Non-pharmacological techniques for pain management in neonates
SEMINARS IN PERINATOLOGY
2007; 31 (5): 318-322
An analysis of factors influencing postanesthesia recovery after pediatric ambulatory tonsillectomy and adenoidectomy
ANESTHESIA AND ANALGESIA
2007; 104 (4): 784-789
Significant progress in understanding the physiology, clinical correlates, and consequences of neonatal pain have resulted in greater attention to pain management during neonatal intensive care. A number of nonpharmacological therapies have been investigated, including nonnutritive sucking, with and without sucrose use, swaddling or facilitated tucking, kangaroo care, music therapy, and multi-sensorial stimulation. Although the efficacy of these approaches is clearly evident, they cannot provide analgesia for moderate or severe pain in the neonate. Further, some of these therapies cannot be effectively applied to all populations of critically ill neonates. Acupuncture, an ancient practice in Chinese medicine, has gained increasing popularity for symptom control among adults and older children. Acupuncture may provide an effective nonpharmacological approach for the treatment of pain in neonates, even moderate or severe pain, and should be considered for inclusion in a graduated multidisciplinary algorithm for neonatal pain management.
View details for DOI 10.1053/j.semperi.2007.07.007
View details for Web of Science ID 000250093900008
View details for PubMedID 17905187
Opioid analgesia in neonates following cardiac surgery.
Seminars in cardiothoracic and vascular anesthesia
2007; 11 (1): 47-58
Many factors contribute to prolonged length of stay (LOS) for pediatric patients in the postanesthesia care unit (PACU). We designed this prospective study to identify the pre- and postoperative factors that prolong LOS.We studied 166 children, aged 1-18 yr, who underwent tonsillectomy and adenoidectomy or tonsillectomy and adenoidectomy, and bilateral myringotomy with tube insertion under general anesthesia. The primary outcome measure was the time spent in the PACU until predetermined discharge criteria were met.The number of episodes of postoperative nausea and vomiting, patient age, and number of oxygen desaturations contributed significantly (P < 0.05) to prolonged LOS. Each episode of postoperative nausea and vomiting (P < 0.05) or oxygen desaturation to <95% (P < 0.05) increased the patient's LOS by 0.5 h. History of upper respiratory tract infection, emergence agitation, and parental anxiety did not significantly predict increased LOS.This investigation is the first composite view of LOS in pediatric patients. The significance of identifying patients at risk of prolonged LOS prior to anesthesia is of use not only in allocating PACU resource and staffing needs, but also for improving quality of care and ensuring a minimally traumatic anesthetic experience for our pediatric patients and their families.
View details for DOI 10.1213/01.ane.0000258771.53068.09
View details for Web of Science ID 000245371900010
View details for PubMedID 17377083
Pain management for pediatric thoracic surgery
CURRENT OPINION IN ANESTHESIOLOGY
2005; 18 (1): 13-21
Pain in the newborn is complex, involving a variety of receptors and mechanisms within the developing nervous system. When pain is generated, a series of sequential neurobiologic changes occur within the central nervous system. If pain is prolonged or repetitive, the developing nervous system could be permanently modified, with altered processing at spinal and supraspinal levels. In addition, pain is associated with a number of adverse physiologic responses that include alterations in circulatory (tachycardia, hypertension, vasoconstriction), metabolic (increased catabolism), immunologic (impaired immune response), and hemostatic (platelet activation) systems. This "stress response" associated with cardiac surgery in neonates could be profound and is associated with increased morbidity and mortality. Neonates undergoing cardiac operations are exposed to extensive tissue damage related to surgery and additional painful stimulation related to endotracheal and thoracostomy tubes that may remain in place for variable periods of time following surgery. In addition, postoperatively neonates endure repeated procedural pain from suctioning of endotracheal tubes, placement of vascular catheters, and manipulation of wounds (eg, sternal closure) and dressings. The treatment and/or prevention of pain are widely considered necessary for humanitarian and physiologic reasons. Improved clinical and developmental outcomes underscore the importance of providing adequate analgesia for newborns who undergo major surgery, mechanical ventilation, and related procedures in the intensive care unit. This article reviews published information regarding opioid administration and associated issues of tolerance and abstinence syndromes (withdrawal) in neonates with an emphasis on those having undergone cardiac surgery.
View details for PubMedID 17484173
Pediatric thoracic anesthesia
CURRENT OPINION IN ANESTHESIOLOGY
2005; 18 (1): 5-11
Pain management after thoracic surgery in children presents the challenge of providing adequate analgesia without excessive sedation, and maintaining adequate respiratory function in the face of compromise resulting from existing pathology, surgical trauma, single-lung ventilation and postoperative ventilation-perfusion abnormalities. In the pediatric population, pain assessment and reporting present additional challenges. The number and complexity of surgical procedures, including video-assisted thoracoscopic procedures, is increasing in the pediatric population. There is a need to explore pain management for these types of patients.There are effective and safe strategies whereby analgesia can be provided to this pediatric population. This review will outline the progress that has been made in this field, including the use of regional techniques. The routine use of caudal catheters in neonates and infants for thoracic surgical procedures and the use of electrical guidance of epidural catheters, the 'Tsui' technique, are reviewed.These techniques, applied within a comprehensive pain management strategy, can be extremely beneficial in the care of the pediatric thoracic patient.
View details for Web of Science ID 000209516600003
Pediatric acute pain management
PEDIATRIC CLINICS OF NORTH AMERICA
2000; 47 (3): 559-?
Surgical interventions, including video-assisted thoracoscopic surgeries, are increasingly being performed in the neonatal and pediatric populations. Thoracic anesthesia in infants and children poses special challenges for the anesthesiologist. These include assessment of the patient's clinical condition, obtaining and maintaining single lung ventilation, and maintaining adequate ventilation and oxygenation while the surgery is in progress.This review will outline the anesthetic management of infants and children undergoing thoracic surgery, including preoperative assessment, and anesthetic induction and maintenance. The physiology and methods of single lung ventilation will be reviewed, including the use of bronchial blockers, Univent tubes and double-lumen tubes. Special considerations for video-assisted thoracoscopic surgery, pectus repair and mediastinal masses will be discussed.These techniques will provide the anesthesiologist with a number of strategies for assessing the pediatric thoracic patient and for managing pediatric single lung ventilation.
View details for Web of Science ID 000209516600002
The past decade has brought about an explosion of knowledge about the physiology of nociception and many new techniques for pain relief, new analgesic drugs, and new applications of old analgesic drugs. These techniques include methods of opioid administration by transdermal and transmucosal absorption and the use of neuraxial analgesia for the management of pain in children. Interest in the use of regional anesthesia in children has been rekindled, and analgesic properties and pre-emptive analgesic properties of many agents not typically considered analgesics, such as clonidine and ketamine, have been recognized. Perhaps the greatest advance has been the paradigm shift in the recognition that pain not only exists in infants and children but also is a significant cause of morbidity and even mortality. Given the unprecedented interest in pain management in adults and children, physicians can now look forward to the development of new methods of drug delivery and of receptor-specific drugs that divorce analgesia from the untoward side effects of existing analgesics. Improvement in the quality of life of hospitalized children also will occur.
View details for Web of Science ID 000086875800006
View details for PubMedID 10835991