The Nursing clinics of North America
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In this article the authors review the developmental pathophysiology of pain and its effects on children. Assessment modalities for differing developmental levels in the pediatric patient are reviewed. Medical modalities including medications administered orally, patient-controlled analgesia, epidurals, and preemptive analgesia are described.
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Advances in many aspects of pediatric anesthesia have resulted in a significant reduction in morbidity and mortality in children. Research and development have created vast improvements in pharmacology. ⋯ Recognition of the psychological needs of children of all ages likely has reduced the incidence of lasting psychological effects after hospitalization. Finally, these important advances have made pediatric anesthesia a safer and more compassionate specialty.
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Extracorporeal membrane oxygenation (ECMO) is prolonged cardiopulmonary bypass used to treat critically ill patients with severe but reversible cardiac and/or respiratory failure. The severity of their symptoms, the rapid deterioration in their conditions, the difficulty in mechanical transportation, and the risks of traveling with an ECMO circuit often prohibit cannulation in an operating room. Cannulation for and decannulation after ECMO therapy can be safely accomplished in the intensive care unit by utilizing experienced perioperative nurses.