TY - JOUR
T1 - Cerebral autoregulation and activity after propofol for endotracheal intubation in preterm neonates
AU - Thewissen, Liesbeth
AU - Caicedo, Alexander
AU - Dereymaeker, Anneleen
AU - Van Huffel, Sabine
AU - Naulaers, Gunnar
AU - Allegaert, Karel
AU - Smits, Anne
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Background: Despite increasing use of propofol in neonates, observations on cerebral effects are limited. Aim: To investigate cerebral autoregulation (CAR) and activity after propofol for endotracheal intubation in preterm neonates. Methods: Twenty-two neonates received propofol before intubation as part of a published dose-finding study. Mean arterial blood pressure (MABP), near-infrared spectroscopy-derived cerebral oxygenation (rScO2), and amplitude-integrated electroencephalography (aEEG) were analyzed until 180 min after propofol. CAR was expressed as transfer function (TF) gain, indicating % change in rScO2 per 1 mmHg change in MABP. Values exceeding mean TF gain + 2 standard deviations (SD) defined impaired CAR. Results: After intubation with a median propofol dose of 1 (0.5–4.5) mg/kg, rScO2 remained stable during decreasing MABP. Mean (±SD) TF gain was 0.8 (±0.3)%/mmHg. Impaired CAR was identified in 1 and 5 patient(s) during drug-related hypotension and normal to raised MABP, respectively. Suppressed aEEG was observed up to 60 min after propofol. Conclusions: Drug-related hypotension and decreased cerebral activity after intubation with low propofol doses in preterm neonates were observed, without evidence of cerebral ischemic hypoxia. CAR remained intact during drug-related hypotension in 95.5% of patients. Cerebral monitoring including CAR clarifies the cerebral impact of MABP fluctuations.
AB - Background: Despite increasing use of propofol in neonates, observations on cerebral effects are limited. Aim: To investigate cerebral autoregulation (CAR) and activity after propofol for endotracheal intubation in preterm neonates. Methods: Twenty-two neonates received propofol before intubation as part of a published dose-finding study. Mean arterial blood pressure (MABP), near-infrared spectroscopy-derived cerebral oxygenation (rScO2), and amplitude-integrated electroencephalography (aEEG) were analyzed until 180 min after propofol. CAR was expressed as transfer function (TF) gain, indicating % change in rScO2 per 1 mmHg change in MABP. Values exceeding mean TF gain + 2 standard deviations (SD) defined impaired CAR. Results: After intubation with a median propofol dose of 1 (0.5–4.5) mg/kg, rScO2 remained stable during decreasing MABP. Mean (±SD) TF gain was 0.8 (±0.3)%/mmHg. Impaired CAR was identified in 1 and 5 patient(s) during drug-related hypotension and normal to raised MABP, respectively. Suppressed aEEG was observed up to 60 min after propofol. Conclusions: Drug-related hypotension and decreased cerebral activity after intubation with low propofol doses in preterm neonates were observed, without evidence of cerebral ischemic hypoxia. CAR remained intact during drug-related hypotension in 95.5% of patients. Cerebral monitoring including CAR clarifies the cerebral impact of MABP fluctuations.
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U2 - 10.1038/s41390-018-0160-3
DO - 10.1038/s41390-018-0160-3
M3 - Article
C2 - 30201953
AN - SCOPUS:85053304746
SN - 0031-3998
VL - 84
SP - 719
EP - 725
JO - Pediatric Research
JF - Pediatric Research
IS - 5
ER -