1
|
Dundaru-Bandi D, Antel R, Ingelmo P. Advances in pediatric perioperative care using artificial intelligence. Curr Opin Anaesthesiol 2024; 37:251-258. [PMID: 38441085 DOI: 10.1097/aco.0000000000001368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE OF THIS REVIEW This article explores how artificial intelligence (AI) can be used to evaluate risks in pediatric perioperative care. It will also describe potential future applications of AI, such as models for airway device selection, controlling anesthetic depth and nociception during surgery, and contributing to the training of pediatric anesthesia providers. RECENT FINDINGS The use of AI in healthcare has increased in recent years, largely due to the accessibility of large datasets, such as those gathered from electronic health records. Although there has been less focus on pediatric anesthesia compared to adult anesthesia, research is on- going, especially for applications focused on risk factor identification for adverse perioperative events. Despite these advances, the lack of formal external validation or feasibility testing results in uncertainty surrounding the clinical applicability of these tools. SUMMARY The goal of using AI in pediatric anesthesia is to assist clinicians in providing safe and efficient care. Given that children are a vulnerable population, it is crucial to ensure that both clinicians and families have confidence in the clinical tools used to inform medical decision- making. While not yet a reality, the eventual incorporation of AI-based tools holds great potential to contribute to the safe and efficient care of our patients.
Collapse
Affiliation(s)
| | - Ryan Antel
- Department of Anesthesia, McGill University
| | - Pablo Ingelmo
- Department of Anesthesia, McGill University
- Division of Pediatric Anesthesia
- Edwards Family Interdisciplinary Center for Complex Pain. Montreal Children's Hospital
- Research Institute, McGill University Health Center
- Alan Edwards for Research on Pain. McGill University, Montreal, Quebec, Canada
| |
Collapse
|
2
|
Lerman J, Ingelmo P. Emergence delirium in children: Do the studies reflect reality? Paediatr Anaesth 2024. [PMID: 38426641 DOI: 10.1111/pan.14870] [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] [Received: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Affiliation(s)
- J Lerman
- Department of Anesthesiology, Oishei Children's Hospital, Jacob's School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, New York, USA
| | - P Ingelmo
- Department of Anesthesiology and Pain Management, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
3
|
Einhorn LM, Hudon J, Ingelmo P. The Pharmacological Treatment of Neuropathic Pain in Children. Curr Neuropharmacol 2024; 22:38-52. [PMID: 37539933 DOI: 10.2174/1570159x21666230804110858] [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] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/22/2023] [Accepted: 03/12/2023] [Indexed: 08/05/2023] Open
Abstract
The International Association for the Study of Pain (IASP) defines neuropathic pain as pain caused by a lesion or disease of the somatosensory nervous system. It is characterized as a clinical condition in which diagnostic studies reveal an underlying cause of an abnormality in the peripheral or central nervous system. Many common causes of neuropathic pain in adults are rare in children. The purpose of this focused narrative review is, to 1) provide an overview of neuropathic pain in children, 2) highlight unique considerations related to the diagnosis and mechanisms of neuropathic pain in children, and 3) perform a comprehensive analysis of the pharmacological treatments available. We emphasize that data for routine use of pharmacological agents in children with neuropathic pain are largely inferred from adult literature with little research performed on pediatric populations, yet have clear evidence of harms to pediatric patients. Based on these findings, we propose risk mitigation strategies such as utilizing topical treatments whenever possible, assessing pain phenotyping to guide drug class choice, and considering pharmaceuticals in the broader context of the multidisciplinary treatment of pediatric pain. Furthermore, we highlight important directions for future research on pediatric neuropathic pain treatment.
Collapse
Affiliation(s)
- Lisa M Einhorn
- Department of Anesthesiology, Pediatric Division, Duke University School of Medicine, Durham, North Carolina, United States
| | - Jonathan Hudon
- Division of Secondary Care, Department of Family Medicine, McGill University Health Centre, Montreal, Qc, Canada
- Palliative Care Division, Jewish General Hospital, Montreal, Qc, Canada
- Alan Edwards Pain Management Unit, Montreal General Hospital, McGill University Health Center, Montreal, Qc, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, Canada
- Edwards Family Interdisciplinary Centre for Complex Pain, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Pablo Ingelmo
- Alan Edwards Centre for Pain Research, McGill University, Montreal, Canada
- Edwards Family Interdisciplinary Centre for Complex Pain, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
- Research Institute of the McGill University Health Center, Montreal, Canada
- Department of Pediatric Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montréal, QC, Canada
| |
Collapse
|
4
|
Soltani S, Killackey T, Birnie KA, Brennenstuhl S, Kopala-Sibley DC, Choiniere M, Pagé MG, Dassieu L, Lacasse A, Lalloo C, Poulin P, Ingelmo P, Ali S, Battaglia M, Campbell F, Smith A, Benayon M, Jordan I, Marianayagam J, Harris L, Mohabir V, Stinson J, Noel M. Pain, mental health and healthcare utilization: Impact of the COVID-19 pandemic on youth with chronic pain, parents and siblings. Eur J Pain 2023; 27:1249-1265. [PMID: 37435883 DOI: 10.1002/ejp.2157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 04/25/2023] [Accepted: 06/22/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Paediatric chronic pain was a public health emergency before the novel coronavirus (COVID-19) pandemic, and this problem is predicted to escalate. Pain tends to occur intergenerationally in families, and youth with chronic pain and their parents have high rates of mental health issues, which can further exacerbate pain. Siblings of youth with chronic pain have been largely overlooked in research, as well as the impact of the pandemic on posttraumatic stress disorder (PTSD) symptoms and healthcare utilization. METHODS This cross-sectional study examined pain, mental health and healthcare utilization in three groups: youth with chronic pain (n = 357), parents of youth with chronic pain (n = 233) and siblings of youth with chronic pain (n = 156) during the COVID-19 pandemic in Canada. RESULTS More so than with pain symptoms, the results revealed high levels of mental health symptoms (i.e. anxiety, depressive, and PTSD), particularly in individuals more personally impacted by the pandemic. The largest effect was seen on PTSD symptoms for all groups. For parents with chronic pain, greater personal COVID-19 impact was related to worse pain interference. Reported rates of healthcare utilization were strikingly high, with youth with chronic pain, parents (reporting on behalf of their children with chronic pain), and siblings of youth with chronic pain reporting that most consultations were due to pain. CONCLUSIONS Longitudinal research assessing these outcomes across continued waves of the pandemic is needed to ensure timely, tailored and equitable access to pain and mental health assessment and treatment. SIGNIFICANCE This study examined pain, mental health, substance use and healthcare utilization in youth with chronic pain, siblings and parents during the COVID-19 pandemic. Greater personal impact of the pandemic was not largely associated with poorer pain outcomes; however, it was associated with mental health, with the largest effect on PTSD symptoms. The high rates and significant association of COVID-19 impact with PTSD symptoms underscore the importance of including PTSD assessment as part of routine screening practices in pain clinics.
Collapse
Affiliation(s)
- Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Tieghan Killackey
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Daniel C Kopala-Sibley
- Department of Psychiatry, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Manon Choiniere
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - M Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Department of Psychology, Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Lise Dassieu
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Department of Biomedical Sciences, Université de Montréal, Montreal, Quebec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Chitra Lalloo
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Poulin
- Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Pablo Ingelmo
- Anesthesia and Chronic Pain Management, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Samina Ali
- Departments of Pediatrics & Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marco Battaglia
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- CYEA Programme, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew Smith
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Myles Benayon
- Internal Medicine Residency Program, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Lauren Harris
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vina Mohabir
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Noel
- Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| |
Collapse
|
5
|
He BH, Diatchenko L, Ingelmo P. Genetic risk factors for chronic postsurgical pain in children: A narrative review. Eur J Anaesthesiol 2023; 40:472-483. [PMID: 37199409 DOI: 10.1097/eja.0000000000001847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Genetic risk factors for chronic postsurgical pain in adults have been established, but little is known whether the same associations exist in children. It is even less clear how much influence single nucleotide polymorphisms can exert on the phenotypic expression of chronic postsurgical pain in children in general. To this effect, a search was made for original articles which met the following criteria: evaluation of postsurgical pain in children with known genetic mutations or, conversely, evaluation of atypical pain trajectories of postsurgical children assessing for possible genetic mutations that may explain the phenotype. All titles and abstracts retrieved were reviewed for suitability for inclusion. The references of the selected articles were also checked for additional relevant papers. To assess the transparency and quality of the genetic studies both STrengthening the REporting of Genetic Association studies scores and Q-Genie scores were applied. Overall, there is a paucity of information regarding the link between genetic mutations and eventual chronic postsurgical pain development although there is some information on acute postoperative pain. Evidence has shown that the contribution of genetic risk factors to chronic postsurgical pain development appears to be minor, with its clinical relevance yet to be described. More advanced techniques in systems biology (proteomics, transcriptomics) suggest promising avenues for investigating the disease.
Collapse
Affiliation(s)
- Billy Haitian He
- From the Department of Anesthesia, McGill University, Montréal, Québec, Canada (BHH), Department of Anesthesia and Faculty of Dentistry, McGill University, Montréal, Québec, Canada (LD), Alan Edwards Centre for Research on Pain, McGill University, Montréal, Québec, Canada (LD, PI), Edwards Family Interdisciplinary Center for Complex Pain. Montreal Children's Hospital. McGill University Health Center. Montréal, Québec, Canada (PI), Research Institute, McGill University Health Center. Montréal, Québec, Canada (PI)
| | | | | |
Collapse
|
6
|
Hochberg U, Ingelmo P, Solé E, Miró J, Rivera G, Perez J. Early Interventional Treatments for Patients with Cancer Pain: A Narrative Review. J Pain Res 2023; 16:1663-1671. [PMID: 37223437 PMCID: PMC10202202 DOI: 10.2147/jpr.s405808] [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] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023] Open
Abstract
Between 10% and 20% of patients with cancer-related pain cannot achieve adequate control following the three-step ladder guidelines by the World Health Organization. Therefore, a "fourth step", including interventional approaches, has been suggested for those cases. Systematic reviews support the early use of interventional procedures to treat refractory cancer pain, control symptoms and prevent opioid dose escalation. There is strong evidence of the efficacy of celiac plexus or splanchnic neurolysis, vertebroplasty, kyphoplasty and intrathecal drug delivery. Those procedures have been found to be associated with a decrease in the symptom burden and opioid consumption, improved quality of life, and suggested as having a potentially positive impact on survival. Several studies have recommended using specific interventional techniques at earlier stages, possibly even when opioid treatment is first being considered. Conversely, leaving these options as a last analgesic resource might not be advisable since the burden these procedures might impose on too ill patients is significant. The objective of this review was to collect the available evidence published on the use of interventional treatments for refractory cancer pain with a particular interest in comparing early versus late indications. The results of the search demonstrated a very low number and quality of articles particularly addressing this question. This scarce number of evidence precluded performing a systematic analysis. A detailed and narrative description of the potential benefits of integrating interventional techniques into clinical guidelines at the early stages of the disease is provided.
Collapse
Affiliation(s)
- Uri Hochberg
- Pain Institute of the Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Pablo Ingelmo
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Edwards Family Interdisciplinary Centre for Complex Pain, Montreal Children’s Hospital McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute, McGill University Health Center, Montreal, Quebec, Canada
| | - Ester Solé
- Universitat Rovira i Virgili, Tarragona, Spain
| | - Jordi Miró
- Universitat Rovira i Virgili, Tarragona, Spain
- Chair in Pediatric Pain, Center for Behavior Assessment (CRAMC), Department of Psychology, Institut d’Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - Gonzalo Rivera
- Hospital de Niños Luis Calvo Mackenna, Santiago de Chile, Chile
- Clínica las Condes, Santiago de Chile, Chile
| | - Jordi Perez
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, Canada
- Edwards Family Interdisciplinary Centre for Complex Pain, Montreal Children’s Hospital McGill University Health Centre, Montreal, Quebec, Canada
- Cancer Pain Clinic, Cedars Cancer Center, McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Boisvert-Plante V, Poulin-Harnois C, Ingelmo P, Einhorn LM. What we know and what we don't know about the perioperative use of methadone in children and adolescents. Paediatr Anaesth 2023; 33:185-192. [PMID: 36281540 PMCID: PMC10416808 DOI: 10.1111/pan.14584] [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: 02/25/2022] [Revised: 09/07/2022] [Accepted: 10/18/2022] [Indexed: 02/05/2023]
Abstract
Postoperative pain control is essential to optimizing patient outcomes, improving satisfaction, and allowing patients to resume their baseline functional activities. Methadone, a synthetic mu-opioid agonist, has multiple pharmacologic properties that may be optimal for perioperative use. Compared to other opioids, methadone has a longer duration of action, rapid onset, extended dosing intervals, high oral bioavailability, low cost, lack of active metabolites, and action on multiple receptors. The current literature examining the use of methadone in the perioperative care of children and adolescents is limited and most often reported within the context of spine or cardiothoracic surgery. Overall, these studies support the hypothesis that perioperative methadone in pediatric patients may decrease postoperative pain, opioid consumption, length-of-stay, and the incidence of some opioid-related side effects, like constipation and urinary retention. A variety of protocols for the perioperative use of methadone have been described, including a single intraoperative dose as well as multiple small doses within multimodal pain protocols. The superiority of these protocols has not been established. Like all opioids, methadone has a side effect profile which includes nausea, vomiting, reduced GI motility, sedation, and respiratory depression at high doses. There is also a concern that it can cause QTc prolongation in patients. The primary aim of this educational review is to examine the pharmacologic data, published perioperative protocols, dosing considerations, and risks and benefits associated with inclusion of methadone in analgesic regimens for surgical patients. A secondary aim is to introduce opportunities for research around the perioperative use of methadone in children and adolescents. Based on our review, we would prioritize establishing optimal procedure-specific methadone protocols, determining generalizability for use in routine pediatric surgeries, and investigating methadone safety and efficacy prospectively as the primary opioid for pain management in the postanesthesia care unit or postsurgical floors.
Collapse
Affiliation(s)
| | - Christelle Poulin-Harnois
- Department of Pediatric Anesthesia, Montreal Children’s Hospital, McGill University Health Center, Montréal, Quebec, Canada
| | - Pablo Ingelmo
- Department of Pediatric Anesthesia, Montreal Children’s Hospital, McGill University Health Center, Montréal, Quebec, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, Quebec, Canada
- Edwards Family Interdisciplinary Complex Pain Centre, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Lisa M. Einhorn
- Department of Anesthesiology, Pediatric Division, Duke University School of Medicine, Durham, North Carolina, United States
| |
Collapse
|
8
|
Antel R, Sahlas E, Gore G, Ingelmo P. Use of artificial intelligence in paediatric anaesthesia: a systematic review. BJA Open 2023; 5:100125. [PMID: 37587993 PMCID: PMC10430814 DOI: 10.1016/j.bjao.2023.100125] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 01/03/2023] [Indexed: 08/18/2023]
Abstract
Objectives Although the development of artificial intelligence (AI) technologies in medicine has been significant, their application to paediatric anaesthesia is not well characterised. As the paediatric operating room is a data-rich environment that requires critical clinical decision-making, this systematic review aims to characterise the current use of AI in paediatric anaesthesia and to identify barriers to the successful integration of such technologies. Methods This review was registered with PROSPERO (CRD42022304610), the international registry for systematic reviews. The search strategy was prepared by a librarian and run in five electronic databases (Embase, Medline, Central, Scopus, and Web of Science). Collected articles were screened by two reviewers. Included studies described the use of AI for paediatric anaesthesia (<18 yr old) within the perioperative setting. Results From 3313 records identified in the initial search, 40 were included in this review. Identified applications of AI were described for patient risk factor prediction (24 studies; 60%), anaesthetic depth estimation (2; 5%), anaesthetic medication/technique decision guidance (2; 5%), intubation assistance (1; 2.5%), airway device selection (3; 7.5%), physiological variable monitoring (6; 15%), and operating room scheduling (2; 5%). Multiple domains of AI were discussed including machine learning, computer vision, fuzzy logic, and natural language processing. Conclusion There is an emerging literature regarding applications of AI for paediatric anaesthesia, and their clinical integration holds potential for ultimately improving patient outcomes. However, multiple barriers to their clinical integration remain including a lack of high-quality input data, lack of external validation/evaluation, and unclear generalisability to diverse settings. Systematic review protocol CRD42022304610 (PROSPERO).
Collapse
Affiliation(s)
- Ryan Antel
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Ella Sahlas
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Quebec, Canada
| | - Pablo Ingelmo
- Department of Anesthesia, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
9
|
Georges M, Engelhardt T, Ingelmo P, Mentegazzi F, Bertolizio G. Glycemic Stress Index: Does It Correlate with the Intensive Care Length of Stay? Children (Basel) 2023; 10:children10020328. [PMID: 36832457 PMCID: PMC9954865 DOI: 10.3390/children10020328] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023]
Abstract
Postoperative hyperglycemia is an independent risk factor for postoperative complications. In adults, perioperative hyperglycemia is influenced by prolonged fasting, but data in children are lacking. The Glycemic Stress Index (GSI) has been shown to predict prolonged Pediatric Intensive Care Unit (PICU) stays in neurosurgical patients. This study aimed to confirm the correlation between GSI and duration of intubation, PICU stay, and postoperative complications in infants undergoing elective open heart surgery. The correlation between preoperative fasting and GSI was also investigated. METHODS A retrospective chart review of 85 infants ≤ 6 months undergoing elective open heart surgery was performed. GSI values ≥ 3.9 and 4.5 were tested to determine whether they carried a higher incidence of postoperative complications (metabolic uncoupling, kidney injury, ECMO, and death). The correlation between GSI and the length of intubation, PICU stay, and duration of fasting were also investigated. Perioperative factors such as age, weight, blood gas analysis, use of inotropes, and risk adjustment for congenital heart surgery were also analyzed as possible predictors. RESULTS GSI correlated with the duration of intubation and PICU stay. A GSI ≥ 4.5, but not 3.9, was associated with a higher incidence of metabolic uncoupling. GSI was not influenced by preoperative fasting. None of the preoperative patient factors analyzed was associated with prolonged intubation, PICU stay, or PICU complications. An abnormal creatinine before surgery increased the risk of developing acute kidney injury postoperatively. CONCLUSIONS GSI may be valuable to predict prolonged intubation, PICU stay, and metabolic derangement in infants undergoing cardiac surgery. Fasting does not appear to affect GSI.
Collapse
Affiliation(s)
- Mathieu Georges
- Department of Anesthesia, Montreal Children’s Hospital, McGill University, Montreal, QC H4A 3J1, Canada
| | - Thomas Engelhardt
- Department of Anesthesia, Montreal Children’s Hospital, McGill University, Montreal, QC H4A 3J1, Canada
- Correspondence: ; Tel.: +1-(514)-412-4400 (ext. 24453); Fax: +1-(514)-938-7399
| | - Pablo Ingelmo
- Department of Anesthesia, Montreal Children’s Hospital, McGill University, Montreal, QC H4A 3J1, Canada
| | - Federico Mentegazzi
- Intensive Care Medicine, Queens Hospital, BHR University Hospital, Romford RM7 0AG, UK
| | - Gianluca Bertolizio
- Department of Anesthesia, Montreal Children’s Hospital, McGill University, Montreal, QC H4A 3J1, Canada
| |
Collapse
|
10
|
Miró J, Solé E, Castarlenas E, Ingelmo P, Nolla MDC, Escribano J, Reinoso-Barbero F. The Treatment of Pediatric Pain in Spain: A Survey Study. Int J Environ Res Public Health 2023; 20:2484. [PMID: 36767850 PMCID: PMC9915536 DOI: 10.3390/ijerph20032484] [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: 12/21/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Pain is a common experience among children and adolescents, and pain management in this population is a challenge to clinicians. The aims of this study were to increase our understanding of current practices in the management of both acute and chronic pediatric pain in Spain, explore potential barriers to ideal practices, and identify professional needs as perceived by healthcare professionals. A total of 277 healthcare professionals took part, all of whom had wide experience in managing children and adolescents with pain (M [SD] age = 44.85, [10.73]; 75% women). Participants had to respond to a web-based survey with 50 questions related to pain education, organizational characteristics of their pain programs (including the characteristics of the patients treated), and current practices in the assessment and treatment of children and adolescents with pain. Almost all the participants (93%) acknowledged important gaps in their training, and only 47% reported that they had received specific education on the management of pediatric pain during their undergraduate and postgraduate studies. A third (31%) were members of multidisciplinary teams, and almost all (99%) understood that protocols to guide the management of pain in young people were necessary. However, only a few of them used a protocol to assess and treat (56% and 48%, respectively) acute and chronic pain (24% and 23%, respectively). The data also showed that a lack of pain education, coordination of professionals, and guidelines was perceived as an important barrier in the care provided to children and adolescents with pain in Spain. The findings of this study can now be used by healthcare professionals in Spain interested in managing pediatric pain, as well as policymakers concerned to improve the education of professionals and the care given to young people with pain.
Collapse
Affiliation(s)
- Jordi Miró
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
| | - Ester Solé
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
| | - Elena Castarlenas
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
| | - Pablo Ingelmo
- Department of Anesthesia, McGill University, 1001 Boul. Decarie, Montreal, QC H4A 3J1, Canada
| | - Maria del Carme Nolla
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
- Xarxa Social i Sanitària, 43003 Tarragona, Spain
| | - Joaquín Escribano
- School of Medicine, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain
- Department of Pediatrics, Hospital Universitari Sant Joan, Avgda. Dr. Josep Laporte 2, 43204 Reus, Spain
| | - Francisco Reinoso-Barbero
- Pediatric Anesthesiology Service, Hospital Universitario La Paz, P. Castellana 261, 28046 Madrid, Spain
| |
Collapse
|
11
|
Antel R, Ingelmo P. Toxicité systémique des anesthésiques locaux. CMAJ 2022; 194:E1704. [DOI: 10.1503/cmaj.220835-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
|
12
|
Bruneau A, Carrié S, Moscaritolo L, Ingelmo P. Mechanism-Based Pharmacological Treatment for Chronic Non-cancer Pain in Adolescents: Current Approaches and Future Directions. Paediatr Drugs 2022; 24:573-583. [PMID: 36053398 DOI: 10.1007/s40272-022-00534-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/26/2022]
Abstract
Chronic non-cancer pain in pediatrics is a widespread phenomenon that affects about 20% of adolescents (10-19 years old). Although interdisciplinary pain treatment programs, which often include pharmacological treatment, have emerged as the standard of care in management of this patient population, evidence regarding an optimal treatment is lacking. The efficacy and safety profiles of pharmacological treatments used to help adolescents suffering from chronic non-cancer pain remain understudied. This lack of evidence may increase polypharmacy and the risk of drug interactions and adverse events. This review examines evidence for the use of pharmacological treatments prescribed to treat chronic pain in adolescents (10-19 years old), with a focus on mechanism-based pharmacology. The objectives of this review are to: (a) review the evidence for mechanism-based pharmacological treatments for chronic non-cancer pain in adolescents and (b) describe the pharmacological agents that are commonly prescribed to manage chronic pain in adolescents, including dosage information, mechanism, and potential adverse effects. Pharmacological treatments should be used carefully with adolescents, ideally within an interdisciplinary treatment program that will incorporate physical rehabilitation, integrative medicine/active mind-body techniques, psychology, and global efforts to normalize daily activities.
Collapse
Affiliation(s)
- Alice Bruneau
- Faculty of Medicine, McGill University, Montreal, QC, H3A 0C7, Canada.
| | - Sabrina Carrié
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children's Hospital, Montreal, QC, Canada
- Department of Anaesthesia, McGill University, Montreal, QC, Canada
| | - Lorenzo Moscaritolo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children's Hospital, Montreal, QC, Canada
- Department of Anaesthesia, McGill University, Montreal, QC, Canada
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children's Hospital, Montreal, QC, Canada
- Department of Anaesthesia, McGill University, Montreal, QC, Canada
- Alan Edward Centre for Research on Pain, Montreal, QC, Canada
- Research Institute, McGill University Health Center, Montreal, QC, Canada
| |
Collapse
|
13
|
Affiliation(s)
- Ryan Antel
- Faculty of Medicine and Health Sciences (Antel), McGill University; Department of Anesthesia (Ingelmo), Montreal Children's Hospital, McGill University Health Centre, Montréal, Que.
| | - Pablo Ingelmo
- Faculty of Medicine and Health Sciences (Antel), McGill University; Department of Anesthesia (Ingelmo), Montreal Children's Hospital, McGill University Health Centre, Montréal, Que
| |
Collapse
|
14
|
Vigouroux M, Amja K, Bertolizio G, Ingelmo P, Hovey R. Reflecting back to move forward: Lessons learned about COVID-19 safety protocols from pediatric anesthesiologists. Paediatr Anaesth 2022; 32:1138-1143. [PMID: 35852924 PMCID: PMC9349821 DOI: 10.1111/pan.14531] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 06/17/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic brought about the immediate need for enhanced safety protocols in health care centers. These protocols had to evolve as knowledge and understanding of the disease quickly broadened. AIMS Through this study, the researchers aimed to understand the experiences of pediatric anesthesiologists at the Montreal Children's Hospital and the Shriners' Hospital Canada as they navigated the first wave of COVID-19 at their institutions. METHODS Nine participants from the Montreal Children's Hospital and the Shriners' Hospital were interviewed. Interviews were recorded, transcribed verbatim, and then analyzed using an applied philosophical hermeneutics approach. FINDINGS Participants expressed their wish for simple and easy-to-apply protocols while recognizing the challenge of keeping up with evolving knowledge on the disease and its transmission. They pointed to some limitations and unintended consequences of the safety protocols and the system-wide flaws that the COVID-19 pandemic helped bring to light. They described their frustrations with some aspects of the safety protocols, which they at times felt could be more efficient or better suited for their daily practice. CONCLUSIONS The findings of this study highlighted the importance of listening to and empowering anesthesiology staff working in the field during crises, the implications of shifting from patient-centered care to community-centered care, and the fine line between sharing as much emerging information as possible and overwhelming staff with information.
Collapse
Affiliation(s)
- Marie Vigouroux
- Faculty of Dental Medicine and Oral Health SciencesMcGill UniversityMontrealQuebecCanada,Edwards Family Interdisciplinary Centre for Complex PainMontreal Children's HospitalMontrealQuebecCanada
| | - Kristina Amja
- Faculty of Dental Medicine and Oral Health SciencesMcGill UniversityMontrealQuebecCanada
| | - Gianluca Bertolizio
- Department of AnesthesiaMontreal Children's HospitalMontrealQuebecCanada,Department of Anesthesia, Faculty of Medicine and Health SciencesMcGill UniversityMontrealQuebecCanada
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Centre for Complex PainMontreal Children's HospitalMontrealQuebecCanada,Department of Anesthesia, Faculty of Medicine and Health SciencesMcGill UniversityMontrealQuebecCanada
| | - Richard Hovey
- Faculty of Dental Medicine and Oral Health SciencesMcGill UniversityMontrealQuebecCanada
| |
Collapse
|
15
|
Stoopler M, Choinière M, Nam A, Guigui A, Walfish L, Mohamed N, Vigouroux M, González-Cárdenas VH, Ingelmo P. Chronic pain-related consultations to the emergency department of children with complex pain conditions: A retrospective analysis of healthcare utilization and costs. Can J Pain 2022; 6:86-94. [PMID: 35756890 PMCID: PMC9225287 DOI: 10.1080/24740527.2022.2070840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background There is limited information regarding the effects of pediatric chronic pain management on the number and cost of chronic pain–related emergency department (ED) consultations. Aim This retrospective study aimed to evaluate the number and costs of chronic pain–related ED consultations of children and adolescents with chronic pain conditions at the Montreal Children’s Hospital (MCH). Methods Charts of patients followed by the Edwards Family Interdisciplinary Center for Complex Pain (CCP) of the MCH between April 2017 and December 2018 were reviewed. ED consultations, specialist consultations, medication prescriptions, hospital admissions, and outpatient consultation referrals were assessed for the period of 1 year before and after the patients’ first consultation with the CCP. Associated costs were also calculated. Results One-hundred sixty-eight patients were included in the analysis. Fifty-one percent consulted the ED and had 151 chronic pain–related ED consultations within 1 year before their initial CCP consultation. In the year following their first CCP consultation, 52 patients (31%) consulted the ED, of which 24 consultations were chronic pain–related (84% reduction). There was an 81% reduction in the costs associated with chronic pain–related ED consultations within 1 year after CCP management. In addition, there was a significant reduction in ED interventions within 1 year after CCP management, though there was no change in medication prescriptions, hospital admissions, or subspecialist consultations. Conclusion Children and adolescents with chronic pain conditions had fewer chronic pain–related ED consultations within 1 year after the first evaluation by an interdisciplinary center for complex pain, contributing to reduced ED costs.
Collapse
Affiliation(s)
- Michelle Stoopler
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Manon Choinière
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Quebec, Canada
- Research Center of the Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Annabelle Nam
- McGill University Health Center, Montreal, Quebec, Canada
| | - André Guigui
- McGill University Health Center, Montreal, Quebec, Canada
| | - Laurel Walfish
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Nada Mohamed
- Edwards Family Interdisciplinary Center for Complex Pain, Department of Anesthesia, Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Marie Vigouroux
- Edwards Family Interdisciplinary Center for Complex Pain, Department of Anesthesia, Montreal Children’s Hospital, Montreal, Quebec, Canada
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Victor-Hugo González-Cárdenas
- School of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia
- Department of Anesthesia, Los Cobos Medical Center; Department of Anesthesia, Pain & Palliative Care, Hospital Universitario de la Samaritana, Bogotá, Colombia
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Department of Anesthesia, Montreal Children’s Hospital, Montreal, Quebec, Canada
- Research Institute. McGill University Health Center, Montreal, Canada
- Alan Edwards Centre for Research on Pain. Montreal, Canada
| |
Collapse
|
16
|
Myers KA, Barmherzig R, Raj NR, Berrahmoune S, Ingelmo P, Saint-Martin C, Khan AQ, Kouri M, Morris C, Hershey AD, Kacperski J, Kabbouche MA, Mohamed N, Rao RR, Lagman-Bartolome AM, Gelfand AA, Szperka CL, Orr SL. The spectrum of indomethacin-responsive headaches in children and adolescents. Cephalalgia 2022; 42:793-797. [PMID: 35302385 PMCID: PMC9218410 DOI: 10.1177/03331024221076483] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Headaches with marked, specific response to indomethacin occur in children, but the phenotypic spectrum of this phenomenon has not been well-studied. Methods We reviewed pediatric patients with headache showing ≥80% improvement with indomethacin, from seven academic medical centers. Results We included 32 pediatric patients (16 females). Mean headache onset age was 10.9 y (range 2–16 y). Headache syndromes included hemicrania continua (n = 13), paroxysmal hemicrania (n = 10), primary stabbing headache (n = 2), short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (n = 1), primary exercise headache (n = 1) and primary cough headache (n = 1). Adverse events were reported in 13, most commonly gastrointestinal symptoms, which often improved with co-administration of gastro-protective agents. Conclusion Indomethacin-responsive headaches occur in children and adolescents, and include headache syndromes, such as primary cough headache, previously thought to present only in adulthood. The incidence of adverse events is high, and patients must be co-treated with a gastroprotective agent.
Collapse
Affiliation(s)
- Kenneth A Myers
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Division of Child Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.,Department of Neurology and Neurosurgery, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Rebecca Barmherzig
- Department of Neurology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Nichelle R Raj
- Department of Neurology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Saoussen Berrahmoune
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Pablo Ingelmo
- Department of Pediatric Anesthesiology, McGill University Health Center, Montreal, Quebec, Canada
| | | | - Afsheen Q Khan
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Megan Kouri
- Faculty of Medicine, 5620McGill University, McGill University, Montreal, Quebec, Canada
| | - Cynthia Morris
- Child and Adolescent Headache Program, University of California San Francisco, San Francisco, CA, USA.,Department of Child Neurology, Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Andrew D Hershey
- Departments of Pediatrics and Neurology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joanne Kacperski
- Departments of Pediatrics and Neurology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marielle A Kabbouche
- Departments of Pediatrics and Neurology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nada Mohamed
- Department of Pediatric Anesthesiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Rashmi R Rao
- Department of Neurology, Louisiana State University Health Sciences Center and Children's Hospital New Orleans, New Orleans, LA, USA
| | - Ana Marissa Lagman-Bartolome
- Division of Neurology, Hospital for Sick Children and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amy A Gelfand
- Child and Adolescent Headache Program, University of California San Francisco, San Francisco, CA, USA
| | - Christina L Szperka
- Department of Neurology, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, USA
| | - Serena L Orr
- Division of Neurology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
17
|
Ahmed N, Vigouroux M, Ingelmo P. Implications of Nerve Fiber Density on the Diagnosis and Treatment of Juvenile Fibromyalgia. J Pain Res 2022; 15:513-520. [PMID: 35210850 PMCID: PMC8860391 DOI: 10.2147/jpr.s340038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/28/2022] [Indexed: 11/23/2022] Open
Abstract
Juvenile fibromyalgia (JFM) is a condition that presents as chronic widespread musculoskeletal pain and affects children and adolescents. JFM remains a challenging diagnosis, as it is both based on subjective criteria and the pathogenesis is poorly understood. Small fiber neuropathy (SFN) is a distinct condition, which is characterized by pathology of small A-delta and C fibers, and can present similarly to JFM. Small fiber pathology is characterized by reduced intraepidermal nerve fiber density (IENFD) on skin biopsy. Recent studies have found that as many as half of patients with JFM can demonstrate decreased IENFD, in pattern similar to SFN. This phenomenon has been referred to as small fiber pathology. The meaning of these findings was disputed; however, the current consensus remains that fibromyalgia and SFN are distinct conditions. Additionally, among patients with fibromyalgia, there are two phenotypes: those with small fiber pathology and those without. The purpose of this review was to characterize the role assessment of IENFD plays in the clinical context. We conducted a narrative review of pertinent articles pertaining to JFM, SFN and small fiber pathology in fibromyalgia. We concluded that assessment of IENFD should be completed if SFN is suspected either when a patient first presents or in patients who were previously diagnosed with fibromyalgia and SFN is later suspected. Distinguishing between JFM and SFN is important because recommended therapies differ between the two conditions. However, there is no evidence to support the use of skin biopsy to distinguish between the two discussed fibromyalgia phenotypes. More studies are needed to elucidate whether IENFD varies with morbidity and if both fibromyalgia phenotypes vary in their response to different therapeutic regimens.
Collapse
Affiliation(s)
- Nabeel Ahmed
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Marie Vigouroux
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
- Correspondence: Marie Vigouroux, Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, 1001 boul. Décarie A02.3523, Montreal, QC, H4A 3J1, Canada, Tel +1 514 412 4448, Fax +1 514 412 4341, Email
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
- Research Institute, McGill University Health Centre, Montreal, QC, Canada
- Alan Edwards Research Center for Pain, McGill University, Montreal, QC, Canada
| |
Collapse
|
18
|
Stoopler M, Vigouroux M, Mohamed N, Macabuag Y, Ingelmo P. Long-term efficacy and adverse effects of outpatient procedural analgesia with nitrous oxide for a child with Epidermolysis Bullosa. Paediatr Anaesth 2022; 32:85-87. [PMID: 34709687 DOI: 10.1111/pan.14318] [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: 03/24/2021] [Revised: 08/25/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
Epidermolysis Bullosa is a dermatologic condition characterized by skin fragility and the formation of painful blisters all over the body. The course of this chronic hereditary disorder involves multiple painful procedures for which adequate analgesia is an ongoing challenge. This case report follows a previously-described pediatric patient with the Dowling-Meara variant of Epidermolysis Bullosa who was treated with at-home nitrous oxide for daily procedural analgesia. We report on the long-term effectiveness of this treatment in addition to any side effects encountered as a result of this treatment.
Collapse
Affiliation(s)
- Michelle Stoopler
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Marie Vigouroux
- Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.,Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Nada Mohamed
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Yandy Macabuag
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children's Hospital, Montreal, Quebec, Canada.,Department of Anesthesia, McGill University, Montreal, Quebec, Canada.,The Alan Edwards Center for Research on Pain, Montreal, Quebec, Canada
| |
Collapse
|
19
|
Daniel SJ, von Ungern-Sternberg BS, Ingelmo P. Without training, they lacked knowledge. Without knowledge, they lacked confidence. Without confidence, they lacked victory (Julius Caesar). Paediatr Anaesth 2021; 31:1138-1139. [PMID: 34658109 DOI: 10.1111/pan.14267] [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] [Received: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sam J Daniel
- Department of Otolaryngology - Head and Neck Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Qc, Canada.,Research Institute, McGill University Health Center, Montreal, Qc, Canada
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, Perioperative Medicine, Perth, WA, Australia
| | - Pablo Ingelmo
- Research Institute, McGill University Health Center, Montreal, Qc, Canada.,Department of Anesthesia, Montreal Children's Hospital, McGill University Health Centre, Montreal, Qc, Canada
| |
Collapse
|
20
|
Boisvert-Plante V, Noutsios CD, Perez J, Ingelmo P. The Telemedicine-Based Pediatric Examination of the Neck and Upper Limbs: A Narrative Review. J Pain Res 2021; 14:3173-3192. [PMID: 34675645 PMCID: PMC8519790 DOI: 10.2147/jpr.s336168] [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: 09/01/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022] Open
Abstract
With the COVID-19 pandemic hastening the adoption of telemedicine into clinical practice, it has also prompted an abundance of new literature highlighting its capabilities and limitations. The purpose of this review is to summarize the current state of the literature on telemedicine applied in the context of a musculoskeletal examination of the neck and upper limbs for children 3 to 18 years old. The PubMed and ScienceDirect databases were searched for relevant articles from January 2015 to August 2021 using a combination of keywords and nested searches. General examination components including inspection, guided self-palpation, range of motion, sensory and motor examination, as well as special testing are described. Although the literature is focused mainly on adult populations, we describe how each component of the exam can be reliably incorporated into a virtual appointment specific to pediatric patients. Caregivers are generally needed for most consultations, but certain maneuvers can be self-performed by older children and adolescents alone. There is general feasibility, validity, and substantial reliability in performing most examination components of the upper limbs remotely, except for the shoulder exam. Compared to those made in person, clinical diagnoses established virtually were found to be either the same or similar in most cases, and management decisions also had high agreement. Despite this, there is evidence that some pediatric providers may not be able to collect all the information needed from a telemedicine visit to make a complete clinical assessment. Lastly, currently available smartphone applications measuring joint range of motion were found to have high reliability and validity. This narrative review not only establishes a foundation for a structured pediatric musculoskeletal examination, but also aims to increase physicians' confidence in incorporating telemedicine into their standard of care.
Collapse
Affiliation(s)
| | | | - Jordi Perez
- Alan Edwards Pain Management Unit, Montreal General Hospital (McGill University Health Centre), Montreal, QC, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
| | - Pablo Ingelmo
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
- Edwards Family Interdisciplinary Complex Pain Centre, Montreal Children’s Hospital (McGill University Health Centre), Montreal, QC, Canada
| |
Collapse
|
21
|
Noutsios CD, Boisvert-Plante V, Laberge E, Perez J, Ingelmo P. The Telemedicine-Based Pediatric Examination of the Back and Lower Limbs: A Narrative Review. J Pain Res 2021; 14:2959-2979. [PMID: 34584449 PMCID: PMC8464344 DOI: 10.2147/jpr.s329173] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/03/2021] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic has accelerated the transition to virtual healthcare while also prompting an abundance of new literature highlighting telemedicine's capabilities and limitations for various medical applications, notably musculoskeletal examinations. Telemedicine provides an opportunity to deliver timely patient- and family-centred care while maintaining physical distancing and improving access to remote communities. This review aims to narrate the current state of the literature on telemedicine applied in the context of a musculoskeletal examination for children aged 3 to 18 years. The PubMed and ScienceDirect databases were searched for relevant articles from January 2015 to August 2021 using a combination of keywords and nested searches. The general examination components relevant to the back and lumbosacral spine, hip, knee, ankle/foot, and gait are described. These components include inspection, palpation, range of motion, motor, and sensory examination as well as special testing. There is general feasibility, validity, and substantial reliability in performing most examination components, and primary diagnoses established virtually were found to be either the same or similar in the vast majority of cases. Despite the current literature focusing mainly on adult populations, we describe how each aspect of the exam can be reliably incorporated into a virtual appointment specific to the pediatric population. Currently available smartphone-based applications that measure joint range of motion were generally found to have high reliability and validity. Caregivers are needed for most of the consultation, especially in younger children, but select physical exam maneuvers can be self-performed by older children and adolescents alone. By providing an overview of the available smartphone tools as well as the reliability and validity of remote assessments, this review not only establishes a foundation for a structured pediatric musculoskeletal examination, but also aims to increase providers' confidence in incorporating telemedicine into their practice.
Collapse
Affiliation(s)
| | | | - Erika Laberge
- Edward’s Family Interdisciplinary Centre for Pediatric Complex Pain, Montreal Children’s Hospital (McGill University Health Centre), Montreal, QC, Canada
| | - Jordi Perez
- Alan Edwards Pain Management Unit, Montreal General Hospital (McGill University Health Centre), Montreal, QC, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
| | - Pablo Ingelmo
- Edward’s Family Interdisciplinary Centre for Pediatric Complex Pain, Montreal Children’s Hospital (McGill University Health Centre), Montreal, QC, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
- Research Institute, McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
22
|
Walfish L, Sbrocchi AM, Rivera G, Ricaurte Gracia YLN, Mohamed N, González Cárdenas VH, Stoopler M, Ingelmo P. Use of bisphosphonates in a retrospective case series of children and adolescents with complex regional pain syndrome. Paediatr Anaesth 2021; 31:871-877. [PMID: 33999470 DOI: 10.1111/pan.14207] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is increasing evidence for the use of bisphosphonates to treat Complex Regional Pain Syndrome in adults. However, there are scarce data for their use in children with Complex Regional Pain Syndrome. AIM This retrospective case series aimed to analyze the effects of intravenous bisphosphonate use in children and adolescents with Complex Regional Pain Syndrome enrolled in a multidimensional pain treatment program. METHODS We analyzed the data of 16 patients (15 females and 1 male, mean age 14 ± 3 years) who received infusions of zoledronic acid (0.015 ± 0.0044mg/kg), pamidronate (0.72 ± 0.17mg/kg), or both depending on their initial response between October 2014 and December 2019. The primary endpoint of the study was the patient's global impression of change. Secondary outcomes included pain intensity, physical function, role function (school attendance), need for pain medications, and adverse effects. RESULTS Nine of 16 patients reported meaningful improvements (global impressions of change of 84% or higher) at a median follow-up time of 16 (8-21) months after their last infusion of bisphosphonates. There were also meaningful reductions in pain intensity and the need for pain medications. There was an increase in the proportion of patients with minimal or without physical disability, and almost all patients normalized their school activities. Thirteen patients (81%) reported adverse effects, mostly flu-like symptoms, for a few days after the infusion. CONCLUSION The use of bisphosphonate infusions may represent an effective treatment option for children with Complex Regional Pain Syndrome, not responding to multidisciplinary pain treatment programs.
Collapse
Affiliation(s)
- Laurel Walfish
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Anne Marie Sbrocchi
- Department of Endocrinology, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Gonzalo Rivera
- Chronic Pain Unit, Department of Anesthesia, Clínica Las Condes, Santiago, Chile
| | | | - Nada Mohamed
- Department of Pediatric Anesthesia, Edwards Family Interdisciplinary Centre for Chronic Pain, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Víctor Hugo González Cárdenas
- School of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia.,Department of Anesthesia, Department of Anesthesia, Pain & Palliative Care, Los Cobos Medical Center, Hospital Universitario de la Samaritana, Bogotá, Colombia
| | | | - Pablo Ingelmo
- Department of Pediatric Anesthesia, Edwards Family Interdisciplinary Centre for Chronic Pain, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada.,The Alan Edward Centre for Research on Pain, McGill University, Montreal, QC, Canada
| |
Collapse
|
23
|
Kouri M, Somaini M, Cárdenas VHG, Niburski K, Vigouroux M, Ingelmo P. Transnasal Sphenopalatine Ganglion Block for the Preventive Treatment of Chronic Daily Headache in Adolescents. Children (Basel) 2021; 8:606. [PMID: 34356585 PMCID: PMC8306937 DOI: 10.3390/children8070606] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 11/25/2022]
Abstract
Chronic headaches are a major source of morbidity in the pediatric population, affecting physical function, school attendance, social capacity, mood, and sleep. In adults, repetitive sphenopalatine ganglion (SPG) blockade has been studied as a preventive treatment for chronic migraines. This case series aims to evaluate the SPG block for the preventive treatment of chronic daily headache (CDH) in adolescents. We prospectively evaluated 17 adolescents (14 females, 14 ± 1 year) with CDH not responding to cognitive behavioral therapy (CBT), physiotherapy, and standard medications. Each patient received 10 SPG blocks (two blocks/week) using the Tx360® device. At the end of treatment, 10 patients (59%) reported a Patient's Global Impression of Change (PGIC) score ≥ 67%, and 3 months after the end of treatment, nine patients (53%) sustained a PGIC ≥ 67%. There was also a statistically significant reduction in the depression subscale of the Revised Children's Anxiety and Depression Scale (RCADS) at the end of treatment and 3 months post-treatment compared with baseline. The procedure was well tolerated with no adverse effects. In our study, the use of repeat SPG blockade was associated with sustained benefits on the PGIC and the depression subscale of the RCADS when used as preventive headache treatment in adolescents with refractory CDH.
Collapse
Affiliation(s)
- Megan Kouri
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada; (M.K.); (K.N.)
| | - Marta Somaini
- Department of Anaesthesia, Grande Ospedale Metropolitano Niguarda, 201262 Milano, Italy;
| | - Victor Hugo González Cárdenas
- Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), 111221 Bogotá, Colombia;
- Department of Anesthesia, Los Cobos Medical Center, 110121 Bogotá, Colombia
- Department of Anesthesia, Pain and Palliative Care, Hospital Universitario de la Samaritana, 110411 Bogotá, Colombia
| | - Kacper Niburski
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada; (M.K.); (K.N.)
| | - Marie Vigouroux
- Faculty of Dentistry, McGill University, Montreal, QC H3A 1G1, Canada;
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC H4A 3J1, Canada
- The Alan Edwards Centre Research on Pain, McGill University, Montreal, QC H3A 0G1, Canada
| |
Collapse
|
24
|
Killackey T, Noel M, Birnie KA, Choinière M, Pagé MG, Dassieu L, Lacasse A, Lalloo C, Brennenstuhl S, Poulin P, Ingelmo P, Ali S, Battaglia M, Campbell F, Smith A, Harris L, Mohabir V, Benayon M, Jordan I, Marianayagam J, Stinson J. COVID-19 Pandemic Impact and Response in Canadian Pediatric Chronic Pain Care: A National Survey of Medical Directors and Pain Professionals. Can J Pain 2021; 5:139-150. [PMID: 34263096 PMCID: PMC8253119 DOI: 10.1080/24740527.2021.1931069] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: The COVID-19 pandemic presents one of the greatest threats to pediatric pain care seen in generations. Due to public health restrictions, many pediatric pain clinics halted in-person appointments, delaying and disrupting access to care. There is no existing research on the impacts of COVID-19 on pediatric chronic pain care in Canada or the challenges experienced by health care professionals and pain clinics. Aims: The aim of this study was to evaluate the impact of COVID-19 on Canadian pediatric chronic pain care by documenting how health care professionals provided care during the first six months of the pandemic. Methods: Two Canadian online cross-sectional surveys were conducted: one among Canadian pediatric pain clinic directors (Study 1) and another among multidisciplinary pediatric pain health care professionals (Study 2). Results: Responses from 13/13 Canadian pediatric pain clinics/rehabilitation programs indicated that all clinics provided virtual care during the pandemic. No significant changes were reported on the frequency of appointment requests. Most clinics reported no perceived change in patient pain levels (n = 9/13, 69%) or occurrence of pain flares (n = 10/13, 77%). Results from 151 individual health care professionals indicated that the majority (90%) of non–emergency department respondents were providing virtual care. The main challenges of virtual care included technological barriers, financial concerns, infrastructure and logistics, privacy, and clinical challenges. Conclusions: This study documented the impact of the COVID-19 pandemic on pediatric chronic pain care in Canada and highlighted the rapid shift to using virtual solutions. Simultaneously, respondents outlined current challenges and potential solutions to consider in the development of virtual care guidelines and policy in Canada.
Collapse
Affiliation(s)
- Tieghan Killackey
- The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, Ontario, Canada
| | - Melanie Noel
- Alberta Children's Hospital, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Manon Choinière
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - M Gabrielle Pagé
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Lise Dassieu
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,Department of Biomedical Sciences, Université de Montréal, Montreal, Quebec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Chitra Lalloo
- The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Poulin
- Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Pablo Ingelmo
- Chronic Pain Service, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Samina Ali
- Departments of Pediatrics & Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marco Battaglia
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Division of Child Youth & Emerging Adulthood Psychiatry, CAMH, Toronto, Ontario, Canada
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Smith
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Interprofessional Pain and Addiction Recovery Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lauren Harris
- The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, Ontario, Canada
| | - Vina Mohabir
- The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, Ontario, Canada
| | - Myles Benayon
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Jennifer Stinson
- The Hospital for Sick Children, Child Health Evaluative Sciences, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Niburski K, Ingelmo P, Buu N. The COVID-19 match: what Canadian anesthesia programs can do for the virtual match cycles. Can J Anaesth 2021; 68:930-931. [PMID: 33598885 PMCID: PMC7889300 DOI: 10.1007/s12630-021-01949-9] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Kacper Niburski
- Faculty of Medicine, McGill University, Montreal, QC, Canada.
| | - Pablo Ingelmo
- Department of Pediatric Anesthesia, McGill University of Health Center, Montreal, QC, Canada
| | - Natalie Buu
- Department of Pediatric Anesthesia, McGill University of Health Center, Montreal, QC, Canada
- McGill Residency Program in Anesthesiology, Montreal, QC, Canada
| |
Collapse
|
26
|
Noutsios CD, Boisvert-Plante V, Perez J, Hudon J, Ingelmo P. Telemedicine Applications for the Evaluation of Patients with Non-Acute Headache: A Narrative Review. J Pain Res 2021; 14:1533-1542. [PMID: 34103978 PMCID: PMC8179807 DOI: 10.2147/jpr.s309542] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/09/2021] [Indexed: 12/17/2022] Open
Abstract
The COVID-19 pandemic has spurred a hasty transition to virtual care but also an abundance of new literature highlighting telehealth’s capabilities and limitations for various healthcare applications. In this review, we aim to narrate the current state of the literature on telehealth applied to migraine care. First, telemedicine in the context of non-acute headache management has been shown to produce non-inferior patient outcomes when compared to traditional face-to-face appointments. The assignment of patients to telehealth appointments should be made after referring more urgent cases to dedicated in-person clinics. During the virtual appointment, physicians can ask their patients about the “3 F’s” in order to perform a thorough assessment of their headaches: frequency of headache days, frequency of acute medication usage and functional impairment. Clinical assessment scores that have been studied and deemed feasible for telemedicine, safe and efficient include the HIT-6, VAS and MIDAS scores. Although MIDAS was found to be redundant and inadequate to use on a daily basis, we suggest that it can be useful in periodic remote follow-up appointments. Additionally, several mobile health apps have been studied including Migraine Buddy, Migraine Coach and Migraine Monitor. All of these are appropriate for use in telemedicine when combined with an adequate trial period with Migraine Buddy being rated the highest, as it captures the most detailed clinical picture. High satisfaction rates have been reported for virtual headache management which were shown to be equal to in-person consults. These are based on patients’ perceived increase in convenience due to avoided travel time, less disruption of their daily routine and feeling more comfortable in the environment of their choice. Despite this, limitations such as technological knowledge, access to videoconferencing modalities and having a more impersonal consultation with the physician may hinder some patients from adopting this service.
Collapse
Affiliation(s)
| | | | - Jordi Perez
- Alan Edwards Pain Management Unit. Montreal General Hospital, McGill University Health Center, Montreal, QC, Canada.,Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada
| | - Jonathan Hudon
- Alan Edwards Pain Management Unit. Montreal General Hospital, McGill University Health Center, Montreal, QC, Canada.,Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada.,Edwards Family Interdisciplinary Complex Pain Centre, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada.,Faculty Lecturer (Clinical), Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Division of Secondary Care, Department of Family Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Pablo Ingelmo
- Alan Edwards Centre for Pain Research, McGill University, Montreal, QC, Canada.,Edwards Family Interdisciplinary Complex Pain Centre, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| |
Collapse
|
27
|
Niburski K, Ingelmo P, Bertolizio G. Perioperative respiratory adverse events in children with Trisomy 21: good news to look forward to. Paediatr Anaesth 2021; 31:388-389. [PMID: 33772958 DOI: 10.1111/pan.14139] [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] [Received: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Kacper Niburski
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Pablo Ingelmo
- Department of Pediatric Anesthesia, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Gianluca Bertolizio
- Department of Pediatric Anesthesia, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| |
Collapse
|
28
|
Poirier C, Alencar Cavalcante Nascimento Lima L, Ingelmo P. It is time to prove that regional anesthesia can be a game changer in the recovery after surgery in children. Minerva Anestesiol 2020; 87:634-636. [PMID: 33331754 DOI: 10.23736/s0375-9393.20.15270-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Pablo Ingelmo
- Department of Anesthesiology, Montreal Children's Hospital, McGill University, Montreal, QC, Canada -
| |
Collapse
|
29
|
Szwimer R, Widjaja M, Ingelmo P, Hovey RB. A Phenomenological Exploration of the Personal Implications of Female Adolescents Living With Chronic Pain. J Pediatr Health Care 2020; 34:470-477. [PMID: 32861426 DOI: 10.1016/j.pedhc.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/14/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Chronic pain (CP) negatively impacts everyday previously taken-for-granted activities resulting in considerable psychosocial stress for the individual. Qualitative research in pediatric CP is limited despite the considerable influence CP has on the process of establishing one's personal identity during these formative years and invites the opportunity to understand how CP affects these young individuals from their perspective. The objective of the study was to inquire into the experiences of female adolescents living with CP in order to enhance our understanding of how CP affects their personal lives. METHOD We used an interpretive phenomenological approach; two researchers interviewed eight female patients of the Montreal Children's Hospital Chronic Pain Management Clinic (aged 14-17 years) for one session each. RESULTS Self-reported factors that improved these female adolescents' personal life included having engaging hobbies, accepting the incurability of CP, and envisioning a fulfilling future. DISCUSSION The findings from this study suggest a need to orient CP-related services around goals and interests that female adolescents living with CP set for themselves in order to improve their perceived quality of life.
Collapse
|
30
|
Matava CT, Kovatsis PG, Summers JL, Castro P, Denning S, Yu J, Lockman JL, Von Ungern-Sternberg B, Sabato S, Lee LK, Ayad I, Mireles S, Lardner D, Whyte S, Szolnoki J, Jagannathan N, Thompson N, Stein ML, Dalesio N, Greenberg R, McCloskey J, Peyton J, Evans F, Haydar B, Reynolds P, Chiao F, Taicher B, Templeton T, Bhalla T, Raman VT, Garcia-Marcinkiewicz A, Gálvez J, Tan J, Rehman M, Crockett C, Olomu P, Szmuk P, Glover C, Matuszczak M, Galvez I, Hunyady A, Polaner D, Gooden C, Hsu G, Gumaney H, Pérez-Pradilla C, Kiss EE, Theroux MC, Lau J, Asaf S, Ingelmo P, Engelhardt T, Hervías M, Greenwood E, Javia L, Disma N, Yaster M, Fiadjoe JE. Pediatric Airway Management in COVID-19 Patients: Consensus Guidelines From the Society for Pediatric Anesthesia's Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society. Anesth Analg 2020; 131:61-73. [PMID: 32287142 PMCID: PMC7173403 DOI: 10.1213/ane.0000000000004872] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2020] [Indexed: 12/14/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) pandemic has challenged medical systems and clinicians globally to unforeseen levels. Rapid spread of COVID-19 has forced clinicians to care for patients with a highly contagious disease without evidence-based guidelines. Using a virtual modified nominal group technique, the Pediatric Difficult Intubation Collaborative (PeDI-C), which currently includes 35 hospitals from 6 countries, generated consensus guidelines on airway management in pediatric anesthesia based on expert opinion and early data about the disease. PeDI-C identified overarching goals during care, including minimizing aerosolized respiratory secretions, minimizing the number of clinicians in contact with a patient, and recognizing that undiagnosed asymptomatic patients may shed the virus and infect health care workers. Recommendations include administering anxiolytic medications, intravenous anesthetic inductions, tracheal intubation using video laryngoscopes and cuffed tracheal tubes, use of in-line suction catheters, and modifying workflow to recover patients from anesthesia in the operating room. Importantly, PeDI-C recommends that anesthesiologists consider using appropriate personal protective equipment when performing aerosol-generating medical procedures in asymptomatic children, in addition to known or suspected children with COVID-19. Airway procedures should be done in negative pressure rooms when available. Adequate time should be allowed for operating room cleaning and air filtration between surgical cases. Research using rigorous study designs is urgently needed to inform safe practices during the COVID-19 pandemic. Until further information is available, PeDI-C advises that clinicians consider these guidelines to enhance the safety of health care workers during airway management when performing aerosol-generating medical procedures. These guidelines have been endorsed by the Society for Pediatric Anesthesia and the Canadian Pediatric Anesthesia Society.
Collapse
Affiliation(s)
- Clyde T. Matava
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pete G. Kovatsis
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
| | - Jennifer Lee Summers
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Pilar Castro
- Department of Anesthesiology and Pain Management, Children’s Hospital of Cleveland Clinic, Cleveland, Ohio
| | - Simon Denning
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie Yu
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Justin L. Lockman
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Stefano Sabato
- Department of Anaesthesia and Pain Management, The Royal Children’s Hospital, Victoria, Australia
| | - Lisa K. Lee
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
| | - Ihab Ayad
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
| | - Sam Mireles
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
| | - David Lardner
- Department of Anesthesia, Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Simon Whyte
- Department of Anesthesiology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Judit Szolnoki
- Department of Anesthesiology; University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
| | | | - Nicole Thompson
- Department of Anesthesiology, Shriners Hospitals for Children, Chicago, Illinois
| | - Mary Lyn Stein
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Nicholas Dalesio
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Robert Greenberg
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - John McCloskey
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - James Peyton
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Anesthesiology and Pain Management, Children’s Hospital of Cleveland Clinic, Cleveland, Ohio
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology and Pain Management, University of Western Australia, Crawley, Australia
- Department of Anaesthesia and Pain Management, The Royal Children’s Hospital, Victoria, Australia
- Department of Anesthesiology, University of California at Los Angeles, Los Angeles, California
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
- Department of Anesthesia, Alberta Children’s Hospital, Calgary, Alberta, Canada
- Department of Anesthesiology, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Department of Anesthesiology; University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, Colorado
- Department of Anesthesiology, Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Anesthesiology, Shriners Hospitals for Children, Chicago, Illinois
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
- Department of Anesthesiology, Duke University, Durham, North Carolina
- Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest, North Carolina
- Department of Anesthesiology and Pain Medicine, Akron Children’s Hospital, Northeast Ohio Medical University, Akron, Ohio
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
- Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas
- Department of Anesthesia, Hospital Son Espases, Illes Balears, Spain
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Anesthesiology, Instituto de Ortopedia Infantil Roosevelt, Bogotá, Colombia
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
- Department of Anesthesiology and Pediatrics, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Department of Anesthesiology, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Anesthesiology, Arkansas Children’s Hospital & University of Arkansas & Medical Science Center, Little Rock, Arkansas
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
- /label>Pediatric Anesthesia Unit, Cardiac and Neonatal Section, Gregorio Marañón University Hospital, Madrid, Spain
- Department of Otorhinolaryngology Head and Neck Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Faye Evans
- Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital of Boston, Harvard School of Medicine, Boston, Massachusetts
| | - Bishr Haydar
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
| | - Paul Reynolds
- Department of Pediatric Anesthesiology, University of Michigan Health Center, Ann Arbor, Michigan
| | - Franklin Chiao
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York
| | - Brad Taicher
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Thomas Templeton
- Department of Anesthesiology, Wake Forest School of Medicine, Wake Forest, North Carolina
| | - Tarun Bhalla
- Department of Anesthesiology and Pain Medicine, Akron Children’s Hospital, Northeast Ohio Medical University, Akron, Ohio
| | - Vidya T. Raman
- Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio
| | | | - Jorge Gálvez
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan Tan
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mohamed Rehman
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christy Crockett
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Patrick Olomu
- Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children’s Health System of Texas, Dallas, Texas
| | - Peter Szmuk
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Chris Glover
- Department of Anesthesiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Maria Matuszczak
- Department of Anesthesiology, University of Texas Medical School at Houston, Houston, Texas
| | - Ignacio Galvez
- Department of Anesthesia, Hospital Son Espases, Illes Balears, Spain
| | - Agnes Hunyady
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - David Polaner
- Department of Anesthesiology and Pain Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Cheryl Gooden
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Grace Hsu
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Harshad Gumaney
- Department of Clinical Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Edgar E. Kiss
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
| | - Mary C. Theroux
- Department of Anesthesiology and Pediatrics, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Lau
- Department of Anesthesiology, Children’s Hospital Los Angeles, Los Angeles, California
| | - Saeedah Asaf
- Department of Anesthesiology, Arkansas Children’s Hospital & University of Arkansas & Medical Science Center, Little Rock, Arkansas
| | - Pablo Ingelmo
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
| | - Thomas Engelhardt
- Montreal Children’s Hospital, McGill University Health Center, McGill University, Montreal, Canada
| | - Mónica Hervías
- /label>Pediatric Anesthesia Unit, Cardiac and Neonatal Section, Gregorio Marañón University Hospital, Madrid, Spain
| | - Eric Greenwood
- From the Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Luv Javia
- Department of Otorhinolaryngology Head and Neck Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nicola Disma
- Department of Pediatric Anesthesia, Istituto Giannina Gaslini, Genova, Italy
| | - Myron Yaster
- Department of Anesthesiology, Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - John E. Fiadjoe
- Department of Anesthesiology, University of Texas Southwestern Medical Center and Children’s Health System of Texas, Dallas, Texas
| |
Collapse
|
31
|
Affiliation(s)
- Marta Somaini
- Department of Anesthesia, Niguarda Ca'Granda Hospital, Milan, Italy -
| | - Pablo Ingelmo
- Department of Anesthesia, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| |
Collapse
|
32
|
Fernandez AM, Reddy SK, Gordish-Dressman H, Muldowney BL, Martinez JL, Chiao F, Stricker PA, Abruzzese C, Apuya J, Beethe A, Benzon H, Binstock W, Brzenski A, Budac S, Busso V, Chhabada S, Cladis F, Claypool D, Collins M, Dabek R, Dalesio N, Falcon R, Fernandez P, Fiadjoe J, Gangadharan M, Gentry K, Glover C, Goobie SM, Gosman A, Grap S, Gries H, Griffin A, Haberkern C, Hajduk J, Hall R, Hansen J, Hetmaniuk M, Hsieh V, Huang H, Ingelmo P, Ivanova I, Jain R, Kars M, Kowalczyk-Derderian C, Kugler J, Labovsky K, Lakheeram I, Lee A, Masel B, Medellin E, Meier P, Mitzel Levy H, Muhly WT, Nelson J, Nicholson J, Nguyen KP, Nguyen T, Olutuye O, Owens-Stubblefield M, Ramesh Parekh U, Petersen T, Pohl V, Post J, Poteet-Schwartz K, Prozesky J, Reid R, Ricketts K, Rubens D, Ryan L, Skitt R, Soneru C, Spitznagel R, Singh D, Singhal NR, Sorial E, Staudt S, Stubbeman B, Sung W, Syed T, Szmuk P, Taicher BM, Thompson D, Tretault L, Ungar-Kastner G, Watts R, Wieser J, Wong K, Zamora L. Perioperative Outcomes and Surgical Case Volume in Pediatric Complex Cranial Vault Reconstruction. Anesth Analg 2019; 129:1069-1078. [DOI: 10.1213/ane.0000000000003515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
33
|
Goobie S, Zurakowski D, Isaac K, Taicher B, Fernandez P, Derderian C, Hetmaniuk M, Stricker P, Abruzzese C, Apuya J, Beethe A, Benzon H, Binstock W, Brzenski A, Budac S, Busso V, Chhabada S, Chiao F, Cladis F, Claypool D, Collins M, Dabek R, Dalesio N, Falconl R, Fernandez A, Fernandez P, Fiadjoe J, Gangadharan M, Gentry K, Glover C, Goobie SM, Gosman A, Grap S, Gries H, Griffin A, Haberkern C, Hajduk J, Hall R, Hansen J, Hetmaniuk M, Hsieh V, Huang H, Ingelmo P, Ivanova I, Jain R, Kars M, Kowalczyk-Derderian C, Kugler J, Labovsky K, Lakheeram I, Lee A, Martinez JL, Masel B, Medellin E, Meier P, Levy HM, Muhly WT, Muldowney B, Nelson J, Nicholson J, Nguyen KP, Nguyen T, Olutuye O, Owens-Stubblefield M, Parekh UR, Petersen T, Pohl V, Post J, Poteet-Schwartz K, Prozesky J, Reddy S, Reid R, Ricketts K, Rubens D, Ryan L, Skitt R, Soneru C, Spitznagel R, Stricker P, Singh D, Singhal NR, Sorial E, Staudt S, Stubbeman B, Sung W, Syed T, Szmuk P, Taicher BM, Thompson D, Tretault L, Ungar-Kastner G, Watts R, Wieser J, Wong K, Zamora L. Predictors of perioperative complications in paediatric cranial vault reconstruction surgery: a multicentre observational study from the Pediatric Craniofacial Collaborative Group. Br J Anaesth 2019; 122:215-223. [DOI: 10.1016/j.bja.2018.10.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/03/2018] [Accepted: 10/15/2018] [Indexed: 11/24/2022] Open
|
34
|
Thompson DR, Zurakowski D, Haberkern CM, Stricker PA, Meier PM, Bannister C, Benzon H, Binstock W, Bosenberg A, Brzenski A, Budac S, Busso V, Capehart S, Chiao F, Cladis F, Collins M, Cusick J, Dabek R, Dalesio N, Falcon R, Fernandez A, Fernandez P, Fiadjoe J, Gangadharan M, Gentry K, Glover C, Goobie S, Gries H, Griffin A, Groenewald CB, Hajduk J, Hall R, Hansen J, Hetmaniuk M, Hsieh V, Huang H, Ingelmo P, Ivanova I, Jain R, Koh J, Kowalczyk-Derderian C, Kugler J, Labovsky K, Martinez JL, Mujallid R, Muldowney B, Nguyen KP, Nguyen T, Olutuye O, Soneru C, Petersen T, Poteet-Schwartz K, Reddy S, Reid R, Ricketts K, Rubens D, Skitt R, Sohn L, Staudt S, Sung W, Syed T, Szmuk P, Taicher B, Tetreault L, Watts R, Wong K, Young V, Zamora L. Endoscopic Versus Open Repair for Craniosynostosis in Infants Using Propensity Score Matching to Compare Outcomes: A Multicenter Study from the Pediatric Craniofacial Collaborative Group. Anesth Analg 2018; 126:968-975. [PMID: 28922233 DOI: 10.1213/ane.0000000000002454] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The North American Pediatric Craniofacial Collaborative Group (PCCG) established the Pediatric Craniofacial Surgery Perioperative Registry to evaluate outcomes in infants and children undergoing craniosynostosis repair. The goal of this multicenter study was to utilize this registry to assess differences in blood utilization, intensive care unit (ICU) utilization, duration of hospitalization, and perioperative complications between endoscopic-assisted (ESC) and open repair in infants with craniosynostosis. We hypothesized that advantages of ESC from single-center studies would be validated based on combined data from a large multicenter registry. METHODS Thirty-one institutions contributed data from June 2012 to September 2015. We analyzed 1382 infants younger than 12 months undergoing open (anterior and/or posterior cranial vault reconstruction, modified-Pi procedure, or strip craniectomy) or endoscopic craniectomy. The primary outcomes included transfusion data, ICU utilization, hospital length of stay, and perioperative complications; secondary outcomes included anesthesia and surgical duration. Comparison of unmatched groups (ESC: N = 311, open repair: N = 1071) and propensity score 2:1 matched groups (ESC: N = 311, open repair: N = 622) were performed by conditional logistic regression analysis. RESULTS Imbalances in baseline age and weight are inherent due to surgical selection criteria for ESC. Quality of propensity score matching in balancing age and weight between ESC and open groups was assessed by quintiles of the propensity scores. Analysis of matched groups confirmed significantly reduced utilization of blood (26% vs 81%, P < .001) and coagulation (3% vs 16%, P < .001) products in the ESC group compared to the open group. Median blood donor exposure (0 vs 1), anesthesia (168 vs 248 minutes) and surgical duration (70 vs 130 minutes), days in ICU (0 vs 2), and hospital length of stay (2 vs 4) were all significantly lower in the ESC group (all P < .001). Median volume of red blood cell administered was significantly lower in ESC (19.6 vs 26.9 mL/kg, P = .035), with a difference of approximately 7 mL/kg less for the ESC (95% confidence interval for the difference, 3-12 mL/kg), whereas the median volume of coagulation products was not significantly different between the 2 groups (21.2 vs 24.6 mL/kg, P = .73). Incidence of complications including hypotension requiring treatment with vasoactive agents (3% vs 4%), venous air embolism (1%), and hypothermia, defined as <35°C (22% vs 26%), was similar between the 2 groups, whereas postoperative intubation was significantly higher in the open group (2% vs 10%, P < .001). CONCLUSIONS This multicenter study of ESC versus open craniosynostosis repair represents the largest comparison to date. It demonstrates striking advantages of ESC for young infants that may result in improved clinical outcomes, as well as increased safety.
Collapse
Affiliation(s)
- Douglas R Thompson
- From the Department of Anesthesiology and Pain Medicine, University of Washington-Seattle Children's Hospital, Seattle, Washington
| | - David Zurakowski
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Charles M Haberkern
- From the Department of Anesthesiology and Pain Medicine, University of Washington-Seattle Children's Hospital, Seattle, Washington.,Department of Pediatrics (adj.), University of Washington-Seattle Children's Hospital, Seattle, Washington
| | - Paul A Stricker
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Petra M Meier
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Vega E, Rivera G, Echevarria GC, Prylutskyy Z, Perez J, Ingelmo P. Interventional procedures in children and adolescents with chronic non-cancer pain as part of a multidisciplinary pain treatment program. Paediatr Anaesth 2018; 28:999-1006. [PMID: 30251303 DOI: 10.1111/pan.13494] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Received: 11/29/2017] [Revised: 08/15/2018] [Accepted: 08/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Interventional procedures are part of multidisciplinary pain treatment programs to treat chronic non-cancer pain conditions in children and adolescents. However, the real benefit of these interventions remains unclear. AIMS The aim of this study was to analyze the potential benefits of the interventional procedures in children and adolescents with chronic non-cancer pain in the setting of a multidisciplinary pain treatment program. METHODS We retrospectively reviewed the charts of 98 children and adolescents receiving 314 diagnostic or therapeutic interventional procedures. We applied the following definitions of efficacy Short-term positive therapeutic effect: block that produced a minimum of 50% reduction in pain intensity for at least 4 weeks. Long-term positive therapeutic effect: a patient with a minimum of 50% reduction in pain intensity for at least 6 months Full recovery: a patient free of pain, not taking analgesics with normal physical and role functioning 6 months after the last procedure. RESULTS Seventy-six of 112 diagnostic blocks (68%) were associated with a 50% reduction in pain intensity for at least 4 weeks after the procedure. One hundred and sixty-six of 202 therapeutics blocks (82%) were associated with a short-term benefit. Seventy-two of 98 patients (73%) referred a 50% reduction in their pain intensity (17%) or had full recovery 6 months after the procedures (56%) and a MPTP. Psychiatric comorbidity and more advanced age were factors associated with failure to respond to interventional procedures. CONCLUSION The use of interventional procedures may represent a valid therapeutic option, associated with positive clinical outcomes within a multidisciplinary program.
Collapse
Affiliation(s)
- Eduardo Vega
- Chronic Pain Service, Department of Anesthesia, McGill University Health Center, Montreal Children's Hospital, Montreal, Québec, Canada.,Department of Anesthesia, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Gonzalo Rivera
- Department of Anesthesia, Clinica Las Condes, Santiago, Chile
| | - Ghislaine C Echevarria
- Department of Anesthesia, Perioperative Care and Pain Medicine, New York University School of Medicine, New York, New York
| | - Zakhar Prylutskyy
- Chronic Pain Service, Department of Anesthesia, McGill University Health Center, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Jordi Perez
- Department of Anesthesia, McGill University Health Center, Montreal General Hospital, Montreal, Québec, Canada.,The Alan Edwards Research Center for Chronic Pain, McGill University, Montreal, Québec, Canada.,Alan Edwards Pain Management Unit, McGill University Health Center, Montreal General Hospital, Montreal, Québec, Canada
| | - Pablo Ingelmo
- Chronic Pain Service, Department of Anesthesia, McGill University Health Center, Montreal Children's Hospital, Montreal, Québec, Canada.,The Alan Edwards Research Center for Chronic Pain, McGill University, Montreal, Québec, Canada.,CIMPARC (Consortium of Multidisciplinary Pain Researchers and Clinicians), Parma, Italy
| |
Collapse
|
36
|
Bertolizio G, Saint-Martin C, Ingelmo P. Cervical instability in patients with Trisomy 21: The eternal gamble. Paediatr Anaesth 2018; 28:830-833. [PMID: 30207016 DOI: 10.1111/pan.13481] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 02/05/2018] [Revised: 07/26/2018] [Accepted: 08/04/2018] [Indexed: 12/18/2022]
Abstract
Patients with Trisomy 21 are particularly at risk of cervical instability due to ligamentous laxity and osseous abnormalities. Up to 30% of Trisomy 21 patients are affected by atlanto-axial or atlanto-occipital instability, but only 1%-2% of cases are symptomatic. The radiologic assessment of cervical instability is not unanimously considered mandatory. The dynamic cervical spine radiograph is the most common screening tool for ruling out cervical spine instability in patients with Trisomy 21, and it is often requested before surgery. Several measurements have been investigated to assess the presence and degree of cervical instability; however, no conclusive recommendations have been forthcoming. In daily practice, many anesthesiologists may provide anesthesia via such means as laryngoscopy and tracheal intubation during surgery, without any radiological investigations before surgery. This review focuses on the diagnostic and prognostic measures available to evaluate the presence and degree of cervical instability in patients with Trisomy 21 and to propose practical recommendations to be applied in clinical practice.
Collapse
Affiliation(s)
- Gianluca Bertolizio
- Department of Anesthesia, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Christine Saint-Martin
- Medical Imaging Department, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Pablo Ingelmo
- Department of Anesthesia, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
37
|
Ferland CE, Teles AR, Ingelmo P, Saran N, Marchand S, Ouellet JA. Blood monoamines as potential biomarkers for conditioned pain modulation efficacy: An exploratory study in paediatrics. Eur J Pain 2018; 23:327-340. [DOI: 10.1002/ejp.1307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/04/2018] [Accepted: 08/12/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Catherine E. Ferland
- McGill Scoliosis and Spine Group; Montreal Québec Canada
- Shriners Hospitals for Children-Canada; Montreal Québec Canada
- McGill University Health Centre; Montreal Québec Canada
- Alan Edwards Centre for Research on Pain; Montreal Québec Canada
- Department of Anesthesia; McGill University; Montreal Québec Canada
| | - Alisson R. Teles
- McGill Scoliosis and Spine Group; Montreal Québec Canada
- Shriners Hospitals for Children-Canada; Montreal Québec Canada
- McGill University Health Centre; Montreal Québec Canada
- Alan Edwards Centre for Research on Pain; Montreal Québec Canada
- Division of Pediatric Orthopaedics; McGill University; Montreal Québec Canada
| | - Pablo Ingelmo
- McGill University Health Centre; Montreal Québec Canada
- Alan Edwards Centre for Research on Pain; Montreal Québec Canada
- Department of Anesthesia; McGill University; Montreal Québec Canada
| | - Neil Saran
- McGill Scoliosis and Spine Group; Montreal Québec Canada
- Shriners Hospitals for Children-Canada; Montreal Québec Canada
- McGill University Health Centre; Montreal Québec Canada
- Division of Pediatric Orthopaedics; McGill University; Montreal Québec Canada
| | - Serge Marchand
- Department of Surgery; Université de Sherbrooke; Sherbrooke Québec Canada
| | - Jean A. Ouellet
- McGill Scoliosis and Spine Group; Montreal Québec Canada
- Shriners Hospitals for Children-Canada; Montreal Québec Canada
- McGill University Health Centre; Montreal Québec Canada
- Alan Edwards Centre for Research on Pain; Montreal Québec Canada
- Division of Pediatric Orthopaedics; McGill University; Montreal Québec Canada
| |
Collapse
|
38
|
Affiliation(s)
- Sylvain Tosetti
- Department of Anesthesia, The Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Gianluca Bertolizio
- Department of Anesthesia, The Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Davinia Withington
- Department of Anesthesia, The Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Vincent Collard
- Department of Anesthesia, The Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Pablo Ingelmo
- Department of Anesthesia, The Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| |
Collapse
|
39
|
Cattaneo S, Ingelmo P, Scudeller L, Gregori MD, Bugada D, Baciarello M, Marchesini M, Alberio G, Normanno M, Jotti GS, Meschi T, Fanelli G, Massimo A. Sex differences in the daily rhythmicity of morphine consumption after major abdominal surgery. J Opioid Manag 2018; 13:85-94. [PMID: 28829523 DOI: 10.5055/jom.2017.0372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The sex of the patients has been shown to affect postoperative pain and morphine consumption; still a clear understanding able to explain the reasons behind this difference struggles to emerge. Our research aimed to investigate one specific aspect of the variability in morphine consumption between sexes. Previous studies have shown that circadian rhythm can influence opioid consumption. Furthermore, circadian rhythm is different between female and male. Our analysis investigated the presence of differences in daily rhythmicity of morphine consumption between males and females. DESIGN This is a secondary analysis of data collected during 2 years long multicenter clinical trial (NCT01233752). SETTINGS Clinical data were collected in two Italian hospitals: IRCCS Foundation Policlinico S. Matteo (Pavia) and San Gerardo Hospital (Monza). PATIENTS The authors recorded data about morphine consumption in 157 patients who underwent major abdominal surgery, who received morphine intravenous patient-controlled analgesia (IV-PCA) as postoperative analgesia. INTERVENTIONS The authors analyzed the daily periodicity of effective boluses delivered by morphine IV-PCA with Poisson multilevel models, adjusted by the time of start for each pump. An effective bolus was defined as a correctly delivered bolus of 1 mg of morphine. The authors also evaluated the interactions among the time of the day and sex, age (</≥55 y), and body mass index (BMI;</≥30 kg/m2). MAIN OUTCOME MEASURE(S) Differences in sex of morphine consumption rhythms over the 24 hours of the day. RESULTS Morphine consumption showed a statistically significant daily periodicity (p < 0.001) in our study population. Consumption was higher around 2 AM (rate 0.4 mg/min·patient) and lower around 12 PM (rate 0.05 mg/min·patient). Global consumption was not associated with the pump start time, age, or sex. The daily periodicity of morphine consumption was different between males and females (p = 0.004), with males consuming more morphine during the night. CONCLUSIONS Our analysis confirmed the presence of daily rhythm for morphine consumption in patients treated with IV-PCA morphine after major abdominal surgery. A difference in the daily periodicity was observed between sexes. No difference emerged in daily periodicity for the categories of age and BMI.
Collapse
|
40
|
Abstract
Epidermolysis bullosa comprises a range of conditions characterized by fragile skin with painful blistering induced by minor trauma and friction. The Dowling-Meara variant is a severe form characterized by disseminated painful blistering requiring lifelong skin and wound care. The natural history of the disease is characterized by a chronic course that tends to improve with advancing age. Various multimodal analgesic strategies have been proposed for painful procedures in children with epidermolysis bullosa. In this case report, we describe the use of nitrous oxide for pain control at home of blister treatments in a 4-year-old child with the Dowling-Meara variant.
Collapse
Affiliation(s)
- Pablo Ingelmo
- Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada.,Allan Edwards Center for Research on Pain, Montreal, QC, Canada
| | - Andrew Wei
- Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Gonzalo Rivera
- Department of Anesthesia, Clinica Las Condes, Santiago, Chile
| |
Collapse
|
41
|
Goobie SM, Cladis FP, Glover CD, Huang H, Reddy SK, Fernandez AM, Zurakowski D, Stricker PA, Gries H, Soneru C, Falcon R, Petersen T, Kowalczyk‐Derderian C, Dalesio N, Budac S, Groenewald N, Rubens D, Thompson D, Watts R, Gentry K, Ivanova I, Hetmaniuk M, Hsieh V, Collins M, Wong K, Binstock W, Reid R, Poteet‐Schwartz K, Gries H, Hall R, Koh J, Colpitts K, Scott L, Bannister C, Sung W, Jain R, Chaudhry R, Fernandez A, Tuite GF, Ruas E, Drozhinin O, Tetreault L, Muldowney B, Ricketts K, Fernandez P, Sohn L, Hajduk J, Taicher B, Burkhart J, Wright A, Kugler J, Barajas‐DeLoa L, Gangadharan M, Busso V, Stallworth K, Staudt S, Labovsky K, Glover C, Huang H, Karlberg‐Hippard H, Capehart S, Streckfus C, Nguyen K, Manyang P, Martinez JL, Hansen J, Brzenski A, Chiao F, Ingelmo P, Mujallid R, Bosenberg A, Meier P, Haberkern C, Nguyen T, Benzon H. Safety of antifibrinolytics in cranial vault reconstructive surgery: a report from the pediatric craniofacial collaborative group. Paediatr Anaesth 2017; 27:271-281. [PMID: 28211198 DOI: 10.1111/pan.13076] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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: 11/14/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antifibrinolytic therapy significantly decreases blood loss and transfusion in pediatric cranial vault reconstructive surgery; however, concern regarding the side effects profile limits clinical use. AIMS The aim was to utilize the Pediatric Craniofacial Surgery Perioperative Registry database to identify the safety profile of antifibrinolytic therapy for cranial vault reconstructive surgery by reporting the incidence of adverse events as they relate to exposure to tranexamic acid and aminocaproic acid compared to no exposure to antifibrinolytics. METHODS The database was queried for cases of open cranial vault reconstructive surgery. Less invasive procedures such as neuro-endoscopic and spring-mediated cranioplasties were excluded. The outcomes evaluated included any perioperative neurological adverse event including seizures or seizure-like movements and thromboembolic events. RESULTS Thirty-one institutions reported a total of 1638 cases from 2010 to 2015. Total antifibrinolytic administration accounted for 59.5% (tranexamic acid, 36.1% and aminocaproic acid, 23.4%), with 40.5% not receiving any antifibrinolytic. The overall incidence of postoperative seizures or seizure-like movements was 0.6%. No significant difference was detected in the incidence of postoperative seizures between patients receiving tranexamic acid and those receiving aminocaproic acid [the odds ratio for seizures being 0.34 (95% confidence interval: 0.07-1.85) controlling for American Society of Anesthesia (ASA) physical class] nor in patients receiving antifibrinolytics compared to those not administered antifibrinolytics (the odds ratio for seizures being 1.02 (confidence interval 0.29-3.63) controlling for ASA physical class). One complicated patient in the antifibrinolytic group with a femoral venous catheter had a postoperative deep venous thrombosis. CONCLUSIONS This is the first report of an incidence of postoperative seizures of 0.6% in pediatric cranial vault reconstructive surgery. There was no significant difference in postoperative seizures or seizure-like events in those patients who received the tranexamic acid or aminocaproic acid vs those that did not. This report provides evidence of the safety profile of antifibrinolytic in children having noncardiac major surgery. Caution should prevail however in using antifibrinolytic in high-risk patients. Antifibrinolytic dosage regimes should be based on pharmacokinetic data avoiding high doses.
Collapse
Affiliation(s)
- Susan M Goobie
- Department of Anesthesiology, Critical Care, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Franklyn P Cladis
- Department of Anesthesiology, The Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Chris D Glover
- Department of Anesthesiology, Texas Children's Hospital, Houston, TX, USA
| | - Henry Huang
- Department of Anesthesiology, Texas Children's Hospital, Houston, TX, USA
| | - Srijaya K Reddy
- Division of Anesthesiology, Children's National Health System, Washington, DC, USA
| | - Allison M Fernandez
- Department of Anesthesiology, Johns Hopkins All Children's Hospital, St Petersburg, FL, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul A Stricker
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Sola C, Vega E, Ingelmo P. TAP block in neonates: need to think beyond effectiveness. Minerva Anestesiol 2017; 83:242-243. [PMID: 28124865 DOI: 10.23736/s0375-9393.17.11848-1] [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: 11/08/2022]
Affiliation(s)
- Chrystelle Sola
- Pediatric Anesthesia Unit, Department of Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Montpellier, France.,Department of Anesthesia, Montreal Children's Hospital, Montreal, QC, Canada
| | - Eduardo Vega
- Department of Anesthesia, Montreal Children's Hospital, Montreal, QC, Canada.,Department of Anesthesiology, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Pablo Ingelmo
- Department of Anesthesia, Montreal Children's Hospital, Montreal, QC, Canada -
| |
Collapse
|
43
|
Stinson J, Lalloo C, Harris L, Cafazzo J, Campbell F, Chorney J, Clark J, Dick B, Forgeron P, Gordon A, Ingelmo P, Jibb L, McGillion M, Montgomery L, Palermo T, Rashiq S, Ruskin D, Simmonds M, Tupper S, Ware M. (540) iCanCope with Pain: User-centered design of an integrated smartphone and web-based pain self-management program for youth and young adults with chronic pain. The Journal of Pain 2016. [DOI: 10.1016/j.jpain.2016.01.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
Affiliation(s)
- Pablo Ingelmo
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, 1001 Decaire Boulevard, B04.2427, Montreal, H4A 3J1, Canada
| | - Gonzalo Rivera
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, 1001 Decaire Boulevard, B04.2427, Montreal, H4A 3J1, Canada
| | - Robert Baird
- Department of Pediatric Surgery, Montreal Children's Hospital, 1001 Decaire Boulevard, B04.2316, Montreal, H4A 3J1, Canada
| |
Collapse
|
45
|
Perotti L, Cusato M, Ingelmo P, Niebel TL, Somaini M, Riva F, Tinelli C, De Andrés J, Fanelli G, Braschi A, Regazzi M, Allegri M. A Comparison of Differences Between the Systemic Pharmacokinetics of Levobupivacaine and Ropivacaine During Continuous Epidural Infusion: A Prospective, Randomized, Multicenter, Double-Blind Controlled Trial. Anesth Analg 2015; 121:348-56. [PMID: 25977992 PMCID: PMC4885546 DOI: 10.1213/ane.0000000000000775] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Epidural infusion of levobupivacaine and ropivacaine provides adequate postoperative pain management by minimizing side effects related to IV opioids and improving patient outcome. The safety profile of different drugs can be better estimated by comparing their pharmacokinetic profiles than by considering their objective side effects. Because levobupivacaine and ropivacaine have different pharmacokinetic properties, our aim was to investigate whether there is a difference in the pharmacokinetic variability of the 2 drugs in a homogeneous population undergoing continuous epidural infusion. This double-blind, multicenter, randomized, controlled trial study was designed to compare the pharmacokinetics of continuous thoracic epidural infusion of levobupivacaine 0.125% or ropivacaine 0.2% for postoperative pain management in adult patients who had undergone major abdominal, urological, or gynecological surgery. This study is focused on the evaluation of the coefficient of variation (CV) to assess the equivalence in the systemic exposure and interindividual variability between levobupivacaine and ropivacaine and, therefore, the possible differences in the predictability of the plasmatic concentrations of the 2 drugs during thoracic epidural infusion. METHODS: One hundred eighty-one adults undergoing major abdominal surgery were enrolled in the study. Patients were randomized to receive an epidural infusion of levobupivacaine 0.125% + sufentanil 0.75 μg/mL or of ropivacaine 0.2% + sufentanil 0.75 μg/mL at 5 mL/h for 48 hours. The primary end point of this study was to analyze the variability of plasma concentration of levobupivacaine and ropivacaine via an area under the curve within a range of 15% of the CV during 48 hours of continuous epidural infusion. The CV shows how the concentration values of local anesthetics are scattered around the median concentration value, thus indicating the extent to which plasma concentration is predictable during infusion. Secondary end points were to assess the pharmacologic profile of the local anesthetics used in the study, including an analysis of mean peak plasma concentrations, and also to assess plasma clearance, side effects, pain intensity (measured with a verbal numeric ranging score, i.e., static Numeric Rating Scale [NRS] and dynamic NRS]), and the need for rescue doses. RESULTS: The comparison between the 2 CVs showed no statistical difference: the difference between area under the curve was within the range of 15%. The CV was 0.54 for levobupivacaine and 0.51 for ropivacaine (P = 0.725). The plasma concentrations of ropivacaine approached the Cmax significantly faster than those of levobupivacaine. Clearance of ropivacaine decreases with increasing patient age. There were no significant differences in NRS, dynamic NRS scores, the number of rescue doses, or in side effects between groups. CONCLUSIONS: Considering the CV, the interindividual variability of plasma concentration for levobupivacaine and ropivacaine is equivalent after thoracic epidural infusion in adults. We found a reduction in clearance of ropivacaine depending on patient age, but this finding could be the result of some limitations of our study. The steady-state concentration was not reached during the 48-hour infusion and the behavior of plasma concentrations of ropivacaine and levobupivacaine during continuous infusions lasting more than 48 hours remains to be investigated, because they could reach toxic levels. Finally, no differences in the clinical efficacy or in the incidence of adverse effects between groups were found for either local anesthetic. Published ahead of print May 14, 2015
Collapse
Affiliation(s)
- Luciano Perotti
- From the *Anesthesia and Intensive Care III, Cardiothoracic and Vascular Surgery Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; †Unit of Clinical Pharmacokinetics in Transplant and Autoimmune Diseases, Infectious Diseases Department, Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; ‡Department of Anesthesia, Montreal Children's Hospital, Alan Edwards Research Center for Pain, McGill University, Montreal, Canada; §Anesthesia and Intensive Care I, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; ∥Anesthesia and Intensive Care I. Ca'Granda Niguarda Hospital, Milano, and Università degli Studi of Milan Bicocca, Milan, Italy; ¶Anesthesia and Intensive Care I. San Gerardo Hospital, Monza, Italy; #Department of Experimental Medicine. University of Milan Bicocca, Milan, Italy; **Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; ††Department of Anesthesia, Critical Care and Pain Medicine, General University Hospital, Valencia, Spain; ‡‡Department of Anesthesiology, Critical Care and Pain Medicine, University of Parma, Parma, Italy; §§Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; ∥∥Unit of Clinical Pharmacokinetics in Transplant and Autoimmune Diseases, Infectious Diseases Department, Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; ¶¶Department of Surgical Sciences, University of Parma, Parma, Italy; and ##Anesthesia, Intensive Care and Pain Medicine Department, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy; SIMPAR Group
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Chin C, Arrica M, Bertolizio G, Ingelmo P. WITHDRAWN Simulation training in pediatric anesthesia. Minerva Anestesiol 2011:R02095514. [PMID: 19337188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Ahead of Print article withdrawn by publisher Although anesthesia has become increasingly safe, there remain significant differences among countries in terms of training standards and practice regulations. There is evidence and widespread consensus that the occasional practice of pediatric anesthesia should be avoided, and there is a trend towards the centralization of pediatric surgical activity. Limited access to adequate learning opportunities and reduced practice in non-pediatric centers can be addressed with the integrated use of traditional and modern training tools, and the availability of different pediatric simulator mannequins is rapidly filling the previously existing gap in simulation training. Medical simulation can be particularly useful in allowing the teaching and integration of technical and non-technical skills, and simulation courses for training and continuing medical education in pediatric anesthesia have been designed. In recent years, focus has been directed at validating the efficacy of simulation training and at its cost-effectiveness for improving learning and patient outcomes. Future challenges will include the best way to integrate simulation into the existing pediatric anesthesia training curricula, the determination of better evidence of its impact on clinical performance and the design and validation of assessment tools for technical and non-technical skills.
Collapse
Affiliation(s)
- C Chin
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | |
Collapse
|
47
|
Frawley G, Smith K, Ingelmo P. Relative potencies of bupivacaine, levobupivacaine, and ropivacaine for neonatal spinal anaesthesia. Br J Anaesth 2009; 103:731-8. [DOI: 10.1093/bja/aep259] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
48
|
Ingelmo P, Frawley G, Astuto M, Duffy C, Donath S, Disma N, Rosano G, Fumagalli R, Gullo A. Relative analgesic potencies of levobupivacaine and ropivacaine for caudal anesthesia in children. Anesth Analg 2009; 108:805-13. [PMID: 19224787 DOI: 10.1213/ane.0b013e3181935aa5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Comparing relative potency of new local anesthetics, such as levobupivacaine and ropivacaine, by the minimum local analgesic concentration model has not been described for caudal anesthesia. Therefore, we performed a prospective, randomized, double-blind study to determine the minimum local analgesic concentrations of a caudal single shot of ropivacaine and levobupivacaine in children and to describe the upper dose-response curve. METHODS We performed a two-stage prospective, randomized, double-blind study comparing the dose-response curves of caudal ropivacaine and levobupivacaine in children. In phase 1, 80 boys were randomized to receive either ropivacaine or levobupivacaine. In the second phase a further 32 patients were randomly allocated to receive caudal anesthesia with doses designed to delineate the upper dose-response range (the 50% effective dose [ED(50)]-ED(95) range). RESULTS There were no significant differences in ED(50) values for caudal ropivacaine and levobupivacaine. The ED(50) for levobupivacaine estimated from the Dixon Massey method was 0.069% (95% CI 0.056%-0.082%) and for ropivacaine was 0.075% (95% CI 0.058%-0.092%). Estimated by isotonic regression the ED(50) and ED(95) respectively of levobupivacaine were 0.068 (0.04-0.09) and 0.20% (95% CI 0.16%-0.24%). For ropivacaine ED 50 and ED95 were 0.066 (0.033-0.098) and 0.225% (95% CI 0.21%-0.24%). CONCLUSIONS In children receiving one minimum alveolar anesthetic concentration of sevoflurane, there were no significant differences in the ED(50) for caudal levobupivacaine and ropivacaine. The potency ratio at ED(50) was 0.92 and 0.89 at ED(95), indicating that caudal levobupivacaine and ropivacaine have a similar potency.
Collapse
Affiliation(s)
- Pablo Ingelmo
- Department of Perioperative Medicine and Intensive, A.O. San Gerardo, Monza, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Locatelli B, Frawley G, Spotti A, Ingelmo P, Kaplanian S, Rossi B, Monia L, Sonzogni V. Analgesic effectiveness of caudal levobupivacaine and ketamine. Br J Anaesth 2008; 100:701-6. [DOI: 10.1093/bja/aen048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
50
|
Ingelmo P, Locatelli BG, Frawley G, Knottenbelt G, Favarato M, Spotti A, Fumagalli R. The optimum initial pediatric epidural bolus: a comparison of four local anesthetic solutions. Paediatr Anaesth 2007; 17:1166-75. [PMID: 17986035 DOI: 10.1111/j.1460-9592.2007.02327.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/29/2022]
Abstract
BACKGROUND There is no consensus on the concentration or type of local anesthetic used for initiation of epidural anesthesia. The aim of this randomized, double-blind, controlled trial was to compare the clinical effectiveness of epidural administration of both levobupivacaine and bupivacaine in 0.2% and 0.25% concentrations in pediatric patients undergoing abdominal and urological surgery. METHODS One hundred and forty-one children scheduled for lower abdominal and urological surgery were randomized to receive 0.4-0.6 ml.kg(-1) epidural, 0.25% bupivacaine, 0.2% bupivacaine, 0.25% levobupivacaine or 0.2% levobupivacaine. Initial epidural volumes, onset times; hemodynamic consequences, postoperative pain scores and degree of residual postoperative motor block were all recorded. RESULTS There were no significant differences in the proportion of children with effective analgesia after incision [0.20% bupivacaine 97%, 0.25% bupivacaine 94%, 0.20% levobupivacaine 91%, 0.25% levobupivacaine 92% (P=0.73)] when a median volume of 0.55 ml.kg(-1) was used. There was no association between the volume used for thoracic, lumbar, or sacral epidural anesthesia and the effectiveness of the agents used. There was a significantly greater incidence of pain on awakening with the 0.2% solutions compared with the 0.25% solutions, but no differences in the incidence of residual motor block between groups. CONCLUSIONS While there is no difference in the proportion of effective surgical anesthesia, the lower incidence of pain and distress with the 0.25% solutions suggests that this concentration has clinical advantages over the 0.2% solutions for pediatric epidural anesthesia.
Collapse
Affiliation(s)
- Pablo Ingelmo
- Department of Anaesthesia and Intensive Care, A.O San Gerardo, Monza, Italy
| | | | | | | | | | | | | |
Collapse
|