The influence of cardiopulmonary bypass on pediatric pharmacokinetics

Saet, Annewil van; Tibboel, Dick

doi:10.1080/17425255.2023.2227556

Cited by 3 publications

(2 citation statements)

References 67 publications

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“…Another limitation of this study is that most patients started VCM after cardiac surgery (149 out of 152 patients). Therefore, the potential influence of cardiac surgery on VCM PK 47 could not be entirely distinguished from the effect of disease in this study and the influence of cardiac surgery may contribute to the decreased VCM CL. However, the covariate analyses indicated that the surgery-related parameters (i.e., post operative day (POD), with/without CPB, CPB time, and the lowest body temperature during CPB) did not influence VCM CL, suggesting the observed decreased VCM CL in this population is…”

Section: Dosing Simulation and Target Attainment Analysismentioning

confidence: 80%

Model‐Informed Vancomycin Dosing Optimization to Address Delayed Renal Maturation in Infants and Young Children with Critical Congenital Heart Disease

Shimamoto,

Fukushima,

Mizuno

et al. 2023

Clin Pharma and Therapeutics

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Ensuring safe and effective drug therapy in infants and young children often requires accounting for growth and organ development; however, data on organ function maturation are scarce for special populations, such as infants with congenital diseases. Children with critical congenital heart disease (CCHD) often require multiple staged surgeries depending on their age and disease severity. Vancomycin (VCM) is used to treat postoperative infections; however, the standard pediatric dose (60–80 mg/kg/day) frequently results in overexposure in children with CCHD. In this study, we characterized the maturation of VCM clearance in pediatric patients with CCHD and determined the appropriate dosing regimen using population pharmacokinetic (PK) modeling and simulations. We analyzed 1,254 VCM serum concentrations from 152 postoperative patients (3 days–13 years old) for population PK analysis. The PK model was developed using a two‐compartment model with allometrically scaled body weight, estimated glomerular filtration rate (eGFR), and postmenstrual age as covariates. The observed clearance in patients aged ≤ 1 year and 1–2 years was 33% and 40% lower compared with that of non‐CCHD patients, respectively, indicating delayed renal maturation in patients with CCHD. Simulation analyses suggested VCM doses of 25 mg/kg/day (age ≤ 3 months, eGFR 40 mL/min/1.73 m2) and 35 mg/kg/day (3 months < age ≤ 3 years, eGFR 60 mL/min/1.73 m2). In conclusion, this study revealed delayed renal maturation in children with CCHD, could be due to cyanosis and low cardiac output. Model‐informed simulations identified the lower VCM doses for children with CCHD compared with standard pediatric guidelines.

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Section: Dosing Simulation and Target Attainment Analysismentioning

confidence: 80%

Model‐Informed Vancomycin Dosing Optimization to Address Delayed Renal Maturation in Infants and Young Children with Critical Congenital Heart Disease

Shimamoto,

Fukushima,

Mizuno

et al. 2023

Clin Pharma and Therapeutics

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“…The highest blood levels are achieved after intercostal nerve block, while subcutaneous administration results in the lowest blood levels. LIDO crosses both the blood-brain and placental barriers, likely via passive diffusion [35][36][37][38][39][40][41][42][43][44][45][46][47][48].…”

Section: Pharmacology and Mechanism Of Actionmentioning

confidence: 99%

A Review of the Lidocaine in the Perioperative Period

Silva,

Mourão,

Vale

2023

JPM

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This review analyzes the controversies surrounding lidocaine (LIDO), a widely recognized local anesthetic, by exploring its multifaceted effects on pain control in the perioperative setting. The article critically analyzes debates about lidocaine’s efficacy, safety, and optimal administration methods. While acknowledging its well-documented analgesic attributes, the text highlights the ongoing controversies in its application. The goal is to provide clinicians with a comprehensive understanding of the current discourse, enabling informed decisions about incorporating lidocaine into perioperative protocols. On the other hand, emphasizes the common uses of lidocaine and its potential role in personalized medicine. It discusses the medication’s versatility, including its application in anesthesia, chronic pain, and cardiovascular diseases. The text recognizes lidocaine’s widespread use in medical practice and its ability to be combined with other drugs, showcasing its adaptability for individualized treatments. Additionally, it explores the incorporation of lidocaine into hyaluronic acid injections and its impact on pharmacokinetics, signaling innovative approaches. The discussion centers on how lidocaine, within the realm of personalized medicine, can offer safer and more comfortable experiences for patients through tailored treatments.

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