Psychologic effects of illness in adolescence. II. Impact of illness in adolescents—crucial issues and coping styles

Objective: We aimed to investigate the effects of dexmedetomidine premedication before intravenous infusion of ketamine in agitated children undergoing strabismus surgery. Subjects and Methods: We enrolled 60 agitated pediatric patients, aged 4.5–11 years. The patients were randomly allocated to one of two anesthesia regimens. Group D patients were premedicated with a single dose of intravenous dexmedetomidine 0.5 µg/kg whereas group P patients received a placebo. Patients in both groups were administered intravenous ketamine 1 mg/kg i.v. over 1 min followed by a continuous infusion of ketamine 1–3 mg/kg/h i.v. (n = 30). Patients were intubated after receiving fentanyl 1 µg/kg and rocuronium bromide 0.5 mg/kg. Results: 21 (70%) patients in group D did not show the oculocardiac reflex (OCR) versus 7 (23%) in group P (p = 0.0006). The preoperative and postoperative agitation scores (p = 0.0001 and p = 0.03, respectively), the score on the Faces Pain Scale during awakening [3.0 (interquartile range, IQR 2.0–4.0) in group D and 0.0 (IQR 1.0–2.25) in group P] (p = 0.001) and at the 60th postoperative minute [IQR 2.0 (1.5–3.0) in group D and 2.0 (IQR 1.5–3.0) in group P] (p = 0.004), sore throat (26.6% in group D and 60% in group P) (p = 0.01) and analgesic requirement (20% in group D and 53% in group P) (p = 0.01) in group P were significantly higher than in group D. The Ramsay Sedation Score (RSS) in group D was significantly higher than in group P during awakening [2.0 (2.0–2.0) in group D and 4.5 (4.0–5.0) in group P] (p = 0.0001). Conclusion: Dexmedetomidine premedication followed by intravenous infusion of ketamine was effective in decreasing OCR, agitation, pain, analgesic requirement in agitated children undergoing strabismus surgery.

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“…Painful procedures necessary for the care of children are increasing [2] . Excessive pain can significantly length- en the postoperative stay.…”

Section: Discussionmentioning

confidence: 99%

“…Both pain and vomiting cause distress, anxiety and agitation in children [2] . As anxiety can increase distress and may cause difficulties in controlling postoperative pain [3] , it is important to provide safe and effective analgesia.…”

Section: Introductionmentioning

confidence: 99%

Dexmedetomidine Use during Strabismus Surgery in Agitated Children

Mızrak¹,

Erbağcı

Arıcı³

et al. 2011

Med Princ Pract

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“…Although some studies reported anxiety, diminished self-esteem, depression, increased dependency, and poor emotional and social adjustment among adolescents with CHD, [37][38][39][40] others reported no significant psychopathology. 41,42 This discrepancy has been attributed to differences in methodology, types of defects, and small sample size. 43 A recent meta-analysis of 11 studies of the psychological problems of children and adolescents with CHD revealed that older children and adolescents had an increased risk of internalizing problems (eg, depression, anxiety) and externalizing behavior problems (eg, aggression, hyperactivity) compared with healthy control subjects.…”

Section: Social/family Dynamics: Impact Of Chronic Illness As Relatedmentioning

confidence: 99%

Best Practices in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: The Transition Process and Medical and Psychosocial Issues

Sable¹,

Foster²,

Uzark³

et al. 2011

Circulation

394

280

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“…In one study, hospital records of severely asthmatic children were evaluated for 57 physiological and psychological variables, and psychologic risk factors were found to be prominent in children who subsequently died of asthma (Strunk et al, 1985). However, many other writers have suggested that children and adolescents with asthma generally do not have higher rates of psychopathology than children with other chronic illnesses Zeltzer et al, 1980;Graham, 1985;Perrin et al, 1989;Nemzer, 1990). In short, reports both deny and confirm negative psychological reactions to asthma in children.…”

Section: Introductionmentioning

confidence: 99%

Psychological adjustment of children with mild and moderately severe asthma

Eksi

Molzan

Savasir

et al. 1995

European Child & Adolescent Psychiatry

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The relationship between the severity and duration of asthma and psychological adjustment was investigated in 29 children with mild and 31 children with moderately severe asthma, who were compared with 60 healthy control children. The severity of asthma was evaluated using the Pearlman-Bierman classification. Psychological adjustment was measured using the Achenbach Child Behavior Checklist (CBCL) and a semi-structured interview. The results of the interviews indicated that regressive symptoms such as clinging, childish behaviour, dependence, and a demanding nature were widespread. Using the illness in the service of achieving other aims was also common in the asthmatic children. CBCL total problem behaviour scores, social competency, and broad band scores were significantly higher in the asthmatic group than the control sample. Problem scores for asthmatic children were significantly correlated with parental friction at home, unsatisfactory relationships with siblings and other health problems in children. However, neither the CBCL total problem scores nor the social competency scores were correlated with the severity and the duration of illness.

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Psychologic effects of illness in adolescence. II. Impact of illness in adolescents—crucial issues and coping styles

Cited by 210 publications

References 10 publications

Dexmedetomidine Use during Strabismus Surgery in Agitated Children

Dexmedetomidine Use during Strabismus Surgery in Agitated Children

Best Practices in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: The Transition Process and Medical and Psychosocial Issues

Psychological adjustment of children with mild and moderately severe asthma

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