Use of naloxone to minimize extubation failure after premedication for INSURE procedure in preterm neonates

Elmekkawi, Amir; Abdelgadir, Dalal; Dyk, Jessie van; Choudhury, Julie; Dunn, Michael

doi:10.3233/npm-915141

Cited by 9 publications

(3 citation statements)

References 21 publications

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“…Naloxone, their antagonist, could attenuate the respiratory drive depression generated by opioids. It had been used by Elmekkawi et al to facilitate extubation in INSURE procedure with high efficacy and no adverse effects [36].…”

Section: Discussionmentioning

confidence: 99%

Analgosedation before Less-Invasive Surfactant Administration: A Systematic Review

Tribolet¹,

Hennuy²,

Snyers³

et al. 2022

Neonatology

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Background: Surfactant therapy is the cornerstone of respiratory distress syndrome management. “Less-invasive surfactant administration (LISA)” is now recommended for spontaneously breathing preterm infants. Analgosedation remains controversial as 52% of European neonatologists do not use any. This systematic review aims to describe the efficacy and safety of different drugs for analgosedation during LISA. Methods: MEDLINE via Ovid, Embase, Scopus, and Cochrane Library of Trials were searched independently by 2 reviewers for studies on sedation or analgesia for LISA, without filters or limits. Results: Eight studies (1 randomized controlled trial) recruiting 945 infants were included. Infant pain was significantly reduced, with more infants evaluated as comfortable. Failure, defined as need for intubation or for a second dose of surfactant, was not different between sedated and unsedated groups. Analgosedation was associated with a higher occurrence of desaturation and need for positive pressure ventilation during procedure, but the need for mechanical ventilation within 24 or 72 h of life was not significantly different. There does not seem to be any difference in clinical tolerance and complications (e.g., hypotension, mortality, air leaks, etc.). Procedural conditions were evaluated as good or excellent in 83% after sedation. Discussion and Conclusion: Analgesia or sedative drugs increase infant comfort and allow good procedural conditions, with a limited impact on the clinical evolution. Questions remain about the best choice of drugs and dosages, with the constraint to maintain spontaneous breathing and have a rapid offset. Further good quality studies are needed to provide additional evidence to supplement those limited existing data.

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Section: Discussionmentioning

confidence: 99%

Analgosedation before Less-Invasive Surfactant Administration: A Systematic Review

Tribolet¹,

Hennuy²,

Snyers³

et al. 2022

Neonatology

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“…Reversal of sedation or use of very short acting sedatives allow for rapid return to spontaneous breathing. 57 However, only about 30% of preterm infants below 32 weeks GA are successfully treated with the INSURE procedure, whereas two out of three patients require longer periods of ventilation or reintubation, due to effect of sedatives, poor gas exchange despite continuous mechanical ventilation during the procedure, or exhaustion. 58,59 More recently LISA was introduced, and this technique was adopted quickly into clinical practice.…”

Section: Clinical Practicementioning

confidence: 99%

Surfactant replacement therapy: from biological basis to current clinical practice

et al. 2020

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This review summarizes the current knowledge on the physiological action of endogenous and exogenous pulmonary surfactant, the role of different types of animal-derived and synthetic surfactants for RDS therapy, different modes of administration, potential risks and strategies of ventilation, and highlights the most promising aims for future development. Scientists have clarified the physicochemical properties and functions of the different components of surfactant, and part of this successful research is derived from the characterization of genetic diseases affecting surfactant composition or function. Knowledge from functional tests of surfactant action, its immunochemistry, kinetics and homeostasis are important also for improving therapy with animal-derived surfactant preparations and for the development of modified surfactants. In the past decade newly designed artificial surfactants and additives have gained much attention and have proven different advantages, but their particular role still has to be defined. For clinical practice, alternative administration techniques as well as postsurfactant ventilation modes, taking into account alterations in lung mechanics after surfactant placement, may be important in optimizing the potential of this most important drug in neonatology.

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“…Fentanyl also distributes almost immediately on intravenous administration, but has a longer elimination half-life of 5.2 and 9.5 h in term and preterm neonates, respectively. Thus, in clinical scenarios where the intubation, surfactant therapy, extubation (INSURE) approach is used, the long halflife of fentanyl may confound attempts at immediate extubation [26]. It is important for the clinician to be aware of data on methods of administration of these opioids.…”

Section: Analgesiamentioning

confidence: 99%

Practical approaches to sedation and analgesia in the newborn

2020

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The prevention, assessment, and treatment of neonatal pain and agitation continues to challenge clinicians and researchers. Substantial progress has been made in the past three decades, but numerous outstanding questions remain. In this setting, clinicians must establish safe and compassionate standardized practices that consider available efficacy data, long-term outcomes, and research gaps. Novel approaches with limited data must be carefully considered against historic standards of care with robust data suggesting limited benefit and clear adverse effects. This review summarizes available evidence while suggesting practical clinical approaches to pain assessment and avoidance, procedural analgesia, postoperative analgesia, sedation during mechanical ventilation and therapeutic hypothermia, and the issues of tolerance and withdrawal. Further research in all areas represents an urgent priority for optimal neonatal care. In the meantime, synthesis of available data offers clinicians challenging choices as they balance benefit and risk in vulnerable critically ill neonates.

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Use of naloxone to minimize extubation failure after premedication for INSURE procedure in preterm neonates

Abstract: Naloxone can be effective in reversing the respiratory depressive effect of analgesic premedication and in turn facilitates expeditious extubation in some preterm infants intubated for INSURE procedure.

Cited by 9 publications

References 21 publications

Analgosedation before Less-Invasive Surfactant Administration: A Systematic Review

Analgosedation before Less-Invasive Surfactant Administration: A Systematic Review

Surfactant replacement therapy: from biological basis to current clinical practice

Practical approaches to sedation and analgesia in the newborn

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