different fields. In the present analysis, we use graphs to study the interaction between cerebral function, brain hemodynamics, and systemic variables in premature neonates. We used data from a propofol dose-finding and pharmacodynamics study as a model in order to evaluate the performance of the graph measures to monitor signal interactions. Concomitant measurements of heart rate, mean arterial blood pressure, arterial oxygen saturation, regional cerebral oxygen saturation-measured by means of near-infrared spectroscopy-and electroencephalography were performed in 22 neonates undergoing INSURE (intubation, surfactant administration, and extubation). The graphs used to study the interaction between these signal modalities were constructed using the RBF kernel. Results indicate that propofol induces a decrease in the signal interaction up to 90 minutes after propofol administration, which is consistent with clinical observations published previously. The clinical recovery phase is mainly determined by the EEG dynamics, which were observed to recover much slower compared to the other modalities. In addition, we found a more pronounced loss in cerebral-systemic interactions with increasing propofol dose.

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Section: Datasetmentioning

confidence: 99%

Section: Datasetmentioning

confidence: 99%

Section: Datasetmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Using Graph Theory to Assess the Interaction between Cerebral Function, Brain Hemodynamics, and Systemic Variables in Premature Infants

et al. 2018

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Premedication for Neonates Requiring Nonemergency Intubation—Reply

Durrmeyer

Tourneux

Dechartres

2018

JAMA

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To the Editor Dr Durrmeyer and colleagues 1 investigated 173 neonates requiring nonemergent intubation in a multicenter, double-blind clinical trial, randomly assigning infants to receive atropine-propofol or atropine-atracuriumsufentanil before nasotracheal intubation. The authors reported that "the frequency of prolonged desaturation did not differ significantly [between groups]…. However, the study may have been underpowered to detect a clinically important difference."We would like to raise 2 points of concern regarding this study. First, the potential toxicity of general anesthetics like propofol administered to children receiving general anesthesia is controversial and has led to a warning from the US Food and Drug Administration (FDA). 2 We wonder whether anesthetic toxicity during intubation and sedation of neonates is relevant.Second, we would like to emphasize the occurrence of intraventricular hemorrhage. The authors stated that "the goal of premedication is to prevent pain, because multiple painful experiences in the neonatal period are associated with poor neurodevelopmental outcome." In this study, neonates were exposed to 2.5 mg/kg of propofol for infants weighing more than 1000 g and 1 mg/kg of propofol for those weighing less than 1000 g. Propofol has no analgesic properties, and we are concerned about whether this practice facilitates the occurrence of intraventricular hemorrhage, especially after Friesen et al 3 demonstrated that intracranial pressure increases by almost 200% during intubation. The difference in the number of intraventricular hemorrhages between groups (20.6% in the atropine-propofol group and 17.6% in the atropine-atracurium-sufentanil group; P = .87) may be underestimated due to the greater number of boys (69.5% vs 49.4%) and premature infants with lower median birth weight of 1130 g in the atropine-propofol group vs 1310 g in the atropine-atracurium-sufentanil group. Both parameters previously have been shown to be independent risk factors for intraventricular hemorrhage. 4,5 In our experience, the use of propofol without analgesia for tracheal intubation in neonates should only be recommended cautiously, although there might be a benefit in preservation of oxygen saturation immediately after intubation.

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Effect of Atropine With Propofol vs Atropine With Atracurium and Sufentanil on Oxygen Desaturation in Neonates Requiring Nonemergency Intubation

Durrmeyer

Breinig²,

Claris

et al. 2018

JAMA

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Propofol Dose-Finding to Reach Optimal Effect for (Semi-)Elective Intubation in Neonates

Cited by 65 publications

References 33 publications

Using Graph Theory to Assess the Interaction between Cerebral Function, Brain Hemodynamics, and Systemic Variables in Premature Infants

Using Graph Theory to Assess the Interaction between Cerebral Function, Brain Hemodynamics, and Systemic Variables in Premature Infants

Premedication for Neonates Requiring Nonemergency Intubation—Reply

Effect of Atropine With Propofol vs Atropine With Atracurium and Sufentanil on Oxygen Desaturation in Neonates Requiring Nonemergency Intubation

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