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• W1584097356 abstract "lnhalational anaesthetic agents The uptake and elimination of the inhaled anaesthetic agents in infants and children have been extensively studied. The high level of alveolar ventilation compared to the functional residual capacity, the larger proportion of vessel rich tissues, and a lower blood gas solubility coefficient all contribute to the rapid induction and recovery phases which occur in the infant. Inhalation anaesthetic agents are probably metabolized less in infants than in older patients; serum bromide levels are lower following halothane in infants than in adults. Serum inorganic fluoride levels are lower following enflurane anaesthesia, but this may also be due to increased bone deposition of fluoride in paediatric patients. The effects of the volatile anaesthetics on the cardiorespiratory system of infants and chidren are now more fully documented, lsoflurane causes an increase in heart rate and halothane slows the heart. At equal levels of anaesthesia, halothane and isoflurane cause a similar degree of hypotension which is dose-related. Isoflurane, however, causes less depression of myocardial contractility but more afterload reduction than halothane. Cardiac output is better maintained with isoflurane provided fluid is administered to maintain preload. 2 The addition of nitrous oxide to the inspired gas mixture results in cardiovascular effects which are similar to those produced by equianaesthetic dose levels of the volatile agents in oxygen. 3 While the volatile anaesthetics all cause similar increases in end-tidal carbon dioxide levels in spontaneously breathing children the patterns of ventilation differ. Depression of the ventilatory response to carbon dioxide is dose-dependent. Halothane causes tachypnoea, isoflurane causes little change in rate, and enflurane tends to slow ventilation. 4 Intercostal muscle activity is suppressed by haiothane, paradoxical breathing occurs at end-tidal concentrations above one per cent. 5 Intravenous anaesthetics and analgesics The dose requirements of thiopentone in infants and children of various ages show wide variation. Newborn infants require 3-4 mg.kg -I while those of 1-6 mo require 7-8 mg.kg-~. 6 In healthy children 5-6 mg. kg-i is the dose required for rapid reliable induction of anaesthesia. 7 The pharmacokinetics of thiopentone in paediatric patients have been studied and show a shorter elimination time in infants and children than in adults) The narcotic analgesics have been widely used in infants, especially for major surgical procedures, fentanyl being the most commonly used drug. The dose response of neonates to fentanyl indicate that a dose 10-12.5 I~g kg -I will prevent any response to surgical stimulation and provide anaesthesia for 60-90 min. 9 Older infants may require higher doses. I~ The pharmacokinetics of fentanyl depend upon age. Neonates show wider variation and slower clearance rates than older infants, who may demonstrate clearance rates higher than those of adults. ~ Preterm infants and neonates with increased intraabdominal pressure predictably demonstrate a prolonged elimination half-life of the drug. J2 Some infants demonstrate secondary peaks in plasma levels of the drug and these may be associated with respiratory depression in patients not on mechanical ventilation. The cardiovascular system is little affected by even large doses of fentanyl, but a useful effect in blunting the neonatal pulmonary vascular responses to stress has been noted. Chest wall compliance is significantly reduced by fentanyl in children." @default.
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• W1584097356 date "1990-05-01" @default.
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• W1584097356 title "New drugs and new understandings of paediatric pharmacology" @default.
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• W1584097356 doi "https://doi.org/10.1007/bf03006272" @default.
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