Ellen de Kort

30 Chapter 2 Table 2. Summary of premedication used before intubation in publications studying the INSURE procedure Author Premedication and dosage Number of patients Ancora et al. 26 Atropine 20 μg/kg, fentanyl 1-3 μg/kg, naloxone 40 μg/kg optional 38 Van den Berg et al. 22 Morphine 100 μg/kg or pethidine 1 mg/kg, naloxone 10 μg/ kg before extubation 16 Bohlin et al. 23 Morphine 200 μg/kg and pentobarbital 2 mg/kg, naloxone 0.1 mg/kg before extubation 42 Cherif et al. 20 Morphine 200 μg/kg 109 Flor-de-Lima et al. 18 Morphine 100 μg/kg, naloxone 100 μg/kg optional 15 Gizzi et al. 25 Fentanyl 0.5-2 μg/kg, naloxone 40 μg/kg optional 64 Leone et al. 27 Fentanyl 0.2 mg/kg 42 Sandri et al. 24 Fentanyl 0.5-2 μg/kg 51 Verder et al. 1994 19 Morphine 100 μg/kg, atropine 10 μg/kg, naloxone 10 μg/ kg optional 35 Verder et al.1999 21 Morphine 100 μg/kg, atropine 10 μg/kg, naloxone 10 μg/ kg optional 60 Welzing et al. 2009 16 Remifentanil 2 μg/kg and atropine 10 μg/kg 21 Welzing et al. 2010 17 Propofol 1 mg/kg and atropine 10 μg/kg 13 Abbreviations: BW, birth weight; GA, gestational age; CPAP, nasal continuous positive airway pressure. In patients whowere extubated to nasal intermittent positive pressure ventilation (nIPPV), INSURE failed in two patients (6%) on account of increased oxygen requirement. 25 Ancora et al. reported INSURE failure in 14 patients (37%), on account of insufficient respiratory drive in 13 patients. INSURE failure occurred at a mean of 99 hours (range 1–150 hours) after extubation. 26 None of the studies reported the necessity of naloxone therapy after fentanyl.