Premedication for nonemergent neonatal intubations

A randomized, controlled trial comparing atropine and fentanyl to atropine, fentanyl, and mivacurium

Kari D Roberts, Tina A. Leone, William H. Edwards, Wade D. Rich, Neil N. Finer

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this work was to investigate whether using a muscle relaxant would improve intubation conditions in infants, thereby decreasing the incidence and duration of hypoxia and time and number of attempts needed to successfully complete the intubation procedure. PATIENTS/METHODS. This was a prospective, randomized, controlled, 2-center trial. Infants requiring nonemergent intubation were randomly assigned to receive atropine and fentanyl or atropine, fentanyl, and mivacurium before intubation. Incidence and duration of hypoxia were determined at oxygen saturation thresholds of ≤85%, ≤75%, ≤60%, and ≤40%. Videotape was reviewed to determine the time and number of intubation attempts and duration of action of mivacurium. RESULTS. Analysis of 41 infants showed that incidence of oxygen saturation ≤60% of any duration was significantly less in the mivacurium group (55% vs 24%). The incidence of saturation level of any duration ≤85%, 75%, and 40%; cumulative time ≥30 seconds; and time below the thresholds were not significantly different. Total procedure time (472 vs 144 seconds) and total laryngoscope time (148 vs 61 seconds) were shorter in the mivacurium group. Successful intubation was achieved in ≤2 attempts significantly more often in the mivacurium group (35% vs 71%). CONCLUSIONS. Premedication with atropine, fentanyl, and mivacurium compared with atropine and fentanyl without a muscle relaxant decreases the time and number of attempts needed to successfully intubate while significantly reducing the incidence of severe desaturation. Premedication including a short-acting muscle relaxant should be considered for all nonemergent intubations in the NICU.

Original languageEnglish (US)
Pages (from-to)1583-1591
Number of pages9
JournalPediatrics
Volume118
Issue number4
DOIs
StatePublished - Oct 1 2006

Fingerprint

Premedication
Fentanyl
Atropine
Intubation
Randomized Controlled Trials
Incidence
Muscles
Oxygen
Laryngoscopes
Videotape Recording
mivacurium

Keywords

  • Atropine
  • Fentanyl
  • Hypoxia
  • Infant
  • Intubation
  • Mivacurium
  • Muscle relaxant
  • Neonate
  • Premedication

Cite this

Premedication for nonemergent neonatal intubations : A randomized, controlled trial comparing atropine and fentanyl to atropine, fentanyl, and mivacurium. / Roberts, Kari D; Leone, Tina A.; Edwards, William H.; Rich, Wade D.; Finer, Neil N.

In: Pediatrics, Vol. 118, No. 4, 01.10.2006, p. 1583-1591.

Research output: Contribution to journalArticle

Roberts, Kari D ; Leone, Tina A. ; Edwards, William H. ; Rich, Wade D. ; Finer, Neil N. / Premedication for nonemergent neonatal intubations : A randomized, controlled trial comparing atropine and fentanyl to atropine, fentanyl, and mivacurium. In: Pediatrics. 2006 ; Vol. 118, No. 4. pp. 1583-1591.
@article{361fa421172640509aa15c6520cfb0b6,
title = "Premedication for nonemergent neonatal intubations: A randomized, controlled trial comparing atropine and fentanyl to atropine, fentanyl, and mivacurium",
abstract = "OBJECTIVE. The purpose of this work was to investigate whether using a muscle relaxant would improve intubation conditions in infants, thereby decreasing the incidence and duration of hypoxia and time and number of attempts needed to successfully complete the intubation procedure. PATIENTS/METHODS. This was a prospective, randomized, controlled, 2-center trial. Infants requiring nonemergent intubation were randomly assigned to receive atropine and fentanyl or atropine, fentanyl, and mivacurium before intubation. Incidence and duration of hypoxia were determined at oxygen saturation thresholds of ≤85{\%}, ≤75{\%}, ≤60{\%}, and ≤40{\%}. Videotape was reviewed to determine the time and number of intubation attempts and duration of action of mivacurium. RESULTS. Analysis of 41 infants showed that incidence of oxygen saturation ≤60{\%} of any duration was significantly less in the mivacurium group (55{\%} vs 24{\%}). The incidence of saturation level of any duration ≤85{\%}, 75{\%}, and 40{\%}; cumulative time ≥30 seconds; and time below the thresholds were not significantly different. Total procedure time (472 vs 144 seconds) and total laryngoscope time (148 vs 61 seconds) were shorter in the mivacurium group. Successful intubation was achieved in ≤2 attempts significantly more often in the mivacurium group (35{\%} vs 71{\%}). CONCLUSIONS. Premedication with atropine, fentanyl, and mivacurium compared with atropine and fentanyl without a muscle relaxant decreases the time and number of attempts needed to successfully intubate while significantly reducing the incidence of severe desaturation. Premedication including a short-acting muscle relaxant should be considered for all nonemergent intubations in the NICU.",
keywords = "Atropine, Fentanyl, Hypoxia, Infant, Intubation, Mivacurium, Muscle relaxant, Neonate, Premedication",
author = "Roberts, {Kari D} and Leone, {Tina A.} and Edwards, {William H.} and Rich, {Wade D.} and Finer, {Neil N.}",
year = "2006",
month = "10",
day = "1",
doi = "10.1542/peds.2006-0590",
language = "English (US)",
volume = "118",
pages = "1583--1591",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "4",

}

TY - JOUR

T1 - Premedication for nonemergent neonatal intubations

T2 - A randomized, controlled trial comparing atropine and fentanyl to atropine, fentanyl, and mivacurium

AU - Roberts, Kari D

AU - Leone, Tina A.

AU - Edwards, William H.

AU - Rich, Wade D.

AU - Finer, Neil N.

PY - 2006/10/1

Y1 - 2006/10/1

N2 - OBJECTIVE. The purpose of this work was to investigate whether using a muscle relaxant would improve intubation conditions in infants, thereby decreasing the incidence and duration of hypoxia and time and number of attempts needed to successfully complete the intubation procedure. PATIENTS/METHODS. This was a prospective, randomized, controlled, 2-center trial. Infants requiring nonemergent intubation were randomly assigned to receive atropine and fentanyl or atropine, fentanyl, and mivacurium before intubation. Incidence and duration of hypoxia were determined at oxygen saturation thresholds of ≤85%, ≤75%, ≤60%, and ≤40%. Videotape was reviewed to determine the time and number of intubation attempts and duration of action of mivacurium. RESULTS. Analysis of 41 infants showed that incidence of oxygen saturation ≤60% of any duration was significantly less in the mivacurium group (55% vs 24%). The incidence of saturation level of any duration ≤85%, 75%, and 40%; cumulative time ≥30 seconds; and time below the thresholds were not significantly different. Total procedure time (472 vs 144 seconds) and total laryngoscope time (148 vs 61 seconds) were shorter in the mivacurium group. Successful intubation was achieved in ≤2 attempts significantly more often in the mivacurium group (35% vs 71%). CONCLUSIONS. Premedication with atropine, fentanyl, and mivacurium compared with atropine and fentanyl without a muscle relaxant decreases the time and number of attempts needed to successfully intubate while significantly reducing the incidence of severe desaturation. Premedication including a short-acting muscle relaxant should be considered for all nonemergent intubations in the NICU.

AB - OBJECTIVE. The purpose of this work was to investigate whether using a muscle relaxant would improve intubation conditions in infants, thereby decreasing the incidence and duration of hypoxia and time and number of attempts needed to successfully complete the intubation procedure. PATIENTS/METHODS. This was a prospective, randomized, controlled, 2-center trial. Infants requiring nonemergent intubation were randomly assigned to receive atropine and fentanyl or atropine, fentanyl, and mivacurium before intubation. Incidence and duration of hypoxia were determined at oxygen saturation thresholds of ≤85%, ≤75%, ≤60%, and ≤40%. Videotape was reviewed to determine the time and number of intubation attempts and duration of action of mivacurium. RESULTS. Analysis of 41 infants showed that incidence of oxygen saturation ≤60% of any duration was significantly less in the mivacurium group (55% vs 24%). The incidence of saturation level of any duration ≤85%, 75%, and 40%; cumulative time ≥30 seconds; and time below the thresholds were not significantly different. Total procedure time (472 vs 144 seconds) and total laryngoscope time (148 vs 61 seconds) were shorter in the mivacurium group. Successful intubation was achieved in ≤2 attempts significantly more often in the mivacurium group (35% vs 71%). CONCLUSIONS. Premedication with atropine, fentanyl, and mivacurium compared with atropine and fentanyl without a muscle relaxant decreases the time and number of attempts needed to successfully intubate while significantly reducing the incidence of severe desaturation. Premedication including a short-acting muscle relaxant should be considered for all nonemergent intubations in the NICU.

KW - Atropine

KW - Fentanyl

KW - Hypoxia

KW - Infant

KW - Intubation

KW - Mivacurium

KW - Muscle relaxant

KW - Neonate

KW - Premedication

UR - http://www.scopus.com/inward/record.url?scp=33750136632&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33750136632&partnerID=8YFLogxK

U2 - 10.1542/peds.2006-0590

DO - 10.1542/peds.2006-0590

M3 - Article

VL - 118

SP - 1583

EP - 1591

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 4

ER -