1 / 27

Analgesics and hypnotics (APA Cambridge 20. June 2013

Analgesics and hypnotics (APA Cambridge 20. June 2013. Tom G. Hansen, MD, PhD, Department of Anaesthesia & Intensive Care Odense University Hospital & University of Southern Denmark DENMARK Email: tomghansen@dadlnet.dk. Topics covered. Some news about old drugs

wade-diaz
Download Presentation

Analgesics and hypnotics (APA Cambridge 20. June 2013

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Analgesics and hypnotics (APA Cambridge 20. June 2013 Tom G. Hansen, MD, PhD, Department of Anaesthesia & Intensive Care Odense University Hospital & University of Southern Denmark DENMARK Email: tomghansen@dadlnet.dk

  2. Topics covered Some news about old drugs Something about a new drug Focus: neonates and infants Focus: outcome, safety and toxicity

  3. Propofol, neonates and haemodynamics

  4. Demographics

  5. Haemodynamics

  6. NIRS

  7. Authors’ conclusions

  8. Endpoints? • Biomarkers for CNS injury (Neuron-specific enolase (NSE) and s-100β protein (t=0 h, after CPB, 6 h, 24 h, 48 h) • Inflammatory mediators • Bayley Scales of Infant Development, 2nd Ed (BSID-II) before and 2-3 w after surgery • MRI with spectroscopy (MRS) just before surgery and just before hospital discharge (n=5): N-acetyl aspartate (NAA), creatine (Cr) and glutamate/glutamine sum • NIRS < 24 h

  9. NSE and CRP

  10. Conclusions

  11. Dexmedetomidine(2 adrenergic agonist)

  12. Dexmedetomedine(Mason & Lerman Anesth Analg 2011) Licenced for PICU  OR+sedation (resp) Problems: PK/PD Infants & neonates? slow onset/prolonged duration indication? haemodynamics (BP↓↑,HR↓) premedication? drug synergism?

  13. Dexmedetomidine attenuates isoflurane-induced neuroapoptosis Sanders et al. Acta Anaesthesiol Scand 2010 Sanders et al. Anesthesiology 2009 (Caspase 3-activation↓)

  14. Context sensitive half times of opioids

  15. Ideal opioid for neonates and infants? Tolerance and hyperalgesia? NICU/PICU? MAC↓  Neurotoxcicity?

  16. NEOPAIN (Anand et al Lancet 2004; 363: 1673-82) RCT, 16 centers: IPPV treated preterm infants, Morphine group (MG; n=449) and placebo group (PG; n=449) Intervention: preemptive morphine in IPPV LD 0.1 mg/kg, followed by CI 10 g/kg/h (GA 23-26) 20 g/kg/h (GA 27-29) 30 g/kg/h (GA 30-32) + open label morphine (OLM) for both groups Composite primary outcome: Death, IVH and PVL Results: Analgesia  but similar rates of deaths, IVH and PVL - OLM  ↑CO and ↑severe IVH in MG vs. PG + OLM  ↑CO in PG +OLM  IVH in MG

  17. Long term outcome

  18. Long term outcome The original Dutch studies (2000-2002) Simons et al. JAMA 2003; 290: 2419-27 Simons et al. Arch Dis Child Fetal Neonatal Ed 2005; 90: F36-40 Simons et al. Arch Dis Child Fetal Neonatal Ed 2006; 91: F46-51 Placebo-controlled RCT (n=150) in preterms on IPPV receiving morphine: LD 0.1 mg/kg CI 10 g/kg/h +open label morphine: LD 0.05 mg/kg, CI 5-10 g/kg/h IVH  in morphine group, but similar analgesia and neurological outcome

  19. Conclusions • Carefull dosing of anaesthetics and analgesics in very premature infants • Impact of haemodynamics on anaesthesia-induced neurotoxicity? • Normal blood pressure? • How do we treat hypotension?

More Related