Kesavan Kalpashri, Ezell Tarrah, Bierman Alexis, Nunes Ana Rita, Northington Frances J, Tankersley Clarke G, Gauda Estelle B
Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD, United States.
Environmental Health Sciences, School of Public Health of Johns Hopkins, Baltimore, MD, United States.
Respir Physiol Neurobiol. 2014 Sep 15;201:93-100. doi: 10.1016/j.resp.2014.06.015. Epub 2014 Jul 5.
Sedative-analgesics are often given to newborn infants and are known to affect many components of the autonomic nervous system. While morphine is most frequently used, α-2 adrenergic receptor agonists are being increasingly used in this population. Alpha-2 adrenergic receptors agonists also have anti-shivering properties which may make it a desirable drug to give to infants undergoing therapeutic hypothermia. The aim of this study was to systematically compare two different classes of sedative-analgesics, morphine, a μ-opioid receptor agonist, and clonidine an α-2 adrenergic receptor agonist on breathing, metabolism and core body temperature (CBT) in neonatal rodents.
Breathing parameters, oxygen consumption (VO2) and carbon dioxide production (VCO2), were measured prior to, 10 and 90 min after intraperitoneal (IP) administration of morphine (2, 10 or 20 mg/kg), clonidine (40, 200 or 400 μg/kg), or saline in Sprague-Dawley rat pups at postnatal day 7 (p7) while continuously monitoring CBT.
Morphine reduced the respiratory rate, VO2 and VCO2 greater than clonidine at all dosages used (p<0.05, morphine vs. clonidine, for all metabolic and respiratory parameters). Furthermore, morphine induced prolonged respiratory pauses, which were not observed in animals treated with clonidine or saline. Morphine caused hypothermia which was dose dependent, while clonidine stabilized CBT in comparison to saline treated animals (p<0.0001).
In the newborn rat, morphine causes profound respiratory depression and hypothermia while clonidine causes minimal respiratory depression and stabilizes CBT. All together, we suggest that clonidine promotes autonomic stability and may be a desirable agent to use in infants being treated with therapeutic hypothermia.
镇静镇痛药常用于新生儿,已知其会影响自主神经系统的许多组成部分。虽然吗啡是最常用的,但α-2肾上腺素能受体激动剂在这一人群中的使用越来越多。α-2肾上腺素能受体激动剂还具有抗寒战特性,这可能使其成为给予接受治疗性低温的婴儿的理想药物。本研究的目的是系统比较两种不同类别的镇静镇痛药,即μ-阿片受体激动剂吗啡和α-2肾上腺素能受体激动剂可乐定,对新生啮齿动物呼吸、代谢和核心体温(CBT)的影响。
在出生后第7天(p7)的Sprague-Dawley幼鼠腹腔内(IP)注射吗啡(2、10或20mg/kg)、可乐定(40、200或400μg/kg)或生理盐水之前、之后10分钟和90分钟测量呼吸参数、耗氧量(VO2)和二氧化碳产生量(VCO2),同时持续监测CBT。
在所有使用的剂量下,吗啡降低呼吸频率、VO2和VCO2的程度均大于可乐定(对于所有代谢和呼吸参数,p<0.05,吗啡与可乐定相比)。此外,吗啡诱导长时间呼吸暂停,而在接受可乐定或生理盐水治疗的动物中未观察到这种情况。吗啡导致体温过低,且呈剂量依赖性,而与生理盐水治疗的动物相比,可乐定使CBT稳定(p<0.0001)。
在新生大鼠中,吗啡会导致严重的呼吸抑制和体温过低,而可乐定引起的呼吸抑制最小,并能稳定CBT。总之,我们认为可乐定可促进自主神经稳定性,可能是用于接受治疗性低温治疗的婴儿的理想药物。