Premedication before intubation in UK neonatal units: a decade of change?

Kelleher, John; Mallya, Prashant; Wyllie, Jonathan

doi:10.1136/adc.2008.154518

Cited by 42 publications

(45 citation statements)

References 17 publications

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“…In contrast to findings in the other national surveys, [7][8][9][10][11][12] midazolam was the preferred sedative in this SA study. Many participants used midazolam as the only premedication drug.…”

Section: Discussioncontrasting

confidence: 53%

“…This study illustrates that almost 30% of the SA clinicians surveyed were not administering premedication to infants before elective or semi-elective intubation, in stark contrast to practice in the UK or Australasia, where recent surveys [9,10,12] indicate that >90% of units are providing premedication. No consensus exists regarding the choice of agent/s, their dose/s or the ideal route of administration, [6] mirroring the findings of the present study and other surveys.…”

Section: Discussionmentioning

confidence: 70%

“…No consensus exists regarding the choice of agent/s, their dose/s or the ideal route of administration, [6] mirroring the findings of the present study and other surveys. [7][8][9][10][11][12] Suxamethonium, as in other national surveys, [7][8][9][10][11][12] was the most commonly used muscle relaxant and is currently considered to be the best choice [17] because of its rapid onset, short duration of action and good side-effect profile.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] However, despite the growing body of evidence and acceptance of premedication as a standard of care, its use is still not universal, and wide variations occur in practice. [7,8] Premedication practices have been surveyed in Europe, [7,9,10] North America [8,11] and Australia. [12] The European surveys had a profound effect on current practice.…”

mentioning

confidence: 99%

“…A decade later, when the survey was repeated, ≥90% of neonatal units had adopted premedication as standard of care. [9,10] Because current neonatal premedication practices have not previously been surveyed in South Africa (SA), we designed a survey with the objective of determining the current practice and standard of care. This survey may provide data that could inform the design of collaborative trials and/or stimulate debate that ultimately leads to change and standardisation of practice.…”

mentioning

confidence: 99%

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Newborns should be receiving premedication before elective intubation

et al. 2014

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Background. Intubation is a common neonatal procedure. Premedication is accepted as a standard of care, but its use is not universal and wide variations exist in practice. Objective. To evaluate current practices for premedication use prior to elective neonatal intubation in South Africa (SA). Method. We invited 481 clinicians to participate in a cross-sectional web-based survey. Results. We received responses from 28.3% of the clinicians surveyed; 54.1% were from the private sector and 45.9% from the state sector. Most respondents worked in medium-sized neonatal units with six to ten beds. Most paediatricians (76.0%) worked in the private sector, and 78.6% of neonatologists in the state sector. Premedication was practised by 71.9% of the respondents, but only 38.5% of neonatal units had a written policy. Sedatives were used for premedication by 63.2% of the respondents. Midazolam (41.5%), morphine (34.0%) and ketamine (20.8%) were most commonly used. Muscle relaxants and atropine were not routinely administered. Suxamethonium was the muscle relaxant of choice. Varied combinations of agents or single agents were used. Midazolam used alone was the preferred option. Conclusion. This first survey of premedication for neonatal intubation in SA revealed variations in practice, with a minority of clinicians following a written policy. The findings can be used to benchmark practice and inform the design of local collaborative trials aimed at determining optimal premedication prior to neonatal intubation. The survey demonstrates clinicians' reluctance to participate in surveys, suggesting a need for a national collaborative network to obtain representative data.

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