To the Editor.—

We welcome the recent contribution by Ghanta et al, which showed the efficacy of propofol as an induction agent to facilitate neonatal endotracheal intubation. Their article provided convincing evidence that in neonates, as in adults and children, propofol without muscle relaxants provides optimal conditions for endotracheal intubation. Hence, skilled or less experienced physicians may be encouraged to sedate infants before semiurgent endotracheal intubation, a procedure that is still underused in most NICUs. Nevertheless, we would like to raise a note of caution regarding the use of propofol as a single agent before intubation in newborn infants. Because propofol is a hypnotic agent with no analgesic effect, propofol should be given with adjunctive analgesics for painful procedures. When given as a bolus in hypnotic doses, propofol commonly causes profound apnea. Although short-lasting (30–90 seconds), this effect may facilitate intubation but also delay adequate ventilation and oxygenation...

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