Pharmacokinetic Model-driven Infusion of Fentanyl in Children

Ginsberg, Brian; Howell, Scott; Glass, Peter S. A.; Margolis, Judith O.; Ross, Allison Kinder; Dear, GdeL; Shafer, Steven L.

doi:10.1097/00000542-199612000-00007

Cited by 47 publications

(30 citation statements)

References 15 publications

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“…Thirteen infants and toddlers (median age 14 [range 3-36] months, weight 11 [5][6][7][8][9][10][11][12][13][14][15][16][17] kg, Group I) and 11 children (68 [45-131] months, 21 kg, Group II) completed the study. Five infants and one older child dropped out either because of catheter dislodgement, or because of the insufficient number of blood samples drawn in the postinfusion period (<3).…”

Section: Resultsmentioning

confidence: 99%

“…Objectives: The aim of the study was to evaluate pharmacokinetics of fentanyl administered as continuous epidural infusion with 0.2% ropivacaine for postoperative pain relief in infants and toddlers, and older children undergoing major abdominal and urological procedures. Methods: Thirteen infants and toddlers (median age 14 [range 3-36] months, 11 [5][6][7][8][9][10][11][12][13][14][15][16][17] kg, Group I) and 11 children (68 [45-131] months, 21 kg, Group II) participated in the study. Epidural catheter was placed under general anesthesia in the L1-L2, L2-L3, or L3-L4 epidural space and threaded up to 4 cm into the epidural space.…”

Section: Discussionmentioning

confidence: 99%

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Fentanyl with ropivacaine infusion for postoperative pain relief in infants and children. Kinetics of epidural fentanyl

Karas-Trzeciak

Grabowski

Wołoszczuk-Gębicka

et al. 2015

Pediatric Anesthesia

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With this dosing regimen, fentanyl concentration in plasma was within the range of analgesic concentrations, and did not exceed 1.0 ng·ml(-1) . After discontinuation of epidural infusion, pharmacokinetics of fentanyl was complicated by a slight increase in plasma concentration during the elimination phase. Both elimination half-life of fentanyl (t1/2, MRT ) and mean residence time (MRT) were much longer than those observed after single IV bolus dose, and longer in Group I than in Group II (t1/2 MRT 15.9 [3.6-31.5] h vs 8.0 [7.1-13.3] h, P < 0.05, MRTstop-last 22.9 [5.1-45.5] h vs 11.5 [10.2-19.1] h, P < 0.05). Therefore, monitoring of vital signs seems warranted for several hours after the termination of the epidural infusion because risk of respiratory depression may persist, especially in the younger age group.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fentanyl with ropivacaine infusion for postoperative pain relief in infants and children. Kinetics of epidural fentanyl

Karas-Trzeciak

Grabowski

Wołoszczuk-Gębicka

et al. 2015

Pediatric Anesthesia

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“…The accuracy of a computerized-assisted continuous infusion using an adult PK dataset was evaluated in children between 2.7 and 11 years of age undergoing noncardiac surgery [34]. The measured fentanyl concentrations mostly exceeded the predicted concentrations; thus, the finally derived pediatric two-compartment model included age and bodyweight as covariates.…”

Section: Intravenous Fentanylmentioning

confidence: 99%

Correction to: Pharmacokinetics of Fentanyl and Its Derivatives in Children: A Comprehensive Review

et al. 2017

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Fentanyl and its derivatives sufentanil, alfentanil, and remifentanil are potent opioids. A comprehensive review of the use of fentanyl and its derivatives in the pediatric population was performed using the National Library of Medicine PubMed. Studies were included if they contained original pharmacokinetic parameters or models using established routes of administration in patients younger than 18 years of age. Of 372 retrieved articles, 44 eligible pharmacokinetic studies contained data of 821 patients younger than 18 years of age, including more than 46 preterm infants, 64 full-term neonates, 115 infants/toddlers, 188 children, and 28 adolescents. Underlying diagnoses included congenital heart and pulmonary disease and abdominal disorders. Routes of drug administration were intravenous, epidural, oral-transmucosal, intranasal, and transdermal. Despite extensive use in daily clinical practice, few studies have been performed. Preterm and term infants have lower clearance and protein binding. Pharmacokinetics was not altered by chronic renal or hepatic disease. Analyses of the pooled individual patients' data revealed that clearance maturation relating to body weight could be best described by the Hill function for sufentanil (R 2 = 0.71, B max 876 mL/min, K 50 16.3 kg) and alfentanil (R 2 = 0.70, B max (fixed) 420 mL/min, K 50 28 kg). The allometric exponent for estimation of clearance of sufentanil was 0.99 and 0.75 for alfentanil clearance. Maturation of remifentanil clearance was described by linear regression to bodyweight (R 2 = 0.69). The allometric exponent for estimation of remifentanil clearance was 0.76. For fentanyl, linear regression showed only a weak correlation between clearance and bodyweight in preterm and term neonates (R 2 = 0.22) owing to a lack of data in older age groups. A large heterogeneity regarding study design, clinical setting, drug administration, laboratory assays, and pharmacokinetic estimation was observed between studies introducing bias into the analyses performed in this review. A limitation of this review is that pharmacokinetic data, based on different modes of administration, dosing schemes, and parameter estimation methods, were combined.The online version of the original article can be found under

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“…After a single intravenous dose, the duration of action of fentanyl is 30-45 min. Given its high lipid solubility, the pharmacokinetic profi le of fentanyl is context sensitive, such that its half-life progressively increases with the duration of the infusion [ 83 ]. High-dose fentanyl has been associated with chest wall rigidity and subsequent diffi culty in ventilation.…”

Section: Fentanylmentioning

confidence: 99%

Pain Assessment and Management

Howard

2014

Neonatal Anesthesia

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Pharmacokinetic Model-driven Infusion of Fentanyl in Children

Abstract: The pharmacokinetics of fentanyl administered by computerized assisted continuous-infusion differ between adults and children. The newly derived parameters are probably more suitable to determine infusion schemes of up to 4 h in children between the ages of 2 and 11 y.

Cited by 47 publications

References 15 publications

Fentanyl with ropivacaine infusion for postoperative pain relief in infants and children. Kinetics of epidural fentanyl

Fentanyl with ropivacaine infusion for postoperative pain relief in infants and children. Kinetics of epidural fentanyl

Correction to: Pharmacokinetics of Fentanyl and Its Derivatives in Children: A Comprehensive Review

Pain Assessment and Management

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