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Remifentanil for endotracheal intubation in neonates: a randomised controlled trial
  1. K Choong1,2,
  2. K AlFaleh3,
  3. J Doucette4,
  4. S Gray4,
  5. B Rich4,
  6. L Verhey5,
  7. B Paes2
  1. 1Division of Critical Care, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
  2. 2Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
  3. 3Department of Pediatrics, Division of Neonatology, King Saud University, Riyadh, Saudi Arabia
  4. 4McMaster Children's Hospital, Hamilton, Ontario, Canada
  5. 5The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Karen Choong, Department of Pediatrics and Critical Care, McMaster Children's Hospital, Room 3A78, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5; choongk{at}


Objective To evaluate the efficacy and safety of remifentanil as a premedication in neonates undergoing elective endotracheal intubation.

Design A double-blind randomised controlled trial.

Setting Tertiary care neonatal intensive care unit.

Patients Haemodynamically stable term and preterm neonates requiring elective endotracheal intubation.

Interventions Infants in the intervention arm received remifentanil (3 µg/kg) and normal saline placebo. The control group received fentanyl (2 µg/kg) and succinylcholine (2 mg/kg). Both groups also received atropine (20 µg/kg) as part of the premedication regime.

Main outcome measures The primary outcome was time to successful intubation. Secondary outcomes included time to return of spontaneous respirations, oxygen saturation, heart rate and blood pressure changes during the procedure, adverse events and a survey of intubation conditions.

Results A total of 15 infants were randomised to each group. Baseline characteristics were similar in both groups. The median time to successful intubation was not statistically different (247 s in the remifentanil group vs 156 s in the fentanyl group, p=0.88). The intubation conditions were rated more favourably with fentanyl by the intubators. Although not statistically significant, chest wall rigidity was observed more commonly with remifentanil.

Conclusions Although remifentanil is comparable to fentanyl and succinylcholine in attenuating adverse physiologic responses during neonatal intubation, muscle rigidity is a concern at doses of 3 µg/kg. Further trials are required to evaluate ideal dosing regimens and combinations of agents for use with remifentanil in neonates.

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  • Funding This trial was partially supported by a grant-in-aid of research from Abbott Laboratories. The authors did not receive input from Abbott on this trial with respect to its design, execution, data acquisition and analysis and the manuscript preparation.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Hamilton Health Sciences Research Ethics Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

    Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.