This document summarizes guidelines for managing acute perioperative pain in infants and children. It discusses pain assessment tools, non-pharmacological approaches like regional anesthesia, and pharmacological options including acetaminophen, NSAIDs, gabapentin, ketamine, dexmedetomidine, and opioids. It emphasizes the need for multimodal analgesia, risk-based dosing due to developmental differences, and close monitoring for sedation and respiratory depression when using opioids in this vulnerable population.
Erector spinae plane block is a relatively novel approach to pain management for a variety of surgical procedures. ESP block is a challenging anesthesia and analgesia technique that needs more research.
Anaesthetic Management of Elderly PatientsMd Rabiul Alam
The Scopes of the presentations are: Anaesthetic definition of elderly & workload, Brief on age-related changes, Importance of good anaesthetic evaluation, Practice of functional reserve/capacity assessment, Morbidity and Mortality, Decision of Surgery & Planning of Anaesthesia & Perioperative management in nutshell.
Stellate ganglion block is useful to denervate sympathetic component involved in upper limb,head and neck disease conditions.
Careful evaluation of sympathetic involvement in disease process should be done before deciding to perform block.
Blocking agent type, dose and subsequent blocks should be decided on the basis of response to primary block.
After even successful stellate ganglion block patient should be monitored for side effects.
Patient Controlled Analgesia: Return to Nursing ProgramIHNA Australia
This presentation outlines how nurses can use Patient Controlled Analgesia (PCA) to benefit patients/clients. This presentation covers:
1. Indications and contraindications of PCA use
2. The advantages of PCA
and
3. The pharmacological principles of pain management
This presentation was compiled by Gulzar Malik, an experienced and qualified Nursing Educator at IHNA. For more information about our return to nursing programs, please call 1800 22 52 83.
Erector spinae plane block is a relatively novel approach to pain management for a variety of surgical procedures. ESP block is a challenging anesthesia and analgesia technique that needs more research.
Anaesthetic Management of Elderly PatientsMd Rabiul Alam
The Scopes of the presentations are: Anaesthetic definition of elderly & workload, Brief on age-related changes, Importance of good anaesthetic evaluation, Practice of functional reserve/capacity assessment, Morbidity and Mortality, Decision of Surgery & Planning of Anaesthesia & Perioperative management in nutshell.
Stellate ganglion block is useful to denervate sympathetic component involved in upper limb,head and neck disease conditions.
Careful evaluation of sympathetic involvement in disease process should be done before deciding to perform block.
Blocking agent type, dose and subsequent blocks should be decided on the basis of response to primary block.
After even successful stellate ganglion block patient should be monitored for side effects.
Patient Controlled Analgesia: Return to Nursing ProgramIHNA Australia
This presentation outlines how nurses can use Patient Controlled Analgesia (PCA) to benefit patients/clients. This presentation covers:
1. Indications and contraindications of PCA use
2. The advantages of PCA
and
3. The pharmacological principles of pain management
This presentation was compiled by Gulzar Malik, an experienced and qualified Nursing Educator at IHNA. For more information about our return to nursing programs, please call 1800 22 52 83.
Awareness and assessment of the pain in
postoperative children is important
Remember the different pharmacology in
neonates, infants and children
Multi-modal approach to preventing and treating
pain to minimize adverse effects
Regional analgesia must be considered unless
contraindicated
Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
1. Pharmacologic management of acute
perioperative pain in infants and children.
Dr. ABHINAV CHAUDHARY ;JUNIOR RESIDENT.
2.
INTRODUCTION
PAIN DEFINITION AND PATHOPHYSIOLOGY
PAIN MANAGEMENT
• PAIN ASSESSMENT SCORES
• NON PHARCOLOGICAL MANAGEMENT
• PHARMACOLOGICAL MANAGEMENT
• PREUMPTIVE ANALGESIA
• MULTIMODAL ANALGESIA
SUMMARY AND CONCLUSION
CONTEND
3.
• Infants and children present unique challenges that
necessitate consideration of the child’s age,
developmental level, cognitive and communication
skills, previous pain experiences, and associated
beliefs.
• Painful experiences can imprint themselves indelibly
on the nervous system.
• Pain in infants, children, and adolescent is often
underestimated and under treated .
INTRODUCTION
4. • Perioperative pain control is an essential component
of the anesthetic plan for infants and children.
• Difficult to assess , led to the creation of numerous
age specific pain management tools and scores.
• Difference in Pharcokinetics and Dynamics of the
drugs.
5.
6. • Unpleasant sensation localised to a part of the body.
• Duality of pain : both a sensation and emotion.
• Acute associated with stress response.
• PERIPHERAL MECHANISMS
The Primary Afferent Nocioceptor
• Peripheral nerve consists of axons of three different
neurons
1. Primary sensory afferent
2. Motor neurons
3. Sympathetic postganglionic neurons
• Cell bodies located in dorsal root ganglion
• Classified : diameter, conduction velocity, myelination.
7. A-beta
Light touch and or moving stimuli
Does not produce pain
A-delta and C fibers
Skin, deep somatic and visceral structures
Produce subjective experience of pain.
Noxious stimuli
Heat, intense cold, mechanical distortion, changes in pH
chemical irritants, serotonin, bradykinin ,histamine.
Vanilloid receptor
TrpV1,mediates perception of some noxious stimuli
Capsaicin
11. Spinal cord and reffered pain
• Axons of primary afferent nociceptors enter the spinal cord
via the dorsal root.
• In presence of noxious stimuli these release
neurotransmitters that excite the spinal cord neurons.
• Glutamate rapidly excite the second order dorsal horn
neurons.
• Peptides Substance P and Calcitonin related peptide-
produce a slower and longer lasting excitation of dorsal
root neurons.
• Axon of each primary afferent contacts many spinal
neurons and each spinal neuron receives convergent input
from many primary afferents.
12. • All spinal neurons that receive inputs from viscera and deep
musculoskeletal structure also receive input from the skin.
• Afferents supplying the diaphragm are derived from third
and fourth cervical dorsal root ganglia, primary afferents with
the cell bodies in the same ganglia supply the skin of the
shoulder and lower neck.
• Mislocalized to a place which roughly corresponds to region of
the skin innervated by same spinal segment.
• Spatial displacement of the pain sensation from the site of injury
that produces it is REFRRED PAIN.
13.
14.
Pain assessment scores
Accurate pain measurements in children are difficult to
achieve.
Three main methods are currently used to measure
pain intensity: self report, behavioral, and physiological
measures.
Numerous scales available ,the most common being the
Neonatal Facial Coding System (NFCS) and the
Neonatal Infant Pain Scale (NIPS).
15. Neonatal Facial Coding System (NFCS).
It is used to monitor facial actions in newborns.
The system looks at eight indicators to measure pain intensity
brow bulge, eye squeeze, nasolabial furrow, open lips,
stretched mouth (horizontal or vertical), lip purse, tout
tongue, and chin quiver .
It has been proven reliable for short duration, acute pain in
infants and neonates.
NFCS is able to discriminate between degrees of distress, but
not between pain-related and non pain-related distress .
The system is also difficult to assess in intubated neonates.
16. Neonatal Infant Pain Scale (NIPS).
The scale takes into account pain measurement before, during and after
a painful procedure, scored in one-minute intervals.
The indicators include: face, cry, breathing pattern, arms, legs, and
state of arousal.
The Premature Infant Pain Profile (PIPP) .
Crying Requires Increased Vital Signs Expression Sleeplessness(CRIES).
Maximally Discriminate Facial Movement Coding System(MAX).
The COMFORT Scale.
The Child Facial Coding System (CFCS).
Poker Chip Tool.
Visual Analogue Scale (VAS).
Paediatric Pain Questionnaire.
22.
REGIONAL
LOCAL
NEURAXIAL
Open thoracotomy or large subcostal incisions (for improved
pulmonary toilet and to allow for early extubation)
Amputations or limb-salvage procedures (eg, tumor surgery)
with risk of developing phantom limb sensations.
Knee surgery that requires continuous range of motion devices
or intensive early physical activity.
Pharcological methods
23. Major osteotomy (eg, pelvic /femoral osteotomy for congenital
hip dislocation)
Procedures that predispose to bladder, ureteral, or muscle
spasm (eg, genitourinarysurgery, tendon transfers, or tendon
lengthening procedures)
CAUDAL EPIDURAL
31. Efficacy of regional anesthesia.
Safety of regional anesthesia in children.
Awakeversus asleep block or catheter placement.
Local anesthetic dosing in children.
Increased risk of LAST with regional anesthesia techniques.
Low serum levels of alpha-1 acid glycoprotein (AAG), which binds
amide LAs
Immature hepatic clearance of these LAs
32. Multimodal approach
Combination of drugs with different MOA
Reduce side effects
Opiod sparing effect
Preumptive analgesia
Introduction of an analgesic regimen before the onset of
noxious stimuli.
Emphasis on preventing sensitization of the nervous
system.
Started before the surgery continued througout the post
surgical period
33.
34.
35.
36. Acetaminophen—
Perioperative acetaminophen for postoperative analgesia.
Continue postoperative, regularly scheduled acetaminophen
for up to 72 hours, depending on the procedure.
Administer acetaminophen 15 mg/kg orally or intravenously
30 minutes before the procedure, and postoperatively every six
hours, maximum dose 3.25 g per day.
Avoid rectal administration.
Avoid fixed dose combination with steroids.
Rectal dosing is never used in the neutropenic child because of
the risk of bacteremia.
38. NSAIDs may be associated with renal injury, platelet
dysfunction, gastrointestinal toxicity, and possibly poor bone
healing.
Reduced dosing or avoid
Age <6 months
Renal dysfunction, or those taking potentially nephrotoxic
medications
Hypoperfused states (eg, hypovolemia, cardiac dysfunction)
Coagulopathy, intrinsic or caused by medications
History of gastrointestinal hemorrhage or inflammatory bowel
disease
39. Non opioid adjunctive medication
Gabapentin –
Administer a single dose of gabapentin 15 to 20 mg/kg orally
(maximum dose 600 mg) two hours prior to induction for
children who undergo major surgical procedures (eg, scoliosis
repair, pectus excavatum repair)
Associated with significant postoperative inflammatory pain
and additional neuropathic pain component.
Limit the dose to 600 mg to avoid delayed emergence from
anesthesia and excessive immediate postoperative sedation.
Do not continue gabapentin postoperatively, due to the risk of
respiratory depression when combined with opioids.
40. Ketamine
NMDA Receptors
Dissociative anaesthesia ;Emergence delirium
Raised intracranial , intraocular pressure ,hypertension.
Analgesic adjuvant at "ultra-low" dose ranges
of 0.025 to 0.05mg/kg/hour up to 0.1 mg/kg/hour IV
Opiod sparing
41. Dexmedetomidine –
Single dose of dexmedetomidine 0.5 to 1 mcg/kg
IV for a wide variety of patients primarily for prophylaxis for
emergence delirium.
Dexmedetomidine is a selective presynaptic alpha
adrenoreceptor agonist with sedative and possible analgesic
properties.
Multimodal opioid-sparing strategy .
ICU sedation.
42. Opioids—
Indicated for moderate to severe postoperative pain.
Safe use of systemic opioids requires modification of doses
for high-risk patients and monitoring for respiratory
depression and side effects.
Start with low doses, and increased in small incremental
amounts as necessary based on patient response.
Prematurity, age, history of apnea, and other underlying
disease.
43. Avoid opioid infusion.
Avoid other respiratory depressants.
High-risk patients.
Regularly scheduled versus as needed dosing.
44. Monitoring for sedation
Modified Pasero Opioid Induced Sedation Scale (m-POSS),
and attempt to maintain a score of 1or 2 (either awake and
alert or slightly drowsy but easily aroused by voice or light
touch).
S – Sleep, easy to arouse: • No action necessary
1 – Awake and alert: No action necessary
2 – Slightly drowsy, easily aroused: No action necessary
3 – Frequently drowsy, arousable, drifts off to sleep during conversation:
monitor respiratory status and sedation level closely until sedation level is
stable at <3; consider reducing opioid dose.
4 – Somnolent, minimal or no response to verbal or physical stimulation: stop
opioid; consider administering naloxone; notify prescriber or anesthesiologist;
monitorrespiratory status and sedation level closely until sedation level is stable
at <3 and respiratory status is satisfactory.
45. Monitoring for respiratory depression
Clinical assessment
Oxygen saturation
Importantly, oxygen administration may improve peripheral
arterial oxygen saturation while masking signs of
hypoventilation.
Intensified monitoring should be utilized in all infants (whose respiratory
control mechanisms may be immature) and any child who has significant
central nervous system or cardiorespiratory comorbidity,
obstructive/central sleep apnea, or who requires supplemental oxygen to
maintain oxygen saturation while receiving IV opioids postoperatively.
End tidal Co2 monitoring
.
46.
47. Patient-controlled analgesia in children
PCA is a widely used modality of IV opioid administration
in children who are capable of understanding and
controlling the PCA pump, usually children over seven or
eight years of age.
Programmed to allow the patient to self-administer small
doses of opioid with a fixed lockout interval.
Reduces delay in patient access to pain medication.
Sense of control over pain.
Lower total dose of opioid compared with as needed or
around the clock bolus opioid administration
48. PCA settings –
The use of a continuous background infusion for PCA is not
routinely recommended.
Limited to patients who are opioid tolerant and/or receiving
care in a properly monitored unit.
If the demand dose alone provides inadequate relief, allow
several supplemental clinician-administered (usually nurse-
administered) bolus doses that are based on strict limits and
clinical evaluation criteria.
Set the patient-activated demand dose lockout interval to at
least 10 minutes and the minimum time period between
clinician boluses set at 15 to 20 minutes.
49. Dose adjustments
Review of the pump history.
Patients who press the button in a staccato fashion are
either highly anxious or need additional education about
the pump's functionality. The same may be true for
patients who rarely use the button and are yet in apparent
pain.
The PCA usage pattern history, the patient's pain intensity,
and underlying medical/surgical condition should be
evaluated within several hours of initiating PCA.
50. If the one hour demand dose total approaches the amount
allowed by the lockout interval, we increase the demand
dose by approximately 20 percent.
An increase in demand dose may also be indicated if
frequent clinician boluses have been required.
If the patient cannot sleep or obtain relief because of the
need for frequent self administered doses, consider a night-
basal infusion (with intensified monitoring required).
If conventional dosing does not relieve pain adequately, the
patient should be evaluated for underlying pathology,
especially for patients who cannot effectively communicate.
51.
52.
53.
54.
55.
References
HARRISON Principles of internal Medicine 20th edition.
Pain in Children: Assessment and Nonpharmacological Management
Rasha Srouji et al.
Pharmacologic management of acute perioperative pain in infants and
children. William Schechter, MD
New Concepts in Acute Pain Therapy: Preemptive AnalgesiaALLAN
GOTTSCHALK, M.D., PH.D.