The Annals of pharmacotherapy
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Randomized Controlled Trial Clinical Trial
Anesthetic efficacy of eutectic prilocaine-lidocaine cream in pediatric oncology patients undergoing lumbar puncture.
To evaluate the efficacy of eutectic mixture of local anesthetics 5% (Emla) in reducing pain associated with lumbar punctures in children. ⋯ The use of Emla cream may reduce pain substantially only in patients who undergo a successful lumbar puncture on the first attempt.
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To summarize and critique the Agency for Health Care Policy and Research (AHCPR) Clinical Practice Guideline for the management of otitis media with effusion (OME) in children. ⋯ The documents were well organized and provide detailed explanation of the recommendations. The Guideline provides specific criteria for the surgical management of OME, but is vague in its recommendations on the medical management of OME with antibiotics, corticosteroids, and the use of invasive tympanocentesis in the evaluation of OME in otherwise healthy children.
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To report a case of methemoglobinemia induced by benzocaine and resorcinol (Vagisil) cream, an over-the-counter medication that was used to treat diaper rash in a neonate. ⋯ Newborn infants are at increased risk for methemoglobinemia due to diminished enzyme systems required to reduce ferrihemoglobin to ferrohemoglobin, as well as because fetal hemoglobin is more easily oxidized than is adult hemoglobin. It is important to recognize possible drug reactions and educate parents on the potential risks of treatment with over-the-counter medications, especially in neonates.
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To evaluate a protocol based on continuous infusion of a benzodiazepine and morphine to produce apnea/decreased respiratory effort as an adjunct to complex mechanical ventilation in patients with respiratory failure. ⋯ Continuous infusion of a benzodiazepine and morphine controlled the respiratory rate in patients with severe respiratory failure requiring complex mechanical ventilatory support.
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There are insufficient data to support the use of Emla cream for circumcision in newborn infants at this time. There are no studies that adequately address safety or efficacy. ⋯ Subsequent studies should be performed within the first 72 hours of birth and assess the following parameters: (1) serum concentrations of metHb, lidocaine, and prilocaine and its metabolites from time zero to at least 24 hours after application of the cream; (2) application time and dose applied should be varied to assess differences in absorption, as well as onset and duration of analgesia; (3) application technique could be varied to assess the depth of analgesia, that is, application to the inner and outer surface of the prepuce versus the outer surface only. Until these studies are completed, routine use of Emla cream for local anesthesia during circumcision cannot be recommended.