Premium
Facilitation of neonatal nasotracheal intubation with premedication: A randomized controlled trial
Author(s) -
Oei J,
Hari R,
Butha T,
Lui K
Publication year - 2002
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1046/j.1440-1754.2002.00726.x
Subject(s) - premedication , medicine , anesthesia , intubation , randomized controlled trial , gestation , nasotracheal intubation , atropine , surgery , pregnancy , biology , genetics
Objectives : To determine if premedication reduces the time and number of attempts by junior medical staff to achieve nasotracheal intubation in neonates. The experimental design was a non‐blinded randomized controlled pilot trial. The setting was a perinatal centre in a university teaching hospital. Methods : Twenty infants (within the ranges of 25–40 weeks gestation, 650–3660 g and 1 h to 81 days of age) requiring semi‐urgent intubation were randomized to either premedication with morphine, atropine and suxamethonium, or to awake intubation. Results : There were no significant differences between the two groups in regard to prior intubation experience of the staff or infant weight or gestation. The intubation procedure, including intervening events, to completion was significantly faster in premedicated infants (median 60 s vs 595 s; P = 0.002) who were intubated at a younger postnatal age. It took twice as many attempts to intubate a conscious infant (median 2 vs 1; P = 0.010). There was a greater decrease in heart rate from the baseline in the unpremedicated group (mean 68 b.p.m. vs 29 b.p.m.; P = 0.017), but decreases in oxygen saturation were not different. Blood was observed in the oral and nasal passages after intubation in five of the awake infants and in one of the premedicated infants. Conclusions : The use of premedication reduces the total time and number of attempts taken to achieve successful nasotracheal intubation of neonates by junior medical staff under supervision.