Use of methohexital for elective intubation in neonates

Naulaers, Gunnar; Deloof, E; Vanhole, Christine; Kola, Ermira; Devlieger, Hugo

doi:10.1136/fn.77.1.f61

Cited by 30 publications

(31 citation statements)

References 33 publications

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“…In January 2013 the standard of care was changed to performing the INSURE procedure for the administration of surfactant in all infants with a gestational age ≥27 weeks and birth weight ≥750 g. As premedication for the INSURE procedure we started to use remifentanil. Remifentanil was administered intravenously as a fast bolus and followed by an intravenous saline flush in 30 s. After administration, the level of sedation was assessed with a standardized sedation score, performed by rubbing the sole of the patient's foot and judging the motor reaction to that stimulus (1 = spontaneous movement; 2 = movement on slight touch; 3 = movement in reaction to firm stimulus; 4 = no movement) [9]. In case of inadequate sedation (score 1 or 2), another dose of remifentanil was administered according to the protocol.…”

Section: Methodsmentioning

confidence: 99%

Insufficient Sedation and Severe Side Effects after Fast Administration of Remifentanil during INSURE in Preterm Newborns

et al. 2016

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Background: Neonatal intubation is stressful and should be performed with premedication. In the case of an INSURE (intubation/surfactant/extubation) procedure a short duration of action of the premedication used is needed to facilitate fast extubation. Given its pharmacological profile, remifentanil seems a suitable candidate. Objectives: The aim here was to evaluate the effect and side effects of remifentanil as a premedication for preterm neonates undergoing INSURE. Methods: A prospective, single-center study in a level III neonatal intensive care unit was conducted. The quality of sedation was assessed in preterm infants receiving remifentanil prior to intubation for the INSURE procedure. Intravenous remifentanil was administered quickly and followed by a saline flush in approximately 30 s. The quality of sedation was defined by a combination of adequate sedation score, good intubation conditions and absence of side effects. Results: The study was terminated after the inclusion of 14 patients because of the high rate of side effects and the poor intubation conditions. Adequate sedation was achieved in only 2 patients (14%). Six patients (43%) needed additional propofol to obtain adequate sedation. Chest wall rigidity occurred in 6 patients (43%). Conclusions: The rapid administration of remifentanil provides insufficient sedation and is associated with a high risk of chest wall rigidity in preterm neonates.

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Section: Methodsmentioning

confidence: 99%

Insufficient Sedation and Severe Side Effects after Fast Administration of Remifentanil during INSURE in Preterm Newborns

et al. 2016

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“…43 In a small cohort study of term and preterm infants, methohexital facilitated intubation with rapid onset within 1 minute of sedation and recovery within 10 minutes. 44 However, more studies are necessary before methohexital can be recommended for use.…”

Section: Sedationmentioning

confidence: 99%

Premedication for Nonemergency Endotracheal Intubation in the Neonate

Kumar¹,

Denson²,

Mancuso³

et al. 2010

Pediatrics

193

211

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“…128 Methohexital in an uncontrolled study was associated with smooth intubating conditions and no apparent distress during intubation. 129 Studies on medications for use during endotracheal intubation are needed to address the requirements for analgesia, prevention of adverse physiologic responses (particularly bradycardia), and pharmacologic paralysis. This complex issue will be discussed further in a forthcoming statement from the American Academy of Pediatrics and Canadian Paediatric Society on the use of medications for elective intubation of neonates.…”

Section: Intubationmentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

419

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The prevention of pain in neonates should be the goal of all caregivers, 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 our 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. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures. INTRODUCTION ObjectivesThis updated statement is intended for health care professionals who care for neonates (preterm to 1 month of age). The objectives are to:1. emphasize that despite increased awareness of the importance of pain prevention, neonates in the NICU continue to be exposed to numerous painful minor procedures daily as part of their routine care;2. present objective means of assessing neonatal pain by health care professionals;3. describe effective strategies to prevent and treat pain associated with routine minor procedures; and 4. review appropriate methods to prevent and treat pain associated with surgery and other major procedures. BackgroundThe prevention of pain in neonates is an expectation of parents. 1 However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of www.pediatrics.org/cgi

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Use of methohexital for elective intubation in neonates

Cited by 30 publications

References 33 publications

Insufficient Sedation and Severe Side Effects after Fast Administration of Remifentanil during INSURE in Preterm Newborns

Insufficient Sedation and Severe Side Effects after Fast Administration of Remifentanil during INSURE in Preterm Newborns

Premedication for Nonemergency Endotracheal Intubation in the Neonate

Prevention and Management of Pain in the Neonate: An Update

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