Factors Associated With Recovery Room Intravenous Opiate Requirement After Pediatric Outpatient Operations

Nafiu, Olubukola O.; Thompson, Aleda; Chiravuri, Srinivas; Cloyd, Benjamin H.; Reynolds, Paul I.

doi:10.1213/ane.0000000000003701

Cited by 13 publications

(12 citation statements)

References 31 publications

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“…In the present study, girls required fewer opioids compared to boys, which contrasts with previous studies in preschool children and adolescents [ 14 , 15 ]. In a study involving pectus excavatum repair in adults, women reported higher pain intensity and greater opioid requirement after repair compared to men [ 16 ].…”

Section: Discussioncontrasting

confidence: 99%

Analysis of Factors Affecting Postoperative Opioid Requirement in Pediatric Patients Undergoing Pectus Excavatum Repair with Multimodal Analgesic Management

Koo

Park²,

Rim³

et al. 2023

JCM

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Children with pectus excavatum are treated with surgical repair in a procedure known as minimally invasive repair of pectus excavatum (MIRPE). MIRPE causes considerable postoperative pain, resulting in the administration of a substantial dose of opioids. This study aimed to identify perioperative factors that influence the requirement for opioids in children undergoing MIRPE. Retrospective data from children who underwent MIRPE were analyzed. A multimodal analgesic protocol was implemented with a continuous wound infiltration system and administration of non-opioid analgesics. Intravenous opioid analgesics were administered if the pain score was greater than 4. The cumulative opioid use was assessed by calculating the morphine equivalent dose at 6, 24, and 48 h after surgery. Perioperative factors affecting the postoperative opioid use were identified with multiple linear regression analyses. This study included 527 children aged 3–6 years, with a mean age of 3.9 years. Symmetrically depressed chest walls, a lower Haller index, and a lower revised depression index were found to be associated with decreased postoperative opioids. Boys required higher opioid doses than girls. Longer pectus bars (10 inches versus 9 inches) were associated with increased opioid use. Severity indices, gender, and the length of pectus bars influence postoperative opioid requirement in children undergoing MIRPE surgery with multimodal analgesia.

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Section: Discussioncontrasting

confidence: 99%

Analysis of Factors Affecting Postoperative Opioid Requirement in Pediatric Patients Undergoing Pectus Excavatum Repair with Multimodal Analgesic Management

Koo

Park²,

Rim³

et al. 2023

JCM

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“…Logistic regression has also been used to create a model for prediction of PACU opioid requirements after outpatient operations in pediatric patients [34]. Similarly, Packiasabapathy et al [35] developed a predictive model to determine the association between quantitative pupillometry and opioid induced respiratory depression in children undergoing elective otolaryngological surgeries.…”

Section: Anesthetic Depth Estimation and Perioperative Opioids Requir...mentioning

confidence: 99%

Advances in pediatric perioperative care using artificial intelligence

Dundaru-Bandi,

Antel,

Ingelmo

2024

Current Opinion in Anaesthesiology

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Purpose of this review This article explores how artificial intelligence (AI) can be used to evaluate risks in pediatric perioperative care. It will also describe potential future applications of AI, such as models for airway device selection, controlling anesthetic depth and nociception during surgery, and contributing to the training of pediatric anesthesia providers. Recent findings The use of AI in healthcare has increased in recent years, largely due to the accessibility of large datasets, such as those gathered from electronic health records. Although there has been less focus on pediatric anesthesia compared to adult anesthesia, research is on- going, especially for applications focused on risk factor identification for adverse perioperative events. Despite these advances, the lack of formal external validation or feasibility testing results in uncertainty surrounding the clinical applicability of these tools. Summary The goal of using AI in pediatric anesthesia is to assist clinicians in providing safe and efficient care. Given that children are a vulnerable population, it is crucial to ensure that both clinicians and families have confidence in the clinical tools used to inform medical decision- making. While not yet a reality, the eventual incorporation of AI-based tools holds great potential to contribute to the safe and efficient care of our patients.

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“…Es importante mencionar que la mayoría de los fármacos analgésicos utilizados en niños, no siempre cuentan con los permisos de las instituciones reguladoras locales. Su uso generalmente es extrapolado de estudios realizados en población adulta y no siempre están disponibles las presentaciones más adecuadas [4], [5], [7], [11], [14], [16], [18].…”

Section: -Técnicas Farmacológicasunclassified

“…Muchas de las vías nerviosas de la transmisión y percepción del dolor se desarrollan a temprana edad, estando presentes y funcionales desde las 24 semanas de gestación intrauterina. El dolor mal tratado tiene consecuencias inmediatas y a largo plazo como empeoramiento de la calidad de vida, uso prolongado de analgésicos y aparición de dolor persistente o crónico [2], [4]. Los niños en etapa preverbal no son capaces de describir su dolor o su experiencia subjetiva y debe ser el cuidador el que aprenda a evaluarlo de manera correcta.…”

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“…El objetivo principal es resaltar la importancia del manejo analgésico efectivo y seguro. El manejo multimodal del dolor es la estrategia más adecuada involucrando técnicas no farmacológicas, farmacológicas y técnicas de anestesia regional [1], [2], [3], [4], [6]. La selección de pacientes, planificación precoz de la estrategia analgesica y educación de los cuidadores son las claves para el éxito [9].…”

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Estrategias analgésicas para cirugía ambulatoria en niños

2021

Rev. chil. anest.

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During the last decades, there has been a significant growth in ambulatory surgeries. Literature, unfortunately, tells us that more than 75% of children have pain during the postoperative period, when they have been discharged, and 40% of these children have mild to severe pain. Caregivers turn to the surgeon, pediatrician or the clinic, places where usually there is no pain management specialist. Frequently, even when pain is evident, children get inadequate treatment. It is inadequate to say that children don't remember or don't respond to a painful experience at the same level as adults do. Many of the transmission and perception nerve tracts are developed in early life, being present and in function since week 24 of intrauterine gestation. The mistreated pain has immediate and long-term consequences. For clinicians, it is of utmost importance the knowledge of these consequences, summarizing, lifestyle deterioration, extended usage of (analgesics) painkillers and onset of persistent or chronic pain. Toddlers are not able to describe their pain or their subjective experience, due to this, the caregiver must learn how to evaluate properly. This evaluation is intended for every pediatric patient who meets the criteria for an ambulatory surgery. The main objective is to highlight the importance of a safe and effective analgesic management. The most appropriate method to treat postoperative severe pain is multimodal, which involves nonpharmacological, pharmacological, and local anesthetic techniques. The patients' selection, the early anesthetic strategy planning and caregivers' education are the keys for success.

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Factors Associated With Recovery Room Intravenous Opiate Requirement After Pediatric Outpatient Operations

Abstract: Postoperative pain requiring PACU IV opioid in children may be determined using a small set of easily obtainable perioperative variables. Our models require validation in other settings to determine their clinical usefulness.

Cited by 13 publications

References 31 publications

Analysis of Factors Affecting Postoperative Opioid Requirement in Pediatric Patients Undergoing Pectus Excavatum Repair with Multimodal Analgesic Management

Analysis of Factors Affecting Postoperative Opioid Requirement in Pediatric Patients Undergoing Pectus Excavatum Repair with Multimodal Analgesic Management

Advances in pediatric perioperative care using artificial intelligence

Estrategias analgésicas para cirugía ambulatoria en niños

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