Nasal midazolam vs ketamine for neonatal intubation in the delivery room: a randomised trial

Milési, Christophe; Baleine, Julien; Mura, Thibault; Benito-Castro, Fernando; Ferragu, Félicie; Thiriez, Gérard; Thevenot, Pierre; Combes, Clémentine; Carbajal, Ricardo; Cambonie, Gilles

doi:10.1136/archdischild-2017-312808

Cited by 31 publications

(51 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is general consensus that an infant should be adequately sedated when an endotracheal intubation procedure is performed 9–12. Although it is known that visualising the vocal cords with a laryngoscope is highly uncomfortable,13 there is still no consensus on whether or not to use sedation during MIST, particularly when a laryngoscope is used.…”

Section: Introductionmentioning

confidence: 99%

Sedation during minimal invasive surfactant therapy: a randomised controlled trial

Dekker

Lopriore

Zanten

et al. 2018

Arch Dis Child Fetal Neonatal Ed

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Sedation during minimal invasive surfactant therapy: a randomised controlled trial

Dekker

Lopriore

Zanten

et al. 2018

Arch Dis Child Fetal Neonatal Ed

View full text Add to dashboard Cite

show abstract

“…A report from the AAP on premedication for non-emergency endotracheal intubation in the neonate stated that midazolam should not be used in preterm infants, but it can be considered for use in the term or older infant as part of the premedication sequence for elective intubation in the NICU 8. Notwithstanding the discouraging results of previous studies, a recent randomised trial assessed nasal administration of midazolam (nMDZ) and concluded that nMDZ was more effective than nasal ketamine to adequately sedate neonates requiring intubation in the delivery room 26. The haemodynamic and respiratory effects of both drugs were comparable.…”

Section: Discussionmentioning

confidence: 99%

Premedication practices for tracheal intubation in neonates transported by French medical transport teams: a prospective observational study

Carbajal

Lodé

Ayachi³

et al. 2019

BMJ Open

Self Cite

View full text Add to dashboard Cite

ObjectivesPremedication practices for neonatal tracheal intubations have not yet been described for neonatal transport teams. Our objective is to describe the use of sedation/analgesia (SA) for tracheal intubations and to assess its tolerance in neonates transported by medical transport teams in France.SettingThis prospective observational study was part of the EPIPPAIN 2 project and collected around-the-clock data on SA practices in neonates intubated by all five paediatric medical transport teams of the Paris region during a 2-month period. Intubations were classified as emergent, semiemergent and non-emergent. Sedation level and conditions of intubation were assessed with the Tonus, Reactivity, Awareness and Conditions of intubation to Help in Endotracheal intubation Assessment (TRACHEA score). The scores range from 0 to 10 representing an increasing ladder from adequate to inadequate sedation, and from excellent to very poor conditions of intubation.Participants40 neonates intubated in 28 different centres.ResultsThe mean (SD) age was 34.9 (3.9) weeks, and 62.5% were intubated in the delivery room. 30/40 (75%) of intubations were performed with the use of SA. In 18/30 (60.0%) intubations performed with SA, the drug regimen was the association of sufentanil and midazolam. Atropine was given in 19/40 intubations. From the 16, 21 and 3 intubations classified as emergent, semiemergent and non-emergent, respectively, 8 (50%), 19 (90.5%) and 3 (100%) were performed with SA premedication. 79.3% of intubations performed with SA had TRACHEA scores of 3 or less. 22/40 (55%) infants had at least one of the following adverse events: muscle rigidity, bradycardia below 100/min, desaturation below 80% and nose or pharynx–larynx bleeding. 7/24 (29.2%) of those who had only one attempt presented at least one of these adverse events compared with 15/16 (93.8%) of those who needed two or more attempts (p<0.001).ConclusionSA premedication is largely feasible for tracheal intubations performed in neonates transported by medical transport teams including intubations judged as emergent or semiemergent.Trial registration number NCT01346813; Results.

show abstract

“…If a venous line is not available, despite every effort having been made to establish an intravenous line, especially in the delivery room, consider using a maximum of two doses of intranasal midazolam (0.2 mg/kg) (50). Low quality of evidence.…”

Section: Endotracheal Intubationmentioning

confidence: 99%

“…One study showed that nasal midazolam provided rapid and effective sedation to intubated neonates in the delivery room (44). Another study showed a lower efficacy of nasal ketamine (2 mg/kg) compared to nasal midazolam (0.2 mg/kg), but similar side effects, in preterm neonates requiring nonemergency endotracheal intubation for surfactant instillation in the delivery room (50). There is no available data at the moment on any other drug used for pain control during endotracheal intubation in infants.…”

Section: Appendix 3: Further Work On the Subject Of Analgesia And Sedmentioning

confidence: 99%

“…Therefore, propofol should be only used in patients with normal blood pressure, after the first 24 hours of life. Blood pressure should be carefully monitored for at least 30 minutes after propofol administration (45)(46)(47); Midazolam (0.2 mg/kg) given in each nostril, if intravenous access is not available, has been shown to be more efficient than nasal ketamine (2 mg/kg) with regard to adequately sedating neonates requiring intubation in the delivery room (50).…”

Section: Appendix 3: Further Work On the Subject Of Analgesia And Sedmentioning

confidence: 99%

See 1 more Smart Citation

Evidence‐based clinical guidelines on analgesia and sedation in newborn infants undergoing assisted ventilation and endotracheal intubation

Ancora

Lago

Garetti³

et al. 2018

Acta Paediatrica

View full text Add to dashboard Cite

Aim: This review informed pain control guidelines for clinicians performing mechanical ventilation, nasal continuous positive airway pressure and endotracheal intubation on term and preterm newborn infants. Methods:We reviewed literature published between 1986 and June 2017 on analgesia and sedation during assisted ventilation and before endotracheal intubation in newborn infants admitted to neonatal intensive care units. The subsequent guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation approach.Results: Our review produced five strong standard of care recommendations. One, reduce neonatal stress and use nonpharmacological analgesia during invasive ventilation. Two, favour intermittent boluses of opioids, administered after pain scores and before invasive procedures, during short expected periods of mechanical ventilation, mainly in preterm infants affected by respiratory distress syndrome. Three, do not use morphine infusion in preterm infants under 27 gestational weeks. Four, always use algometric scores to titrate analgesic drugs doses. Five, use premedication before endotracheal intubation for a more rapid, less painful, less traumatic and safer manoeuvre. We also developed 30 conditional recommendations on therapeutic options. Conclusion:Our review produced 35 recommendations on standard care and therapeutic options relating to the analgesia and sedation of newborn infants during ventilation and before endotracheal intubation.208

show abstract

Nasal midazolam vs ketamine for neonatal intubation in the delivery room: a randomised trial

Abstract: This clinical trial was recorded on the National Library of Medicine registry (NCT01517828).

Cited by 31 publications

References 38 publications

Sedation during minimal invasive surfactant therapy: a randomised controlled trial

Sedation during minimal invasive surfactant therapy: a randomised controlled trial

Premedication practices for tracheal intubation in neonates transported by French medical transport teams: a prospective observational study

Evidence‐based clinical guidelines on analgesia and sedation in newborn infants undergoing assisted ventilation and endotracheal intubation

Contact Info

Product

Resources

About