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Symptomatic inhalational exposures due to irritants are frequent in reports from poison control centers. Residual morbidity was uncommon and did not appear to be statistically related to the degree of irritant exposure. Host-related factors may be better predictors of ongoing morbidity after inhalational exposure.

Postoperative pain treatment affects immediate and long-term outcomes in children undergoing cardiac surgery. Opioids, as part of multimodal analgesia, are effective in treating pain, however, they can be disadvantageous due to adverse side effects. Therefore, we assessed whether the local anesthetic bupivacaine as a parasternal nerve block in children post-cardiac surgery is an effective adjunct to pain management. This was a retrospective cohort study of all patients who underwent cardiothoracic surgery via median sternotomy at a large children’s hospital between November 2011 and February 2014 with and without bupivacaine following the introduction of perioperative bupivacaine in late 2012 on a single unit. 62 out of 148 patients (age 3–17 years) who received bupivacaine demonstrated decreased postoperative opioid use. Within one day of surgery, patients who received bupivacaine required, on average, 0.57 mg/kg (95% CI, 0.46 to 0.68) of total morphine equivalent compared to 0.93 mg/kg (95% CI, 0.80 to 1.06) for patients who did not receive bupivacaine. This difference was statistically significant after adjusting for potential confounders (p-value = 0.002). Length of stay and intubation were shorter on average among patients who received bupivacaine, but these differences were not statistically significant after adjusting for potential confounders. The study results seem to suggest that the perioperative administration of bupivacaine may reduce opioid usage among children post-cardiotomy.

As part of a larger investigation of inhalational toxic exposures, we studied occupationally related cases in order to examine possible preventive strategies. We analyzed data from 224 structured interviews. Of the interviewed subjects, 48 (21%) reported closed space exposures and 44 (20%) concomitant skin exposure at the time of inhalation. Chlorine gas and bleach mixtures were the most common single reported exposure type, occurring in 54 (24%) of cases. The most common occupational groups represented were crafts workers, operatives, and laborers (n = 84, 38%), and service workers (n = 64, 29%). Adjusting for occupational group in a multiple logistic regression analysis that also included length of hire and access to personal respiratory protective equipment, report of prior specific chemical safety training was significantly protective against closed space inhalation (odds ratio (OR) = 0.2; 95% confidence interval (CI) 0.1-0.4) and concomitant skin exposure (OR = 0.3, 95% CI = 0.1-0.7). These data suggest that chemical safety training may be an effective preventive strategy for potentially high-risk inhalational exposure scenarios.