Postoperative Analgesic and Behavioral Effects of Intranasal Fentanyl, Intravenous Morphine, and Intramuscular Morphine in Pediatric Patients Undergoing Bilateral Myringotomy and Placement of Ventilating Tubes

Hippard, Helena Karlberg; Govindan, Kalyani; Friedman, Ellen M.; Sulek, Marcelle; Giannoni, Carla M.; Larrier, Deidre; Minard, Charles G.; Watcha, Mehernoor F.

doi:10.1213/ane.0b013e31825afef3

Cited by 37 publications

(13 citation statements)

References 25 publications

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“…We did not use any of the intraoperative opioids. Opioids are used for treating ED (7,10,14) and could have been a confounding factor. However, it is difficult to completely discriminate between pain-related agitated behavior and emergence delirium in nonverbal and preschool children (3) as there is some overlap of categories in scales assessing pain and ED.…”

Section: Discussionmentioning

confidence: 99%

“…Many of the previous studies did not use validated scales to assess ED (7)(8)(9)(10)(11). Therefore, this study was designed to compare the use of desflurane and sevoflurane to determine the postoperative emergence delirium in children undergoing cataract surgery using the validated Pediatric Anesthesia Emergence Delirium (PAED) scale (12) The second aim was to determine the incidence of ED using PAED scale with a validated cutoff of >12 to discriminate presence and absence of ED in these children (13,14) and lastly, this study also sought to determine the time to emergence.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative emergence delirium in pediatric patients undergoing cataract surgery – a comparison of desflurane and sevoflurane

Sethi

Ghai

Ram

et al. 2013

Pediatric Anesthesia

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Postoperative emergence delirium in pediatric patients undergoing cataract surgery – a comparison of desflurane and sevoflurane

Sethi

Ghai

Ram

et al. 2013

Pediatric Anesthesia

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“…Morphine has not shown to produce any additional analgesic benefits in this patient group when compared with fentanyl 35. Fentanyl can be administered intravenously or intranasally and has the additional benefits of reducing EA or ED in the immediate postoperative period.…”

Section: Perioperative Carementioning

confidence: 82%

Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives

Robinson

Engelhardt

2017

LRA

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PurposeMyringotomy and tube placement is one of the most frequently performed ear, nose and throat (ENT) surgeries in the pediatric population. Effective anesthetic management is vital to ensuring successful ambulatory care and ensuring child and parental satisfaction.Recent findingsThis review summarizes recently published studies about the long-term effects of general anesthesia in young children, novel approaches to preoperative fasting and simplified approaches to the assessment and management of emergence delirium (ED) and emergence agitation (EA). New developments in perioperative ambulatory care, including management of comorbidities and day care unit logistics, are discussed.SummaryLong-term follow-up of children exposed to general anesthesia before the age of 4 years has limited impact on academic achievement or cognitive performance and should not delay the treatment of common ENT pathology, which can impair speech and language development. A more liberal approach to fasting, employing a 6–4–0 regime allowing children fluids up until theater, may become an accepted practice in future. ED and EA should be discriminated from pain in recovery and, where the child is at risk of harm, should be treated promptly. Postoperative pain at home remains problematic in ambulatory surgery and better parental education is needed. Effective ambulatory care ultimately requires a well-coordinated team approach from effective preassessment to postoperative follow-up.

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“…Intranasal drug administration has been studied widely in postoperative patients, 9 in burn patients 10 and in pediatric patients suc- cessfully. 11,12 IN route is becoming a common route of administration in the emergency department setting, but also in prehospital and outpatient settings; it can be useful in cases where is difficult to find a venous access, in patients who abuse IV drugs or restless psychiatric patients.…”

Section: Discussionmentioning

confidence: 99%

Intranasal ketorolac and opioid in treatment of acute renal colic

Etteri¹,

Maj

Maino³

et al. 2018

Emerg Care J

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The usual treatment of pain in acute renal colic is analgesic in intravenous (IV) route. We tried a rapid, non-painful, non-invasive route of administration using intranasal ketorolac plus fentanyl versus IV standard treatment with non steroidal anti-inflammatory drug plus opioid for the relief of pain in renal colic presenting patients to an Emergency Department (ED). We conducted a prospective nonblinded clinical trial. A sample of 82 adult patients with clinical diagnosis of acute renal colic was included to receive either intravenous ketorolac plus fentanyl or intranasal ketorolac plus fentanyl. Pain score was rated by using a 10 cm visual analogue scale at 0, 30 and 60 minutes after the treatment. Primary outcome was pain reduction. Secondary outcomes were adverse events and rescue treatment. Eighty-two patients were enrolled. The first forty-one patients received intranasal ketorolac plus fentanyl and the second forty-one received intravenous ketorolac plus fentanyl. There were not statistically significant differences in reduction of pain between the two groups at 30 and 60 minutes (P-value at 30=0,225; P-value at 60=0,312) although the trend was in favour of IV group. There were no significant differences between the groups with regard to secondary outcomes (adverse events and rescue treatment). Intranasal ketorolac and fentanyl are equivalent in analgesic effect to intravenous ketorolac and fentanyl treatment for ED patients with acute renal colic and the intranasal treatment can be considered a valid alternative to the standard intravenous treatment. IntroductionFive to fifteen percent of the population is found to be affected by urinary stones during their lifetime and the 50% of this population shows recurrent calcolosis within 5-10 years from the first symptons. 1 The classic presentation of a renal stone is acute, colicky flank pain radiating to the groin. In the Emergency Department (ED), 2 initial management of renal colic is based on rational and fast diagnostic process, rapid and effective pain control.Ketorolac and morphine administered with intravenous (IV) route are the drugs of choice to treat pain in acute renal colic. For the treatment of severe pain is useful to combine non-steroidal anti-inflammatory drugs (NSAIDs) and opioids.3-5 However, the insertion of a IV cannula is not always easy in the agitated patient suffering for renal colic. The intranasal route for the administration of NSAIDs and opiates such as ketorolac and fentanyl, is a new and valid alternative method to provide safe and effective analgesia in patients with trauma and burns. Materials and Methods Study designThis study was a prospectic non-blinded trial. The Institutional review board of our center approved the study, and all patients gave written informed consent. Study setting and populationThe patients were adults aged >18, presenting in ED with classical clinical symptoms of renal colic (sudden monolateral flank pain with inguinal irradiation) with a 10-cm visual analogue scale (VAS) greater than or equa...

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Postoperative Analgesic and Behavioral Effects of Intranasal Fentanyl, Intravenous Morphine, and Intramuscular Morphine in Pediatric Patients Undergoing Bilateral Myringotomy and Placement of Ventilating Tubes

Cited by 37 publications

References 25 publications

Postoperative emergence delirium in pediatric patients undergoing cataract surgery – a comparison of desflurane and sevoflurane

Postoperative emergence delirium in pediatric patients undergoing cataract surgery – a comparison of desflurane and sevoflurane

Ambulatory anesthetic care in children undergoing myringotomy and tube placement: current perspectives

Intranasal ketorolac and opioid in treatment of acute renal colic

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