Physiologic Changes Associated with Endotracheal Intubation in Preterm Infants

Marshall, Terry A.; Deeder, Ron; Pal, Somsubhra; Berkowitz, Gerald P.; Austin, Tom L.

doi:10.1097/00132586-198502000-00049

Cited by 35 publications

(47 citation statements)

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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: 95%

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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Section: Common Practicesmentioning

confidence: 95%

Rocuronium for nonemergent intubation of term and preterm infants

et al. 2010

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“…The process of intubation may cause hypoxemia, 17 bradycardia, 18 intracranial hypertension, 19 systemic hypertension, 17 and pulmonary hypertension. 20 Hypoxemia seems to be related either to apnea at the time of intubation or possible airway obstruction associated with positioning.…”

Section: Physiologic Responses To Intubationmentioning

confidence: 99%

“…20 Hypoxemia seems to be related either to apnea at the time of intubation or possible airway obstruction associated with positioning. 17 Bradycardia is presumed to be vagal in origin, because the very rapid onset is suggestive of a reflexive etiology 17 and is not prevented by preoxygenation and the avoidance of hypoxemia. 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.…”

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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“…A number of complications during and following endotracheal intubation of infants are well described in the literature including acute [1][2][3][4] and chronic trauma 5 to hypopharyngeal structures, systemic [6][7][8] and local side effects, 9,10 and adverse effects on oral development. [11][12][13][14][15][16][17] We describe a rare case of an oral commissure defect acquired from prolonged endotracheal intubation in a preterm infant.…”

Section: Introductionmentioning

confidence: 99%