Introduction Endotracheal Intubation (ETI) is a frequently performed procedure in the neonatal unit. For ease of this prodecure and to avert the abnormal physiological responses that occur, premedication with sedatives, analgesics and muscle relaxants are used in non-urgent cases. However, the optimal drug regimen remains unknown and keeps changing from previous follow up surveys.
Objectives To determine the:
· Extent and drug regimens used in premedication for non-urgent ETI in UK Neonatal units.
· Changes in practice from previous surveys.
Methods A literature review on the subject in the UK and internationally was carried out to inform a semi-structured telephone questionnaire design. A survey was then carried out between January–March 2014. Any member of the medical team or the nurse-in-charge was interviewed.
Results · Total Number Neonatal Units surveyed=197
· 192 (97.5%) use premedication; No premedication =5 (2.5%)
· Sedatives used= 189 : Morphine 121, Fentanyl 57, Propofol 7 (5 as single agent), Midazolam 3, Remifentanyl 1;
· 12 units used a sedative as a sole agent.
· Muscle relaxants used: Always =172: Suxamethonium 149, Atracurium 18, Pancuronium 3, Vecuronium 1; as sole agent in 3 units.
· Atropine use: Always = 105; As required =20; Never used =72.
· Most widely used combination: Morphine-Atropine-Suxamethonium 58(29.5%), followed by Fentanyl-Atropine-Suxamethonium 42(21.3%).
Conclusions · Current practice shows lack of consensus.
· Rates of premedication use show Improvement from previous studies: 1998(37%), 2007(93%) to 97.5% in the current study.
· Narrower range of sedatives are currently used.
· Morphine-Atropine-Suxamethonium still remains the commonest regimen.
Propofol is the latest addition in the last 7 yrs although there is currently very limited studies in neonates.