Intracranial pressure during intubation and anesthesia in infants

Raju, Tonse N.K.; Vidyasagar, Dharmapuri; Torres, Christian Vallejo; Grundy, David; Bennett, Edward J.

doi:10.1016/s0022-3476(80)80558-0

Cited by 95 publications

(47 citation statements)

References 6 publications

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“…18 The increase in intracranial pressure may be a result of coughing and struggling of the infant that can result in venous stasis with an increase in cerebral blood volume. 19,21 Systemic arterial hypertension has been investigated in adults and seems to be caused by an increase in systemic vascular resistance, which is probably caused by catecholamine release. 22 Pulmonary hypertension leading to right ventricular failure has been described in adults, 23 and although pulmonary artery pressures have not been measured in newborn infants undergoing intubation, endotracheal suctioning is known to cause an increase in pulmonary artery pressure postoperatively in infants with congenital heart disease 20 and is presumed to occur with intubation.…”

Section: Physiologic Responses To Intubationmentioning

confidence: 99%

Premedication for Nonemergency Endotracheal Intubation in the Neonate

Kumar¹,

Denson²,

Mancuso³

et al. 2010

Pediatrics

194

211

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Section: Physiologic Responses To Intubationmentioning

confidence: 99%

Premedication for Nonemergency Endotracheal Intubation in the Neonate

Kumar¹,

Denson²,

Mancuso³

et al. 2010

Pediatrics

194

211

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“…Intubation, if performed without preprocedural sedation and analgesia, is associated with pain and adverse physiologic responses, including hypoxia, bradycardia, systemic and intracranial hypertension, [1][2][3][4] and a potential risk of intraventricular hemorrhage in preterm infants. [5][6][7] Premedication has the potential to attenuate these potentially deleterious physiologic responses, is more humane, and has a growing body of evidence that it not only improves the physiologic stability but also decreases the time and difficulty of the procedure.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] Premedication has the potential to attenuate these potentially deleterious physiologic responses, is more humane, and has a growing body of evidence that it not only improves the physiologic stability but also decreases the time and difficulty of the procedure. 3,4,8,9 As far back as 1992, Ziegler and Todres 10 performed a preliminary survey to determine the extent and type of premedication used for intubation. The overwhelming majority of the 101 respondents never or only rarely used sedatives, and 97% never used muscle relaxants to facilitate intubation.…”

Section: Introductionmentioning

confidence: 99%

“…Awake endotracheal intubation is a painful and stressful procedure, and can result in stimulation of vagal and mechanical pressure reflexes in the upper airway, causing bradycardia, a drop in oxygen saturation, a rise in systemic blood pressure, and elevation in intracranial pressure. [1][2][3][4] In extremely preterm infants, sudden elevation of intracranial pressure and systemic hypertension can contribute to intraventricular bleeding. [5][6][7] The unfavorable physiologic changes in heart rate, oxygen saturation, blood pressure, and intracranial pressure may be the expression of accompanying pain, and probably reflect autonomic overactivity.…”

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confidence: 99%

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Are newborns receiving premedication before elective intubation?

et al. 2006

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Aims: To determine the extent and type of premedication used for elective endotracheal intubation in neonatal intensive care units (NICUs).Methods: A pretested questionnaire was distributed via e-mail to the program directors of the neonatology divisions with accredited fellowship programs in Neonatal-Perinatal Medicine in the United States.Results: Of the 100 individuals contacted, 78 (78%) participated in the survey. Only 34 of the 78 respondents (43.6%) always use any premedication for elective intubation. Nineteen respondents (24.4%) reported to have a written policy regarding premedication. Morphine or fentanyl was used most commonly (57.1%), with a combination of opioids and midazolam or other benzodiazepines used less frequently. Fourteen respondents (25%) also use muscle relaxants with sedation for premedication, but only nine respondents combined paralysis with atropine and sedation.Conclusion: Most neonatology fellowship program directors do not report always using premedication for newborns before elective endotracheal intubation despite strong evidence of physiologic and practical benefits. Only a minority of the NICUs has written guidelines for sedation, which may preclude effective auditing of this practice. Educational interventions may be necessary to ensure changes in clinical practice.

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“…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.…”

mentioning

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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Intracranial pressure during intubation and anesthesia in infants

Cited by 95 publications

References 6 publications

Premedication for Nonemergency Endotracheal Intubation in the Neonate

Premedication for Nonemergency Endotracheal Intubation in the Neonate

Are newborns receiving premedication before elective intubation?

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

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