A partially inflated cuff inserted by the lateral route is a better method of insertion in children and grade 3 fibreoptic views can be associated with a significant build up of carbon dioxide in children breathing spontaneously.
Adverse childhood experiences (ACEs) increase the likelihood of reduced physical and psychological health in adulthood. Though understanding and psychological management of traumatic experiences is growing, the empirical exploration of ACEs and physical clinical outcomes remains under-represented and under-explored. This topical review aimed to highlight the role of ACEs in the experience of chronic pain, pain management services and clinical decision making by: (1) providing an overview of the relationship between ACEs and chronic pain; (2) identifying biopsychosocial mechanisms through which ACEs may increase risk of persistent pain; (3) highlighting the impact of ACEs on patient adherence and completion of pain management treatment; and (4) providing practical clinical implications for pain management. Review findings demonstrated that in chronic pain, ACEs are associated with increased pain complications, pain catastrophizing and depression and the combination of these factors further heightens the risk of early treatment attrition. The pervasive detrimental impacts of the COVID-19 pandemic on ACEs and their cyclical effects on pain are discussed in the context of psychological decline during long treatment waitlists. The review highlights how people with pain can be further supported in pain services by maintaining trauma-informed practices and acknowledging the impact of ACEs on chronic pain and detrimental health outcomes. Clinicians who are ACE-informed have the potential to minimize the negative influence of ACEs on treatment outcomes, ultimately optimizing the impact of pain management services.
Chronic postsurgical pain (CPSP) is a common problem, with up to a third of patients reporting persistent or intermittent pain 1 year after common operations. A proposed definition is pain that develops after a surgical procedure, which lasts at least 2 months, and where other causes and preexisting pain have been excluded. A variety of preoperative, intraoperative, and postoperative factors are thought to contribute to the pathogenesis of CPSP. Preventive strategies include effective postsurgical acute pain management, preoperative administration of gabapentin or pregabalin continued postoperatively, and considering the necessity of the surgical procedure itself and exploring alternatives.
These data reveal that NSAIDs were still widely used as analgesics for many surgical procedures at the time of the audit. Intravenous (IV) NSAID administration is the preferred route because of its reliability and speed of onset. The results of this audit indicated significant use of IV NSAIDs (ketorolac, diclofenac and ketoprofen) not in accordance with manufacturers' recommendations, with some NSAIDs even being used in the absence of a product licence for use by the IV route. This may be due to a lack of a satisfactory licensed product. A new formulation of IV diclofenac may fulfil this currently unmet need.
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