Published online May 7, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. e1248-e1255 (doi:10.1542/peds.2006-2708)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Ghanta, S.
Right arrow Articles by Oei, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ghanta, S.
Right arrow Articles by Oei, J.
Related Collections
Right arrow Respiratory Tract
Social Bookmarking
 Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ARTICLE

Propofol Compared With the Morphine, Atropine, and Suxamethonium Regimen as Induction Agents for Neonatal Endotracheal Intubation: A Randomized, Controlled Trial

Satish Ghanta, MBBS, MDa, Mohamed E. Abdel-Latif, MBBS, MRCPCH, MPH, MScEpia,b, Kei Lui, MBBS, FRACP, MDa,b, Hari Ravindranathan, MBBS, MDa, John Awad, MBBS, FANZCA, FJFICMc and Julee Oei, MBBS, FRACPa,b

a Department of Newborn Care, Royal Hospital for Women, Randwick, New South Wales, Australia
b School of Women's and Children's Heath, University of New South Wales, Kensington, New South Wales, Australia
c Department of Paediatric Intensive Care, Sydney Children Hospital, Randwick, New South Wales, Australia

OBJECTIVES. The purpose of this work was to compare the efficacy of propofol, a hypnotic agent, to the regimen of morphine, atropine, and suxamethonium as an induction agent for nonemergency neonatal endotracheal intubation. We hypothesized that propofol aids intubation by allowing the continuation of spontaneous breathing.

PATIENTS AND METHODS. We conducted a randomized, open-label, controlled trial of infants who required nonemergency endotracheal intubation. Primary outcome was successful intubation confirmed by chest auscultation and clinical examination of the infant.

RESULTS. Infants randomly assigned to propofol (n = 33) and the morphine, atropine, and suxamethonium regimen (n = 30) were comparable in median gestational age (27 vs 28 weeks), birth weight (1020 vs 1095 g), weight at intubation (1068 vs 1275 g), and age at intubation (4 vs 3 days). Sleep or muscle relaxation were achieved within 60 seconds in both groups, but time to achieve successful intubation was more than twice as fast with propofol (120 vs 260 seconds). Blood pressure and heart rates were not different, but intraprocedural oxygen saturations were significantly lower in infants on the morphine, atropine, and suxamethonium regimen (trough arterial oxygen saturation: 60% vs 80%). Nasal/oral trauma was less common, and recovery time was shorter (780 vs 1425 seconds) in the propofol group. No significant adverse effects were seen in either group.

CONCLUSIONS. Propofol is more effective than the morphine, atropine, and suxamethonium regimen as an induction agent to facilitate neonatal nasal endotracheal intubation. Importantly, hypoxemia was less severe, probably because of the maintenance of spontaneous breathing. A controlled environment may have promoted the ease of intubation, resulting in less trauma. The shorter duration of action would be advantageous in a compromised infant.


Key Words: propofol • endotracheal intubation • suxamethonium • neonatal • randomized control trial

Abbreviations: MASux—combination of morphine, atropine, and suxamethonium regimen


Accepted Nov 28, 2006.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
Arch. Dis. Child. Fetal Neonatal Ed.Home page
B Lemyre, R Cheng, and I Gaboury
Atropine, fentanyl and succinylcholine for non-urgent intubations in newborns
Arch. Dis. Child. Fetal Neonatal Ed., November 1, 2009; 94(6): F439 - F442.
[Abstract] [Full Text] [PDF]


Home page
Arch. Dis. Child. Fetal Neonatal Ed.Home page
J Kelleher, P Mallya, and J Wyllie
Premedication before intubation in UK neonatal units: a decade of change?
Arch. Dis. Child. Fetal Neonatal Ed., September 1, 2009; 94(5): F332 - F335.
[Abstract] [Full Text] [PDF]


Home page
NeoReviewsHome page
C. S. Greenwood and C. E. Colby
Pharmacology Review: Premedication for Endotracheal Intubation of the Neonate: What is the Evidence?
NeoReviews, January 1, 2009; 10(1): e31 - e35.
[Abstract] [Full Text] [PDF]


Home page
EDUCATION AND PRACTICEHome page
J P Wyllie
Neonatal endotracheal intubation
Arch. Dis. Child. Ed. Pract., April 1, 2008; 93(2): 44 - 49.
[Full Text] [PDF]


Home page
Br J AnaesthHome page
K. Allegaert, M. Y. Peeters, R. Verbesselt, D. Tibboel, G. Naulaers, J. N. de Hoon, and C. A. Knibbe
Inter-individual variability in propofol pharmacokinetics in preterm and term neonates
Br. J. Anaesth., December 1, 2007; 99(6): 864 - 870.
[Abstract] [Full Text] [PDF]

eLetters:

Read all eLetters

Further studies needed to establish safety profile
Santanu Sen
Pediatrics Online, 17 Jun 2007 [Full text]
propofol disposition in neonates: interindividual variability is to be anticipated
karel allegaert
Pediatrics Online, 5 Jul 2007 [Full text]