Nasal midazolam vs ketamine for neonatal intubation in the delivery room: a randomised trial.
Arch Dis Child Fetal Neonatal Ed
; 103(3): F221-F226, 2018 May.
Article
em En
| MEDLINE
| ID: mdl-28818854
ABSTRACT
OBJECTIVE:
To compare the effectiveness of sedation by intranasal administration of midazolam (nMDZ) or ketamine (nKTM) for neonatal intubation.DESIGN:
A multicentre, prospective, randomised, double-blind study.SETTING:
Delivery rooms at four tertiary perinatal centres in France. PATIENTS Preterm neonates with respiratory distress requiring non-emergent endotracheal intubation for surfactant instillation.INTERVENTIONS:
Treatment was randomly allocated, with each neonate receiving a bolus of 0.1 mL/kg in each nostril, corresponding to 0.2 mg/kg for nMDZ and 2 mg/kg for nKTM. The drug was repeated once 7 min later at the same dose if adequate sedation was not obtained. MAIN OUTCOMEMEASURES:
Success was defined by adequate sedation before intubation and adequate comfort during the procedure. Intubation features, respiratory and cardiovascular events were recorded.RESULTS:
Sixty newborns, with mean (SD) gestational age and birth weight of 28 (3) weeks and 1100 (350) g, were included within the first 20 min of life. nMDZ was associated with a higher success rate (89% vs 58%; RR 1.54, 95% CI 1.12 to 2.12, p<0.01) and shorter delays between the first dose and intubation (10 (6) vs 16 (8) min, p<0.01).Number of attempts, time to intubation, mean arterial blood pressure measures over the first 12 hours after birth and length of invasive ventilation were not different.CONCLUSIONS:
nMDZ was more efficient than nKTM to adequately sedate neonates requiring intubation in the delivery room. The haemodynamic and respiratory effects of both drugs were comparable. CLINICAL TRIAL This clinical trial was recorded on the National Library of Medicine registry (NCT01517828).Palavras-chave
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Síndrome do Desconforto Respiratório do Recém-Nascido
/
Midazolam
/
Ketamina
/
Anestésicos
Tipo de estudo:
Clinical_trials
/
Observational_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Male
/
Newborn
País/Região como assunto:
Europa
Idioma:
En
Revista:
Arch Dis Child Fetal Neonatal Ed
Assunto da revista:
PEDIATRIA
/
PERINATOLOGIA
Ano de publicação:
2018
Tipo de documento:
Article
País de afiliação:
França