Pharmacology of inhalational anaesthetics in infants and children*

Lerman, Jerrold

doi:10.1111/j.1460-9592.1992.tb00200.x

Cited by 46 publications

(19 citation statements)

References 70 publications

(58 reference statements)

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“…The MAC for most volatiles is less in neonates than in infancy, peaks at 1e6 months of age, and decreases with increasing PMA and PNA after 6 months ( Figure 5). 10 Similar trends have been show for ED50 of thiopenthone. The reasons for these differences remain to be clarified.…”

Section: Eliminationsupporting

confidence: 78%

“…10 Similarly, ED50 have been used to describe potency of IV induction agents such as thiopenthone and propofol. The MAC for most volatiles is less in neonates than in infancy, peaks at 1e6 months of age, and decreases with increasing PMA and PNA after 6 months ( Figure 5).…”

Section: Eliminationmentioning

confidence: 99%

“…Halothane, and to a far lesser extent sevoflurane and particularly desflurane, undergo hepatic metabolism. 10 Pharmacodynamics Developmental pharmacodynamics is the study of the impact of age-related maturation of the structure and function of biologic systems on effects of drugs, and mostly related to the number, affinity and type of receptors or the availability of natural ligands. Although it is generally accepted that development can alter the action of a drug, the available information about the effect of human ontogeny on drugereceptor interactions and the consequence of these interactions are limited.…”

Section: Eliminationmentioning

confidence: 99%

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Developmental paediatric anaesthetic pharmacology

Hansen

2015

Anaesthesia & Intensive Care Medicine

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Section: Eliminationsupporting

confidence: 78%

Section: Eliminationmentioning

confidence: 99%

Section: Eliminationmentioning

confidence: 99%

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Developmental paediatric anaesthetic pharmacology

Hansen

2015

Anaesthesia & Intensive Care Medicine

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“…10 Pharmacodynamics Developmental pharmacodynamics (PD) is the study of the impact of age-related maturation of the structure and function of biologic systems on (side-) effects of drugs, and mostly related to the number, affinity and type of receptors or the availability of natural ligands. A more rapid wash-out may be expected in neonates for any given duration of anaesthesia because there is less distribution to fat and muscle content.…”

Section: Pulmonary Eliminationmentioning

confidence: 99%

Developmental paediatric anaesthetic pharmacology

Hansen¹

2012

Anaesthesia & Intensive Care Medicine

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Safe and efficacious drug therapy in neonates, infants and children require detailed knowledge about the ontogeny of drug disposition and action as well how these interact with genetics and co-morbidity of children. Recent advances in developmental pharmacology in children follow the increased understanding of the impact of growth and development on drug disposition (absorption, distribution, metabolism and excretion (ADME)). Numerous approaches have been used to determine optimal dosing of drugs in children, none of which are ideal. Human growth is a non-linear process and age-related changes in body composition and organ function are dynamic and often discordant during infancy. Major gaps of knowledge remain regarding the ontogeny of drug-metabolizing enzymes and transporting proteins, and the paucity of pharmacodynamic and pharmacogenetic data in the paediatric population is overwhelming.

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“…[64] This agent has a lower blood : gas solubility in infants than in adults. [65] Solubility has a considerable effect on the uptake of inhalational agents in children, since it determines Vd. An inhalational agent with a greater Vd will take longer to reach a steady-state concentration when delivered at a constant rate.…”

Section: Volume Of Distributionmentioning

confidence: 99%

Common Errors of Drug Administration in Infants

Anderson¹,

Ellis²

1999

Pediatric Drugs

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Drug administration errors are common in infants. Although the infant population has a high exposure to drugs, there are few data concerning pharmacokinetics or pharmacodynamics, or the influence of paediatric diseases on these processes. Children remain therapeutic orphans. Formulations are often suitable only for adults; in addition, the lack of maturation of drug elimination processes, alteration of body composition and influence of size render the calculation of drug doses complex in infants. The commonest drug administration error in infants is one of dose, and the commonest hospital site for this error is the intensive care unit. Drug errors are a consequence of system error, and preventive strategies are possible through system analysis. The goal of a zero drug error rate should be aggressively sought, with systems in place that aim to eliminate the effects of inevitable human error. This involves review of the entire system from drug manufacture to drug administration. The nuclear industry, telecommunications and air traffic control services all practise error reduction policies with zero error as a clear goal, not by finding fault in the individual, but by identifying faults in the system and building into that system mechanisms for picking up faults before they occur. Such policies could be adapted to medicine using interventions both specific (the production of formulations which are for children only and clearly labelled, regular audit by pharmacists, legible prescriptions, standardised dose tables) and general (paediatric drug trials, education programmes, nonpunitive error reporting) to reduce the number of errors made in giving medication to infants.

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Pharmacology of inhalational anaesthetics in infants and children*

Cited by 46 publications

References 70 publications

Developmental paediatric anaesthetic pharmacology

Developmental paediatric anaesthetic pharmacology

Developmental paediatric anaesthetic pharmacology

Common Errors of Drug Administration in Infants

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