Morphine for elective endotracheal intubation in neonates: a randomized trial [ISRCTN43546373]

Abstract

BackgroundElective endotracheal intubations are still commonly performed without premedication in many institutions. The hypothesis tested in this study was that morphine given prior to elective intubations in neonates would decrease fluctuations in vital signs, shorten the duration of intubation and reduce the number of attempts.MethodsFrom December 1999 to September 2000, infants of all gestations admitted to a level III neonatal intensive care unit and requiring an elective endotracheal intubation were randomly assigned to receive morphine 0.2 mg/kg IV or placebo 5 minutes before intubation. Duration of severe hypoxemia (HR< 90/min and Sp02<85%), duration of procedure, duration of hypoxemia (Sp02<85%), number of attempts and change in mean blood pressure were compared between groups.Results34 infants (median 989 g and 28 weeks gestation) were included. The duration of severe hypoxemia was similar between groups. Duration of procedure, duration of hypoxemia, number of attempts and increases in mean blood pressure were also similar between groups. 94% of infants experienced bradycardia during the procedure.ConclusionWe failed to demonstrate the effectiveness of morphine in reducing the physiological instability or time needed to perform elective intubations. Alternatives, perhaps with more rapid onset of action, should be considered.

Premedication for intubation with morphine causes prolonged depression of electrocortical background activity in preterm infants

“…At the time when the study was designed, the dose was chosen to meet the clinical need for a semiurgent intervention referring to a previous study that showed that a moderately high dose of morphine, 0.2 mg/kg, had no positive effects as compared with placebo (25). In our trial, additional doses of morphine, 0.15 mg/kg, were administered in both randomization groups as indicated according to validated pain scales.…”

Use of Analgesic and Sedative Drugs in the NICU: Integrating Clinical Trials and Laboratory Data

“…Fast-acting opioids, such as fentanyl (152)(153)(154), are probably more appropriate than morphine (155,156). Despite encouraging results, the paucity of available data for alfentanil (157) and remifentanil (119,158) imposes limitations on the use of these drugs.…”

Premedication for Nonemergency Endotracheal Intubation in the Neonate

“…There was no effect on the severity of physiologic disturbances during intubation including the duration of severe hypoxemia, incidence of bradycardia, and change in mean blood pressure. 26 This lack of effect is thought to be because of the delayed onset of action of morphine 27 related to the relative hydrophilic nature of the drug. Intravenous morphine has a mean onset of action at 5 minutes and peak effect at 15 minutes.…”