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1.
Paediatr Anaesth ; 28(2): 142-148, 2018 02.
Article in English | MEDLINE | ID: mdl-29226493

ABSTRACT

BACKGROUND: Research describing the experience of youth with autism spectrum disorders in the perioperative setting is limited. This study compared youth with autism spectrum disorder to typically developing children in the perioperative setting and examined group differences in: child anxiety, parent anxiety, premedication patterns, induction compliance, and changes in behavior postprocedure. METHODS: Participants were 60 youth (32 with autism spectrum disorder, 28 typically developing) of ages 2-19 years undergoing outpatient surgery and their parents. Parents and research assistants rated children's anxiety at 3 time points (waiting room, preoperative holding, separation), and parents rated their own anxiety in the waiting room and at separation. The anesthesiologist rated induction compliance. Postprocedure behavior change was assessed via phone survey 1 and 7 days postprocedure. Analyses examined group differences in anxiety, medication patterns, and behavior. RESULTS: Children with autism spectrum disorder had higher research assistant reported anxiety than typically developing youth in the holding room only. There were no group differences in parent report of their own anxiety or their child's anxiety across time points. Compared to typically developing youth, children with autism spectrum disorder were more likely to receive a premedication (including nonstandard premedication), and had poorer induction compliance. Groups did not differ on posthospital behavior change 1 or 7 days postsurgery. CONCLUSION: Findings revealed ratings of anxiety in youth with and without autism spectrum disorder facing surgery varied by reporter and setting, highlighting the importance of using multiple reporters in research of youth with autism spectrum disorder in the perioperative period. Furthermore, while results showed group differences in premedication patterns and induction compliance, groups did not differ in level of negative behavior change after surgery. Future research can examine how individual differences in youth with autism impact anxiety in the perioperative setting and degree of behavior change postprocedure.


Subject(s)
Ambulatory Surgical Procedures/psychology , Anxiety/psychology , Autism Spectrum Disorder/psychology , Autism Spectrum Disorder/surgery , Child Behavior/psychology , Perioperative Period/psychology , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Postoperative Period , Prospective Studies , Severity of Illness Index , Young Adult
2.
J Clin Anesth ; 37: 92-96, 2017 Feb.
Article in English | MEDLINE | ID: mdl-28235538

ABSTRACT

STUDY OBJECTIVE: Prior research has indicated that children with developmental delay (DD) experience qualitative and quantitative differences in health care (Boulet et al., 2009). In the perioperative setting, there is concern that children with DD may be more likely to experience postoperative complications including agitation and nausea/vomiting than typically developing patients (TDP). Differences in the administration and dosage of perioperative opioids may contribute to this, however, empirical investigations are lacking. The purpose of this research was to compare the experience of postoperative nausea/vomiting and agitation, as well as to examine perioperative opioid administration, among children with DD as compared to TDP. DESIGN: Retrospective original research. SETTING: Operating room, postanesthesia care unit. PATIENTS: 1145 patients (1-20.9years, ASA I-III, 23.9% with a history of DD) who had undergone outpatient dental surgery involving extraction/restorations under general anesthesia. MEASUREMENTS: Data was obtained and analyzed from the medical records of both DD and TDP across a five-year period. Data included the experience of agitation, nausea/vomiting, as well as perioperative medication administration. MAIN RESULTS: Postoperative agitation and nausea/vomiting did not differ significantly between the DD and TDP groups. Children with DD were significantly less likely to receive opioids during both the intra and postoperative period (χ2=10.02, p=0.001 and χ2=8.08, p=0.003, respectively). Further, higher dosage of intraoperative opioids was predictive of reduced administration of postoperative opioids among TDP; however, no significant association was observed between the dosage of intraoperative opioids and administration of postoperative opioids in the DD group. CONCLUSIONS: Children with DD experience similar rates of postoperative complications including nausea/vomiting and agitation as TDP. DD children were less likely to receive both intra and postoperative opioids than TDP. Importantly, while the dosage of intraoperative opioids was predictive of administration of postoperative opioids in the TDP group, this was not the case for the DD group. Clinical implications are discussed.


Subject(s)
Ambulatory Surgical Procedures/adverse effects , Analgesics, Opioid/administration & dosage , Developmental Disabilities/complications , Perioperative Care/methods , Tooth Extraction/adverse effects , Adolescent , Anesthesia, General , Child , Child, Preschool , Emergence Delirium/epidemiology , Female , Humans , Incidence , Infant , Male , Postoperative Nausea and Vomiting/epidemiology , Retrospective Studies
3.
J Neurosurg Pediatr ; 11(6): 643-52, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23581634

ABSTRACT

OBJECT: Infantile and late-infantile neuronal ceroid lipofuscinoses (NCLs) are invariably fatal lysosomal storage diseases associated with defects in lysosomal enzyme palmitoyl-protein thioesterase 1 (PPT-1) or tripeptidyl peptidase 1 (TPP1) activity. Previous preclinical studies have demonstrated that human CNS stem cells (HuCNS-SCs) produce both PPT-1 and TPP1 and result in donor cell engraftment and reduced accumulation of storage material in the brain when tested in an NCL mouse model. METHODS: HuCNS-SC transplantation was tested in an open-label dose-escalation Phase I clinical trial as a potential treatment for infantile and late-infantile NCL. Study design included direct neurosurgical transplantation of allogeneic HuCNS-SCs into the cerebral hemispheres and lateral ventricles accompanied by 12 months of immunosuppression. RESULTS: Six children with either the infantile or late-infantile forms of NCL underwent low- (3 patients) and high- (3 patients) dose transplantation of HuCNS-SCs followed by immunosuppression. The surgery, immunosuppression, and cell transplantation were well tolerated. Adverse events following transplantation were consistent with the underlying disease, and none were directly attributed to the donor cells. Observations regarding efficacy of the intervention were limited by the enrollment criteria requiring that patients be in advanced stages of disease. CONCLUSIONS: This study represents the first-in-human clinical trial involving transplantation of a purified population of human neural stem cells for a neurodegenerative disorder. The feasibility of this approach and absence of transplantation-related serious adverse events support further exploration of HuCNS-SC transplantation as a potential treatment for select subtypes of NCL, and possibly for other neurodegenerative disorders.


Subject(s)
Immunosuppressive Agents/administration & dosage , Neural Stem Cells/transplantation , Neuronal Ceroid-Lipofuscinoses/diagnosis , Neuronal Ceroid-Lipofuscinoses/surgery , Neurosurgical Procedures/methods , Stem Cell Transplantation/methods , Child , Child, Preschool , Dexamethasone/administration & dosage , Drug Administration Schedule , Feasibility Studies , Female , Humans , Magnetic Resonance Imaging , Male , Mycophenolic Acid/administration & dosage , Mycophenolic Acid/analogs & derivatives , Stereotaxic Techniques , Tacrolimus/administration & dosage , Transplantation, Homologous , Treatment Outcome , Tripeptidyl-Peptidase 1
4.
Anesthesiol Clin ; 30(2): 191-206, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22901606

ABSTRACT

Despite advances in antiepileptic medication therapy, a significant number of pediatric patients with epilepsy have seizures that are not well controlled. This article provides anesthesiologists with an overview of seizures in the pediatric population, including evaluation, medical treatment, surgical options, and the anesthetic implications of caring for this special population.


Subject(s)
Anesthesia/methods , Epilepsy/surgery , Neurosurgical Procedures/methods , Anticonvulsants/adverse effects , Anticonvulsants/therapeutic use , Child , Conscious Sedation , Corpus Callosum/surgery , Drug Interactions , Drug Resistance , Epilepsy/epidemiology , Hemispherectomy , Humans , Preoperative Care , Seizures/epidemiology , Seizures/surgery , Vagus Nerve Stimulation/methods
5.
Paediatr Anaesth ; 19(5): 513-20, 2009 May.
Article in English | MEDLINE | ID: mdl-19453584

ABSTRACT

OBJECTIVE: To describe the differences in intraoperative opioid dosing and associated outcomes in children with and without cerebral palsy (CP). BACKGROUND: Previous work on children with cognitive impairment has suggested that they receive less intraoperative opioid than children without cognitive impairment. This finding may be due to a common concern that impaired children are hypersensitive to the adverse effects of opioids. Patterns in intraoperative opioid dosing have yet to be studied in children with motor impairment (e.g. CP). METHODS: We examined the medical records of pediatric patients with CP who underwent orthopedic surgery over the last decade at our institution, as well as the records of a randomly selected group of pediatric orthopedic patients without CP (non-CP). Outcome variables were intraoperative opioid dosing, postoperative intensive care unit (ICU) admission, and postoperative oxygen desaturation. We collected demographic, surgical, and medical data for covariate analysis. A stepwise multivariate regression was used for each outcome. RESULTS: Seventy-one (71) CP and 77 non-CP charts were included in the study. CP children received significantly less intraoperative opioid (3.26 +/- 3.01 microg.kg(-1) fentanyl dose equivalents) than non-CP children (4.58 +/- 3.79 microg.kg(-1)) (P = 0.02), and this difference was corroborated by the regression analysis, which significantly associated CP with decreased opioid dosing (P < 0.001). In addition, intraoperative opioid dosing, but not CP, predicted ICU admission (odds ratio: 1.463, 95% CI: 1.042-2.054, P = 0.03) and postoperative oxygen desaturation (odds ratio: 1.174, 95% CI: 1.031-1.338, P = 0.02). CONCLUSIONS: Similar to prior research on children with cognitive impairment, a reduction in intraoperative opioid dosing was found in children with CP. Given the discrepant doses of intraoperative opioid between groups, it is unclear whether children with CP are at any greater risk for untoward opioid-related events.


Subject(s)
Analgesics, Opioid/administration & dosage , Cerebral Palsy/surgery , Intraoperative Care/methods , Adolescent , Child , Child, Preschool , Dose-Response Relationship, Drug , Female , Fentanyl/administration & dosage , Humans , Infant , Intensive Care Units/statistics & numerical data , Male , Odds Ratio , Orthopedic Procedures , Oxygen/blood , Postoperative Care/methods , Postoperative Complications , Treatment Outcome
6.
Pediatrics ; 121(5): 979-87, 2008 May.
Article in English | MEDLINE | ID: mdl-18450903

ABSTRACT

OBJECTIVE: The Comparison of Venipuncture and Venous Cannulation Pain After Fast-Onset Needle-Free Powder Lidocaine or Placebo Treatment trial was a randomized, single-dose, double-blind, phase 3 study investigating whether a needle-free powder lidocaine delivery system (a sterile, prefilled, disposable system that delivers lidocaine powder into the epidermis) produces effective local analgesia within 1 to 3 minutes for venipuncture and peripheral venous cannulation procedures in children. METHODS: Pediatric patients (3-18 years of age) were randomly assigned to treatment with the needle-free powder lidocaine delivery system (0.5 mg of lidocaine and 21 +/- 1 bar of pressure; n = 292) or a sham placebo system (n = 287) at the antecubital fossa or the back of the hand 1 to 3 minutes before venipuncture or cannulation. All patients rated the administration comfort of the needle-free systems and the pain of the subsequent venous access procedures with the Wong-Baker Faces Pain Rating Scale (from 0 to 5). Patients 8 to 18 years of age also provided self-reports with a visual analog scale, and parents provided observational visual analog scale scores for their child's venous access pain. Safety also was assessed. RESULTS: Immediately after administration, mean Wong-Baker Faces scale scores were 0.54 and 0.24 in the active system and sham placebo system groups, respectively. After venipuncture or cannulation, mean Wong-Baker Faces scale scores were 1.77 +/- 0.09 and 2.10 +/- 0.09 and mean visual analog scale scores were 22.62 +/- 1.80 mm and 31.97 +/- 1.82 mm in the active system and sham placebo system groups, respectively. Parents' assessments of their child's procedural pain were also lower in the active system group (21.35 +/- 1.43 vs 28.67 +/- 1.66). Treatment-related adverse events were generally mild and resolved without sequelae. Erythema and petechiae were more frequent in the active system group. CONCLUSIONS: The needle-free powder lidocaine delivery system was well tolerated and produced significant analgesia within 1 to 3 minutes.


Subject(s)
Analgesia/methods , Anesthetics, Local/administration & dosage , Catheterization, Peripheral , Drug Delivery Systems , Lidocaine/administration & dosage , Pain/prevention & control , Phlebotomy , Administration, Cutaneous , Adolescent , Anesthetics, Local/adverse effects , Catheterization, Peripheral/adverse effects , Child , Child, Preschool , Double-Blind Method , Drug Delivery Systems/adverse effects , Female , Humans , Lidocaine/adverse effects , Male , Pain/etiology , Pain Measurement , Phlebotomy/adverse effects , Powders
7.
Clin J Pain ; 23(9): 812-20, 2007.
Article in English | MEDLINE | ID: mdl-18075410

ABSTRACT

OBJECTIVES: The purpose of this study was to compare sleep of adolescents with chronic pain and healthy adolescents using both subjective and objective sleep assessments, and to identify correlates of poor sleep. METHODS: Forty adolescents (n=20 with chronic pain and n=20 healthy adolescents), aged 12 to 17 years (72.5% female) participated. Adolescents completed self-report measures of pain, sleep quality and hygiene, presleep arousal/worry, and depressive symptoms. Sleep patterns were assessed over 7 consecutive days using an actigraph, a motion-monitoring device detecting sleep-wake patterns by measuring activity levels. Total sleep time, sleep efficiency, wake time, and wake bouts were derived from the actigraph and aggregated for analysis. RESULTS: Compared with healthy peers, adolescents with chronic pain demonstrated similar total sleep time as healthy adolescents, but significantly poorer sleep. In particular, adolescents with chronic pain subjectively reported poorer sleep quality and increased insomnia symptoms, and demonstrated lower actigraphic sleep efficiency and more wake bouts compared with their healthy peers. Depressive symptoms and worry at bedtime were significant predictors of subjectively reported sleep quality but not of actigraphic sleep. DISCUSSION: Adolescents with chronic pain evidenced poorer sleep quality, increased insomnia symptoms, and less efficient sleep with more wake bouts in comparison with healthy adolescents, findings that require replication in a larger sample. Assessment and management of sleep disturbances is an important aspect of care for children and adolescents with chronic pain.


Subject(s)
Pain/complications , Sickness Impact Profile , Sleep Wake Disorders/diagnosis , Adolescent , Anxiety/etiology , Child , Chronic Disease , Depression/etiology , Evaluation Studies as Topic , Female , Humans , Male , Multivariate Analysis , Polysomnography/methods , Predictive Value of Tests , Quality of Life , Sleep Stages/physiology , Sleep Wake Disorders/complications , Surveys and Questionnaires
8.
Anesthesiol Clin ; 25(3): 465-81, viii, 2007 Sep.
Article in English | MEDLINE | ID: mdl-17884704

ABSTRACT

Craniosynostosis, premature closures of the skull sutures, results in dysmorphic features if left untreated. Brain growth and cognitive development may also be impacted. Craniosynostosis repair is usually performed in young infants and has its perioperative challenges. This article provides background information about the different forms of craniosynostosis, with an overview of associated anomalies, genetic influences, and their connection with cognitive function. It also discusses the anesthetic considerations for perioperative management, including blood-loss management and strategies to reduce homologous blood transfusions.


Subject(s)
Anesthesia , Blood Transfusion/methods , Cranial Sutures , Craniosynostoses/surgery , Blood Loss, Surgical , Blood Transfusion/standards , Brain/growth & development , Cognition/physiology , Cranial Sutures/growth & development , Cranial Sutures/surgery , Craniosynostoses/classification , Craniosynostoses/genetics , Humans , Infant , Perioperative Care , Practice Guidelines as Topic , Transfusion Reaction
10.
Anesth Analg ; 104(4): 847-9, 2007 Apr.
Article in English | MEDLINE | ID: mdl-17377092

ABSTRACT

BACKGROUND: Laser-assisted drug delivery (LAD) has the potential for facilitating topical anesthesia with reduced onset time. METHODS: In this randomized, double-blind, crossover study we compared the efficacy and adverse event profile of LAD for topical anesthesia before venipuncture using two output energies (2.0 and 3.5 J/cm2). RESULTS: Mean Visual Analog Scale pain scores were not statistically different (P = 0.57) between the low-energy (mean = 6.7) and high-energy (mean = 8.1) lasers. CONCLUSIONS: LAD at an energy of 2.0 J/cm2 (570 mJ) is as effective, with similar adverse events, as an energy of 3.5 J/cm2 (1000 mJ) in facilitating topical anesthesia.


Subject(s)
Anesthetics, Local/administration & dosage , Drug Delivery Systems/methods , Lasers , Lidocaine/administration & dosage , Pain/prevention & control , Phlebotomy/adverse effects , Administration, Topical , Adult , Cross-Over Studies , Double-Blind Method , Drug Delivery Systems/instrumentation , Female , Follow-Up Studies , Humans , Lasers/adverse effects , Male , Middle Aged , Ointments , Pain/etiology , Pain Measurement , Reference Values , Time Factors
11.
Clin J Pain ; 22(6): 532-7, 2006.
Article in English | MEDLINE | ID: mdl-16788339

ABSTRACT

OBJECTIVES: The authors' objective was to describe the effect of recurrent pain symptoms on the health-related quality of life (HRQOL) of children and adolescents with cystic fibrosis (CF). Frequent pain, independent of disease severity, was hypothesized to be associated with broad decrements in physical, psychological, and social functioning. METHODS: Forty-six children and adolescents (mean age 12.9 years; 52% female) completed the Cystic Fibrosis Questionnaire-Revised (CFQ-R) to assess their HRQOL and a retrospective pain interview to assess pain location, frequency, intensity, duration, and bother during a routine clinic visit. Forced expiratory volume in 1 second as percent of predicted (FEV1%) was recorded from medical charts to assess the children's disease severity. RESULTS: As hypothesized, pain symptoms were related to children's physical, emotional, and role functioning, CF-related symptoms, and overall perception of their health. Children with frequent pain had significantly reduced physical functioning, vitality, role limitations, and overall perceptions of their health, and increased eating disturbances, treatment burden, respiratory, and digestive symptoms compared with children with no pain or less frequent pain. After controlling for the effects of disease severity, pain frequency continued to predict children's HRQOL in each of these areas. DISCUSSION: Children with frequent CF-related pain experienced broad decrements in their HRQOL. These findings are similar to those found in other populations of children experiencing disease-related pain, suggesting a pervasive impact of pain on overall health and well-being. Future research is needed to evaluate treatments to reduce pain symptoms and improve HRQOL in children with cystic fibrosis.


Subject(s)
Cystic Fibrosis/psychology , Outcome Assessment, Health Care , Pain/psychology , Quality of Life/psychology , Adolescent , Child , Cystic Fibrosis/complications , Demography , Disability Evaluation , Female , Humans , Male , Multivariate Analysis , Pain/etiology , Severity of Illness Index , Sickness Impact Profile , Statistics, Nonparametric , Surveys and Questionnaires
12.
J Pain ; 6(10): 704-6, 2005 Oct.
Article in English | MEDLINE | ID: mdl-16202964

ABSTRACT

UNLABELLED: We describe a 12-year-old patient with severe, protracted complex regional pain syndrome type I. His pain did not respond to gabapentin, amitriptyline, physical therapy, opioids, or nonsteroidal drugs. Sympathetic or regional block was not attempted because of persistent bacteremia and severe local sepsis. His pain responded dramatically to the addition of oxcarbazepine, with rapid improvement in his symptoms and functional status. We suggest that oxcarbazepine might be a useful adjunct in the treatment of gabapentin-resistant complex regional pain syndrome type I in children and should be considered. PERSPECTIVE: Oxcarbazepine's antinociceptive effect is mediated via sodium channel inhibition in neuropathic models and by inhibition of substance P and prostaglandins in anti-inflammatory models. The efficacy of oxcarbazepine in this patient might be attributable to these mechanisms or possibly to synergism with either gabapentin or the anti-inflammatory effects produced by amitriptyline.


Subject(s)
Anticonvulsants/administration & dosage , Carbamazepine/analogs & derivatives , Pain, Intractable/drug therapy , Pain, Intractable/physiopathology , Reflex Sympathetic Dystrophy/drug therapy , Reflex Sympathetic Dystrophy/physiopathology , Amines/therapeutic use , Amitriptyline/therapeutic use , Analgesics, Opioid/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Anticonvulsants/pharmacology , Carbamazepine/administration & dosage , Carbamazepine/pharmacology , Child , Cyclohexanecarboxylic Acids/therapeutic use , Dose-Response Relationship, Drug , Drug Resistance/physiology , Drug Synergism , Drug Therapy, Combination , Gabapentin , Hip Joint/microbiology , Hip Joint/pathology , Hip Joint/physiopathology , Humans , Male , Neuritis/complications , Neuritis/microbiology , Neuritis/physiopathology , Osteomyelitis/complications , Osteomyelitis/microbiology , Oxcarbazepine , Pain, Intractable/microbiology , Reflex Sympathetic Dystrophy/microbiology , Sodium Channels/drug effects , Sodium Channels/physiology , Staphylococcal Infections/complications , Staphylococcus aureus , Tibia/microbiology , Tibia/pathology , Tibia/physiopathology , Treatment Outcome , gamma-Aminobutyric Acid/therapeutic use
13.
Pediatr Pulmonol ; 40(4): 330-5, 2005 Oct.
Article in English | MEDLINE | ID: mdl-16106349

ABSTRACT

Pain is important to assess and treat in children with cystic fibrosis (CF), because pain symptoms may limit children's ability to participate in their CF-related care and may reduce their overall well-being and quality of life. The aims of this study were to: 1) assess acute and chronic pain symptoms as reported by children with CF, and 2) examine the relationship between pain symptoms and disease severity as measured by percentage of forced expired volume in 1 sec (FEV1%). Forty-six children completed a self-report questionnaire assessing characteristics of chronic disease-related pain (frequency, intensity, duration, associated emotional upset, and location of pain). Children also rated their pain intensity associated with common CF-related procedures. The primary locations of pain reported were the abdominal/pelvic region, chest, and head/neck. Forty-six percent of the sample described pain occurring at least once per week. Most children reported their pain intensity as mild and of short duration. However, a small subgroup of children reported longer-lasting and moderately intense pain. Children with chest pain were found to be particularly at risk for experiencing more functional limitations and a significantly lower FEV1% compared to children without chest pain. The majority of children reported that nonpharmacological therapies (e.g., medication, rest, or distracting activities) provided some pain relief. Disease-related pain is common for children and adolescents with CF, suggesting that pain assessment should be a routine part of their clinical care. Further research is clearly needed to better understand the sources of pain and how best to provide relief.


Subject(s)
Cystic Fibrosis/physiopathology , Pain/diagnosis , Acute Disease , Adolescent , Child , Chronic Disease , Female , Humans , Male , Pain/physiopathology , Pain Management , Severity of Illness Index
14.
Paediatr Anaesth ; 14(12): 977-82, 2004 Dec.
Article in English | MEDLINE | ID: mdl-15601345

ABSTRACT

BACKGROUND: Topical anesthetics may help reduce discomfort associated with procedures involving needle-puncture, such as intravenous (i.v.) insertions, in children. EMLA cream has become a common, noninvasive therapy for topical anesthesia in children. ELA-Max is a recently introduced topical anesthetic cream marketed as being as effective in producing topical anesthesia after a 30-min application as EMLA is after a 60-min application. The purpose of this research was to compare ELA-Max at 30 min with EMLA at 60 min for providing topical anesthesia for i.v. insertions in children. METHODS: Sixty children, ages 8-17 years, requiring an i.v. were randomized to receive either the 30 min application of ELA-Max (n = 30) or the 60 min application of EMLA (n = 30). Children rated any pain associated with the i.v. insertion using a 100-mm Visual Analog Scale (VAS). The anesthesiologist assessed the presence of blanching at the site and rated the difficulty of placing the i.v. RESULTS: There was no clinically or statistically significant difference in pain ratings (P = 0.87) between the ELA-Max (mean = 25.7) and the EMLA (mean = 26.8) groups. ELA-Max caused significantly (P = 0.04) less blanching than EMLA, however there was no difference in the anesthesiologists' rating of the difficulty of the i.v. placement between the groups (P = 0.73). CONCLUSION: Results from this study support the claim that a 30-min application of ELA-Max (with occlusion) is as effective as a 60-min application of EMLA (with occlusion) for producing topical anesthesia for i.v. insertion in children.


Subject(s)
Anesthetics, Local/administration & dosage , Catheterization, Peripheral/methods , Lidocaine/administration & dosage , Prilocaine/therapeutic use , Administration, Topical , Adolescent , Catheterization, Peripheral/adverse effects , Child , Double-Blind Method , Female , Humans , Lidocaine/therapeutic use , Lidocaine, Prilocaine Drug Combination , Male , Pain Measurement/statistics & numerical data , Prilocaine/administration & dosage , Treatment Outcome
15.
Pain ; 111(3): 239-244, 2004 Oct.
Article in English | MEDLINE | ID: mdl-15363866

ABSTRACT

Both children and adults with cognitive impairment (CI) have historically been excluded from research examining pain. This is unfortunate since patients with CI may be at higher risk for experiencing pain or having their pain undertreated due to the difficulty of pain assessment and communication. There are now several published reports about the general pain experience of both adult and pediatric patients with cognitive impairment. The purpose of this study was to compare the amount and type of pain medication administered in children with and without CI after surgery to ascertain if there were any differences in analgesic administration patterns between these two groups. One hundred and fifty-two children with borderline to profound CI and 138 non impaired (NI) children were recruited to participate. Analgesic administration data include type and amount of opioid, type of non-opioid medication, and prescribed discharge medications. Results of this study show that children with CI undergoing surgery received less opioid in the perioperative period than children without CI. However, children with CI received comparable amounts and types of analgesics in the postoperative period as children without CI.


Subject(s)
Analgesia/statistics & numerical data , Analgesics, Opioid/therapeutic use , Cognition Disorders/drug therapy , Pain, Postoperative/drug therapy , Perioperative Care/statistics & numerical data , Adolescent , Analgesia/methods , Chi-Square Distribution , Child , Child, Preschool , Cognition Disorders/psychology , Female , Humans , Linear Models , Male , Multivariate Analysis , Pain, Postoperative/psychology , Perioperative Care/methods
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