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Sedation management during therapeutic hypothermia for neonatal encephalopathy: Atropine premedication for endotracheal intubation causes a prolonged increase in heart rate

Hannah Gill, Marianne Thoresen, Elisa Smit, Jonathan Davis, Xun Liu, John Dingley, Maja Elstad

Resuscitation, Volume: 85, Issue: 10, Pages: 1394 - 1398

Swansea University Author: John Dingley

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DOI (Published version): 10.1016/j.resuscitation.2014.07.002

Abstract

AIM:Heart rate (HR) plays an important role in the assessment of stress during therapeutic hypothermia (TH) for neonatal encephalopathy; we aimed to quantify the effect on HR of endotracheal (ET) intubation and drugs given to facilitate it. If atropine premedication independently increased HR, the m...

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Published in: Resuscitation
ISSN: 03009572
Published: 2014
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URI: https://cronfa.swan.ac.uk/Record/cronfa27456
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2018-06-29T19:46:45.8537584</datestamp><bib-version>v2</bib-version><id>27456</id><entry>2016-04-26</entry><title>Sedation management during therapeutic hypothermia for neonatal encephalopathy: Atropine premedication for endotracheal intubation causes a prolonged increase in heart rate</title><swanseaauthors><author><sid>1283ffdd09b091ec57ec3e235a48cfcc</sid><firstname>John</firstname><surname>Dingley</surname><name>John Dingley</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2016-04-26</date><deptcode>PMSC</deptcode><abstract>AIM:Heart rate (HR) plays an important role in the assessment of stress during therapeutic hypothermia (TH) for neonatal encephalopathy; we aimed to quantify the effect on HR of endotracheal (ET) intubation and drugs given to facilitate it. If atropine premedication independently increased HR, the main indicator of effective sedation, we hypothesised that increased sedation would have been given.METHODS:Thirty-two, term, neonates recruited into a randomised pilot study comparing TH and TH combined with 50% Xenon inhalation were studied. Indications for ET intubation included: resuscitation at delivery, clinical need and elective re-intubation with a cuffed ET tube if randomised to Xenon. Standard intubation drugs comprised one or more of intravenous morphine, atropine, and suxamethonium. Local cooling guidelines were followed including morphine infusion for sedation.RESULTS:At postnatal hours five to eight atropine increased HR in a linear regression model (p&amp;#60;0.01). All other independent variables were excluded. Where more than one dose of atropine was given total morphine sedation given up to 8h into the treatment period was significantly higher (p&amp;#60;0.01).CONCLUSION:We have shown that atropine premedication for ET intubation significantly increased HR, the main indicator of effective sedation and total morphine dose for sedation during early TH was increased where more than one dose of atropine was given. Bradycardia was not reported in any neonate, even without atropine premedication. We suggest that the use of atropine as part of standard premedication for ET intubation of term neonates undergoing TH should be reconsidered.</abstract><type>Journal Article</type><journal>Resuscitation</journal><volume>85</volume><journalNumber>10</journalNumber><paginationStart>1394</paginationStart><paginationEnd>1398</paginationEnd><publisher/><issnPrint>03009572</issnPrint><keywords>Birth asphyxia; Induced hypothermia; Neonatal airway management; Neonatal resuscitation; Newborn</keywords><publishedDay>31</publishedDay><publishedMonth>12</publishedMonth><publishedYear>2014</publishedYear><publishedDate>2014-12-31</publishedDate><doi>10.1016/j.resuscitation.2014.07.002</doi><url/><notes/><college>COLLEGE NANME</college><department>Medicine</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>PMSC</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2018-06-29T19:46:45.8537584</lastEdited><Created>2016-04-26T22:30:50.0321807</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Hannah</firstname><surname>Gill</surname><order>1</order></author><author><firstname>Marianne</firstname><surname>Thoresen</surname><order>2</order></author><author><firstname>Elisa</firstname><surname>Smit</surname><order>3</order></author><author><firstname>Jonathan</firstname><surname>Davis</surname><order>4</order></author><author><firstname>Xun</firstname><surname>Liu</surname><order>5</order></author><author><firstname>John</firstname><surname>Dingley</surname><order>6</order></author><author><firstname>Maja</firstname><surname>Elstad</surname><order>7</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling 2018-06-29T19:46:45.8537584 v2 27456 2016-04-26 Sedation management during therapeutic hypothermia for neonatal encephalopathy: Atropine premedication for endotracheal intubation causes a prolonged increase in heart rate 1283ffdd09b091ec57ec3e235a48cfcc John Dingley John Dingley true false 2016-04-26 PMSC AIM:Heart rate (HR) plays an important role in the assessment of stress during therapeutic hypothermia (TH) for neonatal encephalopathy; we aimed to quantify the effect on HR of endotracheal (ET) intubation and drugs given to facilitate it. If atropine premedication independently increased HR, the main indicator of effective sedation, we hypothesised that increased sedation would have been given.METHODS:Thirty-two, term, neonates recruited into a randomised pilot study comparing TH and TH combined with 50% Xenon inhalation were studied. Indications for ET intubation included: resuscitation at delivery, clinical need and elective re-intubation with a cuffed ET tube if randomised to Xenon. Standard intubation drugs comprised one or more of intravenous morphine, atropine, and suxamethonium. Local cooling guidelines were followed including morphine infusion for sedation.RESULTS:At postnatal hours five to eight atropine increased HR in a linear regression model (p&#60;0.01). All other independent variables were excluded. Where more than one dose of atropine was given total morphine sedation given up to 8h into the treatment period was significantly higher (p&#60;0.01).CONCLUSION:We have shown that atropine premedication for ET intubation significantly increased HR, the main indicator of effective sedation and total morphine dose for sedation during early TH was increased where more than one dose of atropine was given. Bradycardia was not reported in any neonate, even without atropine premedication. We suggest that the use of atropine as part of standard premedication for ET intubation of term neonates undergoing TH should be reconsidered. Journal Article Resuscitation 85 10 1394 1398 03009572 Birth asphyxia; Induced hypothermia; Neonatal airway management; Neonatal resuscitation; Newborn 31 12 2014 2014-12-31 10.1016/j.resuscitation.2014.07.002 COLLEGE NANME Medicine COLLEGE CODE PMSC Swansea University 2018-06-29T19:46:45.8537584 2016-04-26T22:30:50.0321807 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Hannah Gill 1 Marianne Thoresen 2 Elisa Smit 3 Jonathan Davis 4 Xun Liu 5 John Dingley 6 Maja Elstad 7
title Sedation management during therapeutic hypothermia for neonatal encephalopathy: Atropine premedication for endotracheal intubation causes a prolonged increase in heart rate
spellingShingle Sedation management during therapeutic hypothermia for neonatal encephalopathy: Atropine premedication for endotracheal intubation causes a prolonged increase in heart rate
John Dingley
title_short Sedation management during therapeutic hypothermia for neonatal encephalopathy: Atropine premedication for endotracheal intubation causes a prolonged increase in heart rate
title_full Sedation management during therapeutic hypothermia for neonatal encephalopathy: Atropine premedication for endotracheal intubation causes a prolonged increase in heart rate
title_fullStr Sedation management during therapeutic hypothermia for neonatal encephalopathy: Atropine premedication for endotracheal intubation causes a prolonged increase in heart rate
title_full_unstemmed Sedation management during therapeutic hypothermia for neonatal encephalopathy: Atropine premedication for endotracheal intubation causes a prolonged increase in heart rate
title_sort Sedation management during therapeutic hypothermia for neonatal encephalopathy: Atropine premedication for endotracheal intubation causes a prolonged increase in heart rate
author_id_str_mv 1283ffdd09b091ec57ec3e235a48cfcc
author_id_fullname_str_mv 1283ffdd09b091ec57ec3e235a48cfcc_***_John Dingley
author John Dingley
author2 Hannah Gill
Marianne Thoresen
Elisa Smit
Jonathan Davis
Xun Liu
John Dingley
Maja Elstad
format Journal article
container_title Resuscitation
container_volume 85
container_issue 10
container_start_page 1394
publishDate 2014
institution Swansea University
issn 03009572
doi_str_mv 10.1016/j.resuscitation.2014.07.002
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 0
active_str 0
description AIM:Heart rate (HR) plays an important role in the assessment of stress during therapeutic hypothermia (TH) for neonatal encephalopathy; we aimed to quantify the effect on HR of endotracheal (ET) intubation and drugs given to facilitate it. If atropine premedication independently increased HR, the main indicator of effective sedation, we hypothesised that increased sedation would have been given.METHODS:Thirty-two, term, neonates recruited into a randomised pilot study comparing TH and TH combined with 50% Xenon inhalation were studied. Indications for ET intubation included: resuscitation at delivery, clinical need and elective re-intubation with a cuffed ET tube if randomised to Xenon. Standard intubation drugs comprised one or more of intravenous morphine, atropine, and suxamethonium. Local cooling guidelines were followed including morphine infusion for sedation.RESULTS:At postnatal hours five to eight atropine increased HR in a linear regression model (p&#60;0.01). All other independent variables were excluded. Where more than one dose of atropine was given total morphine sedation given up to 8h into the treatment period was significantly higher (p&#60;0.01).CONCLUSION:We have shown that atropine premedication for ET intubation significantly increased HR, the main indicator of effective sedation and total morphine dose for sedation during early TH was increased where more than one dose of atropine was given. Bradycardia was not reported in any neonate, even without atropine premedication. We suggest that the use of atropine as part of standard premedication for ET intubation of term neonates undergoing TH should be reconsidered.
published_date 2014-12-31T03:33:17Z
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score 11.012678

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