ABSTRACT
Introduction: Regional anaesthesia in children was firststudied by August Bier in 1899 Intraoperative blockade ofthe neuraxis, whether by the spinal or epidural route providesexcellent analgesia with minimal physiologic alteration.This study was done with the primary aim to compare spinalanaesthesia with caudal anaesthesia in lower paediatric agegroup patients undergoing elective infraumbilical surgery forduration of analgesia and hemodynamic stability. We alsocompared the characteristics of sensory and motor block.Material and methods: In this study 100 patients whofulfilled the eligibility criteria were chosen and the procedurewas explained to the patients attendant. After obtainingwritten and informed consent, patients were randomizedinto two equal groups of 50 each. Group S was given spinalanaesthesia- hyperbaric bupivacaine (0.5%) in a dose of 0.5mg/kg was injected. Group C was given caudal block-0.5%plain bupivacaine 2mg/kg plus normal saline. Postoperativelypatients were observed for analgesia, sedation, hemodynamicand complications if any.Result: The sensory level achieved in all cases of group S wasT10 while in group C it was in 93%.Mean onset time, durationand regression of sensory block as well as for motor block washigher in caudal group than spinal group.The time required forfirst supplement was delayed in caudal group.Cries scale wasnot the limiting factor in both the groups.Conclusion: In short surgeries requiring immediate relaxationspinal anaesthesia is preferable while in surgeries withmoderately prolonged duration caudal is preferable.
ABSTRACT
Abstract Background: Children and adolescents are considered a population at risk for developing posttraumatic stress disorder (PTSD) after a traumatic event. The Children's Revised Impact Scale (CRIES-8) is a self-report scale with 8 items that investigates avoidance and intrusion behaviors related to posttraumatic stress symptoms. Objective: The study consisted of translation and transcultural adaptation of CRIES-8 to Brazilian Portuguese and evaluation of its psychometric properties. Methods: A sample of 235 Brazilian children and adolescents exposed to natural hazards (drought or flood) and non-exposed children participated in the study. The methodological procedure for translation and cultural adaptation were in accordance with the principles described by ISPOR Task Force for Translation and Cultural Adaptation. We also evaluated test reliability and validity based on test content, the relations to other variables, and internal structure. Results: The procedures lead to a final Portuguese version proofread and cultural-adapted. Empirical evidence supports CRIES-8's division in two latent constructs (Intrusion and Avoidance), as well convergence correlations with other measures of child mental health and high reliability. Discussion: A Brazilian-Portuguese version of CRIES-8 is an important tool for a better screening of PTSD among youth who face traumatic events, being a potential informative instrument to identify children at risk.
ABSTRACT
Objective To explore the reliability and validity of the Children' s Impact of Event Scale (Chinese version, CRIES-13) and to determine the value and the optimal cutoff point of the score of CRIES-13 in screening posttraumatic stress disorder(PTSD), so as to provide evidence for PTSD prevention and identify children at risk in Wenchuan earthquake areas. Methods A total of 253 children experienced the Wenchuan earthquake were tested through Stratified random cluster sampling. The authors examined CRIES-13's internal consistency, discriminative validity and predictive value of the cut-off. PTSD was assessed with the DSM-Ⅳ criteria. Area under the curve while sensitivity, specificity and Youden index were computed based on the receiver operating characteristic curve analysis. Optimal cutoff point was determined by the maximum of Youden index. Results 20.9% of the subjects were found to have met the DSM-Ⅳ criteria for PTSD 7 months after the Wenchuan earthquake accident. The Cronbach' s coefficient of CRIES-13 was 0.903 and the mean inter-item correlation coefficients ranged from 0.283 to 0.689, the correlation coefficient of the three factors with the total scale scores ranged from 0.836 to 0.868 while the correlation coefficient among the three factors ranged from 0.568 to 0.718, PTSD cases indicated much higher scores than non-PTSD cases, the Youden index reached maximum value when the total score approached 18 in CRIES-13 with sensitivity and specificity as 81.1% and 76.5% respectively. Consistency check showed that there were no significant differences between the results of CRIES-13 score ≥32 and clinical diagnosis (Kappa=0.529) from the screening program. Conclusion CRIES-13 appeared to be a reliable and valid measure for assessing the posttraumatic stress symptoms among children after the earthquake accident in the Wenchuan area. The CRIES-13 seemed to be a useful self-rating diagnostic instrument for survivors with PTSD symptoms as a clinical concern by using a 18 cut-off in total score. Consistency check showed that there was no significant difference between the screening result of CRIES- 13 score ≥ 32 and clinical diagnosis.
ABSTRACT
Durante las últimas 2 décadas ha aumentado el interés hacia el dolor que perciben los neonatos. Los niños hospitalizados en unidades de cuidados intensivos están expuestos a múltiples procedimientos dolorosos y, desafortunadamente, aún no se ha establecido un tratamiento adecuado para su manejo. Los objetivos de este estudio son: 1) aumentar la sensibilidad del médico ante el sufrimiento del neonato; 2) presentar las escalas más comunes para valorar el dolor en los neonatos (PIPP: Premature Infant Pain Profile; CRIES: Crying, Requires Oxygen to maintain saturation > 95%, Increased vital signs, Expression, Sleeplessness; NIPS: Neonatal Infants Pain Scale); y 3) proponer un manejo terapéutico para el dolor en los neonatos.
During the last 2 decades, awareness of neonatal pain is being increased. Pain has short and long term adverse effects. Babies hospitalized in neonatal intensive care units are exposed to many painful procedures; unfortunately, there is no general consensus in the approach and management of pain in newborns. The objectives of this report are: 1) Increase the awareness of neonatal pain among care givers; 2) present most common neonatal pain assessment scales (PIPP: Premature Infant Pain Profile; CRIES: Crying, Requires Oxygen to maintain saturation > 95 %, Increased vital signs, Expression, Sleeplessness; NIPS: Neonatal Infants Pain Scale); 3) discuss therapeutic approach to management of pain in newborns.