Randomised Trial of Fentanyl Anaesthesia in Preterm Babies Undergoing Surgery: Effects on the Stress Response

Anand, K.J.S.; Sippell, W.G.; Green, A.Aynsley

doi:10.1016/s0140-6736(87)90065-1

Cited by 490 publications

(169 citation statements)

References 20 publications

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“…Because there was no difference in the degree of decrease in MAP at MAC CVR50 among the four age groups, release of catecholamines by skin incision or the cardiac response to adrenergic stimuli might be depressed more with halothane in children of 1-3 yr. Cardiovascular and neuroendocrine responses elicited by surgical stress may affect the incidence of postoperative complications in adults and neonates. [24][25][26] In the present infants and children, although we determined MAC CVR50 using > 10% increase of MAP and HR as an all-or-none positive response, the anaesthetic requirement should also be reassessed with regards to postoperative outcome.…”

Section: Discussionmentioning

confidence: 99%

Halothane concentrations required to block the cardiovascular responses to incision (MAC CVR) in infants and children

Ishizawa

Dohi

1993

Can J Anaesth

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The purpose of this study was to determine the halothane concentration in N20 required to block the cardiovascular responses to skin incision (MAC CVR) L16 + 0.23% at I-6 too, L17 5: 0.18% at 7-12 too, 0.95 + 0.26% at 1-3 yr, and L12 5: 0.16% at 4-7 Age-related changes in autonomic activity in children under anaesthesia have not been well studied. Roizen et al. z suggested the concept of MAC BAR, the concentration required to block adrenergic responses to incision in 50% of subjects. They assessed the depth of anaesthesia by measuring changes of plasma norepinephrine concentration. Although the MAC values for inhalational anaesthetic agents are higher in infants and children than in adults and they decrease in an age-related fashion, 2s there are no reports of the anaesthetic concentration required to block the adrenergic responses to surgical stimulation in children. Therefore, we studied the anaesthetic concentration to block cardiovascular responses to skin incision (MAC CVR) in 64 infants and children aged between one month and seven years during halothanenitrous oxide (N20) anaesthesia. CAN J ANAESTH 1993 / 40: I / pp 18-23

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Section: Discussionmentioning

confidence: 99%

Halothane concentrations required to block the cardiovascular responses to incision (MAC CVR) in infants and children

Ishizawa

Dohi

1993

Can J Anaesth

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“…There is now good evidence that the newborn infant feels and responds to pain stimuli in a similar manner to an adult, with an acute stress response that is readily detected as hormonal and metabolic changes [1,2]. Recent work has shown the benefit of administering morphine or diamorphine to the neonate to provide effective and safe analgesia or sedation [3,4].…”

Section: Introductionmentioning

confidence: 99%

The pharmacokinetics and physiological effects of buprenorphine infusion in premature neonates.

Simpson

Rutter

Kurihara-Bergstrom

et al. 1993

Brit J Clinical Pharma

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1. The pharmacokinetics and physiological effects of buprenorphine were studied in 12 newborn premature neonates (27 to 32 weeks gestational age) who were given a loading dose of 3.0 micrograms kg‐1 of buprenorphine followed by an intravenous infusion of 0.72 micrograms kg‐ 1 h‐1 of buprenorphine. Plasma concentrations of buprenorphine were measured during the infusion, at steady‐state and for 24 h after the cessation of the buprenorphine infusion. 2. The mean steady‐state plasma buprenorphine concentration (+/‐ s.d.) for an infusion rate of 0.72 micrograms kg‐1 h‐1 was 4.3 +/‐ 2.6 ng ml‐1. 3. Buprenorphine clearance was 0.23 +/‐ 0.07 l h‐1 kg‐1, the elimination half‐life was 20 +/‐ 8 h and the volume of distribution was 6.2 +/‐ 2.11 l kg‐1. 4. Small but significant falls were noted in systolic blood pressure at 6 h and heart rate at 1, 6 and 12 h after the administration of buprenorphine, but these did not appear to cause any clinical deterioration. 5. Four of the 12 subjects studied required an increase in the infusion rate of buprenorphine to achieve adequate sedation. 6. The results suggest that this dosing regimen of buprenorphine is safe but may not be as effective as other opioids in producing sedation and analgesia in premature newborns.

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“…Simple unconsciousness with immobility, typically employed when using the classical Liverpool technique, would not be our ideal goal. Anand's [2] study clearly showed that simple hypnosis might not be enough to blunt a stress response and might result in an adverse outcome in neonatal surgical patients.…”

mentioning

confidence: 99%

The cutting edge of neonatal anesthesia: the tide of history is changing

Kuratani

2014

J Anesth

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Randomised Trial of Fentanyl Anaesthesia in Preterm Babies Undergoing Surgery: Effects on the Stress Response

Cited by 490 publications

References 20 publications

Halothane concentrations required to block the cardiovascular responses to incision (MAC CVR) in infants and children

Halothane concentrations required to block the cardiovascular responses to incision (MAC CVR) in infants and children

The pharmacokinetics and physiological effects of buprenorphine infusion in premature neonates.

The cutting edge of neonatal anesthesia: the tide of history is changing

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