Premedication for neonatal intubation: Current practice in Saudi Arabia

Abstract

Background:Despite strong evidence of the benefits of rapid sequence intubation in neonates, it is still infrequently utilized in neonatal intensive care units (NICU), contributing to avoidable pain and secondary procedure-related physiological disturbances.Objectives:The primary objective of this cross-sectional survey was to assess the practice of premedication and regimens commonly used before elective endotracheal intubation in NICUs in Saudi Arabia. The secondary aim was to explore neonatal physicians’ attitudes regarding this intervention in institutions across Saudi Arabia.Methods:A web-based, structured questionnaire was distributed by the Department of Pediatrics, Umm Al Qura University, Mecca, to neonatal physicians and consultants of 10 NICUs across the country by E-mail. Responses were tabulated and descriptive statistics were conducted on the variables extracted.Results:85% responded to the survey. Although 70% believed it was essential to routinely use premedication for all elective intubations, only 41% implemented this strategy. 60% cited fear of potential side effects for avoiding premedication and 40% indicated that the procedure could be executed more rapidly without drug therapy. Treatment regimens varied widely among respondents.Conclusion:Rates of premedication use prior to non-emergent neonatal intubation are suboptimal. Flawed information and lack of unified unit policies hampered effective implementation. Evidence-based guidelines may influence country-wide adoption of this practice.

International consensus is needed on premedication for non‐emergency neonatal intubation after survey found wide‐ranging policies and practices in 70 countries

“…A prospective study of 13 tertiary care units in Paris, France published in 2013 showed that using premedication before intubation was either inconsistent or it did not follow current recommendations (7). Similar results were reported in a Saudi Arabian study published in 2012 (8).…”

Ocorrência de dor em bebês internados em unidade de terapia intensiva neonatal de maternidade terciária

“…4,10 Há evidências de que a intubação orotraqueal sem analgesia em neonatos pode levar a complicações hemodinâmicas como hipoxemia, bradicardia, hipertensão intracraniana e hemorragia periintraventricular. 18,19 Nas unidades de terapia intensiva neonatais, o uso de analgesia e sedação é eventual, desconsiderando-se a dor e o desconforto do paciente, que ainda não apresenta condições verbais de expor o que sente. Apesar dos avanços no conhecimento da fisiologia da dor nessa faixa etária, do desenvolvimento de métodos de avaliação da dor para o lactente pré-verbal e da existência de medidas terapêuticas para o alívio da dor, ainda há uma grande lacuna entre o conhecimento teórico e a conduta prática por parte dos profissionais de saúde.…”

Premedication Use Before Nonemergent Intubation in the Newborn Infant

“…One of the reasons identified from the literature 29,30 for variations in the frequency of premedication is the concern with adverse effects of the drugs. The AAP clinical report attempts to address this concern by listing the available drugs used with their adverse effects and treatment strategies.…”