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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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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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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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Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

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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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The enteral drug administration involves three primary routes: oral, sublingual, and buccal. Oral ingestion is the most prevalent, safe, economical, and convenient method for drug administration. However, it has certain drawbacks, including limited absorption due to the drug's low water solubility or poor membrane permeability, possible emesis from GI mucosa irritation, destruction of drugs by digestive enzymes or low gastric pH, and irregular absorption along with food or other drugs.
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Area of Science:

  • Pediatric Critical Care Medicine
  • Pharmacology
  • Neonatology

Background:

  • Fentanyl, an opioid analgesic, is frequently used for pain management in critically ill children.
  • Its use during extracorporeal membrane oxygenation (ECMO) is cautioned against due to lipophilic properties increasing withdrawal risks.
  • Understanding institutional variation in fentanyl use for pediatric ECMO patients is crucial.

Purpose of the Study:

  • To evaluate institutional variations in fentanyl administration for children undergoing ECMO.
  • To identify factors associated with fentanyl prescribing patterns in this vulnerable population.

Main Methods:

  • Retrospective study of children (<18 years) on ECMO from 2016-2023.
  • Data sourced from the Pediatric Health Information System.
  • Multivariable hierarchical logistic regression analyzed factors linked to fentanyl use.

Main Results:

  • 91.9% of 7731 children received fentanyl during ECMO, with significant institutional variability (13.4%-100%).
  • Hospital differences accounted for 20.3% of variation in fentanyl use.
  • Neonates (OR 2.35) and children with cardiovascular disease (OR 1.63) had higher odds of fentanyl use; premature infants had lower odds (OR 0.50).

Conclusions:

  • Fentanyl remains prevalent in pediatric ECMO despite recognized risks.
  • Significant institutional variation in fentanyl use exists, with neonates being most exposed.
  • Enhanced guidelines for sedation and pain management in pediatric ECMO are urgently needed.