Sir.—Newborns admitted to the neonatal intensive care unit (NICU) frequently require laryngoscopy and endotracheal intubation. These procedures may be associated with detrimental physiologic alterations, including bradycardia, hypoxemia, systemic hypertension, and increased intracranial pressure (ICP).1,2 In addition, they are uncomfortable and at times painful procedures with the potential for traumatic injury to the upper airway.
It is standard practice in pediatric and adult intensive care units to premedicate patients undergoing non-emergency endotracheal intubation. Various medications are used, including atropine sulfate combined with a sedative and, sometimes, a muscle relaxant. The use of these medications provides more favorable conditions for intubation and ensures patient comfort. Studies of neonates have shown that some of the adverse physiologic consequences of laryngoscopy and intubation can be attenuated with the use of these agents.2-4
In our NICU, we routinely use atropine and a sedative, which is usually a short-acting barbiturate or a narcotic,