II. Indications

  1. Maintain patency or reopen ductus arteriosus
  2. See Ductal Dependent Lesions

III. Mechanism

  1. Vasodilation including ductus arteriosus via arterial smooth muscle relaxation

IV. Pharmacokinetics

  1. Onset of effect seen in <30 minutes for cyanotic lesion
  2. Acyanotic lesions may take longer to see effect

V. Contraindications

  1. Total Anomalous Pulonary Venous Return (TAPVR)
    1. Pulmonary veins attach to vena cava
    2. Prostaglandin worsens TAPVR

VI. Preparation: Method 1

  1. Keep refrigerated
  2. Infusion
    1. Start with "x" mg of Prostaglandin E1
      1. Where "x" = 0.3 x WeightKg
    2. Add enough D5W to Prostaglandin for 50 ml total
  3. At this dilution
    1. Infusion rate of 0.5 ml/min provides 0.05 mcg/kg/min

VII. Preparation: Method 2

  1. Dissolve 500 mcg (1 ampule) of PGE-1 in 100 ml D5W
  2. Creates PGE-1 solution 5 mcg/ml
  3. Infusion rate of 0.01 ml/min provides 0.05 mcg/min

VIII. Dose

  1. Start
    1. Infuse 0.01 mcg/kg/min
  2. Titrate to effect
    1. Increase to 0.05 - 0.10 mcg/kg/min as needed
    2. Decrease to 0.025 mcg/kg/min as able as ductus opens
      1. Anticipate Hypotension as circulation re-distributes with increased PDA opening
      2. Monitor Blood Pressure in all 4 limbs to confirm improved ductus flow

IX. Adverse Effects (potentially lethal)

  1. Flushing
  2. Peripheral Edema
  3. Hypotension
  4. Apnea
  5. Hyperpyrexia
  6. Jitteriness
  7. Diarrhea
  8. Hypoglycemia
  9. Hypocalcemia
  10. Renal Failure
  11. Rhythm disturbance
  12. Coagulopathies

X. Precautions

  1. Adverse effects are common and potentially lethal (see above)
  2. Prepare before infusing prostaglandins
    1. Apnea
      1. Intubation
    2. Hypotension
      1. Inotropes: Dobutamine (Milrinone)
      2. Pressors: Norepinephrine, Epinephrine, Phenylephrine
        1. Do NOT pressors if ductal dependent systemic circulation (Aortic Coarctation)
        2. Risk of worsening coarctation and Cardiac Arrest

XI. References

  1. Sloas, Checchia and Orman in Majoewsky (2013) EM: Rap 13(9): 8

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