Ellen de Kort

129 Blood pressure after propofol in neonates 8 INTRODUCTION 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-threatening situations associated with the unavailability of intravenous access, tracheal intubation should be performedwithout 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 and a high incidence of hypotension. 9,10,13 Therefore, questions have been raised about the effectiveness and safety of propofol. In our recently performed propofol dose-finding trial (NEOPROP-2) we showed that propofol starting doses of 1.0 and 1.5 mg/kg were less effective in providing effective sedation compared to a propofol starting dose of 2.0 mg/kg. However, independent of the starting dose, propofol carried an unpredictable high risk of hypotension. 14 The aim of the current study was to further analyze the effects of different propofol starting doses on blood pressure. With this in-depth analysis of the effects of propofol on blood pressure we aimed to provide guidelines for the use of propofol in clinical practice. METHODS Participants Neonates from the previously published NEOPROP-2 trial were considered for inclusion. 14 The NEOPROP-2 trial was a prospective multicenter dose-finding trial conducted at three level III Neonatal Intensive Care Units in the Netherlands. Neonates with a postnatal age of less than 28 days who needed nonemergency endotracheal intubation were eligible for inclusion. Exclusion criteria were major congenital anomalies or neurologic disorders, upper airway anomalies, sedative or opioid administration in the preceding 24 hours and previous inclusion in the trial. Hemodynamic instability and underlying illnesses that are accompanied with a greater risk of hemodynamic instability were no specific exclusion criteria. The hemodynamic status and risk of hemodynamic insufficiency were