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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)
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author
organization
publishing date
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
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
2011-09-04 17:06:45
date last changed
2017-07-30 03:24:31
@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 &lt; .001), the median (IQR) intubation score was 5 (5-6) compared with 12 (10.0-13.5, P &lt; .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 &lt; .009) and mean arterial blood pressure increase (area under the curve, P &lt; .005 and %change: mean ± SD 21% ± 23% versus -2% ± 22%, P &lt; .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 &lt; .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          = {http://dx.doi.org/10.1016/j.jpeds.2011.06.003},
  volume       = {159},
  year         = {2011},
}