Abstract:
BACKGROUND:The significant postnatal maturation of gamma-aminobutyric acid signaling in the developing brain is likely to have important implications for infant pain processing. Gamma-aminobutyric acid receptor activation evokes analgesia and sedation in the adult, but the impact of immature gamma-aminobutyric acid signaling on modulators of the gamma-aminobutyric acid type A receptor, such as the benzodiazepines, is not known in infants. METHODS:Nociceptive processing was measured using behavioral and electrophysiological recordings of hind limb flexor withdrawal threshold and magnitude to mechanical and thermal stimulation of the hind paw. The effects of midazolam (0.1-10 mg/kg subcutaneously, 0.1 mg/kg intrathecally) or saline treatment were compared in rats aged 3, 10, 21, and 40 days (adult). The sedative action of midazolam was assessed at each age using righting reflex latencies. RESULTS:Midazolam dose-dependently decreased mechanical reflex thresholds and increased mechanical and thermal reflex magnitudes in neonates. In older rat pups and adults, midazolam had the reverse effect, increasing thresholds and decreasing reflex magnitude. These differences were mediated supraspinally; intrathecal administration of midazolam did not affect flexion reflexes at any age. Midazolam had no sedative action in the youngest rats; sedation increased gradually through postnatal development. CONCLUSIONS:The results show a striking reversal in the effects of midazolam on nociception and sedation in rats between postnatal days 3 and 10. Midazolam fails to sedate young rats and sensitizes their flexor reflex activity. The sedative and desensitizing effects of midazolam are not observed until later in life after maturation in supraspinal centers. The results indicate a need to better understand the pharmacology of drugs used routinely in neonatal intensive care.
journal_name
Anesthesiologyjournal_title
Anesthesiologyauthors
Koch SC,Fitzgerald M,Hathway GJdoi
10.1097/01.anes.0000296079.45446.15subject
Has Abstractpub_date
2008-01-01 00:00:00pages
122-9issue
1eissn
0003-3022issn
1528-1175pii
00000542-200801000-00019journal_volume
108pub_type
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