Feasibility of monitoring stress using skin conduction measurements during intubation of newborns.
The objective of this study was to assess the feasibility of monitoring stress responses in newborns during naso-tracheal intubation after two different premedication regimens, using skin conductance measurements (SCM). Twenty-two newborns were randomised and premedicated with morphine + vecuronium or propofol. SCM (peaks/s) were collected prior to, during and after the procedure. Threshold for interpreting responses as stressful was 0.21 peaks/s. Intubation conditions and physiological parameters were registered. Intubation conditions were good in all newborns. Administration of morphine (range 1.4-10.3 min) before administration of vecuronium did not affect SCM when a stressful stimulus was applied. Within 1.6 min (range 0.8-3 min) after administration of vecuronium, SCM disappeared in 10 of 11 newborns. Propofol reduced SCM in 10 of 11 newborns at the first attempt. Further attempts were associated with increasing SCM, mostly above a threshold of 0.21 peaks/s. There were no significant changes in physiological parameters during the procedure for either premedication regimen.


CONCLUSIONS
The variation in SCM between individual newborns limits the usefulness of SCM as stress monitor during intubation. The use of neuromuscular blockers for premedication precludes monitoring of SCM completely in newborns.


BACKGROUND
Skin conductance measurements have been used successfully to monitor pain in awake newborn infants.


BACKGROUND
Premedicated newborns display significant interindividual variation in skin conductance measurements during an intubation procedure. Neuromuscular blockade causes skin conductance measurements to disappear completely.
Princess Amalia Department of Paediatrics, Department of Neonatology, Isala Clinics, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. R.vanderlee@amc.nl.|Department of Neonatology, Emma Children's Hospital Academic Medical Center, Amsterdam, The Netherlands. R.vanderlee@amc.nl.|Department of Neonatology, Emma Children's Hospital Academic Medical Center, Meibergdreef 15, 1105AZ, Amsterdam, The Netherlands. R.vanderlee@amc.nl.
Robin
R
van der Lee
Princess Amalia Department of Paediatrics, Department of Neonatology, Isala Clinics, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. l.j.groot.jebbink@isala.nl.
Liesbeth J M Groot
LJ
Jebbink
Hospital Pharmacy, Isala Clinics, Zwolle, The Netherlands. t.h.m.herpen@isala.nl.
Thea H M
TH
van Herpen
Princess Amalia Department of Paediatrics, Department of Neonatology, Isala Clinics, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. e.j.haens@isala.nl.
Esther J
EJ
d'Haens
Princess Amalia Department of Paediatrics, Department of Neonatology, Isala Clinics, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. j.bierhuizen@isala.nl.
Josette
J
Bierhuizen
Princess Amalia Department of Paediatrics, Department of Neonatology, Isala Clinics, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. r.a.van.lingen@isala.nl.
Richard A
RA
van Lingen
D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D054810:Deep Sedation / Q000379:methods*; D005240:Feasibility Studies; D005712:Galvanic Skin Response; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods; D008991:Monitoring, Physiologic / Q000379:methods; D009020:Morphine / Q000008:administration & dosage; D010146:Pain / Q000175:diagnosis*; D011292:Premedication / Q000379:methods*; D015742:Propofol / Q000008:administration & dosage; D013312:Stress, Physiological; D014673:Vecuronium Bromide / Q000008:administration & dosage
D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D009020:Morphine; D014673:Vecuronium Bromide; D015742:Propofol
Deep sedation; Galvanic skin response; Neuromuscular blockade