Ellen de Kort

35 Sedation for the INSURE procedure 2 Therefore, opioid induced respiratory depression antagonized with naloxone can easily return after the effect of naloxone has worn off. All this makes clear that morphine should not be used as premedication in neonatal intubation, especially during the INSURE procedure. Short acting opioids therefore probably are more suitable. Other short acting drugs or combinations of drugs that could theoretically be used as rapid sequence induction for the INSURE procedure, such as midazolam or remifentanil combined with propofol or with thiopental, have not been reported in the literature yet. 49 CONCLUSION In conclusion, propofol and remifentanil both have a very short onset and duration of action and are in theory the most suitable candidates for INSURE procedure premedication. However, only two relatively small studies have evaluated the effects of propofol and remifentanil in this context and insufficient data are available about optimal dosing, effects, and side effects. Therefore, more research including dose-finding studies and randomized controlled trials that compare different drugs are necessary. Morphine should be considered unsuitable because of its delayed onset and prolonged period of action. This literature review revealed too little information to draw a solid conclusion.