Arch Dis Child Fetal Neonatal Ed 2000;82:F38-F41 ( January )

Premedication before intubation in UK neonatal units

Simon Whyte^a, Ginny Birrell^b, Jonathan Wyllie^b

^a Department of Anaesthetics, Liverpool Women's Hospital, Liverpool L8 7SS, ^b Department of Paediatrics, South Cleveland Hospital, Marton Road, Middlesbrough TS4 3BW

Correspondence to: Dr Simon Whyte Email: sdwhyte{at}bigfoot.com Accepted 14 June 1999

AIMSTo establish the extent and type of premedication used before intubation in neonatal units in the United Kingdom.
METHODSA structured telephone survey was conducted of 241 eligible units. Units were subdivided into those that routinely intubated and ventilated babies (routine group) and those that transferred intubated and ventilated babies (transfer group).
RESULTSOf the units contacted, 239 (99%) participated. Only 88/239 (37%) gave any sedation before intubating on the unit and only 34/239 (14%) had a written policy covering this. Morphine was used most commonly (66%), with other opioids and benzodiazepines used less frequently. Of the 88 units using sedation, 19 (22%) also used paralysis. Suxamethonium was given by 10/19 (53%) but only half of these combined it with atropine. Drug doses varied by factors of up to 200, even for commonly used drugs.
CONCLUSIONMost UK neonatal units do not sedate babies before intubating, despite evidence of physiological and practical benefits. Only a minority have written guidelines, which prohibits auditing of practice.

Key messages There is good evidence of physiological and practical benefit when neonates are sedated before intubation, and no evidence that it is harmful. Only 37% of UK neonatal units routinely sedate babies before intubating them on the unit. Only 14% of units have formal guidelines for sedation before intubation, prohibiting audit of practice.

Keywords: intubation; premedication; sedation

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© 2000 by Archives of Disease in Childhood
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