Premedication for intubation with morphine causes prolonged depression of electrocortical background activity in preterm infants

Behavioral effects of perinatal opioid exposure

“…The neuraxial administration of opioids may induce respiratory depression and increase the number of secondary medical interventions (due to postoperative nausea and vomiting, urinary retention and pruritus and decreased recovery of gastrointestinal function) (Hall, 2012;Lonnqvist et al, 2002). Morphine premedication for intubation leads to prolonged (24 h) electroencephalogram (EEG) depression, so this treatment is not recommended for short interventions (Norman et al, 2013). A high dose of opioids may induce EEG spikes, although behavioral convulsions are only rarely detected (van Praag and Frenk, 1992).…”

Does Remifentanil Have a Place for Sedation in the Case of Endotracheal Intubation or Minimally Invasive Surfactant Therapy in Neonates?

“…It seems inappropriate to consider reaching the stage of general anesthesia using an opioid alone. When associated with midazolam or propofol, 1 μg/kg of remifentanil seemed sufficient to obtain quality sedation without side effects [9,10,11]. On the other hand, for MIST, the goal should be to achieve conscious sedation/analgesia and not general anesthesia, so that the patient can maintain spontaneous ventilation.…”

Newborns should be receiving premedication before elective intubation

“…[23] Moreover, safety concerns regarding the use of morphine for premedication in preterm infants have been raised, as it has been associated with prolonged amplified electroence phalography (aEEG) depression, inde pendent of blood pressure changes. [24] Fen tanyl is preferred to morphine, as its more rapid onset of action may improve pain control during intubation. [25] Hamon et al [26] have shown that short-term fentanyl infusion in preterm infants is not associated with changes in systemic and cerebral perfusion pressures.…”