Propofol as an induction agent for endotracheal intubation can cause significant arterial hypotension in preterm neonates

Lars Welzing (1) , Angela Kribs (1) , Frank Eifinger (1) , Christoph Huenseler (1) , Andre Oberthuer (1) , Bernhard Roth (1)

1 Department of Neonatology and Paediatric Intensive Care

Backround: Propofol is gaining increasing popularity as induction agent for paediatric endotracheal intubation. Recently propofol has been described for the first time as induction agent for endotracheal intubation in preterm neonates. Propofol seemed to be efficient, safe and ideally suited for the INSURE (Intubation SURfactant Extubation) procedure in preterm neonates. The purpose of this study was to document intubating conditions, vital signs, extubation times and outcome in preterm neonates receiving propofol as induction agent for the INSURE procedure. Patients and Methods: Preterm neonates with a gestational age of 29 to 32 weeks and respiratory distress were eligible for INSURE with propofol if their postnatal age was less than 8 hours. Exclusion criteria were any kind of disease not allowing early extubation. Results: There were 13 inborn neonates enrolled for INSURE, mean gestational age was 30 weeks + 3 days and mean birth weight was 1428 g (range 1170-1780 g). We stopped our observational study ahead of time due to significant cardiovascular side effects. Propofol generally offered good intubating conditions, but we encountered severe problems with arterial hypotension. A low propofol bolus of 1 mg/kg caused a distinctive decline of mean arterial blood pressure from 38 mmHg (range 29-42 mmHg) prior premedication to 24 mmHg (22–40 mmHg) 10 minutes after propofol application. Conclusions: Our experience with propofol as induction agent for endotracheal intubation in preterm neonates reveals distinctive cardiovascular effects which represent an important risk factor for serious complications of prematurity like intraventricular haemorrhage or periventricular leucomalacia. Propofol should be used with caution in very preterm neonates with respiratory distress during the first hours of life.

Mots clés: Medicine

Lars Welzing, Angela Kribs, Frank Eifinger, Christoph Huenseler, Andre Oberthuer, et al.. Propofol as an induction agent for endotracheal intubation can cause significant arterial hypotension in preterm neonates. Pediatric Anesthesia, 2010, 20 (7), pp.605. ⟨10.1111/j.1460-9592.2010.03330.x⟩. ⟨hal-00552645⟩