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

Millar, Carol; Bissonnette, Bruno

doi:10.1007/bf03009904

Cited by 89 publications

(84 citation statements)

References 20 publications

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“…The MCA, the largest artery of all basal cerebral arteries constituting the Circle of Willis, is responsible for 70% of the blood flow to the ipsilateral hemisphere. 6 The advantage of recording CBFV from the MCA is that the M 1 segment of the MCA presents an angle < 20 ~ in relation to the temporal window which limits the effect on the Doppler shift by < 6% (cosine of the angle). A Medasonics CDS MP218 (Medasonics Inc., Fremont, Ca.)…”

Section: Methodsmentioning

confidence: 99%

Closure of persistently patent arterial duct and its impact on cerebral circulatory haemodynamics in children

Bissonnette

Benson

1998

Can J Anaesth

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Closure of persistently patent arterial duct and its impact on cerebral circulatory haemodynamics in childrenPurpose: Closure of a patent arterial duct (PDA) is suggested as a risk factor associated with intraventricular haemorrhage and/or cerebral ischemia in neonates. This study evaluate the effects of transcatheter closure of a patent arterial duct in children on cerebral blood flow velocity. Methods: Twelve children, aged from one to eight years were enrolled. Anaesthesia induction consisted of thiopentone, fentanyl and diazepam. Tracheal intubation was facilitated with vecuronium. Anaesthesia was maintained with N20 70% in O 2 and a PaCO 2 between 35 to 40 mmHg. No cerebral vasoactive agents were used. Mean arterial pressure (MAP), central venous pressure (CVP), heart rate were continuously recorded. Systolic (Vs) and diastolic (Vd) cerebral blood flow velocity (CBFV) were recorded. Cerebral perfusion pressure (CPP) was calculated. The mean CBF~, the systolic-mean ratio and the cereb~l blood volume were estimated from the area under the velocity-time curve (AUC) before PDA closure, immediately after and for I0 rain following occlusion. Results: The mean (_+ SD) age and weight were 30 -+ 22 mo and 13 -+ 5 kg, respectively. Continuous recording during duct closure showed an abrupt increase in Vd (P < 0.05) whereas Vs remained constant. The AUC increased after closure and persisted for 10 min (P < 0.05). Conclusion: This study confirms that closure of a PDA leads to acute changes in intracerebraJ diastolic flow and volume. This observation gives weight to mechanisms involved in IVH in smaller infants after arterial surgical duct closure. The anaesthetic technique used for arterial duct closure in these procedure could influence these observations.

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Section: Methodsmentioning

confidence: 99%

Closure of persistently patent arterial duct and its impact on cerebral circulatory haemodynamics in children

Bissonnette

Benson

1998

Can J Anaesth

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“…[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.…”

Section: Common Practicesmentioning

confidence: 96%

Rocuronium for nonemergent intubation of term and preterm infants

et al. 2010

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Objective: The aim of this study was to analyze clinical characteristics of rocuronium as premedication for nonemergent intubation in infants.Study Design: Preterm infants requiring nonemergent intubation were randomized to receive atropine and fentanyl with or without rocuronium. Outcomes, patient characteristics and intubator's experience were noted. Onset, duration and degree of clinical paralysis were recorded for rocuronium group and for older infants receiving rocuronium per unit protocol.Result: Forty-four intubations were randomized (20 rocuronium, 24 control). Groups were similar in chronological and corrected gestational age, weight and intubator's experience. Successful intubation on first attempt was achieved in 35% of intubations under rocuronium vs 8% of controls; rocuronium was the only significant variable by logistic regression (odds ratio ¼ 0.052, P ¼ 0.029). Complete paralysis was reported in 80% of 57 rocuronium intubations; onset ranged from 14 to 178 s (65.9±43.4), and duration from 1 to 60 min (16.3 ± 13.5).Conclusion: Rocuronium facilitated successful intubation and provided clinical paralysis quickly in most infants.

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“…In addition to causing discomfort, placing an endotracheal tube (ETT) without premedication is associated with adverse physiologic effects. 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.…”

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confidence: 99%

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

et al. 2006

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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.

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

Abstract: Tracheal intubation is a necessary part of the anaesthetic management of many paediatric patients in the operating room. In adutts, the responses to laryngoscopy and tra-CAN J ANAESTH 1994 / 41:4 / pp281 7

Cited by 89 publications

References 20 publications

Closure of persistently patent arterial duct and its impact on cerebral circulatory haemodynamics in children

Closure of persistently patent arterial duct and its impact on cerebral circulatory haemodynamics in children

Rocuronium for nonemergent intubation of term and preterm infants

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

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