Pharmacological Management of Pain and Anxiety During Emergency Procedures in Children

Kennedy, Robert M.; Luhmann, Jan D.

doi:10.2165/00128072-200103050-00003

Cited by 46 publications

(13 citation statements)

References 131 publications

(148 reference statements)

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“…2007;161:578-582 C HILDREN IN THE EMERgency department (ED) routinely undergo painful procedures as part of their medical treatment. Although a lot of attention has been paid to minimizing pain and stress in children undergoing procedures using pharmacological 1 and nonpharmacological strategies, 2 there is a lack of information on the impact of witnessing pain by their caregivers. Caregivers are frequently present during painful routine procedures.…”

Section: Discussionmentioning

confidence: 99%

Caregivers' Responses to Pain in Their Children in the Emergency Department

Smith

Shah²,

Goldman³

et al. 2007

Arch Pediatr Adolesc Med

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Objective: To explore physiological and anxiety responses of caregivers who witness a venipuncture being performed on their child and the effects of caregivers' responses on child pain and distress. Outcome Measures: The caregiver's heart rate, blood pressure, and anxiety (measured using a 10-cm visual analogue scale). Child-caregiver interactions were measured using the Child-Adult Medical Procedure Interaction ScaleShort Form (child age, Ն2 years) or the Measure of Adult and Infant Soothing and Distress (child age, Ͻ2 years). Child pain was measured using the Faces Pain ScaleRevised.Results: During cannulation, there was a significant increase in a caregiver's heart rate (median maximum difference = 12 beats per minute; PϽ.001) and anxiety (median difference = 2.65 cm; PϽ.001). Mean arterial pressure decreased after cannulation (median difference=4.4 mm Hg; P=.004). Backward linear regression revealed that 34% of the variability in child cannulation pain was predicted by caregiver anxiety and caregiver distress-promoting behavior; 31% of the variability in a child's distress during cannulation was predicted by caregiver distress-promoting behavior. Caregiver heart rate and anxiety during cannulation and caregiver distress-promoting behavior during recovery accounted for 51% of the variability in the child's distress during recovery. Conclusions:Caregivers witnessing an intravenous cannulation in their child had elevated heart rate, blood pressure, and anxiety. These responses predicted child pain and distress. Future studies should evaluate interventions designed to decrease distress responses in caregivers.

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Section: Discussionmentioning

confidence: 99%

Caregivers' Responses to Pain in Their Children in the Emergency Department

Smith

Shah²,

Goldman³

et al. 2007

Arch Pediatr Adolesc Med

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“…Nitrous oxide in oxygen with varying concentrations has been successfully used for many years to provide analgesia for a variety of painful procedures in children. 15, The use of nitrous oxide for minimal sedation is defined as the administration of nitrous oxide (50% or less) with the balance as oxygen, without any other sedative, narcotic, or other depressant drug before or concurrent with the nitrous oxide to an otherwise healthy patient in ASA class I or II. The patient is able to maintain verbal communication throughout the procedure.…”

Section: Nitrous Oxidementioning

confidence: 99%

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Coté¹,

Wilson²

2006

Pediatrics

517

150

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The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical supervision; careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications; appropriate fasting for elective procedures and a balance between depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure; a focused airway examination for large tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction; a clear understanding of the pharmacokinetic and pharmacodynamic effects of the medications used for sedation, as well as an appreciation for drug interactions; appropriate training and skills in airway management to allow rescue of the patient; age-and size-appropriate equipment for airway management and venous access; appropriate medications and reversal agents; sufficient numbers of people to carry out the procedure and monitor the patient; appropriate physiologic monitoring during and after the procedure; a properly equipped and staffed recovery area; recovery to presedation level of consciousness before discharge from medical supervision; and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children. INTRODUCTIONInvasive diagnostic and minor surgical procedures on pediatric patients outside the traditional operating room setting have increased in the last decade. As a consequence of this change and the increased awareness of the importance of providing analgesia and anxiolysis, the need for sedation for procedures in physician offices, dental offices, subspecialty procedure suites, imaging facilities, emergency departments, and ambulatory surgery centers has also markedly increased. In recognition of this need for both elective and emergency use of sedation in nontraditional

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“…1 2 Although the use of anaesthetic creams such as EMLA has significantly reduced the problems associated with VP, VC, painful injections, and implants, 3 the pain alleviation obtained with EMLA is sometimes insufficient and a conflict easily arises between the need for speed, efficiency, and adequate pain reduction.…”

mentioning

confidence: 99%

Nitrous oxide inhalation is a safe and effective way to facilitate procedures in paediatric outpatient departments

Ekbom

Jakobsson

Marcus

2005

Archives of Disease in Childhood

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Aims: To evaluate the efficacy and safety of nitrous oxide treatment given to children presenting procedural problems in a paediatric outpatient department. Methods: The study comprised 70 children 6-18 years old. Two different groups were studied. (1) Children presenting with problems in establishing venous cannulation (VC) (n = 50). The patients were randomised to conventional treatment (CO); cutaneous application of EMLA or nitrous oxide treatment (NO); N 2 O and EMLA. (2) Anxious children/children undergoing painful procedures who repeatedly come to the clinic (n = 20). These children underwent two procedures with CO/NO, the order of priority being randomised. Altogether the study included 90 procedures. Main outcome measures were procedure time, number of attempts required to establish VC, pain, and evaluation. Results: All procedures were performed with NO while four VC (8%) were not possible to perform with CO. The number of attempts required to establish VC was lower when using NO (median 2, range 2-9), compared with CO (median 4, range 2-9). The estimated pain was lower with NO. The total mean time required was similar for NO and CO when the time required for the NO procedure was included. One complication, tinnitus, was observed; it disappeared within 3 minutes. Conclusion: The pretreatment with nitrous oxide is a time effective and safe method for use at paediatric outpatient departments to reduce pain, facilitate venous cannulation, and thereby reduce the number of costly cancellations of planned procedures. P ain, anxiety, and difficulties related to venipunctures (VP), venous cannulations (VC), and other procedures are recurrent problems in paediatric outpatient departments, resulting in trauma for the children and sometimes delayed and cancelled procedures.

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Pharmacological Management of Pain and Anxiety During Emergency Procedures in Children

Cited by 46 publications

References 131 publications

Caregivers' Responses to Pain in Their Children in the Emergency Department

Caregivers' Responses to Pain in Their Children in the Emergency Department

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Nitrous oxide inhalation is a safe and effective way to facilitate procedures in paediatric outpatient departments

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