No abstract

Background: Critically ill children require sedation for comfort and to facilitate mechanical ventilation and interventions. Dexmedetomidine is a newer sedative with little safety data in pediatrics, particularly for therapy lasting longer than 48 h.

BACKGROUND Benzodiazepine and antipsychotic use for acute management of agitation and aggression in the pediatric emergency department (ED) setting has not been well described. OBJECTIVES To describe medication utilization in the management of agitation and aggression in a pediatric ED and to assess the safety of their use. METHODS This was a retrospective observational study. Patients less than 20 years of age who presented to our pediatric ED and had agitation or aggression as part of their chief complaint were included if they received at least 1 dose of benzodiazepine or antipsychotic. Outcomes included frequency of benzodiazepine and antipsychotic use, dosing of medications, and reported adverse events. RESULTS During the 5-year study period, there were 128 visits of 120 patients who met the inclusion criteria. Lorazepam was most commonly given (70%), followed by chlorpromazine (20%). Most patients (82%) required a single dose of medication. Intoxication was associated with needing more than 1 dose of medication. Patients with autism or Asperger syndrome were more likely to receive an antipsychotic medication compared to not having these conditions (75% vs. 28%, respectively). Adverse events were documented in 6 visits: oxygen desaturation (n = 1), dizziness and nausea (n = 2), dizziness (n = 1), and paradoxical excitation (n = 2). The Naranjo Score indicated a probable adverse drug reaction for the cases of paradoxical excitation. CONCLUSIONS Benzodiazepine and antipsychotic drug therapy for acute agitation and aggression in children appears to be safe and well tolerated when used as a single agent and at the recommended doses in this setting.

OBJECTIVES To review pharmacokinetics in obese children and to provide medication dosing recommendations. METHODS EMBASE, MEDLINE, and International Pharmaceutical Abstracts databases were searched using the following terms: obesity, morbid obesity, overweight, pharmacokinetics, drug, dose, kidney function test, creatinine, pediatric, and child. RESULTS We identified 10 studies in which the authors examined drug dosing or pharmacokinetics for obese children. No information was found for drug absorption or metabolism. Obese children have a higher percent fat mass and a lower percent lean mass compared with normal-weight children. Therefore, in obese children, the volume of distribution of lipophilic drugs is most likely higher, and that of hydrophilic drugs is most likely lower, than in normal-weight children. Serum creatinine concentrations are higher in obese than normal-weight children. Total body weight is an appropriate size descriptor for calculating doses of antineoplastics, cefazolin, and succinylcholine in obese children. Initial tobramycin doses may be determined using an adjusted body weight, although using total body weight in the context of monitoring serum tobramycin concentrations would also be an appropriate strategy. We found no information for any of the opioids; antibiotics such as penicillins, carbapenems, vancomycin, and linezolid; antifungals; cardiac drugs such as digoxin and amiodarone; corticosteroids; benzodiazepines; and anticonvulsants. In particular, we found no information about medications that are widely distributed to adipose tissue or that can accumulate there. CONCLUSIONS The available data are limited because of the small numbers of participating children, study design, or both. The number and type of drugs that have been studied limit our understanding of the pharmacokinetics in obese children. In the absence of dosing information for obese children, it is important to consider the nature and severity of a child's illness, comorbidities, organ function, and side effects and physiochemical properties of the drug. Extrapolating from available adult data is possible, as long as practitioners consider the effects of growth and development on the pharmacokinetics relevant to the child's age.

Background: The relationship between a preceptor and a learner is complex and can be prone to conflict. The issue of conflict in experiential education has been studied in medicine, nursing, social work, and education; however, conflict between pharmacy preceptors and learners has not been described. Objective: To describe types of conflict between pharmacy preceptors and learners, the outcomes of such conflict, the impacts on the preceptor-learner relationship, and conflict-resolution strategies. Methods: An anonymous electronic survey of pharmacist preceptors and pharmacy residents in British Columbia was conducted. The survey included various types of questions to enrich the quality of responses (e.g., Likert scale, ranking, and requests for comments). Descriptive statistics were used. Results: Forty-nine participants completed the survey from the preceptor’s perspective, 12 from the learner’s perspective, and 4 from both perspectives. Sixty percent of preceptors (32/53) and 75% of learners (12/16) admitted experiencing conflict. Preceptors (n = 27) cited the learner’s professionalism (74%), knowledge/skills (59%), communication issues (59%), personal issues (56%), and punctuality/ attendance (52%) as causes of conflict. Learners, however (n = 12), cited differing expectations (67%), teaching versus learning style preferences (50%), and communication issues (67%) as causes of conflict. The majority of preceptors and learners indicated that conflict had negatively affected the relationship; however, most preceptors (69% [18/26]) and learners (50% [6/12]) agreed or strongly agreed with the statement, “I have generally felt comfortable working with preceptors/learners after a conflict.” More learners than preceptors felt that the learner’s ability to perform was negatively affected by the conflict (92% [11/12] versus 52% [13/25]). Preceptors were more likely to take initiative to resolve conflict. Verbal communication was the method of conflict resolution preferred by both preceptors and learners. Most preceptors and learners indicated that they felt that conflicts were generally resolved. Conclusions: Conflict was common in the pharmacy preceptor-learner relationship. Pharmacy preceptors and learners had different perspectives about the causes and outcomes of conflict. RÉSUMÉ Contexte : La relation entre le précepteur et l’apprenant est complexe et peut entraîner des conflits. Le problème du conflit dans le domaine de l’éducation expérientielle a été étudié en médecine, en infirmerie, en travail social et en éducation; cependant, il n’existe aucune description des conflits entre les précepteurs et les apprenants en pharmacie. Objectif : Décrire les types de conflits entre les précepteurs en pharmacie et les apprenants, les conséquences de tels conflits ainsi que les impacts sur la relation précepteur-apprenant et les stratégies de résolution de conflit. Méthodes : Une enquête électronique anonyme a été menée auprès de précepteurs et de résidents en pharmacie en Colombie-Britannique. L’enquête comprenait diverses questions visant à enrichir la qualité des réponses (p. ex., échelle de Likert, classement et demandes de commentaires). L’étude s’appuie sur des statistiques descriptives. Résultats : Quarante-neuf participants ont répondu à l’enquête en adoptant le point de vue du précepteur, 12 en adoptant celui de l’apprenant et 4 ont adopté le point de vue de l’apprenant et du précepteur. Soixante pour cent des précepteurs (32/53) et 75 % des apprenants (12/16) ont admis traverser des conflits. Les sources de conflits citées par les précepteurs (n = 27) sont le professionnalisme de l’apprenant (74 %), les connaissances et compétences (59 %), les problèmes de communication (59 %), les problèmes personnels (56 %) ainsi que la ponctualité et la présence (52 %). Quant aux apprenants (n = 12), ils ont cité des attentes divergentes (67 %), des préférences de style d’enseignement ou d’apprentissage (50 %) et des problèmes de communication (67 %) comme causes de conflit. La majorité des précepteurs et des apprenants ont indiqué que ces conflits avaient affecté la relation; cependant, la plupart des précepteurs (69 % [18/26]) et des apprenants (50 % [6/12]) étaient d’accord ou fortement d’accord avec l’énoncé suivant : « En général, je me suis senti à l’aise de travailler avec des précepteurs ou des apprenants après un conflit. » Un plus grand nombre d’apprenants que de précepteurs ont perçu que le conflit avait perturbé la capacité de l’apprenant (92 % [11/12] par rapport à 52 % [13/25]). Les précepteurs étaient plus enclins à faire preuve d’initiative pour résoudre le conflit. La communication verbale était la méthode de résolution de conflit préférée des précepteurs et des apprenants. La plupart des précepteurs et des apprenants ont indiqué ressentir que les conflits étaient généralement résolus. Conclusions : Le conflit était répandu dans la relation précepteur et apprenant en pharmacie. Les précepteurs en pharmacie et les apprenants avaient différents points de vue sur les causes et les conséquences de ces conflits.