Raeford E. Brown

Low-dose droperidol versus standard-dose droperidol for prevention of postoperative vomiting after pediatric strabismus surgery

STUDY OBJECTIVE To determine whether a low dose of droperidol is as effective as a high dose in preventing vomiting after pediatric strabismus surgery. DESIGN Randomized, double-blind study. SETTING Operating room and recovery room at a university medical center. PATIENTS One hundred children undergoing strabismus procedures. INTERVENTIONS Patients were divided randomly into three groups and received either droperidol 75 microgram/kg, droperidol 20 microgram/kg, or saline. MEASUREMENTS AND MAIN RESULTS Vomiting was assessed in all groups, as was time to discharge and ability to perform a satisfactory postoperative eye examination. Children who received droperidol vomited less frequently than those who did not (p = 0.0521). There was no difference in the frequency of vomiting between the two groups that received droperidol. CONCLUSION Droperidol 20 microgram/kg is as effective as droperidol 75 microgram/kg in preventing vomiting after pediatric strabismus surgery. Because higher doses of droperidol may sedate some patients, the lowest effective dose should be used. In this study, however, there was no statistically significant difference with regard to length of recovery room stay.

The Us Opioid Crisis: Current Federal and State Legal Issues

The United States is in the midst of a devastating opioid misuse epidemic leading to over 33,000 deaths per year from both prescription and illegal opioids. Roughly half of these deaths are attributable to prescription opioids. Federal and state governments have only recently begun to grasp the magnitude of this public health crisis. In 2016, the Centers for Disease Control and Prevention released their Guidelines for Prescribing Opioids for Chronic Pain. While not comprehensive in scope, these guidelines attempt to control and regulate opioid prescribing. Other federal agencies involved with the federal regulatory effort include the Food and Drug Administration (FDA), the Drug Enforcement Agency (DEA), and the Department of Justice. Each federal agency has a unique role in helping to stem the burgeoning opioid misuse epidemic. The DEA, working with the Department of Justice, has enforcement power to prosecute pill mills and physicians for illegal prescribing. The DEA could also implement use of prescription drug monitoring programs (PDMPs), currently administered at the state level, and use of electronic prescribing for schedule II and III medications. The FDA has authority to approve new and safer formulations of immediate- and long-acting opioid medications. More importantly, the FDA can also ask pharmaceutical companies to cease manufacturing a drug. Additionally, state agencies play a critical role in reducing overdose deaths, protecting the public safety, and promoting the medically appropriate treatment of pain. One of the states’ primary roles is the regulation of practice of medicine and the insurance industry within their borders. Utilizing this authority, states can both educate physicians about the dangers of opioids and make physician licensure dependent on registering and using PDMPs when prescribing controlled substances. Almost every state has implemented a PDMP to some degree; however, in addition to mandating their use, increased interstate sharing of prescription information would greatly improve PDMPs’ effectiveness. Further, states have the flexibility to promote innovative interventions to reduce harm such as legislation allowing naloxone access without a prescription. While relatively new, these types of laws have allowed first responders, patients, and families access to a lifesaving drug. Finally, states are at the forefront of litigation against pharmaceutical manufacturers. This approach is described as analogous to the initial steps in fighting tobacco companies. In addition to fighting for dollars to support drug treatment programs and education efforts, states are pursuing these lawsuits as a means of holding pharmaceutical companies accountable for misleading marketing of a dangerous product.

Possible malignant hyperthermia in a 7-week-old infant.

Malignant hyperthermia (MH) is a serious and potentially life-threatening complication associated with certain inhalation anesthetics and neuromuscular relaxants. It is an uncommon condition, occurring in approximately 1 among 50,000 anesthetics administered to adults and 1 among 15,000 of those administered to children (1). The youngest patient previously reported to have MH was 3 months of age (2). Here, we report on the development of events that possibly represented MH in a 7-week-old infant given halothane and succinylcholine during induction of anesthesia for repair of an inguinal hernia.

Perioperative management of patients with an intrathecal drug delivery system for chronic pain.

The use of intrathecal medications in the treatment of chronic pain is becoming more commonplace. As such, the incidence of encountering patients receiving therapy via an intrathecal drug delivery system in the perioperative period will also increase. In this case series, we discuss anesthetic management and postoperative analgesic issues in three patients with indwelling intrathecal drug delivery systems placed for treatment of chronic pain.

The Opioid Crisis in the United States: Chronic Pain Physicians Are the Answer, Not the Cause

Opioids for the treatment of acute pain and the pain of malignancy have been strongly encouraged for more than 25 years.1 In the past 2 decades, the treatment of chronic noncancer pain using long-term opioid therapy has become more common. However, recent studies have revealed the astonishing rapidi