Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
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J. Perianesth. Nurs. · Dec 2000
ReviewPerioperative considerations for the child with an upper respiratory tract infection.
The decision to cancel or proceed with elective surgery for the child with an upper respiratory tract infection (URI) has been a source of debate among pediatric anesthesiologists, nurse anesthetists, and perianesthesia nurses for many years. Although some studies suggest that anesthesia for the child with a URI increases the risk of perioperative respiratory complications, others suggest that these complications are easily managed and are not associated with any adverse sequelae. This article describes the pathogenesis of viral respiratory tract infections, reviews the literature regarding anesthesia and URIs, and discusses the assessment and management of the child who presents for elective surgery while harboring a URI. It is hoped that this information will be important to perianesthesia nurses and anesthesia providers in making decisions regarding proceeding or cancelling surgery for children with URIs and in optimizing their perioperative management.
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J. Perianesth. Nurs. · Dec 2000
ReviewSedation/Analgesia for diagnostic and therapeutic procedures in children.
Sedation/analgesia for diagnostic and therapeutic procedures in children has been associated with life-threatening adverse events. Reports of adverse events and recognition of wide variability in sedation practices has led to the development of guidelines and standards of care to ensure the safety of sedated children. ⋯ Children with underlying medical conditions, such as airway abnormalities, may not be suitable subjects for sedation and may require consideration for general anesthesia to aid their procedure. Although significant strides have been made in recognition of the risks of sedation and in development of guidelinesfor safe sedation practices, further work must focus on development of newer sedation regimens with shorter-acting drugs and wider margins of safety.
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Inadequate pain assessment in children may lead to an underestimation of pain, and consequently, undertreatment in this population. This article provides an overview of pain assessment and describes specific measurement tools that can be used with infants, children, and adolescents. Nationally published practice guidelines and standards recommend pain assessment at regular intervals with age-appropriate tools. Pain assessment must be integrated into perianesthesia nursing practice, and nurses must develop competency in the assessment and treatment of pain in children.
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The prevention and treatment of postoperative nausea and vomiting (PONV) in children remains an important challenge for the pediatric anesthesiologist. Despite a clearer understanding of the physiology of emesis and with the development of new anesthetic and antiemetic agents, PONVis still an important cause of morbidity. The approach to minimizing this complication is multifactorial and includes proper preoperative preparation, a rational approach to intraoperative antiemetic prophylaxis, choice of appropriate anesthetic agents and techniques, and a definitive plan for postoperative care. This review gives a brief account of the numerous classes of antiemetics available to treat this condition and the various strategies that can be used to reduce PONV.