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Related Concept Videos

Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

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Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
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Parenteral Anesthetics: Overview01:24

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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

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Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
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Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

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Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
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Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

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In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
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Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

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In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
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A presedation fluid bolus does not decrease the incidence of propofol-induced hypotension in pediatric patients.

Matthew D Jager1, Jean C Aldag2, Girish G Deshpande3

  • 1Clinical Medicine and Pediatrics.

Hospital Pediatrics
|February 4, 2015
PubMed
Summary

A 20-mL/kg fluid bolus before propofol sedation did not prevent hypotension in children. Infants under one year required more propofol, but no signs of hypoperfusion were observed.

Keywords:
hypotensionpediatricspropofolsedation

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Area of Science:

  • Pediatric Anesthesiology
  • Pharmacology
  • Critical Care Medicine

Background:

  • Propofol is a common anesthetic agent for pediatric sedation.
  • Hypotension is a potential adverse effect of propofol induction.
  • Fluid administration is a potential strategy to mitigate propofol-induced hypotension.

Purpose of the Study:

  • To evaluate the efficacy of a preinduction isotonic fluid bolus in preventing propofol-induced hypotension in children.
  • To assess for clinical signs of hypoperfusion during induced hypotension.
  • To investigate age-related differences in propofol dosing.

Main Methods:

  • Prospective, randomized, controlled, nonblinded study design.
  • Inclusion of children aged 6–60 months undergoing sedation for MRI or auditory brainstem-evoked response testing.
  • Administration of a 20-mL/kg isotonic saline bolus prior to propofol induction in the treatment group.
  • Continuous cardiorespiratory monitoring, including pulse oximetry and end-tidal carbon dioxide.
  • Comparison of cardiovascular indices and hypoperfusion signs between groups.
  • Analysis of age-related propofol dosing variations.

Main Results:

  • No significant difference in the incidence of postinduction hypotension between the fluid bolus and control groups.
  • Hypotension occurred in 12 patients (23%) in the treatment group and 14 patients (19%) in the control group.
  • No physical signs of hypoperfusion were observed in any hypotensive patients.
  • Infants ≤12 months of age required significantly higher propofol doses per kilogram compared to older children.

Conclusions:

  • A 20-mL/kg preinduction isotonic fluid bolus is not effective in preventing propofol-induced hypotension in pediatric patients.
  • Induced hypotension during propofol sedation in this cohort was not associated with clinical signs of hypoperfusion.
  • Younger infants (≤12 months) require higher propofol dosages per unit of body weight for procedural sedation.