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Propofol based sedation of MRI: be cautious in neonates
- karel allegaert (15 September 2008)
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Propofol for MRI Sedation: The Ideal Anesthetic!
- Alan Bielsky, Santhanam Suresh, MD FAAP (20 July 2008)
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karel allegaert, MD, PhD NICU, University Hospitals, Leuven, Belgium
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Sir, We read with great interest the experience reported by Machata et al on the use of propofol for sedation in infants and children. We fully agree that propofol likely is the most appropriated drug to be used in such settings because of the predictability and versibility of the dose/response. We however would only like to remind the anaesthesiologic community that we recently published observations on propofol clearance in preterm and term neonates in this journal. In brief, clearance in neonates (1 month of life) is lower. Of relevance during clinical use, interindividual variability in propofol clearance in part depends on both postmenstrual and postnatal age. This suggests that, irrespective of the the gestational age at birth (either preterm or term), it is to be anticipated that propofol clearance will be significantly lower in the first 10 days of postnatal life. Because of the increased use of MRI to further delineate diagnosis and prognosis in early neonatal life (e.g. congenital malformations, peripartal asphyxia), we suggest to titrate propofol administration in this specific population and to anticipate delayed return to pre-sedation level of conciousness. We therefore strongly suggest to maintain cardiorespiratory monitoring at least some hours after the end of the procedural sedation. reference: Allegaert K, et al. Br J Anaesth 2007 Dec;99(6):864-70 Conflict of Interest:None declared |
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Alan Bielsky, Fellow, Pediatric Anesthesiology Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Santhanam Suresh, MD FAAP
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We read with interest the article by Machata et al on the use of propofol sedation for MRI procedures. The experience of the authors mirror our own experience with propofol sedation. However, the younger patients, especially under 3 months of age, may sometimes require assistance with ventilation or airway devices like an LMA to maintain a patent airway. This is our preferred method for providing sedation for MRI procedures. Conflict of Interest:None declared |
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