Safety of ketorolac in neonates and infants after cardiac surgery

@article{Moffett2006SafetyOK,
  title={Safety of ketorolac in neonates and infants after cardiac surgery},
  author={Brady S Moffett and Tiffany I. Wann and Kathleen Carberry and Antonio R. Mott},
  journal={Pediatric Anesthesia},
  year={2006},
  volume={16}
}
Background:  Ketorolac is an injectable nonsteroidal anti‐inflammatory drug that is often used as a transitional short‐term analgesic to treat moderate pain and to decrease opioid use. There is a paucity of literature documenting the safety of using ketorolac in neonates and infants after cardiac surgery. 
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Ketorolac as an analgesic agent for infants and children after cardiac surgery: safety profile and appropriate patient selection.
TLDR
Concerns about renal dysfunction and increased bleeding risk are addressed and ketorolac can be used in specific pediatric patients after cardiac surgery with minimal risk of bleeding or renal dysfunction with appropriate dosing and duration of use.
Safety of ketorolac in surgical neonates and infants 0 to 3 months old.
Narrative review shows that the short‐term use of ketorolac is safe and effective in the management of moderate‐to‐severe pain in children
TLDR
It is found that gastrointestinal side effects were mainly reported with prolonged use, significant bleeding was reported in adenotonsillectomy, and adverse renal effects appeared to be limited to patients with specific coexisting risk factors.
Safety and efficacy of ketorolac in children after cardiac surgery
TLDR
Ketorolac started in the first 12 h after a low-risk cardiac surgery in children is not associated with a measurable difference in renal function, and the data suggest that ket orolac may be effective in reducing the exposure to opioids.
Acute pain management in infants and children-Part 2: Intravenous opioids, intravenous nonsteroidal anti-inflammatory drugs, and managing adverse effects.
TLDR
The following article reviews the use of intravenous opioid and nonsteroidal anti-inflammatory agents for the treatment of moderate to severe pain.
Safety of intravenous use of ketorolac in infants following cardiothoracic surgery
TLDR
Intravenous ketorolac appears to be safe when used in infants less than six months of age with biventricular circulations following cardiothoracic surgery, and does not decrease the use of standard analgesic therapy.
Use of Intravenous Ketorolac as Postoperative Analgesic in Neonates: A Prospective Study in Chittagong, Bangladesh
TLDR
Ketorolac has better analgesic efficacy than acetaminophen as postoperative analgesic in neonates, although associated with bleeding tendency, according to a prospective study undertaken in Bangladesh.
Ketorolac-associated renal morbidity: risk factors in cardiac surgical infants
TLDR
It is concluded that the concomitant use of aspirin with ketorolac is associated with increased renal morbidity in young post-cardiac surgical infants.
Antiplatelet Effect of Ketorolac in Children After Congenital Cardiac Surgery
TLDR
Ketorolac use in a cohort of children after congenital cardiac surgery was associated with platelet inhibition via the AA pathway when evaluated by TEG-PM.
Black box warning: is ketorolac safe for use after cardiac surgery?
TLDR
Korolac appears to be well-tolerated for use when administered selectively after cardiac surgery, and although a black box warning exists, the data highlights the need for further research regarding its perioperative administration.
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References

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TLDR
The aim of this study was to evaluate its safety and analgesic efficacy in the neonate and Ketorolac was evaluated.
Ketorolac after congenital heart surgery: does it increase the risk of significant bleeding complications?
TLDR
The object of this study was to determine if the use of ketorolac is associated with an increased risk of significant postoperative bleeding after congenital heart surgery in infants and children.
Prospective randomized trial of ketorolac after congenital heart surgery.
TLDR
Ketorolac can be used to treat pain after congenital heart surgery without an increased risk of bleeding complications, and is effective in infants and children who underwent cardiopulmonary bypass.
Ketorolac reduces postoperative narcotic requirements.
TLDR
Ketorolac exhibits significant opiate-sparing effects in the immediate postoperative period without introducing additional morbidity to pediatric surgical procedures.
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TLDR
Ketorolac reduces the amount of morphine required after abdominal surgery in infants less than 6 months old, and deserves further study as a method of reducing opioid-associated adverse effects in this patient group.
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TLDR
Korean ketorolac appears to be a safe and effective therapy for children when given in appropriate doses for a limited duration when using as an antipyretic in a large population of children.
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TLDR
Local peripheral and central blocks decrease the need for anesthetics during surgery and provide effective postoperative pain relief, and several studies have demonstrated the relatively strong analgesic potential of these drugs.
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TLDR
It is concluded that rectal Ac up to 40 mg/kg has no opioid-sparing effect, does not result in analgesic Ac plasma concentrations, and lacks proof of its efficacy in infants and small children undergoing cleft palate repair, whereas titrated IV opioid boluses produced rapid and reliable pain relief.
Con: nonsteroidal anti-inflammatory drugs should not be routinely administered for postoperative analgesia after cardiac surgery.
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    Journal of cardiothoracic and vascular anesthesia
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NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs) are nonspecific inhibitors of cyclooxygenase (COX), which is the rate-limiting enzyme involved in the synthesis of prostaglandins. COX exists in two…
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