Premedication before intubation in UK neonatal units

Abstract

Aims-To establish the extent and type of premedication used before intubation in neonatal units in the United Kingdom. Methods-A structured telephone survey was conducted of 241 eligible units. Units were subdivided into those that routinely intubated and ventilated babies (routine group) and those that transferred intubated and ventilated babies (transfer group). Results-Of the units contacted, 239 (99%) participated. Only 88/239 (37%) gave any sedation before intubating on the unit and only 34/239 (14%) had a written policy covering this. Morphine was used most commonly (66%), with other opioids and benzodiazepines used less frequently. Of the 88 units using sedation, 19 (22%) also used paralysis. Suxamethonium was given by 10/19 (53%) but only half of these combined it with atropine. Drug doses varied by factors of up to 200, even for commonly used drugs. Conclusion-Most UK neonatal units do not sedate babies before intubating, despite evidence of physiological and practical benefits. Only a minority have written guidelines, which prohibits auditing of practice. (Arch Dis Child Fetal Neonatal Ed 2000;82:F38-F41)

Rocuronium for nonemergent intubation of term and preterm infants

“…In 1996, a survey by Ziegler and Todres 14 of 74 academic NICU centers who responded revealed only 3% routinely use sedatives, and 57% never used sedatives; 76 and 77% never used succinylcholine and nondepolarizing muscle relaxants, respectively. In 2000, approximately one-third of neonatologists surveyed by Hancock et al 15 and Whyte et al 16 reported providing premedication for intubation on a regular basis. Sixty-six percent of the time opioids were given, and 22% of the time paralytics were given.…”

“…Sixty-six percent of the time opioids were given, and 22% of the time paralytics were given. 16 In 2006, Sarkar et al 17 surveyed 100 US neonatology program directors. In this survey, 34 of the 78 respondents reported using premedication for elective intubation; 25% use paralytics with sedation.…”

Premedication for Nonemergency Endotracheal Intubation in the Neonate

“…11 Despite these recommendations, there remains wide variation in the frequency of use of premedication before intubation, and in the medications used for premedication. 15,16 Some of the reasons offered for not using premedications before intubation are concern for ad-verse reactions and/or toxic effects of the medications, inadequate time for administration of medications in emergency situations, and the perception that risk/benefit ratios are worsened by using premedications. 13 This report will address some of these issues, including the choices of available medications, the circumstances for the use of medications, the risks of these medications, and the appropriate precautions to take while adopting these procedures.…”

Newborns should be receiving premedication before elective intubation

“…[12] The European surveys had a profound effect on current practice. Whyte et al [7] demonstrated in a study conducted in 1998 that 63% of UK neonatal units did not use premedication prior to intubation, their study prompting much discussion. A decade later, when the survey was repeated, ≥90% of neonatal units had adopted premedication as standard of care.…”

“…[4][5][6] However, despite the growing body of evidence and acceptance of premedication as a standard of care, its use is still not universal, and wide variations occur in practice. [7,8] Premedication practices have been surveyed in Europe, [7,9,10] North America [8,11] and Australia. [12] The European surveys had a profound effect on current practice.…”