Sedation in the Neonatal Intensive Care Unit: International Practice

Allegaert, Karel; Anker, John van den

doi:10.1007/978-3-030-58406-1_18

Cited by 2 publications

(4 citation statements)

References 256 publications

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“…Pharmacological treatment of pain together with sedation in the postoperative period is governed by international recommendations for the treatment of moderate to severe pain (postoperative pain profile lasting for 48 hours) for mechanically ventilated neonates, and a combination of systemic analgesics (opioids and nonopioids) and sedatives or regional anaesthesia (levobupivacaine) for some surgeries are selected [27]. Pharmacological treatment includes slow IV boluses, intermittent dosing or using continuous infusion with the commonly used opioid-morphine, and synthetic opioids-fentanyl, or sufentanil in some intensive care units, the effects of which are expressed as morphine potency.…”

Section: Pharmacological Treatment In Neonatal Postoperative Pain Stu...mentioning

confidence: 99%

“…Adverse effects are described among others (arrhythmias, bradycardia, tachycardia, hyper/hypotension, increased salivation, vomiting, tonic-clonic movements, airway obstructions, respiratory depression and hallucinations, etc., difficult to objectify in ELBW neonates) [51]. Dosing: LD 0.5-1.0 mg/kg (maximum 2 mg/kg) while using more smaller doses followed by IV continuous infusion 0.25 mg/kg/hour is more recently recommended [27] for a term neonate. The Kinderformularium doses are LD at induction of anaesthesia: 0.5-1 mg/kg/dose once and MD 0.5-3 mg/kg/hour continuous infusion [42].…”

Section: Ketaminementioning

confidence: 99%

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Multimodal Pain Management in Extremely Low Birth Weight Neonates after Major Abdominal Surgery

Jancova,

Pokorna

2023

Topics in Postoperative Pain

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Limited data are available in the literature on multimodal pain management in extremely low birth weight (ELBW) neonates. This chapter aimed to summarize current knowledge about the effects of analgesics and sedatives (paracetamol, opioids, benzodiazepines and anaesthetics) on postoperative pain management (≤ 48 hours after surgery). The primary endpoints of postoperative pain management were searched using validated pain assessment instruments, such as pain intensity, excessive sedation, drug consumption or adequate rescue medication. The secondary endpoints are the safety parameters of the drugs used, while the determinants of short/long-term outcome (duration of mechanical ventilation, intraventricular haemorrhage—IVH, periventricular leukomalacia—PVL, postnatal growth restriction, stage of chronic lung disease—CLD or neurodevelopmental outcome according to the Bayley-II Scale of Infant Development at 18–24 months or developmental equivalents at early-school age) were assessed as tertiary endpoints. Additionally, one of the most important key elements of clinical science is known as clinical research study validation, including specific tools and techniques within the validation processes. This chapter focuses on postoperative multimodal pain management, including the implementation of pain assessment tools and analgesic and sedative dosing regimens needed to achieve the efficacy and safety goals of an optimal pain profile in ELBW neonates; only proven non-pharmacological procedures are not included.

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Section: Pharmacological Treatment In Neonatal Postoperative Pain Stu...mentioning

confidence: 99%

Section: Ketaminementioning

confidence: 99%

Multimodal Pain Management in Extremely Low Birth Weight Neonates after Major Abdominal Surgery

Jancova,

Pokorna

2023

Topics in Postoperative Pain

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“…Analgesic drug dosages were based on standardized international guidelines (5,(18)(19)(20). All enrolled patients were treated with opioids (morphine or sufentanil) preoperatively because of severe abdominal disease.…”

Section: Medication Utilizationmentioning

confidence: 99%

“…In 2016, a multidisciplinary ESPNIC (The European Society of Pediatric and Neonatal Intensive Care) position statement was published guiding professionals in assessing and re-evaluating treatment interventions for pain, distress, inadequate sedation, withdrawal syndrome, and delirium in the pediatric populations for various pain profiles across ages (1,2). It is widely accepted that neonates can experience pain, and knowledge of the relevance of pain management has increased significantly over the decades (3)(4)(5). However, short-term and long-term consequences of pain management approaches remain sparse in extremely low birth weight (ELBW) infants (6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Rescue Paracetamol in Postoperative Pain Management in Extremely Low Birth Weight Neonates Following Abdominal Surgery: A Single Unit Retrospective Study

et al. 2022

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BackgroundIntravenous paracetamol added to morphine reduces postoperative morphine consumption in (near)term neonates. However, there are only sparse data on intravenous paracetamol as multimodal strategy in extremely low birth weight (ELBW) neonates.ObjectivesThis study aims to assess the effects of rescue intravenous paracetamol on postoperative pain management (≤48 h postoperatively) in relation to both analgesic efficacy (validated pain assessment, drug consumption, adequate rescue medication) and safety (hypotension and bradycardia). This rescue practice was part of a standardized pain management approach in a single neonatal intensive care unit (NICU).MethodsA single-center retrospective observational study included 20 ELBW neonates, who underwent major abdominal surgery. The primary endpoints of the postoperative study period were pain intensity, over-sedation, time to first rescue analgesic dose, and the effect of paracetamol on opiate consumption. Secondary endpoints were safety parameters (hypotension, bradycardia). And as tertiary endpoints, the determinants of long-term outcome were evaluated (i.e., duration of mechanical ventilation, intraventricular hemorrhage - IVH, periventricular leukomalacia - PVL, postnatal growth restriction, stage of chronic lung disease – CLD or neurodevelopmental outcome according to Bayley-II Scales of Infant Development at 18–24 months).ResultsAll neonates received continuous opioids (sufentanil or morphine) and 13/20 also intravenous paracetamol as rescue pain medication during a 48-h postoperative period. Although opioid consumption was equal in the non-paracetamol and the paracetamol group over 48 h, the non-paracetamol group was characterized by oversedation (COMFORTneo < 9), a higher incidence of severe hypotension, and younger postnatal age (p < 0.05). All long-term outcome findings were similar between both groups.ConclusionsOur study focused on postoperative pain management in ELBW neonates, and showed that intravenous paracetamol seems to be safe. Prospective validation of dosage regimens of analgesic drugs is needed to achieve efficacy goals.

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Sedation in the Neonatal Intensive Care Unit: International Practice

Cited by 2 publications

References 256 publications

Multimodal Pain Management in Extremely Low Birth Weight Neonates after Major Abdominal Surgery

Multimodal Pain Management in Extremely Low Birth Weight Neonates after Major Abdominal Surgery

Rescue Paracetamol in Postoperative Pain Management in Extremely Low Birth Weight Neonates Following Abdominal Surgery: A Single Unit Retrospective Study

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