Error traps in the perioperative care of children with chronic pain.

Pediatric patients with a history of chronic pain frequently have complex health needs that are challenging to meet in the perioperative period. Error traps are consequences or errors that are known to occur due to either gaps in knowledge or cognitive errors. Avoiding common error traps in these children can contribute to improved patient care and patient outcomes and overall better patient and family satisfaction. In patients with chronic pain, common errors during their perioperative care included as follows: failure to adequately prepare the patient and family; failure to incorporate past pain history and therapy into current treatment plans; failure to provide adequate multimodal analgesia; and failure to provide multidisciplinary and multimodal analgesia by incorporating other services such as mental health services and physical therapy. Cognitive errors may play a role in these error traps. Recognizing and avoiding them may improve and optimize pain care and outcome.

Loop Diuretics-Analysis of Efficacy Data for the Perioperative Clinician.

HEART FAILURE (HF) is one of the most common causes of hospitalization in the United States. Loop diuretics (LD) are the mainstay of treatment in the management of acute and chronic HF. Although they generally are effective in relieving symptoms and reducing congestion, LD have not been shown to significantly affect morbidity and mortality. The initial decongestion strategy for management of HF is likely to be an LD, with evidence suggesting that an initial "high-dose" strategy either by twice-daily bolus injection or by continuous infusion is likely to be more successful than an initial lower dose in respect to relief of symptoms but at the expense of increased worsening of renal function. This review focuses on the current state of evidence of different strategies related to the use of LD in the treatment of congestive symptoms in critically ill patients and presents a summary of the body of evidence regarding dosages, timing, and different diuretic agents.

Assessment of Multisensory Sensitivity May Assist With the Management of Children With Chronic Pain.

Chronic pain is a significant problem in adults; however, it can also be challenging to evaluate and manage effectively in pediatric and adolescent populations. Many theories implicate different factors that cause pain to become chronic, more severe, or more detrimental to function. There is emerging evidence for the role of generalized multisensory sensitivity (MSS) as a contributing factor to chronic pain in the adult population; however, similar evidence in the pediatric literature is lacking. Thus, the purpose of this case series is to highlight the clinical use of MSS assessment in children and adolescents with chronic pain to better phenotype and provide targeted treatment. In this case series, we reviewed 5 patients between 12 and 16 years of age who received evaluation for multifocal, chronic pain in a multidisciplinary pain clinic. During the initial consultations, we reviewed the medical records, completed a full medical history, performed a physical examination, and assessed for MSS. It is theorized that MSS is a marker of increased central nervous system sensitivity to sensory input that may also impact pain processing and, potentially, a poorer prognosis. Four patients with MSS appeared to benefit from the inclusion of additional therapies, such as desensitization and occupational therapy, which was in contrast to the patient without notable MSS. Based on anecdotal observation of these 5 cases, increased sensory hypersensitivity is 1 additional factor that may be used to delineate possible neurobiological mechanisms and aid in the treatment decision-making for this challenging population.