Amy Kiskaddon, PharmD, MBA, BCPPS, summarizes a study she and cardiac intensivist Arabela Stock, along with Neil A. Goldenberg, M.D., Ph.D., presented at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery showing how Ketorolac can reduce the need for opioids in neonates.
Hi, my name is Amy Kis Cadden and I'm a pharmacist at Johns Hopkins, all Children's Hospital in the Heart Institute. I'm also assistant professor of pediatrics in the Johns Hopkins University School of Medicine. And I'm going to share a little bit about our project that I presented at the World Congress of Pediatric Cardiology and congenital heart surgery in August of 2023 on the use of Korla in neonates, falling congenital heart surgery. And to provide a little bit of background on this, I have strong interest in research, um sedation, analgesia thrombosis and one of our intensivist doctor Arabella Stock has similar interests in pain management, sedation and delirium following cardiac surgery. And when we met a few years ago, um our interest in this particular topic led us to develop a pathway um specifically looking at the use of non opioid agents in our patients down to neonates following congenital heart surgery. And this included KORAC. Um there is some concern with using KORAC, given concerns of bleeding and renal impairment in the in the neonatal population. But in developing our institutional proof algorithm, we decided to uh make make certain criteria that would allow the neonates to actually get it. And so after a couple of years of using it, we decided to retrospectively look at our data and we had about 40 patients total who had received korac who are specifically neonates, falling congenital heart surgery at a dose of 0.5 mg per kilo every six hours for up to 48 hours with regards to renal impairment. Uh the per the CADI go guidelines, we actually didn't observe any clinically or statistically significant rates of renal impairment. And we didn't see any major bleeding that would be according to the isth criteria or by the criteria published by needles and colleagues. And then with regard to opioid administration, while we didn't have an actual group of patients to compare them to. Since this was a single center retrospective cohort study, we did compare our opioid requirements for these patients to what's been published in the literature. And we actually found that there was pretty low rates of opioid administration in the patients who had um acetaminophen and ketorolac. Um This is actually good because we are trying to look for ways to minimize opioid exposure in this patient population due to the long term outcomes that have are potentially negative. Um So we're very excited about these findings and we're looking forward to future opportunities with research and ways of looking at the data to come up with ways that we can help provide optimum care to our patients who are undergoing congenital heart surgery. Thank you.