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.
Highlights
This article begins by highlighting the features of neonatal and infant physiology that differ from those of adults and impact drug handling
Morphine and remifentanil will be used as examples of older versus recently developed opiates to compare and contrast pharmacokinetics in infants
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 is a new area with clinical studies beginning in adults; this constitutes an important area to follow
Summary
This article begins by highlighting the features of neonatal and infant physiology that differ from those of adults and impact drug handling. Morphine and remifentanil will be used as examples of older versus recently developed opiates to compare and contrast pharmacokinetics in infants The pharmacodynamics of these agents is important to consider in this vulnerable group. Higher doses of TRV130 (4 mg) produced less respiratory depression than morphine but were associated with increased reports of nausea and headache Another molecule recently identified, PZM21, shows selective activation of the G-protein pathway with a better side effect profile compared with TRV130 in rodents[70]. They included 158 neonates (58 prematurely born) from four studies with 943 acetaminophen concentration Cl from this larger group of infants was 5 L/hour per 70 kg, and adult Cl of 16.2 L/hour per 70 kg was found at the age of 1 year.
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