Premedication for Nonemergency Endotracheal Intubation in the Neonate

Kumar, Praveen; Denson, Susan E.; Mancuso, Thomas J.; Newborn, Section on Anesthesiology

doi:10.1542/peds.2009-2863

Cited by 193 publications

(225 citation statements)

References 56 publications

Supporting

Mentioning

217

Contrasting

Unclassified

Order By: Relevance

“…The American Academy of Pediatrics' clinical report encouraging premedication for nonemergent intubation acknowledges the need for further study to establish an 'ideal' combination of agents. 7 This is the first report to our knowledge that examines the efficacy and safety of rocuronium for the nonemergent endotracheal intubation in term and preterm infants in the NICU. Several studies provide information on the drug in older pediatric populations.…”

Section: Drug Of Choicementioning

confidence: 93%

“…5 Improving intubation success rates is worthwhile, given data that reveal more than half of all intubation attempts by pediatric residents are unsuccessful, leading to multiple attempts by caregivers to properly place the endotracheal tube. 6 As of March 2010, the American Academy of Pediatrics endorses the use of premedication for nonemergent intubation; the clinical report by Kumar et al 7 advocates for the administration of analgesic agents and states, 'vagolytic agents and rapid-onset muscle relaxants should be considered'.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Rocuronium for nonemergent intubation of term and preterm infants

et al. 2010

View full text Add to dashboard Cite

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.

show abstract

Section: Drug Of Choicementioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Rocuronium for nonemergent intubation of term and preterm infants

et al. 2010

View full text Add to dashboard Cite

show abstract

“…The AAP recommends routine pain management during procedures such as circumcision, 90 chest drain insertion and removal, 2 and nonemergency intubations. 91 However, effective management strategies for pain and sedation during mechanical ventilation remain elusive. A recent systematic review reported limited favorable effect with selective rather than routine use of opioids for analgesia in mechanically ventilated infants.…”

Section: Opioids Benzodiazepines and Other Drugsmentioning

confidence: 99%

Prevention and Management of Procedural Pain in the Neonate: An Update

Keels¹,

Sethna²,

Watterberg³

et al. 2016

Pediatrics

332

171

View full text Add to dashboard Cite

The prevention of pain in neonates should be the goal of all pediatricians and health care professionals who work with neonates, not only because it is ethical but also because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor, yet painful procedures. Therefore, every health care facility caring for neonates should implement (1) a pain-prevention program that includes strategies for minimizing the number of painful procedures performed and (2) a pain assessment and management plan that includes routine assessment of pain, pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and measures for minimizing pain associated with surgery and other major procedures.

show abstract

“…Premedication regimens that include neuromuscular blockade have been shown to improve intubation conditions [31], decrease bradycardia and oxygen desaturation [32] and decrease the duration and number of intubation attempts [33,34]. While supported by the American Academy of Pediatrics [35], premedication is still not widely utilized in many American NICUs [36].…”

Section: Neonatal Intubation Safety Researchmentioning

confidence: 99%

Improving neonatal intubation safety: A journey of a thousand miles

Sawyer

Foglia

Hatch

et al. 2017

NPM

View full text Add to dashboard Cite

Abstract. Neonatal intubation is one of the most common procedures performed by neonatologists, however, the procedure is difficult and high risk. Neonates who endure the procedure often experience adverse events, including bradycardia and severe oxygen desaturations. Because of low first attempt success rates, neonates are often subjected to multiple intubation attempts before the endotracheal tube is successfully placed. These factors conspire to make intubation one of the most dangerous procedures in neonatal medicine. In this commentary we review key elements in the journey to improve neonatal intubation safety. We begin with a review of intubation success rates and complications. Then, we discuss the importance of intubation training. Next, we examine quality improvement efforts and patient safety research to improve neonatal intubation safety. Finally, we evaluate new tools which may improve success rates, and decrease complications during neonatal intubation.

show abstract

Premedication for Nonemergency Endotracheal Intubation in the Neonate

Abstract: Endotracheal intubation is a common procedure in newborn care. The purpose of this clinical report is to review currently available evidence on use of premedication for intubation, identify gaps in knowledge, and provide guidance for making decisions about the use of premedication.

Cited by 193 publications

References 56 publications

Rocuronium for nonemergent intubation of term and preterm infants

Rocuronium for nonemergent intubation of term and preterm infants

Prevention and Management of Procedural Pain in the Neonate: An Update

Improving neonatal intubation safety: A journey of a thousand miles

Contact Info

Product

Resources

About