title: The clinical pharmacology of short acting analgo-sedatives in neonates.
abstract: Effective pain management remains an important indicator of the quality of care provided to neonates, not only from an ethical, but also from a clinical outcome perspective. Significant progresses in non-pharmacological therapies have been made. However - in the meanwhile - neonatal practice also evolved. These shifts in clinical care also induced in a shift in pharmacodynamic end points, and consequently, new pharmacological observations are needed with emphasis on short acting procedural analgo-sedatives. Analgo-sedation in neonates remains a balanced decision based on systematic assessment (pharmacodynamics, PD), followed by titrated administration of the most appropriate analgesic(s) (PK) with subsequent re-assessment (PD) to adapt and further titrate exposure and effects. In this review, we will focus on aspects of the clinical pharmacology (pharmacokinetics (PK) and -dynamics) of newly emerging, short acting analgo-sedatives (midazolam, propofol, remifentanil, inhalational agents, ketamine) in neonates. Based on the currently available information on predictability of disposition and the limited pharmacodynamic side effects (hemodynamics, neuro-apoptosis), it seems that remifentanil is the most promising compound for further evaluation.
authors.affiliation: Neonatal Intensive Care Unit, University Hospitals Leuven, Belgium. karel.allegaert@uz.kuleuven.ac.be
authors.forename: Karel
authors.initials: K
authors.lastname: Allegaert
mesh_terms: D000700:Analgesics / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology*; D018686:Anesthetics, Intravenous / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology; D000818:Animals; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology*; D007231:Infant, Newborn; D010146:Pain / Q000188:drug therapy*; D011787:Quality of Health Care; D013997:Time Factors
chemical_list: D000700:Analgesics; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives