What medications can be given to a neonate before intubation?
Table 1
| Medicationa | Dosage Rangeb,c | Onset of Actiona,c |
|---|---|---|
| Morphine | 100–300 mcg/kg | 5–15 minutes |
| Midazolam | 200 mcg/kg | 1–5 minutes |
| Thiopental | 2–6 mg/kg | 30–60 seconds |
| Propofol | 1–2.5 mg/kg | < 30 seconds |
What are the contraindications for neonatal intubation?
Contraindications and precautions
- Intubation drugs should not be used if there is a known allergy to any of the agents.
- Suxamethonium should not be used if there is a family history of malignant hyperthermia, if there is a suspicion of muscular dystrophy, or if there is significant hyperkalaemia.
Can an infant be intubated?
—Newborns admitted to the neonatal intensive care unit (NICU) frequently require laryngoscopy and endotracheal intubation. These procedures may be associated with detrimental physiologic alterations, including bradycardia, hypoxemia, systemic hypertension, and increased intracranial pressure (ICP).
When should you intubate a neonate?
Common indications for intubation include: neonatal resuscitation where PPV using a T-piece device/self-inflating bag and mask ventilation is ineffective or prolonged, evidenced by bradycardia (HR<100 bpm), falling oxygen saturations or failure to reach target oxygen saturation ranges.
How do you intubate a newborn?
3 Intubate – Position self at patient’s head, hold scope in left hand, open mouth with fingers (not blade), insert blade into right side of mouth, move blade to center of mouth pushing tongue to the left side, slowly advance blade and lift epiglottis till larynx is visualized.
What are the complications of endotracheal intubation in infants?
Two Complications of Tracheal Intubation in a Neonate: Gastric Perforation and Lung Collapse.
When are chest compressions indicated NRP?
The indication for chest compressions is a heart rate <60 bpm after 30 seconds of effective ventilation, ideally through an alternative airway such as an ETT.
Which of the following is an indication for endotracheal intubation in a newborn?
During neonatal resuscitation, endotracheal intubation may be indicated when bag-mask ventilation is ineffective or prolonged, when chest compressions are performed, or for special circumstances such as congenital diaphragmatic hernia.
What anatomical differences make intubation of an infant more difficult?
Unlike in the adult, the airway in infants and children is wider at the top, above the glottis, and narrows below the larynx in the subglottic area (Figure 5). This funnel shape predisposes the child to a greater risk for airway obstruction from processes causing subglottic edema, such as croup or intubation trauma.
Why would a newborn need to be intubated?
Endotracheal intubation, a common procedure in newborn care, is associated with pain and cardiorespiratory instability. The use of premedication reduces the adverse physiological responses of bradycardia, systemic hypertension, intracranial hypertension and hypoxia.
Why neonates are intubated?
Neonatal tracheal intubation may be required for a number of reasons including airway management, assisting ventilation in respiratory insufficiency and for surfactant administration. The procedure has the potential to provoke marked physiological changes and should never be undertaken lightly(1-5).
Why do we need premedication for newborn intubation?
Several trials have demonstrated that the use of premedication for intubation of the newborn significantly improves intubating conditions, decreases the time and number of attempts needed to complete the intubation procedure, and minimizes the potential for intubation-related airway trauma.
When do you need premedication for endotracheal intubation?
Perhaps more importantly, premedication decreases the pain and discomfort associated with the procedure. All newborn infants, therefore, should receive analgesic premedication for endotracheal intubation except in emergency situations.
When is the best time to start an intubation?
Most intubations occur at the time of delivery in the process of resuscitation, or semi-electively in infants with either poor respiratory effort or with severe immediate respiratory distress in the immediate newborn period. Intubation medications are therefore not usually given.
When to give morphine to infants before intubation?
It has been used for acute postoperative pain control and as a continuous infusion for ventilated infants. The use of morphine for premedication for intubation was studied in a randomized, controlled trial of 34 premature infants in which infants were given either morphine alone or placebo 5 minutes before the intubation.