Haemodynamic effects of premedication for neonatal intubation: an observational study

Objective To examine changes in blood pressure (BP), cardiac output (CO) and cerebral regional oxygen saturation (rScO2) with administration of premedication for neonatal intubation. Design Pilot, prospective, observational study. Oxygen saturation, heart rate, CO, rScO2 and BP data were collected. Monitoring began 5 min prior to premedication and continued until spontaneous movement. Setting Single-centre, level 3 neonatal intensive care unit Patients 35 infants, all gestational ages. 81 eligible infants: 66 consented, 15 refused. Interventions Intravenous atropine, fentanyl or morphine, ±cisatracurium Main outcome measures BP, CO, rScO2 Results n=37 intubations. Mean gestational age and median birth weight were 31 4/7 weeks and 1511 g. After premedication, 10 episodes resulted in a BP increase from baseline and 27 in a BP decrease. Of those whose BP decreased, 17 had Conclusion About 30% of infants dropped their BP by ≥20% after premedication for elective intubation. These BP changes were not associated with any significant change in rScO2 or CO. More data are needed to better characterise the immediate haemodynamic changes and clinical outcomes associated with premedication.