Use of premedication for intubation in tertiary neonatal units in the United Kingdom.
BACKGROUND
Endotracheal intubation and laryngoscopy are frequently performed procedures in neonatal intensive care. These procedures represent profoundly painful stimuli and have been associated with laryngospasm, bronchospasm, hemodynamic changes, raised intracranial pressure and an increased risk of intracranial hemorrhage. These adverse changes can cause significant neonatal morbidity but may be attenuated by the use of suitable premedication.


OBJECTIVE
To evaluate current practices for premedication use prior to elective intubation in UK tertiary neonatal units.


METHODS
Telephone questionnaire survey of all 50 tertiary neonatal units in the UK.


RESULTS
Ninety percent of units report the routine use of sedation prior to intubation and 82% of units routinely use a muscle relaxant. Morphine was the most commonly used sedative and suxamethonium was the most commonly used muscle relaxant. Approximately half of the units also used atropine during intubation. Seventy seven percent of units had a written policy for premedication. Ten percent of the units did not routinely use any sedatives or muscle relaxants for elective intubation.


CONCLUSIONS
In comparison with data from a 1998 survey, our study demonstrated an increase in the number of units that have adopted a written policy for premedication use, and in the number routinely using premedication drugs for elective intubation. There remains little consensus as to which drugs should be used and in what dose.
Chaudhary
Rajiv
R
Neonatal Unit, Addenbrooke's Hospital, Cambridge, UK.
Chonat
Satheesh
S
Gowda
Harsha
H
Clarke
Paul
P
Curley
Anna
A
D000759:Adjuvants, Anesthesia; D001285:Atropine; D019538:Health Care Surveys; D006801:Humans; D006993:Hypnotics and Sedatives; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007442:Intubation, Intratracheal; D009125:Muscle Relaxants, Central; D010146:Pain / Q000517:prevention & control; D011229:Preanesthetic Medication / Q000706:statistics & numerical data*; D006113:United Kingdom
D000759:Adjuvants, Anesthesia; D006993:Hypnotics and Sedatives; D009125:Muscle Relaxants, Central; D001285:Atropine