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Radiation Risk to Children From Computed Tomography

cotic in combination with propofol in our randomized trial, because one of our goals was to search for a single premedicating agent that would ease clinical practice. Furthermore, concurrent administration of analgesics with propofol has been shown to increase the likelihood of adverse outcomes,3 and there is evidence from pediatric and adult literature that propofol offers good sedation with no need for additional analgesia.4 It is important that the depth of sedation be controlled to achieve safe and effective intubation with as little discomfort as possible without causing hemodynamic or other instability. In our trial we used doses of 2.5 mg/kg, and by no means are we suggesting that this dose is optimal. Allegaert et al5 demonstrated reduced clearance and marked interindividual variability in pharmacokinetic estimates of propofol in neonates, which makes recommendation of an optimal dose particularly difficult, especially in combination with other narcotics. Most of the medications used for analgesia in the NICU, including fentanyl, have significantly longer half-lives than the 2to 4-minute initial redistribution half-life of propofol. If concurrent narcotic analgesics were to be used, we feel it may be worth titrating from a lower initial propofol bolus dose of 1.0 to 1.5 mg/kg, similar to the approach of Gottschling et al.6 Additional clinical, pharmacokinetic, and pharmacodynamic studies are required before using propofol routinely in neonates, and the study from Papoff et al no doubt adds to this knowledge.