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Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL, Lasa JJ, Lavonas EJ, Levy A, Mahgoub M, Meckler GD, Roberts KE, Sutton RM, Schexnayder SM. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S469-S523. [PMID: 33081526 DOI: 10.1161/cir.0000000000000901] [Citation(s) in RCA: 194] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Cladis FP, Mai CL, Yaster M, Davis PJ. The advancement of pediatric anesthesia pharmacology: David Ryan Cook (scions, serendipity, and six degrees of separation). Paediatr Anaesth 2019; 29:114-119. [PMID: 30414345 DOI: 10.1111/pan.13543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/20/2018] [Accepted: 11/02/2018] [Indexed: 11/30/2022]
Abstract
Dr David Ryan Cook, Professor Emeritus of Anesthesiology and Pharmacology at the University of Pittsburgh and Chief of Anesthesiology at Children's Hospital of Pittsburgh (1977-1999), is a pioneer in the field of pediatric anesthesiology and pharmacology. Dr Cook contributed significantly to the understanding of pharmacologic differences among infants, children, and adults. His work as a clinician-scientist, educator, and mentor defined the pharmacology of many of the anesthetic agents we continue to use today. He brought science to the art of anesthesia and enhanced the safety of pediatric perioperative care. Based on a 2017 interview with Dr Cook, this article outlines the development of his career and his contributions to the field of anesthesiology and pharmacology.
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Affiliation(s)
- Franklyn P Cladis
- Department of Anesthesiology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Christine L Mai
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Myron Yaster
- Department of Anesthesiology, The Children's Hospital of Colorado, The University of Colorado, Denver, Colorado
| | - Peter J Davis
- Department of Anesthesiology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, Berg MD, de Caen AR, Fink EL, Freid EB, Hickey RW, Marino BS, Nadkarni VM, Proctor LT, Qureshi FA, Sartorelli K, Topjian A, van der Jagt EW, Zaritsky AL. Part 14: Pediatric Advanced Life Support. Circulation 2010; 122:S876-908. [DOI: 10.1161/circulationaha.110.971101] [Citation(s) in RCA: 473] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric advanced life support. Pediatrics 2006; 117:e1005-28. [PMID: 16651281 DOI: 10.1542/peds.2006-0346] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
Naloxone has enjoyed long-standing success as a safe and effective opioid antagonist and has been invaluable in defining the role of endogenous opioid pathways in the response to pathological states such as sepsis and hypovolemia. We look forward to exciting research to further elucidate these pathways and to improve outcome by modulating the patient's physiological response to these stresses.
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Affiliation(s)
- J M Chamberlain
- Emergency Medical Trauma Center, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
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Abstract
One hundred fifty-one total colonoscopies were performed in 105 children ranging from 1 month to 15 years of age. The cecum was reached successfully in 136 examinations without complications, generally within 30 minutes. Our major indications for total colonoscopy were abnormal findings in a contrast enema, undiagnosed rectal bleeding, and possible organic lesion causing intussusception. All procedures were performed using sedation only. The pediatric gastroscope was employed for total colonoscopy on infants less than 6 years of age; the cecum was reached successfully in 98 of 106 procedures with this instrument. Our total colonoscopy series contributed to the diagnosis of various disorders in 86 children and of normality in the 19 remaining children. The results suggest that, if performed with proper precautions and techniques, total colonoscopy is a safe and useful procedure with which to examine the entire colon of infants and children.
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Affiliation(s)
- T Kawamitsu
- Department of Pediatric Surgery, Koshigaya Hospital, Dokkyo University School of Medicine, Saitama, Japan
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Maio RF, Griener JC, Clark MR, Gifford G, Wiegenstein JG. Intralingual naloxone reversal of morphine-induced respiratory depression in dogs. Ann Emerg Med 1984; 13:1087-91. [PMID: 6507968 DOI: 10.1016/s0196-0644(84)80328-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A descriptive study was done to determine whether naloxone is efficacious in reversing morphine-induced respiratory depression in dogs when administered intralingually into the ventral lateral surface of the tongue. Mean minute ventilation was depressed to half of resting baseline levels using fixed intravenous doses of morphine sulfate. Intralingually administered naloxone reversed this respiratory depression rapidly within one minute, and resulted in a greater than fourfold increase in mean minute ventilation above established baseline levels.
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Abstract
Naloxone hydrochloride, a synthetic N-allyl derivative of oxymorphone, is an effective agent for the reversal of the cardiovascular and respiratory depression associated with narcotic and possibly some non-narcotic overdoses. It is essentially a pure narcotic antagonist, is relatively safe, and is a useful diagnostic and therapeutic agent. Due to naloxone's pharmacokinetic profile, a continuous infusion protocol is recommended when prolonged narcotic antagonist effects are required. The complex pharmacodynamics of naloxone, specifically relating to endorphin receptor sites, focus its potential use in a variety of clinical situations as continuing research illustrates the association of endogenous opioid compounds with various disease states.
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Abstract
Naloxone, an opiate antagonist, was administered to unrestrained awake cats to determine whether endogenous opioids tonically inhibit breathing. Whole body plethysmography was used to assess ventilation. Minute ventilation, tidal volume and breathing frequency were determined in each of 4 cats before and after 0.4 and 4.0 mg/kg naloxone. Analysis of variance did not show a significant difference between ventilatory values obtained before and after naloxone administration. Similarly, end-tidal pCO2 did not change systematically throughout a given trial.
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Zagon IS, McLaughlin PJ, Weaver DJ, Zagon E. Opiates, endorphins and the developing organism: a comprehensive bibliography. Neurosci Biobehav Rev 1982; 6:439-79. [PMID: 6294570 DOI: 10.1016/0149-7634(82)90027-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A comprehensive bibliography of the literature concerned with opiates, endorphins, and the developing organism is presented. A total of 1378 clinical and laboratory references, with citations beginning in 1875, are recorded. A series of indexed accompanies the citations in order to make the literature more accessible. These indexes are divided into clinical and laboratory topics. The clinical section is subdivided into: age of subject examined; maternal aspects; effects on the fetus; pharmacology, physiology, and the withdrawal syndrome; and "other" effects on the offspring. The laboratory section is subdivided into: type of opiate/endorphin studied; species utilized; and major subject areas explored.
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Farber JP, Maltby MA. Ventilatory effects of naloxone and morphine in the developing opossum. RESPIRATION PHYSIOLOGY 1980; 41:279-87. [PMID: 7455398 DOI: 10.1016/0034-5687(80)90077-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To determine whether endogenous opiates might tonically suppress ventilation in the immature mammal, young opossums between the 15th and 50th day of development were challenged with the opiate antagonist, naloxone, while ventilation was assessed using pressure plethysmorgraphy. The youngest animals (to about 25 days of age) typically showed an increase in breathing, but this was accompanied by somatic motor activity (assessed using electromyography) resembling behavioral arousal. In older animals a behavioral response was not always obtained; but in the absence of a behavioral effect, stimulation of breathing was not typically observed. When animals were tested with the opiate agonist morphine, respiratory depression was observed. Again, the most potent effects were obtained in the youngest animals. These data suggest that activation of opiate receptors can result in depression of breathing in young opossums; however, the stimulation of breathing by an opiate antagonist is best interpreted in terms of effects on wakefulness, rather than removal of tonic inhibition from respiratory neurons.
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Greenberg MI, Roberts JR, Baskin SI. Endotracheal naloxone reversal of morphine-induced respiratory depression in rabbits. Ann Emerg Med 1980; 9:289-92. [PMID: 7386953 DOI: 10.1016/s0196-0644(80)80060-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In an emergency, intravenous access may be difficult to obtain rapidly. Alternate routes of administration for drugs are, therefore, desirable. Our study was performed to determine if naloxone could be efficacious in reversing morphine-induced respiratory depression in rabbits when administered using the endotracheal route. Our results indicate that naloxone administered in this fashion is effective in reversing morphine-induced respiratory depression in the rabbit. Mean minute ventilation was depressed to greater than half of resting baseline levels using morphine sulfate. Endotracheally administered naloxone reversed this respiratory depression and resulted in a greater than five-fold increase in mean minute ventilation above baseline levels. We concluded that endotracheal naloxone is efficacious in reversing morphine-induced respiratory depression in the rabbit. The endotracheal route may be an effective alternative for naloxone administration in man when rapid intravenous access is not obtainable.
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Arnér S, Gordon E. The antagonist effect of naloxone hydrochloride after neuroleptanaesthesia during neurosurgery. Acta Anaesthesiol Scand 1976; 20:201-6. [PMID: 785928 DOI: 10.1111/j.1399-6576.1976.tb05029.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The effects of naloxone were studied in 82 patients undergoing intracranial surgery under general anaesthesia with fentanyl or phenoperidine. After the operation was finished the patients' alertness, sensitivity to pain, blood pressure, pulse rate, respiratory rate, tidal and minute volume were recorded parallel with arterial blood gas analyses prior to and immediately after the administration of varying amounts of naloxone i.v. in a single dose. These parameters were also repeatedly controlled for several hours in the postoperative period. The results show that a single i.v. naloxone dose of 1 mug/kg b.w. is effective in the rapid and definite reversal of the respiratory depression caused by the analgesics. This dose was neither correlated to the total amount of analgesics given, nor to the time period which elapsed between the last dose of the analgesic drug and the administration of naloxone. No side effects or complications were encountered when the indicated doses of naloxone were given. It is concluded that, even in a small single dose, naloxone effectively antagonises the respiratory depression caused by fentanyl and phenoperidine without totally eliminating the immediate postoperative analgesic effects of these agents.
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