Prevention and Treatment of Laryngospasm in the Pediatric Patient: A Literature Review.

Laryngospasm is an exaggeration of a protective reflex that prevents aspiration of foreign objects into the lower airway (eg, during swallowing). This results in complete or partial closure of the glottis, and impedance or total obstruction of airflow to the trachea and lungs. Often, the resulting hypoxia will by itself break a laryngospasm; however, if the spasm continues without relief, it can lead to pulmonary edema, cardiac dysrhythmias, cardiac arrest, and ultimately death. This evidence-based literature review explores the pathophysiology of laryngospasm and covers mechanical and pharmacologic prevention and treatment modalities in pediatric patients.

Intravenous acetaminophen and intravenous ketorolac for management of pediatric surgical pain: a literature review.

Pediatric surgical patients are a population at risk of inadequate pain management. The American Society of Anesthesiologists' 2012 Practice Guidelines for Acute Pain Management in the Perioperative Setting recommend a multimodal approach as the most effective way to prevent and treat pain in children. A multimodal approach entails the use of 2 or more analgesic medications that act by different mechanisms, to maximally target a variety of pain receptors and reduce the potential for side effects. One method for incorporating a multimodal approach is to augment intravenous (IV) opioids with nonopioid IV analgesics. Ketorolac and acetaminophen are the 2 nonopioid IV analgesics currently available for use in the United States. This article provides a review of the literature of IV ketorolac and IV acetaminophen regarding their pharmacology, analgesic efficacy, limitations, and practical considerations, with a focus on patients 16 years of age and younger.

Anesthesia-induced neuronal apoptosis during synaptogenesis: a review of the literature.

Anesthesia is generally accepted as safe in most adult populations; however, in pediatric patients questions exist regarding the potential for long-term detrimental effects. Various anesthetic agents are associated with neuronal degeneration when administered to neonatal animals. The mechanism of damage is thought to be via accelerated apoptosis, a normally beneficial process in the maintenance of homeostasis. This review of the literature examines the current evidence in neonatal rodents, nonhuman primates, and humans experiencing anesthesia-induced neuronal apoptosis. Included are studies published between the years 2000 and 2010. Much of the early research subjects were rodents, with more recent studies examining nonhuman primates. Retrospective research of human populations is included as well, some of which is currently underway. Clear evidence exists that neuronal apoptosis occurs when anesthetics are administered to neonatal rodents and primates, and behavioral and cognitive testing from some authors indicate long-term effects persist well into an animal's adulthood. Preliminary human trials reveal a link between anesthesia and subsequent developmental delays. This review of the literature clarifies the need for further research in humans.