Pharmacological therapy for analgesia and sedation in the newborn

Behavioral effects of perinatal opioid exposure

“…A high dose of opioids may induce EEG spikes, although behavioral convulsions are only rarely detected (van Praag and Frenk, 1992). Additionally, placebo-controlled trials in ventilated neonates found that fentanyl reduced stress hormones (catecholamines and glucocorticoids), episodes of hypoxia and behavioral stress scores but increased ventilation requirements (Anand and Hall, 2006). Moreover, morphine seems to provide adequate sedation and analgesia during hypothermia for the treatment of neonatal asphyxial encephalopathy (Roka et al, 2008).…”

Synthesis and in vivo evaluation of 5-chloro-5-benzobarbiturates as new central nervous system depressants

“…They are also known as GABA-mimetics, thus functioning as agonists of GABA receptors. 3,4 For many years the barbiturates were the main drugs used to cause effects on the CNS. However, after the discovery of the very effective benzodiazepines, their use became less common simply because benzodiazepines have less potential for lethal overdoses.…”

“…1 The mechanism of action of barbiturates at the CNS is not well known, but it has been shown that they are able to interfere with acetylcholine, norepinephrine and glutamate activity and also that they can inhibit the calcium uptake of nerve terminals, thus allowing their use as analgesics. 2,3 In fact, today barbiturates are commonly used to induce anesthesia in surgery procedures. They are also known as GABA-mimetics, thus functioning as agonists of GABA receptors.…”

Exposição, avaliação e manejo da dor aguda do recém-nascido em unidades neonatais de um hospital estadual

“…O tramadol apesar de ter excelentes propriedades analgésicas, causando menos obstipação intestinal e depressão respiratória do que a morfina, seu uso em crianças é escasso e existem poucos estudos sobre sua aplicação em neonatos (ANAND; HALL, 2006;BALDA;GUINSBURG, 2010;GUINSBURG, 1999). Embora o relato da utilização de tramadol em recém-nascido seja raro, essa medicação foi administrada em pesquisas clínicas com neonatos na dose de 5 mg/kg/dia por via oral ou endovenosa e em infusão contínua na dose de 0,10 a 0,25 mg/kg/hora, não havendo relatos de efeitos adversos importantes, no entanto, recomenda-se a retirada gradativa do tramadol, quando seu uso for superior a cinco dias (ALENCAR et al, 2012).…”