Postoperative Patient-Controlled Analgesia in the Pediatric Cardiac Intensive Care Unit

Epstein, Hanna M.

doi:10.4037/ccn2017724

Cited by 9 publications

(8 citation statements)

References 5 publications

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“…Similarly, in the ICU, patientcontrolled analgesia or even patient-controlled sedation may be appropriate for highly selected patients. 45,46 Intravenous pump shortages Intravenous infusions are utilized in the ICU more than any other area of the hospital. In the event that hospitals and ICUs surge over capacity, it is possible that there may be a relative shortage of IV pumps.…”

Section: Personal Protective Equipment Shortagesmentioning

confidence: 99%

Therapeutic alternatives and strategies for drug conservation in the intensive care unit during times of drug shortage: a report of the Ontario COVID-19 ICU Drug Task Force

Pittman

Dubinsky

Patel

et al. 2020

Can J Anesth/J Can Anesth

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During the coronavirus disease global pandemic, urgent strategies to alleviate shortages are required. Evaluation of the feasibility, practicality, and value of drug conservation strategies and therapeutic alternatives requires a collaborative approach at the provincial level. The Ontario COVID-19 ICU Drug Task Force was directed to create recommendations suggesting drug conservation strategies and therapeutic alternatives for essential drugs at risk of shortage in the intensive care unit during the COVID-19 pandemic. Recommendations were rapidly developed using a modified Delphi method and evaluated on their ease of implementation, feasibility, and supportive evidence. This article describes the recommendations for drug conservation strategies and therapeutic alternatives for drugs at risk of shortage that are commonly used in the care of critically ill patients. Recommendations are identified as preferred and secondary ones that might be less desirable. Although the impetus for generating this document was the COVID-19 pandemic, recommendations should also be applicable for mitigating drug shortages outside of a pandemic. Proposed provincial strategies for drug conservation and therapeutic alternatives may not all be appropriate for every institution.Local implementation will require consultation from end-users and hospital administrators.

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Section: Personal Protective Equipment Shortagesmentioning

confidence: 99%

Therapeutic alternatives and strategies for drug conservation in the intensive care unit during times of drug shortage: a report of the Ontario COVID-19 ICU Drug Task Force

Pittman

Dubinsky

Patel

et al. 2020

Can J Anesth/J Can Anesth

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“…Patient-controlled analgesia produces a stable blood concentration, which is often used for postoperative analgesia in children, and its effectiveness has been well documented [ 16 , 17 ]. Sufentanil is the opioid with the most potent analgesic effect, and its analgesic strength is 1000 times that of morphine and 7–10 times that of fentanyl.…”

Section: Discussionmentioning

confidence: 99%

Clinical effect of dexmedetomidine combined with sufentanil on postoperative analgesia for transthoracic device closure of ventricular septal defects in children with ultrafast track anesthesia

Wang

Xie

Lei

et al. 2021

J Cardiothorac Surg

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Background To observe the effect of combining dexmedetomidine with sufentanil on postoperative analgesia in children who underwent transthoracic device closure of ventricular septal defects (VSDs) with ultrafast track anesthesia. Methods This was a retrospective study. Eighty-seven children who underwent transthoracic device closure of VSDs were retrospectively analyzed. Patients were divided into three groups based on the different drugs used for postoperative patient-controlled analgesia. Results No statistically significant differences in hemodynamic parameters were noted among the three groups after surgery (p > 0.05). The FLACC score in the SD2 group was significantly greater than those in the S groups and SD1 groups after surgery (p < 0.001). The Ramsay score in the S group was significantly lower than that of the SD1 and SD2 groups at 6 h (p < 0.001 and p = 0.003), 12 h (p = 0.002 and p = 0.012), and 24 h (p < 0.001 and p < 0.001) after surgery. The pressing frequency of the analgesic pump 48 h after the operation in the SD2 group was significantly greater than that in the other two groups (p < 0.05). The incidences of respiratory depression, nausea, and vomiting in the S group were significantly greater than those in the SD1 and SD2 groups (p < 0.05). Conclusion The combination of 0.04 μg/kg/h dexmedetomidine and 0.04 μg/kg/h sufentanil intravenous analgesia was more effective than the other two analgesic strategies in children who underwent transthoracic device closure of ventricular septal defects (VSDs) with ultrafast track anesthesia.

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“…There is insufficient evidence to recommend for or against continuous infusion with patient-controlled analgesia. 62,63 Moderate Weak…”

Section: Moderate Strongmentioning

confidence: 99%

Management of routine postoperative pain for children undergoing cardiac surgery: a Paediatric Acute Care Cardiology Collaborative Clinical Practice Guideline

et al. 2022

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Background: Pain following surgery for cardiac disease is ubiquitous, and optimal management is important. Despite this, there is large practice variation. To address this, the Paediatric Acute Care Cardiology Collaborative undertook the effort to create this clinical practice guideline. Methods: A panel of experts consisting of paediatric cardiologists, advanced practice practitioners, pharmacists, a paediatric cardiothoracic surgeon, and a paediatric cardiac anaesthesiologist was convened. The literature was searched for relevant articles and Collaborative sites submitted centre-specific protocols for postoperative pain management. Using the modified Delphi technique, recommendations were generated and put through iterative Delphi rounds to achieve consensus Results: 60 recommendations achieved consensus and are included in this guideline. They address guideline use, pain assessment, general considerations, preoperative considerations, intraoperative considerations, regional anaesthesia, opioids, opioid-sparing, non-opioid medications, non-pharmaceutical pain management, and discharge considerations. Conclusions: Postoperative pain among children following cardiac surgery is currently an area of significant practice variability despite a large body of literature and the presence of centre-specific protocols. Central to the recommendations included in this guideline is the concept that ideal pain management begins with preoperative counselling and continues through to patient discharge. Overall, the quality of evidence supporting recommendations is low. There is ongoing need for research in this area, particularly in paediatric populations.

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Postoperative Patient-Controlled Analgesia in the Pediatric Cardiac Intensive Care Unit

Cited by 9 publications

References 5 publications

Therapeutic alternatives and strategies for drug conservation in the intensive care unit during times of drug shortage: a report of the Ontario COVID-19 ICU Drug Task Force

Therapeutic alternatives and strategies for drug conservation in the intensive care unit during times of drug shortage: a report of the Ontario COVID-19 ICU Drug Task Force

Clinical effect of dexmedetomidine combined with sufentanil on postoperative analgesia for transthoracic device closure of ventricular septal defects in children with ultrafast track anesthesia

Management of routine postoperative pain for children undergoing cardiac surgery: a Paediatric Acute Care Cardiology Collaborative Clinical Practice Guideline

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