ABSTRACT
Pain following eye surgery is often described as being relatively moderate; however, there are also procedures that lead to a pronounced pain experience. Particularly in pediatric patients, pain therapy is often insufficient due to a lack of knowledge and fear of complications. These individual and organizational deficits lead to unnecessary discomfort for children and parents. Each institution providing surgical treatment must have pain management concepts in its portfolio for the appropriate age groups. This includes a child-oriented setting, age-appropriate information, systematic pain assessment, and pain protocols. Pain management should be planned prior to surgery and individually adapted as it progresses. Children have a right to a perioperative course with low stress and pain.
Subject(s)
Pain Management , Pain , Humans , Child , Pain Management/methods , Pain/etiology , Ophthalmologic Surgical Procedures/adverse effects , Health Facilities , Pain Measurement/methodsABSTRACT
Acute pain therapy in children is highly complex. Already preoperatively, the course for a successful therapy is set in the interaction with the child and parents. The goal of the treatment is a satisfied child. This means the use of empathy and therapy planning aimed at a balance between effect and side effect and functionality. Modern concepts are opioid-sparing and procedure-specific. Regional anaesthesia plays a major role, among other things due to excellent safety data. Knowledge of age- and block-specific local anaesthetic dosages is essential. Little is known about pharmacodynamic data of analgesics in children. Although knowledge about pharmacokinetic characteristics is increasing, off-label use of analgesics is inevitable. International databases such as the Kinderformularium provide up-to-date information. When using opioids, rules for safe handling must be followed both in terms of use and prescribing. Non-opioids and adjuvants - individually or in combination - have an established place in perioperative pain management. Non-pharmacological interventions can reduce anxiety and pain. Anxiety is one of the risk factors for chronic postsurgical pain.
Subject(s)
Analgesics, Opioid , Pain Management , Analgesics/therapeutic use , Analgesics, Opioid/adverse effects , Anesthetics, Local , Child , Humans , Pain, Postoperative/drug therapy , Pain, Postoperative/prevention & controlABSTRACT
BACKGROUND: A preliminary national audit of real fasting times including 3324 children showed that the fasting times for clear fluids and light meals were frequently shorter than recommended in current guidelines, but the sample size was too small for subgroup analyses. AIMS: Therefore, the primary aim of this extended study with more participating centers and a larger sample size was to determine whether shortened fasting times for clear fluids or light meals have an impact on the incidence of regurgitation or pulmonary aspiration during general anesthesia in children. The secondary aim was to evaluate the impact of age, emergent status, ASA classification, induction method, airway management or surgical procedure. METHODS: After the Ethics Committee's approval, at least more than 10 000 children in total were planned to be enrolled for this analysis. Patient demographics, real fasting times, anesthetic and surgical procedures, and occurrence of target adverse events defined as regurgitation or pulmonary aspiration were documented using a standardized case report form. RESULTS: At fifteen pediatric centers, 12 093 children scheduled for surgery or interventional procedures were included between October 2018 and December 2019. Fasting times were shorter than recommended in current guidelines for large meals in 2.5%, for light meals in 22.4%, for formula milk in 5.3%, for breastmilk in 10.9%, and for clear fluids in 39.2%. Thirty-one cases (0.26%) of regurgitation, ten cases (0.08%) of suspected pulmonary aspiration, and four cases (0.03%) of confirmed pulmonary aspiration were reported, and all of them recovered quickly without any consequences. Fasting times for clear fluids shortened from 2 hours to 1 hour did not affect the incidence of adverse events (upper limit 95% CI 0.08%). The sample size of the cohort with fasting times for light meals shorter than 6 hours was too small for a subgroup analysis. An age between one and 3 years (odds ratio 2.7,95% CI 1.3 to 5.8%; P < .01) and emergent procedures (odds ratio 2.8,95% CI 1.4 to 5.7;P < .01) increased the incidence of adverse events, whereas ASA classification, induction method, or surgical procedure had no influence. The clear fluid fasting times were shortest under 6/4/0 as compared to 6/4/1 and 6/4/2 fasting regimens, all with an incidence of 0.3% for adverse events. CONCLUSION: This study shows that a clear fluid fasting time shortened from 2 hours to 1 hour does not affect the incidence of regurgitation or pulmonary aspiration, that an age between one and 3 years and emergent status increase the incidence of regurgitation or pulmonary aspiration, and that pulmonary aspiration followed by postoperative respiratory distress is rare and usually shows a quick recovery.
Subject(s)
Anesthesia, General , Fasting , Anesthesia, General/adverse effects , Child , Child, Preschool , Humans , Incidence , Infant , Preoperative Care , Prospective Studies , VomitingABSTRACT
Following an uncomplicated outpatient colonoscopy, a patient was found unconscious with bradycardia in the waiting room of a practice of an internist. After a half an ampoule of atropine, the pulse quickened but the patient remained unconscious. Even flumazenil did not improve the situation. The now responding emergency physician was confronted with numerous, unspecific neurological symptoms and considered various differential diagnoses. The situation was aggravated by the rural infrastructure. In the course of the clinical investigation, the patient's condition deteriorated rapidly and intubation was necessary. The correct underlying diagnosis was finally made following a telephone call and disclosed an (almost) fatal chain of misunderstandings.
