REMOVED: Drugs of Choice for Sedation and Analgesia in the Neonatal ICU

Hall, Richard; Shbarou, Rolla

doi:10.1016/j.clp.2008.09.007

Cited by 37 publications

(11 citation statements)

References 62 publications

(77 reference statements)

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“…Despite being widely used, both local analgesia with a topical EMLA cream and systemically administered acetaminophen failed to provide adequate pain control after common neonatal intensive care unit procedures [ 7 , 8 ]. Opioids are also commonly used in human neonates and have been shown to provide adequate procedural analgesia in this population [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Current research, however, indicates that neonates not only do experience pain, but that controlling pain early in life is critical to preventing lasting changes to developing somatosensory systems [3][4][5]. In human medicine, a number of analgesic agents have been evaluated in neonates and infants, including topical anesthesia, acetaminophen, and opioids [6]. Despite being widely used, both local analgesia with a topical EMLA cream and systemically administered acetaminophen failed to provide adequate pain control after common neonatal intensive care unit procedures [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Sustained release buprenorphine effectively attenuates postoperative hypersensitivity in an incisional pain model in neonatal rats (Rattus norvegicus)

et al. 2021

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Despite the need for safe and effective postoperative analgesia in neonates, research regarding pain management in neonatal rodents is relatively limited. Here, we investigate whether sustained release buprenorphine (Bup SR) effectively attenuates thermal hypersensitivity in a neonatal rat model of incisional pain. Male and female postnatal day 3 Sprague Dawley rat pups (n = 34) were randomly assigned to one of four treatment groups: 1) saline (control), 0.1 mL, once subcutaneously (SC); 2) buprenorphine HCl (Bup HCl), 0.05 mg/kg, once SC; 3) low dose Bup SR (low-SR), 0.5 mg/kg, once SC; 4) high dose Bup SR (high-SR), 1 mg/kg, once SC. Pups were anesthetized with sevoflurane and a 0.5-cm long skin incision was made over the left lateral thigh. The underlying muscle was dissected and closed using surgical glue. Thermal hypersensitivity testing was performed at 24 h prior to surgery and subsequently at 1, 4, 8, 24, and 48 h post-surgery using an infrared diode laser. Thermal hypersensitivity was attenuated at 1 h post-surgery in the Bup HCl group, while it was attenuated through the entire postoperative period in both low-SR and high-SR groups. This data suggests that a single dose of low-SR (0.5 mg/kg) or high-SR (1 mg/kg) effectively attenuates thermal hypersensitivity for at least 8 h in neonatal rat pups.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sustained release buprenorphine effectively attenuates postoperative hypersensitivity in an incisional pain model in neonatal rats (Rattus norvegicus)

et al. 2021

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“…Such effects have previously been ascribed to alterations in vascular tone [ 6 , 24 , 25 ], despite no differences observed in the cutaneous microvasculature nor blood pressure during the current study. Cardiovascular depression is commonly noted with most sedative agents including alfaxalone and diazepam or midazolam [ 26 ], with commonly used adjuvants potentiating their effects [ 27 ]. Ketamine acts directly and indirectly on the cardiovascular system to simultaneously depress and enhance function [ 6 ], such that its cardiovascular effects are minimal, and are only observed when an adjuvant exacerbates its efficacy (e.g., KZ [ 22 ]).…”

Section: Discussionmentioning

confidence: 99%

Differential effects of four intramuscular sedatives on cardiorespiratory stability in juvenile guinea pigs (Cavia porcellus)

et al. 2021

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Background Non-invasive physiological monitoring can induce stress in laboratory animals. Sedation reduces the level of restraint required, thereby improving the validity of physiological signals measured. However, sedatives may alter physiological equilibrium introducing unintended bias and/or, masking the experimental outcomes of interest. We aimed to investigate the cardiorespiratory effects of four short-acting sedatives in juvenile guinea pigs. Method 12 healthy, 38 (26–46) day-old Dunkin Hartley guinea pigs were included in this blinded, randomised, crossover design study. Animals were sedated by intramuscular injection using pre-established minimum effective doses of either alfaxalone (5 mg/kg), diazepam (5 mg/kg), ketamine (30 mg/kg), or midazolam (2 mg/kg) administered in random order with a minimum washout period of 48 hours between agents. Sedative depth, a composite score comprised of five assessment criteria, was observed every 5-min from dosing until arousal. Physiological monitoring of cardiorespiratory status included measures of heart rate, blood pressure, respiratory rate, and peripheral microvascular perfusion. Results Ketamine and alfaxalone were most effective in inducing stable sedation suitable for physiological monitoring, and diazepam less-so. Midazolam was unsuitable due to excessive hypersensitivity. All sedatives significantly increased heart rate above non-sedated control rates (P<0.0001), without altering blood pressure or microvascular perfusion. Alfaxalone and ketamine reduced respiratory rate relative to their control condition (P<0.0001, P = 0.05, respectively), but within normative ranges. Conclusion Ketamine and alfaxalone are the most effective sedatives for inducing short duration, stable sedation with minimal cardiorespiratory depression in guinea pigs, while diazepam is less-so. However, alfaxalone is the most appropriate sedative for longitudinal studies requiring multiple physiological timepoints.

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“…Hence, subtle hemodynamic changes induced by medications or other procedures might potentiate cerebral hypoxia and ischemic injury in the preterm brain. Fentanyl, an opioid analgesic, is one such medication that is commonly used for pain control and sedation in the neonatal intensive care unit (NICU) [3].…”

Section: Introductionmentioning

confidence: 99%

Effect of Fentanyl Boluses on Cerebral Oxygenation and Hemodynamics in Preterm Infants: A Prospective Observational Study

et al. 2020

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Background: Fentanyl is a commonly used off-label medication for pain control and sedation in preterm infants. Yet, the effect of fentanyl on cerebral hemodynamics in preterm neonates remains unexplored. Objective: To evaluate the effect of a bolus dose of fentanyl on the regional cerebral oxygen saturation (RcSO2), cerebral fractional tissue oxygen extraction (cFTOE) and left ventricular output (LVO) as compared with pre-administration baseline in preterm infants. Methods: This was a prospective observational study conducted in a level III Canadian NICU from September 2017 to February 2019. Preterm infants born <37 weeks of gestation and scheduled to receive a fentanyl bolus (1–2 μg/kg/dose) were eligible. Infants with major congenital anomalies, medically unstable and those who had received fentanyl in the previous 48 h were excluded. Outcomes: The primary outcome was the difference between RcSO2 measured 5 min prior to and RcSO2 measured at defined time points after administration of fentanyl. Results: Twenty-eight infants were enrolled during the study period (median gestational age 28 weeks; interquartile range [IQR] 25–29 weeks; median birth weight 1,035 g [IQR 830–1,292 g]; median age 4 days [IQR 3–7 days]). Mean (±standard deviation) baseline RcSO2 was 73.6% (±11.8), cFTOE was 21.9 (±11.2) and LVO was 380 (±147) mL/kg/min prior to fentanyl infusion. One-way ANOVA showed no statistically significant difference between baseline and any of the post-fentanyl cerebral oxygenation, tissue oxygen extraction or cardiac output measures (p > 0.05). Conclusion: Administration of fentanyl bolus for procedural pain and sedation was not shown to significantly affect cerebral oxygenation, cerebral tissue oxygen extraction or cardiac output in stable preterm infants.

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REMOVED: Drugs of Choice for Sedation and Analgesia in the Neonatal ICU

Cited by 37 publications

References 62 publications

Sustained release buprenorphine effectively attenuates postoperative hypersensitivity in an incisional pain model in neonatal rats (Rattus norvegicus)

Sustained release buprenorphine effectively attenuates postoperative hypersensitivity in an incisional pain model in neonatal rats (Rattus norvegicus)

Differential effects of four intramuscular sedatives on cardiorespiratory stability in juvenile guinea pigs (Cavia porcellus)

Effect of Fentanyl Boluses on Cerebral Oxygenation and Hemodynamics in Preterm Infants: A Prospective Observational Study

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