Adaptación transcultural de la escala Induction Compliance Checklist para la evaluación del comportamiento del niño durante la inducción de la anestesia / Transcultural adaptation into Spanish of the Induction Compliance Checklist for assessing children's behaviour during induction of anaesthesia

OBJETIVO: Adaptar al español la escala de evaluación del comportamiento del niño durante la inducción anestésica Induction Compliance Checklist (ICC). MÉTODO: Estudio observacional de validación realizado a una muestra de 81 niños de 2 a 12 años operados en una Unidad de Cirugía Ambulatoria de un hospital pediátrico de Barcelona. Adaptación por el método de traducción-retrotraducción de la herramienta y análisis de validez y fiabilidad de la escala. RESULTADOS: Se garantizó la validez aparente de la herramienta mediante un grupo de discusión y se evaluó la fiabilidad interobservadores; el índice de correlación intraclase obtenido fue de r = 0,956. CONCLUSIONES: La escala ICC validada para la población española puede ser una herramienta eficaz para la evaluación de las actividades prequirúrgicas que se realizan para minimizar la ansiedad de los niños. La ICC es una escala fácil de usar y de completar por el personal de quirófano y que aportaría gran información en cuanto al comportamiento del niño durante la inducción anestésica

OBJECTIVE: Cross-cultural adaptation into Spanish of the Induction Compliance Checklist (ICC) for assessing children's behaviour during induction of anaesthesia. Method: A descriptive cross-sectional observational study was conducted on a sample of 81 children aged 2 to 12 years operated in an ambulatory surgery unit of a paediatric hospital in Barcelona. Adaptation by translation-back translation of the tool and analysis of the scale's validity and reliability. RESULTS: Face validity of the tool was guaranteed through a discussion group and inter-observer reliability was evaluated, obtaining an intraclass correlation index of r = 0.956. CONCLUSIONS: The ICC scale validated for the Spanish population can be an effective tool for the presurgical evaluation of activities carried out to minimise children's anxiety. The ICC is an easy-to-use scale completed by operating room staff in one minute and would provide important information about children's behaviour, specifically during induction

Local anesthesia before IV catheterization.

BACKGROUND: Intradermal buffered lidocaine is known to be effective in producing local anesthesia prior to IV catheterization. Recently, intradermal bacteriostatic normal saline has been suggested as a possible alternative. OBJECTIVE: To compare the efficacy of intradermal bacteriostatic normal saline with that of intradermal buffered lidocaine in providing local anesthesia to adult patients prior to IV catheterization. METHODS: In a randomized, double-blind, parallel-design, quasiexperimental study, we compared pain ratings of adult patients receiving either intradermal buffered lidocaine or intradermal bacteriostatic normal saline before IV catheterization. We measured pain at venipuncture through the use of a verbal numeric rating scale, used the test to compare group differences, and performed an analysis of covariance to test for outcome differences related to age, sex, and race or ethnicity. RESULTS: The final sample (N = 148) was 65% women and 82% white, with a mean age of 52 years (range, 19 to 80 years). Demographic characteristics between the two treatment groups were similar. Intradermal buffered lidocaine was demonstrated to be significantly superior to intradermal bacteriostatic normal saline in reducing the pain of IV catheterization (P = 0.007). Differences in pain ratings between the two groups were not associated with age, sex, race or ethnicity, catheter size, or location of the IV site. CONCLUSIONS: Intradermal buffered lidocaine was superior to intradermal bacteriostatic normal saline in providing local anesthesia prior to IV catheterization in this group of predominately white adults and should be the solution of choice for venipuncture pretreatment.

Plastic surgery: understanding abdominoplasty and liposuction.

Requests for plastic surgery procedures that alter one's body image are on the rise. To ensure the best possible outcome, patients who request a combined procedure (eg, abdominoplasty and liposuction) must meet certain criteria to be eligible for surgery. It is critically important for patients to understand that these surgeries are not weight-reduction procedures, and they must be prepared to make lifestyle changes to ensure long-lasting results. These procedures are performed in a variety of facilities (eg, surgeons' offices, surgery centers, hospitals). Perioperative nurses must have a basic knowledge and understanding of abdominoplasty and liposuction and the special requirements and potential complications involved with these procedures.

Menstrual cycle-related variations in postoperative analgesia with the preemptive use of N-methyl D-aspartate antagonist ketamine: a pilot study.

Several studies have supported that N-methyl-D-aspartate receptor antagonist can reduce the perception of postoperative pain. Hormonal fluctuations throughout the human menstrual cycle can influence pain pathways. In this pilot study, we evaluated postoperative pain in 22 female participants between the ages of 20 and 56 years undergoing laparoscopic abdominal procedures. Participants were randomly assigned to receive either placebo or ketamine at the induction of anesthesia. Progesterone levels were measured to determine menstrual phase. Visual analog scale scores were obtained at arrival into and discharge from the post anesthesia care unit. Total equipotent analgesic administration was also recorded. We found trends suggesting that women receiving ketamine and women in the luteal phase of their menstrual cycle had lower visual analog scale scores upon arrival to the unit. Ketamine recipients also received less rescue analgesic medication in the unit.

Sucrose decreases infant biobehavioral pain response to immunizations: a randomized controlled trial.

PURPOSE: To evaluate the effectiveness and age-related changes in analgesia of oral sucrose as a preprocedural intervention during routine immunizations in infants at 2 and 4 months of age. DESIGN: A double-blind, randomized, placebo-controlled clinical trial of 40 healthy term infants scheduled to receive routine immunizations from a pediatric ambulatory care clinic during May 2005 to July 2005. METHODS: Infants received 24% oral sucrose solution or the control solution of sterile water 2 minutes before routine immunizations at both their 2- and 4-month, well-child visits. The University of Wisconsin Children's Hospital pain scale was used to measure serial acute behavioral pain responses at baseline, 2, and 5 minutes after administration of the solution. Repeated measures ANOVA was used to examine between-group differences and within-subject variability of the effects of treatment on overall behavioral pain scores. FINDINGS: Infants receiving oral sucrose (n=20) showed a significant reduction in behavioral pain response 5 minutes after administration compared to those in the placebo group (n=20). At 2 minutes following solution administration, both sucrose and sterile water showed the highest mean pain score (4.54 and 4.39 respectively) indicating a severe amount of pain. At 5 minutes, the sucrose group returned to near normal at 0.27 while the placebo group remained at 3.02 indicating a percentage difference in mean pain scores relative to sterile water pain scores of 90.9. No statistically significant age-related change in behavioral pain response was noted between 2- and 4-month-old infants at 2 minutes and 5 minutes following treatment administration. CONCLUSION: Sucrose is an effective preprocedural intervention for decreasing behavioral pain response in infants after immunizations. CLINICAL RELEVANCE: Efforts to decrease the pain associated with immunizations can promote parental adherence to recommended immunizations schedules, prevent a resurgence of vaccine-preventable diseases and mitigate adverse neurologic outcomes in infants.

Gastrointestinal prophylaxis in critically ill patients.

Physiologic stress associated with illness and hospitalization is known to result in gastrointestinal ulceration, especially among the critically ill. The complication of this stress-related mucosal disease could be prevented with appropriate application of pharmacologic prophylaxis. Vigilance by the nursing staff is required to properly detect and manage the condition.

Anesthetic management in a pediatric patient with Noonan syndrome, mastocytosis, and von Willebrand disease: a case report.

This case report describes anesthetic considerations for a 6-year-old boy, admitted for adenoidectomy under general anesthesia, who had a complicated medical history, including mastocytosis, Noonan syndrome, and von Willebrand disease. Each affected the anesthetic plan and was addressed preoperatively among all surgical and anesthesia providers. Mastocytosis created a major concern, with its increased numbers of histamine-filled mast cells. Each drug that was added or eliminated from the anesthetic plan, to prevent histamine release by the activation of triggers, was considered. Patient handling and temperature control were also concerns. One of Noonan syndrome's characteristics is heart anomalies. This patient had a history of a patent foramen ovale and pulmonary stenosis; therefore, air was carefully removed from all intravenous lines and syringes. The main concern for bleeding difficulties was attributed to the history of von Willebrand disease, which results in prolonged bleeding time and can lead to delayed bleeding or serious postsurgical hemorrhage. Desmopressin was administered preoperatively to increase platelet aggregation and the von Willebrand factor level. The use of aspirin and other nonsteroidal anti-inflammatory drugs was avoided. We discuss the clinical and anesthetic management of this case with a review of pertinent literature.

Improving patient outcomes in an ambulatory infusion setting: decreasing infusion reactions of patients receiving paclitaxel and carboplatin.

Nurses working in the outpatient ambulatory setting treat patients with multiple infusion drug regimens. Patients can have allergic reactions to infusions ranging from very mild to life-threatening. The reaction and the subsequent treatment measures can be very disconcerting to the patients and to the visitors in the infusion area. The nursing team described in this article took a proactive approach to minimize infusion reactions in the authors' facility, thereby ensuring the safety of other patients. Staff members examined the performance improvement data, conducted a retrospective study, and collaborated with the primary physician providers to develop rechallenge protocols for patients receiving paclitaxel and carboplatin regimens.

The effective management and administration of premedication.

Nurses play an essential role in preparing patients for surgical procedures, whether the operation is planned or an emergency. Part of this preparation may include administration of premedication. Government initiatives such as The NHS Plan (Department of Health, 2000) and Essence of Care (DoH, 2001) emphasise the need to get the fundamental aspects of nursing care right, and nurses have a professional responsibility to deliver evidence-based care (NMC, 2002). Additionally, the publication of Building a Safer NHS for Patients: Improving Medication Safety (DoH, 2004) aims to improve patient safety by reducing the incidence of drug errors. This article looks at why pharmacological intervention is no longer a routine preoperative preparation. It will discuss drugs that are used to aid anaesthesia and those used as prophylaxis to aid postoperative recovery, consider the ways in which premedication can now include psychological interventions, and look at the nurse's role.

Induction pain perception after premedication with propofol vs lidocaine: a pilot study.

Propofol, an intravenous (i.v.) sedative-hypnotic agent, is commonly used for the induction of general anesthesia. It has, however, a substantial potential for causing burning pain at the i.v. site. Several preinduction pharmacologic agents are used routinely to blunt or diminish this burning sensation. Little is published on the effect of a preinduction dose of propofol for pain reduction. Lidocaine, the most studied agent, is recommended by the manufacturer of propofol as a preinduction agent to minimize this burning sensation. If lidocaine could be eliminated, time and cost savings from decreased use of drug, syringes, needles, and alcohol swabs would be realized. The purpose of this study was to determine the clinical effectiveness of administering preinduction doses of lidocaine vs propofol for decreasing pain experienced during anesthetic induction with propofol. Thirty unmedicated patients, ASA physical status I or II, scheduled to undergo general anesthesia for a surgical procedure were included. Patients were randomly assigned, using a random number chart, to receive 20 mg propofol or 40 mg lidocaine intravenously before entering the operating room suite. A minimum of 30 seconds, but not more than 45 seconds, following the administration of randomized drug with open-flow i.v. fluid, the induction dose of propofol (2.5 mg/kg) was begun through the same i.v. site. When one half of the dose had been administered and cleared the tubing by visualization, the patient was asked whether any discomfort was felt in the hand. If the response was yes, the patient was asked to rate the pain as mild, moderate, or severe. Then, the anesthetic process continued normally. No statistically significant difference occurred in pain prevention between treatment groups. In the lidocaine group, 53% (8/15) of patients were pain-free; in the propofol group, 47% (7/15) were painfree. However, when pain occurred, it was more likely to be classified as severe by the propofol group, 50% (4/8), compared with the lidocaine group, 14% (1/7). No difference existed in the ability of propofol or lidocaine to decrease the incidence of pain during an induction dose of propofol. The incidence of severe pain, however, was more frequent in the propofol group. The small number of patients experiencing severe pain precluded statistical analysis. Blunting pain associated with propofol warrants further study.

A review of preemptive analgesia.

Postoperative pain, although frequently encountered, is often undertreated. A new method of treating postoperative pain is preemptive analgesia, which seeks to prevent or diminish pain before it is caused. A variety of drugs may be used and include nonsteriodal anti-inflammatory drugs, local anesthetics, opioids, and ketamine. They may be given before, during, and after surgery through the oral, intramuscular, intravenous, epidural, intrathecal, and intra-articular routes.

Ketorolac as a preoperative nonnarcotic analgesic to enhance anesthesia and postanesthesia recovery.

The benefits of using ketorolac as a preoperative intramuscular (IM) non-narcotic analgesic are described and illustrated by the presentation of two case reports. Case Summary--Patient 1: A 53-year-old female who had experienced refractory nausea and vomiting after six previous exposures to anesthesia presented for outpatient ureteroscopy and dilatation of strictures. Instead of using an opiate narcotic, ketorolac 60 mg IM was given 1 hour before induction as the analgesic portion of anesthesia. Case Summary--Patient 2: A 65-year-old male with mild chronic obstructive lung disease presented for extracorporeal shock wave lithotripsy (ESWL). To avoid the respiratory depression associated with opioid narcotics, ketorolac 60 mg IM was given as an analgesic 1 hour before the ESWL procedure.