Morphine increases synchronous ventilation in preterm infants

Dyke, M; Kohan, Rolland; Evans, Sharon F.

doi:10.1111/j.1440-1754.1995.tb00780.x

Cited by 70 publications

(48 citation statements)

References 10 publications

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“…Sedation with midazolam and analgesia with morphine are commonly used and effective to obtain well-tolerated artificial ventilation in preterm infants [1,2] . However, adverse effects of both midazolam and morphine have been described.…”

Section: Introductionmentioning

confidence: 99%

Effects of Midazolam and Morphine on Cerebral Oxygenation and Hemodynamics in Ventilated Premature Infants

Velden¹,

Hopman²,

Klaessens³

et al. 2006

Neonatology

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Background: Midazolam sedation and morphine analgesia are commonly used in ventilated premature infants. Objectives: To evaluate the effects of midazolam versus morphine infusion on cerebral oxygenation and hemodynamics in ventilated premature infants. Methods: 11 patients (GA 26.6–33.0 weeks, BW 780–2,335 g) were sedated with midazolam (loading dose 0.2 mg/kg, maintenance 0.2 mg/kg/h) and 10 patients (GA 26.4–33.3 weeks, BW 842–1,955 g) were sedated with morphine (loading dose 0.05 mg/kg, maintenance 0.01 mg/kg/h). Changes in oxyhemoglobin (ΔcO₂Hb) and deoxyhemoglobin (ΔcHHb) were assessed using near infrared spectrophotometry. Changes in cHbD (= ΔcO₂Hb – ΔcHHb) reflect changes in cerebral blood oxygenation and changes in concentration of total hemoglobin (ΔctHb = ΔcO₂Hb + ΔcHHb) represent changes in cerebral blood volume (ΔCBV). Changes in cerebral blood flow velocity (ΔCBFV) were intermittently measured using Doppler ultrasound. Heart rate (HR), mean arterial blood pressure (MABP), arterial oxygen saturation (saO₂) and transcutaneous measured pO₂ (tcpO₂) and pCO₂ (tcpCO₂) were continuously registered. Statistical analyses were carried out using linear mixed models to account for the longitudinal character study design. Results: Within 15 min after the loading dose of midazolam, a decrease in saO_2,tcpO₂and cHbD was observed in 5/11 infants. In addition, a fall in MABP and CBFV was observed 15 min after midazolam administration. Immediately after morphine infusion a decrease in saO_2, tcpO₂and cHbD was observed in 6/10 infants. Furthermore, morphine infusion resulted in a persistent increase in CBV. Conclusions: Administration of midazolam and morphine in ventilated premature infants causes significant changes in cerebral oxygenation and hemodynamics, which might be harmful.

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Section: Introductionmentioning

confidence: 99%

Effects of Midazolam and Morphine on Cerebral Oxygenation and Hemodynamics in Ventilated Premature Infants

Velden¹,

Hopman²,

Klaessens³

et al. 2006

Neonatology

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“…Esta gran variabilidad ha podido ser detectada gracias a una recogida de datos en la cabecera del paciente; es muy probable que el uso de estas medicaciones no pudiese ser detectado en estudios tipo encuesta. De forma similar, Jenkins et al, en un estudio prospectivo de 338 pacientes pediátricos (incluyendo 39 neonatos) de 20 unidades en Reino Unido, reportan 24 fármacos sedantes o analgésicos distintos 32 . Es fácil concluir que estas diferencias entre unidades dificultan la comparación de resultados y el estudio de la S/A en nuestro país.…”

Section: Discussionunclassified

“…Nonetheless, the propensity score matching was used with the aim of minimising bias created by baseline characteristics. Discussion about opioid use in ventilated neonates include developmentally regulated pain sensitivity, clinical instability from acute pain or stress, unsynchronised breathing, and suboptimum ventilation, 32 and long-term eff ects on brain development. [33][34][35][36] A Cochrane review concluded that opioids reduce neonatal pain scores, and do not prolong ventilation, alter mortality or subsequent intelligence, motor function, or behaviour, 33 but evidence for the routine treatment of ventilated newborn babies with opioids is insuffi cient.…”

Section: Discussionmentioning

confidence: 99%

Manejo de la sedación y la analgesia en unidades de cuidados intensivos neonatales españolas

Ávila-Álvarez¹,

Carbajal²,

Courtois³

et al. 2015

Anales de Pediatría

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“…54,75,76,88,116,123,124 Numerous randomized, controlled trials have evaluated pain control in mechanically ventilated newborns, but many have been underpowered. 19,39,102,[125][126][127][128] Two recent appropriately powered studies enrolled a total of 1048 neonates and demonstrated no differences in the incidence of severe intraventricular hemorrhage, periventricular leukomalacia, or death outcomes between the ventilated infants who received morphine or placebo infusions. 122,124 Pain assessments during tracheal suctioning were unaltered in 1 trial 124 and minimally diminished in the other trial.…”

Section: Procedural Painmentioning

confidence: 99%

“…90,99 Future studies should examine the influence of administration of perioperative analgesics on the duration of assisted ventilation required, the timing of extubation, and overall respiratory function. [100][101][102] General anesthesia includes achieving unconsciousness (lack of implicit recall and lack of awareness of surgery), analgesia, suppression of autonomic responses to noxious stimuli, and immobility. Studies using general anesthesia in the pediatric age group need to address whether newer agents are safer in the short-term than existing agents and investigate their immediate and long-term postoperative outcomes.…”

Section: Procedural Painmentioning

confidence: 99%

Summary Proceedings From the Neonatal Pain-Control Group

et al. 2006

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Recent advances in neurobiology and clinical medicine have established that the fetus and newborn may experience acute, established, and chronic pain. They respond to such noxious stimuli by a series of complex biochemical, physiologic, and behavioral alterations. Studies have concluded that controlling pain experience is beneficial with respect to short-term and perhaps long-term outcomes. Yet, pain-control measures are adopted infrequently because of unresolved scientific issues and lack of appreciation for the need for control of pain and its long-term sequelae during the critical phases of neurologic maturation in the preterm and term newborn. The neonatal pain-control group, as part of the Newborn Drug Development Initiative (NDDI) Workshop I, addressed these concerns. The specific issues addressed were (1) management of pain associated with invasive procedures, (2) provision of sedation and analgesia during mechanical ventilation, and (3) mitigation of pain and stress responses during and after surgery in the newborn infant. The cross-cutting themes addressed within each category included (1) clinical-trial designs, (2) drug prioritization, (3) ethical constraints, (4) gaps in our knowledge, and (5) future research needs. This article provides a summary of the discussions and deliberations. Full-length articles on procedural pain, sedation and analgesia for ventilated infants, perioperative pain, and study designs for neonatal pain research were published in Clinical Therapeutics (June 2005).www.pediatrics.org/cgi

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Morphine increases synchronous ventilation in preterm infants

Cited by 70 publications

References 10 publications

Effects of Midazolam and Morphine on Cerebral Oxygenation and Hemodynamics in Ventilated Premature Infants

Effects of Midazolam and Morphine on Cerebral Oxygenation and Hemodynamics in Ventilated Premature Infants

Manejo de la sedación y la analgesia en unidades de cuidados intensivos neonatales españolas

Summary Proceedings From the Neonatal Pain-Control Group

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