Pharmacokinetic profiles of epidural bupivacaine and ropivacaine following single‐shot and continuous epidural use in young infants

Calder, Alyson; Bell, Graham; Andersson, Martin; Thomson, Alison; Watson, David; Morton, Neil S.

doi:10.1111/j.1460-9592.2011.03771.x

Cited by 30 publications

(21 citation statements)

References 26 publications

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“…Various RA/LA techniques are well known. Despite these differences in routes of administration, literature suggests plasma LA concentrations do not exceed 10 µM . It would appear that the lower the concentration of LA used, the greater its clinical relevance.…”

Section: Discussionmentioning

confidence: 99%

“…Despite these differences in routes of administration, literature suggests plasma LA concentrations do not exceed 10 mM. [84][85][86][87] It would appear that the lower the concentration of LA used, the greater its clinical relevance. However, LA used for topical infiltration, for example, during skin cancer resection, may reach high concentrations in the hundreds of mM or mM.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The potential benefits of the use of regional anesthesia in cancer patients

Xuan

Hankin

Zhao

et al. 2014

Intl Journal of Cancer

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Cancer is a leading cause of morbidity and mortality worldwide. In light of demographic changes among other factors, it is anticipated this trend will continue. Surgical resection is the primary method of treating solid tumours. Unfortunately, even with the use of adjunct therapies, metastatic disease is a leading cause of death in people with cancer. Recent evidence suggests choice of anesthetic technique may influence cancer outcome. This review considers the latest evidence regarding local and regional anesthesia in the context of cancer biology. There is a focus on the indirect and direct mechanisms involved. An integrated approach is used such that diverse areas of research are explored; ranging from epigenetics to cell death pathways. With a better understanding of how regional anesthesia and/or local anesthetics interact with cancer cells, these techniques can be trialed and evaluated to ascertain potential clinical benefits in cancer patients. Thus far, there is insufficient evidence to warrant a change in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The potential benefits of the use of regional anesthesia in cancer patients

Xuan

Hankin

Zhao

et al. 2014

Intl Journal of Cancer

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“…Metabolism and elimination clearance (i.e., excretion) together reflect the clearance capacity, that is, the volume of blood or plasma from which a drug is completely removed per unit of time. Table 1 provides some illustrations on the impact of population-specific characteristics on the pharmacokinetics of compounds also administered in the perioperative period (1,9,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24).…”

Section: Clinical Pharmacology In Neonates: Limited Size and Extensivmentioning

confidence: 99%

Neonatal clinical pharmacology

Allegaert

Velde

Anker

2013

Pediatric Anesthesia

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Effective and safe drug administration in neonates should be based on integrated knowledge on the evolving physiological characteristics of the infant who will receive the drug, and the pharmacokinetics (PK) and pharmacodynamics (PD) of a given drug. Consequently, clinical pharmacology in neonates is as dynamic and diverse as the neonates we admit to our units while covariates explaining the variability are at least as relevant as median estimates. The unique setting of neonatal clinical pharmacology will be highlighted based on the hazards of simple extrapolation of maturational drug clearance when only based on ‘adult’ metabolism (propofol, paracetamol). Secondly, maturational trends are not at the same pace for all maturational processes. This will be illustrated based on the differences between hepatic and renal maturation (tramadol, morphine, midazolam). Finally, pharmacogenetics should be tailored to neonates, not just mirror adult concepts. Because of this diversity, clinical research in the field of neonatal clinical pharmacology is urgently needed, and facilitated through PK/PD modeling. In addition, irrespective of already available data to guide pharmacotherapy, pharmacovigilance is needed to recognize specific side effects. Consequently, paediatric anesthesiologists should consider to contribute to improved pharmacotherapy through clinical trial design and collaboration, as well as reporting on adverse effects of specific drugs.

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“…It is infused into the lumbar epidural space through a catheter or a needle, although administration through a catheter is generally preferred: the dose may be adjusted during surgery and postoperative analgesia may be provided [1]. In general, data suggests satisfactory regional anesthesia and analgesia [2] in male and female patients [3].…”

Section: Introductionmentioning

confidence: 99%

“…Bupivacaine may be administered alone or in combination with selected adjuvants [1,4,5], at doses ranging from 28 mg [6] to 187 mg [7] and at infusion rates as slow as 0.04 mL/s [7] or as fast as 1 mL/s [8], either through a needle [7] or a catheter [9,10] regardless whether patients are adults [7,10] or children [2,6]. The pharmacological effect is attained within a few minutes and lasts depending on the formulation used [1,11,12].…”

Section: Introductionmentioning

confidence: 99%