Efficacy of Buzzy Device Versus EMLA Cream for Reducing Pain During Needle-Related Procedures in Children: A Randomized Controlled Trial.

OBJECTIVES: Several pain management tools exist but with limitations in their efficacy or applicability. The EMLA (eutectic mixture of local anesthetics) cream is currently used for pain relief for needle-related procedures; however, it needs a minimum of 30 to 45 minutes to be effective. The Buzzy is a device that generates vibrations with cold leading to quicker pain relief. Our aim was to evaluate the effect of the Buzzy device in pain and anxiety reduction compared with EMLA cream in children requiring intravenous cannulation or venepuncture. METHODS: This was a randomized clinical trial comparing pain and anxiety reduction by Buzzy device with the standard care (EMLA cream) in children aged 2 to 14 years who required blood extraction or intravenous cannulation based on their clinical needs. Eligible patients were randomized to either Buzzy device as the intervention or EMLA cream as the control. The outcome measures were the degree of pain scores and anxiety ratings at different stages of the needle-related procedures. RESULTS: A total of 300 patients with a mean age of 6.5 ± 3.1 years were enrolled. Baseline characteristics were similar between the Buzzy device and EMLA cream groups. The observed pain scores by research nurses and a parent were significantly lower in the EMLA group compared with the Buzzy device group; however, the pain scores by the self-assessment scale were not statistically significant with mean difference of -0.332, 95% confidence interval, -0.635 to -0.028 ( P = 0.062). The level of anxiety was significantly lower in EMLA compared with Buzzy device ( P = 0. 0.0001). Both staff and parents' satisfaction, success rate of cannulation, type of blood tests, and comment on the physician on the results were similar in both groups. CONCLUSIONS: Pain and anxiety relief using the Buzzy device is not as effective as EMLA cream in children requiring venepuncture. However, rapid onset of action of the Buzzy device is valuable in decreasing waiting time in a busy emergency department. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT05354739.

Outcome and complications of outpatient parenteral therapy in pediatric emergency utilizing only peripheral vascular access: A retrospective descriptive study.

OBJECTIVES: To describe the cure and complication rates of outpatient parenteral therapy (OPT) utilizing only peripheral vascular access. METHODS: Using a retrospective descriptive study design, we reviewed the medical charts for children aged up to 15 years old who had been discharged from the emergency department into the care of the OPT unit from January 2018 to April 2019. The primary outcomes were cure and complication rates. RESULTS: Out of 814,150 visits, 2,788 (0.34%), accounting for 2,126 patients, were managed in the OPT unit. The majority had 2 days of symptoms, and 26.4% had comorbidities. Most patients started the treatment for suspected sepsis and suspected or confirmed urinary tract infections. The total days of therapy for all patients were 3,663. Cephalosporins were used for 75%, mostly ceftriaxone. Most patients completed the IV therapy within 2 days, 2.8% of cases required a change of antibiotics. Readmission avoidance and full recovery were achieved in 99.3%, and 0.7% needed readmission. All patients had peripheral vascular access. Complications occurred in 21%. Most were related to vascular access, but more than 80% were managed by one-time IV cannula re-insertion, and only 0.5% had treatment modification because of these complications. CONCLUSION: For carefully selected patients in the pediatric emergency, outpatient parenteral therapy seems effective, safe with manageable complications, and may result in less family disturbance than hospital admission.

Effect of submersion injury on water safety practice after the event in children, Saudi Arabia.

OBJECTIVE: To bring to light issues surrounding water safety practices and the impact of such incidents on these practices in our community. METHODS: We conducted a prospective observational study at King Abdul-Aziz Medical City, Riyadh, Kingdom of Saudi Arabia of all children <12 years of age presenting with submersion injury in the period between January 1999 through December 2004 noting the demographics and the pattern of water safety practices prior to and after event. RESULTS: A total of 29 patients were included. The majority of incidents took place in swimming pools. Water safety practices were lacking in most cases as evidenced by the fact that 87% of the victims were not properly supervised at the time of the event. None of swimming pools met the required safety regulations. Cardiopulmonary resuscitation knowledge was virtually nonexistent. The event did not have a positive impact on the water safety practices of the affected families. CONCLUSION: Submersion injury is also prevalent in land locked areas. Water safety practices are deficient in our community. Submersion injury was not enough to have a consistent positive impact on water safety practices of the affected families. Much can be carried out to improve water safety and save lives.

Chloral hydrate. An effective agent for sedation in children with age and weight dependent response.

OBJECTIVE: Diagnostic and therapeutic procedures in children are made easier using sedation. However, there is no consensus about which drug should be used to achieve this. Furthermore, none of the drugs used for sedation are risk free. The aim of this work is to study sedation indications, effectiveness, and safety at our center. METHODS: A prospective observational study conducted at the Pediatric Day Care Unit, King Fahad National Guard Hospital, Riyadh, Saudi Arabia. The study covered 17.5 weeks in 2 periods: May 9th 1999 to June 13th 1999 and October 31st 2001 to February 11th 2002. Children <12 years were included. Collected data included demographics, indication, drug dosing and outcome. Data were reported as mean +/- SD. RESULTS: We included 148 patients, age 38 +/- 30 months. Adequate sedation was achieved in 79% after initial chloral hydrate (CH) dose of 56.9 +/- 9.3 mg/kg, in 95% after adding 18.5 +/- 6.4 mg/kg CH and in 96% after adding second drug. Compared to nonrespondents, first CH dose respondents were younger and lower in weight. The CH side effects were few and mild. CONCLUSION: Chloral hydrate is a safe and effective agent for sedation in children with an age and weight dependent response.