Randomized controlled trial of sevoflurane for intubation in neonates.
BACKGROUND
Our aim was to determine whether sevoflurane can be used with safety and efficacy for anesthesia during intubation in term and preterm neonates in a prospective randomized-controlled nonblinded study in a tertiary neonatal intensive care unit.


METHODS
Thirty-three neonates were randomly allocated to receive sevoflurane (inspired concentrations varying from 2% to 5%) or no medication (preoxygenation with 100% oxygen alone) before intubation. Minute by minute heart rate (HR), mean arterial blood pressure, SpO(2) and number of episodes of bradycardia (HR < 100 b.min(-1)) and desaturation (SpO(2) < 85% for >30 s) were noted from 5 min before to 10 min after intubation. Operator experience, ease and number of attempts were noted.


RESULTS
No major adverse events were noted in the study group compared with the control group [hypotension (37.5% vs 37.5%, NS), number of desaturations [37.5% vs 44.5%, NS)]. Hypertension (25%, vs 56.3%P = 0.04) and incidence of bradycardias (8.3% vs 44.4%, P < 0.01) were greater in the control group. Intubation was easier in the study group: no movements: 95.5% vs 28% (P < 0.005); good glottis visualization: 73% vs 33% (P = 0.013). The failure rate was lower in the study group (25% vs 39%), but this difference was not statistically significant.


CONCLUSIONS
Anesthesia for intubation with sevoflurane in neonates is well tolerated, even in the less mature. It facilitates the conditions for intubation and leads to fewer adverse events. Other studies are necessary to confirm these preliminary results.
Hassid
Sophie
S
Département d'Anesthésie Réanimation, Unité de Réanimation pédiatrique et néonatale CHU Nord, Chemin des Bourrely, Marseille, France. sophieariane.hassid@ap-hm.fr
Nicaise
Claire
C
Michel
Fabrice
F
Vialet
Renaud
R
Thomachot
Laurent
L
Lagier
Pierre
P
Martin
Claude
C
D001784:Blood Gas Analysis / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal; D008738:Methyl Ethers / Q000008:administration & dosage*; D008991:Monitoring, Physiologic; D011229:Preanesthetic Medication / Q000379:methods*; D000077149:Sevoflurane
D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D000077149:Sevoflurane