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Narcotic sedation stabilizes arterial blood pressure fluctuations in sick premature infants
1Department of Pediatrics, Duke University Medical Center, Durham, NC 27710.
Insights
Narcotic sedation effectively reduces blood pressure (BP) fluctuations in premature infants with respiratory distress syndrome (RDS). This offers a potential alternative to muscle paralysis for stabilizing BP in vulnerable newborns.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Pharmacology
Background:
- Blood pressure (BP) fluctuations in infants with respiratory distress syndrome (RDS) are linked to spontaneous respirations and intraventricular hemorrhage.
- Mechanical ventilation and muscle paralysis can stabilize BP fluctuations in these infants.
Purpose of the Study:
- To investigate the efficacy of narcotic sedation in decreasing BP fluctuations in premature infants with RDS.
- To compare the effects of narcotic sedation with muscle paralysis on BP stability.
Main Methods:
- Twenty premature infants received pancuronium (muscle paralysis), morphine, or fentanyl (narcotic sedation).
- Blood pressure and respiratory tracings were analyzed pre- and post-medication.
- Systolic BP (SBP) fluctuations were quantified using the coefficient of variation (CV); spontaneous respirations (SResp) were also measured.
Main Results:
- All three drugs significantly reduced BP fluctuations (CV) and spontaneous respirations (SResp).
- Pancuronium increased peak inspiratory pressure and ventilator rate.
- A strong association was observed between decreased CV and SResp in sedated infants.
Conclusions:
- Narcotic sedation is effective in stabilizing BP fluctuations in premature infants with RDS.
- Narcotic sedation presents potential advantages over muscle paralysis for managing BP instability in this population.
Abstract:
Blood pressure (BP) fluctuations in infants with respiratory distress syndrome (RDS) are related to spontaneous respirations and have been associated with an increased incidence of intraventricular hemorrhage. Both initiation of mechanical ventilation in the nonventilated infant and muscle paralysis in the ventilated infant can help stabilize these fluctuations. We hypothesized that narcotic sedation would also be effective in decreasing BP fluctuations when pharmacologic intervention is deemed necessary. Twenty premature infants were paralyzed with pancuronium or sedated with morphine or fentanyl for clinical indications. Blood pressure and respiratory tracings before and after medication were analyzed for average peak systolic BP (SBP) and the percentage of spontaneous respirations (SResp). Fluctuations of SBP were quantitated using the coefficient of variation (CV). A marked reduction was found in both CV and SResp following administration of all three drugs. Peak inspiratory pressure and ventilator rate were increased in the pancuronium group. In 7 out of 14 patients in whom spontaneous respirations persisted following sedation, there was a strong association between the percentage of decrease in CV and SResp. Advantages of narcotic sedation over muscle paralysis are discussed.