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      Procedural sedation and analgesia in pediatric patients

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          Abstract

          A spectrum of conditions requires sedation and analgesia in pediatric population. Ineffective treatment of pain may result in physiological and behavioral responses that can adversely affect the developing nociceptive system. The recognition of pain in children can be facilitated by different pain scales. This article reviews the procedural sedation and analgesia (PSA) practices in children along with pharmacology of the drugs used for this purpose.

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          The FLACC: a behavioral scale for scoring postoperative pain in young children.

          S I Merkel, T Voepel-Lewis, J Shayevitz … (1997)
          To evaluate the reliability and validity of the FLACC Pain Assessment Tool which incorporates five categories of pain behaviors: facial expression; leg movement; activity; cry; and consolability. Eighty-nine children aged 2 months to 7 years, (3.0 +/- 2.0 yrs.) who had undergone a variety of surgical procedures, were observed in the Post Anesthesia Care Unit (PACU). The study consisted of: 1) measuring interrater reliability; 2) testing validity by measuring changes in FLACC scores in response to administration of analgesics; and 3) comparing FLACC scores to other pain ratings. The FLACC tool was found to have high interrater reliability. Preliminary evidence of validity was provided by the significant decrease in FLACC scores related to administration of analgesics. Validity was also supported by the correlation with scores assigned by the Objective Pain Scale (OPS) and nurses' global ratings of pain. The FLACC provides a simple framework for quantifying pain behaviors in children who may not be able to verbalize the presence or severity of pain. Our preliminary data indicates the FLACC pain assessment tool is valid and reliable.
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            Pain and its effects in the human neonate and fetus.

            K J Anand, David P Hickey (1987)
            Article 0 comments Cited 164 times – based on 0 reviews     Review now
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              Long-term impact of neonatal intensive care and surgery on somatosensory perception in children born extremely preterm.

              Adam Walker, Janet Stocks, Jonathan Myles … (2008)
              Alterations in neural activity due to pain and injury in early development may produce long-term effects on sensory processing and future responses to pain. To investigate persistent alterations in sensory perception, we performed quantitative sensory testing (QST) in extremely preterm (EP) children (n=43) recruited from the UK EPICure cohort (born less than 26 weeks gestation in 1995) and in age and sex matched term-born controls (TC; n=44). EP children had a generalized decreased sensitivity to all thermal modalities, but no difference in mechanical sensitivity at the thenar eminence. EP children who also required neonatal surgery had more marked thermal hypoalgesia, but did not differ from non-surgical EP children in the measures of neonatal brain injury or current cognitive ability. Adjacent to neonatal thoracotomy scars there was a localized decrease in both thermal and mechanical sensitivity that differed from EP children with scars relating to less invasive procedural interventions or from those without scars. No relationship was found between sensory perception thresholds and current pain experience or pain coping styles in EP or TC children. Neonatal care and surgery in EP children are associated with persistent modality-specific changes in sensory processing. Decreases in mechanical and thermal sensitivity adjacent to scars may be related to localized tissue injury, whereas generalized decreases in thermal sensitivity but not in mechanical sensitivity suggest centrally mediated alterations in the modulation of C-fibre nociceptor pathways, which may impact on responses to future pain or surgery.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Pediatr Neurosci
                Journal ID (iso-abbrev): J Pediatr Neurosci
                Journal ID (publisher-id): JPN
                Title: Journal of Pediatric Neurosciences
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 1817-1745
                ISSN (Electronic): 1998-3948
                Publication date (Print): Jan-Apr 2014
                Volume: 9
                Issue: 1
                Pages: 1-6
                Affiliations
                [1]Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
                [1 ]Department of Anesthesiology, Fortis Memorial Research Institute, Gurgaon, Haryana, India
                Author notes
                Address for correspondence: Dr. Charu Mahajan, Department of Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. E-mail: charushrikul@ 123456gmail.com
                Article
                Publisher ID: JPN-9-1
                DOI: 10.4103/1817-1745.131469
                PMC ID: 4040023
                SO-VID: 5c7fc8fb-8e4d-41e1-b231-4c9a2553aba8
                Copyright © Copyright: © Journal of Pediatric Neurosciences
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Categories
                Subject: Review Article

                ScienceOpen disciplines: Neurosciences
                Keywords: analgesia,children,procedural sedation
                Data availability:
                ScienceOpen disciplines: Neurosciences
                Keywords: analgesia, children, procedural sedation

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