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2.
Can J Anaesth ; 67(2): 225-234, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31529370

RESUMO

PURPOSE: Intraoperative hypoglycemia can result in devastating neurologic injury if not promptly diagnosed and treated. Few studies have defined risk factors for intraoperative hypoglycemia. The authors sought to characterize children with intraoperative hypoglycemia and determine independent risk factors. METHODS: This retrospective observational single-institution study included all patients < 18 yr of age undergoing an anesthetic from January 1 2012 to December 31 2016. The primary outcome was blood glucose < 3.3 mmol·L-1 (60 mg·dl-1). Data collected included patient characteristics, comorbidities, and intraoperative factors. A multivariable logistic regression model was used to identify independent predictors of intraoperative hypoglycemia. RESULTS: Blood glucose was measured in 7,715 of 73,592 cases with 271 (3.5%) having a glucose < 3.3 mmol·L-1 (60 mg·dl-1). Young age, weight for age < 5th percentile, developmental delay, presence of a gastric or jejunal tube, and abdominal surgery were identified as independent predictors for intraoperative hypoglycemia. Eighty percent of hypoglycemia cases occurred in children < three years of age and in children < 15 kg. CONCLUSION: Young age, weight for age < 5th percentile, developmental delay, having a gastric or jejunal tube, and abdominal surgery were independent risk factors for intraoperative hypoglycemia in children. Frequent monitoring of blood glucose and judicious isotonic dextrose administration may be warranted in these children.

3.
Anesth Analg ; 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31569160

RESUMO

BACKGROUND: Transporting patients under anesthesia care incurs numerous potential risks, especially for those with critical illness. The purpose of this study is to identify and report all pediatric anesthesia transport-associated adverse events from a preexisting database of perioperative adverse events. METHODS: An extract of the Wake Up Safe database was obtained on December 14, 2017, and screened for anesthesia transport-associated complications. This was defined as events occurring during or immediately after transport or movement of a pediatric patient during or in proximity to their care by anesthesiologists, including repositioning and transfer to recovery or an inpatient unit, if the cause was noted to be associated with anesthesia or handover. Events were excluded if the narrative clearly states that an event was ongoing and not impacted by anesthesia transport, such as a patient who develops cardiac arrest that then requires emergent transfer to the operating room. The search methodology included specific existing data elements that indicate transport of the patient, handover or intensive care status preoperatively as well as a free-text search of the narrative for fragments of words indicating movement. Screened events were reviewed by 3 anesthesiologists for inclusion, and all data elements were extracted for analysis. RESULTS: Of 2971 events in the database extract, 63.8% met screening criteria and 5.0% (148 events) were related to transport. Events were primarily respiratory in nature. Nearly 40% of all reported events occurred in infants age ≤6 months. A total of 59.7% of events were at least somewhat preventable and 36.4% were associated with patient harm, usually temporary. Of the 86 reported cardiac arrests, 50 (58.1%) had respiratory causes, of which 74% related to anesthesia or perioperative team factors. Respiratory events occurred at all stages of care, with 21.4% during preoperative transport and 75.5% postoperatively. Ninety-three percent of unplanned extubations occurred in patients 6 months and younger. Ten medication events were noted, 2 of which resulted in cardiac arrest. Root causes in all events related primarily to provider and patient factors, with occasional references to verbal miscommunication. CONCLUSIONS: Five percent of reported pediatric anesthesia adverse events are associated with transport. Learning points highlight the risk of emergence from anesthesia during transport to recovery or intensive care unit (ICU). ICU patients undergoing anesthesia transport face risks relating to transitions in providers, equipment, sedation, and physical positioning. Sedation and neuromuscular blockade may be necessary for transport in some patients but has been associated with adverse events in others.

4.
J Perianesth Nurs ; 34(2): 297-302, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30270047

RESUMO

PURPOSE: Determine whether preoperative oral acetaminophen increases gastric residual volume and lowers gastric pH. DESIGN: Prospective, randomized. METHODS: Healthy children, 1 to 14 years, having elective magnetic resonance imaging (MRI) were randomized to oral acetaminophen within 1 hour of induction versus fasting. Gastric volume and pH were measured immediately after intubation. Adverse events were documented from induction through 72 hours post MRI. FINDINGS: Thirty-seven children completed the study (16 treatment, 21 control). Gastric residual volume between groups was not significantly different. The acetaminophen group had significantly higher pH than control group (1.86 ± 0.42 vs 1.56 ± 0.34; P ≤ .044). Three children in the control and 6 in the treatment group experienced minor adverse events. CONCLUSIONS: Findings suggest administering oral acetaminophen prior to induction of anesthesia is not associated with increased gastric residual volume and increases the gastric pH. Further study is needed to examine outcomes such as aspiration pneumonitis risk.


Assuntos
Acetaminofen/administração & dosagem , Anestesia Geral/métodos , Imagem por Ressonância Magnética/métodos , Acetaminofen/farmacologia , Administração Oral , Adolescente , Criança , Pré-Escolar , Jejum , Feminino , Humanos , Concentração de Íons de Hidrogênio , Lactente , Masculino , Estudos Prospectivos
5.
Paediatr Anaesth ; 28(10): 873-880, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30302887

RESUMO

BACKGROUND: Persistent postoperative pain is a significant problem for many children, particularly for those undergoing major surgery such as posterior spine fusion. More than two-thirds report persistent pain after spine fusion, yet factors that may contribute to poorer outcomes remain poorly understood. AIMS: This prospective, longitudinal study examined how psychologic and somatic symptoms cluster together in children aged 10-17 years with idiopathic scoliosis, and tested the hypothesis that a higher psychological and somatic symptom cluster would predict worse pain outcomes 1 year after fusion. METHODS: Otherwise healthy children with idiopathic scoliosis completed preoperative surveys measuring recent pain intensity, pain location(s), somatic symptom severity, painDETECT (neuropathic-type pain symptoms), pain interference, fatigue, depression, anxiety, and pain catastrophizing. Pain outcome data were collected during hospitalization, and at 1 year after surgery. RESULTS: Ninety-five children completed baseline surveys and a cluster analysis differentiated 28 (30%) with a high symptom profile that included; higher depression, fatigue, pain interference, catastrophizing, and painDETECT scores. High symptom cluster membership independently predicted higher pain interference at 1 year (ß 9.92 [95% CI 6.63, 13.2], P < 0.001). Furthermore, children in this high symptom cluster reported significantly higher pain intensity and painDETECT scores, and had a 50% higher probability of continued analgesic use at 1 year compared to those in the Low Symptom Cluster (95% CI 21.3-78.5, P = 0.001). CONCLUSION: Findings from this exploratory study suggest a need to comprehensively assess children with scoliosis for preoperative signs and symptoms that may indicate an underlying vulnerability for persistent pain. This, in turn may help guide a comprehensive perioperative treatment strategy to mitigate the potential for long-term pain trajectories.


Assuntos
Analgésicos/administração & dosagem , Dor Crônica/etiologia , Sintomas Inexplicáveis , Dor Pós-Operatória/etiologia , Escoliose/diagnóstico , Adolescente , Criança , Dor Crônica/tratamento farmacológico , Feminino , Humanos , Estudos Longitudinais , Masculino , Dor Pós-Operatória/tratamento farmacológico , Valor Preditivo dos Testes , Estudos Prospectivos , Escoliose/fisiopatologia , Escoliose/psicologia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos
6.
J Adolesc Health ; 63(5): 594-600, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30348282

RESUMO

BACKGROUND: One in five adolescents and emerging adults have reported prescription opioid misuse (POM), posing significant risks for opioid-related adverse outcomes. Devising prevention strategies requires a better understanding of the decisional factors underlying risky misuse behavior. This research examined the associations between past opioid use behavior, opioid risk knowledge and perceptions, and intentional POM decisions. METHODS: Participants aged 15-23years completed surveys assessing past prescription opioid use and misuse, opioid risk knowledge, opioid risk perceptions, and pain relief preferences (i.e., analgesic benefit vs. risk aversion preference). The outcome, Willingness to Misuse (i.e., intentional decisions to use a prescription opioid in a non-compliant manner) was measured using hypothetical pain decision scenarios. RESULTS: Surveys were completed by 972 adolescents and young adults. In total, 44% had taken a prescription opioid and 32% of these reported past POM. Willingness to Misuse was significantly associated with lower opioid misuse risk perceptions (ß = .75 [95% CI .66-.86]) and past opioid misuse (ß = 1.81 [95% CI 1.13-2.91]) but not simple risk knowledge (ß = .81 [95% CI .58-1.11]. The probability of future misuse was highest for those who reported past opioid misuse and had low risk perceptions (58.7% [95% CI 51.3-65.8]) and high pain relief preferences (53.4% [95% CI 45.3%-61.3%]). CONCLUSIONS: Findings suggest that simple knowledge of prescription opioid risks is insufficient to curtail misuse among adolescents and emerging adults. Rather, it may be important to heighten opioid risk perceptions and strengthen opioid risk aversion values when prescribing opioid analgesics to better prevent future misuse in this high risk population.


Assuntos
Analgésicos Opioides/efeitos adversos , Tomada de Decisões , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Adolescente , Adulto , Analgésicos Opioides/uso terapêutico , Feminino , Humanos , Masculino , Manejo da Dor/efeitos adversos , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
8.
Anesth Analg ; 124(5): 1594-1602, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28319509

RESUMO

BACKGROUND: Preoperative pain predicts persistent pain after spine fusion, yet little is understood about the nature of that pain, related symptoms, and how these symptoms relate to postoperative pain outcomes. This prospective study examined children's baseline pain and symptom profiles and the association between a high symptom profile and postoperative outcomes. METHODS: Seventy children (aged 10-17 years) scheduled for correction of idiopathic scoliosis completed pain and symptom surveys during their preoperative visit (ie, pain intensity [0-10 numeric rating scores], a pediatric version of the 2011 fibromyalgia survey criteria [including pain locations and symptom severity scale], neuropathic pain symptoms [painDETECT], and Patient-Reported Outcome Measurement System measures of fatigue, depression, function, pain interference, and pain catastrophizing). Pain intensity and total analgesic use were recorded daily postoperatively and for 2 weeks after discharge. A 2-step cluster analysis differentiated a high and low pain and symptom profile at baseline, and a multivariate main effects regression model examined the association between pain profile and posthospital discharge pain and analgesic outcomes. RESULTS: The cluster analysis differentiated 2 groups of children well characterized by their baseline symptom reporting. Thirty percent (95% confidence interval [CI], 20.2%-41.8%) had a high symptom profile with higher depression, fatigue, pain interference, a pediatric version of the fibromyalgia survey criteria symptoms, neuropathic pain, and catastrophizing. Girls were more likely than boys to be clustered in the high symptom profile (odds ratio [OR], 5.76 [95% CI, 1.20-27.58]; P = .022) as were those with preoperative pain lasting >3 months (OR, 3.42 [95% CI, 1.21-9.70]; P = .018). Adjusting for sex, age, and total in-hospital opioid consumption, high cluster membership was independently associated with higher self-reported pain after discharge (mean difference +1.13 point [97.5% CI, 0.09-2.17]; P = .015). Children in the high symptom cluster were more likely to report ongoing opioid use at 2 weeks compared with the low symptom group (87% vs 50%; OR, 6.5 [95% CI, 1.30-33.03]; P = .015). At 6 months, high symptom cluster membership was associated with higher pain intensity, higher pain interference, and ongoing analgesic use (P ≤ .018). CONCLUSIONS: A behavioral pain vulnerable profile was present preoperatively in 30% of children with idiopathic scoliosis and was independently associated with poorer and potentially long-lasting pain outcomes after spine fusion in this setting. This high symptom profile is similar to that described in children and adults with chronic and centralized pain disorders and was more prevalent in girls and those with long-standing pain. Further study is needed to elucidate the potential mechanisms behind our observations.


Assuntos
Dor Pós-Operatória/epidemiologia , Dor/complicações , Período Pré-Operatório , Fusão Vertebral/efeitos adversos , Adolescente , Catastrofização , Criança , Feminino , Fibromialgia/epidemiologia , Fibromialgia/psicologia , Humanos , Masculino , Neuralgia/epidemiologia , Neuralgia/psicologia , Dor/etiologia , Medição da Dor , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Valor Preditivo dos Testes , Estudos Prospectivos , Escoliose/complicações , Escoliose/cirurgia , Caracteres Sexuais
12.
Paediatr Anaesth ; 26(4): 384-91, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26738465

RESUMO

BACKGROUND AND OBJECTIVES: There are limited data on pediatric emergency tracheal intubation on inpatient units and in the emergency department by anesthesiologists. This retrospective cohort study was designed to describe the frequency of difficult intubation and adverse events associated with emergency tracheal intubation performed by pediatric anesthesiologists in a large children's hospital. METHODS: All emergency tracheal intubation on inpatient units and the emergency department performed by pediatric anesthesiologists over a 7-year period in children <18 years were identified by querying our perioperative clinical information system. Medical records were comprehensively reviewed to describe the emergency intubation process and outcomes. RESULTS: One hundred and thirty-two intubations from 120 children (median age 3.3 years) were eligible. The majority of emergency tracheal intubations were successful with 1-2 laryngoscopy attempts, while 14 (10.6%) were difficult. Despite grade 3 view in 3/14 cases, the airway was secured after multiple direct laryngoscopy attempts. Eleven required use of an alternative airway device to secure the airway. A preexisting airway abnormality or craniofacial abnormality was present in 57% of cases with difficult intubation including half with micrognathia or retrognathia. Major intubation-related adverse events such as aspiration, occurred in 5 (3.8%) emergency tracheal intubations. Mild-to-moderate intubation-related adverse events occurred in 23 (17.4%) emergency tracheal intubations including mainstem bronchus intubation (13.6%). CONCLUSION: A significant rate of difficult intubation and mild-to-moderate intubation-related adverse events were found in emergency tracheal intubations on inpatient units and the emergency department in children performed by a pediatric anesthesiology emergency airway team. Difficult intubation was observed frequently in children with preexisting airway and craniofacial abnormalities and often required the use of an alternative airway device to successfully secure the airway.


Assuntos
Serviços Médicos de Emergência/métodos , Intubação Intratraqueal/métodos , Manuseio das Vias Aéreas/métodos , Anestesiologistas , Criança , Pré-Escolar , Estudos de Coortes , Anormalidades Craniofaciais , Serviço Hospitalar de Emergência , Humanos , Lactente , Recém-Nascido , Pacientes Internados , Intubação Intratraqueal/efeitos adversos , Laringoscopia , Assistência Perioperatória , Anormalidades do Sistema Respiratório , Estudos Retrospectivos
13.
Paediatr Anaesth ; 25(12): 1280-6, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26467292

RESUMO

BACKGROUND: Intrathecal (IT) opioid administration has been associated with postoperative benefits including reduced pain and opioid use in children. However, the postoperative benefits and risks of IT opioid administration during major urologic surgery in children remain unclear. AIM: The aim of this study was to compare postoperative pain and adverse event outcomes among children who received IT vs intravenous (IV) opioids during major urologic surgery. METHODS: We reviewed the medical records of children 3-17 years of age who underwent ureteroneocystostomy or pyeloplasty between 2006 and 2012. Electronically captured anesthetic and surgical data, postanesthesia care recovery unit (PACU) and nursing flowsheets, and daily progress notes through hospital discharge were reviewed. Analgesic techniques (i.e., IT or IV patient/nurse controlled opioids), all analgesic drugs and doses were recorded. Outcome measures included pain scores, need for rescue analgesics, opioid-related adverse events, and their treatments. RESULTS: Seventy-seven children received IT opioids and 51 received IV opioids. More children in the IV group required rescue analgesics and had higher pain scores at PACU discharge. Children in the IV group required rescue opioids more frequently than the IT group from 0 to 8 h and 8 to 16 h after PACU discharge, but rates were similar by 16-24 h 70% of children in IT group transitioned directly to oral opioids. Seven IT placements were considered as failed due to early need for rescue opioids. Four (8%) of the IV group and seven (9%) of the IT group experienced oxygen desaturation. Two of these, both in IT group required naloxone and one was admitted to ICU for observation. The IT group experienced a higher incidence of pruritus, constipation and hypotension. CONCLUSION: We observed better postoperative pain control in children who received IT vs IV opioids for the first 16 h with no discernible difference thereafter. The intrathecal group experienced higher incidences of pruritus, constipation, and hypotension.


Assuntos
Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Procedimentos Cirúrgicos Urológicos/métodos , Administração Intravenosa , Adolescente , Analgésicos Opioides/efeitos adversos , Período de Recuperação da Anestesia , Criança , Pré-Escolar , Feminino , Humanos , Injeções Espinhais , Masculino , Medição da Dor/efeitos dos fármacos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
15.
Paediatr Anaesth ; 24(8): 857-62, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24708463

RESUMO

INTRODUCTION: Pediatric obesity is a major health concern in the United States and as many as 34% of those who require general anesthesia are overweight or obese (OW). The lack of data and recommendations for dosing medications in obese children leaves significant gaps in the understanding of correct dosing in the clinical setting. OBJECTIVE: To determine whether OW children were more likely to receive doses of medications outside the recommended range. METHODS: Following IRB approval, patient medical records were queried to identify children 2 through 17 years who underwent noncardiac surgeries and received at least one medication of interest. Children with hepatic disease, renal disease, neurological impairment, sleep-disordered breathing, or missing height or weight measurements were excluded. Children were stratified into weight categories based on age and gender percentiles as per CDC guidelines. Those ≥85th percentile were classified as overweight/obese. Ideal and lean weight (for age, gender) were calculated. Drug doses were stratified as under-dosed (>10% below minimum recommended dose), overdosed (>10% above maximum recommended dose), or within recommended dose (dose ± 10%). Actual doses were compared to recommended doses as per actual, ideal, or lean weight (as recommended for specific drugs) in the overweight/obese groups vs the control weight (CW) group. RESULTS: Ten thousand five hundred and nine doses were reviewed. Overweight/obese children were more likely to receive doses outside the recommended dose range than the CW group. CONCLUSIONS: Overweight/obese children were more likely to receive doses of common anesthetic medications outside the recommended doses potentially adding risk of adverse outcomes in these children.


Assuntos
Anestésicos/administração & dosagem , Cálculos da Dosagem de Medicamento , Erros de Medicação/estatística & dados numéricos , Sobrepeso , Adolescente , Anestesia Geral , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Obesidade , Estudos Retrospectivos
17.
Anesthesiology ; 119(6): 1284-95, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24126262

RESUMO

BACKGROUND: Although predictors of laryngeal mask airway failure in adults have been elucidated, there remains a paucity of data regarding laryngeal mask airway failure in children. METHODS: The authors performed a retrospective database review of all pediatric patients who received a laryngeal mask anesthetic at their institution from 2006 to 2010. Device brands were restricted to LMA Unique™ (Cardinal Health, Dublin, OH) and LMA Classic™ (LMA North America, San Diego, CA), and primary outcome was laryngeal mask failure, defined as any airway event requiring device removal and tracheal intubation. Potential risk factors were analyzed with both univariate and multivariate techniques and included medical history, physical examination, surgical, and anesthetic characteristics. RESULTS: Of the 11,910 anesthesia cases performed in the study, 102 cases (0.86%) experienced laryngeal mask failure. Common presenting features of laryngeal mask failures included leak (25%), obstruction (48%), and patient intolerance such as intractable coughing/bucking (11%). Failures occurred before incision in 57% of cases and after incision in 43%. Independent clinical associations included ear/nose/throat surgical procedure, nonoutpatient admission status, prolonged surgical duration, congenital/acquired airway abnormality, and patient transport. CONCLUSIONS: The findings of the study support the use of the LMA Unique™ and LMA Classic™ as reliable pediatric supraglottic airway devices, demonstrating relatively low failure rates. Predictors of laryngeal mask airway failure in the pediatric surgical population do not overlap with those in the adult population and should therefore be independently considered.


Assuntos
Máscaras Laríngeas/efeitos adversos , Adolescente , Fatores Etários , Obstrução das Vias Respiratórias/epidemiologia , Obstrução das Vias Respiratórias/etiologia , Anestesia , Criança , Pré-Escolar , Interpretação Estatística de Dados , Bases de Dados Factuais , Falha de Equipamento , Feminino , Previsões , Humanos , Lactente , Recém-Nascido , Masculino , Análise Multivariada , Período Perioperatório , Doenças Respiratórias/congênito , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
18.
Paediatr Anaesth ; 23(6): 517-23, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23551906

RESUMO

BACKGROUND: Nearly 20% of anesthesia-related pediatric cardiopulmonary arrests (CPAs) occur during emergence or recovery. The aims of this study were to describe (i) the nature of pediatric postanesthesia care unit (PACU) CPA and subsequent outcomes and (ii) factors associated with mortality. METHODS: Cardiopulmonary Arrests occurring in PACU in children (<18 years) were identified from the American Heart Association Get With The Guidelines-Resuscitation, multicenter CPA registry. Demographics, underlying conditions, cause(s) of CPA, monitoring, interventions and outcomes were extracted. Descriptive statistics were used to characterize data, and odds ratios (OR) with confidence intervals (CI) were calculated as appropriate to compare survivors and nonsurvivors. RESULTS: Twenty seven CPA events were included: 67% in children <5 years and 30% in infants (<1 year). Most children (78%) had underlying comorbidities, including 15% with congenital heart disease. Respiratory issues were the most frequent causes of CPA (44%), but cardiac/hemodynamic causes were associated with nonsurvival (P = 0.01). Nonsurvival was also associated with older age (P = 0.02), weekend occurrence (P < 0.01), nonpediatric setting (P = 0.02) and occurrence at night (P = 0.04). CONCLUSIONS: This study identified similar risk factors and underlying causes as described in previous reports of pediatric perioperative CPA, with higher mortality following a cardiac/hemodynamic cause.


Assuntos
Período de Recuperação da Anestesia , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Parada Cardíaca/terapia , American Heart Association , Pré-Escolar , Comorbidade , Intervalos de Confiança , Meio Ambiente , Feminino , Fidelidade a Diretrizes , Guias como Assunto , Parada Cardíaca/epidemiologia , Parada Cardíaca/mortalidade , Humanos , Lactente , Masculino , Razão de Chances , Sala de Recuperação , Sistema de Registros , Fatores de Risco , Análise de Sobrevida , Sobreviventes , Resultado do Tratamento , Estados Unidos
19.
Paediatr Anaesth ; 23(2): 162-9, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22978850

RESUMO

OBJECTIVES: Examine factors associated with opioid adverse drug events (ADE) in children. SPECIFIC AIMS: Examine whether adjuvant nonopioid use is associated with a decreased probability of opioid-ADEs and need for rescue. BACKGROUND: Opioid-ADEs contribute to serious preventable harm for hospitalized children. Adjuvant nonopioid use may mitigate opioid risk postoperatively, yet few studies support this notion. METHOD: This nested case-control study included children who required intervention or rescue from opioid-ADEs and procedure-matched controls. Data were recorded from medical records and primary outcomes included serious opioid-ADEs (over-sedation and respiratory depression) and need for rescue (e.g., naloxone, rapid response team). Hierarchical logistic regression (HLR) models examined relationships between factors and opioid-ADEs. Early clinical signs and symptoms of deterioration were examined. RESULTS: Twenty five children with opioid-ADEs and 98 children without events were included. ASA-PS remained an independent risk factor (odds ratio, 2.56 [1.09, 6.03]; P = 0.031), while adjuvant nonopioids a risk reduction factor for opioid-ADEs (OR, 0.16 [0.05, 0.47]; P = 0.001) and need for rescue (0.14 [0.04, 0.47]; P = 0.001). Supplemental oxygen use at PACU discharge was associated with an increased odds of opioid-ADEs (OR, 3.72 [1.35, 10.23]; P = 0.007) and need for rescue (5.5 [1.7, 17.82]; P = 0.002). CONCLUSIONS: Findings from this study suggest that strategies such as early use of adjuvant nonopioids may reduce risk of opioid-ADEs postoperatively. Furthermore, children who require supplemental oxygen early postoperatively may be at heightened risk of later events.


Assuntos
Analgésicos não Entorpecentes/uso terapêutico , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Analgesia Controlada pelo Paciente , Estudos de Casos e Controles , Criança , Pré-Escolar , Interpretação Estatística de Dados , Feminino , Humanos , Infusões Intravenosas , Modelos Logísticos , Masculino , Razão de Chances , Oxigênio/sangue , Oxigenoterapia , Dor Pós-Operatória/complicações , Fatores de Risco , Tamanho da Amostra , Resultado do Tratamento
20.
Paediatr Anaesth ; 22(10): 962-8, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22967153

RESUMO

Surgical safety has emerged as a significant global public health concern with reported mortality rates varying tremendously between developing and industrialized countries. This manuscript reviews some of the challenges encountered in providing safe anesthesia care in the humanitarian space; identifies the difficulties with providing high-quality education in developing countries; and describes how audits and quality improvement databases enhance our understanding of the nature and causes of harm to patients to inform the development of strategies for improvement.


Assuntos
Anestesiologia/educação , Segurança do Paciente/normas , Anestesia/efeitos adversos , Bases de Dados Factuais , Países Desenvolvidos , Países em Desenvolvimento , Cirurgia Geral/educação , Guias como Assunto , Humanos , Cooperação Internacional , Procedimentos Cirúrgicos Operatórios/efeitos adversos
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