Vocal and verbal expression of postoperative pain in preschoolers.

The purpose of this study was to examine the development and construction of vocal and verbal expression of postoperative pain in young children with limited linguistic abilities. The main objective was to highlight specific pain vocalizations, which may lead to easy and quick detection and assessment of postoperative pain relative to the age of the suffering child. Forty-seven children aged 1 to 6 years were observed during two periods of surgical hospitalization: a preoperative and a postoperative period. The results showed that there was a significant relation between their age and the types of vocalization they expressed during the postoperative period. Regarding the development in relation to certain contexts, a minor modification seems to be concerned not with the type but with the frequency of the items of vocalizations. The study confirms earlier observations and clinical experience that an efficient and reliable assessment of pain in infants and young children necessitates taking several factors into account, such as the developmental age of the children, and especially a consideration of the whole spectrum of pain markers present in the child's behavior and captured by the assessment tools.

A multicenter study comparing the ProSeal and Classic laryngeal mask airway in anesthetized, nonparalyzed patients.

BACKGROUND: The laryngeal mask airway ProSeal (PLMA), a new laryngeal mask device, was compared with the laryngeal mask airway Classic (LMA) with respect to: (1) insertion success rates and times; (2) efficacy of seal; (3) fiberoptically determined anatomic position; (4) orogastric tube insertion success rates and times; (5) total intraoperative complications; and (6) postoperative sore throat in nonparalyzed adult patients undergoing general anesthesia, hypothesizing that these would be different. METHODS: Three hundred eighty-four nonparalyzed anesthetized adult patients (American Society of Anesthesiologists physical status I-II) were randomly allocated to the PLMA or LMA for airway management. In addition, 50% of patients were randomized for orogastric tube placement. Unblinded observers collected intraoperative data, and blinded observers collected postoperative data. RESULTS: First-attempt insertion success rates (91 vs. 82%, P = 0.015) were higher for the LMA, but after three attempts success rates were similar (LMA, 100%; PLMA, 98%). Less time was required to achieve an effective airway with the LMA (31 +/- 30 vs. 41 +/- 49 s; P = 0.02). The PLMA formed a more effective seal (27 +/- 7 vs. 22 +/- 6 cm H2O; P < 0.0001). Fiberoptically determined anatomic position was better with the LMA (P < 0.0001). Orogastric tube insertion was more successful after two attempts (88 vs. 55%; P < 0.0001) and quicker (22 +/- 18 vs. 38 +/- 56 s) with the PLMA. During maintenance, the PLMA failed twice (leak, stridor) and the LMA failed once (laryngospasm). Total intraoperative complications were similar for both groups. The incidence of postoperative sore throat was similar. CONCLUSION: In anesthetized, nonparalyzed patients, the LMA is easier and quicker to insert, but the PLMA forms a better seal and facilitates easier and quicker orogastric tube placement. The incidence of total intraoperative complications and postoperative sore throat are similar.