Academic Journal
Prediction of levobupivacaine concentrations in neonates and infants following neuraxial rescue blocks
| العنوان: | Prediction of levobupivacaine concentrations in neonates and infants following neuraxial rescue blocks |
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| المؤلفون: | Frawley, G, Ignacio Cortinez, L, Anderson, BJ |
| بيانات النشر: | WILEY |
| سنة النشر: | 2021 |
| المجموعة: | The University of Melbourne: Digital Repository |
| الوصف: | AIM: Pharmacokinetic simulation was used to characterize levobupivacaine disposition after regional anesthetic rescue for failed spinal anesthesia in neonates and infants. METHODS: Population pharmacokinetics of levobupivacaine were estimated after spinal blockade in a cohort of neonates and infants (n = 25, postnatal age 5-18 weeks, gestation 21-41 weeks, weight 2.4-6 kg). Total levobupivacaine concentrations were assayed 3-4 times in the first hour after spinal levobupivacaine 1 mg kg-1 administration. Parameters were estimated using nonlinear mixed-effects models and supported by priors. Covariates included postnatal age and total body weight. Parameter estimates were used to simulate total levobupivacaine concentrations after a primary spinal levobupivacaine 1 mg kg-1 with rescue caudal levobupivacaine 1.5-2.5 mg kg-1 . RESULTS: A one-compartment model with a mature clearance 21.5 L h-1 70 kg-1 (CV 47.3%) and central volume 189 L 70 kg-1 (CV 37%) adequately described time-concentration profiles. Clearance maturation was described using a maturation half-time of 11.5 weeks postnatal age. The absorption half-time for spinal levobupivacaine was 2.6 min (CV 56.8%). The upper (97.5% prediction) for peak concentrations after rescue caudal levobupivacaine were 1.5 mg kg-1 , 2 mg kg-1 , and 2.5 mg kg-1 was 2.05 mg L-1 , 2.5 mg L-1 , and 2.9 mg L-1 respectively. CONCLUSION: Total bupivacaine concentrations greater than 2.5 mg L-1 are associated with neurotoxicity in adults. Predicted concentrations after either a repeat spinal or a caudal rescue dose of levobupivacaine 1.5 mg kg-1 1 h after spinal levobupivacaine administration are below the neurotoxic concentration threshold. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| تدمد: | 1155-5645 1460-9592 |
| Relation: | Frawley, G., Ignacio Cortinez, L. & Anderson, B. J. (2021). Prediction of levobupivacaine concentrations in neonates and infants following neuraxial rescue blocks. PEDIATRIC ANESTHESIA, 31 (6), pp.655-664. https://doi.org/10.1111/pan.14170.; http://hdl.handle.net/11343/310994 |
| الاتاحة: | http://hdl.handle.net/11343/310994 |
| رقم الانضمام: | edsbas.4122B983 |
| قاعدة البيانات: | BASE |
| تدمد: | 11555645 14609592 |
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