Rapid Sequence Induction is Superior to Morphine for Intubation of Preterm Infants: A Randomized Controlled Trial.
Norman, Elisabeth LU ; Wikström, Sverre ; Hellström-Westas, Lena LU ; Turpeinen, Ursula ; Hämäläinen, Esa and Fellman, Vineta LU
(2011)
In Journal of Pediatrics
159.
p.45-893
- Abstract
- OBJECTIVES:
To compare rapid sequence intubation (RSI) premedication with morphine for intubation of preterm infants.
STUDY DESIGN:
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... (More) - OBJECTIVES:
To compare rapid sequence intubation (RSI) premedication with morphine for intubation of preterm infants.
STUDY DESIGN:
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.
CONCLUSION:
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. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/2151711
- author
- Norman, Elisabeth
LU
; Wikström, Sverre
; Hellström-Westas, Lena
LU
; Turpeinen, Ursula
; Hämäläinen, Esa
and Fellman, Vineta
LU
- organization
- publishing date
- 2011
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Journal of Pediatrics
- volume
- 159
- pages
- 45 - 893
- publisher
- Academic Press
- external identifiers
-
- wos:000296849400006
- pmid:21798556
- scopus:80755146097
- pmid:21798556
- ISSN
- 1097-6833
- DOI
- 10.1016/j.jpeds.2011.06.003
- language
- English
- LU publication?
- yes
- id
- fcf07bfc-3ed7-4406-817d-bd157547c573 (old id 2151711)
- alternative location
- http://www.ncbi.nlm.nih.gov/pubmed/21798556?dopt=Abstract
- date added to LUP
- 2016-04-01 10:57:00
- date last changed
- 2025-04-04 15:04:05
@article{fcf07bfc-3ed7-4406-817d-bd157547c573,
abstract = {{OBJECTIVES:<br/><br>
To compare rapid sequence intubation (RSI) premedication with morphine for intubation of preterm infants.<br/><br>
<br/><br>
STUDY DESIGN:<br/><br>
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.<br/><br>
<br/><br>
RESULTS:<br/><br>
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.<br/><br>
<br/><br>
CONCLUSION:<br/><br>
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.}},
author = {{Norman, Elisabeth and Wikström, Sverre and Hellström-Westas, Lena and Turpeinen, Ursula and Hämäläinen, Esa and Fellman, Vineta}},
issn = {{1097-6833}},
language = {{eng}},
pages = {{45--893}},
publisher = {{Academic Press}},
series = {{Journal of Pediatrics}},
title = {{Rapid Sequence Induction is Superior to Morphine for Intubation of Preterm Infants: A Randomized Controlled Trial.}},
url = {{https://lup.lub.lu.se/search/files/2262286/2438646.pdf}},
doi = {{10.1016/j.jpeds.2011.06.003}},
volume = {{159}},
year = {{2011}},
}