Intubation in the delivery room: Experience with nasal midazolam

Background: Neonates are often intubated in the delivery room (DR) without anesthesia because vascular access is impossible. Aims: To assess neonatal comfort and adverse events after use of nasal midazolam (nMDZ) for intubation in the DR. Study design: Prospective data collection over 6 months on the intubation of neonates with respiratory distress requiring tracheal instillation of surfactant. Subjects: Twenty-seven neonates with median (Q25-75) gestational age and birthweight of, respectively, 29 (27-33) weeks and 1270 (817-1942) g received a 0.1 mg/kg dose of nMDZ, and intubation was performed at the onset of tonus resolution or apnea. Outcome measures: Comfort was assessed with a scale of hetero-pain assessment and electrical skin conductance monitoring. Continuous pulse oximetry was recorded in the first postnatal hour, with oscillometric blood pressure measurement every 10 min. Results: Seventy percent of the patients required a single dose, with intubation performed 4.8 (3-9) mm after administration. Combined electro-clinical assessment found adequate comfort during the procedure in 68% of neonates. Mean blood pressure decreased from 39 (34-44) mm Hg before to 31(25-33) mm Hg 1 h following nMDZ (p = 0.011). Conclusion: nMDZ provided rapid and effective sedation to intubate neonates in the DR but potentially exposed them to hypotension, thus requiring close hemodynamic monitoring. (C) 2013 Elsevier Ireland Ltd. All rights reserved.