Pharmacokinetic considerations for pediatric patients receiving analgesia in the intensive care unit; targeting postoperative, ECMO and hypothermia patients
Language English Country England, Great Britain Media print-electronic
Document type Journal Article, Review
- Keywords
- ECMO, Pediatric, cardiac surgery, hypothermia, intensive care, pharmacodynamics, pharmacokinetics, population PK, post-operative,
- MeSH
- Analgesics administration & dosage pharmacokinetics MeSH
- Analgesia methods MeSH
- Pain drug therapy MeSH
- Child MeSH
- Intensive Care Units MeSH
- Cardiac Surgical Procedures methods MeSH
- Humans MeSH
- Extracorporeal Membrane Oxygenation methods MeSH
- Pain, Postoperative drug therapy MeSH
- Hypothermia, Induced methods MeSH
- Dose-Response Relationship, Drug MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Names of Substances
- Analgesics MeSH
Adequate postoperative analgesia in pediatric patients in the intensive care unit (ICU) matters, since untreated pain is associated with negative outcomes. Compared to routine postoperative patients, children undergoing hypothermia (HT) or extracorporeal membrane oxygenation (ECMO), or recovering after cardiac surgery likely display non-maturational differences in pharmacokinetics (PK) and pharmacodynamics (PD). These differences warrant additional dosing recommendations to optimize pain treatment. Areas covered: Specific populations within the ICU will be discussed with respect to expected variations in PK and PD for various analgesics. We hereby move beyond maturational changes and focus on why PK/PD may be different in children undergoing HT, ECMO or cardiac surgery. We provide a stepwise manner to develop PK-based dosing regimens using population PK approaches in these populations. Expert opinion: A one-dose to size-fits-all for analgesia is suboptimal, but for several commonly used analgesics the impact of HT, ECMO or cardiac surgery on average PK parameters in children is not yet sufficiently known. Parameters considering both maturational and non-maturational covariates are important to develop population PK-based dosing advices as part of a strategy to optimize pain treatment.
Division of Pharmacology LACDR Leiden University Leiden The Netherlands
e Department of Clinical Pharmacy St Antonius Hospital Nieuwegein The Netherlands
f Department of Development and Regeneration KU Leuven Leuven Belgium
References provided by Crossref.org
Drug Disposition and Pharmacotherapy in Neonatal ECMO: From Fragmented Data to Integrated Knowledge
