Premedication for Nonemergent Neonatal Intubations: A Randomized, Controlled Trial Comparing Atropine and Fentanyl to Atropine, Fentanyl, and Mivacurium
Premedication for Nonemergent Neonatal Intubations: A Randomized, Controlled Trial Comparing Atropine and Fentanyl to Atropine, Fentanyl, and Mivacurium
复制标题
非急诊新生儿插管的术前用药：比较阿托品和芬太尼与阿托品、芬太尼和米库溴铵的随机对照试验
作者：
K. Roberts;T. Leone;W. Edwards;W. Rich;N. Finer
目标。这项工作的目的是研究使用肌肉松弛剂是否会改善婴儿的插管条件，从而减少缺氧的发生率和持续时间，以及成功完成插管过程所需的时间和次数。病人/方法。这是一项前瞻性、随机、对照、双中心试验。需要非紧急插管的婴儿被随机分配到插管前接受阿托品和芬太尼或阿托品、芬太尼和微量。在血氧饱和度阈值≤85%、≤75%、≤60%和≤40%时测定缺氧发生率和持续时间。回顾录像以确定插管次数和插管时间以及真空作用的持续时间。结果。对41名婴儿的分析显示，在任何持续时间内，氧饱和度≤60%的发生率在微量尿片组明显更低（55%对24%）。任意时段饱和水平发生率≤85%、75%、40%；累计时间≥30秒；低于阈值的时间差异不显著。总手术时间（472 vs 144秒）和总喉镜检查时间（148 vs 61秒）在真空组更短。微创组插管成功率≤2次明显高于对照组（35% vs 71%）。结论。与不使用肌肉松弛剂的阿托品和芬太尼相比，预先使用阿托品、芬太尼和米瓦库利可减少成功插管所需的时间和次数，同时显著降低严重去饱和的发生率。在新生儿重症监护病房的所有非紧急插管中，应考虑使用包括短效肌肉松弛剂在内的预用药。
OBJECTIVE. The purpose of this work was to investigate whether using a muscle relaxant would improve intubation conditions in infants, thereby decreasing the incidence and duration of hypoxia and time and number of attempts needed to successfully complete the intubation procedure. PATIENTS/METHODS. This was a prospective, randomized, controlled, 2-center trial. Infants requiring nonemergent intubation were randomly assigned to receive atropine and fentanyl or atropine, fentanyl, and mivacurium before intubation. Incidence and duration of hypoxia were determined at oxygen saturation thresholds of ≤85%, ≤75%, ≤60%, and ≤40%. Videotape was reviewed to determine the time and number of intubation attempts and duration of action of mivacurium. RESULTS. Analysis of 41 infants showed that incidence of oxygen saturation ≤60% of any duration was significantly less in the mivacurium group (55% vs 24%). The incidence of saturation level of any duration ≤85%, 75%, and 40%; cumulative time ≥30 seconds; and time below the thresholds were not significantly different. Total procedure time (472 vs 144 seconds) and total laryngoscope time (148 vs 61 seconds) were shorter in the mivacurium group. Successful intubation was achieved in ≤2 attempts significantly more often in the mivacurium group (35% vs 71%). CONCLUSIONS. Premedication with atropine, fentanyl, and mivacurium compared with atropine and fentanyl without a muscle relaxant decreases the time and number of attempts needed to successfully intubate while significantly reducing the incidence of severe desaturation. Premedication including a short-acting muscle relaxant should be considered for all nonemergent intubations in the NICU.