Opioid-prescribing patterns, storage, handling, and disposal in postoperative pediatric urology patients.

BACKGROUND: Emerging research on surgeons and the opioid epidemic have focused on the adult population. Consequently, little is known regarding opioid-prescribing practices in the pediatric population. The goal of this study is to examine postoperative opioid-prescribing and consumption patterns, as well as storage and disposal trends for specific pediatric urologic procedures. STUDY DESIGN: Patients undergoing surgery associated with specified Current Procedural Terminology codes were retrospectively identified, and details regarding opioid medications were obtained through our pharmacy database. Patients' guardians were contacted two weeks postoperatively to determine opioid usage. Opioids were prescribed at a standard dosing of 0.1 mg/kg per dose or the equivalent. RESULTS: Of the 171 identified patients, 117 patients were successfully contacted, with 67 (39%) completing telephone surveys. The 3 most common pediatric urology procedures were inguinal hernia repair (N = 39), circumcision (N = 27), and cystoscopy (N = 16). Across all procedures, there was an average excess of 9.8 doses prescribed, corresponding to an overprescription rate of 64%. Of the patients prescribed opioids, 41 (62%) had leftover opioid medication two weeks postoperatively. Thirty-two of 41 (78%) patients did not dispose of their leftover medication. Only 13 patients received perioperative counseling on appropriate storage and disposal of opiates. DISCUSSION: Prescribing practices for an array of pediatric urologic procedures are non-standardized and often generously excessive. We show universal overprescribing for all our reviewed urologic procedures. Sixty-two percent of pediatric urology patients did not use their entire prescribed opiate, leaving a significant pool of medicine within the pediatric family home. Given the low incidence of perioperative education, unsurprisingly a majority of our patients improperly handled and disposed off excess opioid medication. CONCLUSION: There is general overprescription of postoperative opioids and poor perioperative opioid education in the pediatric urology population.

Aldicarb toxicosis in a flock of sheep.

Aldicarb toxicosis was diagnosed in 200 sheep that died suddenly. Carbamate insecticide toxicosis was suspected based on observed clinical signs (hypersalivation, diarrhea, urination, paddling, seizures, miosis, and deaths occurring within 1 hour). Tissue samples were submitted from 4 Columbian ewes for pathologic and analytical evaluation. Severe diffuse pulmonary edema was observed on gross and histologic examination. Inhibition of cholinesterase activity in retina (21.2-68.1% of normal activity, n = 3), brain (40.6-45.6% of normal activity, n = 3), and whole blood (27% of normal activity, n = 1) supported a diagnosis of carbamate toxicosis. Reversal of brain and whole blood cholinesterase activities (reactivation factor greater than 1.4) following an in vitro 1 hour incubation at 37 C was also consistent with carbamate poisoning. Aldicarb toxicosis was confirmed following its detection in rumen contents at 1.5, 5.5, and 334 ppm using both high-pressure liquid chromatography with UV detection and gas chromatography with nitrogen/phosphorus detection.

Anionic sites in the human kidney: ex vivo perfusion studies.

Heparan sulfate-proteoglycan (HS-PG) anionic sites located in the glomerular basement membrane (GBM) are thought to contribute to glomerular permselectivity in man. The number and distribution of HS-PG anionic sites in the GBM and mesangial matrix of seven normal human kidneys and three kidneys from children with congenital nephrotic syndrome (CNS) were evaluated by ex vivo perfusion of polyethyleneimine (PEI; Mr 40,000 to 60,000). In the normal kidneys lamina rara externa (LRE) anionic sites (21.8 +/- 2.4 per 1000-nm actual GBM length) were well labeled and similar to those obtained by immersion staining of fixed tissue with Mr 1200 PEI. Lamina rara interna (LRI) anionic site number (22.0 +/- 2.6 per 1000-nm GBM) and appearance were better demonstrated by PEI perfusion than by the immersion technique. PEI perfusion also demonstrated regularly arranged (60 to 120 nm apart) mesangial matrix anionic sites (20- to 30-nm diameter) at 4.09 +/- 0.59 x 10(3) sites per nm2 matrix. PEI perfusion of three kidneys from children with CNS demonstrated decreased (16.3 +/- 1.9 per 1000-nm GBM) LRE anionic sites and normal LRI anionic sites (22.0 +/- 3.5 per 1000-nm GBM). Mesangial volume was increased, and mesangial anionic sites were less frequent (3.24 +/- 0.42 x 10(3) per nm2 matrix) and irregular in size in the children with CNS.(ABSTRACT TRUNCATED AT 250 WORDS)