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Iowa Neonatology Handbook: Pharmacology
Analgesics and Sedatives
Jeffrey L. Segar, MD
Peer Review Status: Internally Peer Reviewed
Systemic narcotics are the most commonly used agents for management of pain
in the post-operative patient. They are also the most frequently used agents
given to ventilated children, particularly when paralyzed with neuromuscular
blockers, or those with bronchopulmonary dysplasia.
|
DRUG |
DOSE |
COMMENT |
|
Narcotic analgesics and sedatives
|
Morphine |
50 mcg/kg (optional)
followed by 10 -20 mcg/kg/h IV
|
Increased entero-hepatic circulation prolongs
T1/2 in preterm infants. Higher doses needed as tolerance develops |
|
Fentanyl |
1-3 mcg/kg/h IV (may need up to 10 mcg/kg/h) |
Minimal hemodynamic effects. Rapid onset
of tolerance. Consider 5-10 µg/kg for sedation prior to ETT suction in
unstable PPHN patients. |
|
Benzodiazepines: |
Lorazepam |
0.05 - 0.3 mg/kg q 6 h IV |
|
|
Midazolam |
0.2 mg/kg followed by 0.4 mcg/kg/min. IV |
enhanced sedation with analgesics. Contains
benzyl alcohol |
|
Barbiturate sedative/ anticonvulsant: |
Phenobarbital |
5 mg/kg/dose
q 12 - 24 h |
tolerance to sedation develops rapidly |
|
Hypnotic: |
Chloral hydrate |
25 - 50 mg/kg/dose
q 6-12 h |
Cardiac toxicity at high levels. Repeated
high doses in TPN dependent patients increase risk of cholestasis |
|
Non-narcotic analgesic: |
Acetaminophen |
10-15 mg/kg/dose PO; PR |
|
Treatment of withdrawal (abstinence) from narcotics:
Treatment as needed to alleviate symptoms and signs of withdrawal.
- Preferably with narcotics (e.g., paregoric, methadone)
- Phenobarbital may also be used.
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