Document Detail


Canadian neonatologist practices regarding opioid use in ventilated and spontaneously breathing infants undergoing medical procedures.
MedLine Citation:
PMID:  20473050     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Opioids are indicated for the management of procedural pain in neonates. There are limited data describing factors influencing patterns of use. PATIENTS AND METHODS: We conducted an online English survey of Canadian neonatologists using Survey Monkey, whereby they answered questions about the frequency and pattern of use of opioids, and specifically, of morphine and fentanyl, for ventilated and spontaneously breathing infants undergoing selected painful medical procedures. RESULTS: Hundred and twenty nine of 225 (57%) eligible neonatologists participated. They reported that opioids were part of their practice for managing procedural pain in 100% of ventilated infants and 93% of spontaneously breathing infants. Frequency of opioid use was associated with infant ventilation status: spontaneously breathing infants were 28% less likely to receive them (P=0.013). For morphine, the most commonly used dose was 100 microg/kg in ventilated infants and 50 microg/kg in spontaneously breathing infants. For fentanyl, 1 microg/kg was the most frequently used dose in both infant populations. Use of morphine and fentanyl were significantly associated with 2-way interactions (P<0.0001) between infant ventilation status, gestational age, and opioid dose. Eighty-two percent of respondents cited respiratory depression as a concern for spontaneously breathing infants compared with 31% for ventilated infants (P<0.0001). CONCLUSIONS: Neonatologists frequently report using opioids to manage procedural pain, however, spontaneously breathing infants are less likely to receive them, and their use varies according to infant and procedure characteristics. These data point to the need to further investigate, in a more controlled design, the pharmacologic effects of opioids in this population to better guide clinicians about their optimal use.
Authors:
Anna Taddio; Ryan Pulleyblank; Derek Stephens; Carol McNair; Vibhuti Shah
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Clinical journal of pain     Volume:  26     ISSN:  1536-5409     ISO Abbreviation:  Clin J Pain     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-17     Completed Date:  2010-08-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8507389     Medline TA:  Clin J Pain     Country:  United States    
Other Details:
Languages:  eng     Pagination:  422-8     Citation Subset:  IM    
Affiliation:
Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada. anna.taddio@utoronto.ca
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MeSH Terms
Descriptor/Qualifier:
Analgesics, Opioid / administration & dosage,  therapeutic use
Canada
Fentanyl / administration & dosage,  therapeutic use*
Health Care Surveys
Humans
Infant
Infant, Newborn
Morphine / administration & dosage,  therapeutic use*
Pain / drug therapy*
Physician's Practice Patterns*
Pulmonary Ventilation
Grant Support
ID/Acronym/Agency:
//Canadian Institutes of Health Research
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 437-38-7/Fentanyl; 57-27-2/Morphine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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