A review of the peri-operative management of paediatric burns: Identifying adverse events

Rode, H.; Brink, Christie; Bester, Kotie; Coleman, Mary; Baisey, T; Martinez, R.

doi:10.7196/samj.2016.v106i11.10938

Cited by 8 publications

(3 citation statements)

References 13 publications

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“…Effective communication between surgeons and anesthesia clinicians will ensure appropriate patient selection. Reviewed literature endorses regional anesthetic techniques, including peripheral and neuraxial nerve blocks, to decrease opioid requirements for various pediatric surgical specialties, including orthopedics, otolaryngology, urology, plastic surgery, ophthalmology, and general surgery . The heterogeneity of the literature did not allow for definitive recommendations for specific surgical procedures but did illustrate overall effectiveness of regional techniques to minimize opioid use.…”

Section: Resultsmentioning

confidence: 99%

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

et al. 2021

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IMPORTANCEOpioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking.OBJECTIVE To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery.EVIDENCE REVIEW Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique.FINDINGS Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery.CONCLUSIONS AND RELEVANCE These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.

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Section: Resultsmentioning

confidence: 99%

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

et al. 2021

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“…However, in severely burned patients, the risks of prehospital cooling increase significantly with burn severity, expressed by TBSA and full-thickness depth, the presence of inhalation injury, as well as the need for pre-hospital intubation and anaesthesia [ 52 , 63 , 64 ]. Among practices currently executed in the prevention and treatment of burn-associated hypothermia is raising the ambient temperature in preclinical rescue vehicles, as well as in the operating room (OR) and the intensive care unit (ICU), staged excision and grafting, limiting operating time if possible [ 65 , 66 ] and administering warm fluids [ 67 , 68 ]. Ideally, all vehicles and rooms in which the burn patient is treated are heated and closely connected to prevent cooling during transportation [ 69 ].…”

Section: Resultsmentioning

confidence: 99%

Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism, adrenergic stress and hypothalamic regulation—a systematic review

et al. 2022

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Background In this systematic review, we summarize the aetiology as well as the current knowledge regarding thermo(dys)regulation and hypothermia after severe burn trauma and aim to present key concepts of pathophysiology and treatment options. Severe burn injuries with >20% total body surface area (TBSA) affected commonly leave the patient requiring several surgical procedures, prolonged hospital stays and cause substantial changes to body composition and metabolism in the acute and long-term phase. Particularly in severely burned patients, the loss of intact skin and the dysregulation of peripheral and central thermoregulatory processes may lead to substantial complications. Methods A systematic and protocol-based search for suitable publications was conducted following the PRISMA guidelines. Articles were screened and included if deemed eligible. This encompasses animal-based in vivo studies as well as clinical studies examining the control-loops of thermoregulation and metabolic stability within burn patients Results Both experimental animal studies and clinical studies examining thermoregulation and metabolic functions within burn patients have produced a general understanding of core concepts which are, nonetheless, lacking in detail. We describe the wide range of pathophysiological alterations observed after severe burn trauma and highlight the association between thermoregulation and hypermetabolism as well as the interactions between nearly all organ systems. Lastly, the current clinical standards of mitigating the negative effects of thermodysregulation and hypothermia are summarized, as a comprehensive understanding and implementation of the key concepts is critical for patient survival and long-term well-being. Conclusions The available in vivo animal models have provided many insights into the interwoven pathophysiology of severe burn injury, especially concerning thermoregulation. We offer an outlook on concepts of altered central thermoregulation from non-burn research as potential areas of future research interest and aim to provide an overview of the clinical implications of temperature management in burn patients.

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“…Subeschar injection (clysis) of bupivacaine and adrenaline can also help reduce blood loss. 20 Diluted in saline 0.9% or Hartmann's solution, bupivacaine (0.001%) and adrenaline (1:500,000) are administered into subeschar and donor areas.…”

Section: Monitoringmentioning

confidence: 99%

Update on the management of burns in paediatrics

Suman

Owen

2020

BJA Education

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Describe the initial management of a child presenting with burn injury. Understand the importance of accurate estimation of burns as a percentage of total body surface area and subsequent fluid resuscitation. Discuss the anaesthetic management of a child with severe burns. Explain the benefits of providing optimal sedation and analgesia for children having burns procedures outside the operating theatre, and the drugs commonly used.Burns injuries in children are common. They are the fifth most common presentation of non-fatal childhood injuries worldwide (WHO). 1 An estimated 37,700 children per year attend emergency departments in England and Wales. Approximately 6,600 (17.5% of all trauma cases) are admitted for burns management. 2 The majority of admissions result from scalds, followed by contact and flame burns. Less common injuries in children include electrical, chemical and radiation burns.

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A review of the peri-operative management of paediatric burns: Identifying adverse events

Abstract: Burn surgery is a high-risk procedure and comorbidities are common. Anaesthesia and surgery must be well planned and executed with special reference to temperature control, rapid blood loss, preceding respiratory illnesses and measures to reduce blood loss.

Cited by 8 publications

References 13 publications

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

Current understanding of thermo(dys)regulation in severe burn injury and the pathophysiological influence of hypermetabolism, adrenergic stress and hypothalamic regulation—a systematic review

Update on the management of burns in paediatrics

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