Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Feb 8:6:120.
doi: 10.12688/f1000research.10272.1. eCollection 2017.

A review of perioperative anesthesia and analgesia for infants: updates and trends to watch

Lizabeth D Martin  1 , Nathalia Jimenez  1 , Anne M Lynn  1
Affiliations
Review

A review of perioperative anesthesia and analgesia for infants: updates and trends to watch

Lizabeth D Martin et al. F1000Res. .

Abstract

This review focuses on pharmacokinetics and pharmacodynamics of opioid and non-opioid analgesics in neonates and infants. The unique physiology of this population differs from that of adults and impacts drug handling. Morphine and remifentanil are described as examples of older versus recently developed opiates to compare and contrast pharmacokinetics and pharmacodynamics in infants. Exploration of genetics affecting both pharmacokinetics and pharmacodynamics of opiates is an area of active research, as is the investigation of a new class of mu-opiate-binding agents which seem selective for analgesic pathways while having less activity in pathways linked to side effects. The kinetics of acetaminophen and of ketorolac as examples of parenteral non-steroidal analgesics in infants are also discussed. The growth in regional anesthesia for peri-operative analgesia in infants can fill an important role minimizing intra-operative anesthetic exposure to opioids and transitioning to post-operative care. Use of multi-modal techniques is recommended to decrease undesirable opiate-related side effects in this vulnerable population.

Keywords: neonatal and infant pharmacology; perioperative anesthesia and analgesia; pharmacodynamics; pharmacokinetics.

PubMed Disclaimer

Conflict of interest statement

Competing interests: The authors declare that they have no competing interests.No competing interests were disclosed.No competing interests were disclosed.

Figures

Figure 1.
Figure 1.. Morphine clearance (mL/min per kg) versus age in infants receiving morphine.
Reprinted with permission from Wolters Kluwer Health .
See this image and copyright information in PMC

References

    1. Behrman RE, Kliegman R, Jenson HB, editor: Nelson Textbook of Pediatrics.17 ed: Elselvier;2004. Reference Source
    1. Davis P, Cladis F, Motoyama E, editor: Smith's Anesthesia for Infants and Children.8 ed: Elsevier;2011. Reference Source
    1. Hughes MA, Glass PS, Jacobs JR: Context-sensitive half-time in multicompartment pharmacokinetic models for intravenous anesthetic drugs. Anesthesiology. 1992;76(3):334–41. 10.1097/00000542-199203000-00003 - DOI - PubMed
    1. Anderson BJ: Pediatric models for adult target-controlled infusion pumps. Paediatr Anaesth. 2010;20(3):223–32. 10.1111/j.1460-9592.2009.03072.x - DOI - PubMed
    1. Anderson BJ, Hodkinson B: Are there still limitations for the use of target-controlled infusion in children? Curr Opin Anaesthesiol. 2010;23(3):356–62. 10.1097/ACO.0b013e32833938db - DOI - PubMed

LinkOut - more resources