title: Nitrous oxide analgesia for intubating preterm neonates: a pilot study.
abstract: 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.
authors.affiliation: Paediatric and Neonatal Intensive Care Unit, Montpellier University Hospital, Montpellier, France. christophe.milesi2@wanadoo.fr
authors.forename: Christophe
authors.initials: C
authors.lastname: Milesi
authors.forename: Odile
authors.initials: O
authors.lastname: Pidoux
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Sabatier
authors.forename: Malia
authors.initials: M
authors.lastname: Badr
authors.forename: Gilles
authors.initials: G
authors.lastname: Cambonie
authors.forename: Jean Charles
authors.initials: JC
authors.lastname: Picaud
mesh_terms: 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*
chemical_list: D018712:Analgesics, Non-Narcotic; D011663:Pulmonary Surfactants; D009609:Nitrous Oxide