Intranasal sufentanil/ketamine analgesia in children

Nielsen, Bendt; Friis, Susanne Molin; Rømsing, Janne; Schmiegelow, Kjeld; Anderson, Brian J.; Ferreiròs, Nerea; Labocha, Sandra; Henneberg, Steen Winther

doi:10.1111/pan.12268

Cited by 44 publications

(16 citation statements)

References 47 publications

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“…Reid et al 16 described the single case of a 9-year-old boy with burns, who was administered 0.5 mg/kg of intranasal ketamine for transfer to hospital. Nielsen et al 17 reported an observational open-label study in which a mixture of intranasal ketamine (0.5 mg/kg) and sufentanil (0.5 mg/kg) was administered to children undergoing painful procedures such as drain removal or dressing changes. The primary outcome for that study was reduction of pain score to less than 5 of 10 during the procedures, and this was achieved in 78% of subjects.…”

Section: Discussionmentioning

confidence: 99%

The PICHFORK (Pain in Children Fentanyl or Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine and Fentanyl for the Relief of Moderate to Severe Pain in Children With Limb Injuries

Graudins

Meek

Egerton-Warburton

et al. 2015

Annals of Emergency Medicine

114

118

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Section: Discussionmentioning

confidence: 99%

The PICHFORK (Pain in Children Fentanyl or Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine and Fentanyl for the Relief of Moderate to Severe Pain in Children With Limb Injuries

Graudins

Meek

Egerton-Warburton

et al. 2015

Annals of Emergency Medicine

114

118

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“…Plasma concentrations after intranasal application (single dose 2 lg/kg) showed a C max 15-30 min after administration [129]. In another study, C max occurred 13.8 min after application and bioavailability was 24.6% [130].…”

Section: Transmucosal Sufentanilmentioning

confidence: 95%

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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“…Two separate studies found the topical application of tramadol and ketamine to be a safe, effective, and easy analgesic approach for decreasing post-tonsillectomy pain [71,72] . Nielsen [73] suggested that a sufentanil and ketamine nasal spray provides a rapid onset of analgesia for a variety of painful procedures with few adverse effects and has promising features for use in pediatric procedural pain management. A prospective, randomized, double-blind study that included patients from 1 to 5 years old, with burn areas up to 10% of total body surface area that required bedside wound care, showed that the combination of oral midazolam and ketamine provided better analgesia than the combination of midazolam, acetaminophen, and codeine [74] .…”

Section: Pediatric Usementioning

confidence: 99%

Ketamine use in current clinical practice

2016

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After nearly half a century on the market, ketamine still occupies a unique corner in the medical armamentarium of anesthesiologists or clinicians treating pain. Over the last two decades, much research has been conducted highlighting the drug's mechanisms of action, specifically those of its enantiomers. Nowadays, ketamine is also being utilized for pediatric pain control in emergency department, with its anti-hyperalgesic and anti-inflammatory effects being revealed in acute and chronic pain management. Recently, new insights have been gained on ketamine's potential anti-depressive and antisuicidal effects. This article provides an overview of the drug's pharmacokinetics and pharmacodynamics while also discussing the potential benefits and risks of ketamine administration in various clinical settings.

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Intranasal sufentanil/ketamine analgesia in children

Abstract: Sufentanil/ketamine nasal spray provided rapid onset of analgesia for a variety of painful procedures with few adverse effects and has promising features for use in pediatric procedural pain management.

Cited by 44 publications

References 47 publications

The PICHFORK (Pain in Children Fentanyl or Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine and Fentanyl for the Relief of Moderate to Severe Pain in Children With Limb Injuries

The PICHFORK (Pain in Children Fentanyl or Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine and Fentanyl for the Relief of Moderate to Severe Pain in Children With Limb Injuries

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

Ketamine use in current clinical practice

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