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von Ungern-Sternberg BS, Sommerfield A, Sommerfield D, Engelhardt T, Wilson G. The effect of the COVID-19 pandemic on paediatric anaesthesia research as evidenced by the contrasting recruitment experiences of centres in Australia and Scotland. Anaesth Crit Care Pain Med 2024; 43:101365. [PMID: 38460886 DOI: 10.1016/j.accpm.2024.101365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Australia; Peri-operative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Australia; Institute of Paediatric Perioperative Excellence, The University of Western Australia.
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Australia; Peri-operative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Australia; Institute of Paediatric Perioperative Excellence, The University of Western Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Australia; Peri-operative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Australia; Institute of Paediatric Perioperative Excellence, The University of Western Australia
| | - Thomas Engelhardt
- Department of Anesthesia, Montreal Children's Hospital, Montreal, Canada; McGill University, Montreal, Canada
| | - Graham Wilson
- Department of Anaesthesia, Royal Aberdeen Children's Hospital, Aberdeen, Scotland
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Humphreys S, Schibler A, Williams T, Spall S, Pham T, Atkins T, Goyal V, Sommerfield D, Sommerfield A, Keys A, Hauser N, von Ungern-Sternberg BS. Flexible bronchoscopy insufflated and high-flow nasal oxygen pilot trial (BUFFALO protocol pilot trial). Pilot Feasibility Stud 2024; 10:45. [PMID: 38424597 PMCID: PMC10902996 DOI: 10.1186/s40814-024-01464-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 02/09/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Hypoxaemia occurs in approximately 30% of children during anaesthesia for flexible bronchoscopy. High-flow nasal oxygen (HFNO) can prolong safe apnoea time and be used in children with abnormal airways. During flexible bronchoscopy, there is limited evidence if HFNO confers advantages over current standard practice in avoiding hypoxaemia. The aim is to investigate feasibility of HFNO use during anaesthesia for flexible bronchoscopy to reduce frequency of rescue oxygenation and hypoxaemia. METHODS BUFFALO is a bi-centre, unmasked, randomised controlled, parallel group, protocol for a pilot trial comparing HFNO techniques to standard practice during anaesthesia. Children (n = 81) aged > 37 weeks to 16 years presenting for elective bronchoscopy who fulfil inclusion but not exclusion criteria will be randomised prior to the procedure to HFNO or standard care oxygenation post induction of anaesthesia. Maintenance of anaesthesia with HFNO requires total venous anaesthesia (TIVA) and with standard, either inhalational or TIVA at discretion of anaesthetist in charge of the patient. Outcomes will include the feasibility of recruitment and adherence to trial procedures, acceptability of the intervention of the protocol and completion rates of data collection methods. DISCUSSION Findings of this trial will determine feasibility to plan for a larger multicentre randomised clinical trial and support the feasibility of the proposed study procedures. TRIAL REGISTRATION BUFFALO trial was registered with Australia and New Zealand Clinical Trials Registry (TRN12621001635853) on 29 November 2021 and commenced recruitment in May 2022. https://www.anzctr.org.au/ . The primary manuscript will be submitted for publication in a peer-reviewed journal.
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Affiliation(s)
- Susan Humphreys
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia.
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia.
- Wesley Research Institute, Wesley Hospital, Auchenflower, Australia.
| | - Andreas Schibler
- Wesley Research Institute, Wesley Hospital, Auchenflower, Australia
- Critical Care Research Group, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia
| | - Tara Williams
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Susan Spall
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Trang Pham
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Tiffany Atkins
- Institute for Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Department of Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Adam Keys
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Neil Hauser
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Nedlands, Western Australia, Australia
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Sommerfield D, Sommerfield A, Evans D, Khan RN, Luke A, Vijayasekaran S, Bumbak P, Herbert H, von Ungern-Sternberg BS. Jelly snakes to reduce early postoperative vomiting in children after adenotonsillectomy: The randomized controlled snakes trial. Anaesth Crit Care Pain Med 2024; 43:101334. [PMID: 38048987 DOI: 10.1016/j.accpm.2023.101334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Despite the use of dual antiemetic agents, postoperative nausea and vomiting (PONV) occurs in an unacceptably large number of patients post-tonsillectomy. There has been increased interest in alternative and non-pharmacological treatments for PONV e.g., chewing gum. We investigated if chewing a large confectionary jelly snake had prophylactic antiemetic effects postoperatively in young children. METHODS Prospective, open-label randomised controlled trial of 240 patients, 2-16 years. Patients administered a confectionary jelly snake to chew postoperatively were compared with a control group. The primary outcome was the number of episodes of vomiting within 6 h of the operation on an intention-to-treat basis. SECONDARY OUTCOMES incidence of nausea, vomiting at 6 and 24 h, rescue antiemetic use, acceptability, delayed discharge. RESULTS 233 patients were randomised to receive the confectionary snake (snake group, 118) or standard care (control group, 115). The number of vomiting episodes in 6 h was similar between groups on an intention-to-treat basis, with 39 episodes across 22 (19%) patients in the control group and 31 across 19 (16%) patients in the snake group (p = 0.666). From post anaesthetic care unit until 24 h there was no difference in doses of antiemetics or delayed discharge due to PONV. A secondary as per protocol analysis did not change this result. CONCLUSIONS Chewing of confectionery jelly snakes within one hour of waking following adenotonsillectomy with vapour-maintained anaesthesia and two prophylactic antiemetics did not further reduce the incidence of early vomiting. REGISTRATION prospective registration at the Australia and New Zealand Clinical Trials Registry (ACTRN12618000637246).
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Affiliation(s)
- David Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Australia; Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Australia; Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Australia
| | - Daisy Evans
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Australia; Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia; School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, Australia
| | - R Nazim Khan
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia; Department of Mathematics and Statistics, The University of Western Australia, Crawley, Australia
| | - Abigail Luke
- School of Biomedical Sciences, The University of Western Australia, Australia.
| | - Shyan Vijayasekaran
- Department of Otolaryngology/Head and Neck Surgery, Perth Children's Hospital, Nedlands, Australia
| | - Paul Bumbak
- Department of Otolaryngology/Head and Neck Surgery, Perth Children's Hospital, Nedlands, Australia
| | - Hayley Herbert
- Department of Otolaryngology/Head and Neck Surgery, Perth Children's Hospital, Nedlands, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Australia; Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Australia.
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Stepanovic B, Sommerfield A, Sommerfield D, von Ungern-Sternberg B. The influence of the COVID pandemic on the management of URTI in children. BJA Educ 2023; 23:473-479. [PMID: 38009138 PMCID: PMC10667611 DOI: 10.1016/j.bjae.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 11/28/2023] Open
Affiliation(s)
| | - A. Sommerfield
- Perth Children's Hospital, Perth, Australia
- Telethon Kids Institute, Perth, Australia
| | - D. Sommerfield
- Perth Children's Hospital, Perth, Australia
- Telethon Kids Institute, Perth, Australia
- University of Western Australia, Perth, Australia
| | - B.S. von Ungern-Sternberg
- Perth Children's Hospital, Perth, Australia
- Telethon Kids Institute, Perth, Australia
- University of Western Australia, Perth, Australia
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Ohn M, Sommerfield D, Nguyen J, Evans D, Khan RN, Hauser N, Herbert H, Bumbak P, Wilson AC, Eastwood PR, Maddison KJ, Walsh JH, von Ungern-Sternberg BS. Predicting obstructive sleep apnoea and perioperative respiratory adverse events in children: role of upper airway collapsibility measurements. Br J Anaesth 2023; 131:1043-1052. [PMID: 37891122 DOI: 10.1016/j.bja.2023.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) and perioperative respiratory adverse events are significant risks for anaesthesia in children undergoing adenotonsillectomy. Upper airway collapse is a crucial feature of OSA that contributes to respiratory adverse events. A measure of upper airway collapsibility to identify undiagnosed OSA can help guide perioperative management. We investigated the utility of pharyngeal closing pressure (PCLOSE) for predicting OSA and respiratory adverse events. METHODS Children scheduled for elective adenotonsillectomy underwent in-laboratory polysomnography 2-12 weeks before surgery. PCLOSE measurements were obtained while the child was anaesthetised and breathing spontaneously just before surgery. Logistic regression was used to assess the predictive performance of PCLOSE for detecting OSA and perioperative respiratory adverse events after adjusting for potential covariates. RESULTS In 52 children (age, mean [standard deviation] 5.7 [1.8] yr; 20 [38%] females), airway collapse during PCLOSE was observed in 42 (81%). Of these, 19 of 42 (45%) patients did not have OSA, 15 (36%) had mild OSA, and eight (19%) had moderate-to-severe OSA. All 10 children with no evidence of airway collapse during the PCLOSE measurements did not have OSA. PCLOSE predicted moderate-to-severe OSA (odds ratio [OR] 1.71; 95% confidence interval [CI]: 1.2-2.8; P=0.011). All children with moderate-to-severe OSA could be identified at a PCLOSE threshold of -4.0 cm H2O (100% sensitivity), and most with no or mild OSA were ruled out (64.7% specificity; receiver operating characteristic/area under the curve=0.857). However, there was no significant association between respiratory adverse events and PCLOSE (OR 1.0; 95% CI: 0.8-1.1; P=0.641). CONCLUSIONS Measurement of PCLOSE after induction of anaesthesia can reliably identify moderate or severe OSA but not perioperative respiratory adverse events in children before adenotonsillectomy. CLINICAL TRIAL REGISTRATION ANZCTR ACTRN 12617001503314.
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Affiliation(s)
- Mon Ohn
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia; Division of Paediatrics, Medical School, University of Western Australia, Crawley, WA, Australia; Perioperative Medicine Team, Peri-operative Care Programme, Telethon Kids Institute, Nedlands, WA, Australia.
| | - David Sommerfield
- Perioperative Medicine Team, Peri-operative Care Programme, Telethon Kids Institute, Nedlands, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, University of Western Australia, Crawley, WA, Australia; Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, WA, Australia
| | - Julie Nguyen
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia; Perioperative Medicine Team, Peri-operative Care Programme, Telethon Kids Institute, Nedlands, WA, Australia; Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, WA, Australia
| | - Daisy Evans
- Perioperative Medicine Team, Peri-operative Care Programme, Telethon Kids Institute, Nedlands, WA, Australia; Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, WA, Australia; School of Physics, Mathematics and Computing, University of Western Australia, Crawley, WA, Australia
| | - R Nazim Khan
- Department of Mathematics and Statistics, University of Western Australia, Crawley, WA, Australia
| | - Neil Hauser
- Perioperative Medicine Team, Peri-operative Care Programme, Telethon Kids Institute, Nedlands, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, University of Western Australia, Crawley, WA, Australia; Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, WA, Australia
| | - Hayley Herbert
- Division of Paediatrics, Medical School, University of Western Australia, Crawley, WA, Australia; Department of Otolaryngology/Head and Neck Surgery, Perth Children's Hospital, Nedlands, WA, Australia
| | - Paul Bumbak
- Department of Otolaryngology/Head and Neck Surgery, Perth Children's Hospital, Nedlands, WA, Australia
| | - Andrew C Wilson
- Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, WA, Australia; Division of Paediatrics, Medical School, University of Western Australia, Crawley, WA, Australia; Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia
| | - Peter R Eastwood
- Health Futures Institute, Murdoch University, Perth, WA, Australia
| | - Kathleen J Maddison
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Jennifer H Walsh
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology & Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Centre for Sleep Science, School of Human Sciences, University of Western Australia, Crawley, WA, Australia
| | - Britta S von Ungern-Sternberg
- Perioperative Medicine Team, Peri-operative Care Programme, Telethon Kids Institute, Nedlands, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, University of Western Australia, Crawley, WA, Australia; Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, WA, Australia
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Zhang E, Hauser N, Sommerfield A, Sommerfield D, von Ungern‐Sternberg BS. A review of pediatric fasting guidelines and strategies to help children manage preoperative fasting. Paediatr Anaesth 2023; 33:1012-1019. [PMID: 37533337 PMCID: PMC10947285 DOI: 10.1111/pan.14738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/21/2023] [Accepted: 07/24/2023] [Indexed: 08/04/2023]
Abstract
Fasting for surgery is a routine step in the preoperative preparation for surgery. There have however been increasing concerns with regard to the high incidence of prolonged fasting in children, and the subsequent psycho-social distress and physiological consequences that this poses. Additionally, the past few years have yielded new research that has shown significant inter-individual variation in gastric emptying regardless of the length of the fast, with some patients still having residual gastric contents even after prolonged fasts. Additionally, multiple large-scale studies have shown no long-term sequalae from clear fluid aspiration, although two deaths from aspiration have been reported within the large Wake Up Safe cohort. This has led to a change in the recommended clear fluid fasting times in multiple international pediatric societies; similarly, many societies continue to recommend traditional fasting times. Multiple fasting strategies exist in the literature, though these have mostly been studied and implemented in the adult population. This review hopes to summarize the recent updates in fasting guidelines, discuss the issues surrounding prolonged fasting, and explore potential tolerance strategies for children.
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Affiliation(s)
- Eileen Zhang
- Department of Anaesthesia and Pain MedicinePerth Children's HospitalPerthWestern AustraliaAustralia
| | - Neil Hauser
- Department of Anaesthesia and Pain MedicinePerth Children's HospitalPerthWestern AustraliaAustralia
- Perioperative Medicine Team, Perioperative Care ProgramTelethon Kids InstitutePerthWestern AustraliaAustralia
- Division of Emergency Medicine, Anaesthesia and Pain MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain MedicinePerth Children's HospitalPerthWestern AustraliaAustralia
- Perioperative Medicine Team, Perioperative Care ProgramTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - David Sommerfield
- Department of Anaesthesia and Pain MedicinePerth Children's HospitalPerthWestern AustraliaAustralia
- Perioperative Medicine Team, Perioperative Care ProgramTelethon Kids InstitutePerthWestern AustraliaAustralia
- Division of Emergency Medicine, Anaesthesia and Pain MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Britta S. von Ungern‐Sternberg
- Department of Anaesthesia and Pain MedicinePerth Children's HospitalPerthWestern AustraliaAustralia
- Perioperative Medicine Team, Perioperative Care ProgramTelethon Kids InstitutePerthWestern AustraliaAustralia
- Division of Emergency Medicine, Anaesthesia and Pain MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
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Ohn M, Salerno S, Nguyen J, Sommerfield D, Herbert H, Bumbak P, Hillman D, Khan RN, Maddison KJ, Walsh JH, Eastwood PR, von Ungern‐Sternberg BS. Feasibility of upper airway collapsibility measurements in anesthetized children. Paediatr Anaesth 2023; 33:263-265. [PMID: 36398409 PMCID: PMC10946944 DOI: 10.1111/pan.14603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/04/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Mon Ohn
- Department of Respiratory and Sleep MedicinePerth Children's HospitalNedlandsWestern AustraliaAustralia
- Division of Pediatrics, Medical SchoolUniversity of Western AustraliaCrawleyWestern AustraliaAustralia
- Perioperative Medicine TeamTelethon Kids InstituteNedlandsWestern AustraliaAustralia
| | - Sarah Salerno
- Division of Emergency Medicine, Anesthesia and Pain Medicine, Medical SchoolThe University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Julie Nguyen
- Department of Respiratory and Sleep MedicinePerth Children's HospitalNedlandsWestern AustraliaAustralia
- Perioperative Medicine TeamTelethon Kids InstituteNedlandsWestern AustraliaAustralia
- Department of Anesthesia and Pain ManagementPerth Children's HospitalNedlandsWestern AustraliaAustralia
| | - David Sommerfield
- Perioperative Medicine TeamTelethon Kids InstituteNedlandsWestern AustraliaAustralia
- Division of Emergency Medicine, Anesthesia and Pain Medicine, Medical SchoolThe University of Western AustraliaCrawleyWestern AustraliaAustralia
- Department of Anesthesia and Pain ManagementPerth Children's HospitalNedlandsWestern AustraliaAustralia
| | - Hayley Herbert
- Department of Otolaryngology/Head and Neck SurgeryPerth Children's HospitalNedlandsWAAustralia
| | - Paul Bumbak
- Department of Otolaryngology/Head and Neck SurgeryPerth Children's HospitalNedlandsWAAustralia
| | - David Hillman
- Centre for Sleep Science, School of Human SciencesThe University of Western AustraliaCrawleyWestern AustraliaAustralia
- Department of Pulmonary Physiology & Sleep Medicine, West Australian Sleep Disorders Research InstituteSir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
| | - Ramzan Nazim Khan
- Department of Mathematics and StatisticsThe University of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Kathleen J. Maddison
- Centre for Sleep Science, School of Human SciencesThe University of Western AustraliaCrawleyWestern AustraliaAustralia
- Department of Pulmonary Physiology & Sleep Medicine, West Australian Sleep Disorders Research InstituteSir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
| | - Jennifer H. Walsh
- Centre for Sleep Science, School of Human SciencesThe University of Western AustraliaCrawleyWestern AustraliaAustralia
- Department of Pulmonary Physiology & Sleep Medicine, West Australian Sleep Disorders Research InstituteSir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
| | - Peter R. Eastwood
- Flinders Health and Medical Research Institute, College of Medicine & Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Britta S. von Ungern‐Sternberg
- Perioperative Medicine TeamTelethon Kids InstituteNedlandsWestern AustraliaAustralia
- Division of Emergency Medicine, Anesthesia and Pain Medicine, Medical SchoolThe University of Western AustraliaCrawleyWestern AustraliaAustralia
- Department of Anesthesia and Pain ManagementPerth Children's HospitalNedlandsWestern AustraliaAustralia
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Riva T, Engelhardt T, Basciani R, Bonfiglio R, Cools E, Fuchs A, Garcia-Marcinkiewicz AG, Greif R, Habre W, Huber M, Petre MA, von Ungern-Sternberg BS, Sommerfield D, Theiler L, Disma N. Direct versus video laryngoscopy with standard blades for neonatal and infant tracheal intubation with supplemental oxygen: a multicentre, non-inferiority, randomised controlled trial. The Lancet Child & Adolescent Health 2023; 7:101-111. [PMID: 36436541 DOI: 10.1016/s2352-4642(22)00313-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tracheal intubation in neonates and infants is a potentially life-saving procedure. Video laryngoscopy has been found to improve first-attempt tracheal intubation success and reduce complications compared with direct laryngoscopy in children younger than 12 months. Supplemental periprocedural oxygen might increase the likelihood of successful first-attempt intubation because of an increase in safe apnoea time. We tested the hypothesis that direct laryngoscopy is not inferior to video laryngoscopy when using standard blades and supplemental oxygen is provided. METHODS We did a non-inferiority, international, multicentre, single-blinded, randomised controlled trial, in which we randomly assigned neonates and infants aged up to 52 weeks postmenstrual age scheduled for elective tracheal intubation to either direct laryngoscopy or video laryngoscopy (1:1 ratio, randomly assigned using a secure online service) at seven tertiary paediatric hospitals across Australia, Canada, Italy, Switzerland, and the USA. An expected difficult intubation was the main exclusion criteria. Parents and patients were masked to the assigned group of treatment. All infants received supplemental oxygen (1 L/Kg per min) during laryngoscopy until the correct tracheal tube position was confirmed. The primary outcome was the proportion of first-attempt tracheal intubation success, defined as appearance of end-tidal CO2 curve at the anaesthesia monitor, between the two groups in the modified intention-to-treat analysis. A 10% non-inferiority margin between direct laryngoscopy or video laryngoscopy was applied. The trial is registered with ClinicalTrials.gov (NCT04295902) and is now concluded. FINDINGS Of 599 patients assessed, 250 patients were included between Oct 26, 2020, and March 11, 2022. 244 patients were included in the final modified intention-to-treat analysis. The median postmenstrual age on the day of intubation was 44·0 weeks (IQR 41·0-48·0) in the direct laryngoscopy group and 46·0 weeks (42·0-49·0) in the video laryngoscopy group, 34 (28%) were female in the direct laryngoscopy group and 38 (31%) were female in the video laryngoscopy group. First-attempt tracheal intubation success rate with no desaturation was higher with video laryngoscopy (89·3% [95% CI 83·7 to 94·8]; n=108/121) compared with direct laryngoscopy (78·9% [71·6 to 86·1]; n=97/123), with an adjusted absolute risk difference of 9·5% (0·8 to 18·1; p=0·033). The incidence of adverse events between the two groups was similar (-2·5% [95% CI -9·6 to 4·6]; p=0·490). Post-anaesthesia complications occurred seven times in six patients with no difference between the groups. INTERPRETATION Video laryngoscopy with standard blades in combination with supplemental oxygen in neonates and infants might increase the success rate of first-attempt tracheal intubation, when compared with direct laryngoscopy with supplemental oxygen. The incidence of hypoxaemia increased with the number of attempts, but was similar between video laryngoscopy and direct laryngoscopy. Video laryngoscopy with oxygen should be considered as the technique of choice when neonates and infants are intubated. FUNDING Swiss Pediatric Anaesthesia Society, Swiss Society for Anaesthesia and Perioperative Medicine, Foundation for Research in Anaesthesiology and Intensive Care Medicine, Channel 7 Telethon Trust, Stan Perron Charitable Foundation, National Health and Medical Research Council.
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Affiliation(s)
- Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Engelhardt
- Department of Anaesthesia, Montreal Children's Hospital, McGill University Health Centre, Montréal, QC, Canada
| | - Reto Basciani
- Department of Anaesthesiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Rachele Bonfiglio
- Unit for Research in Anaesthesia, Department of Paediatric Anaesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Evelien Cools
- Unit for Anaesthesiological Investigations, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Alexander Fuchs
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annery G Garcia-Marcinkiewicz
- Department of Anaesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert Greif
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Walid Habre
- Unit for Anaesthesiological Investigations, Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria-Alexandra Petre
- Department of Anaesthesia, Montreal Children's Hospital, McGill University Health Centre, Montréal, QC, Canada
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Australia; Perioperative Medicine Team, Telethon Kids Institute, Perth, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Australia; Perioperative Medicine Team, Telethon Kids Institute, Perth, Australia
| | - Lorenz Theiler
- Department of Anaesthesiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Nicola Disma
- Unit for Research in Anaesthesia, Department of Paediatric Anaesthesia, IRCCS Istituto Giannina Gaslini, Genova, Italy.
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9
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Sommerfield A, Sommerfield D, Bell E, Humphreys S, Taverner F, Lee K, Frank B, von Ungern-Sternberg BS. Consumer research priorities for pediatric anesthesia and perioperative medicine. Paediatr Anaesth 2023; 33:144-153. [PMID: 36178177 PMCID: PMC10092273 DOI: 10.1111/pan.14564] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/06/2022] [Accepted: 09/25/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Consumer-driven research is increasingly being prioritized. AIM Our aim was to partner with consumers to identify the top 10 research priorities for pediatric anesthesia and perioperative medicine. The ACORN (Anesthesia Consumer Research Network) was formed to collaborate with children and families across Australia. METHODS A prospective online survey was developed to generate research ideas from consumers. The survey was developed in Qualtrics, a survey research platform. Consumers were invited to participate through poster advertising, social media posts, via consumer networks at participating hospitals and in addition 35 national consumer/patient representative organizations were approached. We also conducted a similar idea generating survey for clinicians through email invitation and via Twitter. A second round of surveys was conducted to prioritize the long list of research questions and a shortlist of priorities developed. A single consensus meeting was held, and a final consensus list of top 10 priorities emerged. RESULTS A total of 281 research ideas were submitted between 356 consumers in the idea generating survey and from four consumer/patient representative groups. Seventy-five clinicians responded to the clinician idea generation survey. This was consolidated into 20 research ideas/themes for the second survey for each group. 566 responses were received to the consumer prioritization top 10 survey and 525 responses to the clinician survey. The consensus meeting produced the final 10 consumer research priorities. CONCLUSION This study has given Australian consumers the opportunity to shape the anesthesia and perioperative medicine research agenda for pediatric patients both nationally and internationally.
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Affiliation(s)
- Aine Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Emily Bell
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Susan Humphreys
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia.,Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Fiona Taverner
- Department of Paediatric Anaesthesia, Women's and Children's Hospital, North Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
| | - Kenneth Lee
- Discipline of Pharmacy, School of Allied Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Belinda Frank
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Britta Sylvia von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
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10
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Heath C, Hii J, Thalayasingam P, von Ungern-Sternberg BS, Sommerfield D. Perioperative intravenous lidocaine use in children. Paediatr Anaesth 2022; 33:336-346. [PMID: 36424875 DOI: 10.1111/pan.14608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
Perioperative pain management impacts patient morbidity, quality of life, and hospitalization cost. In children, it impacts not only the child, but the whole family. Adjuncts for improved perioperative analgesia continue to be sought to minimize adverse side effects associated with opioids and for those in whom regional or neuraxial anesthesia is not suitable. The use of ketamine and alpha agonists may be useful in these settings but have noted adverse effects including hallucinations, hemodynamic instability, and excessive sedation. One alternative is intravenous lidocaine. Despite its off-label use, intravenous lidocaine has demonstrated anti-neuropathic, anti-hyperalgesic, and anti-inflammatory actions and is an emerging technique. Multiple studies in adults have demonstrated beneficial effects of perioperative intravenous lidocaine including improved perioperative analgesia with reduced postoperative opioid use, improved gastrointestinal function, earlier mobilization, and reduction in hospital length of stay. Despite the limited pediatric literature, some of these findings have been replicated. Large-scale trials providing evidence for the pediatric pharmacokinetics and high-quality safety data with respect to intravenous lidocaine are still however lacking. To date, dose ranges studied in the pediatric population have not been associated with serious side effects and current data suggests perioperative intravenous lidocaine in a subgroup of pediatric surgical patients seems well-tolerated and beneficial.
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Affiliation(s)
- Chloe Heath
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Justin Hii
- Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Anaesthesia, Joondalup Health Campus, Joondalup, WA, Australia
| | - Priya Thalayasingam
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
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11
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Collins K, Rueter K, Lucas M, Sommerfield D, Sommerfield A, Khan N, von Ungern‐Sternberg BS. Penicillin allergy SHACK: Survey of hospital and community knowledge. J Paediatr Child Health 2022; 58:1414-1419. [PMID: 35502826 PMCID: PMC9546145 DOI: 10.1111/jpc.16007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
AIM Penicillin allergy accounts for the majority of all reported adverse drug reactions in adults and children. Foregoing first-line antibiotic therapy due to penicillin allergy label is associated with an increased prevalence of infections by resistant organisms and longer hospitalisation. Clinician awareness of allergy assessment, referral indications, management of allergy and anaphylaxis is therefore vital but globally lacking. We aim to assess the knowledge of penicillin allergy, assessment and management in Western Australian health professionals. METHODS An anonymous survey was distributed to pharmacists, nurses and physicians within Western Australian paediatric and adult Hospitals, Community and General Practice. RESULTS In total, 487/611 were completed and included in the statistical analysis. Only 62% (301/487) of respondents routinely assessed for patient medication allergies. Of those who assessed allergy, 9% (28/301) of respondents met the Australian standards for allergy assessment. Only 22% (106/487) of participants correctly cited all indications for management with adrenaline in anaphylaxis to antibiotics and 67% (197/292) of physicians rarely or never referred to an allergy service. Paediatric clinicians had an increased understanding of allergy assessment and anaphylaxis management. Recent penicillin allergy education within a 5-year period led to significant improvements in allergy knowledge. CONCLUSION Overall, knowledge, assessment and management of penicillin allergies among practitioners in Western Australia are currently inadequate in adults and paediatric clinicians to provide safe and effective clinical care. The implementation of a targeted education program for WA health professionals is urgently required and is expected to improve clinician knowledge and aid standardised penicillin assessment (de-labelling) practices.
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Affiliation(s)
- Katherine Collins
- Department of Anaesthesia and Pain ManagementPerth Children's HospitalPerthWestern AustraliaAustralia
| | - Kristina Rueter
- Department of Emergency MedicinePerth Children's HospitalPerthWestern AustraliaAustralia,Department of ImmunologyPerth Children's HospitalPerthWestern AustraliaAustralia,School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Michaela Lucas
- Department of ImmunologyPerth Children's HospitalPerthWestern AustraliaAustralia,School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia,Department of ImmunologySir Charles Gairdner HospitalPerthWestern AustraliaAustralia,Institute for Immunology and Infectious DiseasesMurdoch UniversityMurdochWestern AustraliaAustralia,PathWest Laboratory MedicinePerthWestern AustraliaAustralia
| | - David Sommerfield
- Department of Anaesthesia and Pain ManagementPerth Children's HospitalPerthWestern AustraliaAustralia,School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia,Perioperative MedicineTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain ManagementPerth Children's HospitalPerthWestern AustraliaAustralia,Perioperative MedicineTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Nazim Khan
- Department of Mathematics and StatisticsUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Britta S von Ungern‐Sternberg
- Department of Anaesthesia and Pain ManagementPerth Children's HospitalPerthWestern AustraliaAustralia,School of MedicineThe University of Western AustraliaPerthWestern AustraliaAustralia,Perioperative MedicineTelethon Kids InstitutePerthWestern AustraliaAustralia
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12
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Drake‐Brockman TFE, Smallbone HE, Sommerfield D, von Ungern‐Sternberg BS. Remote after-care using smartphones: A feasibility study of monitoring children's pain with automated SMS messaging. Paediatr Anaesth 2022; 32:954-960. [PMID: 35569012 PMCID: PMC9544247 DOI: 10.1111/pan.14481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Monitoring children's recovery postoperatively is important for routine care, research, and quality improvement. Although telephone follow-up is common, it is also time-consuming and intrusive for families. Using SMS messaging to communicate with families regarding their child's recovery has the potential to address these concerns. While a previous survey at our institution indicated that parents were willing to communicate with the hospital by SMS, data on response rates for SMS-based postoperative data collection is limited, particularly in pediatric populations. AIMS We conducted a feasibility study with 50 completed pain profiles obtained from patients at Perth Children's Hospital to examine response rates. METHODS We collected and classified daily average pain (0-10 parent proxy score) on each day after tonsillectomy until pain-free for two consecutive days. RESULTS We enrolled 62 participants and recorded 50 (81%) completed pain profiles, with 711 (97.9%) of 726 requests for a pain score receiving a response. Two families (3%) opted out of the trial, and 10 (16%) were lost to follow-up. Responses received were classified automatically in 92% of cases. No negative feedback was received, with a median (range) satisfaction score of 5 on a 5-point Likert scale (1 = very unhappy, 5 = very happy). CONCLUSIONS This methodology is likely to generalize well to other simple clinical questions and produce good response rates in further similar studies. We expect SMS messaging to permit expanded longitudinal data collection and broader investigation into patient recovery than previously feasible using telephone follow-up at our institution.
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Affiliation(s)
- Thomas F. E. Drake‐Brockman
- Division of Emergency Medicine, Anaesthesia and Pain MedicineMedical School, The University of Western AustraliaPerthWestern AustraliaAustralia,Department of Anaesthesia and Pain ManagementPerth Children's HospitalPerthWestern AustraliaAustralia,Perioperative Medicine TeamTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Harry E. Smallbone
- Division of Emergency Medicine, Anaesthesia and Pain MedicineMedical School, The University of Western AustraliaPerthWestern AustraliaAustralia
| | - David Sommerfield
- Division of Emergency Medicine, Anaesthesia and Pain MedicineMedical School, The University of Western AustraliaPerthWestern AustraliaAustralia,Department of Anaesthesia and Pain ManagementPerth Children's HospitalPerthWestern AustraliaAustralia,Perioperative Medicine TeamTelethon Kids InstitutePerthWestern AustraliaAustralia
| | - Britta S. von Ungern‐Sternberg
- Division of Emergency Medicine, Anaesthesia and Pain MedicineMedical School, The University of Western AustraliaPerthWestern AustraliaAustralia,Department of Anaesthesia and Pain ManagementPerth Children's HospitalPerthWestern AustraliaAustralia,Perioperative Medicine TeamTelethon Kids InstitutePerthWestern AustraliaAustralia
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13
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Al Khayrallah Z, Al-Saeedy Z, Medriano RAA, Lee K, Sommerfield A, Sommerfield D, Ware B, Huppatz D, Campbell A, Lim LY, von Ungern-Sternberg BS. Prescribing in a pediatric hospital setting - Lost in translation? Patient Educ Couns 2022; 105:1614-1619. [PMID: 34688523 DOI: 10.1016/j.pec.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To determine parental understanding of directions on common pediatric prescription pharmacy labels and to identify enablers and barriers that affect interpretation of these labels. METHODS Prospective qualitative descriptive study (July to August 2020) of 20 parents in post-surgical wards at a single Australian tertiary pediatric center. RESULTS Four key themes emerged through inductive analysis of the interview transcripts: 1) the addition of specific directions, such as administration with/without food and treatment course duration were perceived to be beneficial; 2) explicit phrasing of dosing intervals and times were more easily interpreted; 3) the use of simpler and common terminology enhanced understanding of the directions; and 4) presentation of multiple-step directions (e.g. tapering regimens) in a simplified and more organized manner was identified as an enabler and was thought to reduce confusion. CONCLUSION Differences in wording and presentation of pediatric prescription medication label directions led to variable interpretation by parents. PRACTISE IMPLICATIONS Therefore, there is a need for guidelines to standardize the wording of prescription medication advice labels. Findings from this study can be used to achieve this goal.
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Affiliation(s)
- Zainab Al Khayrallah
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia; Pharmacy Department, Perth Children's Hospital, Perth, Australia.
| | - Zahraa Al-Saeedy
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia.
| | - Rose Ann Ayes Medriano
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia.
| | - Kenneth Lee
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia.
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia; Perioperative Medicine, Telethon Kids Institute, Perth Australia.
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia; Perioperative Medicine, Telethon Kids Institute, Perth Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Australia.
| | - Benjamin Ware
- Pharmacy Department, Perth Children's Hospital, Perth, Australia.
| | - Dean Huppatz
- Pharmacy Department, Perth Children's Hospital, Perth, Australia.
| | - Andrew Campbell
- Pharmacy Department, Sir Charles Gairdner Hospital, Nedlands, Australia.
| | - Lee Yong Lim
- Division of Pharmacy, School of Allied Health, The University of Western Australia, Perth, Australia.
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia; Perioperative Medicine, Telethon Kids Institute, Perth Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Australia.
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14
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Bruins S, Powers N, Sommerfield D, von Ungern-Sternberg BS. Impact of airway and a standardized recruitment maneuver on CT chest imaging quality in a pediatric population: A retrospective review. Paediatr Anaesth 2022; 32:572-576. [PMID: 34811851 DOI: 10.1111/pan.14341] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION When performing computerized tomography chest imaging in children, obtaining high quality, motion-free images is important in the accurate diagnosis of underlying pathology. General anesthesia is associated with the development of atelectasis, which can impair accurate diagnosis by obscuring or altering the appearance of the lung parenchyma or airways. Recruitment maneuvers, performed by anesthesiologists, can be used to effectively re-expand atelectatic lung. METHODS The computerized tomography chest imaging in 44 children aged between 2 months and 7 years, undergoing serial imaging for monitoring of cystic fibrosis, were reviewed and graded for atelectasis. The first scan performed on each child was performed with a supraglottic airway device and a non-standardized recruitment maneuver. The second scan on each child was performed with a cuffed endotracheal tube and a standardized recruitment maneuver. RESULTS When a supraglottic airway device and a non-standardized recruitment maneuver were used, 77% of patients demonstrated atelectasis of any degree on their computerized tomography chest imaging, compared with only 39% when a cuffed endotracheal tube and standardized recruitment maneuver were used. The percentage of computerized tomography chest scans that were scored acceptable (with either a total combined lung atelectasis score of 0 or 1) improved from 37% to 75% when a cuffed endotracheal tube and standardized recruitment maneuver were used. In particular, the mean atelectasis score for both lungs improved from 2.91 (SD ± 2.6) to 1.11 (SD ± 1.9), with a mean difference of 1.8 (95% CI 0.82-2.77; p: .0004). CONCLUSION The use of a cuffed endotracheal tube and a standardized recruitment maneuver is an effective way to reduce atelectasis as a result of general anesthesia. Anesthesiologists can actively contribute toward improved image quality through their choice of airway and recruitment maneuver.
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Affiliation(s)
- Suze Bruins
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia
| | - Neil Powers
- Department of Medical Imaging, Perth Children's Hospital, Perth, WA, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia
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15
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Bruins S, Sommerfield D, Powers N, von Ungern-Sternberg BS. Atelectasis and lung recruitment in pediatric anesthesia: An educational review. Paediatr Anaesth 2022; 32:321-329. [PMID: 34797011 DOI: 10.1111/pan.14335] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 12/24/2022]
Abstract
General anesthesia is associated with development of pulmonary atelectasis. Children are more vulnerable to the development and adverse effects of atelectasis. We review the physiology and risk factors for the development of atelectasis in pediatric patients under general anesthesia. We discuss the clinical significance of atelectasis, the use and value of recruitment maneuvers, and other techniques available to minimize lung collapse. This review demonstrates the value of a recruitment maneuver, maintaining positive end-expiratory pressure (PEEP) until extubation and lowering FiO2 where possible in the daily practice of the pediatric anesthetist.
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Affiliation(s)
- Suze Bruins
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Crawley, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia
| | - Neil Powers
- Department of Medical Imaging, Perth Children's Hospital, Nedlands, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Crawley, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia
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16
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Hii J, Templeton TW, Sommerfield D, Sommerfield A, Matava CT, von Ungern-Sternberg BS. Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in pediatric anesthesia-Part 1 patient and surgical factors. Paediatr Anaesth 2022; 32:209-216. [PMID: 34897906 DOI: 10.1111/pan.14377] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 01/22/2023]
Abstract
Pediatric surgery cases are increasing worldwide. Within pediatric anesthesia, perioperative respiratory adverse events are the most common precipitant leading to serious complications. They can have intraoperative impact on the surgical procedure itself, lead to premature case termination and in addition may have postoperative impact resulting in longer hospitalization stays and costs. Although most perioperative respiratory adverse events can be promptly detected and managed, and will not lead to any sequelae, the risk of life-threatening progression remains. The incidence of respiratory adverse events increases in children with comorbid respiratory and/or nonrespiratory illnesses. Optimized perioperative patient care, risk-stratified care level choice, and practitioners with appropriate training allow for risk mitigation. This review will discuss patient and surgical risk factors with a focus on common patient comorbid illnesses and review scoring systems to quantify risk.
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Affiliation(s)
- Justin Hii
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Department of Anaesthesia, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - T Wesley Templeton
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David Sommerfield
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, University of Western Australia, Crawley, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Aine Sommerfield
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Clyde T Matava
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, Termerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Britta S von Ungern-Sternberg
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, University of Western Australia, Crawley, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia
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17
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Templeton TW, Sommerfield D, Hii J, Sommerfield A, Matava CT, von Ungern-Sternberg BS. Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in Pediatric Anesthesia-Part 2: Anesthesia-related risk and treatment options. Paediatr Anaesth 2022; 32:217-227. [PMID: 34897894 DOI: 10.1111/pan.14376] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 12/17/2022]
Abstract
Perioperative respiratory adverse events are the most common cause of critical events in children undergoing anesthesia and surgery. While many risk factors remain unmodifiable, there are numerous anesthetic management decisions which can impact the incidence and impact of these events, especially in at-risk children. Ongoing research continues to improve our understanding of both the influence of risk factors and the effect of specific interventions. This review discusses anesthesia risk factors and outlines strategies to reduce the rate and impact of perioperative respiratory adverse events with a chronologic based inquiry into anesthetic management decisions through the perioperative period from premedication to postoperative disposition.
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Affiliation(s)
- Thomas Wesley Templeton
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - David Sommerfield
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Justin Hii
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Department of Anaesthesia, Joondalup Health Campus, Joondalup, Western Australia, Australia
| | - Aine Sommerfield
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Clyde T Matava
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, Termerty Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Britta S von Ungern-Sternberg
- Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Western Australia, Australia
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18
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Yoo O, Tang EKY, Salman S, Nguyen MN, Sommerfield D, Sommerfield A, Khan N, von Ungern Sternberg BS, Lim LY. A randomised controlled trial of a novel tramadol chewable tablet: pharmacokinetics and tolerability in children. Anaesthesia 2022; 77:438-448. [PMID: 35083739 DOI: 10.1111/anae.15650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Abstract
Tramadol is a bitter atypical opioid analgesic drug and is prescribed to treat postoperative pain in children. However, in many countries there is no licensed paediatric tramadol formulation available. We have formulated a novel chewable chocolate-based drug delivery system for the administration of tramadol to children. This pilot, single-centre, open-label, randomised clinical study assessed the taste tolerability and comparative population pharmacokinetics of the novel tramadol chewable tablet against a compounded tramadol hydrochloride oral liquid, at a dose of 1 mg.kg-1 . A 5-point facial hedonic scale was used by the children, parents and nurses to assess tolerability. One hundred and forty-one children aged 3-16 years were given tramadol 30 min before general anaesthesia. Blood samples were taken following the induction of anaesthesia and for up to 5 h following tramadol administration. Tramadol and its active metabolite O-desmethyltramadol were analysed using reversed-phase high-performance liquid chromatography. A population pharmacokinetic model was built using non-linear mixed effects modelling. The relative bioavailability for the tablet was 1.25 times higher (95%CI 1.16-1.35) than for tramadol hydrochloride oral liquid, while the absorption rate constant for the tablet was significantly lower (1.97 h-1 vs. 3.34 h-1 , p < 0.001). Larger inter-individual variability in absorption rates were observed with the liquid tramadol. The tramadol chewable tablet was more acceptable in taste to children when assessed by the children, parents and nurses (all p < 0.001). We conclude that the novel tramadol chewable tablet has favourable acceptability and more reliable relative bioavailability in children compared with tramadol hydrochloride oral liquid.
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Affiliation(s)
- O Yoo
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - E K Y Tang
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - S Salman
- Clinical Pharmacology and Toxicology Unit, PathWest, Perth, WA, Australia.,Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - M N Nguyen
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - D Sommerfield
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia.,Department of Anaesthesia and Pain Management, Perth's Children Hospital, Perth, WA, Australia
| | - A Sommerfield
- Department of Anaesthesia and Pain Management, Perth's Children Hospital, Perth, WA, Australia.,Peri-operative Medicine Team, Telethon Kids Institute, Perth, WA, Australia
| | - N Khan
- Department of Mathematics and Statistics, University of Western Australia, Perth, WA, Australia
| | - B S von Ungern Sternberg
- Department of Anaesthesia and Pain Management, Perth's Children Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, University of Western Australia, Perth, WA, Australia
| | - L Y Lim
- Division of Pharmacy, School of Allied Health, University of Western Australia, Perth, WA, Australia
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19
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Batchelor C, Drake-Brockman T, Lowe A, Sommerfield A, von Ungern-Sternberg BS, Sommerfield D. Procedural anesthesia and sedation for children undergoing diagnostic and medical procedures - A review of postprocedural pain, nausea, and vomiting by questionnaire-based survey. Paediatr Anaesth 2022; 32:67-73. [PMID: 34773336 DOI: 10.1111/pan.14334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/23/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Sedation and anesthesia are widely used to relieve pain and ensure cooperation during elective diagnostic and medical procedures in the pediatric population. However, there is currently limited evidence about the recovery trajectory following deep sedation or general anesthesia for such procedures in children. AIMS The primary aim was to describe the severity and duration of pain, nausea, and vomiting after common diagnostic and medical procedures. Secondary outcomes include return to baseline functioning and incidence of medical re-presentation. METHODS Recruitment was achieved postprocedurally by telephone interview with parents or legal guardians of patients who underwent botox injection, bronchoscopy, either or both a colonoscopy or upper gastrointestinal endoscopy, or MRI scan. Daily pain scores, nausea and vomiting, administration of at-home analgesia, and any adverse events requiring medical attention were obtained. Children were followed until pain completely resolved and baseline activity resumed. RESULTS A total of 307 patients were included (50 botox injection, bronchoscopy and MRI; 48 colonoscopy, 58 upper gastrointestinal endoscopy, 51 colonoscopy plus upper gastrointestinal endoscopy). Parental-rated pain scores peaked on day of procedure across all groups and decreased over time, with most children resuming normal activity within 1 day postprocedure. Pain was mostly mild and resolved quickly in botox injection (10% moderate to severe and 22% mild), bronchoscopy (8% and 10%, respectively), and MRI (2% mild) patients. Combined upper gastrointestinal endoscopy and colonoscopy was associated with greatest pain severity (29% moderate to severe and 20% mild). Highest rates of nausea and/or vomiting were observed in colonoscopy (23%), upper gastrointestinal endoscopy (28%), and combined procedure groups (20%). At-home simple analgesia was administered in 21% of patients. Unplanned medical re-presentations were infrequent across all groups. CONCLUSION This study demonstrates that the recovery trajectory following procedural sedation and anesthesia is short, with minimal requirement for additional medical attention. These findings will aid in alleviating parental anxiety and encourage utilization of regular simple analgesia.
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Affiliation(s)
- Chloe Batchelor
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia
| | - Thomas Drake-Brockman
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia
| | - Andrew Lowe
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
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20
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Bell E, Dodd M, Sommerfield D, Sommerfield A, von Ungern-Sternberg BS. Kids voices: Exploring children's perspective of tonsillectomy surgery. Paediatr Anaesth 2021; 31:1368-1370. [PMID: 34478177 DOI: 10.1111/pan.14288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Emily Bell
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia
| | - Megan Dodd
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Nedlands, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Australia
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21
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Jeon A, Han E, Lee K, Sommerfield A, Lim LY, Sommerfield D, von Ungern-Sternberg BS. Parents' perspectives towards paediatric confectionary masked medications: a qualitative study. Int J Clin Pharm 2021; 44:374-380. [PMID: 34813028 DOI: 10.1007/s11096-021-01349-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/30/2021] [Indexed: 11/29/2022]
Abstract
Background The availability of age-appropriate, taste-masked oral solid medications for the paediatric population is currently inadequate. We have developed a novel chocolate-based drug delivery platform to taste-mask bitter drugs commonly utilised in the hospital setting, but there is limited evidence regarding parent's perspectives on these medications. Aim To identify key themes regarding parents' perspectives on taste-masked medications that look like confectionary. Additionally, to explore and identify the various barriers and facilitators to using oral medication among the paediatric population.Methods Qualitative descriptive study (July to August 2020) at a single tertiary paediatric hospital (Perth Children's Hospital-PCH). Parents with at least one child (2-18 years) that underwent any elective operation at PCH were included in the study, in total 17 were interviewed. Results The two primary themes that underpinned parent's perspectives on taste-masked medications that look like confectionary were medication safety and taste. Majority of parents supported the use of the proposed medication on the basis that the favourable taste profile will facilitate oral consumption, as opposed to their previous experiences with conventional paediatric medications that do not taste mask the bitter flavour. However, medication safety, in the forms of patient education and appropriate packaging, must be considered to minimise harmful misuse of the proposed medication. Conclusion Participants unanimously support the short-term use of taste-masked medications that look like confectionary, particularly in the hospital setting. However, patient education is highly sought after by parents regarding the role of these medications, to ensure medication safety with their children.
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Affiliation(s)
- Andy Jeon
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western, Crawley, Australia.,School of Public Health, The University of Sydney, Sydney, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia
| | - Ellen Han
- Division of Pharmacy, School of Allied Health, The University of Western, Crawley, Australia
| | - Kenneth Lee
- Division of Pharmacy, School of Allied Health, The University of Western, Crawley, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia
| | - Lee Yong Lim
- Division of Pharmacy, School of Allied Health, The University of Western, Crawley, Australia
| | - David Sommerfield
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western, Crawley, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia
| | - Britta S von Ungern-Sternberg
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western, Crawley, Australia. .,Department of Anaesthesia and Pain Management, Perth Children's Hospital, 15 Hospital Ave, Nedlands, WA, 6009, Australia. .,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Australia.
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22
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Remedios E, Sommerfield D, Fellingham W, Powers N, Stannage K, Hii JWS. Paraspinal desmoid fibromatosis after lumbar epidural analgesia. Anaesth Rep 2021; 9:e12129. [PMID: 34396135 DOI: 10.1002/anr3.12129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A 14-year-old girl with cerebral palsy presented for bilateral lower limb surgery for spasticity. A lumbar epidural catheter was sited under general anaesthesia on the third attempt and used intra-operatively with good effect. A local anaesthetic infusion was used for postoperative analgesia but was noted to be leaking under the dressing with a patchy, unilateral block. The catheter was therefore removed on the second postoperative day. Following discharge, the patient progressively developed new back and leg pain for which she was re-admitted seven weeks later. This was investigated and initially thought to be myositis of the erector spinae muscles on magnetic resonance imaging. When the patient failed to respond to treatment, a muscle biopsy demonstrated desmoid fibromatosis. Trauma may cause or accelerate the development of desmoid fibromatosis, which has also been theorised to arise from scar tissue in previously injured areas. We hypothesise that challenging epidural placement or the leakage of the local anaesthetic agent into the surrounding muscular tissue, inducing local myonecrosis, could have been the triggering or accelerating event in tumour development. This may be the first reported case of extra-abdominal desmoid fibromatosis in association with epidural placement.
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Affiliation(s)
- E Remedios
- Perth Children's Hospital Perth Australia
| | - D Sommerfield
- Department of Anaesthesia Perth Children's Hospital Perth Australia.,Telethon Kids Institute Perth Australia
| | - W Fellingham
- Department of Anaesthesia Perth Children's Hospital Perth Australia
| | - N Powers
- Department of Radiology Perth Children's Hospital Perth Australia
| | - K Stannage
- Department of Orthopaedic Surgery Perth Children's Hospital Perth Australia
| | - J W S Hii
- Perth Children's Hospital Perth Australia.,Perioperative Medicine Team Telethon Kids Institute Perth Australia
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23
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Lagrange C, Jepp C, Slevin L, Drake-Brockman TFE, Bumbak P, Herbert H, von Ungern-Sternberg BS, Sommerfield D. Impact of a revised postoperative care plan on pain and recovery trajectory following pediatric tonsillectomy. Paediatr Anaesth 2021; 31:778-786. [PMID: 33788340 DOI: 10.1111/pan.14187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/03/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND A previous cohort of adenotonsillectomy patients at our institution demonstrated moderate-severe post-tonsillectomy pain scores lasting a median (range) duration of 6 (0-23) days and postdischarge nausea and vomiting affecting 8% of children on day 1 following surgery. In this subsequent cohort, we evaluate the impact of changes to our discharge medication and parental education on post-tonsillectomy pain and recovery profile. METHODS In this follow-on, prospective observational cohort study, all patients undergoing tonsillectomy at our institution during the study period were discharged with standardized analgesia. Parents received a revised education package and a medication diary which were not provided to the previous cohort. Pain scores, rates of nausea and vomiting, medication usage and unplanned representation rates were collected by telephone from parents. RESULTS Sixty-nine patients were recruited. Moderate-severe pain lasted a median (range) of 5 (0-12) days. Twenty-nine (42%) had pain scores ≥4/10 beyond postoperative day 7. By postoperative day 5, only 37 (53%) parents continued to administer regular analgesia. The median number of oxycodone doses used was 5 (0-22), and only 28 (41%) parents had disposed of leftover oxycodone within 1 month of surgery. Twenty-four (35%) patients experienced nausea or vomiting postdischarge. The median (range) time for return to normal activities was 6 (0-14) days. Thirty-two/sixty-nine (46%) patients had unplanned medical representations. Most occurred between postoperative day 5 and 7. Pain contributed to 16 (35%) representations. CONCLUSIONS Despite extensive changes to our discharge protocols parents continued to report a prolonged period of pain, post operative nausea and vomiting, and behavioral changes. Further work is required to examine barriers to compliance with simple analgesia and education in appropriate methods of opioid disposal.
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Affiliation(s)
- Claudia Lagrange
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Catherine Jepp
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Lliana Slevin
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia
| | - Thomas F E Drake-Brockman
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
| | - Paul Bumbak
- Department of Otolaryngology-Head and Neck Surgery, Perth Children's Hospital, Perth, WA, Australia
| | - Haley Herbert
- Department of Otolaryngology-Head and Neck Surgery, Perth Children's Hospital, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
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24
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Drake-Brockman TFE, Chambers NA, Sommerfield D, von Ungern-Sternberg BS. The impact of surgical cancellations on children, families, and the health system in an Australian paediatric tertiary referral hospital. Paediatr Anaesth 2021; 31:578-586. [PMID: 33555097 DOI: 10.1111/pan.14153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/11/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reasons for elective surgery cancelations and their impact vary from one institution to another. Cancelations have emotional and financial implications for patients and their families. Our service has a particularly broad and geographically diverse patient population; hence, we sought to examine these impacts in our service. METHODS We identified families with procedural cancelations and administered a telephone questionnaire. Survey items included the reason for and timing of cancelation, how the family was informed, the mode of transport and distance traveled to the hospital, associated leave from work, expenses, whether the child was required to fast, missed school, as well as the child's and parent's emotional responses to the cancelation, along with overall parental satisfaction with how the cancelation was handled. RESULTS During our study period, a total of 7870 procedures were booked. 6734 (86%) of these were completed and 1136 (14%) were canceled, with 6% canceled on the day of surgery. In 750 (66%) of these cancelations, families were successfully contacted by telephone and agreed to participate. Of these 305 (41%) cancelations were family-initiated and 444 (59%) were hospital-initiated, with these hospital-initiated cancelations occurring closer to scheduled surgery. The most common cause of cancelation was that the child could not undergo the procedure due to illness (22%) or being unable attend the hospital (14%). The greatest disruption to families and children occurred when procedures were canceled late, particularly when the cancelation occurred on the day of the planned procedure.
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Affiliation(s)
- Thomas F E Drake-Brockman
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia
| | - Neil A Chambers
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
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25
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Hii J, von Ungern-Sternberg BS, Sommerfield A, Sommerfield D. Perioperative pediatric tonsillectomy analgesia: A single-center review of practice and cost-effectiveness analysis. Paediatr Anaesth 2021; 31:497-498. [PMID: 33484060 DOI: 10.1111/pan.14134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Justin Hii
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
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26
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Garcia-Marcinkiewicz AG, Kovatsis PG, Hunyady AI, Olomu PN, Zhang B, Sathyamoorthy M, Gonzalez A, Kanmanthreddy S, Gálvez JA, Franz AM, Peyton J, Park R, Kiss EE, Sommerfield D, Griffis H, Nishisaki A, von Ungern-Sternberg BS, Nadkarni VM, McGowan FX, Fiadjoe JE. First-attempt success rate of video laryngoscopy in small infants (VISI): a multicentre, randomised controlled trial. Lancet 2020; 396:1905-1913. [PMID: 33308472 DOI: 10.1016/s0140-6736(20)32532-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 09/26/2020] [Accepted: 10/08/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Orotracheal intubation of infants using direct laryngoscopy can be challenging. We aimed to investigate whether video laryngoscopy with a standard blade done by anaesthesia clinicians improves the first-attempt success rate of orotracheal intubation and reduces the risk of complications when compared with direct laryngoscopy. We hypothesised that the first-attempt success rate would be higher with video laryngoscopy than with direct laryngoscopy. METHODS In this multicentre, parallel group, randomised controlled trial, we recruited infants without difficult airways abnormalities requiring orotracheal intubation in operating theatres at four quaternary children's hospitals in the USA and one in Australia. We randomly assigned patients (1:1) to video laryngoscopy or direct laryngoscopy using random permuted blocks of size 2, 4, and 6, and stratified by site and clinician role. Guardians were masked to group assignment. The primary outcome was the proportion of infants with a successful first attempt at orotracheal intubation. Analysis (modified intention-to-treat [mITT] and per-protocol) used a generalised estimating equation model to account for clustering of patients treated by the same clinician and institution, and adjusted for gestational age, American Society of Anesthesiologists physical status, weight, clinician role, and institution. The trial is registered at ClinicalTrials.gov, NCT03396432. FINDINGS Between June 4, 2018, and Aug 19, 2019, 564 infants were randomly assigned: 282 (50%) to video laryngoscopy and 282 (50%) to direct laryngoscopy. The mean age of infants was 5·5 months (SD 3·3). 274 infants in the video laryngoscopy group and 278 infants in the direct laryngoscopy group were included in the mITT analysis. In the video laryngoscopy group, 254 (93%) infants were successfully intubated on the first attempt compared with 244 (88%) in the direct laryngoscopy group (adjusted absolute risk difference 5·5% [95% CI 0·7 to 10·3]; p=0·024). Severe complications occurred in four (2%) infants in the video laryngoscopy group compared with 15 (5%) in the direct laryngoscopy group (-3·7% [-6·5 to -0·9]; p=0·0087). Fewer oesophageal intubations occurred in the video laryngoscopy group (n=1 [<1%]) compared with in the direct laryngoscopy group (n=7 [3%]; -2·3 [-4·3 to -0·3]; p=0·028). INTERPRETATION Among anaesthetised infants, using video laryngoscopy with a standard blade improves the first-attempt success rate and reduces complications. FUNDING Anaesthesia Patient Safety Foundation, Society for Airway Management, and Karl Storz Endoscopy.
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Affiliation(s)
- Annery G Garcia-Marcinkiewicz
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Pete G Kovatsis
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital Boston, MA, USA
| | - Agnes I Hunyady
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Patrick N Olomu
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Health System of Texas, Dallas, TX, USA
| | - Bingqing Zhang
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Adolfo Gonzalez
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Health System of Texas, Dallas, TX, USA
| | - Siri Kanmanthreddy
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - Jorge A Gálvez
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amber M Franz
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA
| | - James Peyton
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital Boston, MA, USA
| | - Raymond Park
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital Boston, MA, USA
| | - Edgar E Kiss
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Children's Health System of Texas, Dallas, TX, USA
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, University of Western Australia, Nedlands, WA, Australia
| | - Heather Griffis
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, University of Western Australia, Nedlands, WA, Australia
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Francis X McGowan
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John E Fiadjoe
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Akl N, Sommerfield A, Slevin L, Drake-Brockman TF, Wong S, Winters JC, Ungern-Sternberg BSV, Sommerfield D. Anaesthesia, pain and recovery profiles in children following dental extractions. Anaesth Intensive Care 2020; 48:306-313. [PMID: 32819166 DOI: 10.1177/0310057x20942532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this prospective cohort study was to describe the anaesthetic practices, rates of postoperative pain and the recovery trajectory of children having urgent dental extractions at our institution. Demographic, anaesthetic and surgical details of children undergoing dental extractions were obtained by case note review. Parent-proxy pain scores were collected via telephone on the day of surgery and on postoperative days, as well as details of analgesia given, behavioural disturbance, and nausea and vomiting. Follow-up was continued until each child no longer had pain. Datasets were analysed for 143 patients. Fasting times were prolonged, with 81 children (56.6%) fasted for over four hours from fluids. Moderate or severe pain was recorded in 14 children (9.8%) postoperatively on the day of surgery, with higher rates in children who had a greater number of teeth extracted. Low rates of moderate to severe pain were observed during follow-up, affecting six children (4.2%) on postoperative day 1 and three children (2.1%) on postoperative day 2 with primarily simple analgesia administered at home. Only eight children (5.6%) had nausea and/or vomiting on the day of surgery. Rates of reported behavioural disturbance at home were low, extending beyond the second postoperative day in only two children (1.4%), and only four children (2.8%) attended a dentist during the follow-up period. In conclusion, the low rates of pain and nausea and vomiting reported in the days following surgery for urgent dental procedures suggest that children can be cared for at home with simple analgesia.
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Affiliation(s)
- Natalie Akl
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Department of Paediatric Dentistry, Perth Children's Hospital, Perth, Australia
| | - Lliana Slevin
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Department of Paediatric Dentistry, Perth Children's Hospital, Perth, Australia
| | - Thomas Fe Drake-Brockman
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Medical School, The University of Western Australia, Perth, Australia
| | - Susan Wong
- Telethon Kids Institute, Perth, Australia
| | - John C Winters
- Telethon Kids Institute, Perth, Australia.,Dental School, The University of Western Australia, Perth, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Medical School, The University of Western Australia, Perth, Australia.,Department of Paediatric Dentistry, Perth Children's Hospital, Perth, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Medical School, The University of Western Australia, Perth, Australia
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Hilyard A, Kingsley J, Sommerfield D, Taylor S, Bear N, Gibson N. Feasibility of a Randomized Controlled Trial of Paediatric Interdisciplinary Pain Management Using Home-Based Telehealth. J Pain Res 2020; 13:897-908. [PMID: 32431538 PMCID: PMC7200248 DOI: 10.2147/jpr.s217022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/18/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Chronic pain is common in adolescents. Evidence-based guidelines recommend interdisciplinary treatment, but access is limited by geography. The development of hybrid programs utilizing both face-to-face and videoconference treatment may help overcome this. We developed a 7-week hybrid pediatric interdisciplinary pain program (Hybrid-PIPP) and wished to compare it to individual face-to-face sessions (Standard Care). Our objective was to test the feasibility of a protocol that used a matched pair un-blinded randomized controlled design to investigate the efficacy and cost-effectiveness of the Hybrid-PIPP compared to Standard Care. Patients and Methods Parent-adolescent dyads were recruited from tertiary pediatric clinics and matched by disability before randomization to minimize allocation bias. The adolescents (aged 11-17) had experienced primary pain for >3 months. Hybrid-PIPP involved 11 hrs of group therapy and 4 individual videoconference sessions. Standard care was provided by the same clinical team, using the same treatment model and similar intensity as the Hybrid-PIPP. The intention was to recruit participants for 3 Hybrid-PIPP groups with a comparison stream. Recruitment was ceased after 2 groups due to the high participant disability requiring more intensive intervention. Results Eighteen dyads were screened and 13 randomized (7 Hybrid-PIPP, 6 Standard Care, 2 unsuitable, 3 unallocated when the study was stopped). The study met a priori feasibility criteria for staff availability; recruitment rate; treatment completion; and data collection. Global satisfaction ratings were similar in both streams (SC median 7, range 5-9 and Hybrid-PIPP median 8.5, range 5-10). Challenges were identified in both streams. A future modified Hybrid-PIPP was considered acceptable if the intensity is increased to manage the high level of disability. Standard care was considered inefficient. No adverse events were reported. Conclusion The study determined that the protocol met a priori feasibility criteria, but to be practicable in a real world, health environment requires significant modifications. Registration ANZTR(ACTRN2614000489695).
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Affiliation(s)
- Anna Hilyard
- Complex Pain Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Discipline of Psychology, College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
| | - Julia Kingsley
- Complex Pain Service, Perth Children's Hospital, Perth, Western Australia, Australia
| | - David Sommerfield
- Complex Pain Service, Perth Children's Hospital, Perth, Western Australia, Australia.,Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Susan Taylor
- Complex Pain Service, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Occupational Therapy, Social Work and Speech Pathology, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Child Research, Child Adolescent Health Service, Perth, Western Australia, Australia
| | - Noula Gibson
- Physiotherapy Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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von Ungern-Sternberg BS, Sommerfield D, Hall GL. Albuterol and Pediatric Perioperative Respiratory Complications-Reply. JAMA Pediatr 2019; 173:1107-1108. [PMID: 31524934 DOI: 10.1001/jamapediatrics.2019.3188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Medical School, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, Perth, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Medical School, The University of Western Australia, Perth, Australia
| | - Graham L Hall
- Telethon Kids Institute, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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Humphreys S, von Ungern-Sternberg BS, Skowno J, Williams T, Taylor J, Taverner F, Gibbons K, Burgoyne L, Sommerfield D, Stephens P, Hallett B, Vijayasekaran S, Slee N, Burns H, Sowa M, Davidson A, Schibler A. High-flow oxygen for children's airway surgery: rando mi sed controll ed trial protocol (HAMSTER). BMJ Open 2019; 9:e031873. [PMID: 31615801 PMCID: PMC6797255 DOI: 10.1136/bmjopen-2019-031873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Hypoxaemia during anaesthesia for tubeless upper airway surgery in children with abnormal airways is common due to the complexity of balancing adequate depth of anaesthesia with maintenance of spontaneous breathing and providing an uninterrupted field of view of the upper airway for the surgeon. High-flow nasal oxygenation (HIGH-FLOW) can prolong safe apnoea time and be used in children with abnormal airways but to date has not been compared with the alternative technique of low-flow nasal oxygenation (LOW-FLOW). The aim is to investigate if use of HIGH-FLOW can reduce the number of hypoxaemic events requiring rescue oxygenation compared with LOW-FLOW. METHODS AND ANALYSIS: High-flow oxygen for children's airway surgery: randomised controlled trial (HAMSTER) is a multicentre, unmasked, randomised controlled, parallel group, superiority trial comparing two oxygenation techniques during anaesthesia. Children (n=530) aged >37 weeks to 16 years presenting for elective tubeless upper airway surgery who fulfil inclusion but not exclusion criteria will be randomised prior to surgery to HIGH-FLOW or LOW-FLOW post induction of anaesthesia. Maintenance of anaesthesia with HIGH-FLOW requires Total IntraVenous Anaesthesia (TIVA) and with LOW-FLOW, either inhalational or TIVA at discretion of anaesthetist. The primary outcome is the incidence of hypoxaemic events requiring interruption of procedure for rescue oxygenation by positive pressure ventilation and the secondary outcome includes total hypoxaemia time, adverse cardiorespiratory events and unexpected paediatric intensive care admission admission. Hypoxaemia is defined as Sp02 <90%. Analysis will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION Ethical approval has been obtained by Children's Health Queensland Human Research Ethics Committee (HREC/18/QRCH/130). The trial commenced recruitment in 2018. The primary manuscript will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER The HAMSTER is registered with the Australia and New Zealand Clinical TrialsRegistry: ACTRN12618000949280.
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Affiliation(s)
- Susan Humphreys
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Britta Sylvia von Ungern-Sternberg
- Anaesthesia, Perth Children's Hospital, Nedlands, Queensland, Australia
- University of Western Australia, Crawley, Western Australia, Australia
| | - Justin Skowno
- Department of Anaesthesia, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tara Williams
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Julia Taylor
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Fiona Taverner
- Department of Anaesthesia, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- University of South Australia, Adelaide, South Australia, Australia
| | - Kristen Gibbons
- Statistics, Mater Medical Research Institute, South Brisbane, Queensland, Australia
| | - Laura Burgoyne
- Department of Anaesthesia, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- University of South Australia, Adelaide, South Australia, Australia
| | - David Sommerfield
- Anaesthesia, Perth Children's Hospital, Nedlands, Queensland, Australia
- University of Western Australia, Crawley, Western Australia, Australia
| | - Philip Stephens
- Department of Anaesthesia, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Ben Hallett
- Department of Anaesthesia, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Shyan Vijayasekaran
- University of Western Australia, Crawley, Western Australia, Australia
- Ear, Nose and Throat Surgery, Perth Children's Hospital, Nedlands, Queensland, Australia
| | - Nicola Slee
- Department of Surgery; Ear, Nose and Throat, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Hannah Burns
- Department of Surgery; Ear, Nose and Throat, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Marcin Sowa
- Health Economics, The University of Queensland, South Brisbane, Queensland, Australia
| | - Andrew Davidson
- Department of Anaesthesia, Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Andreas Schibler
- Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
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Stepanovic B, Sommerfield D, Lucas M, von Ungern-Sternberg BS. An update on allergy and anaphylaxis in pediatric anesthesia. Paediatr Anaesth 2019; 29:892-900. [PMID: 31379063 DOI: 10.1111/pan.13703] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 07/07/2019] [Accepted: 07/09/2019] [Indexed: 01/31/2023]
Abstract
Childhood allergy is common, and increasing. Many children are incorrectly labeled as having allergy or adverse drug reactions. This can pose a dilemma for anesthetists and lead to a change in practice or drug selection. We review the pathophysiology of hypersensitivity reactions and the implications for anesthesia of food allergy, atopy, and family history of allergy in children. The epidemiology of anaphylaxis is discussed. We discuss the common triggers of perioperative anaphylaxis in children and explore emerging triggers including chlorhexidine and sugammadex. Accurate data on pediatric perioperative anaphylaxis is limited worldwide, with marked geographic variation. This highlights the need for accurate local, district and/or nationwide incident reporting. The clinical features, diagnosis, and management of anaphylaxis under anesthesia are discussed. We review the process of expert allergy testing following a suspected case of anaphylaxis to guide future safe anesthesia administration. The preoperative consultation is an opportunity for referral for allergy testing to allow de-labeling. This has the potential for improved antibiotic stewardship and more effective treatment with first-line therapeutic agents.
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Affiliation(s)
- Bojana Stepanovic
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Michaela Lucas
- Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Department of Immunology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Medical School, The University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, Perth, Western Australia, Australia
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32
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von Ungern-Sternberg BS, Sommerfield D, Slevin L, Drake-Brockman TFE, Zhang G, Hall GL. Effect of Albuterol Premedication vs Placebo on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomies: The REACT Randomized Clinical Trial. JAMA Pediatr 2019; 173:527-533. [PMID: 31009034 PMCID: PMC6547220 DOI: 10.1001/jamapediatrics.2019.0788] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Tonsillectomy is a common pediatric procedure for the treatment of sleep-disordered breathing and chronic tonsillitis. Up to half of children having this procedure experience a perioperative respiratory adverse event. OBJECTIVE To determine whether inhaled albuterol sulfate (salbutamol sulfate) premedication decreases the risk of perioperative respiratory adverse events in children undergoing anesthesia for tonsillectomy. DESIGN, SETTING, AND PARTICIPANTS A randomized, triple-blind, placebo-controlled trial (the Reducing Anesthetic Complications in Children Undergoing Tonsillectomies [REACT] trial) was conducted at Perth Children's Hospital (formerly Princess Margaret Hospital for Children), the only tertiary pediatric hospital in Western Australia. Participants included 484 children aged 0 to 8 years who were undergoing anesthesia for tonsillectomy. The study was conducted between July 15, 2014, and May 18, 2017. INTERVENTIONS Participants were randomized to receive either albuterol (2 actuations, 200 μg) or placebo before their surgery. MAIN OUTCOMES AND MEASURES Occurrence of perioperative respiratory adverse events (bronchospasm, laryngospasm, airway obstruction, desaturation, coughing, and stridor) until discharge from the postanesthesia care unit. RESULTS Of 484 randomized children (median [range] age, 5.6 [1.6-8.9] years; 285 [58.9%] boys), 479 data sets were available for intention-to-treat analysis. Perioperative respiratory adverse events occurred in 67 of 241 children (27.8%) receiving albuterol and 114 of 238 children (47.9%) receiving placebo. After adjusting for age, type of airway device, and severity of obstructive sleep apnea in a binary logistic regression model, the likelihood of perioperative respiratory adverse events remained significantly higher in the placebo group compared with the albuterol group (odds ratio, 2.8; 95% CI, 1.9-4.2; P < .001). Significant differences were seen in children receiving placebo vs albuterol in laryngospasm (28 [11.8%] vs 12 [5.0%]; P = .009), coughing (79 [33.2%] vs 27 [11.2%]; P < .001), and oxygen desaturation (54 [22.7%] vs 36 [14.9%]; P = .03). CONCLUSIONS AND RELEVANCE Albuterol premedication administered before tonsillectomy under general anesthesia in young children resulted in a clinically significant reduction in rates of perioperative respiratory adverse events compared with the rates in children who received placebo. Premedication with albuterol should be considered for children undergoing tonsillectomy. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry identifier: ACTRN12614000739617.
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Affiliation(s)
- Britta S. von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children’s Hospital, Perth, Australia,Division of Anaesthesiology, Medical School, The University of Western Australia, Perth, Australia,Telethon Kids Institute, Perth, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children’s Hospital, Perth, Australia,Division of Anaesthesiology, Medical School, The University of Western Australia, Perth, Australia
| | - Lliana Slevin
- Department of Anaesthesia and Pain Management, Perth Children’s Hospital, Perth, Australia,Telethon Kids Institute, Perth, Australia
| | - Thomas F. E. Drake-Brockman
- Department of Anaesthesia and Pain Management, Perth Children’s Hospital, Perth, Australia,Division of Anaesthesiology, Medical School, The University of Western Australia, Perth, Australia
| | - Guicheng Zhang
- School of Public Health, Curtin University, Perth, Australia,Centre for Genetic Origins of Health and Disease, Curtin University, Perth, Australia,University of Western Australia, Perth, Australia
| | - Graham L. Hall
- Telethon Kids Institute, Perth, Australia,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia,Centre for Child Health Research, University of Western Australia, Perth, Australia
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33
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Ledowski T, Sommerfield D, Slevin L, Conrad J, von Ungern-Sternberg BS. Surgical pleth index: prediction of postoperative pain in children? Br J Anaesth 2019; 119:979-983. [PMID: 29028932 DOI: 10.1093/bja/aex300] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 11/14/2022] Open
Abstract
Background Surgical Pleth Index (SPI) is a non-invasive, dimensionless score (0-100) aimed to allow an estimate of intraoperative nociception. Thus, it may be a useful tool to guide intraoperative analgesia. However, no optimum SPI target range for the use in children has yet been defined. It was the aim of this study to define a clinically appropriate SPI target to predict moderate-severe postoperative pain in children. Methods After ethics approval 105 children (2-16 yr) undergoing elective sevoflurane/opioid-based anaesthesia were included. SPI was recorded directly before the end of surgery and compared with acute postoperative pain (age appropriately assessed on different pain scales in the age groups two to three yr, four to eight yr and nine to16 yr) in the postoperative acute care unit (PACU). Results Data of 93 children were analysed. A significant negative correlation was found between age and SPI (r=-0.43; P=0.03). The SPI cut-off value with the highest sensitivity (76%) and specificity (62%) in all children combined was 40. The negative predictive value for SPI ≤ 40 to predict the absence of moderate-severe pain in PACU was 87.5%. The commonly used SPI cut-off (50) published in all related studies had neither any clinically relevant sensitivity nor specificity to predict the presence or absence of acute pain in PACU. Conclusions The results suggest that a lower (≤ 40) than previously published (50) target for SPI may be more appropriate in studies investigating SPI guided anaesthesia in children, if the avoidance of moderate-severe postoperative pain is the main goal. Clinical trial registration ACTRN12616001139460.
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Affiliation(s)
- T Ledowski
- Medical School, University of Western Australia, Perth, Australia.,Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia
| | - D Sommerfield
- Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Australia
| | - L Slevin
- Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Australia.,Telethon Kids Institute, Perth, Australia
| | - J Conrad
- Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Australia.,Medical School, Christian-Albrechts-University Kiel, Kiel, Germany
| | - B S von Ungern-Sternberg
- Medical School, University of Western Australia, Perth, Australia.,Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Australia
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34
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Salman S, Tang EKY, Cheung LC, Nguyen MN, Sommerfield D, Slevin L, Lim LY, von Ungern Sternberg BS. A novel, palatable paediatric oral formulation of midazolam: pharmacokinetics, tolerability, efficacy and safety. Anaesthesia 2018; 73:1469-1477. [DOI: 10.1111/anae.14318] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- S. Salman
- Faculty of Health and Medical Sciences; Medical School; University of Western Australia; Perth Australia
| | - E. K. Y. Tang
- Division of Pharmacy; Faculty of Health and Medical Sciences; School of Allied Health; University of Western Australia; Perth Australia
| | - L. C. Cheung
- Telethon Kids Institute; University of Western Australia; Perth Australia
- School of Pharmacy and Biomedical Sciences; Curtin University; Perth Australia
- Department of Pharmacy; Princess Margaret Hospital for Children; Perth Australia
| | - M. N. Nguyen
- Division of Pharmacy; Faculty of Health and Medical Sciences; School of Allied Health; University of Western Australia; Perth Australia
| | - D. Sommerfield
- Department of Anaesthesia and Pain Management; Princess Margaret Hospital for Children; Perth Australia
| | - L. Slevin
- Telethon Kids Institute; University of Western Australia; Perth Australia
| | - L. Y. Lim
- Division of Pharmacy; Faculty of Health and Medical Sciences; School of Allied Health; University of Western Australia; Perth Australia
| | - B. S. von Ungern Sternberg
- Department of Anaesthesia and Pain Management; Princess Margaret Hospital for Children; Perth Australia
- Faculty of Health and Medical Sciences; Medical School; University of Western Australia; Perth Australia
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35
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Stewart RM, Wong JWY, Runions KC, Rao P, Moore JK, Davies SR, von Ungern-Sternberg BS, Sommerfield D, Zepf FD. Nitrous oxide (N 2O) and subsequent open-label SSRI treatment of adolescents with depression (NOTAD): study protocol for a randomised controlled trial. Trials 2017; 18:617. [PMID: 29273063 PMCID: PMC5741960 DOI: 10.1186/s13063-017-2342-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 11/21/2017] [Indexed: 01/24/2023] Open
Abstract
Background The first line of pharmacological treatment for severe depressive disorders in young people is selective serotonin reuptake inhibitors (SSRIs). However, beneficial clinical effects are rarely observed before several weeks into treatment. Nitrous oxide (N2O) has a long-standing safety record for pain relief and has been used in adults and young people. In adults with severe treatment-resistant depression, a single dose of N2O had significant antidepressant effects, with maximum antidepressant effects observed 24 h after administration. However, the antidepressant effects of N2O have never been investigated in adolescents with a confirmed diagnosis of depression in a prospective trial. The aims of this study are to (1) investigate whether a single inhaled N2O administration leads to antidepressant effects in adolescents with depression at 24 h, (2) determine whether combined N2O and SSRI administration (commenced after N2O intervention) provides a clinically significant improvement in mood over and above the benefits from SSRI administration alone, and, (3) investigate whether the effect seen following N2O administration can be used as a predictor of SSRI treatment response. Methods/design In this study, we will use a single-blind, randomised, placebo-controlled design. Patients aged between 12 and 17 years with major depressive disorder will be recruited. This study will consist of two phases: phase A and phase B. During phase A, participants will be randomised to receive either inhaled N2O or placebo (air) for 1 h. In phase B, participants will receive open-label pharmacological treatment with the SSRI fluoxetine and will be followed over a 12-week period. Participants will undertake mood assessments at 2 and 24 h after N2O or placebo administration (phase A) and weekly during the 12-week follow up in phase B. Discussion We expect an antidepressant effect from a single dose of inhaled N2O compared with placebo at 24 h after administration. Additionally, we expect that subjects treated with N2O will also show greater improvements than the placebo group after 6 and 12 weeks into fluoxetine treatment because of potential additive antidepressant effects. Such findings would be of clinical importance because currently children and adolescents often do not experience any symptom alleviation for several weeks following the initiation of SSRIs. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12616001568404. Registered on 14 November 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2342-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Richard M Stewart
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Paediatrics and Child Health & Division of Psychiatry and Clinical Neurosciences, The University of Western Australia, 35 Stirling Highway (M561), Crawley, WA 6009, Perth, Australia
| | - Janice W Y Wong
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Paediatrics and Child Health & Division of Psychiatry and Clinical Neurosciences, The University of Western Australia, 35 Stirling Highway (M561), Crawley, WA 6009, Perth, Australia.,Telethon Kids Institute, Perth, Australia.,Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health, Perth, Australia
| | - Kevin C Runions
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Paediatrics and Child Health & Division of Psychiatry and Clinical Neurosciences, The University of Western Australia, 35 Stirling Highway (M561), Crawley, WA 6009, Perth, Australia.,Telethon Kids Institute, Perth, Australia
| | - Pradeep Rao
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Paediatrics and Child Health & Division of Psychiatry and Clinical Neurosciences, The University of Western Australia, 35 Stirling Highway (M561), Crawley, WA 6009, Perth, Australia.,Community Child and Adolescent Mental Health Services (CAMHS), Department of Health, Perth, Australia
| | - Julia K Moore
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Paediatrics and Child Health & Division of Psychiatry and Clinical Neurosciences, The University of Western Australia, 35 Stirling Highway (M561), Crawley, WA 6009, Perth, Australia.,Acute Child and Adolescent Mental Health Services (CAMHS), Department of Health, Perth, Australia
| | - Simon R Davies
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Paediatrics and Child Health & Division of Psychiatry and Clinical Neurosciences, The University of Western Australia, 35 Stirling Highway (M561), Crawley, WA 6009, Perth, Australia.,Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health, Perth, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, Australia
| | - Florian Daniel Zepf
- Centre & Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, School of Medicine, Division of Paediatrics and Child Health & Division of Psychiatry and Clinical Neurosciences, The University of Western Australia, 35 Stirling Highway (M561), Crawley, WA 6009, Perth, Australia. .,Telethon Kids Institute, Perth, Australia. .,Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health, Perth, Australia.
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36
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Chambers NA, Ramgolam A, Sommerfield D, Zhang G, Ledowski T, Thurm M, Lethbridge M, Hegarty M, von Ungern-Sternberg BS. Cuffed vs. uncuffed tracheal tubes in children: a randomised controlled trial comparing leak, tidal volume and complications. Anaesthesia 2017; 73:160-168. [DOI: 10.1111/anae.14113] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2017] [Indexed: 11/29/2022]
Affiliation(s)
- N. A. Chambers
- Department of Anaesthesia; Princess Margaret Hospital for Children; Perth Australia
- School of Medicine and Pharmacology; The University of Western Australia; Perth Australia
| | - A. Ramgolam
- Department of Anaesthesia; Princess Margaret Hospital for Children; Perth Australia
- Children's Lung Health; Telethon Kids Institute; Perth Australia
| | - D. Sommerfield
- Department of Anaesthesia; Princess Margaret Hospital for Children; Perth Australia
| | - G. Zhang
- School of Public Health; Centre for Genetic Origins of Health and Disease; Curtin University and University of Western Australia; Australia
| | - T. Ledowski
- Department of Anaesthesia; Royal Perth Hospital; Perth Australia
| | - M. Thurm
- Department of Anaesthesia; Princess Margaret Hospital for Children; Perth Australia
| | - M. Lethbridge
- Department of Anaesthesia; Princess Margaret Hospital for Children; Perth Australia
| | - M. Hegarty
- Department of Anaesthesia; Princess Margaret Hospital for Children; Perth Australia
| | - B. S. von Ungern-Sternberg
- Department of Anaesthesia; Princess Margaret Hospital for Children; Perth Australia
- School of Medicine and Pharmacology; The University of Western Australia; Perth Australia
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37
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Wilson CA, Sommerfield D, Drake-Brockman TFE, Lagrange C, Ramgolam A, von Ungern-Sternberg BS. A prospective audit of pain profiles following general and urological surgery in children. Paediatr Anaesth 2017; 27:1155-1164. [PMID: 29030932 DOI: 10.1111/pan.13256] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postoperative pain is frequently undertreated in children both in hospital and at home following discharge. Pain has both short- and long-term consequences for children, their families, and the healthcare system. A greater understanding of procedure-specific postoperative pain trajectories is required to improve pain management. AIM To determine the duration and severity of acute postoperative pain experienced by children undergoing 8 different general and urological procedures (primary outcomes). Behavioral disturbance rates, nausea and vomiting scores, and parental satisfaction were also examined during the follow-up period (secondary outcomes). METHOD Families of children (0-18 years) undergoing common general and urological procedures were invited to enroll in the study. Children's pain scores, measured using a parental proxy 0-10 numerical rating scale, were collected by telephone interview until pain was resolved. Analgesia prescribed and given, behavioral disturbance, nausea and vomiting scores, the method of medication education communication, and parental satisfaction were also measured. RESULTS Of 360 patients recruited, 326 complete datasets were available. Patients underwent laparoscopic appendicectomy (57), open appendicectomy (19), circumcision (50), cystoscopy (52), hypospadias repair (22), inguinal hernia repair (51), orchidopexy (51), or umbilical hernia repair (24). Postoperative pain peaked on the day of or the day after surgery in all groups, and decreased over time. Pain lasted a median duration of 5 postoperative days following open appendicectomy, and 0-2 postoperative days for other procedures. Behavioral disturbance rates closely followed pain scores. Analgesia administration at home varied widely between and within groups. CONCLUSION Pain management was inadequate in most of the groups studied, particularly after appendicectomy or umbilical hernia repair, with most children experiencing at least moderate pain on the day of and day after surgery. There was a need for a standardized management, with increased dual analgesia prescribing, to ensure that children receive adequate postoperative analgesia in hospital and at home.
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Affiliation(s)
- Caroline A Wilson
- Department of Paediatric Anaesthesia, Bristol Royal Hospital for Children, Bristol, UK
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Thomas F E Drake-Brockman
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
| | - Claudia Lagrange
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia
| | | | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
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Braconnier L, Arnold A, Sommerfield A, Slevin L, Sommerfield D, Rueter K, von Ungern-Sternberg BS, Lucas M. P12: THE RATE OF ATOPIC DISEASES IN CHILDREN WITH REPORTED ANTIBIOTIC ALLERGIES. Intern Med J 2017. [DOI: 10.1111/imj.12_13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L Braconnier
- School of Medicine and Pharmacology; University of Western Australia; Australia
- Immunology Department, Princess Margaret Hospital; Perth Australia
| | - A Arnold
- Immunology Department, Princess Margaret Hospital; Perth Australia
| | - A Sommerfield
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital; Perth Australia
- Telethon Kids Institute; Perth Australia
| | - L Slevin
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital; Perth Australia
- Telethon Kids Institute; Perth Australia
| | - D Sommerfield
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital; Perth Australia
| | - K Rueter
- Immunology Department, Princess Margaret Hospital; Perth Australia
- School of Paediatrics and Child Health; University of Western Australia; Perth Australia
- Immunology Department, PathWest Laboratory Medicine; WAPerth Australia
| | - BS von Ungern-Sternberg
- School of Medicine and Pharmacology; University of Western Australia; Australia
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital; Perth Australia
- Telethon Kids Institute; Perth Australia
| | - M Lucas
- School of Medicine and Pharmacology; University of Western Australia; Australia
- Immunology Department, Princess Margaret Hospital; Perth Australia
- Immunology Department, PathWest Laboratory Medicine; WAPerth Australia
- School of Pathology and Laboratory Medicine; University of Western Australia; Australia
- Institute for Immunology and Infectious Diseases; Murdoch University; Australia. Immunology Department, Sir Charles Gairdner Hospital; Perth Australia
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Arnold A, Jeelall Y, Braconnaire L, Sommerfield A, Bundell C, Sommerfield D, Slevin L, Rueter K, von Ungern-Sternberg BS, Lucas M. P8: THE EFFICACY OF SKIN TESTING, SPECIFIC IgE AND BASAL ACTIVATION TESTING IN PREDICTING THE OUTCOME OF ORAL PROVOCATION CHALLENGES IN CHILDREN WITH SUSPECTED BETA-LACTAM ALLERGY. Intern Med J 2017. [DOI: 10.1111/imj.8_13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Arnold
- Immunology Department; Princess Margaret Hospital; Perth Australia
| | - Y Jeelall
- School of Medicine and Pharmacology; University of Western Australia; Australia
| | - L Braconnaire
- School of Medicine and Pharmacology; University of Western Australia; Australia
| | | | - C Bundell
- Telethon Kids Institute; Perth Australia
| | - D Sommerfield
- Department of Anaesthesia and Pain Management; Princess Margaret Hospital; Perth Australia
| | - L Slevin
- Telethon Kids Institute; Perth Australia
| | - K Rueter
- Immunology Department; Princess Margaret Hospital; Perth Australia
- School of Medicine and Pharmacology; University of Western Australia; Australia
- Department of Clinical Research and Education; Princess Margaret Hospital; Perth Australia
| | - BS von Ungern-Sternberg
- Department of Anaesthesia and Pain Management; Princess Margaret Hospital; Perth Australia
- School of Medicine and Pharmacology; University of Western Australia; Australia
| | - M Lucas
- Immunology Department; Princess Margaret Hospital; Perth Australia
- School of Medicine and Pharmacology; University of Western Australia; Australia
- Immunology Department; PathWest Laboratory Medicine WA; Perth Australia
- School of Biomedical Sciences; University of Western Australia; Australia
- Immunology Department; Sir Charles Gairdner Hospital; Perth Australia. Institute for Immunology and Infectious Diseases; Murdoch University; Perth Australia
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Ramgolam A, Hall G, Sommerfield D, Slevin L, Drake-Brockman T, Zhang G, von Ungern-Sternberg B. Premedication with salbutamol prior to surgery does not decrease the risk of perioperative respiratory adverse events in school-aged children. Br J Anaesth 2017; 119:150-157. [DOI: 10.1093/bja/aex139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sommerfield D, Ramgolam A, Barker A, Bergesio R, von Ungern-Sternberg BS. Epidural insertion height for ureteric reimplant surgery; does location matter? Paediatr Anaesth 2016; 26:951-9. [PMID: 27061337 DOI: 10.1111/pan.12895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical correction of vesicoureteric reflux through ureteric reimplantation is a common, highly successful treatment. Postoperative pain can be severe and may relate to somatic wound pain from the lower abdominal incision or from visceral bladder spasm pain. AIM To conduct a prospective quality improvement audit to compare four perioperative analgesic techniques. METHODS Observational data were collected on 217 patients following open ureteroneocystostomy over 5 days. The patients were split into four groups: (i) 'morphine' infusion; (ii) 'caudal'-single-shot caudal; (iii) 'epidural'-epidural catheter inserted at T10-L2 given a bolus, followed by an infusion of 0.125% bupivacaine with fentanyl 2 μg·ml(-1) ; (iv) 'caudal catheter'-caudal placed epidural catheter was treated similar to the epidural catheter. Data regarding postoperative analgesic interventions were recorded. Intravesical pethidine was used for bladder spasm pain and i.v. morphine for wound pain. RESULTS Over the study period, the caudal catheter technique (mean interventions/patient = 1.8 ± 2.6) and the single-shot caudal (6.1 ± 4) needed significantly less bladder spasm interventions than morphine (9.2 ± 4) and epidural (8.0 ± 4.4) patients. For wound pain, the caudal catheter (8.8 ± 3.3) and epidural groups (11.4 ± 3.2) needed significantly less interventions than morphine (16.1 ± 3) and caudal (15.3 ± 3.3) patients. Overall, caudal catheter patients on average required about half the number of pain interventions and were associated with less high nursing workload. CONCLUSIONS Despite some limitations in data collection and study design, the caudal catheter technique was superior at reducing pain interventions, particularly bladder spasm interventions. Overall epidural analgesia was not superior to a single-shot caudal followed by opioid infusion. The issue of bladder spasm may be similar to the phenomenon of sacral sparing in obstetric epidural anesthesia. Thus, regional techniques, such as caudal epidural, targeting a better balance between sacral and lumber nerves are required.
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Affiliation(s)
- David Sommerfield
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Anoop Ramgolam
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.,Paediatric Respiratory Physiology, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Andrew Barker
- Department of Paediatric Surgery, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Ric Bergesio
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
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Wilson CA, Sommerfield D, Drake-Brockman TFE, von Bieberstein L, Ramgolam A, von Ungern-Sternberg BS. Pain after discharge following head and neck surgery in children. Paediatr Anaesth 2016; 26:992-1001. [PMID: 27397757 DOI: 10.1111/pan.12974] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is well established that children experience significant pain for a considerable period following adenotonsillectomy. Less is known, however, about pain following other common head and neck operations. AIM The aim of this study was to describe the severity and duration of postoperative pain experienced by children undergoing elective head and neck procedures (primary outcomes). Behavioral disturbance, nausea and vomiting, parental satisfaction, and medical reattendance rates were also measured (secondary outcomes). METHOD Parents of children (0-18 years) undergoing common head and neck operations were invited to participate. Pain scores on the day of surgery and each day post discharge were collected via multiple telephone interviews. Data collected included pain levels, analgesia prescribed and given, behavioral disturbance rates, and nausea and vomiting scores. Follow-up was continued until pain resolved. RESULTS Two hundred and fifty-one patients were analyzed (50 adenoidectomy, 51 adenotonsillectomy, 19 myringoplasty, 52 myringotomy, 43 strabismus, and 36 tongue tie divisions). On the day of surgery myringoplasty, strabismus surgery, and adenotonsillectomy patients on average had moderate pain, whereas adenoidectomy, tongue tie, and myringotomy patients had mild pain. Adenotonsillectomy patients continued to have moderate pain for several days with pain lasting on average 9 days. From day 1 postoperatively mild pain was experienced in the other surgical groups with the average duration of pain varying from 1 to 3 days depending on the surgery performed. Frequency of behavioral issues closely followed pain scores for each group. Analgesic prescribing and regimes at home varied widely, both within and between the different surgical groups. Rates of nausea and vomiting following discharge were low in all groups. The overall unplanned medical reattendance rate was 16%. CONCLUSION Adenotonsillectomy patients represent the biggest challenge in postoperative pain management of the head and neck surgeries evaluated. The low rates of pain, nausea, and vomiting reported in the days following surgery for the other procedures suggests that children can be cared for at home with simple analgesia. Discharge information and analgesia prescribing on discharge should be tailored to the operation performed.
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Affiliation(s)
- Caroline A Wilson
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Thomas F E Drake-Brockman
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
| | - Lita von Bieberstein
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Anoop Ramgolam
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Princess Margaret Hospital for Children, Perth, WA, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
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Chalkiadis GA, Sommerfield D, Low J, Orsini F, Dowden SJ, Tay M, Penrose S, Pirpiris M, Graham HK. Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single-event multilevel surgery. Dev Med Child Neurol 2016; 58:402-8. [PMID: 26400818 DOI: 10.1111/dmcn.12930] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2015] [Indexed: 11/30/2022]
Abstract
AIM To compare diazepam use, muscle spasm, analgesia, and side effects when clonidine or fentanyl are added to epidural bupivacaine in children with cerebral palsy after multilevel orthopaedic surgery. METHOD Fifty children were prospectively randomized to receive clonidine (n=24, mean age 10y 10mo [SD 2y 11mo]) or fentanyl (n=26, mean age 10y 11mo [SD 2y 10mo]). RESULTS There was no difference in primary outcome measures: median diazepam use (fentanyl 0, interquartile range [IQR] 0-0; clonidine 0, IQR 0-0; p=0.46), any muscle spasm (no muscle spasms in: fentanyl, 36%; clonidine, 62%; p=0.11), painful muscle spasm (fentanyl 40%; clonidine 25%; p=0.46), or pain score ≥6 (none: fentanyl 44%; clonidine 42%; p=0.29). There were differences in secondary outcome measures: no vomiting (clonidine 63%; fentanyl 20%); vomiting occurred more frequently with fentanyl (32% vomited more than three times; clonidine none; p=0.001). Fentanyl resulted in more oxygen desaturation (at least two episodes: fentanyl 20%; clonidine 0; p<0.001). Clonidine resulted in lower mean (SD) area under the curve for systolic blood pressure (fentanyl 106.5 [11.0]; clonidine 95.7mmHg [7.9]) and heart rate (fentanyl 104.9 beats per minute [13.6]; clonidine 85.3 [11.5]; p<0.001). INTERPRETATION Clonidine and fentanyl provide adequate analgesia with low rates of muscle spasm, resulting in low diazepam use. The choice of epidural additive should be based upon the most tolerable side-effect profile.
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Affiliation(s)
- George A Chalkiadis
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia.,Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia
| | - David Sommerfield
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Janette Low
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Francesca Orsini
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia
| | - Stephanie J Dowden
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Michelle Tay
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Sueann Penrose
- Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Marinis Pirpiris
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Department of Orthopaedics, Royal Children's Hospital, Melbourne, Vic., Australia
| | - H Kerr Graham
- Murdoch Childrens Research Institute, Melbourne, Vic., Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Vic., Australia.,Department of Orthopaedics, Royal Children's Hospital, Melbourne, Vic., Australia
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Sommerfield D, Hu P, O’Keeffe D, McKeatinga K. Caesarean section in a parturient with a spinal cord stimulator. Int J Obstet Anesth 2010; 19:114-7. [DOI: 10.1016/j.ijoa.2009.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 05/19/2009] [Accepted: 08/25/2009] [Indexed: 12/17/2022]
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Abstract
OBJECTIVE To evaluate the impact of nephrectomy on renal function in people who are potential candidates for nephron sparing surgery, i.e. partial nephrectomy. PATIENTS AND METHODS A retrospective analysis was carried out of 109 patients (35 women, 74 men) who had undergone a nephrectomy for stage I renal carcinoma at the University of Michigan between 1960 and 1979. All patients had a functioning contralateral kidney and had undergone at least one post-operative serum creatinine evaluation. Statistical analysis was by Pearson's correlation coefficient. RESULTS One individual developed a transitional cell carcinoma in the remaining renal pelvis and was treated with nephroureterectomy. No other patient progressed to dialysis. Five patients had post-operative serum creatinine levels from 221 to 354 mumol/l, one of whom had undergone both a nephrectomy and a partial nephrectomy for bilateral renal tumours. The remaining four had renal disease including diabetes, hypertension, pyelonephritis and renal artery stenosis. There was a strong association between pre-operative and post-operative serum creatinine values. CONCLUSION Patients with low stage renal tumours and a normal contralateral kidney are at low risk of progression to renal failure.
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Affiliation(s)
- H B Grossman
- Department of Surgery, University of Michigan, Ann Arbor
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