Sedation and comfort issues in the ventilated infant and child

Brinker, Debbie

doi:10.1016/j.ccell.2004.03.003

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…Opioids (fentanyl, morphine, or methadone) produce analgesia and comfort. 50 In rhesus monkeys, propofol anesthesia concurrent with TH did not impair the coupling between cerebral metabolism and blood flow. 51 Neurotransmitters are also commonly used in neonatal population for their action on the cardiovascular system.…”

Section: Medication Effectsmentioning

confidence: 96%

Cerebral Oxygen Metabolism in Neonatal Hypoxic Ischemic Encephalopathy during and after Therapeutic Hypothermia

Dehaes

Aggarwal

Lin

et al. 2013

J Cereb Blood Flow Metab

107

121

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Pathophysiologic mechanisms involved in neonatal hypoxic ischemic encephalopathy (HIE) are associated with complex changes of blood flow and metabolism. Therapeutic hypothermia (TH) is effective in reducing the extent of brain injury, but it remains uncertain how TH affects cerebral blood flow (CBF) and metabolism. Ten neonates undergoing TH for HIE and seventeen healthy controls were recruited from the NICU and the well baby nursery, respectively. A combination of frequency domain near infrared spectroscopy (FDNIRS) and diffuse correlation spectroscopy (DCS) systems was used to non-invasively measure cerebral hemodynamic and metabolic variables at the bedside. Results showed that cerebral oxygen metabolism (CMRO 2i ) and CBF indices (CBF i ) in neonates with HIE during TH were significantly lower than post-TH and age-matched control values. Also, cerebral blood volume (CBV) and hemoglobin oxygen saturation (SO 2 ) were significantly higher in neonates with HIE during TH compared with age-matched control neonates. Post-TH CBV was significantly decreased compared with values during TH whereas SO 2 remained unchanged after the therapy. Thus, FDNIRS-DCS can provide information complimentary to SO 2 and can assess individual cerebral metabolic responses to TH. Combined FDNIRS-DCS parameters improve the understanding of the underlying physiology and have the potential to serve as bedside biomarkers of treatment response and optimization. Keywords: cerebral blood circulation; cerebral hemoglobin oxygen saturation; cerebral metabolic rate of oxygen consumption; near infrared spectroscopy; neonatal hypoxic ischemic encephalopathy; therapeutic hypothermia INTRODUCTION Neonatal hypoxic ischemic encephalopathy (HIE) occurs in B2 to 3 per 1,000 live births in the USA, with devastating consequences including neurodevelopmental disabilities such as cerebral palsy, life-long cognitive impairment, and epilepsy.1 In HIE, there is a period of reduced blood flow (ischemia) and oxygen delivery (hypoxia) followed by reperfusion with transient energy recovery, and then a secondary energy failure.2 Treatment is aimed at preventing the cascade of events that begin with reperfusion and lead to secondary energy failure and inevitable cell death; this is the 'window of opportunity.' 3 Theories for injury mechanisms in this window suggest a central role for excitotoxicity and oxidative stress with the injury evolving over hours to weeks.2 Therapeutic hypothermia (TH) is the treatment of choice for HIE, as it is the only treatment with proven efficacy and acts through a variety of mechanisms, including those associated with decreased neuronal energy metabolism. 4 Although early studies showed that TH decreased rates of both mortality and disability, recently published long-term outcomes have demonstrated significance only for decreased mortality rates.5 In addition, a recent

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