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Propofol for procedural sedation/anaesthesia in neonates
Elective medical or surgical procedures are commonplace for neonates admitted to NICU. Agents such as opioids are commonly used for achieving sedation/analgesia/anaesthesia for such procedures; however, these agents are associated with adverse effects. Propofol is used widely in paediatric and adult populations for this purpose. The efficacy and safety of the use of propofol in neonates has not been defined.
The objective is to determine the efficacy and safety of propofol treatment compared to placebo or no treatment or alternate active agents in neonates undergoing sedation or anaesthesia for procedures. To conduct subgroup analyses according to method of propofol administration (bolus or continuous infusion), type of active control agent (neuromuscular blocking agents with or without the use of sedative, analgesics or anxiolytics), type of procedure (endotracheal intubation, eye examination, other procedure), and gestational age (preterm and term).
There was no statistically significant difference in the number of infants who required multiple intubation attempts (39% in the propofol group versus 57% in the morphine‐atropine‐suxamethonium group; RR 1.40, 95% CI 0.85 to 2.29). Times required to prepare medication, to complete the procedure and for recovery to previous clinical status were shorter in the propofol group. No difference in clinically significant side effects was observed; however, the number of events was small.Authors’ conclusions are that no practice recommendation can be made based on the available evidence regarding the use of propofol in neonates. Further research is needed on the pharmacokinetics of propofol in neonates and once a relatively safe dose is identified, randomised controlled trials assessing the safety and efficacy of propofol are needed.
Authors : Prakeshkumar S Shah, Vibhuti S Shah
Correspondence to : Department of Paediatrics and Department of Health Policy, Management and Evaluation, Rm 775A, University of Toronto, Toronto, Canada
pshah@mtsinai.on.ca
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Cyanoacrylate Glue in neonatal peripheral venous access
During the 5th GAVePed Conference in Rimini, Roland van Rens, active member of the NEVAT, presented his experience with cyanoacrylate glue in neonatal peripheral venous access.
He also explained us the 5 rights for neonatal vascular access.Authors : Roland van Rens
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RaCeVA – Rapid Central Vein Assessment
Alfamed 3Fr Tunnellized Central Venous Catheter in Baby
In this video, published by GaVeCelt on their YouTube channel, they show a placement of a 3Fr tunnellized Central Venous Catheter in a baby by RaCeVA – Rapid Central Vein Assessment
You can also find a lot of other interesting information on their website.
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Opioids: A review of Pharmacokinetics and Pharmacodynamics in Neonates, Infants, and Children
Pain management in the pediatric population is complex for many reasons. Mild pain is usually managed quite well with oral acetaminophen or ibuprofen. Situations involving more severe pain often require the use of an opioid, which may be administered by many different routes, depending on clinical necessity.
Although there has been significant progress in the understanding of opioid pharmacokinetics and pharmacodynamics in neonates, infants, children, and adolescents, somewhat limited data exist from which necessary information, concerning the safe and effective use of these agents, may be drawn. The evidence here provided is intended to be helpful in directing the practitioner to patient-specific reasons for preferring one opioid over another. As our knowledge of opioids and their effects has grown, it has become clear that older medications like codeine and meperidine (pethidine) have very limited use in pediatrics. This review provides pharmacokinetic and pharmacodynamic evidence on the currently available opioids: morphine, fentanyl (and derivatives), codeine, meperidine, oxycodone, hydrocodone, hydromorphone, methadone, buprenorphine, butorphanol, nalbuphine, pentazocin, ketobemidone, tramadol, piritramide, naloxone and naltrexone. Morphine, being the most studied opioid analgesic, is the standard against which all others are compared.Authors : James C Thigpen1, Brian L Odle1, Sam Harirforoosh2
1Department of Pharmacy Practice, Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, USA.
2Department of Pharmaceutical Sciences, Gatton College of Pharmacy, East Tennessee State University, Box 70594, Johnson City, TN, 37614-1708, USA. harirfor@etsu.edu.
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Umbilical venous catheter placement in the newborn – tip location by ultrasound
In this video, published by GaVeCelt on their YouTube channel, they show an umbilical venous catheter placement in the newborn and how to do tip location by ultrasound.
You can also find a lot of other interesting information on their website. -
Practical approaches to sedation and analgesia in the newborn
The prevention, assessment, and treatment of neonatal pain and agitation continues to challenge clinicians and researchers. Substantial progress has been made in the past three decades, but numerous outstanding questions remain. In this setting, clinicians must establish safe and compassionate standardized practices that consider available efficacy data, long-term outcomes, and research gaps. Novel approaches with limited data must be carefully considered against historic standards of care with robust data suggesting limited benefit and clear adverse effects. This review summarizes available evidence while suggesting practical clinical approaches to pain assessment and avoidance, procedural analgesia, postoperative analgesia, sedation during mechanical ventilation and therapeutic hypothermia, and the issues of tolerance and withdrawal.
Critically ill neonates are exposed to frequent painful procedures and agitating stimuli, with a negative impact on long-term outcome in the most vulnerable patients. Despite extensive research, the optimal approach to assessment, nonpharmacologic care, and pharmacotherapy remains elusive in most circumstances. Investigators must prioritize study designs that ethically generate novel data, ideally in collaboration with regulatory agencies to reduce the exclusively off-label utilization of medications discussed in this review. Even in the absence of scientific consensus, neonatal units must develop algorithms for the avoidance and treatment of pain and agitation in common clinical situations. Strong consideration should be given to the short-term and long-term safety of available interventions in the setting of limited data regarding objective efficacy. Existing analgesia or sedation practices should be maintained only where sufficient historic data support that standard. In the absence of data supporting efficacy, safety, and long-term benefit, novel interventions should be strongly considered in current clinical practice.Authors :
Christopher McPherson 1,2 ● Cynthia M. Ortinau1 ● Zachary Vesoulis1
Christopher McPherson mcphersonc@wustl.edu
1 Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
2 Department of Pharmacy, St. Louis Children’s Hospital, St. Louis, MO, USA -
Femoral venous access dressing in neonate
In this video, published by GaVeCelt on their YouTube channel, they show you how to do an emergency site management: antisepsis with chloraprep, fixing with statlock, application of histoacrylate glue and covering with semi-permeable transparent dressing.
You can also find a lot of other interesting information on their website. -
Placement of CICC in neonate in the neonatal intensive care unit
In this video, published by GaVeCelt on their YouTube channel, they show you how to do an echo-guided venipuncture of the right anonymous vein, verification of tip position by intracavitary ECG, tunnelling.
You can also find a lot of other interesting information on their website. -
EMLA versus glucose for PICC insertion: a randomised triple-masked controlled study
Preterm neonates experience a large number of painful procedures during their stay in the neonatal intensive care units (NICUs) and these procedures are often not accompanied by satisfactory analgesia. Peripherally inserted central catheter (PICC) insertion is a painful intervention employed recurrently to provide a secure venous access.
The aim of this study was to determine whether 25% oral glucose or EMLA cream was a better strategy for controlling pain in preterm neonates undergoing PICC insertion.Authors : Juliana de Oliveira Marcatto, Paula C B Vasconcelos, Claudirene Milagres Araújo, Eduardo Carlos Tavares, Yerkes Pereira e Silva
Correspondence to Juliana de Oliveira Marcatto, Rua Guilherme de Almeida 435, Apto 102, Belo Horizonte, Minas Gerais 30350230, Brazil; julianamarcatto@uol.com.br
This study was conducted with the approval of the Research Ethics Committee of Neonatal Division of the Hospital of the Federal University of Minas Gerais and Neonatal Division of Julia Kubitschek Hospital in the city of Belo Horizonte, Brazil.
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Tunnelled FICC in newborns, echo-guided and ECG-guided placement
In this video, published by GaVeCelt on their YouTube channel, they show you how to place a tunneled FICC in a newborn, echo-guided and ECG-guided placement.
You can also find a lot of other interesting information on their website.
