Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
Acta Paediatr. 2013 Nov;102(11):e487-92. doi: 10.1111/apa.12367. Epub 2013 Aug 27.
To determine the effects of propofol for endotracheal intubation in neonates in daily clinical practice.
We prospectively studied the pharmacodynamic effects of intravenous propofol administration in neonates who needed endotracheal intubation at the neonatal intensive care unit.
Propofol was used for 62 intubations in neonates with postmenstrual ages ranging from 24 + 3 weeks to 44 + 5 weeks and bodyweights ranging from 520 to 4380 g. A 2 mg/kg bodyweight propofol starting dose was sufficient in 37% of patients; additional propofol was needed less often on the first postnatal day. The mean amount of propofol used was 3.3 (±1.2) mg/kg. The success rate of intubation depended on the experience of the physician and was related to the total administered amount of propofol. Hypotension occurred in 39% of patients and occurred more often at the first postnatal day. In 15% of procedures, propofol mono therapy was insufficient.
This study shows that high doses of propofol are needed to reach effective sedation in neonates for intubation, with hypotension as a side effect in a considerable percentage of patients. Further research in newborn patients needs to identify optimal propofol doses and risk factors for hypotension.
在日常临床实践中确定丙泊酚在新生儿气管插管中的作用。
我们前瞻性研究了静脉注射丙泊酚在新生儿重症监护病房需要气管插管的新生儿中的药效学作用。
丙泊酚用于 62 例胎龄 24+3 周至 44+5 周、体重 520 至 4380 克的新生儿进行插管。37%的患者需要 2mg/kg 体重的起始剂量丙泊酚；在出生后的第一天，需要较少的丙泊酚。平均使用丙泊酚剂量为 3.3（±1.2）mg/kg。插管成功率取决于医生的经验，并与给予的丙泊酚总量有关。39%的患者出现低血压，且更多发生在出生后的第一天。在 15%的操作中，丙泊酚单一疗法不足。
本研究表明，新生儿插管时需要高剂量的丙泊酚才能达到有效的镇静效果，相当一部分患者会出现低血压作为副作用。在新生儿患者中，需要进一步研究以确定最佳丙泊酚剂量和低血压的危险因素。
