• K Choong, K AlFaleh, J Doucette, S Gray, B Rich, L Verhey, and B Paes.
• Division of Critical Care, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. choongk@mcmaster.ca
• Arch. Dis. Child. Fetal Neonatal Ed. 2010 Mar 1; 95 (2): F80-4.

ObjectiveTo evaluate the efficacy and safety of remifentanil as a premedication in neonates undergoing elective endotracheal intubation.DesignA double-blind randomised controlled trial.SettingTertiary care neonatal intensive care unit.PatientsHaemodynamically stable term and preterm neonates requiring elective endotracheal intubation.InterventionsInfants in the intervention arm received remifentanil (3 microg/kg) and normal saline placebo. The control group received fentanyl (2 microg/kg) and succinylcholine (2 mg/kg). Both groups also received atropine (20 microg/kg) as part of the premedication regime.Main Outcome MeasuresThe primary outcome was time to successful intubation. Secondary outcomes included time to return of spontaneous respirations, oxygen saturation, heart rate and blood pressure changes during the procedure, adverse events and a survey of intubation conditions.ResultsA total of 15 infants were randomised to each group. Baseline characteristics were similar in both groups. The median time to successful intubation was not statistically different (247 s in the remifentanil group vs 156 s in the fentanyl group, p=0.88). The intubation conditions were rated more favourably with fentanyl by the intubators. Although not statistically significant, chest wall rigidity was observed more commonly with remifentanil.ConclusionsAlthough remifentanil is comparable to fentanyl and succinylcholine in attenuating adverse physiologic responses during neonatal intubation, muscle rigidity is a concern at doses of 3 microg/kg. Further trials are required to evaluate ideal dosing regimens and combinations of agents for use with remifentanil in neonates.

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