Propofol in neonates causes a dose‐dependent profound and protracted decrease in blood pressure

Abstract

It is known that awake endotracheal intubation in newborns causes multiple harmful effects. 1-3 Therefore, in 2001 consensus was reached that only in the delivery room and in life-threating situations associated with the unavailability of intravenous access, tracheal intubation should be performed without the use of analgesia or sedation. 4 Almost twenty years later, the most effective and safe premedication strategy in the newborn population is still to be determined. Propofol is considered one of the acceptable options 5 and is shown to be very easy in use. 6 Therefore, propofol has been implemented into clinical practice. 7-11 In the past decade, several studies have appeared reporting on the use of propofol for neonatal intubation, with somewhat conflicting results about the sedative effect related to dose. 6,9,10,12,13 Results regarding the hypotensive effect of propofol are probably even more conflicting, varying from no or only a slight decrease in blood pressure, 6,11 to a more pronounced decrease in blood pressure

Reply to Letter ‘Propofol in preterm neonates’

“…We found a profound and long-lasting decline in blood pressure after propofol and a high incidence of propofol-induced hypotension. 1 These findings are in accordance with other studies. Although some authors indicate this hypotension as permissive, to our opinion evidence on the effects of propofol-induced hypotension and the sudden and long-lasting decline in blood pressure regardless of the existence of hypotension on the short and long term is lacking.…”

“…We found a profound and long‐lasting decline in blood pressure after propofol and a high incidence of propofol‐induced hypotension 1 . These findings are in accordance with other studies.…”

“…We welcome the interest that is shown by Meyer et al 1 in our article on the effects of propofol used as premedication for endotracheal intubation on blood pressure in newborns.…”

Propofol in preterm neonates

“…In their prospepective study in very preterm neonates, De Kort et al analysed the effects of different propofol starting doses as premedication for endotracheal intubation on blood pressure (1.0 mg/kg (n = 30), 1.5 mg/kg (n = 23) or 2.0 mg/kg (n = 26)). 1 The authors demonstrated that propofol caused a dose-dependent profound and protracted drop in blood pressure which was mainly dependent on the initial propofol starting dose rather than the cumulative propofol dose. Conversely, in their initial analysis, De Kort et al showed that a propofol starting dose of 2.0 mg/kg provided effective sedation in 86% of patients, compared to 13% and 4% of the patients who received a starting dose of 1.5 mg/kg or 1.0 mg/ kg, respectively.…”

“…In their prospepective study in very preterm neonates, De Kort et al analysed the effects of different propofol starting doses as premedication for endotracheal intubation on blood pressure (1.0 mg/kg ( n = 30), 1.5 mg/kg ( n = 23) or 2.0 mg/kg ( n = 26)) 1 . The authors demonstrated that propofol caused a dose‐dependent profound and protracted drop in blood pressure which was mainly dependent on the initial propofol starting dose rather than the cumulative propofol dose.…”