II. Indications
- Maintain patency or reopen ductus arteriosus
- See Ductal Dependent Lesions
III. Mechanism
- Vasodilation including ductus arteriosus via arterial Smooth Muscle relaxation
IV. Pharmacokinetics
- Onset of effect seen in <30 minutes for cyanotic lesion
- Acyanotic lesions may take longer to see effect
V. Contraindications
- Total Anomalous Pulonary Venous Return (TAPVR)
- Pulmonary veins attach to vena cava
- Prostaglandin worsens TAPVR
VI. Preparation: Method 1
- Keep refrigerated
- Infusion
- Start with "x" mg of Prostaglandin E1
- Where "x" = 0.3 x WeightKg
- Add enough D5W to Prostaglandin for 50 ml total
- Start with "x" mg of Prostaglandin E1
- At this dilution
- Infusion rate of 0.5 ml/min provides 0.05 mcg/kg/min
VII. Preparation: Method 2
- Dissolve 500 mcg (1 ampule) of PGE-1 in 100 ml D5W
- Creates PGE-1 solution 5 mcg/ml
- Infusion rate of 0.01 ml/min provides 0.05 mcg/min
VIII. Dose
- Start
- Infuse 0.01 mcg/kg/min
- Titrate to effect
- Increase to 0.05 - 0.10 mcg/kg/min as needed
- Decrease to 0.025 mcg/kg/min as able as ductus opens
- Anticipate Hypotension as circulation re-distributes with increased PDA opening
- Monitor Blood Pressure in all 4 limbs to confirm improved ductus flow
IX. Adverse Effects (potentially lethal)
- Flushing
- Peripheral Edema
- Hypotension
- Apnea
- Hyperpyrexia
- Jitteriness
- Diarrhea
- Hypoglycemia
- Hypocalcemia
- Renal Failure
- Rhythm disturbance
- Coagulopathies
X. Precautions
- Adverse effects are common and potentially lethal (see above)
- Prepare before infusing Prostaglandins
- Apnea
- Intubation
- Hypotension
- Inotropes: Dobutamine, Milrinone
- Pressors: Norepinephrine, Epinephrine, Phenylephrine
- Do NOT pressors if ductal dependent systemic circulation (Aortic Coarctation)
- Risk of worsening coarctation and Cardiac Arrest
- Apnea
XI. References
- Sloas, Checchia and Orman in Majoewsky (2013) EM: Rap 13(9): 8