Halothane–Morphine Compared with High-Dose Sufentanil for Anesthesia and Postoperative Analgesia in Neonatal Cardiac Surgery

Anand, K.J.S.; Hickey, Paul R.

doi:10.1056/nejm199201023260101

Cited by 774 publications

(154 citation statements)

References 35 publications

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“…Morphine seems to downregulate specific stress-related changes in gene expression that protect the cell against apoptosis [13]. In older human infants, the beneficial effect of anesthesia for surgery was established decades ago [21]. There is, however, no human clinical evidence of long-term beneficial effects of morphine administered for daily neonatal care.…”

Section: Discussionmentioning

confidence: 99%

Effects of Repetitive Exposure to Pain and Morphine Treatment on the Neonatal Rat Brain

Dührsen¹,

Simons

Dzietko³

et al. 2012

Neonatology

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Background: Untreated exposure to pain in preterm neonates might damage the vulnerable premature brain and alter development. Pain treatment is limited because analgesic agents may also have adverse neurodevelopmental consequences in newborns. Objective: To study the effects of neonatal pain and morphine treatment on the developing brain in a neonatal rat model. Methods: Newborn rats were randomly assigned to: treatment with formalin injections (group 1), saline injections (group 2) and controls receiving no injections (group 3). Treatment was given on postnatal days 1–3 (model A), 1–5 (model B) and 10–12 (model C). Brains were studied histologically and protein expression was evaluated (protein kinase C epsilon and doublecortin). Effects of preemptive morphine treatment were studied in the same models (models A+M and B+M). Results: Formalin injections resulted in increased apoptotic scores in models A and B. Saline injections increased the number of degenerative cells only in model B. Morphine showed protective effects in formalin-treated animals of model A+M and saline-treated animals of model B+M only. In model C, no neurodegenerative effects were detected. The protein expression of doublecortin showed a pain-related upregulation in the thalamus region, whereas protein kinase C epsilon expression was upregulated in the cortex. Conclusions: Severe inflammatory pain and pain caused by repetitive injections in neonatal rats may cause major changes in the developing brain during the first week of life. Morphine may only protect the newborn brain against these changes in specific situations.

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Section: Discussionmentioning

confidence: 99%

Effects of Repetitive Exposure to Pain and Morphine Treatment on the Neonatal Rat Brain

Dührsen¹,

Simons

Dzietko³

et al. 2012

Neonatology

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“…Fetuses and newborn babies cannot understand language and perceive danger, but their nociception pathways are fully functional so that they require analgesia as well as anesthesia for surgical safety [234, [505][506][507][508][509][510].…”

Section: The Spinal Pathwaymentioning

confidence: 99%

“…Combinations of analgesia that inhibits the spinal pathway, anesthesia that inhibits the cognitive pathway, and treatments that inhibit the tissue pathway can mitigate positive feedback reduce the risk of malignancy, and induce apoptosis to cure malignancy [505][506][507]606,607].…”

Section: Inflammation Apoptosis and Malignancymentioning

confidence: 99%

Stress repair mechanism activity explains inflammation and apoptosis

Coleman¹

2012

ABB

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“…Intraoperative Schmerzfreiheit ist aber eine "conditio sine qua non" in der Kinderanästhesie: Intraoperativer Stress durch flache Narkose und Schmerzen während und nach der Operation haben einen negativen Einfluss auf den intraund postoperativen Verlauf und das Outcome der Kinder [4,5,6]. Die analgetischen Eigenschaften von Lachgas reichen für eine suffiziente Analgesie während schmerzhafter Operationen aber nicht aus [5].…”

Section: Kombination Mit Analgetikaunclassified

Total intraven�se An�sthesie

Strauß

Giest

2003

Der Anaesthesist

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Since venous cannulation in children has become easier and extensive experience has been gained with total intravenous anaesthesia (TIVA) in adults, the interest in TIVA for children has recently increased. An intensified sensitivity of the operating room atmosphere to contamination with volatile anaesthetic agents is another important reason to choose intravenous techniques for paediatric anaesthesia. One of the most interesting agents for TIVA in paediatric anaesthesia is propofol. The pharmacokinetic and pharmacodynamic data for modern intravenous drugs is poor. Because the interpatient variability is relatively large, pharmacokinetic data can only provide guidelines for the dosage of propofol. Propofol has a rapid and smooth onset of action and is as easy to titrate in children as in adults. Propofol can be excellently controlled. Severe haemodynamic side-effects are missing in healthy children and plasma is cleared rapidly of propofol by redistribution and metabolism. There is no evidence of significant accumulation, not even after prolonged infusion times. Because propofol has no analgetic properties it must be combined with analgetics or a regional block for all painful procedures. The combination with the ultra-short acting remifentanil is a major advantage, but requires effective analgetic concepts for painful procedures. In comparison the combination of propofol with long acting opioids abolishes some of the favourable properties of propofol. Further studies of the kinetics and dynamics of propofol and other intravenous agents are needed in paediatrics which should focus on age, maturity and severity of illness. The whole importance of the propofol-infusion syndrome has to be cleared up urgently. TIVA has an important significance in paediatric anaesthesia for diagnostic and therapeutic procedures, especially where these have to be repeated. In day-case anaesthesia TIVA has advantages for all short procedures and for ENT and ophthalmic surgery: even after prolonged infusion children have an short recovery time. There is no evidence of agitation or other behavioural disorders after TIVA with propofol in paediatric anaesthesia. Propofol has anti-emetic properties. TIVA with propofol can be combined with regional anaesthesia advantageously to provide long-lasting analgesia after surgery. TIVA with propofol has been used successfully for sedation of spontaneously breathing children for MRI and CT and other procedures with open airways like bronchoscopy or endoscopy. Propofol facilitates endotracheal intubation without the use of muscle relaxants. Of course, in malignant hyperthermia TIVA will continue to be the technique of choice. Nothing is known about awareness under TIVA in paediatric patients. TIVA must be considered by comparison with the volatile agents. The use of ultra-short acting agents may cause problems such as awareness, vagal response, involuntary movements and in some cases slow recovery after prolonged infusion of propofol. But it is not known exactly how often this happens during paediatri...

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Halothane–Morphine Compared with High-Dose Sufentanil for Anesthesia and Postoperative Analgesia in Neonatal Cardiac Surgery

Cited by 774 publications

References 35 publications

Effects of Repetitive Exposure to Pain and Morphine Treatment on the Neonatal Rat Brain

Effects of Repetitive Exposure to Pain and Morphine Treatment on the Neonatal Rat Brain

Stress repair mechanism activity explains inflammation and apoptosis

Total intraven�se An�sthesie

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