The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG
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J Pediatr Pharmacol Ther · Jan 2006
Propofol-related infusion syndrome in critically ill pediatric patients: coincidence, association, or causation?
Over the past two decades numerous reports have described the development of a propofol-related infusion syndrome (PRIS) in critically ill adult and pediatric patients who received continuous infusion propofol for anesthesia or sedation. The syndrome is generally characterized by progressive metabolic acidosis, hemodynamic instability and bradyarrhythmias that are refractory to aggressive pharmacological treatments. ⋯ These reports have generated considerable discussion and debate regarding the relationship, if any, between propofol and a constellation of clinical symptoms and features that have been attributed to its use in critically ill pediatric patients. This paper reviews the literature concerning PRIS, its clinical presentation, proposed mechanisms for the syndrome, and potential management should the syndrome occur.
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J Pediatr Pharmacol Ther · Jul 2005
A History of Neonatal Medicine-Past Accomplishments, Lessons Learned, and Future Challenges: Part II-The 1990s, the New Millennium, Future Challenges.
This is the second of two articles reviewing the history of newborn medicine. This article will discuss recent accomplishments in the field of newborn medicine, current health outcome data, and future challenges facing the fields of neonatal and perinatal medicine.
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J Pediatr Pharmacol Ther · Jan 2005
Control of Coagulation during Extracorporeal Membrane Oxygenation.
The use of extracorporeal membrane oxygenation (ECMO) requires maintaining a delicate balance between the prevention of thrombosis and the avoidance of hemorrhage. Anticoagulation is necessary to maintain circuit flow. It counteracts the activation of clotting mechanisms that occurs as a result of the interaction between circulating blood and the foreign surfaces of the ECMO equipment as well as endothelial damage within the vasculature. ⋯ In addition, thrombolysis with alteplase is now being used in patients who develop clots despite anticoagulation. Aminocaproic acid has been used for more than a decade to manage or prevent hemorrhage in patients on ECMO, but a new report suggests that activated recombinant factor VII may also be useful as a hemostatic agent. Over the next decade, it is likely that the role of these newer agents will grow, making them important tools in the management of patients on ECMO.
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J Pediatr Pharmacol Ther · Oct 2004
Chemical stability of extemporaneously prepared Lorazepam suspension at two temperatures.
The objective of this study was to determine the chemical stability of extemporaneously prepared lorazepam suspension (1 mg/mL) stored at two temperatures (4°C and 22°C) for 3 months. Lorazepam tablets marketed by two manufacturers (Mylan Pharmaceuticals and Watson Laboratories) were used to extemporaneously formulate two independently prepared suspensions. Each suspension was prepared using sterile water, Ora-Plus(®) and Ora-Sweet(®) to achieve a final concentration of 1 mg/mL. ⋯ The chemical stabilities of these two extemporaneously prepared lorazepam suspensions were comparable throughout the study. Both lorazepam suspensions were stable for 63 days when stored at 4°C or 22°C, and both were stable for 91 days when refrigerated at 4°C. When stored at room temperature, the suspension prepared from the Watson tablet retained 88.9 ± 1.4% of the initial concentration on day 91 and was therefore considered unstable, while the suspension prepared from the Mylan tablet was stable for the entire 91-day study.