title: Rapid sequence induction is superior to morphine for intubation of preterm infants: a randomized controlled trial.
abstract: OBJECTIVE
  To compare rapid sequence intubation (RSI) premedication with morphine for intubation of preterm infants.
  
  
  METHODS
  Preterm infants needing semi-urgent intubation were enrolled to either RSI (glycopyrrolate, thiopental, suxamethonium, and remifentanil, n = 17) or atropine and morphine (n = 17) in a randomized trial. The main outcome was "good intubation conditions" (score ≤10 assessed with intubation scoring), and secondary outcomes were procedural duration, physiological and biochemical variables, amplitude-integrated electroencephalogram, and pain scores.
  
  
  RESULTS
  Infants receiving RSI had superior intubation conditions (16/17 versus 1/17, P < .001), the median (IQR) intubation score was 5 (5-6) compared with 12 (10.0-13.5, P < .001), and a shorter procedure duration of 45 seconds (35-154) compared with 97 seconds (49-365, P = .031). The morphine group had prolonged heart rate decrease (area under the curve, P < .009) and mean arterial blood pressure increase (area under the curve, P < .005 and %change: mean ± SD 21% ± 23% versus -2% ± 22%, P < .007) during the intubation, and a subsequent lower mean arterial blood pressure 3 hours after the intubation compared with baseline (P = .033), concomitant with neurophysiologic depression (P < .001) for 6 hours after. Plasma cortisol and stress/pain scores were similar.
  
  
  CONCLUSIONS
  RSI with the drugs used can be implemented as medication for semi-urgent intubation in preterm infants. Because of circulatory changes and neurophysiological depression found during and after the intubation in infants given morphine, premedication with morphine should be avoided.
authors.affiliation: Department of Pediatrics, Lund University and Lund University Hospital, Lund, Sweden. elisabeth.norman@med.lu.se
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Norman
authors.forename: Sverre
authors.initials: S
authors.lastname: Wikström
authors.forename: Lena
authors.initials: L
authors.lastname: Hellström-Westas
authors.forename: Ursula
authors.initials: U
authors.lastname: Turpeinen
authors.forename: Esa
authors.initials: E
authors.lastname: Hämäläinen
authors.forename: Vineta
authors.initials: V
authors.lastname: Fellman
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal; D008297:Male; D009020:Morphine / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine