Anemia of Prematurity - Portal Neonatal

Drug Category: Opioid analgesics -- Used for deep sedation to allow adequate mechanical
ventilation. They may be particularly useful in decreasing sympathetic pulmonary vasoconstriction in
response to noxious stimuli such as suctioning.
Drug Name
Pediatric Dose
Contraindications
Interactions
Fentanyl (Duragesic, Sublimaze) -- Synthetic opioid that is 75-200 times
more potent than morphine. It is highly lipophilic and protein-bound.
Prolonged exposure leads to accumulation in fat and delays the weaning
process. By itself fentanyl causes minor cardiovascular compromise,
although the addition of benzodiazepines or other sedatives may result in
decreased cardiac output and blood pressure.
Intermittent: 1-5 mcg/kg IV q2h by slow bolus
Continuous infusion: 1-10 mcg/kg/min IV
Documented hypersensitivity; hypotension; potentially compromised
airway when establishing rapid airway control would be difficult
Phenothiazines may antagonize analgesic effects of opiate agonists;
tricyclic antidepressants may potentiate adverse effects of fentanyl when
both drugs are used concurrently
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions
Caution in hypotension, respiratory depression, constipation, nausea,
emesis, and urinary retention; acute muscle rigidity (chest syndrome)
may occur following rapid infusion; tolerance develops rapidly,
withdrawal symptoms may develop if used for >5 d
Drug Category: Neuromuscular relaxing agents -- Paralysis is sometimes necessary in the infant
who is unstable despite adequate sedation; however, the use of paralysis is controversial and should
be reserved for unusual cases in which the infant cannot be treated with appropriate sedation.
Drug Name
Pancuronium (Pavulon) -- Relatively long-acting nondepolarizing muscle
relaxant. Onset of action is 1-2 min, and duration of action is 45-90 min.
Excretion is renal (80%) and hepatic (20%), and duration of action may be
longer if renal or hepatic failure is present.
Pediatric Dose 0.05-0.15 mg/kg/dose IV bolus
Contraindications Documented hypersensitivity; myasthenia gravis or related syndromes
Interactions
Increased effect with magnesium sulfate, furosemide, aminoglycosides,
amphotericin, ketamine, cyclosporine, inhalation anesthetics, or
antiarrhythmics; decreased effect with calcium, carbamazepine,
phenytoin, corticosteroids, theophylline, or caffeine
Pregnancy C - Safety for use during pregnancy has not been established.
Precautions
May cause tachycardia, hypotension, and excessive salivation; caution
with conditions that may potentiate neuromuscular blockade (eg,
electrolyte abnormalities, neuromuscular disease, acidosis, renal or
hepatic failure)