Propofol for procedural sedation/anaesthesia in neonates

Shah, Prakeshkumar S; Shah, Vibhuti

doi:10.1002/14651858.cd007248.pub2

Cited by 38 publications

(26 citation statements)

References 24 publications

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“…180 One study compared propofol to morphine, atropine and suxamethonium for intubation and found that propofol led to shorter intubation times, higher oxygen saturations, and less trauma than the combination regimen in neonates, but these effects were not significantly different 181,182 However, propofol should be used with caution in young infants because its clearance and potential for neurotoxicity are inversely related to neonatal and postmenstrual age. There is significant inter-individual variability in the pharmacokinetics of propofol in preterm neonates 183 and its use can lead to severe hypotension, with transient decreases in heart rate and oxygen saturations.…”

Section: Non-opioid Therapiesmentioning

confidence: 99%

Pain Management in Newborns

Hall¹,

Anand

2014

Clinics in Perinatology

203

126

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Effective pain management is a desirable standard of care for preterm and term newborns and may potentially improve their clinical and neurodevelopmental outcomes. Neonatal pain should be assessed routinely using context-specific, validated and objective pain methods, despite the limitations of currently available tools. Reducing invasive procedures, and using pharmacological, behavioral or environmental measures can be used to manage neonatal pain. Non-pharmacologic approaches include kangaroo care, facilitated tucking, non-nutritive sucking, sucrose and other sweeteners, massage and acupuncture therapy. They are used for procedures causing acute, transient, or mild pain, or as adjunctive therapy for moderate or severe pain. Local and topical anesthetics can reduce the acute pain caused by skin-breaking or mucosa-injuring procedures. Opioids form the mainstay for treatment of severe pain; morphine and fentanyl are the most commonly used drugs, although other opioids are also available. Non-opioid drugs include various sedatives and anesthetic agents, mostly used as adjunctive therapy in ventilated neonates. Acetaminophen, ibuprofen and other drugs are used for neonates, although their efficacy and safety remains unproven. Approaches for implementing an effective pain management program in the Neonatal ICU are summarized, together with practical protocols for procedural, postoperative, and mechanical ventilation-associated neonatal pain and stress.

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Section: Non-opioid Therapiesmentioning

confidence: 99%

Pain Management in Newborns

Hall¹,

Anand

2014

Clinics in Perinatology

203

126

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“…In many European neonatal intensive care units, propofol is currently used as a standard single agent for endotracheal intubation. The used dosages are currently extrapolated from knowledge available from older children and adults . These dosages might be wrong because it is very reasonable to assume that neonatal propofol metabolism, transporters and receptors are immature .…”

Section: Introductionmentioning

confidence: 99%

Clinical evaluation of propofol as sedative for endotracheal intubation in neonates

2013

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“…They reported faster intubation times, better oxygen saturation maintenance and shorter recovery times in the propofol group, and there was no difference in bradycardia or hypotension between the two groups. [5] A paucity of data remains regarding the use of propofol in infants; the Cochrane review by Shah et al [27] only included the 63 infants in Ghanta et al's RCT. There are also significant concerns regarding the safety of propofol, Welzing et al [28] demonstrating a significant drop in arterial blood pressure when propofol was injected as a fast push.…”

Section: Discussionmentioning

confidence: 99%

Newborns should be receiving premedication before elective intubation

et al. 2014

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Background. Intubation is a common neonatal procedure. Premedication is accepted as a standard of care, but its use is not universal and wide variations exist in practice. Objective. To evaluate current practices for premedication use prior to elective neonatal intubation in South Africa (SA). Method. We invited 481 clinicians to participate in a cross-sectional web-based survey. Results. We received responses from 28.3% of the clinicians surveyed; 54.1% were from the private sector and 45.9% from the state sector. Most respondents worked in medium-sized neonatal units with six to ten beds. Most paediatricians (76.0%) worked in the private sector, and 78.6% of neonatologists in the state sector. Premedication was practised by 71.9% of the respondents, but only 38.5% of neonatal units had a written policy. Sedatives were used for premedication by 63.2% of the respondents. Midazolam (41.5%), morphine (34.0%) and ketamine (20.8%) were most commonly used. Muscle relaxants and atropine were not routinely administered. Suxamethonium was the muscle relaxant of choice. Varied combinations of agents or single agents were used. Midazolam used alone was the preferred option. Conclusion. This first survey of premedication for neonatal intubation in SA revealed variations in practice, with a minority of clinicians following a written policy. The findings can be used to benchmark practice and inform the design of local collaborative trials aimed at determining optimal premedication prior to neonatal intubation. The survey demonstrates clinicians' reluctance to participate in surveys, suggesting a need for a national collaborative network to obtain representative data.

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Propofol for procedural sedation/anaesthesia in neonates

Cited by 38 publications

References 24 publications

Pain Management in Newborns

Pain Management in Newborns

Clinical evaluation of propofol as sedative for endotracheal intubation in neonates

Newborns should be receiving premedication before elective intubation

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