Clinical Pharmacokinetics,
Journal Year:
2025,
Volume and Issue:
unknown
Published: May 1, 2025
This
scoping
review
aimed
to
summarise
all
available
population
pharmacokinetic
models
of
morphine
and
its
metabolites
(morphine-3-glucoronide
[M3G],
morphine-6-glucoronide
[M6G])
in
children
describe
how
exposure
varies
across
paediatric
age
groups
settings.
Identifying
the
factors
that
contribute
variability
may
improve
our
understanding
a
patient's
pharmacodynamic
response
morphine.
We
searched
Embase
MEDLINE
databases
from
inception
8
March
2024
for
metabolites.
Two
reviewers
independently
screened
abstracts
full
texts
extracted
data.
The
was
conducted
according
Preferred
Reporting
Items
Systematic
Reviews
Meta-Analysis
(PRISMA)
guidelines.
In
total,
21
were
identified;
12
studies
also
included
(M3G
and/or
M6G).
Neonates
young
(<
6
years)
most
studied
(18/21;
86%),
whereas
older
(>
adolescents
10
only
(29%)
models.
Morphine
pharmacokinetics
commonly
described
with
two-compartment
(52%)
one-compartment
(38%)
structure
first-order
elimination.
Several
model
covariates
identified:
bodyweight,
post-natal
neonates,
body
temperature,
therapeutic
cooling,
duration
mechanical
ventilation,
genetic
variation
drug
transporters
mediate
uptake
(e.g.
OCT1).
paediatrics
have
been
published
diverse
patient
groups.
Bodyweight
age-related
emerged
as
common
affecting
clearance
distribution;
other
covariates,
including
variation,
impacted
pharmacokinetics.
Further
research
should
focus
on
validating
predictive
accuracy
different
populations
combined
effect
such
those
related
critical
illness
Journal of Radiation Research and Applied Sciences,
Journal Year:
2024,
Volume and Issue:
17(1), P. 100833 - 100833
Published: Jan. 22, 2024
This
review
aims
to
synthesize
the
current
body
of
knowledge
surrounding
complexities,
advancements,
and
best
practices
in
sedation
anesthesia
for
pediatric
patients
undergoing
radiological
diagnostic
therapeutic
procedures.
The
article
examines
several
types
procedures
that
necessitate
sedation,
pre-sedation
assessment
protocols,
pharmacological
considerations.
It
explores
into
intricacies
patient
monitoring,
potential
benefits
risks,
special
considerations
healthcare
providers
must
account
for.
Emphasis
is
placed
on
qualifications
required
non-anesthesiologists
involved
administering
or
along
with
essential
equipment
safety
protocols.
also
addresses
ethical,
legal,
psychosocial
facets
this
multifaceted
clinical
issue,
culminating
an
overview
future
research
directions
concluding
remarks
quality
improvement
measures.
found
have
improved
significantly
terms
safety,
administration,
monitoring;
however,
gaps
opportunities
remain,
such
as:
quantifying
effectiveness
non-pharmacological
interventions;
exploring
individualized
protocols;
investigating
impact
cultural
factors;
assessing
long-term
neurodevelopmental
effects;
developing
machine
learning
algorithms;
evaluating
post-procedural
life
patients.
Frontiers in Pediatrics,
Journal Year:
2023,
Volume and Issue:
11
Published: Oct. 6, 2023
Introduction
This
systematic
review
aimed
to
evaluate
the
quality
of
clinical
practice
guidelines
(CPGs)
and
recommendations
for
managing
pain,
sedation,
delirium,
iatrogenic
withdrawal
syndrome
in
pediatric
intensive
care
(PICU).
The
objectives
included
evaluating
recommendations,
synthesizing
harmonizing
strength
recommendation
(SoR)
certainty
evidence
(CoE),
assessing
relevance
supporting
evidence.
Methods
A
comprehensive
search
four
electronic
databases
(Medline,
Embase.com,
CINAHL
JBI
EBP
Database),
9
guideline
repositories,
13
professional
societies
was
conducted
identify
CPGs
published
from
January
2010
end
May
2023
any
language.
assessed
using
AGREE
II
AGREE-REX
instruments.
Thematic
analysis
used
synthesize
GRADE
SoR
CoE
harmonization
method
interpret
credibility
summary
recommendations.
Results
total
18
170
were
identified.
Most
medium-quality,
three
classified
as
high.
30
synthesized
across
each
condition,
focused
on
common
management
approaches.
There
inconsistency
SoRs
those
assessment
showed
highest
consistency,
remaining
conditional,
inconsistent,
inconclusive,
lacked
support
Conclusion
provides
an
overview
these
conditions
PICU.
While
achieved
high-quality
ratings,
overall
findings
reveal
gaps
base
patient
family
involvement,
resources
implementation.
highlight
need
more
rigorous
evidence-based
approaches
development
reporting
enhance
their
trustworthiness.
Further
research
is
necessary
this
setting.
results
can
provide
a
valuable
foundation
future
CPG
development.
Systematic
Review
Registration
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=274364
,
PROSPERO
(CRD42021274364).
The Egyptian Journal of Hospital Medicine,
Journal Year:
2024,
Volume and Issue:
94(1), P. 154 - 160
Published: Jan. 1, 2024
Background:
Many
adjuvants
have
been
used
to
increase
the
analgesic
duration
of
intrathecal
bupivacaine.Objective:
This
work
was
aimed
at
comparing
ketamine
vs
dexmedetomidine
for
patients
with
lower
limb
surgery
regarding
advantages,
efficacies,
and
hemodynamic
stability.Patients
methods:
prospective
randomized
double-blind
study
involved
100
individuals
whose
ages
ranged
from
eighteen
fifty
years,
both
sexes,
who
underwent
orthopedic
surgeries.All
participants
went
through
an
even
categorization
into
two
groups:
Group
D:
administering
calculated
dosage
hyperbaric
bupivacaine
0.5
%
according
body
weight
5μg
K:
0.1
mg/kg
ketamine.Results:
Intraoperative
HR
as
well
MAP
measurements
were
significantly
higher
during
15
min,
30min,
45min
end
within
group
K
opposed
D
(P
value
<0.05).Postoperative
HR,
MAP,
SaO2
VAS
less
30
2h,
4h
6h
<0.05).Time
first
request
delayed
value<0.001).Complications
(bradycardia
hypotension)
insignificantly
varied
among
groups.Respiratory
depression
occurrence
not
present
in
groups.Conclusions:
Ketamine
produces
better
outcomes
compared
surgery.However,
it
is
associated
intraoperative
postoperative
no
difference
complications
them.
Intensive Care Medicine – Paediatric and Neonatal,
Journal Year:
2024,
Volume and Issue:
2(1)
Published: June 27, 2024
Abstract
Background
Knowledge
of
clinical
pharmacology
concepts
is
essential
to
improve
patients’
outcomes.
Scarce
data
available
on
the
utilisation
these
in
paediatric
intensive
care
unit
(PICU).
We
aimed
investigate
self-perceived
knowledge
concepts,
educational
needs
and
identify
priorities
for
pharmacological
research
across
European
PICUs.
Methods
From
July
November
2022
an
online
survey
was
distributed
evaluate
i)
self-reported
knowledge,
ii)
application
key
practice
(using
a
likert
scale
from
1
=
never
apply
10
always
apply);
iii)
need
additional
education
them;
iv)
areas
future
research.
The
Society
Paediatric
Neonatal
Intensive
Care
(ESPNIC)
members
other
national
PICUs
societies
members.
Results
Two-hundred-thirty-seven
responses
149
were
collected.
54%
reported
have
pharmacologist
consultation
during
drug
prescription
65%
them
regularly
contact
prescribing
process.
Among
parameter
with
highest
half-life
(99%)
lowest
pharmacodynamics
volume-of-distribution
(92%).
median
ranged
between
5/10
7/10.
Most
respondents
specific
concepts.
Reported
mostly
involved
analgesics/sedatives
(87%),
antimicrobials
(86%),
cardiovascular
medications
(55%).
Conclusions
Self-reported
seems
good,
but
may
most
report
education.
These
findings
call
concerted
multidisciplinary
efforts
streamline
guidelines
fill
this
gap.
Frontiers in Molecular Neuroscience,
Journal Year:
2024,
Volume and Issue:
17
Published: Sept. 10, 2024
Pain
is
a
subjective
concept
which
ever-present
in
the
medical
field.
Health
professionals
are
confronted
with
variety
of
pain
types
and
sources,
as
well
challenge
managing
patient
acute
or
chronic
suffering.
An
even
bigger
presented
pediatric
population,
often
cannot
quantify
numerical
scale
like
adults.
Infants
small
children
especially
show
their
discomfort
through
behavioral
physiological
indicators,
leaving
health
provider
task
rating
pain.
Depending
on
pathophysiology
it,
can
be
classified
neuropathic
nociceptive,
first
being
defined
by
an
irregular
signal
processing
nervous
system
second
appearing
cases
direct
tissue
damage
prolonged
contact
certain
stimulant.
The
approach
generally
either
pharmacological
non-pharmacological
it
vary
from
using
NSAIDs,
local
anesthetics,
opiates
to
physical
psychological
routes.
Unfortunately,
some
pathologies
involve
intense
that
managed
traditional
methods.
Recent
studies
have
involved
nanoparticles
special
characteristics
such
dimension
large
surface
area
facilitate
carrying
treatments
tissues
offer
intrinsic
analgesic
properties.
Pediatrics
has
benefited
significantly
application
nanotechnology,
enabled
development
novel
strategies
for
drug
delivery,
disease
diagnosis,
engineering.
This
narrative
review
aims
evaluate
role
nanotechnology
current
therapy,
emphasis
children.
European Journal of Pharmaceutics and Biopharmaceutics,
Journal Year:
2024,
Volume and Issue:
204, P. 114532 - 114532
Published: Oct. 11, 2024
For
pediatric
radiological
procedures
(RP),
pentobarbital
sodium
(PNa)
can
be
used
orally
or
rectally
to
replace
intravenous
anesthesia.
Since
no
commercial
PNa
suppositories
exist,
they
must
prepared
by
compounding
pharmacies.
This
study
aims
develop
fast-dissolving
for
fast
pharmacological
activity
during
RP.
We
gelatin
(G),
gelatin/polyethylene
glycol
4000
(GP),
and
polyethylene
(P)
suppositories,
with
without
pH
adjustment,
assessed
their
dosage
uniformity
(DU),
softening
time,
rupture
resistance,
in-vitro
dissolution.
An
optimal
formulation
was
selected,
release
compared
that
of
fat-based
using
dissolution
tests.
Additionally,
the
quality
control
process
(analytical
performance,
safety/eco-friendliness
productivity/practical
effectiveness)
these
formulas
were
a
RGB
method.
All
hydrophilic
(HF)
met
DU
requirement
(AV
<
8
%)
except
P
15.62
±
4
%).
adjustment
enhanced
G
GP
resistance
2.2
0.2
kg
2.0
0.3
kg,
respectively,
allowed
100
%
in
under
10
min.
In
contrast,
lipophilic
released
less
than
80
at
best
after
120
These
results
show
biopharmaceutical
suitability
HF
RP
ones,
but
pharmacokinetic
is
needed
confirm
data.
