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Narcotics in pediatrics

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https://www.readbyqxmd.com/read/28114786/a-non-narcotic-pathway-for-the-management-of-postoperative-pain-following-pediatric-robotic-pyeloplasty
#1
Ziho Lee, Marion Schulte, William Robert DeFoor, Pramod Puli Reddy, Brian VanderBrink, Eugene Minevich, Zachary Liss, Katherine Corbyons, Paul Hyungwook Noh
PURPOSE: The purpose of this study is two-fold: first to describe the non-narcotic pathway for the management of postoperative pain after robotic pyeloplasty; second, to compare perioperative outcomes for children undergoing robotic pyeloplasty whose postoperative pain was managed with and without the non-narcotic pathway. PATIENTS AND METHODS: A retrospective reviewed was performed on 96 consecutive patients from October 2011 to December 2015 who underwent robotic pyeloplasty by three primary surgeons at a single pediatric institution...
January 23, 2017: Journal of Endourology
https://www.readbyqxmd.com/read/28087135/surgical-site-infection-related-to-use-of-elastomeric-pumps-in-pectus-excavatum-repair-lessons-learned-from-root-cause-analysis
#2
Nadja Apelt, Joshua Schaffzin, Christina Bates, Rebeccah L Brown, Marc Mecoli, Senthilkumar Sadhasivam, Victor Garcia
BACKGROUND: Pectus excavatum repair (PEX) is among the most painful thoracic procedures performed. Continuous peripheral nerve blockade (CPNB) is known to be efficacious in optimizing pain control while limiting narcotic use in adult thoracic procedures. It was introduced in May 2015 as a bridge to oral pain control in children undergoing PEX. Consequently, the surgical site infection (SSI) rate increased from 2.7% to 27.7%. METHODS: SSI surveillance followed national guidelines...
January 6, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28079605/delirium-in-critically-ill-children-an-international-point-prevalence-study
#3
Chani Traube, Gabrielle Silver, Ron W Reeder, Hannah Doyle, Emily Hegel, Heather A Wolfe, Christopher Schneller, Melissa G Chung, Leslie A Dervan, Jane L DiGennaro, Sandra D W Buttram, Sapna R Kudchadkar, Kate Madden, Mary E Hartman, Mary L deAlmeida, Karen Walson, Erwin Ista, Manuel A Baarslag, Rosanne Salonia, John Beca, Debbie Long, Yu Kawai, Ira M Cheifetz, Javier Gelvez, Edward J Truemper, Rebecca L Smith, Megan E Peters, A M Iqbal O'Meara, Sarah Murphy, Abdulmohsen Bokhary, Bruce M Greenwald, Michael J Bell
OBJECTIVES: To determine prevalence of delirium in critically ill children and explore associated risk factors. DESIGN: Multi-institutional point prevalence study. SETTING: Twenty-five pediatric critical care units in the United States, the Netherlands, New Zealand, Australia, and Saudi Arabia. PATIENTS: All children admitted to the pediatric critical care units on designated study days (n = 994). INTERVENTION: Children were screened for delirium using the Cornell Assessment of Pediatric Delirium by the bedside nurse...
January 10, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28002386/should-grade-of-solid-organ-injury-determine-need-for-hospitalization-in-children
#4
Jillian Walsh, Pierre Schmit, Natalie Yanchar
BACKGROUND: Management of solid organ injuries (SOI) in children is often predicated on radiologic grade of injury. Hypothesizing that grade may not necessarily determine hospitalization need, we investigated factors associated with hospitalization in cases of isolated SOI in children. METHODS: Retrospective review of all cases admitted to one pediatric trauma centre over 10 yrs revealed 86 cases with SOI established by computed tomography (CT) scan upon admission...
January 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/27867308/effect-of-n-methyl-d-aspartate-receptor-antagonist-dextromethorphan-on-opioid-analgesia-in-pediatric-intensive-care-unit
#5
Mohammed Naeem, Hala Al Alem, Ali Al Shehri, Majed Al-Jeraisy
Objective. Pain control is an essential goal in the management of critical children. Narcotics are the mainstay for pain control. Patients frequently need escalating doses of narcotics. In such cases an adjunctive therapy may be beneficial. Dextromethorphan (DM) is NMDA receptor antagonist and may prevent tolerance to narcotics; however, its definitive role is still unclear. We sought whether dextromethorphan addition could decrease the requirements of fentanyl to control pain in critical children. Design. Double-blind, randomized control trial (RCT)...
2016: Pain Research & Management: the Journal of the Canadian Pain Society
https://www.readbyqxmd.com/read/27842790/otolaryngology-concerns-for-illicit-and-prescription-drug-use
#6
REVIEW
Nathan J Gonik, Martin H Bluth
Concern for illicit and restricted drug use in otolaryngology is similar to other surgical specialties with a few notable exceptions. Many illicit drugs are consumed transnasally. Repeated nasal exposure to stimulants or narcotics can cause local tissue destruction that can present as chronic rhinosinusitis or nasoseptal perforation. Further, the Food and Drug Administration has taken a stance against codeine for pediatric patients undergoing adenotonsillectomy. They have identified an increased risk of death postoperatively with these medications...
December 2016: Clinics in Laboratory Medicine
https://www.readbyqxmd.com/read/27831525/narcotic-and-antidepressant-use-and-hospital-readmission-rates-in-children-with-functional-abdominal-pain
#7
Kathleen J Holland, William E Bennett
Functional abdominal pain is a common presentation in the pediatric population, and it carries a large financial and emotional burden. The objective of this study was to describe the association between the use of narcotics and antidepressants and hospital readmission in children admitted for abdominal pain without an organic cause. We analyzed data from the Pediatric Health Information System database. A multivariate logistical regression model was used to assess the association between medication type and hospital readmission rates within 30 and 90 days...
November 8, 2016: Clinical Pediatrics
https://www.readbyqxmd.com/read/27798391/pain-management-for-sickle-cell-disease-in-the-pediatric-emergency-department-medications-and-hospitalization-trends
#8
Chantel Cacciotti, Sarah Vaiselbuh, Eleny Romanos-Sirakis
The majority of emergency department (ED) visits and hospitalizations for patients with sickle cell disease (SCD) are pain related. Adequate and timely pain management may improve quality of life and prevent worsening morbidities. We conducted a retrospective chart review of pediatric patients with SCD seen in the ED, selected by sickle cell-related ICD-9 codes. A total of 176 encounters were reviewed from 47 patients to record ED pain management and hospitalization trends. Mean time to pain medication administration was 63 minutes...
October 23, 2016: Clinical Pediatrics
https://www.readbyqxmd.com/read/27757429/surgeon-driven-neurophysiologic-monitoring-in-a-spinal-surgery-population
#9
Michael Pickell, Stephen M Mann, Rajesh Chakravertty, Daniel P Borschneck
BACKGROUND: This is a prospective observational study examining the use of a surgeon-driven intraoperative neurophysiologic monitoring system. Intraoperative neurophysiologic monitoring is becoming the standard of care for spinal surgeries with potential post-operative neurologic deficits. This standard applies to both adult and pediatric spinal surgery, but a shortage of appropriately trained and certified technologists and physiologists can compromise monitoring capabilities in some centers...
September 2016: Journal of Spine Surgery (Hong Kong)
https://www.readbyqxmd.com/read/27627568/patterns-of-poisoning-in-urban-and-rural-children-a-single-center-study
#10
Elżbieta Pac-Kożuchowska, Paulina Krawiec, Agnieszka Mroczkowska-Juchkiewicz, Beata Mełges, Agnieszka Pawłowska-Kamieniak, Katarzyna Kominek, Dorota Gołyska
BACKGROUND: Poisoning among children is a current issue in pediatrics. The pattern and risk factors of poisoning are heterogeneous and vary within the same country. OBJECTIVES: The aim of the study was to analyze the determinants in the incidence and nature of poisoning between urban and rural children, in order to identify children at higher risk. MATERIAL AND METHODS: The study entailed a retrospective analysis of the medical records of 848 children admitted to the Department of Pediatrics at the Medical University of Lublin, Poland, due to exposure to poison from July 2008 to December 2012...
March 2016: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
https://www.readbyqxmd.com/read/27600629/primary-caregiver-perception-of-pain-control-following-pediatric-adenotonsillectomy-a-cross-sectional-survey
#11
Justin C Sowder, Craig M Gale, Jacob L Henrichsen, Kristy Veale, Katie B Liljestrand, Barbara C Ostlund, Aaron Sherwood, Austin Smith, Griffin H Olsen, Mark Ott, Jeremy D Meier
OBJECTIVES: To (1) review pain medications prescribed following pediatric adenotonsillectomy (T&A), (2) identify pain medications reported to be helpful, and (3) compare parent-reported outcomes among various combinations of pain medications. STUDY DESIGN: Case series with planned data collection. SETTING: Multihospital network. SUBJECTS AND METHODS: The primary caregivers of children aged 1 to 18 years who underwent isolated T&A from June to December 2014 were contacted 14 to 21 days after surgery...
November 2016: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/27567385/prospective-comparative-study-of-pulsed-electron-avalanche-knife-peak-and-bipolar-radiofrequency-ablation-coblation-pediatric-tonsillectomy-and-adenoidectomy
#12
Zorik Spektor, David J Kay, David L Mandell
PURPOSE: To compare post-operative pain severity, analgesic intake, and complications in children undergoing tonsillectomy and adenoidectomy with bipolar radiofrequency ablation (Coblation) vs. pulsed-electron avalanche knife (PEAK) technology. MATERIALS AND METHODS: This was a prospective, non-randomized, non-blinded comparative cohort study in a private practice setting with three fellowship-trained pediatric otolaryngologists. Patients aged 3 to 12years undergoing tonsillectomy and adenoidectomy were assigned to surgery with either bipolar radiofrequency ablation or pulsed electron avalanche knife instrumentation...
November 2016: American Journal of Otolaryngology
https://www.readbyqxmd.com/read/27341355/clinical-chronic-pancreatitis
#13
Walter G Park
PURPOSE OF REVIEW: To summarize observations in clinical chronic pancreatitis in the past year. RECENT FINDINGS: A predisposing genetic mutation was identified in 67% of cases of pediatric chronic pancreatitis. A novel susceptibility gene involving a hybrid allele is associated with idiopathic chronic pancreatitis. ABO blood type B and FUT2 nonsecretor status is associated with asymptomatic hyperlipasemia and chronic pancreatitis. Alcohol consumption impairs cystic fibrosis transmembrane conductance regulator (CFTR) activity leading to decreased bicarbonate secretion and patients with susceptible CFTR mutations can develop clinical pancreatitis...
June 22, 2016: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/27083963/enhancing-recovery-in-pediatric-surgery-a-review-of-the-literature
#14
REVIEW
Julia K Shinnick, Heather L Short, Kurt F Heiss, Matthew T Santore, Martin L Blakely, Mehul V Raval
BACKGROUND: Enhanced recovery after surgery (ERAS), guidelines entail a strategy of perioperative management proven to hasten postoperative recovery and reduce complications in adult populations. Relatively few studies have investigated the applicability of this paradigm to pediatric populations. Our objective was to perform a systematic review of existing evidence regarding the use and efficacy of enhanced recovery protocols (ERPs) in the pediatric population. MATERIALS AND METHODS: Data were collected through a PubMed/MEDLINE literature search...
May 1, 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/26957384/obstructive-sleep-apnea-preoperative-screening-and-postoperative-care
#15
REVIEW
Robert M Wolfe, Jonathan Pomerantz, Deborah E Miller, Rebecca Weiss-Coleman, Tony Solomonides
The incidence of obstructive sleep apnea (OSA) has reached epidemic proportions, and it is an often unrecognized cause of perioperative morbidity and mortality. Profound hypoxic injury from apnea during the postoperative period is often misdiagnosed as cardiac arrest due to other causes. Almost a quarter of patients entering a hospital for elective surgery have OSA, and >80% of these cases are undiagnosed at the time of surgery. The perioperative period puts patients at high risk of apneic episodes because of drug effects from sedatives, narcotics, and general anesthesia, as well as from the effects of postoperative rapid eye movement sleep changes and postoperative positioning in the hospital bed...
March 2016: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/26884362/implementation-of-a-pediatric-posttonsillectomy-pain-protocol-in-a-large-group-practice
#16
Lauren J Luk, David Mosen, Carol J MacArthur, Anna H Grosz
OBJECTIVE: In response to the increased risk of respiratory failure and death after tonsillectomy related to codeine use, Kaiser Permanente Northwest restricted use of opioids in patients <7 years old via electronic health record (EHR). However, opioids could be prescribed at physician discretion by overriding the EHR. This study aims to examine protocol compliance in a large group practice using EHR order sets and complication rates as compared with historical data. STUDY DESIGN: Case series with chart review...
April 2016: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/26857320/the-role-of-larygotracheal-reconstruction-in-the-management-of-recurrent-croup-in-patients-with-subglottic-stenosis
#17
Bianca Siegel, Prasad Thottam, Deepak Mehta
OBJECTIVES: To determine the role of laryngotracheal reconstruction for recurrent croup and evaluate surgical outcomes in this cohort of patients. METHODS: Retrospective chart review at a tertiary care pediatric hospital. RESULTS: Six patients who underwent laryngotracheal reconstruction (LTR) for recurrent croup with underlying subglottic stenosis were identified through a search of our IRB-approved airway database. At the time of diagnostic bronchoscopy, all 6 patients had grade 2 subglottic stenosis...
March 2016: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/26593636/pancreatic-islet-autotransplantation-for-nonmalignant-and-malignant-indications
#18
REVIEW
Yvette C Tanhehco, Stuart Weisberg, Joseph Schwartz
The standard therapy for patients with chronic pancreatitis (CP) and severe abdominal pain is total pancreatectomy (TP) followed by islet autotransplantation (IAT) to prevent the development of brittle diabetes. In adult patients, narcotic independence is achieved in up to 73% of patients 1 to 5 years after transplantation whereas insulin independence is achieved in up to 40% of patients 1 to 2 years after transplantation. Pediatric patients have shown similar outcomes for narcotic independence (up to 79%) but better outcomes for insulin independence (up to 56% 1 year after transplantation)...
March 2016: Transfusion
https://www.readbyqxmd.com/read/26579844/an-analysis-of-34-218-pediatric-outpatient-controlled-substance-prescriptions
#19
Jessica A George, Paul S Park, Joanne Hunsberger, Joanne E Shay, Christoph U Lehmann, Elizabeth D White, Benjamin H Lee, Myron Yaster
BACKGROUND: Prescription errors are among the most common types of iatrogenic errors. Because of a previously reported 82% error rate in handwritten discharge narcotic prescriptions, we developed a computerized, web-based, controlled substance prescription writer that includes weight-based dosing logic and alerts to reduce the error rate to (virtually) zero. Over the past 7 years, >34,000 prescriptions have been created by hospital providers using this platform. We sought to determine the ongoing efficacy of the program in prescription error reduction and the patterns with which providers prescribe controlled substances for children and young adults (ages 0-21 years) at hospital discharge...
March 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26493396/caudal-extradural-catheterization-in-pediatric-renal-transplant-and-its-effect-on-perioperative-hemodynamics-and-pain-scoring-a-prospective-randomized-study
#20
RANDOMIZED CONTROLLED TRIAL
Sherif M Soaida, Mohammed S ElSheemy, Ahmed M Shouman, Ahmed I Shoukry, Hany A Morsi, Doaa M Salah, Fatina I Fadel, Hafez M Bazaraa
PURPOSE: 'Hockey stick incision' used in renal transplant is large enough to cause severe postoperative morbidity especially in pediatric recipients. Although epidural analgesia is known to be effective in pain control, the resulting sympathectomy might affect hemodynamics interfering with the transplant process. In our study, we evaluated the feasibility and safety of inserting an epidural catheter to the thoracic level via the caudal route, and the effect of using epidural local anesthetics at low concentrations on hemodynamics...
February 2016: Journal of Anesthesia
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