The use of methohexital during chest tube removal in neonates.
BACKGROUND
The aim of the study was the evaluation of the effect of methohexital during chest tube removal (CTR) in neonates.


METHODS
Evaluation was based on the degree of sedation (grades 1-4) and relaxation (grades 1-4) and trends in vital signs heart rate, mean arterial blood pressure (MAP), oxygen saturation at time points (-10, -5, -3, -1, 0, 1, 3, 5, and 10 min) before and after administration of methohexital. A multidimensional pain scale [Leuven Neonatal Pain Scale (LNPS)] was used to evaluate pain expression. Effective sedation and relaxation (grade >2) would enable the physician to perform CTR without difficulties. Paired Wilcoxon was used to compare vital signs and pain expression before and after the procedure.


RESULTS
Twenty-two procedures in 22 infants were recorded. Eleven infants were ventilated and 21 infants were having intravenous analgesics during CTR. Birth weight was 2645 g (range 1235-4500 g). Postnatal age was 6 days (range 1-80 days). Methohexital had no effect on ventilatory weaning, MAP or oxygen saturation. Heart rate increased from 144 (49) to 162 (43) (P = 0.012) b.min(-1). Sedation and relaxation were effective (>grade 2) and lasted for <5 min. No major side effects were documented. Adequate analgesia by LNPS was more difficult to evaluate as clinical pain evaluation was not feasible during full muscular relaxation.


CONCLUSIONS
Administration of methohexital for CTR resulted in adequate sedation and relaxation without major side effects in neonates. This approach should be compared with other strategies.
Allegaert
K
K
Neonatal Intensive Care Unit, Department of Paediatrics, University Hospitals, Gasthuisberg, Leuven, Belgium. karel.allegaert@uz.kuleuven.ac.be
Naulaers
G
G
Debeer
A
A
Breysem
L
L
Ferens
I
I
Vanhole
C
C
Devlieger
H
H
Tibboel
D
D
D000700:Analgesics / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001724:Birth Weight; D001794:Blood Pressure / Q000187:drug effects; D015505:Chest Tubes; D020878:Device Removal; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D008723:Methohexital / Q000008:administration & dosage*; D009119:Muscle Contraction / Q000187:drug effects; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D011446:Prospective Studies; D012121:Respiration, Artificial; D018709:Statistics, Nonparametric; D013997:Time Factors
D000700:Analgesics; D018686:Anesthetics, Intravenous; D008723:Methohexital; D010100:Oxygen