Intranasal Fentanyl in the Palliative Care of Newborns and Infants

Harlos, Mike; Stenekes, Simone; Lambert, David; Hohl, Chris; Chochinov, Harvey Max

doi:10.1016/j.jpainsymman.2012.07.009

Cited by 62 publications

(30 citation statements)

References 44 publications

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“…Neither opioids nor sedatives have been shown to reduce this sign 32 33. The decision to start medication in these cases of gasping or dyspnoea might therefore be related to the professional's own distress or to (supposed or real) parental distress 16 26 34 35. Eol symptoms have nonetheless been reported to be difficult for babies and distressing for medical staff 26 34 35.…”

Section: Discussionmentioning

confidence: 99%

“…The decision to start medication in these cases of gasping or dyspnoea might therefore be related to the professional's own distress or to (supposed or real) parental distress 16 26 34 35. Eol symptoms have nonetheless been reported to be difficult for babies and distressing for medical staff 26 34 35. Parents may well be distressed after treatment withdrawal in the NICU by their baby's gasping respiration, which some may interpret as the baby saying: ‘I want to live’;36 a few cases have described parents' requests to stop their babies from gasping after extubation 17 18.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Delivery room deaths of extremely preterm babies: an observational study

Durrmeyer

Scholer-Lascourrèges

Boujenah

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Delivery room deaths of extremely preterm babies: an observational study

Durrmeyer

Scholer-Lascourrèges

Boujenah

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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“…Oral transmucosal fentanyl citrate should be carefully used in children less than 6 years of age [94][95][96][97]. Intranasal fentanyl (dosed 1-2 lg/kg) has been effectively used in premedication, emergency analgesia, and palliative care [98][99][100][101][102].…”

Section: Transmucosal Fentanylmentioning

confidence: 99%

Correction to: Pharmacokinetics of Fentanyl and Its Derivatives in Children: A Comprehensive Review

et al. 2017

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Fentanyl and its derivatives sufentanil, alfentanil, and remifentanil are potent opioids. A comprehensive review of the use of fentanyl and its derivatives in the pediatric population was performed using the National Library of Medicine PubMed. Studies were included if they contained original pharmacokinetic parameters or models using established routes of administration in patients younger than 18 years of age. Of 372 retrieved articles, 44 eligible pharmacokinetic studies contained data of 821 patients younger than 18 years of age, including more than 46 preterm infants, 64 full-term neonates, 115 infants/toddlers, 188 children, and 28 adolescents. Underlying diagnoses included congenital heart and pulmonary disease and abdominal disorders. Routes of drug administration were intravenous, epidural, oral-transmucosal, intranasal, and transdermal. Despite extensive use in daily clinical practice, few studies have been performed. Preterm and term infants have lower clearance and protein binding. Pharmacokinetics was not altered by chronic renal or hepatic disease. Analyses of the pooled individual patients' data revealed that clearance maturation relating to body weight could be best described by the Hill function for sufentanil (R 2 = 0.71, B max 876 mL/min, K 50 16.3 kg) and alfentanil (R 2 = 0.70, B max (fixed) 420 mL/min, K 50 28 kg). The allometric exponent for estimation of clearance of sufentanil was 0.99 and 0.75 for alfentanil clearance. Maturation of remifentanil clearance was described by linear regression to bodyweight (R 2 = 0.69). The allometric exponent for estimation of remifentanil clearance was 0.76. For fentanyl, linear regression showed only a weak correlation between clearance and bodyweight in preterm and term neonates (R 2 = 0.22) owing to a lack of data in older age groups. A large heterogeneity regarding study design, clinical setting, drug administration, laboratory assays, and pharmacokinetic estimation was observed between studies introducing bias into the analyses performed in this review. A limitation of this review is that pharmacokinetic data, based on different modes of administration, dosing schemes, and parameter estimation methods, were combined.The online version of the original article can be found under

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“…Intranasal diamorphine is widely used in the management of paediatric pain [18], and although there are no published studies of its use in paediatric dyspnoea, there are anecdotal reports of its use in clinical practice. Fentanyl has been used for dyspnoea management in adults [19] and there is one neonatal report (a retrospective chart review) that suggests intranasal fentanyl is efficacious in the reduction of laboured breathing [20]. There may also be a role for transmucosal fentanyl [21], although emerging evidence does not look promising [22].…”

Section: Opioidsmentioning

confidence: 99%