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Biomedical subjects

I Choonara

Publications and source records attributed to I Choonara.

66 records · Page 4Linked to original sources
PubMed1994

A prospective study of the adverse effects of midazolam on withdrawal in critically ill children.

Fifty-three critically ill infants and children received midazolam as sedation in a regional intensive care unit. Assessment of the level of sedation was carried out at regular intervals on withdrawal of midazolam. Forty-nine patients were fully alert within 4 h of midazolam being stopped. Four patients took from 6 h to 1 week to become fully alert. Four patients had abnormal behaviour highly suggestive of midazolam withdrawal. The onset of abnormal behaviour was within 12 h of discontinuation of midazolam. The duration of the abnormal behaviour ranged from 3 h to 1 week. One child had a paradoxical reaction to midazolam. The overall incidence of adverse effects to midazolam in the patients studied was 17%. No adverse effects were observed in infants; all adverse effects were observed in children. We have shown that it is possible to prospectively study the toxicity of sedatives in critically ill infants and children.

Child↗
PubMed1993

Hallucinations on withdrawal of isoflurane used as sedation.

Hallucinations on withdrawal of midazolam have been noted in intensive care patients. Isoflurane is increasingly used as an alternative drug for sedation. We report a seven-year-old child with 15% burns who, on withdrawal of isoflurane, suffered hallucinations, a generalized seizure and disorientation. The adverse symptoms occurred within hours of stopping the isoflurane and lasted for five days.

Child↗
PubMed1992

Morphine metabolism in neonates and infants.

The metabolism of morphine was studied in seven fullterm neonates and five infants receiving a continuous infusion of morphine. All the patients had detectable plasma concentrations of morphine 3-glucuronide (M3G) and 10 had detectable concentrations of morphine 6-glucuronide (M6G). The mean plasma clearance of morphine was 20.1 ml min-1 kg-1 in neonates and 23.4 ml min-1 kg-1 in the group as a whole. The M3G/morphine ratio (7.3) was higher than that previously reported for preterm neonates (5.0) but lower than that reported for children (23.9).

Chromatography, High Pressure Liquid↗
PubMed1990

Morphine sulphation in children.

The metabolism of morphine was studied in nine children and seven preterm neonates receiving a continuous infusion of morphine. All the neonates and three children had detectable concentrations of morphine-3-sulphate (M3S) in urine. None of the neonates or the children had detectable concentrations of morphine-6-sulphate (M6S) in urine. None of the children had detectable concentrations of M3S in plasma. The M3S/morphine ratios were significantly higher in neonates than children (P less than 0.01), suggesting that morphine sulphation decreases after the neonatal period. The amount of M3S formed, even in neonates, is low suggesting that this is a minor metabolic pathway.

Humans↗
PubMed1990

Long term high dose morphine, ketamine and midazolam infusion in a child with burns.

The metabolism of morphine and ketamine was studied in a 14 month old child with extensive burns, who received infusions of both drugs for more than 30 days. The mean plasma clearance of morphine was 29 ml min-1 kg-1 and the plasma ratios of morphine-6-glucuronide to morphine were similar to those previously reported in children. The mean plasma clearance of ketamine was 32 ml min-1 kg-1 which is greater than that previously reported in older children and adults. There were no complications despite high dose long term therapy with morphine, ketamine and midazolam.

Burns↗
PubMed1989

Pharmacokinetics of prednisolone in children with acute lymphoblastic leukaemia.

The pharmacokinetics of soluble oral prednisolone were studied during induction therapy in six children with acute lymphoblastic leukaemia. There was a three- to four-fold variation in the pharmacokinetics of total and free prednisolone. For total prednisolone, the mean elimination half-life was relatively short (1.37 h) and the total clearance, relatively high (15.1 ml min-1 kg-1). The mean free fraction was high (0.37).

Antineoplastic Combined Chemotherapy Protocols↗