Anesthesia and analgesia during and after surgery in neonates.
BACKGROUND
Historically, the use of anesthetics and analgesics in neonates and infants has been based on extrapolations from studies performed in adults and older children. Over the past 20 years, there has been a growing body of research on the clinical pharmacology and clinical outcomes of these agents in neonates and infants.


OBJECTIVE
This article summarizes clinical pharmacology and clinical outcomes studies of opioids, opioid antagonists, sedative-hypnotics, nonsteroidal anti-inflammatory drugs and acetaminophen, and local anesthetics in neonates and infants to highlight gaps in the available knowledge, review some concerns about study design, and identify drugs that should receive high priority for future study.


METHODS
Relevant studies were identified through a search of MEDLINE and a review of textbooks, conference proceedings, and abstracts. The available literature was subjected to expert committee-based review.


CONCLUSIONS
There is a growing body of information on analgesic and anesthetic pharmacokinetics, pharmacodynamics, and clinical outcomes in neonates and infants, permitting safe and effective use in some clinical settings. Major gaps in knowledge persist, however. Future research may involve a combination of clinical trials and preclinical studies in suitable infant animal surrogate models.
Berde
Charles B
CB
Department of Anaesthesia, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA. charles.berde@childrens.harvard.edu
Jaksic
Tom
T
Lynn
Anne M
AM
Maxwell
Lynne G
LG
Soriano
Sulpicio G
SG
Tibboel
Dick
D
D000698:Analgesia / Q000379:methods* / Q000639:trends; D000758:Anesthesia / Q000379:methods* / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007432:Intraoperative Period; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*