Use of premedication for intubation in tertiary neonatal units in the United Kingdom

Chaudhary, Rajiv; Chonat, Satheesh; Gowda, Harsha; Clarke, Paul; Curley, Anna

doi:10.1111/j.1460-9592.2008.02829.x

Cited by 42 publications

(36 citation statements)

References 20 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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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Newborns should be receiving premedication before elective intubation

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Part Introduction

2011

Neonatal Formulary 6

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Premedication practices for neonatal tracheal intubation: Results from the EPIPPAIN 2 prospective cohort study and comparison with EPIPPAIN 1

Walter-Nicolet

Marchand-Martin

Guellec

et al. 2021

Paediatric and Neonatal Pain

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To describe the frequency and nature of premedication practices for neonatal tracheal intubation (TI) in 2011; to identify independent risk factors for the absence of premedication; to compare data with those from 2005 and to confront observed practices with current recommendations. Data concerning TI performed in neonates during the first 14 days of their admission to participating neonatal/pediatric intensive care units were prospectively collected at the bedside. This study was part of the Epidemiology of Procedural Pain in Neonates study (EPIPPAIN 2) conducted in 16 tertiary care units in the region of Paris, France, in 2011. Multivariate analysis was used to identify factors associated with premedication use and multilevel analysis to identify center effect. Results were compared with those of the EPIPPAIN 1 study, conducted in 2005 with a similar design, and to a current guidance for the clinician for this procedure. One hundred and twenty-one intubations carried out in 121 patients were analyzed. The specific premedication rate was 47% and drugs used included mainly propofol (26%), sufentanil (24%), and ketamine (12%). Three factors were associated with the use of a specific premedication: nonemergent TI (Odds ratio (OR) [95% CI]: 5.3 [1.49-20.80]), existence of a specific written protocol in the ward (OR [95% CI]:4.80 [2.12-11.57]), and the absence of a nonspecific concurrent analgesia infusion before TI (OR [95% CI]: 3.41 [1.46-8.45]). No center effect was observed. The specific premedication rate was lower than the 56% rate observed in 2005. The drugs used were more homogenous and consistent with the current recommendations than in 2005, especially in centers with a specific written protocol.Premedication use prior to neonatal TI was low, even for nonemergent procedures.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Use of premedication for intubation in tertiary neonatal units in the United Kingdom

Cited by 42 publications

References 20 publications

Newborns should be receiving premedication before elective intubation

Newborns should be receiving premedication before elective intubation

Part Introduction

Premedication practices for neonatal tracheal intubation: Results from the EPIPPAIN 2 prospective cohort study and comparison with EPIPPAIN 1

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