Pediatric clinics of North America
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Pediatr. Clin. North Am. · Oct 1989
ReviewLytic/"DPT" cocktail: time for rational and safe alternatives.
These therapeutic approaches to the premedication of children, in our opinion, offer a more rational, probably safer, and at least equally efficacious treatment regimen as the DPT/lytic cocktail. It is understood that controlled, double-blind comparative clinical trials in children are needed of these or other potential premedicant regimens for specific pediatric procedures (e.g., cardiac catheterization, CT scans, bone marrow aspiration, gastrointestinal endoscopy, pleural taps, etc.) to establish the premedication treatment(s) with the greatest benefit-to-risk ratio. Until these data are available, we must maintain prudence in the selection (design) of premedicant regimens and carefully monitor all children receiving these "cocktails."
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For people with sickle cell disease, vaso-occlusive crisis pain is a frequently encountered problem that poses unique and often perplexing challenges in management. This article reviews the natural history of vaso-occlusive crisis and discusses intervention appropriate for the care of patients with pain due to this chronic illness.
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Our approach to the management of fear and pain in the pediatric emergency department is presented. Tricks to attempt the gaining of rapport with frightened children in pain are noted, with emphasis on a developmental approach. The use of analgesic medications, local anesthetics, ketamine, and nitrous oxide as appropriate to emergency situations is outlined. Lastly, the guidelines of the American Academy of Pediatrics for outpatient sedation are reviewed.
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Pediatr. Clin. North Am. · Aug 1989
ReviewPharmacologic management of pain in children and adolescents.
In the management of chronic pain conditions, the combination of pharmacologic measures with physical and psychologic modalities becomes even more important. A pain clinic and pain consultation service are one model that facilitates this combined approach. Initial management of mild to moderate pain begins with nonopioid analgesics such as acetaminophen and NSAIDs. ⋯ For example, remarkably little is known about the effects of chronic opioid administration in childhood on growth and development. Certainly, this issue deserves further study before general recommendations can be made. It seems prudent to emphasize the importance of maximizing nonpharmacologic and nonopioid approaches in the management of chronic pain in children prior to embarking on long-term use of opioids.
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This article reviews methods to relieve postoperative pain in most children. It also discusses the major barriers to treatment and considers the provision of opioids via a painless route as an alternative to the more usual intramuscular (and painful) route.