The oxygenation of neonates with PPHN is labile, and these infants are hemodynamically unstable. They react to procedures poorly. Intubation is one of the most stressful procedures these neonates have to undergo. Although thiopental has been used for induction of anesthesia in the operating room, its use in the NICU setting is rare. The hemodynamic response to intubation in neonates with PPHN after the administration of thiopental was examined.

Methods: Seventeen orotracheally intubated neonates with severe PPHN were transferred to our NICU for ECMO. All neonates were continuously monitored with EKG, pulse oximetry and blood pressures from indwelling arterial lines. Thiopental 6mg/kg i.v. bolus was given prior to reintubation with a nasotracheal tube. After loss of eyelid reflex, the intubation was carried out by personnel experienced with the procedure. Heart rates and blood pressures were serially recorded (every minute) from five minutes before till 10 minutes after intubation.

Results: Mean heart rate prior to intubation (149.9± 15.6) was not significantly different from post intubation heart rate(156.2 ± 12.8) with p = 0.095. There was no significant change (p = 0.165) in the pre and post intubation mean arterial blood pressures, the values being 47.9 ± 5.5 and 45.9 ± 8.2 respectively.

Conclusion: In infants with PPHN there is no significant hemodynamic response to nasal intubation when pre-treated with thiopental.