Ellen de Kort

122 Chapter 7 could have helped to study the clinical relevance of hypotension on cerebral oxygenation and perfusion in greater detail. Third, the treatment of hypotension was left to the discretion of the treating physician, which is likely to have caused variability between clinicians and between centers. CONCLUSIONS The results of this large dose-finding study suggest that in the neonatal population it is difficult to achieve effective sedationwithout the occurrence of significant side effectswith a single propofol bolus. The effects and side effects of propofol in the neonatal population are highly variable and unpredictable. Propofol in the neonatal population should only be used after careful consideration in each individual patient and should be titrated based on the sedative effect with strict monitoring of blood pressure and hemodynamic status. As long as the ideal premedication strategy in the neonatal population has not been elucidated, the pros and cons of different strategies including propofol should be balanced against each other. A greater effort should be made to move forward from a one-strategy-fits-all idea towards personalized neonatal pharmacology.