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Premedication for LISA/ MIST


Premedication for LISA/ MIST  

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Do you use premedication for LISA/ MIST procedure? What combination do you use? We have started our LISA procedures successfully, but a lot of concerns from our faculty that we should be using premedication as we do for intubations. Any advice much appreciated.

We started off with 28-34w and for those on neonatal unit only (plan to include delivery room once unit confidence builds up). For this category we use sucrose + swaddle only. However we’ve been facing an occasional vigorous baby, who we have had to revert to premedication and ventilation. We need to find a middle ground for these babies. Maybe LMA/ fentanyl/ ramifentanyl?


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We've been doing LISA/MIST for a few years now, but there is still no clear guideline in our hospital concerning premedication. Almost every attending and fellow uses some sort of narcotic, though everybody uses different medication, and some use no premedication at all (most of the time). I'm wondering, does anybody use Propofol for LISA/MIST currently? If so, what is your experience with it? Which dosage do you use?

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We are doing MIST/LISA from 24 weeks onwards. We use sucrose en facilitated tucking, wich works fine in most of the cases, and, if necessary (rarely), atropine. We do not use any other premedication except caffeine, of course. But it remains an issue. If a baby is too vigoruous we switch to INSURE with propofol sedation. 

The colleagues in Leiden use propofol, 0,5-1 mg/kg I think. They published a paper in 2018: https://pubmed.ncbi.nlm.nih.gov/30068669/

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We've been practising LISA from 2007 on in the dpt i was til 2016 an the meds were Coffein Atropin Propofol, later we saw it worked well without caffein- unfotunately i'm not up to date concerning neuro(developm.) issues with using Propofol in preemies, if ist's still safe i would use it again, worked well titrating 1mg/kg Up to 2 or 3 

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