Baleine Julien, Milési Christophe, Mesnage Renaud, Rideau Batista Novais Aline, Combes Clémentine, Durand Sabine, Cambonie Gilles
Neonatal Intensive Care Unit, Department of Pediatrics, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 34000 Montpellier, France.
Neonatal Intensive Care Unit, Department of Pediatrics, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 34000 Montpellier, France.
Early Hum Dev. 2014 Jan;90(1):39-43. doi: 10.1016/j.earlhumdev.2013.10.007. Epub 2013 Dec 9.
Neonates are often intubated in the delivery room (DR) without anesthesia because vascular access is impossible.
To assess neonatal comfort and adverse events after use of nasal midazolam (nMDZ) for intubation in the DR.
Prospective data collection over 6months on the intubation of neonates with respiratory distress requiring tracheal instillation of surfactant.
Twenty-seven neonates with median (Q25-75) gestational age and birthweight of, respectively, 29 (27-33)weeks and 1270 (817-1942)g received a 0.1mg/kg dose of nMDZ, and intubation was performed at the onset of tonus resolution or apnea.
Comfort was assessed with a scale of hetero-pain assessment and electrical skin conductance monitoring. Continuous pulse oximetry was recorded in the first postnatal hour, with oscillometric blood pressure measurement every 10min.
Seventy percent of the patients required a single dose, with intubation performed 4.8 (3-9)min after administration. Combined electro-clinical assessment found adequate comfort during the procedure in 68% of neonates. Mean blood pressure decreased from 39 (34-44)mmHg before to 31 (25-33)mmHg 1h following nMDZ (p=0.011).
nMDZ provided rapid and effective sedation to intubate neonates in the DR but potentially exposed them to hypotension, thus requiring close hemodynamic monitoring.
由于无法建立血管通路，新生儿常在产房不使用麻醉剂的情况下进行气管插管。
评估在产房使用鼻内咪达唑仑（nMDZ）进行气管插管后新生儿的舒适度和不良事件。
对6个月内需要气管内滴注表面活性剂的呼吸窘迫新生儿进行气管插管的前瞻性数据收集。
27例中位（第25-75百分位数）胎龄和出生体重分别为29（27-33）周和1270（817-1942）克的新生儿接受了0.1mg/kg剂量的nMDZ，并在肌张力消退或呼吸暂停开始时进行气管插管。
采用异源性疼痛评估量表和皮肤电导率监测评估舒适度。出生后第1小时记录连续脉搏血氧饱和度，每10分钟测量一次振荡式血压。
70%的患者需要单次给药，给药后4.8（3-9）分钟进行气管插管。综合电临床评估发现68%的新生儿在操作过程中舒适度良好。nMDZ给药前平均血压为39（34-44）mmHg，给药后1小时降至31（25-33）mmHg（p=0.011）。
nMDZ能为产房气管插管的新生儿提供快速有效的镇静，但可能使他们面临低血压风险，因此需要密切监测血流动力学。
