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Opiates and children

Anne Victoria Neale, Marjorie A Bowman, Dean A Seehusen
This issue is about improving primary health care outcomes, from behavioral health to opioid issues to diagnosing hypertension to providing hope for childhood obesity. It includes hints for integrating behavioral health and care managers into family medicine practices. Opiate prescribing practices vary considerably between Japan and the United States, with helpful insights for our opiate abuse epidemic. Suicidality is high among patients taking opiates. Diagnosing hypertension the recommended way is not easily accomplished...
March 2017: Journal of the American Board of Family Medicine: JABFM
Daniel M Fein, Jeffrey R Avner, Kathryn Scharbach, Deepa Manwani, Hnin Khine
BACKGROUND: Analgesia administration for children with vaso-occlusive crises is often delayed in the emergency department. Intranasal fentanyl (INF) has been shown to be safe and effective in providing rapid analgesia for other painful conditions. Our objective was to determine if children with a vaso-occlusive crisis (VOC) who received initial treatment with INF compared to placebo achieved a greater decrease in pain score after 20 min. PROCEDURE: This was a randomized, double-blind, placebo-controlled trial...
June 2017: Pediatric Blood & Cancer
Pilar Anton-Martin, Vinai Modem, Donna Taylor, Donald Potter, Cindy Darnell-Bowens
INTRODUCTION: The purpose of this study is to describe the sedative and analgesic requirements identifying factors associated with medication escalation in neonates and children supported on ECMO. METHOD: Observational retrospective cohort study in a tertiary pediatric intensive care unit from June 2009 to June 2013. RESULTS: One hundred and sixty patients were included in the study. Fentanyl and midazolam were the first line agents used while on ECMO...
April 2017: Perfusion
John M Wo, Thomas V Nowak, Shamaila Waseem, Matthew P Ward
Gastroparesis is a heterogeneous clinical syndrome. Some patients have debilitating vomiting, weight loss, and dehydration, while others have effortless regurgitation of undigested foods or postprandial distress suggestive of functional dyspepsia. Gastric electrical stimulation (GES) has been proposed as an effective treatment option for patients with gastroparesis refractory to medical therapy. Evidence suggests that the clinically available device, a low-energy high-frequency GES, activates the vagal afferent pathways to influence the central control mechanisms for nausea and vomiting...
December 2016: Current Treatment Options in Gastroenterology
James Dodington, Pina Violano, Carl R Baum, Kirsten Bechtel
Significant breakthroughs in the field of injury prevention and childhood safety have occurred during the past half-century. For example, the Poison Prevention Packaging Act of 1970 and the institution of child passenger safety laws are responsible for a significant reduction in injuries among children and adolescents. This review will focus on the following three topics because of their significant contribution to pediatric injury morbidity, especially among adolescents, and their promise for further effective prevention research...
October 26, 2016: Pediatric Research
Asia N Rashed, Stephen Tomlin
INTRODUCTION: Opiate intravenous infusions are the therapy of choice in severe pain. However, administering infusions to children requires complex dosage calculations, rate adjustments and often multiple manipulations of injectable medicines to obtain the final "ready to use" solution for both continuous infusion and additional boluses; potentially putting children at high risk.1 2 AIM: To investigate the practice and accuracy of healthcare professionals (HCPs) in hospital theatres and wards in preparing morphine infusions for nurse/patient controlled analgesia (N/PCA) use in a UK children's hospital...
September 2016: Archives of Disease in Childhood
Junndeep Sidhu, Neil Tickner
AIM: To evaluate clinical management of acute pain with respect to pain assessment, scoring and timing of analgesia and whether appropriate supportive medicines were prescribed alongside strong opiates. A previous pain audit found dosing of analgesia was appropriate but did not assess clinical management against pain scores. Our paediatric guideline does not currently stipulate guidance on appropriate time frames to administer analgesia and re-assess pain. Standards were developed with a multidisciplinary team to audit against...
September 2016: Archives of Disease in Childhood
D V Dmytriyev, V S Konoplytskyi
The investigation was conducted in 20 children, operated on for abdominal oncological diseases in a 2010-2015 yrs period, using various methods of analgesia. While application of a constant infusion of high doses of phentanyl--1-4 MKr/(kg x h) in perioperative period the occurrence of the opiate-induced hyperalgesia is possible with the accompanied morphological changes in intestinal wall; in anesthesia of a transverse abdominal muscle (a TAP-blockade) and combined spinal epidural analgesia such changes were not observed...
March 2016: Klinichna Khirurhiia
Arun K Srinivasan, Dhiren Shrivastava, Rebecca E Kurzweil, Dana A Weiss, Christopher J Long, Aseem R Shukla
OBJECTIVE: To compare the efficacy of the intrathecal opiate vs wound site local anesthetic infiltration for perioperative pain control during and after surgery in patients undergoing minimally invasive pediatric urologic procedures. METHODS: Using an Institutional Review Board-approved registry database, we identified patients who underwent minimally invasive urologic procedures at our institution between 2009 and 2013. We collected all relevant preoperative variables and postoperative outcomes...
November 2016: Urology
Melissa J Maguire, Cerian F Jackson, Anthony G Marson, Sarah J Nolan
BACKGROUND: Sudden Unexpected Death in Epilepsy (SUDEP) is defined as sudden, unexpected, witnessed or unwitnessed, non-traumatic or non-drowning death of people with epilepsy, with or without evidence of a seizure, excluding documented status epilepticus and in whom postmortem examination does not reveal a structural or toxicological cause for death. SUDEP has a reported incidence of 1 to 2 per 1000 patient years and represents the most common epilepsy-related cause of death. The presence and frequency of generalised tonic-clonic seizures (GTCS), male sex, early age of seizure onset, duration of epilepsy, and polytherapy are all predictors of risk of SUDEP...
July 19, 2016: Cochrane Database of Systematic Reviews
Lorin R Browne, Manish I Shah, Jonathan R Studnek, Daniel G Ostermayer, Stacy Reynolds, Clare E Guse, David C Brousseau, E Brooke Lerner
BACKGROUND: The National Association of Emergency Medical Services Physicians' (NAEMSP) Position Statement on Prehospital Pain Management and the joint National Highway Traffic Safety Administration (NHTSA) and Emergency Medical Services for Children (EMSC) Evidence-based Guideline for Prehospital Analgesia in Trauma aim to improve the recognition, assessment, and treatment of prehospital pain. The impact of implementation of these guidelines on pain management in children by emergency medical services (EMS) agencies has not been assessed...
November 2016: Prehospital Emergency Care
Beryl F Yaghmai, Jane L Di Gennaro, Gretchen A Irby, Kristina H Deeter, Jerry J Zimmerman
OBJECTIVES: To reevaluate the effect of a nursing-driven sedation protocol for mechanically ventilated patients on analgesic and sedative medication dosing durations. We hypothesized that lack of continued quality improvement efforts results in increased sedation exposure, as well as mechanical ventilation days, and ICU length of stay. DESIGN: Quasi-experimental, uncontrolled before-after study. SETTING: Forty-five-bed tertiary care, medical-surgical-cardiac PICU in a metropolitan university-affiliated children's hospital...
August 2016: Pediatric Critical Care Medicine
Egil Nygaard, Kari Slinning, Vibeke Moe, Kristine B Walhovd
Multiple studies have found that children born to mothers with opioid or poly-substance use during pregnancy have more behavior and attention problems and lower cognitive functioning than non-exposed children. The present study aimed to investigate whether behavior and attention problems are more prominent than general cognitive deficits in this risk group and whether the problems wane or increase over time. This prospective longitudinal cross-informant study compared 72 children who were prenatally exposed to heroin and multiple drugs with a group of 58 children without known prenatal risk factors...
2016: PloS One
Nassir Messaadi, Jonathan Favre, Benjamin Rolland, Olivier Cottencin, Matthieu Calafiore, Bertrand Stalnikiewicz, Christophe Berkhout
OBJECTIVE: Management with opiate replacement regimens (ORRs) of patients presenting to primary care settings with opiate addiction has become a long-term follow-up. The aim of this survey study was to describe patients who had been prescribed ORRs for at least 10 years by their general practitioner (GP). METHOD: In 2011, two questionnaires were sent to a sample of 38 GPs prescribing ORRs in Northern France. Doctors' questionnaires collected their typology and opinions on their patients receiving opiate substitution treatments for over 10 years...
October 2016: Thérapie
Asher Ornoy, Victoria Finkel-Pekarsky, Einat Peles, Miriam Adelson, Shaul Schreiber, P Richard Ebstein
BACKGROUND: Polymorphisms in genes such as DAT1, 5HTTLPR, D4DR4, and MAO-A have been linked to attention deficit hyperactivity disorder (ADHD) and susceptibility for opiate addiction. We investigated in opiate-addicted parents and their children the rate of ADHD and genetic markers that could predict susceptibility to ADHD and/or opiate addiction. METHODS: We studied 64 heroin-addicted, methadone-maintained parents, and their 94 children who had or had not been exposed prenatally to opiates...
August 2016: Pediatric Research
Leah J Welty, Anna J Harrison, Karen M Abram, Nichole D Olson, David A Aaby, Kathleen P McCoy, Jason J Washburn, Linda A Teplin
OBJECTIVES: To examine sex and racial/ethnic differences in the prevalence of 9 substance-use disorders (SUDs)--alcohol, marijuana, cocaine, hallucinogen or PCP, opiate, amphetamine, inhalant, sedative, and unspecified drug--in youths during the 12 years after detention. METHODS: We used data from the Northwestern Juvenile Project, a prospective longitudinal study of 1829 youths randomly sampled from detention in Chicago, Illinois, starting in 1995 and reinterviewed up to 9 times in the community or correctional facilities through 2011...
May 2016: American Journal of Public Health
Adrian P Murphy, Macartan Hughes, Siobhan Mccoy, Gloria Crispino, Abel Wakai, Ronan O'Sullivan
INTRODUCTION: Acute pain is the most common symptom in the emergency setting and its optimal management continues to challenge prehospital emergency care practitioners, particularly in the paediatric population. Difficulty in establishing vascular access and fear of opiate administration to small children are recognized reasons for oligoanalgesia. Intranasal fentanyl (INF) has been shown to be as safe and effective as intravenous morphine in the treatment of severe pain in children in the Emergency Department setting...
March 15, 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
C Bréhin, C Cessans, C Monchaud, M Lavit, C Majorel, I Claudet
UNLABELLED: We report a case of a pseudo encephalitis presentation of pediatric intoxication - Case report - a 7 year-old girl was admitted to our pediatric emergency unit after she developed sudden agitation, visual and tactile hallucinations. She was febrile (38.3 °C). She had not experienced any recent head trauma, infection or toxic ingestion; she did not take any medication for ADD. Her physical exam revealed tachycardia, normal pupils, reflexes and normal plantar responses. Laboratory investigations (complete blood count, basic metabolic panel, plasma lactate level, ammonia level) produced normal results...
May 2016: European Journal of Paediatric Neurology: EJPN
James K Hamill, Jamie-Lee Rahiri, Andrew Liley, Andrew G Hill
INTRODUCTION: The role of rectus sheath blocks (RSB) and transversus abdominis plane (TAP) blocks in pediatric surgery has not been well established. OBJECTIVE: We aimed to determine if RSB and TAP blocks decrease postoperative pain and improve recovery in children. DATA SOURCES: Duplicate searching of MEDLINE, EMBASE, Cochrane, Web of Science, and trial registries databases by two reviewers. STUDY SELECTION: Included were randomized trials in children on RSB or TAP block in abdominal operations, excluding inguinal procedures...
April 2016: Paediatric Anaesthesia
Laurne S Terasaki, Julie Gomez, Jaclyn M Schwarz
Early-life exposure to drugs and alcohol is one of the most preventable causes of developmental, behavioural and learning disorders in children. Thus a significant amount of basic, animal and human research has focused on understanding the behavioural consequences and the associated neural effects of exposure to drugs and alcohol during early brain development. Despite this, much of the previous research that has been done on this topic has used predominantly male subjects or rodents. While many of the findings from these male-specific studies may ultimately apply to females, the purpose of this review is to highlight the research that has also examined sex as a factor and found striking differences between the sexes in their response to early-life opiate and alcohol exposure...
February 19, 2016: Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences
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