Abstract
BackgroundElective endotracheal intubations are still commonly performed without premedication in many institutions. The hypothesis tested in this study was that morphine given prior to elective intubations in neonates would decrease fluctuations in vital signs, shorten the duration of intubation and reduce the number of attempts.MethodsFrom December 1999 to September 2000, infants of all gestations admitted to a level III neonatal intensive care unit and requiring an elective endotracheal intubation were randomly assigned to receive morphine 0.2 mg/kg IV or placebo 5 minutes before intubation. Duration of severe hypoxemia (HR< 90/min and Sp02<85%), duration of procedure, duration of hypoxemia (Sp02<85%), number of attempts and change in mean blood pressure were compared between groups.Results34 infants (median 989 g and 28 weeks gestation) were included. The duration of severe hypoxemia was similar between groups. Duration of procedure, duration of hypoxemia, number of attempts and increases in mean blood pressure were also similar between groups. 94% of infants experienced bradycardia during the procedure.ConclusionWe failed to demonstrate the effectiveness of morphine in reducing the physiological instability or time needed to perform elective intubations. Alternatives, perhaps with more rapid onset of action, should be considered.
Highlights
Elective endotracheal intubations are still commonly performed without premedication in many institutions
As morphine has been used for years in neonates with apparent safety and efficacy for pain and as staff in our unit were comfortable with this medication, we aimed to evaluate the efficacy of morphine, in achieving better intubation conditions and success while maintaining vital signs stability
Physiological stability was maintained in all infants, between the time the study drug was given, to the time the endotracheal intubation was performed
Summary
Elective endotracheal intubations are still commonly performed without premedication in many institutions. Endotracheal intubation is a painful and stressful procedure, which is associated with acute increases in blood pressure and intracranial pressure, bradycardia and hypoxemia [1]. These physiologic changes are potentially of sufficient magnitude to produce the reperfusion injury and venous congestion associated with intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) [2,3]. Most premature infants and many term infants admitted to neonatal intensive care units (NICU) will require one or more endotracheal intubations during their stay. In 1994, 84% of Canadian NICUs, including ours, rarely or never used premedication for elective intubations [7]. Perceived lack of evidence of benefits and fear of side effects were reasons
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
