Document Detail


Premedication for tracheal intubation in neonates: confusion or controversy?
MedLine Citation:
PMID:  17905186     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Tracheal intubation is performed frequently in the NICU and delivery room. This procedure is extremely distressing, painful, and has the potential for airway injury. Premedication with sedatives, analgesics, and muscle relaxants is standard practice for pediatric and adult intubation, yet the use of these drugs is not common for intubation in neonates. The risks and benefits of using premedications for intubating unstable newborns are hotly debated, although recent evidence shows that premedication for non-urgent or semi-urgent intubations is safer and more effective than awake intubations. This article reviews clinical practices reported in surveys on premedication for neonatal intubation, the physiological effects of laryngoscopy and intubation on awake neonates, as well as the clinical and physiological effects of different drug combinations used for intubation. A wide variety of drugs, either alone or in combination, have been used as premedication for elective intubation in neonates. Schematically, these studies have been of three main types: (a) studies comparing awake intubation versus those with sedation or analgesia, (b) studies comparing different premedication regimens comprising sedatives, analgesics, and anesthetics, and (c) case series of neonates in which some authors have reported their experience with a specific premedication regimen. The clinical benefits described in these studies and the need for pain control in neonates make the case for using appropriate premedication routinely for elective or semi-urgent intubations. Tracheal intubation without the use of analgesia or sedation should be performed only for urgent resuscitations in the delivery room or other life-threatening situations when intravenous access is unavailable.
Authors:
Ricardo Carbajal; B Eble; K J S Anand
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Seminars in perinatology     Volume:  31     ISSN:  0146-0005     ISO Abbreviation:  Semin. Perinatol.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-01     Completed Date:  2008-01-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7801132     Medline TA:  Semin Perinatol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  309-17     Citation Subset:  IM    
Affiliation:
Centre National de Ressources de lutte contre la Douleur, Hôpital d'Enfants Armand Trousseau, Paris, France. ricardo.carbajal@trs.aphp.fr
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MeSH Terms
Descriptor/Qualifier:
Analgesics / administration & dosage*
Evidence-Based Medicine / methods
Humans
Hypnotics and Sedatives / administration & dosage
Infant, Newborn
Intensive Care Units, Neonatal
Intensive Care, Neonatal / methods
Intubation, Intratracheal / adverse effects*,  methods
Muscle Relaxants, Central / administration & dosage
Pain / drug therapy,  prevention & control*
Premedication / methods*
Randomized Controlled Trials as Topic
Chemical
Reg. No./Substance:
0/Analgesics; 0/Hypnotics and Sedatives; 0/Muscle Relaxants, Central

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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