Therapeutic

Class Medication

Mechanism of

Action Metabolism

Route of

Administration

(neonates) Dose and Frequency Reversal Agent Comments

Lidocaine 4%

liposomal

cream

Blocks initiation

and conduction

of nerve impulses

via ↓ sodium permeability

Hepatic/dermal:

CYP-450 and small

amount of dermal

metabolism to

Monoethylglycinexylidide

Topical Topical: Local skin reactions Use in term infants for short term

procedures.

Avoid use in premature infants: contains

benzyl alcohol.

Avoid prolonged contact.p

Lidocaine 2.5%/

prilocaine

2.5% eutectic

mixture

cream

Blocks initiation

and conduction

of nerve impulses

via ↓ sodium permeability

Hepatic/dermal:

CYP-450 and small

amount of dermal

metabolism to

Monoethylglycinexylidide

Topical Topical

0.5–2 g under occlusive

dressing 1 hr prior to

procedure

2 g = Term infants

0.5 g = Preterm

Avoid applying over larger

areas and for >2 h

duration

Local skin reactions

Methemoglobinemia

Methemoglobinemia prolonged contact/

large amounts in young infants/

children.q

Drugs predisposing to methemoglobinemia include:

Sulfas, acetaminophen, benzocaine,

nitrofurantoin, nitroglycerin, phenobarbital, phenytoin

Has been used safely in preterms in

small amounts once daily.

Do not apply near or in open wounds.

Do use in severe hepatic disease.

Use with caution in infants receiving

class I antiarrhythmics.

aAnderson BJ. Paracetamol (acetaminophen): mechanisms of action. Paediatr Anaesth. 2008;18(10):915. bSection on Clinical Pharmacology and Therapeutics; Committee on Drugs, Sullivan JE, Farrar HC. Fever and antipyretic use in children. Pediatrics. 2011;127(3):580.

cvan Lingen RA, Deinum JT, Quak JM, et al. Pharmacokinetics and metabolism of rectally administered paracetamol in preterm neonates. Arch Dis Child Fetal Neonatal Ed. 1991;80(1)F59. dOfirmev (acetaminophen). Injection package labeling. San Diego, CA: Cadence Pharmaceuticals, Inc.; 2010.

eReuters T. Red Book: Pharmacy’s Fundamental Reference. Los Angeles, CA: PDR Network; 2011. fTaketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook, 18th ed. Hudson, OH: Lexi-Comp; 2011.

gCaldolor (ibuprofen). Injection package labeling. Nashville, TN: Cumberland Pharmaceuticals Inc.: 2009. hLei-Lai M, Kauffman R, Uy H, et al. A randomized comparison of ketorolac tromethamine to morphine for postoperative analgesia in critically ill children. Crit Care Med. 1999;27:2786.

iFahnenstich H, Steffan J, Kau N, et al. Fentanyl-induced chest wall rigidity and laryngospasm in preterm and term infants. Crit Care Med. 2000;28:836.

jArnold JH, Truog RD, Orav EJ, et al. Tolerance and dependence in neonates sedated with fentanyl during extracorporeal membrane oxygenation. Anesthesiology. 1990;73:1136. kChana SK, Anand KJS. Can we use methadone for analgesia in preterm infants? Arch Dis Child Fetal Neonatal Ed. 2001;85:F79. lOzcengik D, Gunes Y, Atci M. Preliminary experience with dexmedetomidine in neonatal anesthesia. J Anesthesa Clin Pharmacol. 2011;27(1):17.

mBhutta AT. Ketamine: a controversial drug for neonates. Semin Perinatol. 2007;31:303.

nShah PS, Shah VS. Propofol for procedural sedation/anaesthesia in neonates. Cochrane Database Syst Rev. 2011;(3):CD007248.

oAnand KJ, Barton BA, McIntosh N, et al Analgesia and sedation in preterm infants who require ventilator support: results from the NOPAIN trial. Arch Pediatr Adolesc Med. 1999;153:331.

pTutag Lehr V, Taddio A, Practical approach to topical anesthetics in the neonate. Semin Perinatol. 2007;(5):323.

qGuay J. Methhemoglobinemia related to local anesthetics; a summary of 242 episodes. Anesth Analg. 2009;108:837.

Table A.2 Sedative and Analgesic Agents Commonly Used in Pediatrics (Continued)

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