piperidines and Enterocolitis--Necrotizing

Topics: Analgesics, Opioid; Anesthetics, Intravenous; Enterocolitis, Necrotizing; Humans; Infant, Premature, Diseases; Laparotomy; Piperidines

Endothelin-1, prostaglandins (PGs), and nitric oxide (NO) have been implicated in the intestinal microvascular dysfunction of necrotizing enterocolitis (NEC). We hypothesized that direct peritoneal resuscitation (DPR) dilates the intestinal microvasculature and improves blood flow independent of these mechanisms.. Rat pups were assigned by litter to experimental NEC or CONTROL groups. Laser Doppler flowmetry evaluation of intestinal microvascular blood flow was studied at baseline, with mediator blockade (endothelin-A receptor, endothelin-B receptor, PG synthesis, or NO synthase) and with DPR. Repeated-measures analysis of variance test was applied with Tukey-Kramer honestly significant difference test (P < .05).. At baseline, NEC animals demonstrated significantly decreased ileal blood flow as compared with CONTROLs (P < .05). Endothelin-A receptor and PG inhibition increased flow in the intestinal microvasculature, but this was significantly augmented by the addition of DPR (P < .05). Blockade of NO synthase decreased intestinal blood flow, which was overcome with addition of DPR (P < .05).. Ileal blood flow was significantly reduced in NEC animals as compared with CONTROLs. The addition of DPR to the peritoneum increased ileal blood flow significantly in all groups in spite of blockade of these known vasoactive mechanisms. Direct peritoneal resuscitation may be a novel strategy to improve intestinal blood flow in NEC.

Topics: Animals; Animals, Newborn; Cyclooxygenase Inhibitors; Dialysis Solutions; Endothelin A Receptor Antagonists; Endothelin B Receptor Antagonists; Enterocolitis, Necrotizing; Ileum; Infusions, Parenteral; Mefenamic Acid; Microcirculation; Models, Animal; NG-Nitroarginine Methyl Ester; Nitric Oxide Synthase; Oligopeptides; Osmolar Concentration; Peptides, Cyclic; Piperidines; Random Allocation; Rats; Rats, Sprague-Dawley; Resuscitation; Solutions; Urinary Bladder

Premature babies experience pain and require adequate analgesia for any painful procedure. Fentanyl and morphine resulted in safe and effective anesthesia in the past; however, their pharmacokinetics may be impaired in preterm babies with multiorgan failure. Remifentanil, despite the absence of available pharmacokinetic data in preterm infants and few reports in newborns, demonstrated its advantages in children undergoing either major surgery or minor painful procedures and has been shown to be useful even in neonates, because its elimination is independent of organ function. We report two cases of babies born at 26 weeks' and 27 weeks' gestation, weighing 580 g and 400 g, respectively, undergoing laparotomy for necrotizing enterocolitis. Both received midazolam bolus and remifentanil infusion at high doses. This technique seems to be an advantageous alternative even in extremely low-birth-weight prematures. Furthermore, it becomes a technique of choice in these babies because the available ventilators are often not equipped with halogenated vaporizers. Particularly in intensive care, where there are no scavenger systems, it could allow to operate without moving out the preterm babies and avoiding stress and hypothermia.

Topics: Anesthetics, Intravenous; Enterocolitis, Necrotizing; Fatal Outcome; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Infusions, Intravenous; Laparotomy; Piperidines; Remifentanil