Sedation for nonemergent neonatal intubation

A newborn lies wide-awake, about to be intubated. The infant is able to feel everything, to hear everything--but cannot do anything to change the situation. Big people hold down the newborn and place a laryngoscope blade into the mouth, then a large endotracheal tube into the trachea. As the baby struggles, coughs, chokes, gags, and cries, blood pressure and intracranial pressure increase dramatically, and the heart rate plummets. Infants, like adults, do feel pain and anxiety. Yet recent studies show that NICU staff continue neonatal intubation utilizing only force. In pediatric emergency/critical care settings, rapid-sequence intubation (RSJ), once confined to the environment of the operating room, is now the standard of care. An understanding of commonly administered PSI medications is essential to bring this practice to standard use in the NICU as well. In the pediatric and adult critical care population, rapid-sequence intubation (RSI)--the use of sedatives and chemical paralytics to facilitate tracheal intubation--is considered the standard of care. Use of these medications optimizes intubating conditions and helps to minimize the adverse physiologic effects of intubation. Neonatology has yet to embrace this trend, however. This article addresses the issue of sedation for intubation in the neonatal population.