Findings suggest that all measures of outcome have acceptable to excellent reliability with a slight improvement in agreement for the NARCO compared with the ASA-PS. This study supports the validity of both the NARCO and the ASA-PS in predicting perioperative risk in children with a slight improvement in correlations when combined with the SS score.

CLIs were a helpful adjuvant in the four cases presented and may be an effective therapy for a more diverse array of refractory cancer pain. The majority of patients experienced pain relief well beyond the metabolic elimination of the lidocaine, corroborating a modulation effect on pain windup. Additional research regarding infusion rates, serum concentrations, side effects, and outpatient follow-up in a larger group of patients will provide additional insight into the role and safety of this therapy in children.

The efficacy of intraoperative intrathecal morphine for postoperative analgesia in the posterior spinal fusion patient population has been shown previously; however, the pain and analgesic trajectory, including transition to other analgesics, has not previously been studied. Our findings suggest that for many patients, use of intrathecal morphine in addition to routine administration of nonopioid medications facilitates direct transition to oral analgesics in the early postoperative period and earlier routine ambulation and discharge of posterior spinal fusion patients.

BACKGROUND When pain management has been studied in settings such as pediatric emergency departments, racial disparities have been clearly identified. To our knowledge, this has not been studied in the pediatric perioperative setting. We sought to determine whether there are differences based on race in the administration of analgesia to children suffering from pain in the post anesthesia care unit. METHODS A prospective, observational, study of 771 children aged 4–17 years who underwent elective outpatient surgery. Racial differences in probability of receiving analgesia for pain in the recovery room were assessed using bivariable and multivariable logistic regression analyses. RESULTS A total of 294 children (38.2%) received at least one class of analgesia (opioid or non-opioid); while 210 (27.2%) received intravenous opioid analgesia in the recovery room. Overall post anesthesia care unit analgesia utilization was similar between white and minority children (whites 36.8% vs. minority children 43.4%, OR 1.3; 95% CI = 0.92–1.89; p=0.134). We found no significant difference by racial/ethnic group in the likelihood of a child receiving intravenous opioid for severe postoperative pain (whites 76.0% vs. 85.7%, OR 1.89; 95% CI = 0.37–9.67; p=0.437). However, minority children were more likely to receive intravenous opioid analgesia than their white peers (whites 24.5% vs. minority children 34.2%, OR 1.5; 95% CI = 1.04–2.2; p=0.03). On multivariable analysis, minority children had a 63% higher adjusted odds of receiving intravenous opioids in the recovery room (OR =1.63; 95% CI, 1.05–2.62; p=0.03). CONCLUSIONS Receipt of analgesia for acute postoperative pain was not significantly associated with a child’s race. Minority children were more likely to receive IV opioids for the management of mild pain.

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AEs were described as tachycardia or ventricular tachycardia. Of note, all the AEs occurred during emergence from anesthesia and with the administration of both reversal agents (anticholinesterase/ anticholinergic drugs) and the use of the antiemetic ondansetron. The authors mention that 28 patients received ondansetron or reversal agents alone without provocation of arrhythmias. Whether these events represent synergism between 5-HT 3 receptor antagonist prolongation of the QT interval and anticholinergic-mediated tachycardia is unclear. Quite possibly, these events are idiosyncratic and skewed because of small sample size.In 2001, the Food and Drug Administration placed a black box warning on droperidol, citing concerns about QT prolongation stemming from case reports of sudden cardiac death involving patients who received large doses of droperidol. Despite the fact that much smaller, antiemetic doses of droperidol are administered by anesthesiologists, we continue to practice in a world obsessed about the QT interval and rare events likely unrelated to drug therapy.

Management of perioperative pain is critical in the pediatric patient undergoing orthopaedic surgery. A variety of modalities can be used to manage pain and optimize recovery and patient satisfaction, including nonopioid and opioid analgesia; local anesthetic injection; and regional analgesia such as intrathecal morphine, epidural therapy, and peripheral nerve blocks. Acute pain management can be tailored based on the needs of the patient, the surgical site, and the anticipated level of postoperative pain. A preoperative discussion of the plan for perioperative pain control with the patient, his or her parents, and the anesthesiologist can help manage expectations and maximize patient satisfaction.

Debate about whether the academy functions to indoctrinate students in a liberal agenda frequently presumes a conception of political identity as binary, discrete, or mappable along a single spectrum, and as doxastic, in that it is reducible to one’s professed beliefs.  Such an assumption, however, ignores the ways in which power dynamics and hierarchies that exist outside the classroom also operate within it.  We propose here that the critical examination of positionality within the classroom, and of how classroom activities can contest, reinforce, and reconfigure such power dynamics, offers an alternative way of conceiving the political.  We argue that the methods and literature from the academic study of religion offers a particular contribution to make in such a project.