• MeSH
• komplikace těhotenství MeSH
• lidé MeSH
• methadon škodlivé účinky   MeSH
• novorozenec MeSH
• novorozenecký abstinenční syndrom etiologie   terapie   MeSH
• závislost na heroinu komplikace   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH

• MeSH
• analgetika terapeutické užití   MeSH
• bolest farmakoterapie   MeSH
• dítě MeSH
• lidé MeSH
• novorozenec MeSH
• opium aplikace a dávkování   metabolismus   terapeutické užití   MeSH
• poruchy spojené s užíváním opiátů MeSH
• receptory opiátové fyziologie   metabolismus   MeSH
• tolerance léku MeSH
• závislost na morfiu aplikace a dávkování   farmakokinetika   terapeutické užití   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• novorozenec MeSH

BACKGROUND: Orofacial clefts are the most common congenital abnormalities. Cleft lip reconstruction is performed mostly in 3 months of life including the neonatal period. The consumption of opioids during anesthesia is one of the monitored parameters of anesthesia safety. We investigated the effect of using an infraorbital nerve block for reducing opioid consumption during cleft lip surgery in neonates. PATIENTS/METHODS: Overall, 100 patients who underwent primary cleft lip surgery in neonatal age between 2018 and 2021 were included in the study. The primary outcome was to compare opioid requirements during cleft lip surgery with and without using regional anesthesia. Secondary outcomes included a first oral intake from surgery between neonates with and without regional anesthesia and complications rate of infraorbital nerve block. RESULTS: Data from 100 patients (46 patients with and 64 without regional anesthesia) were retrospectively analyzed and classified into two groups according to whether regional anesthesia during neonatal cleft lip surgery had been performed or not. The use of infraorbital block was found to be positively correlated with lower doses of opioids used during the general anesthesia for the surgery (mean 0.48 μg/kg vs 0.29 μg/kg, p < 0.05). The postoperative course was evaluated based on the interval from surgery to first oral intake which was statistically insignificant shorter (p = 0.16) in the group of patients using regional anesthesia. No complications were recorded in the group of patients with regional anesthesia. CONCLUSIONS: Regional anesthesia is associated with reduced opioid consumption during anesthesia thereby increasing the safety of anesthesia in neonates. GOV IDENTIFIER: NCT06067854https://clinicaltrials.gov/study/NCT06067854?cond=NCT06067854&rank=1.

• MeSH
• lidé MeSH
• nervová blokáda * metody   MeSH
• novorozenec MeSH
• opioidní analgetika * terapeutické užití   MeSH
• pooperační bolest farmakoterapie   prevence a kontrola   MeSH
• retrospektivní studie MeSH
• rozštěp patra * chirurgie   MeSH
• rozštěp rtu * chirurgie   MeSH
• svodná anestezie * metody   MeSH
• zákroky plastické chirurgie metody   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• analgosedace metody   MeSH
• dítě MeSH
• flunitrazepam aplikace a dávkování   terapeutické užití   MeSH
• lidé MeSH
• novorozenec nedonošený MeSH
• novorozenec MeSH
• opioidní analgetika aplikace a dávkování   terapeutické užití   MeSH
• vysokofrekvenční ventilace MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• přehledy MeSH
• srovnávací studie MeSH

INTRODUCTION: Sufentanil is a potent synthetic opioid used for analgesia in neonates; however, data concerning drug disposition of sufentanil and dosage regimen are sparse in this population. Therefore, the aim of the study was to explore sufentanil disposition and to propose optimal loading and maintenance doses of sufentanil in ventilated full-term neonates. METHODS: Individual sufentanil pharmacokinetic parameters were calculated based on therapeutic drug monitoring data using a 2-compartmental model. Linear regression models were used to explore the covariates. RESULTS: The median (IQR) central volume of distribution (Vdc) and clearance (CL) for sufentanil were 4.7 (4.1-5.4) L/kg and 0.651 (0.433-0.751) L/h/kg, respectively. Linear regression models showed relationship between Vdc (L) and GA (r2 = 0.3436; p = 0.0452) as well as BW (r2 = 0.4019; p = 0.0268). Median optimal sufentanil LD and MD were 2.13 (95% CI: 1.78-2.48) μg/kg and 0.29 (95% CI: 0.22-0.37) μg/kg/h, respectively. Median daily COMFORT-B (IQR) scores ranged from 6 to 23 while no significant relationship between pharmacokinetic parameters and COMFORT-B scores was found. DISCUSSION/CONCLUSION: Body weight and gestational age were found as weak covariates for sufentanil distribution, and the dosage regimen was developed for a prospective trial.

• MeSH
• biologické modely * MeSH
• gestační stáří MeSH
• lidé MeSH
• monitorování léčiv metody   MeSH
• novorozenec MeSH
• opioidní analgetika aplikace a dávkování   farmakokinetika   MeSH
• retrospektivní studie MeSH
• sufentanil aplikace a dávkování   farmakokinetika   MeSH
• tělesná hmotnost MeSH
• tkáňová distribuce MeSH
• umělé dýchání * MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

BACKGROUND AND AIMS: Dexmedetomidine and remifentanil use in obstetric general anesthesia is controversial. This study aimed to compare the effects of remifentanil and dexmedetomidine on mothers and neonates during cesarean section under general anesthesia. METHODS: A total of 120 patients scheduled for elective cesarean section under general anesthesia were randomly allocated to dexmedetomidine (D), remifentanil (R), and control (C) groups. Anesthesia was induced with propofol and muscle relaxants in all groups. Anesthesia in groups D and R was induced with dexmedetomidine (induction, 0.5 µg/kg; maintenance, 0.5 µg/kg.h) and remifentanil (induction, 0.5 µg/kg; maintenance, 2 µg/kg.h), respectively, until birth. Group C received equivalent volumes of normal saline. Mean arterial blood pressure (MAP), heart rate (HR), plasma catecholamine, visual analog pain score (VAS), and total tramadol consumption at 1, 2, and 3 hours after extubation were recorded. Neonatal effects were assessed by Apgar scores and umbilical blood gas analysis. RESULTS: Post induction, MAP was significantly higher in group D compared to groups C and R, and significantly lower in group R than in group C. At intubation/skin incision and delivery, MAP, HR, and plasma epinephrine and norepinephrine concentrations were significantly lower in groups D and R than in group C. Compared to group R, MAP was significantly higher, and HR, plasma epinephrine, and norepinephrine concentrations were significantly lower in group D. Compared with groups C and D, the percentage of neonates with Apgar score < 7 was higher in group R at 1 min after delivery. Compared with groups C and R, the VAS was significantly lower in group D at 1 and 2 h postoperatively. Total tramadol consumption was significantly lower in group D at 3 hours postoperatively. CONCLUSION: During general anesthesia for cesarean section, remifentanil demonstrated better control of hemodynamic stability, while dexmedetomidine demonstrated better neonatal Apgar scores, postoperative analgesia, and decreased catecholamine release. TRIAL REGISTRATION: Chinese Clinical Trial Register (ChiCTR) - ChiCTR1800017125.

• MeSH
• celková anestezie metody   MeSH
• císařský řez metody   MeSH
• dexmedetomidin aplikace a dávkování   MeSH
• dospělí MeSH
• hypnotika a sedativa aplikace a dávkování   MeSH
• lidé MeSH
• matky MeSH
• novorozenec MeSH
• opioidní analgetika aplikace a dávkování   MeSH
• remifentanil aplikace a dávkování   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

Background: Intravenous paracetamol added to morphine reduces postoperative morphine consumption in (near)term neonates. However, there are only sparse data on intravenous paracetamol as multimodal strategy in extremely low birth weight (ELBW) neonates. Objectives: This study aims to assess the effects of rescue intravenous paracetamol on postoperative pain management (≤48 h postoperatively) in relation to both analgesic efficacy (validated pain assessment, drug consumption, adequate rescue medication) and safety (hypotension and bradycardia). This rescue practice was part of a standardized pain management approach in a single neonatal intensive care unit (NICU). Methods: A single-center retrospective observational study included 20 ELBW neonates, who underwent major abdominal surgery. The primary endpoints of the postoperative study period were pain intensity, over-sedation, time to first rescue analgesic dose, and the effect of paracetamol on opiate consumption. Secondary endpoints were safety parameters (hypotension, bradycardia). And as tertiary endpoints, the determinants of long-term outcome were evaluated (i.e., duration of mechanical ventilation, intraventricular hemorrhage - IVH, periventricular leukomalacia - PVL, postnatal growth restriction, stage of chronic lung disease - CLD or neurodevelopmental outcome according to Bayley-II Scales of Infant Development at 18-24 months). Results: All neonates received continuous opioids (sufentanil or morphine) and 13/20 also intravenous paracetamol as rescue pain medication during a 48-h postoperative period. Although opioid consumption was equal in the non-paracetamol and the paracetamol group over 48 h, the non-paracetamol group was characterized by oversedation (COMFORTneo < 9), a higher incidence of severe hypotension, and younger postnatal age (p < 0.05). All long-term outcome findings were similar between both groups. Conclusions: Our study focused on postoperative pain management in ELBW neonates, and showed that intravenous paracetamol seems to be safe. Prospective validation of dosage regimens of analgesic drugs is needed to achieve efficacy goals.

• Publikační typ
• časopisecké články MeSH

There is lack of knowledge about the safety of treatment with methadone and buprenorphine as part of opioid maintenance treatment (OMT) during pregnancy. The purpose of this study was to examine neonatal outcomes concerning the use of OMT during pregnancy. We used nationwide registry linkages from the Czech Republic (2000-2014) and Norway (2004-2013). We compared prenatally OMT-exposed newborns with (a) newborns of women hospitalized with opioid use disorder during pregnancy in the Czech sample and (b) newborns with neonatal abstinence syndrome (NAS) in Norway. We performed multivariate linear and binary logistic regression exploring the associations between OMT and neonatal outcomes (growth parameters, gestational age, fetal death, small for gestational age, Apgar score, and NAS). Regression coefficients (b) and odds ratios (ORs) were estimated. The cohorts consisted of 333 Czech, and 235 Norwegian OMT-exposed newborns, and 106 and 294 newborns in the comparison groups, respectively. In both countries, the neonatal growth parameters were similar in the OMT and the comparison groups. In Norway, OMT exposure prolonged gestational age (adjusted b = 0.96 weeks, 95% confidence interval [CI] =0.39-1.53) while the odds of preterm birth and Apgar score at 5 minutes were lower than in the comparison group (adjusted OR = 0.35, 0.16-0.75 and aOR = 0.21, 0.06-0.78, respectively). Newborns of women in OMT had similar growth parameters as newborns of women with opioid use disorders who were not in OMT during pregnancy. Overall, our findings do not suggest that OMT results in worse neonatal outcomes.

• MeSH
• buprenorfin terapeutické užití   MeSH
• dospělí MeSH
• komplikace těhotenství farmakoterapie   MeSH
• lidé MeSH
• logistické modely MeSH
• methadon terapeutické užití   MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• novorozenecký abstinenční syndrom epidemiologie   MeSH
• opiátová substituční terapie MeSH
• poruchy spojené s užíváním opiátů farmakoterapie   MeSH
• registrace MeSH
• těhotenství MeSH
• vývoj dítěte MeSH
• zpožděný efekt prenatální expozice epidemiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Norsko MeSH

Bolestivé výkony sú súčasťou intenzívnej starostlivosti o nedonosených a kriticky chorých novorodencov. Bolesť v novorodeneckom veku má nepriaznivé krátkodobé aj dlhodobé následky na vývoj jedinca. Z toho dôvodu majú byť bolestivé procedúry minimalizované, a ak nejde o urgentné, život zachraňujúce výkony, výkony majú byť dôsledne naplánované s ohľadom na analgetickú prípravu. Prejavy bolesti je potrebné u hospitalizovaných novorodencov sledovať, bolesť má byť systematicky hodnotená spoľahlivým skórovacím systémom. Pri každej potenciálne bolestivej procedúre má byť zabezpečená adekvátna prevencia a redukcia bolesti s ohľadom na aktuálne literárne údaje, typ výkonu a charakteristiky konkrétneho novorodenca. Nefarmakologické stratégie kontroly bolesti by mali byť používané vždy, keď je to možné. Ak sú indikované farmakologické intervencie, je vhodné kombinovať ich s nefarmakologickými. Obavy z nežiaducich účinkov liekov nemajú viesť k tolerancii procedurálnej bolesti. Je však dôležité pamätať na zraniteľnosť vyvíjajúceho sa organizmu zo širšej a dlhodobej perspektívy.

Painful procedures are unavoidable in care of preterm and critically ill neonates in the NICU. Neonatal pain has the potential for shortterm and long-term adverse sequelae. Therefore, the number of painful procedures should be controlled to the minimum. If a procedure is not urgent and life-saving, it has to be carefully planned, deciding for appropriate pain control strategies. Pain indicators have to be monitored, it is essential to use reliable pain assessment tools. Novel evidence, type of procedure and infant’s characteristics have to be considered in order to prevent and reduce procedural pain adequately. Nonpharmacological techniques to control pain should be employed whenever possible. When pharmacological strategies are being administered, it is effective to combine them with nonpharmacological methods. Fear of medications' adverse effects should not result in tolerance of procedural pain in neonates. However, vulnerability of neonatal organism and long-term neurodevelopmental outcome have to be kept in mind.

• MeSH
• intenzivní péče o novorozence MeSH
• lidé MeSH
• měření bolesti MeSH
• neopioidní analgetika aplikace a dávkování   terapeutické užití   MeSH
• novorozenec nedonošený * MeSH
• novorozenec MeSH
• opioidní analgetika aplikace a dávkování   terapeutické užití   MeSH
• procedurální bolest * farmakoterapie   prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• novorozenec MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: Remifentanil has been suggested for its short duration of action to replace standard opioids for induction of general anaesthesia in caesarean section. While the stabilizing effect of remifentanil on maternal circulation has been confirmed, its effect on postnatal adaptation remains unclear, as currently published studies are not powered sufficiently to detect any clinical effect of remifentanil on the newborn. METHODS: Using a double-blinded randomized design, a total of 151 parturients undergoing caesarean delivery under general anaesthesia were randomized into two groups--76 patients received a bolus of remifentanil prior to induction, while 75 patients were assigned to the control group. Remifentanil 1 μg/kg was administered 30 seconds before the standard induction of general anaesthesia. The primary outcome measure was an assessment of neonatal adaptation using the Apgar score, while secondary outcomes included the need for respiratory support after delivery and differences in umbilical blood gas analysis (Astrup). RESULTS: The incidence of lower Apgar scores between 0 and 7 was significantly higher in the remifentanil group at one minute (25% vs. 9.3% of newborns, p = 0.017); whilst at five minutes and later no Apgar score differences were observed. There was no difference in the need for moderate (nasal CPAP) or intensive (intubation) respiratory support, but significantly more neonates in the remifentanil group required tactile stimulation for breathing support (21% vs. 7% of newborns, p = 0.017). There was no difference in the parameters from umbilical cord blood gas analysis between the groups. CONCLUSION: At a dose of 1 μg/kg, remifentanil prior to induction of general anaesthesia increases the risk of neonatal respiratory depression during first minutes after caesarean delivery but duration of clinical symptoms is short. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01550640.

• MeSH
• anestetika celková škodlivé účinky   MeSH
• Apgar skóre MeSH
• celková anestezie škodlivé účinky   MeSH
• císařský řez * MeSH
• dospělí MeSH
• dvojitá slepá metoda MeSH
• fyziologická adaptace účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• opioidní analgetika škodlivé účinky   MeSH
• piperidiny škodlivé účinky   MeSH
• poruchy dýchání chemicky indukované   MeSH
• prospektivní studie MeSH
• těhotenství MeSH
• umělé dýchání MeSH
• výsledek těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH