Published online October 1, 2007
PEDIATRICS
Vol. 120
No. 4
October 2007, pp.
933
(doi:10.1542/peds.2007-2352)
Propofol Compared With the Morphine, Atropine, and Suxamethonium Regimen as Induction Agents for Neonatal Endotracheal Intubation: A Randomized, Controlled Trial: In Reply
Mohamed E. Abdel-Latif, MBBS, MRCPCH, MPH, MScEpi
Julee Oei, MBBS, FRACP
Kei Lui, MBBS, FRACP, MD
Department of Newborn Care,
Royal Hospital for Women,
Randwick, New South Wales 2031, Australia,
School of Women's and Children's Health,
University of New South Wales,
Kensington, New South Wales 2032, Australia
We welcome the interest shown by Meyer et al in our article on propofol as an induction agent for neonatal endotracheal intubation.1 However, the authors seem to have made a few misinterpretations of our trial results. We did not report an increase in blood pressure, as claimed by these authors. In our propofol group, the median mean blood pressures were 42, 42.5, and 41 mmHg at baseline and during and after intubation, respectively, as illustrated in the original article. We also showed that the median mean blood pressure was comparable between the 2 study groups. We did not encounter any major complication in our trial, although it was not powered to detect adverse effects.
Gottschling et al have performed a number of studies using propofol as a sedation agent for diagnostic and therapeutic procedures in children outside the intensive care or anesthetic settings. In their studies, avoidance of intubation would be of paramount necessity in contrast to our randomized trial, which compared propofol with a regimen of morphine, atropine, and suxamethonium as rapid induction agents for endotracheal intubation. These authors reported a mean (±SD) sedation dose of 2.6 ± 0.7 mg/kg (interindividual range: 1.1–5.0 mg/kg).2 Sedations were given mostly for lumbar puncture, MRI, radiation therapy, and a few other minor invasive procedures. We chose a fixed initial dose of 2.5 mg/kg rather than a variable dose, because we thought that this approach was more appropriate for achieving the objectives of the study. Furthermore, despite this dose being similar to the mean dose from their findings, we found that 24.2% (95% confidence interval: 12.8–41.0) of the infants required a second dose to achieve hypnosis and successful intubation.
We would caution against the use of propofol outside critical care settings in young infants regardless of whether they are <1 month of age. Propofol used in our intubation trial was, in this context, part of critical care management and not for sedation or analgesia for brief diagnostic or therapeutic procedures, as recently reviewed by Meyer et al.3 Nonetheless, more studies are required, and we are planning a dose-refining study. On the basis of the result of this trial, we may progress to a randomized, controlled trial that compares sedation efficacy of different doses of propofol.
REFERENCES
- Ghanta S, Abdel-Latif ME, Lui K, Ravindranathan H, Awad J, Oei J. Propofol compared with the morphine, atropine, and suxamethonium regimen as induction agents for neonatal endotracheal intubation: a randomized, controlled trial.
Pediatrics. 2007;119(6)
. Available at: www.pediatrics.org/cgi/content/full/119/6/e1248
- Gottschling S, Meyer S, Reinhard H, Furtwängler R, Klotz D, Graf N. Intraindividual propofol dosage variability in children undergoing repetitive procedural sedations.
Pediatr Hematol Oncol. 2006;23
:571
–578[CrossRef][ISI][Medline]
- Meyer S, Grundmann U, Gottschling S, Kleinschmidt S, Gortner L. Sedation and analgesia for brief diagnostic and therapeutic procedures in children.
Eur J Pediatr. 2007;166
:291
–302[CrossRef][ISI][Medline]
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
