title: Analgesics, sedatives, anticonvulsant drugs, and the cooled brain.
abstract: Multiple randomized controlled trials have shown that prolonged, moderate cerebral hypothermia initiated within a few hours after severe hypoxia-ischemia and continued until resolution of the acute phase of delayed cell death reduces mortality and improves neurodevelopmental outcome in term infants. The challenge is now to find ways to further improve outcomes. In the present review, we critically examine the evidence that conventional analgesic, sedative, or anticonvulsant agents might improve outcomes, in relation to the known window of opportunity for effective protection with hypothermia. This review strongly indicates that there is insufficient evidence to recommend routine use of these agents during therapeutic hypothermia. Further systematic research into the effects of pain and stress on the injured brain, and their treatment during hypothermia, is essential to guide the rational development of clinical treatment protocols.
authors.affiliation: Department of Physiology, University of Auckland, Auckland, New Zealand.
authors.forename: Guido
authors.initials: G
authors.lastname: Wassink
authors.affiliation: Department of Physiology, University of Auckland, Auckland, New Zealand.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Lear
authors.affiliation: Department of Physiology, University of Auckland, Auckland, New Zealand.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Gunn
authors.affiliation: Department of Physiology, University of Auckland, Auckland, New Zealand.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Dean
authors.affiliation: Department of Physiology, University of Auckland, Auckland, New Zealand.
authors.forename: Laura
authors.initials: L
authors.lastname: Bennet
authors.affiliation: Department of Physiology, University of Auckland, Auckland, New Zealand. Electronic address: aj.gunn@auckland.ac.nz.
authors.forename: Alistair J
authors.initials: AJ
authors.lastname: Gunn
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000627:therapeutic use*; D001238:Asphyxia Neonatorum / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D002658:Developmental Disabilities / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D007231:Infant, Newborn
chemical_list: D000700:Analgesics; D000927:Anticonvulsants; D006993:Hypnotics and Sedatives
keywords: Analgesia; Anticonvulsant therapy; Hypoxic–ischemic encephalopathy; Sedation