Liesbeth Thewissen1, Alexander Caicedo2, Anneleen Dereymaeker3, Sabine Van Huffel2, Gunnar Naulaers3, Karel Allegaert4, Anne Smits3. 1. Department of Neonatology, University Hospitals Leuven, Leuven, Belgium. liesbeth.thewissen@uzleuven.be. 2. Department of Electrical Engineering, ESAT-Stadius, KU Leuven, Leuven, Belgium. 3. Department of Neonatology, University Hospitals Leuven, Leuven, Belgium. 4. Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
Abstract
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.
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.
Authors: Yaroslava Longhitano; Francesca Iannuzzi; Giulia Bonatti; Christian Zanza; Antonio Messina; Daniel Godoy; Wojciech Dabrowski; Li Xiuyun; Marek Czosnyka; Paolo Pelosi; Rafael Badenes; Chiara Robba Journal: Front Neurol Date: 2021-11-16 Impact factor: 4.003
Authors: Ellen H M de Kort; Jos W R Twisk; Ellen P G van T Verlaat; Irwin K M Reiss; Sinno H P Simons; Mirjam M van Weissenbruch Journal: Acta Paediatr Date: 2020-04-20 Impact factor: 2.299