Anterior Fontanelle Pressure Responses to Tracheal Intubation in the Awake and Anaesthetized Infant †

Abstract

In order to define the changes in intracranial pressure which occur during tracheal intubation in young infants, a Ladd transducer was used to monitor anterior fontanelle pressure (AFP) non-invasively in awake (group 1, n = 14) and anaesthetized (group 2, n = 10) infants during intubation of the trachea. Heart rate and systolic arterial pressure were also recorded. In quiet, undisturbed infants, AFP (mean +/- SEM) was similar in groups 1 (9.6 +/- 0.5 mm Hg) and 2 (8.7 +/- 0.8 mm Hg); with crying, AFP increased significantly in both groups. During laryngoscopy in group 1, AFP increased to 33.5 +/- 3.6 mm Hg, which was significantly greater than in the quiet infant, but did not differ significantly from measurements in the crying infant. In group 2, AFP increased significantly to 15.8 +/- 18 mm Hg during laryngoscopy. This increase was significantly less than the group 1 response. Neither heart rate nor systolic arterial pressure changed significantly in either group during laryngoscopy--when compared with measurements in the quiet state. It was concluded that AFP increases significantly during intubation and during crying in the infant. The response to intubation is only partially attenuated by the prior administration of general anaesthesia.

Rocuronium for nonemergent intubation of term and preterm infants

“…[23][24][25] In addition to improving chances for successful intubation, paralytic agents are reported to attenuate adverse physiologic changes experienced during intubation attempts. Increased intracranial pressure, 2,3,26,27 increased systolic blood pressure 28 and longer duration of hypoxemia 10,29 have been reported in awake vs paralyzed neonatal intubations. The longterm consequences of these physiologic changes are not known.…”

“…Although several studies have shown adverse effects of awake intubations, [1][2][3] premedication with sedatives, analgesics or paralytics before this invasive procedure is not yet routine. 4 Successful intubations after fewer attempts are reported for chemically paralyzed newborns.…”

Premedication for Nonemergent Neonatal Intubations: A Randomized, Controlled Trial Comparing Atropine and Fentanyl to Atropine, Fentanyl, and Mivacurium

“…These effects include bradycardia, 2,3 fluctuations in blood pressure (BP), [2][3][4][5][6][7][8] hypoxia, 2,3,7,[9][10][11] and increases in intracranial pressure (ICP). 3,4,6,8,12,13 Previous studies have shown that these potentially adverse effects can be attenuated by using pharmacologic agents. Anticholinergic medication can attenuate the decrease in heart rate (HR), 3,[6][7][8]14 potent analgesics or anesthetic agents can attenuate the hypertensive response, 11 and muscle relaxants have been shown to attenuate the increase in ICP.…”

Awake intubation increases intracranial pressure without affecting cerebral blood flow velocity in infants

“…J. 6 The increases in AFP are greater in the awake than in the anaesthetized infants. Several theories have been advanced to account for this including hypoxaemia and the change in systolic blood pressure.…”