Ghanta Satish, Abdel-Latif Mohamed E, Lui Kei, Ravindranathan Hari, Awad John, Oei Julee
Department of Newborn Care, Royal Hospital for Women, Barker Street, Randwick, New South Wales 2031, Australia.
Pediatrics. 2007 Jun;119(6):e1248-55. doi: 10.1542/peds.2006-2708. Epub 2007 May 7.
The purpose of this work was to compare the efficacy of propofol, a hypnotic agent, to the regimen of morphine, atropine, and suxamethonium as an induction agent for nonemergency neonatal endotracheal intubation. We hypothesized that propofol aids intubation by allowing the continuation of spontaneous breathing.
We conducted a randomized, open-label, controlled trial of infants who required nonemergency endotracheal intubation. Primary outcome was successful intubation confirmed by chest auscultation and clinical examination of the infant.
Infants randomly assigned to propofol (n = 33) and the morphine, atropine, and suxamethonium regimen (n = 30) were comparable in median gestational age (27 vs 28 weeks), birth weight (1020 vs 1095 g), weight at intubation (1068 vs 1275 g), and age at intubation (4 vs 3 days). Sleep or muscle relaxation were achieved within 60 seconds in both groups, but time to achieve successful intubation was more than twice as fast with propofol (120 vs 260 seconds). Blood pressure and heart rates were not different, but intraprocedural oxygen saturations were significantly lower in infants on the morphine, atropine, and suxamethonium regimen (trough arterial oxygen saturation: 60% vs 80%). Nasal/oral trauma was less common, and recovery time was shorter (780 vs 1425 seconds) in the propofol group. No significant adverse effects were seen in either group.
Propofol is more effective than the morphine, atropine, and suxamethonium regimen as an induction agent to facilitate neonatal nasal endotracheal intubation. Importantly, hypoxemia was less severe, probably because of the maintenance of spontaneous breathing. A controlled environment may have promoted the ease of intubation, resulting in less trauma. The shorter duration of action would be advantageous in a compromised infant.
本研究旨在比较催眠药丙泊酚与吗啡、阿托品和琥珀胆碱联合用药方案作为非急诊新生儿气管插管诱导剂的疗效。我们假设丙泊酚通过允许自主呼吸的持续来辅助插管。
我们对需要非急诊气管插管的婴儿进行了一项随机、开放标签、对照试验。主要结局是通过婴儿胸部听诊和临床检查确认插管成功。
随机分配至丙泊酚组（n = 33）和吗啡、阿托品和琥珀胆碱联合用药组（n = 30）的婴儿在中位胎龄（27对28周）、出生体重（1020对1095克）、插管时体重（1068对1275克）和插管时年龄（4对3天）方面具有可比性。两组均在60秒内实现睡眠或肌肉松弛，但丙泊酚组实现成功插管的时间快两倍多（120对260秒）。血压和心率无差异，但吗啡、阿托品和琥珀胆碱联合用药组婴儿术中氧饱和度显著更低（动脉血氧饱和度最低值：60%对80%）。丙泊酚组鼻/口创伤较少见，恢复时间较短（780对1425秒）。两组均未观察到显著不良反应。
作为促进新生儿经鼻气管插管的诱导剂，丙泊酚比吗啡、阿托品和琥珀胆碱联合用药方案更有效。重要的是，低氧血症较轻，可能是因为自主呼吸得以维持。可控环境可能促进了插管的顺利进行，从而减少了创伤。作用持续时间较短对病情较重的婴儿有利。
Zotero 插件