Clinical Pharmacokinetics in Newborns and Infants Age-related Differences and Therapeutic Implications

Morselli, P. L.; Franco-Morselli, Rosetta; Bossi, Laura

doi:10.2165/00003088-198005060-00001

Cited by 330 publications

(139 citation statements)

References 45 publications

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“…O fluxo sangüíneo hepático é menor no neonato e na criança abaixo de 3 meses e os mecanismos metabólicos, imaturos. Aliado a essas característi-cas está o fato de que nestas crianças as concentrações da albumina e µ 1 glicoproteína ácida são baixas, contribuindo para o aumento da concentração do anestésico local em sua forma livre e aumentando a possibilidade de efeitos tó-xicos 12,[19][20][21] . O grande volume de distribuição no estado de equilíbrio pode conferir proteção clínica por diminuir a concentração plasmática dos anestésicos locais e de outras drogas 19,21,22 .…”

Section: Anestésicos Locaisunclassified

“…Liver blood flow is lower in neonates and children under 3 months of age and metabolic mechanisms are immature. In addition, albumin and a 1 acid glycoprotein concentrations are low, contributing to the increased concentration of free local anesthetics and increasing the odds for toxic effects 12,[19][20][21] . The large balanced distribution volume may give clinical protection by decreasing local anesthetics and other drugs plasma concentration 12,21,22 .…”

Section: Local Anestheticsmentioning

confidence: 99%

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Anestesia subaracnóidea em crianças

Módolo¹,

Castiglia²

2001

Rev. Bras. Anestesiol.

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RESUMO minutos e também pela analgesia não abranger o p ó s -o p e r a t ó r i o . A s c o m p l i c a ç õ e s s ã o a s me s m a s encontradas no paciente adulto, incluindo cefaléia por punção dural e irritação radicular transitória. As indicações são várias: cirurgias de abdômen inferior, genitália, membros inferiores, região perineal e, em alguns casos, até em cirurgias torácicas. Seu emprego tem particular interesse nos recém-nascidos prematuros, pelo risco de apresentarem a apnéia da prematuridade.Conclusões -A anestesia subaracnóidea em crianças é técnica relativamente segura, com poucas complicações e pode ser considerada como opção para anestesia geral, principalmente nos recém-nascidos prematuros com risco de apresentarem complicações respiratórias no pós-operatório. U N I T E R M O S -A N E S T E S I A , P e d i á t r i c a ; T É C N I C A S ANESTÉSICAS, Regional: subaracnóidea SUMMARY

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Section: Anestésicos Locaisunclassified

Section: Local Anestheticsmentioning

confidence: 99%

Anestesia subaracnóidea em crianças

Módolo¹,

Castiglia²

2001

Rev. Bras. Anestesiol.

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“…Crucial studies to determine morphine blood and tissue levels in these developmental models are required to determine whether age-specific manifestations of opioid-induced hypersensitivity are due to altered 1) pharmacokinetics and dynamics of opioids, 2) opioid tissue distribution and 3) opioid clearance at different stages of development. Certainly in human infants altered pharmacokinetics and dynamics have been reported as compared to older patients (Morselli et al, 1980) ((Koehntop et al, 1986, Lynn et al, 2000.…”

Section: Opioid-induced Allodyniamentioning

confidence: 99%

Tolerance, opioid-induced allodynia and withdrawal associated allodynia in infant and young rats

Zissen,

Zhang,

McKelvy

et al. 2007

Neuroscience

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Our laboratory has previously characterized age-dependent changes in nociception upon acute morphine withdrawal. This study characterizes changes in mechanical and thermal nociception following acute, intermittent, or continuous morphine administration in infant (postnatal day 5-8) and young (postnatal day 19-21). Morphine was given as a single acute administration (AM), intermittently twice a day for 3 days (IM), or continuously for 72 hours via a subcutaneous pump implanted (CM). AM did not produce long-term changes in mechanical or thermal nociception in either infant or young rats. CM produced changes in mechanical nociception that included the development of tolerance, opioid-induced mechanical allodynia and withdrawal-associated mechanical allodynia in young rats, but only tolerance and a prolonged withdrawal-associated mechanical allodynia in infant rats. IM produced withdrawal-associated mechanical allodynia in both infant and young rats. Measuring paw withdrawal responses to thermal stimuli, infant and young rats showed tolerance without opioid-induced thermal hyperalgesia or withdrawal-associated thermal hyperalgesia following CM. In contrast to CM, withdrawal-associated thermal hyperalgesia was seen in both ages following IM. In conclusion, CM versus IM differentially modified mechanical and thermal nociception, suggesting that opioid-dependent thermal hyperalgesia and mechanical allodynia can be dissociated from each other in infant and young rats. Furthermore, tolerance, opioidinduced hypersensitivity, and withdrawal-associated hypersensitivity are age-specific and may be mediated by distinct mechanisms.Keywords morphine withdrawal; spinal cord; allodynia; hyperalgesia; neonatal rat It has long been recognized that morphine exerts two paradoxical actions on the adult nervous system: the inhibition of pain processing manifested as analgesia and the facilitation of nociceptive sensitivity manifested as allodynia and hyperalgesia (Bederson et al., 1990, Kim et al., 1990, Kaplan and Fields, 1991. This facilitation of nociceptive sensitivity can be observed in as little as 20 min post-morphine administration by precipitating withdrawal with Corresponding Author: Sarah M. Sweitzer, PhD, Department of Pharmacology, Physiology, Neuroscience, University of South Carolina School of Medicine, Columbia, SC 29208, Phone: (803) Fax: (803) 733-1523 Email: sweitzer@med.sc.edu. Section Editor: Dr. Donna Hammond Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptNeuroscience. Author manuscript; available in PMC 2008 January 5. (Bede...

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“…If a drug is administered in the upper part of rectum, it will be subject to the hepatic first pass effect whereas drugs in the lower part of the rectum will bypass the liver via the inferior vena cava. On average, about 50% of rectal acetaminophen will bypass the liver [8]. Because of reduced efficacy due to poor absorption and the risk of cumulative toxicity due to high or frequent doses, even American Academy of Paediatrics (AAP) has recommended that suppository be used only for oral intolerance cases like as vomiting [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…On average, about 50% of rectal acetaminophen will bypass the liver [8]. Because of reduced efficacy due to poor absorption and the risk of cumulative toxicity due to high or frequent doses, even American Academy of Paediatrics (AAP) has recommended that suppository be used only for oral intolerance cases like as vomiting [7][8][9]. In a meta-analysis, published by Goldstein et al [10] in 2008, it was found that there was no difference in oral and rectal acetaminophen antipyretic effects [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Acetaminophen in Children: Which Dosage, Which Route?

Hashemian¹

2017

J Infect Dis Med

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Fever is one of the most common symptoms among children, which worries parents and makes them go to physicians or emergency centers. One way to control the fever is to administer acetaminophen. Limited studies have been done on the dosage and route of administration of acetaminophen in children. This paper is a review of the correct use of acetaminophen in children based on existing randomized clinical trial studies and with emphasis on dosage and route of administration.

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Clinical Pharmacokinetics in Newborns and Infants Age-related Differences and Therapeutic Implications

Cited by 330 publications

References 45 publications

Anestesia subaracnóidea em crianças

Anestesia subaracnóidea em crianças

Tolerance, opioid-induced allodynia and withdrawal associated allodynia in infant and young rats

Acetaminophen in Children: Which Dosage, Which Route?

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