Pharmacokinetics and Pharmacology of Drugs Used in Children

Coté, Charles J.; Lerman, Jerrold; Ward, Robert M.; Lugo, Ralph A.; Goudsouzian, Nishan G.

doi:10.1016/b978-141603134-5.50010-x

Cited by 24 publications

(53 citation statements)

References 1,401 publications

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“…1,2 Body tissue composition: neonates have a smaller proportion of weight in the form of fat and muscle compared with adults ( Figure 2). 3 In adults thiopentone or fentanyl have an early peak plasma concentration followed by a rapid redistribution to muscle (and fat). In the neonate with less muscle mass, this redistribution capacity will be reduced, causing prolonged higher plasma concentrations.…”

Section: Distributionmentioning

confidence: 99%

“…Disease states can influence clearance; infants who have had cardiac surgery show a markedly reduced clearance compared with children who have undergone noncardiac surgery. 3 Those with renal impairment have the potential to accumulate the metabolites morphine-6-glucuronide (potent μ opioid receptor activity) and morphine-3-glucuronide (antanalgesic effect). 4 As with all opioid infusions, neonates should have continuous monitoring and frequent assessment with a high nurse:patient ratio.…”

Section: Individual Drug Groups Analgesicsmentioning

confidence: 99%

“…Many phase I reactions involve isoenzymes found in the CYP1, CYP2 and CYP3 gene families of the cytochrome P450 system. 3 Premature neonates are able to metabolize drugs; however, different enzymes have variable development. Genetic polymorphism of phase I and phase II enzymes add to this variability (e.g.…”

Section: Figurementioning

confidence: 99%

“…This effect is clinically more pronounced with highly protein-bound drugs. 3 Important examples of acidic drugs binding albumin include diazepam, thiopental and phenytoin. Basic drugs tend to bind α 1 -acid glycoprotein, which will also have reduced binding in the neonate (e.g.…”

Section: Distributionmentioning

confidence: 99%

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Neonatal pharmacology

Skinner

2008

Anaesthesia & Intensive Care Medicine

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the absorption, distribution, metabolism and excretion of drugs in a neonate differ markedly from those of older children. the neonate under goes rapid developmental change from birth, which alters the pharmaco kinetic profile of many drugs. the pathology seen in neonates can also have marked effects on drug handling; low cardiac output states, raised intraabdominal pressure, hepatic and renal disease have signifi cant implications for drug pharmacokinetics. there is also considerable interpatient variability concerning all aspects of drug disposition. these factors make accurate drug administration difficult, and leave the new born particularly susceptible to adverse drug reactions, morbidity and mortality. By applying neonatal pharmacokinetic principles to individual drugs, we identify important differences between neonates and older children. adverse effects of commonly used drugs in neonates may be reduced by applying neonatal pharmacokinetic principles. anaesthetic agents, sedatives, analgesics and local anaesthetics are discussed in this article in relation to their particular behaviour in neonates.

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Section: Distributionmentioning

confidence: 99%

Section: Individual Drug Groups Analgesicsmentioning

confidence: 99%

Section: Figurementioning

confidence: 99%

Section: Distributionmentioning

confidence: 99%

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Neonatal pharmacology

Skinner

2008

Anaesthesia & Intensive Care Medicine

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“…However, it is recommended to avoid depolarizing neuromuscular blockers for prevention of rhabdomyolysis, which has been associated with neuromuscular and mitochondrial disorders. 15 Longer-acting nondepolarizing neuromuscular blockers should also be avoided, as they may have prolonged effects in patients with mitochondrial myopathies. 16 Many anesthetic agents suppress mitochondrial function, which is of greater concern in an MD patient.…”

mentioning

confidence: 99%

Anesthetic Management of a Child With Unspecified Mitochondrial Disease in an Outpatient Dental Setting

Gordon

Montandon

2017

Anesthesia Progress

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Mitochondrial disease (MD) represents a category of metabolic disorders with a wide range of symptoms across a variety of organ systems. It occurs with an incidence of greater than 1:5000 and can be difficult to specifically diagnose because of the variety of clinical presentations and multiple genomic origins. Although phenotypically variable, MD symptoms often include hypotonia, cardiac defects, dysautonomia, and metabolic dysfunction. Mitochondrial disease presents a unique challenge in terms of anesthetic management, as many anesthetic drugs suppress mitochondrial function. Additional considerations may need to be made in order to evaluate the patient's metabolic compensation prior to surgery. This article presents an in-depth discussion of a case involving a nearly 10-year-old boy with a history of an unspecified form of MD, who presented for endodontic treatment of tooth No. 30 under deep sedation. The article also provides a thorough review of the current literature surrounding the anesthetic management of patients with MD.

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Effects of exposure to the inhalational anaesthetic sevoflurane on the male reproductive system in rats

Liu

Zhang

et al. 2023

Veterinary Medicine & Sci

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Objectives:The purpose of this study was to explore the effects of inhalational anaesthetics on the male reproductive system in neonatal rats.Methods: Postnatal day 6 (P6) male rat pups were assigned to 2 groups of 40 rats each. The control group did not receive anaesthesia, and the test group was exposed to air containing 3% sevoflurane in a chamber. After sevoflurane exposure, the effects on the male reproductive system in neonatal rats exposed to inhalational anaesthetics were tested. The rats were maintained to P60. The fertility, sperm and spermatid count, sperm motility, organ weights and histological changes in rats were determined.Results: Compared with those of the control group, the sperm count and motility of the sevoflurane group were significantly decreased (p < 0.05), and there was also a decrease in the number of foetal rats from the sevoflurane group (p < 0.05). Furthermore, the arrangement of the seminiferous tubule was regular in the control group, whereas the arrangement of the seminiferous tubule was distorted and the spermatocytes were detached and irregularly lined in the sevoflurane group. TUNEL analysis showed that the number of apoptotic cells in the testes of the sevoflurane group was significantly increased (p < 0.05). SOD and MDA analyses showed that SOD was decreased, while MDA expression was increased.Conclusions: These data indicated that young rats suffered as a result of inhalation of the anaesthetic sevoflurane and had reduced reproductive system function during adolescence in males. These studies are useful as a foundation for clinical studies.

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Pharmacokinetics and Pharmacology of Drugs Used in Children

Cited by 24 publications

References 1,401 publications

Neonatal pharmacology

Neonatal pharmacology

Anesthetic Management of a Child With Unspecified Mitochondrial Disease in an Outpatient Dental Setting

Effects of exposure to the inhalational anaesthetic sevoflurane on the male reproductive system in rats

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