Sarah R. Martin

Pediatric Pain After Ambulatory Surgery: Where's the Medication?

OBJECTIVE: The purpose of this controlled study was to provide a description of childrens postoperative pain, including pain intensity and analgesic consumption. METHODS: Participants included 261 children, 2 to 12 years of age, undergoing routine tonsillectomy and adenoidectomy surgery. Baseline and demographic data were collected before surgery, and a standardized approach to anesthesia and surgical procedures was used. Pain and analgesic consumption were recorded for 2 weeks at home. RESULTS: On the first day at home, although parents rated 86% of children as experiencing significant overall pain, 24% of children received 0 or just 1 medication dose throughout the entire day. On day 3 after surgery, although 67% of children were rated by parents as experiencing significant overall pain, 41% received 0 or 1 medication dose throughout the entire day. CONCLUSIONS: We conclude that a large proportion of children receive little analgesic medication after surgery and research efforts should be directed to the discrepancy between high ratings of postoperative pain provided by parents and the low dosing of analgesics they use for their children.

Perioperative anxiety in children

Objectives & Aim:  The purpose of this investigation was to examine children’s anxiety across the perioperative setting.

Preoperative anxiety in adolescents undergoing surgery: a pilot study

Objectives:  The purpose of this study was to conduct a prospective assessment of preoperative anxiety in adolescents undergoing surgery.

Parental attitudes regarding analgesic use for children: differences in ethnicity and language

PURPOSE The aim of this study was to identify the impact of ethnicity and language on parental attitudes regarding analgesic use to treat childrens pain. METHODS A total of 206 parents of children undergoing outpatient surgery were recruited to complete the Medication Attitudes Questionnaire, a measure of parental beliefs about using analgesic medications to treat childrens pain. Parents were grouped into one of 3 categories according to ethnicity and primary language spoken: English-speaking white, English-speaking Hispanic, and Spanish-speaking Hispanic. Group differences in pain medication attitudes were examined. RESULTS After controlling for socioeconomic status, English-speaking Hispanic parents endorsed higher levels of misconceptions about pain medication use, including a tendency to avoid analgesic use for children, compared with English-speaking white and Spanish-speaking Hispanic parents. CONCLUSIONS This study highlights parental characteristics, including ethnicity and language, which may place children at higher risk for undertreatment of acute pain based on misconceptions about analgesic use for children. Specifically, English-speaking Hispanic parents may be most likely to undertreat childrens pain at home. Future studies are needed to identify the most appropriate means of providing education to counter parental misconceptions and support optimal pain management of childrens pain in the home setting.

Children's Behavior in the Postanesthesia Care Unit: The Development of the Child Behavior Coding System-PACU (CBCS-P)

OBJECTIVE To develop and validate a behavioral coding measure, the Childrens Behavior Coding System-PACU (CBCS-P), for childrens distress and nondistress behaviors while in the postanesthesia recovery unit. METHODS A multidisciplinary team examined videotapes of children in the PACU and developed a coding scheme that subsequently underwent a refinement process (CBCS-P). To examine the reliability and validity of the coding system, 121 children and their parents were videotaped during their stay in the PACU. Participants were healthy children undergoing elective, outpatient surgery and general anesthesia. The CBCS-P was utilized and objective data from medical charts (analgesic consumption and pain scores) were extracted to establish validity. RESULTS Kappa values indicated good-to-excellent (κs > .65) interrater reliability of the individual codes. The CBCS-P had good criterion validity when compared to childrens analgesic consumption and pain scores. CONCLUSIONS The CBCS-P is a reliable, observational coding method that captures childrens distress and nondistress postoperative behaviors. These findings highlight the importance of considering context in both the development and application of observational coding schemes.

Effects of therapeutic suggestion in children undergoing general anesthesia: a randomized controlled trial

Objectives and aim:  The goal of this randomized controlled trial was to examine the effect of intraoperative positive therapeutic suggestion on postoperative nausea and vomiting (PONV) in children undergoing general anesthesia and otolaryngological surgery.

Desire for perioperative information and parental ethnicity.

Objectives:  To examine the role of ethnicity, language, and socioeconomic variables in parental desire for information regarding children’s surgery.

Gender Biases in Adult Ratings of Pediatric Pain

Accurate assessment is critical in pediatric pain, and often adults gauge pain via children’s behavior. To measure adults’ gender biases in regard to children’s pain, 183 adults completed measures and rated the pain of a videotaped child receiving a finger stick blood test. Half of the participants were told the child was male and half female. Participants rated the “male” patient as having greater pain. Similarly, participants’ indicated beliefs that girls are more sensitive and reactive to pain than boys. Results suggest adults hold explicit and implicit biases that girls are more sensitive and reactive to pain than boys.

Presenting Your Research

When you consider submitting your research for a conference presentation, it is wise to weigh the costs and benefits of the endeavor. The benefits include disseminating information to appreciative audiences, such as professors, students, clinicians, teachers, and other professionals interested in new ideas to assist them in their own work. As a personal gain, your audience may provide feedback on your research findings which may be invaluable to you in the development of your research program. Presenting research at conferences also allows for the opportunity to meet potential future advisors, employers, collaborators, and/or colleagues. Conferences are ideal settings for networking and, in fact, many conferences have forums organized for this exact purpose (e.g., job openings listed on a bulletin board and networking luncheons). The costs include the time commitment of writing and constructing the presentation, the potential for rejection from the reviewers, the cost of attending the conference, the anxiety inherent in formal presentations, and the time and expenses of traveling to the meeting. Although we do believe that the benefits of presenting at conferences outweigh the costs, you should consider the specific pros and cons for you, your research, the specific meeting, and your particular situation before embarking on this experience.

Changing Health Care Providers’ Behavior During Pediatric Inductions With an Empirically Based Intervention

COMMENT Advances in medical technology and drug development have revolutionized the practice of anesthesiology during the last 30 years. The importance of pulse oximetry, modern anesthesia machines, and drugs with predictable pharmacology is sometimes overlooked as we enter the next phase of pharmacogenomics and applied pharmacology. In the current era, we administer drugs based on total body weight, although lean body LBM may represent a more accurate means of drug dosing. The current authors previously published methods for deriving LBM from height and weight using elegantly simple formulas (from Boer). Here, Peters et al estimate LBM based on theoretical formulas (eLBM = 3.8 eECVe and eECV = 0.0215 W0.6469 H0.7236) and compare results to empirical data obtained from children and adults. The authors conclude that the theoretical formulas agree with the empirical data for both adults and children (mean ratio of 1.04 for children with an SD of 0.18). The authors have validated a simple method for calculating LBM from height and weight. However, these calculations assume that the linear relationship between ECV and LBM for adults holds true for children. This is quite a big step, if not a leap. Although these relationships may hold true for young children and adolescents, they may prove challenging in neonatal populations with unusual relationships between ECV, weight, and height. The current study provides a simple means for calculating LBM from height and weight that should be studied in neonatal and young infant populations.