Abstract
Objective
To assess the use of midazolam and morphine as premedication for elective intubation in neonates, and to compare the intubation conditions with these combination versus awake intubation.
Methods
A non blind randomized prospective study was conducted at Prince Hashim Hospital between November 2009 and December 2010. Forty premature neonates in intensive care unit requiring nonemergency intubation were assigned to receive 0.1 mg /kg IV morphine followed by 0.1 mg/kg IV midazolam two minutes before intubation (study group) or awake intubation (control group). Number of attempts, duration of procedure, heart rate and blood pressure were monitored.

Results
Out of 40 intubations, 20 were enrolled in each group; there were no significant demographic differences between the groups. Successful intubation on first attempt was achieved in 16 premature (80 %) in study group versus 8 (40%) of controls. After10 minutes post intubation, median increase of mean blood pressure in study group were -5.9, versus 0.15 in control group. Mean time for intubation in study group was significantly less; 38.05 versus 123.05 seconds in control group. Incidence of bradycardia was 50% in control group and 60% in study group. 70% of study group had hypoxemia after one minute versus 55% of control group; 45% of study group had severe hypoxia versus 30% of control group.
Conclusion
Morphine and midazolam decreased time and number of attempt needed for intubation, however, neonates should have cardiorespiratory, oxygen saturation, and blood pressure monitoring during intubation. (Rawal Med J 2012;37:42-45).

Key words: Premedication, elective endotracheal intubation, awake intubation