Abstract:
© 2019 Elsevier Inc. All rights reserved. The pharmacokinetics (PK) and pharmacodynamics (PD) of most medications in children especially neonates, differ from those in adults. Children exhibit different PK and PD from adults because of their immature renal and hepatic function, different body composition, altered protein binding, distinct disease spectrum, diverse behavior, and dissimilar receptor patterns. PK differences necessitate modification of the dose and the interval between doses to achieve the desired concentration associated with a clinical response and to avoid toxicity. In addition, some medications may displace bilirubin from its protein binding sites and possibly predispose to kernicterus in premature neonates. Drug effect may be influenced by altered capacity of the end organ, such as the heart or bronchial smooth muscle, to respond to medications in children compared with adults. In this chapter we discuss basic pharmacologic principles as they relate to drugs commonly used by anesthesiologists.
