Ellen de Kort

31 Sedation for the INSURE procedure 2 Patient characteristics Time to extubation INSURE failure Reasons for INSURE failure GA < 32 weeks and BW <1500 grams Not described 14 patients Severe apnea in 13 patients GA < 32 weeks Not described Not described Not described GA 27-34 weeks Not described 1 patient Overdose of pentobarbital GA 27-35 weeks 6.3 ± 1.7 min (range 5-12 min) 35 patients Not described BW < 1500 grams Not described Not described Not described GA < 32 weeks Not described 13 patients Apnea in 4 patients GA < 34 weeks Not described Not described Not described GA 28-32 weeks Not described Not described Not described GA 25-35 weeks Not described 15 patients Apnea in 10 patients GA < 30 weeks Not described 4 patients Apnea in 2 patients GA 29-32 weeks Start CPAP at 10.9 min (1-30 min) and extubation at 42.4 min (1-330 min) Not described Not described GA 29-32 weeks Start CPAP at 25 min (2- 120 min) 1 patient Inadequate respiratory drive DISCUSSION Although the need for premedication before neonatal intubation is well recognized, there is no consensus on the most effective sedative to eliminate pain, discomfort, and physiological instability and to provide conditions for a rapid and safe intubation without adverse effects. Moreover, duration of action must be as short as possible to allow for a sufficient breathing pattern within several minutes after surfactant administration, so that extubation can be performed as quickly as possible (see Figure 1). This review found that only two pharmacological studies evaluated the effect of premedication for the INSURE procedure, that is, remifentanil and propofol.