Facilitation of neonatal nasotracheal intubation with premedication: a randomized controlled trial.
OBJECTIVE
To determine if premedication reduces the time and number of attempts by junior medical staff to achieve nasotracheal intubation in neonates. The experimental design was a non-blinded randomized controlled pilot trial. The setting was a perinatal centre in a university teaching hospital.


METHODS
Twenty infants (within the ranges of 25-40 weeks gestation, 650-3660 g and 1 h to 81 days of age) requiring semi-urgent intubation were randomized to either premedication with morphine, atropine and suxamethonium, or to awake intubation.


RESULTS
There were no significant differences between the two groups in regard to prior intubation experience of the staff or infant weight or gestation. The intubation procedure, including intervening events, to completion was significantly faster in premedicated infants (median 60 s vs 595 s; P = 0.002) who were intubated at a younger postnatal age. It took twice as many attempts to intubate a conscious infant (median 2 vs 1; P = 0.010). There was a greater decrease in heart rate from the baseline in the unpremedicated group (mean 68 b.p.m. vs 29 b.p.m.; P = 0.017), but decreases in oxygen saturation were not different. Blood was observed in the oral and nasal passages after intubation in five of the awake infants and in one of the premedicated infants.


CONCLUSIONS
The use of premedication reduces the total time and number of attempts taken to achieve successful nasotracheal intubation of neonates by junior medical staff under supervision.
Oei
J
J
Department of Newborn Care, Royal Hospital for Women, Randwick, Australia.
Hari
R
R
Butha
T
T
Lui
K
K
D000701:Analgesics, Opioid / Q000008:administration & dosage; D001285:Atropine / Q000008:administration & dosage; D001315:Australia; D006339:Heart Rate; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods* / Q000592:standards; D007442:Intubation, Intratracheal / Q000379:methods* / Q000592:standards; D009020:Morphine / Q000008:administration & dosage; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage; D009666:Nose; D010100:Oxygen / Q000097:blood; D010276:Parasympatholytics / Q000008:administration & dosage; D010865:Pilot Projects; D011292:Premedication / Q000706:statistics & numerical data; D013390:Succinylcholine / Q000008:administration & dosage
D000701:Analgesics, Opioid; D009467:Neuromuscular Depolarizing Agents; D010276:Parasympatholytics; D009020:Morphine; D001285:Atropine; D013390:Succinylcholine; D010100:Oxygen