title: Propofol as an induction agent for endotracheal intubation can cause significant arterial hypotension in preterm neonates.
abstract: BACKGROUND
  Propofol is gaining increasing popularity as induction agent for pediatric 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.
  
  
  METHODS
  Preterm neonates with a gestational age of 29-32 weeks and respiratory distress were eligible for INSURE with propofol if their postnatal age was <8 h. 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 as a result of 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(-1) caused a distinctive decline in mean arterial blood pressure from 38 mmHg (range 29-42 mmHg) prior premedication to 24 mmHg (22-40 mmHg) 10 min 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 hemorrhage or periventricular leucomalacia. Propofol should be used with caution in very preterm neonates with respiratory distress during the first hours of life.
authors.affiliation: Department of Neonatology and Paediatric Intensive Care, University Hospital of Cologne, Children's Hospital, Cologne, Germany. lars.welzing@uk-koeln.de
authors.forename: Lars
authors.initials: L
authors.lastname: Welzing
authors.forename: Angela
authors.initials: A
authors.lastname: Kribs
authors.forename: Frank
authors.initials: F
authors.lastname: Eifinger
authors.forename: Christoph
authors.initials: C
authors.lastname: Huenseler
authors.forename: Andre
authors.initials: A
authors.lastname: Oberthuer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Roth
mesh_terms: D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000139:chemically induced*; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal / Q000379:methods*; D010865:Pilot Projects; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects*
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol