BACKGROUND: Propofol is gaining increasing popularity as induction agent for 
pediatric endotracheal intubation. Recently, propofol has been described for the 
first time as induction agent for endotracheal intubation in preterm neonates. 
Propofol seemed to be efficient, safe and ideally suited for the INSURE 
(Intubation SURfactant Extubation) procedure in preterm neonates. The purpose of 
this study was to document intubating conditions, vital signs, extubation times 
and outcome in preterm neonates receiving propofol as induction agent for the 
INSURE procedure.
PATIENTS AND METHODS: Preterm neonates with a gestational age of 29-32 weeks and 
respiratory distress were eligible for INSURE with propofol if their postnatal 
age was <8 h. Exclusion criteria were any kind of disease not allowing early 
extubation.
RESULTS: There were 13 inborn neonates enrolled for INSURE, mean gestational age 
was 30 weeks + 3 days, and mean birth weight was 1428 g (range 1170-1780 g). We 
stopped our observational study ahead of time as a result of significant 
cardiovascular side effects. Propofol generally offered good intubating 
conditions, but we encountered severe problems with arterial hypotension. A low 
propofol bolus of 1 mg kg(-1) caused a distinctive decline in mean arterial 
blood pressure from 38 mmHg (range 29-42 mmHg) prior premedication to 24 mmHg 
(22-40 mmHg) 10 min after propofol application.
CONCLUSIONS: Our experience with propofol as induction agent for endotracheal 
intubation in preterm neonates reveals distinctive cardiovascular effects, which 
represent an important risk factor for serious complications of prematurity like 
intraventricular hemorrhage or periventricular leucomalacia. Propofol should be 
used with caution in very preterm neonates with respiratory distress during the 
first hours of life.