Pharmacocinétique du thiopental chez la femme et le nouveau-né

Monrigal, C.; Premel-Cabic, A; Turcant, Alain; Bourgeonneau, M.C.; Cavellat, M; Allain, Pierre

doi:10.1016/s0750-7658(86)80063-6

Cited by 5 publications

(2 citation statements)

References 16 publications

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“…The elimination pharmacokinetics of thiopental sodium appear to be almost similar in mothers and neonates. [59,60] However, Westrin et al [61] and Jonmarker et al, [62] using an upand-down allocation technique, showed that there were marked differences in ED50 for induction between neonates, infants, and children. The curve representing ED50 versus age was very similar to the curve representing MAC versus age for halogenated agents.…”

Section: Intravenous Agentsmentioning

confidence: 99%

Pharmacokinetic/Pharmacodynamic Modeling of Anesthetics in Children

Mazoit

2006

Pediatric Drugs

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Modeling the pharmacokinetics and pharmacodynamics of anesthetics in children is performed as a response to the clinical need for safe and efficacious administration of drugs with a low therapeutic index. Rates and concentrations of these drugs, which are the primary parameters used by anesthesiologists, depend on physiologic parameters that are markedly affected by development. Volatile anesthetics have been used for >50 years in pediatric patients. The pharmacokinetics of inhalation agents are context sensitive, but little difference between age groups has been described. These agents are not only eliminated unchanged by the lung but they are also metabolized by the liver. Halothane has Michaelis-Menten kinetics, with up to 40% of the administered dose metabolized by the liver. For volatile anesthetics, the effect measured is the minimum alveolar concentration (MAC) that leads to movement of the limb in response to skin incision in 50% of the patients studied. The MAC is higher in infants than in children and adults. Infants aged 6 months have a MAC 1.5-1.8 times the MAC observed in adults aged 40 years. Children have a greater clearance and volume of distribution of propofol than adults. In order to achieve similar plasma concentrations, children require three times the initial dose used in adults. In adults, an increased sensitivity to propofol has been demonstrated with aging, but nothing is known about the effects in children. However, it is clear that equipotent doses of propofol induce marked deleterious hemodynamic effects in infants compared with children. Regional anesthesia is used in pediatrics, both in combination with general anesthesia during surgery or alone for postoperative analgesia. A marked decrease in protein binding has been described in infants. In the postoperative period, a rapid increase in binding because of inflammation decreases the free fraction, but the free drug concentration remains constant because of the resulting decrease in total clearance. A low clearance because of liver function immaturity has been observed during the first year(s) of life for bupivacaine and ropivacaine. Pharmacodynamic interactions between general anesthesia and regional anesthesia need to be modeled. This is one of the future tasks for pharmacokineticists. Methods such as the Dixon up-and-down allocation and the isobolographic technique are promising in this field.

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Section: Intravenous Agentsmentioning

confidence: 99%

Pharmacokinetic/Pharmacodynamic Modeling of Anesthetics in Children

Mazoit

2006

Pediatric Drugs

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“…Pharmacokinetic studies of this agent in patients undergoing caesarean section have shown some conflicting results, partly because of differences in modelling technique and sam piing regimens (table I) [Christensen et al 1981;Monrigal et al 1986;Morgan et al 1981]. Hepatic metabolism of thiopental is capacity limited and the increased clearance during pregnancy may be a result of hormonal enzyme induction.…”

Section: Thiopentalmentioning

confidence: 99%

Pharmacokinetic Optimisation of General Anaesthesia in Pregnancy

Gin

1993

Clinical Pharmacokinetics

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A significant proportion of women require general anaesthesia during pregnancy or for delivery. There are many practical difficulties in studying anaesthetic drugs and techniques to determine what may be best for both the mother and fetus. Physiological changes of pregnancy may alter the pharmacokinetics and pharmacodynamics of anaesthetics and the fetal disposition of drugs is largely unknown. With the limited pharmacokinetic data available, conclusions on the suitability of drugs are reached in conjunction with sophisticated neonatal neurobehavioural testing. The normal fetus appears able to withstand a variety of anaesthetic techniques but there is little information regarding the compromised fetus or premature neonate. Provided that adequate maternal anaesthesia is achieved, it is prudent to choose an anaesthetic technique which minimises fetal exposure to drugs and use agents which can be eliminated quickly by the neonate. Currently available drugs with rapid maternal and neonatal elimination include propofol, suxamethonium, atracurium, nitrous oxide and isoflurane.

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Anästhesiologische Aspekte in der Neu- und Frühgeborenenchirurgie

Breschan¹,

Likar²

2006

Anaesthesist

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The physiology of the preterm and term neonate is characterized by a high metabolic rate, limited pulmonary, cardiac and thermoregulatory reserve and decreased renal function. Multisystem immaturity creates important developmental differences in drug administration and response when compared to older children. Specific monitoring techniques are required because the neonate is not physically accessible to the anesthetist during the operation. This contribution reviews the specific pathophysiological characteristics of the newborn with relevance to anesthesia and also provides robust guidelines for the anesthetic management of the most frequent non-cardiac procedures which need surgery during the neonatal period. Consideration will also be given to the anesthetic management of very low birth-weight infants with anesthetic key issues such as avoiding hyperoxia, keeping hemodynamic parameters as stable as possible and preventing hypothermia.

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Pharmacocinétique du thiopental chez la femme et le nouveau-né

Cited by 5 publications

References 16 publications

Pharmacokinetic/Pharmacodynamic Modeling of Anesthetics in Children

Pharmacokinetic/Pharmacodynamic Modeling of Anesthetics in Children

Pharmacokinetic Optimisation of General Anaesthesia in Pregnancy

Anästhesiologische Aspekte in der Neu- und Frühgeborenenchirurgie

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