Though there is a protocol in place to premedicate with fentanyl for elective intubation and INSURE in the unit, not really sure how to go about it if the baby does not have a iv line in place and requires surfactant but not iv fluids. Most of our babies would be started on full feeds if there are no contraindications(aggressive enteral nutrition).
Should a iv cannula be inserted for administering analgesia before INSURE!? and then removed.
In our unite we routinely give premedication to all elective intubation, but I wondered about given medication before INSURE, is it needed. Because I think it prolong duration on mechanical ventilation. We are not able to wean baby quickly. We give usually atropine, fentanyl and suxammethonium Sent from my MHA-L29 using Tapatalk
I have never practiced with a group that did INSURE, but I've often wondered about premedication, especially after the study from Albany with an astonishingly high failure rate when using morphine as the premedication. Helpfully, that same group now provides data on use of remifentanyl instead: https://www.ncbi.nlm.nih.gov/m/pubmed/29789465/
Personally, the biggest change for me once we go to INSURE (assuming we don't just skip to MIST/LISA) is that I've routinely muscle relaxed for intubation for a number of years.
We talk about it. I want to get there, but one not so great experience makes me hesitant. If we are doing INSURE in our delivery room, I don't think it is practical enough and leans more to emergent in those cases. But if we are admitted in our unit, then I think it is the best. I'm convinced its better for babies getting intubated in general, but not consistent in my practice yet. FYI, we don't routinely use muscle relaxant and our standard is atropine and fentanyl.