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1.
Pediatr Emerg Care ; 32(11): 779-784, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27814325

RESUMO

INTRODUCTION: Ondansetron is commonly used to treat vomiting in gastroenteritis, but has a United States Food and Drug Administration black box warning for risk of Q wave to T wave time interval (QT) prolongation. We report 2 pediatric cases of fatal refractory cardiac arrest after administration of ondansetron. CASES: A 10-year-old previously healthy boy presented to the emergency room with gastroenteritis symptoms. After intravenous fluids, morphine, antibiotics, and 2 doses of ondansetron, the patient became unresponsive with agonal respirations and a wide complex tachycardia consistent with ventricular tachycardia. In a second case, an 86-day-old infant with previously unidentified congenital cardiomyopathy presented to our emergency department with gastroenteritis symptoms. The patient received ondansetron and subsequently experienced repeated bouts of supraventricular tachycardia which progressed to ventricular fibrillation. Resuscitation efforts failed in each case, and both patients expired. DISCUSSION: Ondansetron can cause dose-dependent QT prolongation effects, which are more clinically relevant when other proarrhythmic elements are present. There is very limited published experience on use of ondansetron in children younger than 2 years. Our 2 cases join 2 previous case reports of death after ondansetron administration for gastroenteritis. The pharmacology of ondansetron's cardiac effects and drug-induced QT prolongation is discussed. CONCLUSIONS: Patients may have hidden risk factors that, together with ondansetron, could result in a proarrhythmic state that could lead to adverse effects, such as arrhythmias. Administration of ondansetron should be individualized and used cautiously in patients with risk factors for arrhythmia.


Assuntos
Gastroenterite/tratamento farmacológico , Parada Cardíaca/induzido quimicamente , Ondansetron/efeitos adversos , Criança , Evolução Fatal , Humanos , Lactente , Masculino , Ondansetron/uso terapêutico , Estados Unidos
2.
Am J Emerg Med ; 31(1): 20-5, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22809774

RESUMO

OBJECTIVES: The aim of the study was to assess the differences in reported pain from venipuncture comparing liposomal 4% lidocaine with placebo cream in a pediatric population. Other factors assessed were patient anxiety, difficulty of venipuncture, and history of venipuncture. METHODS: A prospective, randomized, double-blind, placebo control study design was used in which subjects were assigned to receive either liposomal 4% lidocaine or placebo cream. The study population consisted of pediatric patients aged 5 to 18 years old who presented to 1 site of a multisite, academic, community emergency department. Once subjects had consented and randomized, the liposomal 4% lidocaine or placebo cream was applied for 15 minutes under occlusion. A 6-point validated FACES pain scale was used to evaluate each patient's level of pain during venipuncture. Patient anxiety was evaluated using a 100-mm visual analogue scale before, during, and after the venipuncture. Heart rate was captured as an indirect measurement of pain. RESULTS: There were no significant differences between the study and placebo groups (P > .05) in mean levels of patient ratings of anxiety, patient heart rate, or the patient's mean rating of pain before, during, or after the venipuncture procedure. There was an association between increased anxiety with an increase in venipuncture pain and an inverse association between age and pain. CONCLUSION: Topical liposomal 4% lidocaine cream in this case did not prove to be effective with a 15-minute dwell time under occlusion because there were no differences in pain between study groups.


Assuntos
Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Manejo da Dor/métodos , Dor/etiologia , Dor/prevenção & controle , Flebotomia/efeitos adversos , Administração Tópica , Adolescente , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Frequência Cardíaca , Humanos , Modelos Lineares , Lipossomos , Masculino , Medição da Dor , Flebotomia/métodos , Placebos , Estudos Prospectivos , Resultado do Tratamento
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