Hallo.

Which drugs do You use before intubation the neonates, and what doses?

I notised that in every hospital people use different drugs. I wonder which drug is the most common.

We typically use midazolam 0.1mg/kg and/or morphine sulfate 0.1 mg/kg for elective intubations.

Our pre-med strategy usually includes a slow injection of morphine before intubation (0.1-0.2 mg/kg iv) and pentobarbital immediate before intubation (2-5 mg/kg iv).

We use fentanyl, atropine and suxamethonium.

we usually don not give medication for itubation of VLBW infants , but we give premedication for larger babies such as midazolam .

We use Morphine in our unit

Morphine Sulphate always, and Sux sometimes, depending on the docs preference.

We are currently using, Morphine 0.1mg/kg, Midazolam 0.1mg/kg and Tracrium (atracurium) 0.5mg/kg

Regards Norbert

Hi

for elective Intubation on Nicu (or changing tubes because of blocking or leakage) we use atropin, morphin 0,1-0,2 mg/kg, Trapanal 4 mg/kg, and (depending to doc) pancuronium. Works well, infants are stable, easy to intubate.

Greetings

Bernhard Bungert:)

Morphine + diazepam

I'm sorry for my question ( maybe a little stupid): Why do You use Morfine? Does it relieve acute pain? Or just for sedation the baby? How about fentanyl or thiopenthal? Those drugs "work" for schorter time than morfine, I think. And how about delivery room? Do you use any drugs before intubation?

Thank You for Your answers.

in my unit

we don't use sedation or m paralyzing agent

but in large.and actively fighting baby we might use midazolam (0.1 mg kg and even less) giving the half dose slowly first and give the rest according to response

and it depends on the experience and how fast and efficient in intubation

we do not use any premed in my old hospital. in the present hospital, premed used are fentanyl and atropine followed by suxamethonium just before the procedure.

Fentanyl + Midaz

Hi

We use no med in the delivery Room. At "home": Atropin/Morphin/Thiopental (slowly) sometimes parlaysis. Works fantastic. Morphin against acute pain. No fentaly because of thorax rigidity (30% in our own expierience), no midazolam cause of seizures.

An other scenario: a blue, alert child (bec of congenital heart desease), your are 100 km away from home, and you have to use prostaglandine . No medication for intubation? no intubation? No risk no fun?

Hi,

out of extreme life threating situation, we use Midaz. + Fentanyl/or sufentanyl, in rare cases we adjust atropine.

Hi

We use no med in the delivery Room. At "home": Atropin/Morphin/Thiopental (slowly) sometimes parlaysis. Works fantastic. Morphin against acute pain. No fentaly because of thorax rigidity (30% in our own expierience), no midazolam cause of seizures.

An other scenario: a blue, alert child (bec of congenital heart desease), your are 100 km away from home, and you have to use prostaglandine . No medication for intubation? no intubation? No risk no fun?

A blue cyanotic baby suspected of DA- dependent congenital heart disease - does it always implicate you must intubate? If you administer constant infusion of prostaglandine you have to consider risk of apnea but it can be easily treated with aminophyllin or caffeine. In our experience we have many children born with HLHS who were completely stable and respiratory sufficient for days or weeks before surgery.

BTW during my three year practice of transporting newborns I don't remember any situation that I intubate without sedation no matter of distance from my maternal hospital. Mostly it was tiopental because of its short time of action. Answering your question- intubation without sedation is certainly no fun for anybody, especially for the baby.

Edited January 15, 200916 yr by Agnieszka Domanska

... If you administer constant infusion of prostaglandine you have to consider risk of apnea ....

This maybe relevant here:

LINK

There is a nice review about premedication prior to intubation in the January 2009 issue of neoreviws.

I found it very enlightening.

Greenwood CS, Colby CE. Pharmacology Review: Premedication for Endotracheal Intubation of the Neonate: What is the Evidence? Neoreviews. 2009 Jan 1;10(1):e31-35.

LINK

Dear Jack would you be kind and send me a copy

Greenwood CS, Colby CE. Pharmacology Review: Premedication for Endotracheal Intubation of the Neonate: What is the Evidence? Neoreviews. 2009 Jan 1;10(1):e31-35.

sory but I havent accses in this link

Thank you

Just a thought...

Those of you using only Midazolam - remember that midazolam has no analgetic effect but only a behavioural modifying effect caused by sedation.

The pain signals to the brain remains unaltered - i.e. when administered, the pain sensation remains but we don´t see the baby fighting the pain.

BTW: Anyone who has experience using propofol in the newborn?

Moreover benzodiazepins and barbituranes can even make the pain stronger!

And speeking about propofol - we have never used it in newborn. But I have my personal experience about beeing treated with propofol. After short surgery I woke up quickly and suffered no side effects expect from severe pain in place of injection at the beginning of anesthesia. I think you sholud consider that before administer propofol to the baby.

Atropina-Fentanyl-Mivacurium

Javier Casanovas

Sevilla

Spain

we use midazolam +atropine

i think intubation is a horrible experience . even for a newbrn .we should adminster as a premedication both analgesic" Bcoz of psychological and hemodynamic impact of pain " and sedative " to ensure rapid easy intubation".

bebi23: http://neoreviews.aappublications.org/cgi/content/abstract/10/1/e31?fulltext=&searchid=QID_NOT_SET is the article you´re looking for. Only an abstract though....

We will probably move away from our morphine + diazepam routine and instead use Propofol as a single drug, single dose in elective intubation.

NICU Uppsala has quite a lot of experience on Propofol in these situations and my personal experience is also positive.

I´m looking for available research results in the field and so far this is quite interesting: http://pediatrics.aappublications.org/cgi/content/full/119/6/e1248

Anyone who knows any more good articles?

The neuotoxic effect still remains unclear but other studies has concluded that the clearance of propofol in newborns is slower than toddlers and older children, thus no infusion is recommended.

Please refer to the latest report from AAP about premedications for non-emergency intubation it has just been published this week and you can download it for free from "Pediatrics". I think morphine (fentanyl) + Atropine + Pancruminm will be our chioce in Mansoura in our new guidelines.