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Articles: Corryn S. Greenwood and Christopher E. Colby Pharmacology Review: Premedication for Endotracheal Intubation of the Neonate: What is the Evidence? Neoreviews 2009; 10: e31-e35 [Abstract] [Full text] [PDF]

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Remifentanil for intubating preterm neonates

Yerkes P Silva, Renato Gomez, Juliana Marcatto and Ana Cristina Simőes e Silva   (14 January 2009)

Correct Dosing Of Remifentanil

Chris Colby   (18 January 2009)

Remifentanil for intubating preterm neonates 14 January 2009
Yerkes P Silva, Pediatrician and anesthesiologist Department of Pediatrics of Federal University of Minas Gerais, Renato Gomez, Juliana Marcatto and Ana Cristina Simőes e Silva Send letter to journal: Re: Remifentanil for intubating preterm neonates yerkesps{at}uol.com.br Yerkes P Silva, et al.	Dr.Greenwood and Dr. Colby have provided a thoughtful review of the evidence of premedication for endotracheal intubation of the neonate. However, some points deserve consideration. Regrettably, elective tracheal intubation is still performed many times without premedication. The available evidence definitely supports the use of premedication in this situation. According to a recent review by Carbajal and Anand, “the issue of whether it is necessary to give analgesic or anesthetic drugs before neonatal intubation should now be replaced by a different question: is there a reason not to give analgesic or anesthetic drugs before neonatal intubation?” Furthermore the question must spotlight on “which is the most appropriate drug or drug combination for elective intubation”. The choice of the drug or drug combination must be made on an individual basis and also consider the available knowledge of pharmacokinetics and pharmacodynamics of the drugs. Our group has studied the use of remifentanil for elective tracheal intubation of preterm neonates with respiratory distress syndrome in a double blind randomized controlled study. We showed that the overall intubation conditions were significantly better when we used remifentanil compared to morphine. This study was cited by Dr. Greenwood and Dr. Colby, however there was a mistake regarding the dose of remifentanil used for intubation. Actually, we used 1.0 µcg/Kg which corresponds to 0.001mg/Kg and not 0.01mg/Kg; that maybe occurred due to units’ conversion (µcg/Kg to mg/Kg). In our study we did not observe any severe complication related to this dose such as chest wall rigidity, rash, significant hypotension, bradycardia, arrhythmia or hypoxemia. According to our findings, remifentanil due to its pharmacological characteristics seems to be a good choice for premedication mainly considering the relatively new concept in neonatology intubate-surfactant-extubate. In this context, a hypnotic drug that might be considered to be associated with remifentanil should have the same pharmacological characteristics in order to reach this concept. In this context drugs like propofol could be interesting and should be studied. Conflict of Interest: None declared
Correct Dosing Of Remifentanil 18 January 2009
Chris Colby, neonatologist Mayo Clinic Send letter to journal: Re: Correct Dosing Of Remifentanil colby.christopher{at}mayo.edu Chris Colby	Dear Drs. Silva and Philip, I have reviewed the comments made by Dr. Silva. He is correct in pointing out the error in the review article. His group certainly used a dose of 1 microgram/kg for remifentanil in his published study. The error was made in the conversion to milligrams. I thank him very kindly for correction of this important dose. Conflict of Interest: None declared