Pharmacokinetics and Pharmacology of Drugs Used in Children

Anderson, Brian J.; Lerman, Jerrold; Coté, Charles J.

doi:10.1016/b978-0-323-42974-0.00007-0

Cited by 11 publications

(19 citation statements)

References 1,863 publications

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“…Literature data in infants and children indicate that sleep latency time is about 20 ± 10 minutes and patients wake up after 60 ± 32 minutes. [29][30][31][32] The 1-sample t-test applied on the time to achieve sedation showed that the average results obtained are significantly lower from the reference value (p < 0.05). This can be explained by the weight and average age of our sample which is less elevated than the panel used in previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, sedation was effective after the first dose in 94% of patients. Literature data in infants and children indicate that sleep latency time is about 20 ± 10 minutes and patients wake up after 60 ± 32 minutes [29][30][31][32] pain and amount of sedative and analgesic drugs use in opium addicted critically ill patients. In a prospective, randomized, controlled trial from September 2011 to June 2012, this study has been conducted in Kerman, Iran.…”

Section: Discussionmentioning

confidence: 99%

“…8,33,42 Administration of CH at repeated doses is not recommended because of the risk of accumulation of metabolites causing renal toxicity and metabolic acidosis resulting from their interferences with the binding of bilirubin to albumin. 31 In newborns, the half-life of the trichlorethanol, the active metabolite of CH, increases. Short-Term sedation with a single dose of 20 to 75 mg/kg is considered relatively safe, but its repeated administration carries a risk of serious toxicity 8,9,43 with patient demographics, sedation dose, comorbidities, time to discharge, and side effects of sedation noted.…”

Section: Discussionmentioning

confidence: 99%

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Clinical and Stability Assessment of Chloral Hydrate Syrup for Sedation in Pediatrics

Omar¹,

Yacine²,

Karim³

et al. 2022

IJDDT

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To develop a stable chloral hydrate (CH) syrup and to test its clinical efficacy in inducing painless sedation during diagnostic imaging examinations in children under 4 years of age. For the physico-chemical tests, the vials were stored at + 5 and + 25°C and the analysis was carried out for 60 days. The microbiological tests were performed in 4 days of analysis. The prospective clinical study was conducted in 33 infants and children after receiving CH syrup orally for sedation prior to magnetic resonance imaging (MRI). After two months of storage, the average concentrations in all tests were greater than 95% of the initial chloral hydrate concentration. No microbiological growth was noted after 60 days of storage. The clinical use of syrup in children resulted in effective sedation in 100% of children and rare side effects. Compared to midazolam, chloral hydrate is more effective for sedating children under 5 years of age and is significantly less expensive. The prescription of 5% CH syrup for sedation prior to imaging diagnosis has well-established efficacy. However, the safe use of chloral hydrate in infants and children under 5 years of age should be in accordance with international recommendations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical and Stability Assessment of Chloral Hydrate Syrup for Sedation in Pediatrics

Omar¹,

Yacine²,

Karim³

et al. 2022

IJDDT

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“…The effect-site partial pressure is estimated as the plasma effect-site equilibration rate constant (k e0 ) and the time for equilibration of anesthetic partial pressures is estimated by computing the time constant for equilibration in the tissue. [ 20 21 ] The predictable depth of anesthesia can be measured as the end-tidal concentration, under steady-state conditions. Thus, inhalational anesthesia is clinically achievable by closely observing and titrating the end-tidal concentration of the volatile anesthetic once equilibration between the alveolar and blood concentration occurs.…”

Section: Discussionmentioning

confidence: 99%

EC₅₀ of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial

Sethi

Goel

Ghai

et al. 2020

J Anaesthesiol Clin Pharmacol

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Background and Aims: Literature documents EC 50 (End-tidal) of sevoflurane for CLMA (Classic Laryngeal Mask airway) insertion between 1.5 and 2% and most of these studies suggest maintaining the required end-tidal sevoflurane concentration for 10-25 minutes before LMA insertion. Waiting for this long interval for blood brain sevoflurane equilibration may not be feasible in children especially during failed ventilation. We aimed to estimate EC 50 of sevoflurane for CLMA insertion at equilibration time points of 2.5 min and 5.0 min. Material and Methods: In this randomized trial, children aged 2_8 years of either sex having American Society of Anesthesiologists status I undergoing elective cataract surgery were included. After inhalational induction of general anesthesia with 8% sevoflurane and 100% oxygen, intravenous cannulation was secured. The sevoflurane vaporizer was finely adjusted to maintain an end-tidal sevoflurane concentration at 2% for 2.5 min for first child in group 2.5 and 5 min in group 5.0. This was followed by LMA insertion which was considered to be unsuccessful if there was “movement” and successful if “no movement” occurred. End-tidal concentration was increased/decreased (step-size 0.2%) using Dixon and Massey up and down method in the next patient depending upon the previous patient's response. Results: EC 50 of sevoflurane for insertion of classic LMA in children aged 2-8 yrs in 100% oxygen was 1.1% (0.9-1.2) at 2.5 min and 1.6% (1.5-1.7) at 5.0 min. Derived EC 95 (95% CI) at 2.5 min was 1.8% (1.5-9.2) and at 5.0 min was 1.8% (1.4-8.8) respectively. Conclusion: We suggest maintaining end-tidal sevoflurane of 1.6% for 2.5 min and 1.8% for 5 min for successful CLMA insertion.

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“…It has various effects on the other systems in the body some of which are listed in Table 4. Adverse reactions associated with ketamine include dreams, hallucinations, delirium, agitation, vomiting, increased salivation, and laryngospasm [7]. It causes increase in intraocular and intracranial pressures after its administration.…”

Section: Clinical Effects Of Ketaminementioning

confidence: 99%

Uses of Ketamine in the Paediatric Population

Ramesh¹

2022

Ketamine Revisited - New Insights Into NMDA Inhibitors

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General anesthesia in pediatric patients can vary from light sedation to complete anesthesia with unconsciousness, amnesia and muscle relaxation. A wide variety of procedures are done under general anesthesia in children ranging from surgeries done for correction of congenital defects, cardiac surgeries, scoliosis surgery, hernia surgery etc. to procedures done outside the operating room (OR) for diagnostic and therapeutic purposes. Non-Operating room Anesthesia (NORA) may include painless procedures like CT scan, MRI, radiotherapy for cancer treatment etc. or painful procedures like biopsy, lumbar puncture, securing IV access, insertion of central line etc. done in ICU which requires a cooperative child. Ketamine has an important role in the pediatric population, both as an induction agent and as a sedative-analgesic drug especially in countries where newer drugs are not readily available. Ketamine helps to alleviate separation anxiety. Even procedures done under regional techniques in some older children require use of sedation. Ketamine can be administered through various routes-IV, IM, intranasal etc. It can be used along with other groups of drugs like Benzodiazepines, Barbiturates, Alpha 2 agonists, Propofol etc. Thus Ketamine is a versatile drug with various indications for use in the pediatric population which will be discussed in the current chapter.

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Pharmacokinetics and Pharmacology of Drugs Used in Children

Cited by 11 publications

References 1,863 publications

Clinical and Stability Assessment of Chloral Hydrate Syrup for Sedation in Pediatrics

Clinical and Stability Assessment of Chloral Hydrate Syrup for Sedation in Pediatrics

EC₅₀ of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial

Uses of Ketamine in the Paediatric Population

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Pharmacokinetics and Pharmacology of Drugs Used in Children

Cited by 11 publications

References 1,863 publications

Clinical and Stability Assessment of Chloral Hydrate Syrup for Sedation in Pediatrics

Clinical and Stability Assessment of Chloral Hydrate Syrup for Sedation in Pediatrics

EC50 of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial

Uses of Ketamine in the Paediatric Population

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EC₅₀ of sevoflurane for classic laryngeal mask airway insertion in children at different time points: A randomized blind trial