Randomised controlled trial of thiopental for intubation in neonates

Aims-To determine the effects of premedication with thiopental on heart rat e, blood pressure, and oxygen saturation during semi-elective nasotracheal intubation in neonates. Methods-A randomised, placebo controlled, non-blinded study design was used to study 30 neonates (mean birthweight 3.27 kg) requiring semi-elective na sotracheal intubation. The babies were randomly allocated to receive either 6 mg/kg of thiopental (study group) or an equivalent volume of physiologic al saline (control group) one minute before the start of the procedure. Six infants were intubated primarily and 24 were changed from orotracheal to a nasotracheal tube. The electrocardiogram, arterial pressure wave, and tran scutaneous oxygen saturation were recorded continuously 10 minutes before, during, and 20 minutes after intubation. Minute by minute measurements of h eart rate, heart rate variability, mean blood pressure (MBP) and transcutan eous oxygen saturation (SpO(2)) were computed. The differences for all of t hese between the baseline measurements and those made during and after intu bation were determined. Differences in the measurements made in the study a nd the control groups were compared using Student's t test. Results-During intubation, heart rate increased to a greater degree (12.0 u s - 0.5 beats per minute, p < 0.03) and A MBP increased to a lesser degree (-2.9 vs 4.4 mm Hg; p < 0.002) in the infants who were premedicated with th iopental. After intubation only the changes in MBP differed significantly b etween the two groups (-3.8 vs 4.6 mm Hg; p < 0.001). There were no signifi cant changes in the oxygen saturation between the two groups during or afte r intubation. The time taken for intubation was significantly shorter in th e study group (p < 0.04). Conclusions The heart rate and blood pressure of infants who are premedicat ed with thiopental are maintained nearer to baseline values than those of s imilar infants who receive no premedication. Whether this lessening of the acute drop in the heart rate and increase in blood pressure typically seen during intubation of unmedicated infants is associated with long term advan tages to the infants remains to be determined.