Cerebral and Systemic Hemodynamic Effects of Intravenous Bolus Administration of Propofol in Neonates

Abstract

Objectives: To assess variability of systemic hemodynamics and its covariates following bolus propofol administration in (pre)term neonates, and to analyze the effect of propofol on cerebral tissue oxygenation index (TOI) and fractional tissue oxygen extraction measured by near-infrared spectroscopy. Methods: In (pre)term neonates, we recorded mean arterial blood pressure (MABP), saturation (SaO₂), heart rate (HR) and TOI from 5 min before up to 60 min after intravenous bolus propofol (3 mg kg^–1) administration during elective chest tube removal. Covariate analysis included postmenstrual age (PMA ≤ or >37 weeks), postnatal age (PNA ≤ or >10 days), comedication (fentanyl +/– midazolam) and congenital cardiopathy (yes/no). Fractional tissue oxygen extraction was calculated as (SaO₂ – TOI)/SaO₂. Results: Twenty recordings in 19 neonates were assessed. Following propofol administration, an abrupt, minor decrease in HR and SaO₂ was seen with fast recovery, while MABP decreased up to 1 h. TOI decreased during the first 3 min, reflecting an imbalance between cerebral oxygen delivery and demand. Despite sustained decrease in MABP, TOI then returned to baseline, suggesting a better balance between oxygen delivery and demand. PNA ≤10 days, comedication and absence of cardiopathy were associated with more subtle decreases in cerebral oxygenation and faster recovery. Conclusions: Propofol-induced decrease in HR, SaO₂ and cerebral oxygenation is short lasting while a decrease in MABP is observed up to 60 min. The variability in the effects of propofol is influenced by PNA, comedication or cardiopathy. Near-infrared spectroscopy can be used to assess hemodynamic effects of hypnotics on the cerebral oxygenation.

Cerebral Tissue Oxygenation and Regional Oxygen Saturation Can Be Used to Study Cerebral Autoregulation in Prematurely Born Infants

“…The scores of our propofol dataset are shown to be related to clinical intervention because they change concordant to the administration of propofol (18). No other conclusions can be drawn because the populations used here are too small.…”

“…This dataset, called the propofol dataset in this article, was also used in a separate study presented in Ref. 18. The second dataset contains the recordings of 20 prematurely born infants with need for intensive care that were monitored during the first 3 d of life at the same NICU of the University Hospital Leuven, and it will be referred to as the Leuven dataset.…”

Prevention and Management of Procedural Pain in the Neonate: An Update

“…104 It has also been associated with bradycardia, desaturations, and prolonged hypotension in newborn infants. 105 Limited experience with dexmedetomidine in preterm and term infants suggests that it may provide effective sedation and analgesia. Preliminary pharmacokinetic data showed decreased clearance in preterm infants compared with term infants and a favorable safety profile over a 24-hour period.…”

Using Graph Theory to Assess the Interaction between Cerebral Function, Brain Hemodynamics, and Systemic Variables in Premature Infants

“…Combined with the blunted reflex tachycardia, this can result in hypotension [10]. Therefore, a decrease in MABP is observed up to one hour after administration of propofol in neonates [8]. Premedicating neonates with propofol generally causes a modest and short-lasting decrease in HR, SaO 2 , and rScO 2 , as opposed to the longer-lasting and more pronounced decrease in MABP [8], [11,16,17].…”