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1637 Use of Premedication Drugs for Neonatal Intubation: Is this the time to Think of Changing Clinical Practice?
  1. Y Singh,
  2. M Lester,
  3. V Ng,
  4. L Miall
  1. Neonatal Medicine, The Leeds Teaching Hospitals NHS Trust, Leeds, UK

Abstract

Background A recent national survey of tertiary neonatal units in the UK showed that six different premedication drugs are being used in ten different combinations. Preparation and administration of three premedication drugs, especially regimen having controlled drugs, may take significantly longer time and may delay intubation.

Aims and objectives:

To study the time taken for preparation and administration of commonest drug regimen (combination of Fentanyl, Atropine and Suxamethonium).

To study its efficacy during neonatal intubation.

Design and methods A prospective study in a tertiary neonatal setting in the UK included elective and semi-elective intubations. Neonatal intubations done in the delivery suite and emergency situation, where patient was collapsed, were excluded.

Results Data was collected from use of premedication drugs during 24 neonatal intubations. Mean time taken to obtain and prepare premedication drugs was 18 minutes (Range: 3–94 minutes) and mean time taken to administer premedication drugs was 3 minutes (Range: 1–10 minutes).

Mean time taken from insertion of laryngoscope in mouth to successful intubation was 5 minutes (Range: 1–24 min) and mean number of attempts were 2 (Range: 1–7 attempts). Only 8% cases needed repeat premedication drugs.

Conclusion The average time taken for preparation and administration of three premedication drugs was 18 minutes which is significantly longer than expected for emergency situations. Use of single un-controlled premedication like Propofol can be quick and cost effective. Is this time to change our practice or do we need more randomised trials to study the efficacy of Propofol?

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