Ventilatory arrest after a fluid challenge in a neonate receiving s.c. morphine

Current concepts in pain management: pharmacologic options for the pediatric, geriatric, hepatic and renal failure patient

This article provides a review for current practice. Strict guidelines are not available on some topics, and they may never be drafted because pain is such a unique individual experience. It is recommended to coordinate care with other medical specialties when patients present with organ dysfunctions or are at the extremes of age. More data are required in the field of pain management, particularly with regard to renal and hepatic dysfunction. In turn, these data serve as a foundation for physicians making practice decisions based on current evidence. Until this is achieved, clinicians must rely on anecdotal evidence and the experiences of others to treat a complex issue: pain.

Postoperative pain management in paediatrics

Pain is defined by the International Association for the Study of Pain as 'an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage'. It is now accepted that pain should be anticipated, and safely and effectively controlled, in all children, whatever their age, maturity or severity of illness (Fisher & Morton 1998).

Biochemical changes in prostanoids and cerebral expression of cyclooxygenase (COX)-1 and COX-2 during morphine sulfate infusion in the newborn piglet

To examine the biochemical regulation of morphine sulfate (MS) on prostanoid synthesis, conscious newborn piglets received a bolus dose of 100 microg/kg followed by a continuous infusion dose of 100 microg/kg/h. The control group received equivalent volume bolus and continuous infusion of 5% dextrose. Blood samples were drawn from the femoral artery and sagittal sinus vein before, during and after infusion for measurement of prostanoids. The expression of mRNAs encoding cyclooxygenases (COX)-1 and -2 in the brainstem, thalamus, cortex, and cerebellum of the newborn piglets were also examined. Systemic PGE2 levels declined substantially during and post MS infusion (p < 0.01), whereas sagittal sinus vein PGE2 levels increased following the bolus dose (p < 0.01) and at 4 h of continuous infusion (p < 0.01). MS infusion did not affect systemic 6-ketoPGF1alpha levels, however, in the cerebral circulation 6-ketoPGF1alpha levels increased 146% (p < 0.01) following the bolus dose and remained elevated throughout the infusion and post infusion times. Systemic TxB2 levels increased transiently at 4 h (p < 0.01) and sagittal sinus vein TxB2 increased at 0.5 and 1 h (p < 0.01) during continuous infusion. RT-PCR assays revealed a 1.5- (p < 0.001) to 4-fold (p < 0.001) increased expression of COX-1 mRNA in the MS-infused brain samples. In contrast, no differences in COX-2 mRNA were detected between the groups. These data imply that MS may have significant effects on prostanoid synthesis in the newborn. The data further show that the MS-induced prostanoid responses appear to be mediated via COX-1.