Ellen de Kort

12 Chapter 1 In both INSURE and LISA, laryngoscopy is performed and an endotracheal tube (INSURE) or thin catheter (LISA) is placed through the vocal cords. Both procedures, therefore, have considerable similarities with the procedure of endotracheal intubation for the purpose of mechanical ventilation. Likely, the harmful effects of performing INSURE or LISA in awake patients are comparable with the harmful effects of performing awake intubation. Ideally, during INSURE and LISA premedication should be used. Studies on the use of INSURE do report on the use of various drugs as premedication. 40,57-67 LISA, however, is often performed without the use of premedication. 44,49,51-56 The choice of premedication for these procedures should be carefully made. A very short period of action to facilitate rapid extubation in case of INSURE and complete preservation of the respiratory drive in case of LISA are of utmost importance for success of both procedures. CONTENTS OF THIS THESIS The overall aim of this thesis was to increase patient safety and comfort during endotracheal intubation in newborn infants by optimizing the use of premedication. The specific aims of this thesis were: 1. Premedication use during INSURE and LISA: to find the most optimal premedication strategy for the INSURE procedure and to evaluate the need for premedication use during LISA by describing the effects of performing LISA without premedication. 2. Measurement of the effect of premedication: to standardize the intubation procedure by developing an objective scoring system to determine level of sedation after the administration of premedication. 3. Propofol as premedication: to find suitable doses of propofol that provide optimal sedation without significant side effects in newborns of different gestational and postnatal ages.