GOLD Learning Speakers

There has been an evolution in knowledge regarding the consequences of untreated pain in the infant as well as the unintended long-term effects of providing systemic analgesics. Infants were often subjected to surgical procedures without analgesia until the landmark paper by Anand and Hickey demonstrated improved morbidity and mortality when proper anesthesia and analgesia were provided to infants undergoing surgical procedures. Early life stress and chronic pain has shown evidence of long-term adverse neurodevelopmental effects upto adulthood. An FDA Drug Safety Communication Alert advised practitioners that repeated or lengthy exposures to anesthetics and sedatives have the potential to have adverse effects on neurodevelopmental outcomes. Many anesthetics, benzodiazepines, and opiates act via NMDA (N-methyl-D-aspartate) receptor agonism, GABA (gamma amino butyric acid) agonism or both. Animal model studies have demonstrated neuro-apoptosis and subsequent cognitive impairments due to these drug-receptor interactions. Cumulative opioid exposure has been associated with adverse cognitive outcomes in former extremely low birth weight infants (ELBW). These concerns prompted many to pursue other pharmacologic modalities and surgical techniques to minimize the use of postoperative opioids. This lecture will discuss the use of Regional analgesia (RA) and Nurse Controlled Analgesia (NCA) in post operative infants in the NICU.