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Rapid Sequence Induction is Superior to Morphine for Intubation of Preterm Infants: A Randomized Controlled Trial
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics.
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2011 (English)In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 159, no 6, 893-899 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To compare rapid sequence intubation (RSI) premedication with morphine for intubation of preterm infants.

Study design: Preterminfants needing semi-urgent intubation were enrolled to either RSI (glycopyrrolate, thiopental, suxamethonium, and remifentanil, n=17) or atropine andmorphine (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.

Place, publisher, year, edition, pages
2011. Vol. 159, no 6, 893-899 p.
Keyword [en]
aEEG, Amplitude-integrated electroencephalogram; AUC, Area under the curve; EEG, Electroencephalogram; HR, Heart rate; MABP, Mean arterial blood pressure; NICU, Neonatal intensive care unit; RCT, Randomized controlled trial; rScO2, Regional cerebral oxygenation; RSI, Rapid sequence induction; SpO2, Peripheral oxygen saturation
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Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-163650DOI: 10.1016/j.jpeds.2011.06.003ISI: 000296849400006OAI: oai:DiVA.org:uu-163650DiVA: diva2:465730
Available from: 2011-12-15 Created: 2011-12-13 Last updated: 2017-12-08Bibliographically approved

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Wikström, SverreHellström-Westas, Lena

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