Anagesia And Sedation In Infants

Optimal postoperative pain control is of utmost importance in the surgical population. 1-2 Analgesic techniques in paediatric patients having surgery are often delayed by the inherent difficulties of conducting a large randomized clinical trial in those patients. 3,-4 The optimal dose of local anaesthetics in paediatric regional anaesthetic techniques remain unknown. 5- 6

Special care and attention must be given to infants in the Neonatal Intensive Care Unit (NICU) because of their small size and the health complications they face. One particular challenge faced by health care professionals in the NICU is the management of pain for preterm babies. Preterm infants must undergo a wide range of tests, procedures, and, often, life-saving measures during their hospitalizations, which not only subjects them to pain, but pain-related stress and anxiety. This has an impact on the infants themselves, as well as on the family members and friends who are involved in their care (Smith, Steelfisher, Salhi, & Shen, 2012). The purpose of this paper is to examine the problem of pain management among preterm NICU patients and propose the implementation of kangaroo care as a pain management technique.

When managing the childs pain during cancer treatment the nurse must work with an interdisciplinary team involving many different experts to come up with the best possible pain management plan for the child. The nurse would be the one to carry this plan out in the child’s care. Knowing what opioid’s, nonopioids, NSAIDS, acetaminophen with codeine, oxycodone, and morphine to give during different times is crucial. The nurse must also know the side effects of these medication and monitor the child closely.

In a study conducted by Hatfield and Young (2007), 1,727 procedures such as venipuncture, intravenous (IV) catheter placement, intramuscular (IM) injections, urinary catheterizations, and nasogastric tube placement in 1,210 children have been reviewed. Their findings reveal that almost none of the patients received pain management. Although traumatic for the patient, these procedures are considered to be minor by many nurses, and the culture of pain management has not been seen as the standard of care (Hatfield & Young, 2007). Nursing staff is encouraged to change the culture by embracing their role as patient advocate. Every patient deserves a triage pain assessment with ongoing assessments as necessary. Pain control measures must be implemented prior to beginning potentially painful procedures. Discussion must take place between the parents and healthcare staff in order to deliver the best comfort measures on a case-by-case basis.

According to surveys, up to 80% of patients reported moderate to severe post-surgical pain, which can sometimes be left undertreated (Sinatra et al., 2005). Postoperative pain is generally managed with opioids, which carry numerous side effects. Side effects can be bothersome and possibly cause a delay in the postoperative healing process (Beard, Leslie, & Nemeth, 2011). IV acetaminophen can possibly decrease opioid consumption, minimize side effects, increase patient satisfaction, and decrease costs (Wininger et al., 2010). The purpose of this paper is to dive further into the research to present data on the effectiveness of IV acetaminophen in decreasing opioid usage and whether it produces an additive effect causing more effective pain management in the postop patient.

One of the many changes that affect us every day is oxygen toxicity in premature

According to the American Pregnancy organization “more than 50% of woman giving birth at hospitals use Epidural Anesthesia”. These women turn to epidural to relieve the pain of labor; however this decision poses many risks to both mother and child. An epidural is a type of regional anesthesia where pain medication is administered to the lumbar and sacral region of the back near clusters of nerves. The placement allows for nerve impulses to be blocked from the lower regions of the body resulting in decreased sensations. Although the epidural is known for taking pain away it could very well cause it too. Epidurals include the use of various narcotics and have side effects like hypotension, fever, fetal malposition, decreased fetal heart rate, respiratory depression, breastfeeding complications, an increased likelihood of operative vaginal delivery and cesarean and many more. These are the effects faced in result to a procedure that is not definite to work. In Fact “One in every 8 women” (OAA) will experience inadequate pain relief and must venture to other means of medication. Therefore, mothers should abstain from epidural anesthesia due to the risks it poses to themselves and to the fetus.

Opioid addicted babies need treatment in the hospital setting to help them through the withdrawal process. Studies are showing what medications to use to help reduce the length of hospital stay. Today, many neonates stay in the hospital much longer than years past, this is generally due to being born addicted to opioids. The United States is suffering from an epidemic of opioid abuse. When a pregnant mother is addicted to opioids these drugs cross the placenta, causing the neonates to be born addicted. According to Hall et al. (2015), this epidemic can cause opioid misuse, overdose or even death. When looking at the United States from 2005-2011, “more than 14% of pregnant women were dispensed an opioid at some time in their pregnancy”, (Hall, 2015, pg.40). Depending on the length of medication used and timing during the pregnancy will determine how a neonate will withdraw after birth. This withdrawal is becoming a common practice and is known as Neonatal Abstinence Syndrome (NAS). By 2015, this syndrome would affect one neonate in 200 births. Improvements in medications and techniques help neonates get through withdrawal. I have created a PICO to help form this paper. This paper will compare the two medications; Morphine and Buprenorphine are most commonly used to help neonates withdrawing in the

The database was searched for main terms for information on the related topic included oral sucrose, infants, and immunizations. Alternative terms included oral sweeteners, neonates, needles, and analgesia. MeSH terms included Needles*, Sucrose/*administration & dosage, Pain/*prevention & control, Punctures/*adverse effects, Sweetening Agents/*administration & dosage, Humans; Infant; Randomized Controlled Trials as Topic. Inclusion criteria included infants < 1 year of age, publication dates: 2005-2016, randomized control trial, systematic review, USA, glucose/sucrose,

Several analysis and statistics have been done on Fentanyl. The PLOS ONE did an analysis, their goal was to establish the effect Fentanyl had on children with the presence of emergence agitation (EA) under sevoflurane anesthesia. In all 16 studies were done which included 1362 patients, 737patients were for the Fentanyl group and the rest were for the placebo group, which is an ineffectual treatment for a medical condition. With the presence of Fentanyl, the incidence of EA as well as pain was decreased. However, it increased the frequency of nausea and vomiting denoting the period following the surgical operation. The study concluded that Fentanyl may be associated with a decreased incidence of EA in children and was proven to have a higher

If the infant is showing extreme discomfort and crankiness, the pain can be treated with over-the-counter medication. Infant acetaminophen can be used to help with the pain, and ibuprofen can be used to help with both swelling and discomfort. Be sure to use the dosage that is accurate for the infant’s weight, and to use as directed. Talk with a pediatrician about concerns, and about rotating the medications.

Pediatric pain management is measured subjectively because it is based off of what the patient says or how the nurse interprets the pain scale. Pain is rated using different scales, unfortunately these different scales could yield different results. Nurses are trained to use pediatric pain scales to analyze and treat pain but parents are not supplied with the tools to manage pain when the patient goes home. With 84% of all pediatric surgical procedures performed on an outpatient basis, the importance of teaching parents how to assess for and manage pain has become more important than ever (Rony, Fortier, Chorney, Perret, & Kain, 2010). According to Rony’s et al. (2010) study, it is apparent that pediatric pain is not being treated effectively. The study showed that 58.8% of children were receiving less than the daily recommended does prescribed by the pediatrician (p.1). Results of the study also showed that parents had false assessments on if their child was actually in pain. 36% of parents believed that if their child was in pain, they would cry out for the parent , 30% agreed that their child would always tell them if they are in pain, while 22% said that the child would report their pain immediately (Rony, Fortier, Chorney, Perret, & Kain, 2010, ). Children do not always verbalize when they are in pain. Sometimes the pain can be so intense that a child is unable to talk. If the child catches on to the parents negative perception of pain medications, the child may not

The ability to provide safe and effective local anesthesia is one of the most important skills required in the dentistry. To be able to achieve this required skill is amazing, however, to work with complications and still be efficient, is commendable. There are so many complications one might encounter in a dental office, particularly morbidly obese children. Childhood obesity is a serious problem amongst our country today, especially concerning the oral health. According to the CDC, did you know that in the United States, one in every five children has obesity? Obese children posture exceptional difficulties when establishing appropriate doses suitable for local anesthesia. The explanation for this is because of the vast measure of adipose tissue in the oral cavity, which makes it hard to distinguish the patient's intraoral anatomy.

Pharmacological comfort measures can provide partial or complete pain relief. The epidural is the most efficient way of reducing labor pain. Opioids can be given continuously or in intermittent doses at the patient 's request or through the patient controlled pump. There is the potential for these drugs to have some effect on the fetus, such as breathing difficulties that may require assistance through the use of Narcan. Providing pain relief during the labor process is solely the patient’s choice, and as the nurse only support and encouragement should be given for however she chooses to handle the pain. (Jansen, Gibson, Bowles, & Leach, 2013)

The drugs that are used to treat neonates can be used multipurposely and often innovation drives creative uses of drugs to treat uncommon multifactorial complications (Allegaert & van den Anker, 2015). Knowledge of the drugs and their adverse effects is increasingly important when dosing a neonate. Due to their undeveloped body systems, in an event of an undesired reaction or drug error, the neonate would not be able to compensate and recover like the other patient groups may (Skene, Gupta, Flaherty, & Sherwood, 2012). Furthermore, this stresses the importance of being competent in drug calculations and being aware of the effect of medicines on this particularly vulnerable patient group (Stavroudis, Shore, Morlock, Hicks, Bundy, & Miller,