Nitrous oxide analgesia for intubating preterm neonates: a pilot study.
OBJECTIVE
To evaluate the administration of an equimolar mixture of N2O and O2 for intratracheal intubation in preterm neonates with respiratory distress syndrome (RDS).


METHODS
Prospective evaluation of N2O/O2 in premature neonates with RDS.


METHODS
Tertiary neonatal unit from March to August 2003.


METHODS
Twenty-six of 79 neonates admitted for RDS within 48 h of birth.


METHODS
N2O/O2 was administered until muscle tone was suppressed. Surfactant was given intratracheally. Patients were extubated as soon as possible.


METHODS
The time needed for N2O/O2 to suppress muscle tone, an evaluation of sedation/analgesia through movements of the limbs, and indicators of stress-related haemodynamic change, all recorded by an independent observer.


RESULTS
In the 26 patients, gestational age was 30.5 (25th, 75th percentile: 30, 32) wk and median body weight was 1540 (1220, 1900) g. Postnatal age at intubation was 2 (2, 3) h. N2O/O2 administration time was 8 (6, 10) min (range 4-15 min). Sedation/analgesia was complete in 77% of patients. No significant differences between pre-procedure and post-procedure values were found for heart rate (p=0.29) or mean arterial blood pressure (p=0.13) (paired Wilcoxon test). Time needed for intubation was 30 (20, 37) s (range 10-60 s). Side effects included transient agitation (3/26) and retching (2/26). Extubation occurred 5 (5, 10) min (range 2-15 min) after surfactant instillation. Apnoeas occurred in 3/26 patients within 2 h after extubation. Two patients required reintubation to repeat surfactant administration within 24 h after extubation.


CONCLUSIONS
N2O/O2 may be helpful for intubation in preterm neonates. Larger randomized, double-blind studies are needed for a thorough evaluation of effectiveness and safety.
Milesi
Christophe
C
Paediatric and Neonatal Intensive Care Unit, Montpellier University Hospital, Montpellier, France. christophe.milesi2@wanadoo.fr
Pidoux
Odile
O
Sabatier
Elisabeth
E
Badr
Malia
M
Cambonie
Gilles
G
Picaud
Jean Charles
JC
D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D009609:Nitrous Oxide / Q000627:therapeutic use*; D010865:Pilot Projects; D011663:Pulmonary Surfactants / Q000008:administration & dosage; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy*
D018712:Analgesics, Non-Narcotic; D011663:Pulmonary Surfactants; D009609:Nitrous Oxide