Background Propofol is increasingly used as a rapid and short acting induction agent. Concerns about cardiovascular side effects have limited its use in neonates. In our level III NICU and prehospital paediatric medical team, propofol is the first drug of choice for all intubations in hemodynamically stable newborns.
Aim To evaluate efficacy and tolerance of propofol in neonates.
Methods Monocentric prospective observational study, conducted between June 2012 and March 2014 including neonates needing elective endotracheal intubation. Patients received a starting dose of 1 mg/kg of propofol. Additional doses of 0.5 mg/kg were repeated until sufficient sedation was obtained. Haemodynamic parameters were recorded before, during and after propofol injection. The level of sedation, intubation conditions, and side effects were recorded.
Results Propofol was used in 89 intubations in 83 patients with a median gestational age of 31 wk + 5 d (25 wk +6 d to 41 wk +3 d), postnatal age was 4 h (17 min to 67 days), and weight was 1530 g (610–4820 g). A propofol starting dose was sufficient in 34% of patients. A total dose of 2 mg/kg was efficient in the 73% of patients. Physicians were satisfied about the intubation conditions in 75%. Short and moderate hypotension occurred in 32% of patients independently of doses and gestational ages (91% before 12 h of age). No patients required neither fluids nor vasopressor. The following side effects were also noted: apnea (35%), bradycardia (<10%).
Conclusion Propofol offered good intubation conditions without significant side effects. Doses needed to obtain sufficient sedation varied widely.