Table 4.
Proposed doses for possible sedatives and anesthetics for premedication before laryngoscopy.
| Molecule | Class | Onset delay | Duration of action | Procedures | Doses according to corrected gestational age | ||
|---|---|---|---|---|---|---|---|
| <28 weeks | 28–32 weeks | >32 weeks | |||||
| Ketamine | Sedative/anesthetic | IV 1–5 min | IV = 10–20 min | Intubation | 1–2 mg/kg IV 2–4 mg/kg IN | 2–3 mg/kg IV 2– 4 mg/kg IN | 3–5 mg/kg IV 2– 4 mg/kg IN |
| LISA/MIST | Titration by increments of 0.5 mg/kg Maximum dose 1 mg/kg | Titration by increments of 0.5 mg/kg Maximum dose 1.5 mg/kg | Titration by increments of 0.5 mg/kg Maximum dose 2 mg/kg | ||||
| Laryngeal maska | N/A | 2–3 mg/kg IV | 3–5 mg/kg IV | ||||
| Propofol | Anesthetic | 1 min | T½: 13 min | Intubation | Titration by increments of 1 mg/kg Maximum dose 2 mg/kg | Titration with 1st dose 2 mg/kg If reinjection: 1 mg/kg Maximum dose 4 mg/kg | Titration with 1st dose 2 mg/kg If reinjection: 1 mg/kg Maximum dose 5 mg/kg |
| LISA/MIST | Titration by increments of 0.5–1 mg/kg Maximum dose 2 mg/kg | Titration by increments of 0.5–1 mg/kg Maximum dose 2 mg/kg | Titration by increments of 1 mg/kg Maximum dose 2 mg/kg | ||||
| Laryngeal maska | N/A | Titration with 1st dose 2 mg/kg If reinjection: 1 mg/kg Maximum dose 4 mg/kg | Titration with 1st dose 2 mg/kg If reinjection: 1 mg/kg Maximum dose 5 mg/kg | ||||
| Midazolam | Benzodiazepine/hypnotic | 1–2 min (if IN: 5 min) | T½: 6.3 h | Intubation | IV route not recommended 100–200 µg/kg IN | 50 µg/kg IV 100–200 µg/kg IN | 50–200 µg/kg IV 100–200 µg/kg IN |
| LISA/MIST | ? | ? | ? | ||||
| Laryngeal maska | N/A | 50 µg/kg | 50–200 µg/kg |
LISA, less invasive surfactant administration; MIST, minimally invasive surfactant treatment; N/A, not applicable; IV, intravenous; IN, intranasal; T½, half-life.
a
In the absence of published data on premedication for laryngeal mask placement in neonates, these proposals are extrapolations of those made for tracheal intubation.