scholarly journals Clinical Pharmacology of Rocuronium in Infants and Children

2022 ◽  
Vol 3 ◽  
pp. 01-07
Author(s):  
Gian Maria Pacifici
Keyword(s):  
Human Placenta ◽  
Intravenous Infusion ◽  
Muscle Relaxation ◽  
Assisted Ventilation ◽  
Neuromuscular Blocking ◽  
Infants And Children ◽  
P Value ◽  
Published Data ◽  
Surgical Manipulations ◽  
In Infants And Children

The main clinical use of the neuromuscular blocking agents is an adjuvant in surgical anaesthesia to obtain relaxation of skeletal muscle, particularly of the abdominal wall, to facilitate surgical manipulations. Rocuronium can be used instead of suxamethonium to provide rapid muscle paralysis during tracheal intubation but the recovery is much slower. Rocuronium is administered intravenously to infants and children. In infants, rocuronium is administered at a dose of 450 µg/kg for providing muscle relaxation for laryngeal intubation. To provide sustained paralysis, rocuronium is given at a dose of 600 µg/kg. In children, the neuromuscular blockade is obtained with 600 µg/kg followed by an intravenous infusion of 150 µg/kg per hour. For assisted ventilation in intensive care, rocuronium is administered at a dose of 600 µg/kg followed by an intravenous infusion of 300 to 600 µg/kg per hour. The effects of rocuronium have been extensively studied in infants and children. Rocuronium is converted into 17-desacetyl rocuronium. The pharmacokinetics of rocuronium have been studied in infants and children and the mean residence time is 55.6 and 25.6 min (P-value < 0.01) in infant and children, respectively. Rocuronium interacts with drugs, the treatment of infants and children with rocuronium has been studied, and rocuronium poorly crosses the human placenta. The aim of this study is to review the published data on rocuronium dosing, pharmacokinetics, and treatment in infants and children, and rocuronium metabolism and transfer across the human placenta.

scholarly journals Clinical pharmacology of lorazepam in infants and children

2022 ◽  
Vol 3 (1) ◽  
pp. 01-07
Author(s):  
Gian Maria Pacifici
Keyword(s):  
Breast Milk ◽  
Adverse Effects ◽  
Human Placenta ◽  
Liver Microsomes ◽  
Intravenous Dose ◽  
Infants And Children ◽  
Published Data ◽  
Elimination Half ◽  
And Migration ◽  
In Infants And Children

Lorazepam is a benzodiazepine has antiepileptic activity; it may be administered intravenously, intramuscularly, orally, by intranasal or buccal application and following oral dosing it is well absorbed. In infants, the initial intravenous dose of lorazepam is 100 µg/kg and in children the initial oral and intravenous dose is 50 to 100 µg/kg and the dose varies according to the child age. Lorazepam has been found efficacy and safe in infants and children but it may induce adverse-effects. Lorazepam is a racemate and the R and S enantiomers are conjugated with glucuronic acid in human liver microsomes and the respective Km and Vmax values are 29+8.9 and 36+10 µM and 7.4+1.9 and 10+3.8 pmol/min*mg. Lorazepam interacts with drugs and the interaction may affect the activity or metabolism of lorazepam. The pharmacokinetics of lorazepam have been studied in infants and children and in diseased children. In infants and children the elimination half-life is about 15 hours and it is about 24 hours and about 37 hours in children with severe malaria and convulsions following intravenous and intramuscular administration, respectively. The treatment and trials with lorazepam have been studied in infants and children. Lorazepam freely crosses the human placenta and poorly migrates into the breast-milk. The aim of this study is to review the published data on lorazepam dosing, efficacy and safety, adverse-effects, metabolism, interaction with drugs, pharmacokinetics, treatment and trials in infants and children and the lorazepam transfer across the human placenta and migration into the breast-milk.

scholarly journals Clinical pharmacology of morphine in infants and children

2021 ◽  
Vol 4 (5) ◽  
pp. 01-08
Author(s):  
Gian Maria Pacifici
Keyword(s):  
Breast Milk ◽  
Adverse Effects ◽  
Human Brain ◽  
Human Placenta ◽  
Rectal Administration ◽  
Infants And Children ◽  
Published Data ◽  
And Migration ◽  
Control Pain ◽  
In Infants And Children

Morphine is used to treat pain, for treatment of opioid dependence, and neonatal abstinence syndrome. Morphine is modestly absorbed from the gastrointestinal tract whereas after rectal administration, by intranasal or buccal application morphine is well absorbed. Morphine is eliminated by glomerular filtration and by conjugation with glucuronic acid; morphine-3-glucurinide and morphine-6-glucurinide are the main metabolites and the last has analgesic effect. In infants, morphine is used to treat severe or sustained pain, sedation, and pain relief. In children, morphine is used to control pain and morphine may be administered by subcutaneous or intravenous injection, orally, by rectum, or by continuous subcutaneous infusion and morphine dose varies according to the child age. Morphine has been found efficacy and safe in infants and children but may induce adverse-effects. The effects caused by morphine and the treatment with morphine have been studied in infants and children. In newborns, morphine elimination half-life ranges from 7.7 to 13.5 hours and decreases with infant maturation. In newborns, infants and children, the total body clearance of morphine ranges from 14.5 to 71.1 L/h/70kg and increases with infant maturation and child development. Morphine is transported in the human brain, poorly crosses the human placenta and accumulates in breast-milk. The aim of this study is to review the published data on morphine dosing, efficacy and safety, effects, adverse-effects, pharmacokinetics, metabolism, drug interaction, treatment, transport into human brain of infants and children and morphine transfer across the human placenta and migration into the breast-milk.

Venostomy, an Improved "Cutdown" Procedure in Infants and Children

PEDIATRICS ◽  
1956 ◽  
Vol 18 (3) ◽  
pp. 466-466
Keyword(s):  
Intravenous Infusion ◽  
Infants And Children ◽  
New Technique ◽  
Continuous Intravenous Infusion ◽  
Simple Apparatus ◽  
A New Technique ◽  
In Infants And Children

A new technique for the insertion of a polyethylene catheter into a vein for continuous intravenous infusion is described. Noteworthy amongst the advantages is that the patency of the vein is not destroyed. The technique does not involve ligation or division of the vein. Simple apparatus to facilitate the use of the technique is available from a commercial firm. Detailed description aided by diagrammatic illustration is provided.

Effects of high neuromuscular blocking agent dose on post‐operative respiratory complications in infants and children

2019 ◽  
Vol 64 (2) ◽  
pp. 156-167 ◽  
Author(s):  
Flora T. Scheffenbichler ◽  
Maíra I. Rudolph ◽  
Sabine Friedrich ◽  
Friederike C. Althoff ◽  
Xinling Xu ◽  
...  
Keyword(s):  
Blocking Agent ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agent ◽  
Infants And Children ◽  
Respiratory Complications ◽  
In Infants And Children

Femoral Artery Blood Flow in Infants and Children

2005 ◽  
Vol 29 (2) ◽  
pp. 75-78 ◽  
Author(s):  
K. Kröger ◽  
J. Nettelrodt ◽  
C. Müntjes ◽  
U. Neudorf ◽  
A. Feuersenger ◽  
...  
Keyword(s):  
Blood Flow ◽  
Confidence Intervals ◽  
Femoral Artery ◽  
Pulsatility Index ◽  
Average Velocity ◽  
Resistance Index ◽  
Peak Systolic Velocity ◽  
Infants And Children ◽  
P Value ◽  
In Infants And Children

Background We measured Doppler parameter of common femoral artery (CFA) blood flow in infants and children and investigated how far these parameters change with age, height, weight, body mass index (BMI), and body surface area (BSA). Material and Methods CFA was investigated in 97 infants and children (43 females, 54 males, ages ranged from 0.13 to 220 months) on both sides in a supine position after 5 min rest using a 7.5-MHz linear transducer (Type Elegra, Siemens, Germany) 1 cm proximal to the femoral bifurcation. Peak systolic velocity, end-diastolic velocity, blood flow volume, mean average velocity, resistance index, and pulsatility index were measured. Results Theoretically, Doppler parameters could change with age, height, weight, BMI, and BSA. Because age, weight, height, and BSA were highly correlated (Spearman correlation coefficient > 0.90) only one of these variables could be included in a regression model. Only diameter and flow velocity (FV) correlated with age and height. Peak systolic velocity, mean average velocity, pulsatility index, and resistance index did not. Correlation between BMI and age and BMI and height was small. A regression model for the natural logarithm of FV was estimated: ln(FV) = −5.853 + 0.021 height + 0.049 BMI (R2 = 0.73, p < 0.0001 of height, p value of BMI: 0.028; p value of intercept: < 0.0001). The 95% confidence intervals were: −6.470 to −5.237 for the intercept, 0.006 to 0.093 for BMI, and 0.017 to 0.025 for height. Predicted FV and their 95% confidence intervals were calculated. The upper confidence limits were 8–10 times that of the lower ones. Conclusion Only FV showed height- and BMI-dependent changes in growing children. Prediction of FV in individual arteries was possible, but with a large range.

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