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Managing painful paediatric procedures
194 Ketamine: A safe and effective agent for painful procedures in the pediatric burn patient Owens V.F., Palmieri T.L., Comroe C.M., Conroy J.M., Scavone J.A., Greenhalgh D.G. J Burn Care Res 2006;27(2):211—6 Ketamine is an effective agent when used for sedation during painful bedside procedures. We developed a ketamine administration protocol for nonanesthesiologists for the purpose of establishing safe monitoring and documentation during ketamine sedation procedures. From June 1, 2002, through June 30, 2003, a total of 522 sedation events using ketamine were performed; 347 of these events were analysed. Seventeen (4.9%) events contained potentially adverse outcome indicators, 10 (2.9%) of which required intervention. Eight events were airway related and responded to repositioning, supplemental oxygen, or bag-valvemask ventilation. Two patients had a decrease in blood pressure, which responded to fluid administration. Total doses of ketamine administered were between 6 and 800 mg, for procedures ranging from 1 to 105 min, in patients weighing between 3 and 111 kg. The development of a strict protocol ensures the safe administration of ketamine for the pediatric burn patient. ©2006 by the American Burn Association. doi:10.1016/j.acpain.2006.09.026
Abstracts in 2001. During that same period the incidence of ASD decreased from 12.1% in 1993—1994 to 8.7% of patients in 2001. For effective pain and anxiety management, the average administered dose of lorazepam and morphine also increased, providing impetus to revise the pharmacotherapeutic pain protocol. Having a standard pain protocol furnishes a framework for periodic review and facilitates updating of pain and anxiety treatment practices. ©2006 Elsevier Ltd and ISBI. doi:10.1016/j.acpain.2006.09.027 Managing painful paediatric procedures Murtagh J.E. Aust Prescrib 2006;29(4):94—6 Prevention of procedural pain in children reduces the risk of subsequent morbidity including pain sensitisation. The primary emphasis for reducing pain should be on appropriate distraction and rapportbuilding strategies, however the doctor’s technique can also assist. Topical anaesthetic preparations supplement the painless suturing of wounds. They can also reduce the pain of injections, including venepuncture. Studies of mass vaccination show that injections into the buttock cause less irritability than injections into the thigh. If the thigh is used then an injection at right angles is preferred to angulation. doi:10.1016/j.acpain.2006.09.028
The effectiveness of a pain and anxiety protocol to treat the acute pediatric burn patient Ratcliff S.L., Brown A., Rosenberg L., Rosenberg M., Robert R.S., Cuervo L.J., Villarreal C., Thomas C.R., Meyer W.J. III Burns 2006;32(5):554—62 This retrospective review of 286 acute pediatric burn survivors treated in 2001 evaluated the effectiveness of a pharmacotherapeutic protocol for pain, anxiety, and itching. Background pain, procedural pain, exercise pain, anxiety, incidence of acute stress disorder (ASD), and itch were measured with standardized instruments. When this review was compared to similar reviews done in 1993—1994 and 1998, a steady trend toward using more potent pain medications in this patient population is evident. While the use of acetaminophen alone decreased from 50.6% of patients in 1993—1994 and 26.3% in 1998 to 7.3% in 2001, the use of opiates increased from 44.8% in 1993—1994 and 66.9% in 1998 to 81.3% of patients in 2001. Likewise, the use of benzodiazepines for anxiety has increased from 59.8% in 1998 to 77.5% of patients
GUIDELINES FOR ACUTE PAIN TREATMENT Standardised postoperative analgesic system in orthothopedic surgery Giesa M., Drees P., Meurer A., Jage J., Eckardt A. Z Orthop Ihre Grenzgeb 2006;144(3):267—71 In order to treat patients with postoperative acute pain effectively, we have developed a standardised algorithm for analgesia. This process includes three levels and the appropriate supply of medication. The therapy level is defined based on the scale of the operation. Accordingly, the prescription and handling of the pain medication is simplified for the attending physician and nurses. The pain level has to be measured by the nursing staff using a visual analogue scale (VAS). Thus, the efficiency of the analgesics will be continuously evaluated and controlled. The standardised supply medication can be applied in those cases with pain levels ≥4 (VAS). It is possible to up- or down-grade the level within the system depending on the actual pain experienced by the patient. With this structured pain therapy
Abstracts in 2001. During that same period the incidence of ASD decreased from 12.1% in 1993—1994 to 8.7% of patients in 2001. For effective pain and anxiety management, the average administered dose of lorazepam and morphine also increased, providing impetus to revise the pharmacotherapeutic pain protocol. Having a standard pain protocol furnishes a framework for periodic review and facilitates updating of pain and anxiety treatment practices. ©2006 Elsevier Ltd and ISBI. doi:10.1016/j.acpain.2006.09.027 Managing painful paediatric procedures Murtagh J.E. Aust Prescrib 2006;29(4):94—6 Prevention of procedural pain in children reduces the risk of subsequent morbidity including pain sensitisation. The primary emphasis for reducing pain should be on appropriate distraction and rapportbuilding strategies, however the doctor’s technique can also assist. Topical anaesthetic preparations supplement the painless suturing of wounds. They can also reduce the pain of injections, including venepuncture. Studies of mass vaccination show that injections into the buttock cause less irritability than injections into the thigh. If the thigh is used then an injection at right angles is preferred to angulation. doi:10.1016/j.acpain.2006.09.028
The effectiveness of a pain and anxiety protocol to treat the acute pediatric burn patient Ratcliff S.L., Brown A., Rosenberg L., Rosenberg M., Robert R.S., Cuervo L.J., Villarreal C., Thomas C.R., Meyer W.J. III Burns 2006;32(5):554—62 This retrospective review of 286 acute pediatric burn survivors treated in 2001 evaluated the effectiveness of a pharmacotherapeutic protocol for pain, anxiety, and itching. Background pain, procedural pain, exercise pain, anxiety, incidence of acute stress disorder (ASD), and itch were measured with standardized instruments. When this review was compared to similar reviews done in 1993—1994 and 1998, a steady trend toward using more potent pain medications in this patient population is evident. While the use of acetaminophen alone decreased from 50.6% of patients in 1993—1994 and 26.3% in 1998 to 7.3% in 2001, the use of opiates increased from 44.8% in 1993—1994 and 66.9% in 1998 to 81.3% of patients in 2001. Likewise, the use of benzodiazepines for anxiety has increased from 59.8% in 1998 to 77.5% of patients
GUIDELINES FOR ACUTE PAIN TREATMENT Standardised postoperative analgesic system in orthothopedic surgery Giesa M., Drees P., Meurer A., Jage J., Eckardt A. Z Orthop Ihre Grenzgeb 2006;144(3):267—71 In order to treat patients with postoperative acute pain effectively, we have developed a standardised algorithm for analgesia. This process includes three levels and the appropriate supply of medication. The therapy level is defined based on the scale of the operation. Accordingly, the prescription and handling of the pain medication is simplified for the attending physician and nurses. The pain level has to be measured by the nursing staff using a visual analogue scale (VAS). Thus, the efficiency of the analgesics will be continuously evaluated and controlled. The standardised supply medication can be applied in those cases with pain levels ≥4 (VAS). It is possible to up- or down-grade the level within the system depending on the actual pain experienced by the patient. With this structured pain therapy