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Propofol Formulation Affects Myocardial Function in Newborn Infants

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Abstract

This study aimed to evaluate the effects of propofol in diluted and undiluted formulations on cardiac function in infants. Infants > 30 days received propofol sedation for central line insertion. Cases were divided into two groups: those who received undiluted 1% propofol (P1%); and those who received a diluted formulation (Pd) of equal volumes propofol 1% and 0.9% NaCl. Echocardiograms were performed pre (t0)-, immediately post (t1)-, and 1-h post (t2) propofol administration. Myocardial deformation was assessed with tissue Doppler imaging (TDI) analysis and peak longitudinal strain (LS). 18 cases were included: nine (50%) P1% and nine (50%) Pd. In the P1% group, TDI velocities and LS were significantly reduced at t1 and t2. In the Pd Group, only TDI velocities in the left ventricle were reduced at t1, but not at t2. Dilution of propofol may minimize myocardial dysfunction while maintaining adequate sedation in infants. Further comparative studies are needed to investigate the safety and efficacy of this approach.

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Abbreviations

BP:

Blood pressure

CL:

Central line

DBP:

Diastolic blood pressure

TDI E’:

Diastolic velocity

ECMO:

Extra corporeal membrane oxygenation

FLACC:

Face, legs, activity, cry, and consolability scale

HR:

Heart rate

LV:

Left ventricle

LS:

Longitudinal strain

P1%:

Propofol 1%

Pd:

Propofol diluted

PP:

Pulse pressure

RV:

Right ventricle

SR:

Sarcoplasmatic reticulum

STE:

Speckle tracking echocardiography

SBP:

Systolic blood pressure

TDI S’:

Systolic velocity

TDI:

Tissue doppler imaging

SpO2 :

Transcutaneous oxygen saturation

References

  1. Anand KJS, Johnston CC, Oberlander TF et al (2005) Analgesia and local anesthesia during invasive procedures in the neonate. Clin Ther 27:844–876

    Article  CAS  PubMed  Google Scholar 

  2. Roofthooft DWE, Simons SHP, Van Lingen RA et al (2017) Randomized controlled trial comparing different single doses of intravenous paracetamol for placement of peripherally inserted central catheters in preterm infants. Neonatology. https://doi.org/10.1159/000468975

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chidambaran V, Costandi A, D’Mello A (2015) Propofol: a review of its role in pediatric anesthesia and sedation. CNS Drugs 27:543–563

    Article  Google Scholar 

  4. Trapani G, Altomare C, Liso G et al (2000) Propofol in anesthesia. Mechanism of action, structure-activity relationships, and drug delivery. Curr Med Chem 7:249–271. https://doi.org/10.2174/0929867003375335

    Article  CAS  PubMed  Google Scholar 

  5. Allegaert K (2011) The clinical pharmacology of short acting analgo-sedatives in neonates. Curr Clin Pharmacol 6:222–226

    Article  CAS  PubMed  Google Scholar 

  6. Welzing L, Kribs A, Eifinger F et al (2010) Propofol as an induction agent for endotracheal intubation can cause significant arterial hypotension in preterm neonates. Paediatr Anaesth 20:605–611. https://doi.org/10.1111/j.1460-9592.2010.03330.x

    Article  PubMed  Google Scholar 

  7. Simons SHP, Van Der Lee R, Reiss IKM, Van Weissenbruch MM (2013) Clinical evaluation of propofol as sedative for endotracheal intubation in neonates. Acta Paediatr Int J Paediatr 102:487–492. https://doi.org/10.1111/apa.12367

    Article  CAS  Google Scholar 

  8. Smits A, Thewissen L, Caicedo A et al (2016) Propofol dose-finding to reach optimal effect for (semi)elective intubation in neonates. J Pediatr 179:54–60.e9. https://doi.org/10.1016/j.jpeds.2016.07.049

    Article  CAS  PubMed  Google Scholar 

  9. Vanderhaegen J, Naulaers G, Van Huffel S et al (2010) Cerebral and systemic hemodynamic effects of intravenous bolus administration of propofol in neonates. Neonatology 98:57–63. https://doi.org/10.1159/000271224

    Article  CAS  PubMed  Google Scholar 

  10. Park WK, Lynch C 3rd (1992) Propofol and thiopental depression of myocardial contractility. A comparative study of mechanical and electrophysiologic effects in isolated guinea pig ventricular muscle. Anesth Analg 74:395–405

    Article  CAS  PubMed  Google Scholar 

  11. Larsen JR, Torp P, Norrild K, Sloth E (2007) Propofol reduces tissue-Doppler markers of left ventricle function: a transthoracic echocardiographic study. Br J Anaesth 98:183–188. https://doi.org/10.1093/bja/ael345

    Article  CAS  PubMed  Google Scholar 

  12. Riedijk MA, Milstein DM (2017) Effects of propofol on the microcirculation in children with continuous video microscopy imaging. Crit Care. https://doi.org/10.1186/s13054-017-1630-4

    Article  PubMed Central  Google Scholar 

  13. Krassioukov AV, Gelb AW, Weaver LC (1993) Action of propofol on central sympathetic mechanisms controlling blood pressure. Can J Anaesth. https://doi.org/10.1007/BF03009773

    Article  PubMed  Google Scholar 

  14. Perlstein M, Aserin A, Wachtel EJ, Garti N (2015) Propofol solubilization and structural transformations in dilutable microemulsion. Colloids Surf B 136:282–290. https://doi.org/10.1016/j.colsurfb.2015.08.044

    Article  CAS  Google Scholar 

  15. Cai W, Deng W, Yang H et al (2012) A propofol microemulsion with low free propofol in the aqueous phase: formulation, physicochemical characterization, stability and pharmacokinetics. Int J Pharm 436:536–544. https://doi.org/10.1016/j.ijpharm.2012.07.008

    Article  CAS  PubMed  Google Scholar 

  16. Piersigilli F, Di Pede A, Catena G et al (2017) Propofol and fentanyl sedation for laser treatment of retinopathy of prematurity to avoid intubation. J Matern Neonatal Med 32:517

    Article  Google Scholar 

  17. EL-Khuffash A, Schubert U, Levy PT et al (2018) Deformation imaging and rotational mechanics in neonates: a guide to image acquisition, measurement, interpretation, and reference values. Pediatr Res. 84:30–45

    Article  PubMed  PubMed Central  Google Scholar 

  18. Patel N, Massolo AC, Paria A et al (2018) Early postnatal ventricular dysfunction is associated with disease severity in patients with congenital diaphragmatic hernia. J Pediatr. https://doi.org/10.1016/j.jpeds.2018.07.062

    Article  PubMed  PubMed Central  Google Scholar 

  19. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S (1997) Practice applications of research. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 23:293–297

    CAS  PubMed  Google Scholar 

  20. Jain A, Mohamed A, El-Khuffash A et al (2014) A comprehensive echocardiographic protocol for assessing neonatal right ventricular dimensions and function in the transitional period: normative data and z scores. J Am Soc Echocardiogr 27:1293–1304. https://doi.org/10.1016/j.echo.2014.08.018

    Article  PubMed  Google Scholar 

  21. Nestaas E, Schubert U, de Boode WP, EL-Khuffash A (2018) Tissue Doppler velocity imaging and event timings in neonates: a guide to image acquisition, measurement, interpretation, and reference values. Pediatr Res 84:18–29

    Article  PubMed  PubMed Central  Google Scholar 

  22. Mori K (2004) Pulsed wave Doppler tissue echocardiography assessment of the long axis function of the right and left ventricles during the early neonatal period. Heart. https://doi.org/10.1136/hrt.2002.008110

    Article  PubMed  PubMed Central  Google Scholar 

  23. Levy PT, Machefsky A, Sanchez AA et al (2016) Reference ranges of left ventricular strain measures by two-dimensional speckle-tracking echocardiography in children: a systematic review and meta-analysis. J Am Soc Echocardiogr. https://doi.org/10.1016/j.echo.2015.11.016

    Article  PubMed  PubMed Central  Google Scholar 

  24. Patel N, Kipfmueller F (2017) Cardiac dysfunction in congenital diaphragmatic hernia: pathophysiology, clinical assessment, and management. Semin Pediatr Surg 26:154–158. https://doi.org/10.1053/j.sempedsurg.2017.04.001

    Article  PubMed  Google Scholar 

  25. Yang HS, Kim TY, Bang S et al (2014) Comparison of the impact of the anesthesia induction using thiopental and propofol on cardiac function for non-cardiac surgery. J Cardiovasc Ultrasound 22:58–64. https://doi.org/10.4250/jcu.2014.22.2.58

    Article  PubMed  PubMed Central  Google Scholar 

  26. Riou B, Besse S, Lecarpentier Y, Viars P (1992) In vitro effects of propofol on rat myocardium. Anesthesiology 76:609–616. https://doi.org/10.1097/00000542-199204000-00019

    Article  CAS  PubMed  Google Scholar 

  27. Cook DJ, Housmans PR (1994) Mechanism of the negative inotropic effect of propofol in isolated ferret ventricular myocardium. Anesthesiology 80:859–871

    Article  CAS  PubMed  Google Scholar 

  28. Oh CS, Lee Y, Kang WS, Kim SH (2016) Impact of effect-site concentration of propofol on cardiac systolic function assessed by tissue Doppler imaging. J Int Med Res 44:453–461. https://doi.org/10.1177/0300060516635384

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We are grateful to the neonatal clinical staff at the Department of Medical and Surgical Neonatology for their assistance with the study, and to Dr Pietro Bagolan and Dr Esther Aspinall for their expert advice in design and data analysis.

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Authors and Affiliations

  1. Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, IRCCS, Piazzale Sant’Onofrio 4, 00165, Rome, Italy

    Anna Claudia Massolo, Fiammetta Piersigilli, Irma Capolupo, Jole Rechichi, Francesca Landolfo, Flaminia Calzolari & Alessandra Toscano

  2. Department of Anesthesiology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Stefania Sgrò & Sergio Picardo

  3. Department of Development and Regeneration, KU Leuven, Leuven, Belgium

    Karel Allegaert

  4. Division of Neonatology, Department of Pediatrics, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Karel Allegaert

  5. Department of Neonatology, Royal Hospital for Children, Glasgow, UK

    Neil Patel

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  1. Anna Claudia Massolo
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Correspondence to Anna Claudia Massolo.

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All authors declare that there are no known financial or conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by our Institutional Review Board and as a retrospective analysis with no patient identifiable information, and therefore was approved without need for written consent.

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Massolo, A.C., Sgrò, S., Piersigilli, F. et al. Propofol Formulation Affects Myocardial Function in Newborn Infants. Pediatr Cardiol 40, 1536–1542 (2019). https://doi.org/10.1007/s00246-019-02182-4

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