Arch Dis Child Fetal Neonatal Ed 2000;82:F34-F37 ( January )

Randomised controlled trial of thiopental for intubation in neonates

A Bhutada, R Sahni, S Rastogi, J-T Wung

Division of Neonatal-Perinatal Medicine, Babies and Children's Hospital of New York, College of Physicians and Surgeons, Columbia University, 3959 Broadway, BHN-1201, New York, NY 10032 USA

Correspondence to: Dr Jen-Tien Wung

Accepted 13 July 1999

AIMSTo determine the effects of premedication with thiopental on heart rate, blood pressure, and oxygen saturation during semi-elective nasotracheal intubation in neonates.
METHODSA randomised, placebo controlled, non-blinded study design was used to study 30 neonates (mean birthweight 3.27 kg) requiring semi-elective nasotracheal intubation. The babies were randomly allocated to receive either 6 mg/kg of thiopental (study group) or an equivalent volume of physiological saline (control group) one minute before the start of the procedure. Six infants were intubated primarily and 24 were changed from orotracheal to a nasotracheal tube. The electrocardiogram, arterial pressure wave, and transcutaneous oxygen saturation were recorded continuously 10 minutes before, during, and 20 minutes after intubation. Minute by minute measurements of heart rate, heart rate variability, mean blood pressure (MBP) and transcutaneous oxygen saturation (SpO₂) were computed. The differences for all of these between the baseline measurements and those made during and after intubation were determined. Differences in the measurements made in the study and the control groups were compared using Student's t test.
RESULTSDuring intubation, heart rate increased to a greater degree (12.0 vs 0.5 beats per minute, p < 0.03) and MBP increased to a lesser degree (2.9 vs 4.4 mm Hg; p < 0.002) in the infants who were premedicated with thiopental. After intubation only the changes in MBP differed significantly between the two groups (3.8 vs 4.6 mm Hg; p < 0.001). There were no significant changes in the oxygen saturation between the two groups during or after intubation. The time taken for intubation was significantly shorter in the study group (p < 0.04).
CONCLUSIONSThe heart rate and blood pressure of infants who are premedicated with thiopental are maintained nearer to baseline values than those of similar infants who receive no premedication. Whether this lessening of the acute drop in the heart rate and increase in blood pressure typically seen during intubation of unmedicated infants is associated with long term advantages to the infants remains to be determined.


Keywords: heart rate; blood pressure; oxygen saturation

---

© 2000 by Archives of Disease in Childhood
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Greenwood, C. S., Colby, C. E. (2009). Pharmacology Review: Premedication for Endotracheal Intubation of the Neonate: What is the Evidence?. NeoReviews 10: e31-e35 [Abstract] [Full Text]  
• VanLooy, J., Schumacher, R. E, Bhatt-Mehta, V. (2008). Efficacy of a Premedication Algorithm for Nonemergent Intubation in a Neonatal Intensive Care Unit. The Annals of Pharmacotherapy 42: 947-955 [Abstract] [Full Text]  
• Ghanta, S., Abdel-Latif, M. E., Lui, K., Ravindranathan, H., Awad, J., Oei, J. (2007). Propofol Compared With the Morphine, Atropine, and Suxamethonium Regimen as Induction Agents for Neonatal Endotracheal Intubation: A Randomized, Controlled Trial. Pediatrics 119: e1248-e1255 [Abstract] [Full Text]  
• American Academy of Pediatrics, , Committee on Fetus and Newborn and Section on Surg, , Canadian Paediatric Society, , Fetus and Newborn Committee, (2006). Prevention and Management of Pain in the Neonate: An Update. Pediatrics 118: 2231-2241 [Abstract] [Full Text]  
• Anand, K J S, Hall, R W (2006). Pharmacological therapy for analgesia and sedation in the newborn.. Arch. Dis. Child. Fetal Neonatal Ed. 91: F448-F453 [Abstract] [Full Text]  
• Roberts, K. D., Leone, T. A., Edwards, W. H., Rich, W. D., Finer, N. N. (2006). Premedication for Nonemergent Neonatal Intubations: A Randomized, Controlled Trial Comparing Atropine and Fentanyl to Atropine, Fentanyl, and Mivacurium. Pediatrics 118: 1583-1591 [Abstract] [Full Text]  
• Dempsey, E M, Al Hazzani, F, Faucher, D, Barrington, K J (2006). Facilitation of neonatal endotracheal intubation with mivacurium and fentanyl in the neonatal intensive care unit. Arch. Dis. Child. Fetal Neonatal Ed. 91: F279-F282 [Abstract] [Full Text]  
• ATTARDI, D. M, PAUL, D. A, TUTTLE, D. J, GREENSPAN, J. S (2000). Premedication for intubation in neonates. Arch. Dis. Child. Fetal Neonatal Ed. 83: 160F-160 [Full Text]  
• HANCOCK, S., NEWELL, S., BRIERLEY, J., BERRY, A. (2000). Premedication for neonatal intubation: current practice in Australia and the United Kingdom. Arch. Dis. Child. Fetal Neonatal Ed. 83: 74F-74 [Full Text]