Most neonatal units in the UK do not sedate babies before intubation, a new study has shown. Dr Simon Whyte (department of anaesthetics, Liverpool Women's hospital) and colleagues found that "despite evidence of the physiological and practical benefits," only 37 per cent of 239 neonatal units surveyed said that they routinely sedated babies before intubating them. In addition, only 14 per cent had a formal written policy for sedation before intubation.
Among units which gave sedation, morphine was the most commonly used drug, in 66 per cent of units. Muscle relaxants, most commonly suxamethonium, were used by 22 per cent of units. Other drugs used included diamorphine, fentanyl, benzodiazepines and atracurium.The survey was conducted by telephone questionnaire to the sister in charge of the neonatal unit. The authors comment that, while reasons for not using premedication were not formally documented, "many commented that there was not time, particularly in an emergency reintubation". They suggest that ventilation using a bag-valve-mask or T piece should be carried out while premedication is being prepared.
Although further studies are necessary, the authors conclude that "there is sufficient evidence to support the routine practice of neonatal premedication prior to elective intubation" (Archives of Diseases in Childhood Fetal and Neonatal Edition 2000;82:F38).