Intraoperative opioid dosing in children with and without cerebral palsy

Long, L. Stephen; Ved, Sudha A.; Koh, Jeffrey L.

doi:10.1111/j.1460-9592.2009.02980.x

Cited by 26 publications

(17 citation statements)

References 15 publications

(14 reference statements)

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“…This could be seen as an improvement, because a previous survey found that 89% of the physicians have a tendency to prescribe subtherapeutic doses of opioids (2). In addition, two other studies report lower doses of intraoperative opioids in intellectually disabled children (16,17). One previous study by Malviya et al.…”

Section: Discussionmentioning

confidence: 99%

Pain management in intellectually disabled children: a survey of perceptions and current practices among Dutch anesthesiologists

Valkenburg

Kreeft

Leeuw

et al. 2012

Pediatric Anesthesia

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Anesthesiologists in the Netherlands take a different approach when caring for intellectually disabled children and they were not aware of pain observation scales for these children. However, the majority think that intellectually disabled children are not more sensitive to pain or require more analgesia. These opinions did not change over the 4-year period. One way to proceed is to implement validated pain assessment tools and to invest in education.

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Section: Discussionmentioning

confidence: 99%

Pain management in intellectually disabled children: a survey of perceptions and current practices among Dutch anesthesiologists

Valkenburg

Kreeft

Leeuw

et al. 2012

Pediatric Anesthesia

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show abstract

“…Opioid dosing is commonly reduced in children with cognitive impairment (87), an observation supported by lower BIS scores in this cohort when given doses similar to healthy comparators (88). Behavioral predispositions such as preoperative anxiety also increases propofol induction dose (89).…”

Section: Pharmacodynamic Variabilitymentioning

confidence: 63%

My child is unique; the pharmacokinetics are universal

Anderson¹

2012

Pediatric Anesthesia

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The pharmacokinetic (PK) parameters that are important for dosing (e.g., clearance and volume) are well known. They are used in universal mathematical formulae that describe the time course of drug concentration. Additional formulae can be used to describe major covariate effects in children, such as size and maturation. PK parameters describing the time-concentration profile of a drug after administration are those for a typical individual in a population. These parameters are associated with variability. Further, any one individual may not be typical of the population studied. While size and maturation are two important considerations in children and assist with dosing estimation, there are also a number of additional PK covariates (e.g., organ function, disease, drug interactions, pharmacogenetics), and identifying these sources of variability allows us to individualize drug dose. Pharmacology is not simply an application of PK, and determinants of drug dose also require an understanding of the variability associated with pharmacodynamic response and a balancing of beneficial effects against unwanted effects. Each child is unique in this respect.

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“…Even when the pain is acknowledged, this population receives fewer analgesics than the general population (51, 52). Pain is a subjective and complex phenomenon; self-assessment may be the best defense against misconceptions.…”

Section: Resultsmentioning

confidence: 99%

Beyond Misconceptions: Assessing Pain in Children with Mild to Moderate Intellectual Disability

Zabalia¹

2013

Front. Public Health

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To assess and manage pain in children and adolescents with mild to moderate intellectual disability, healthcare providers need access to updated tools and current knowledge. Recent studies show that these children can verbally express pain and use self-assessment tools accurately. Moreover, they know pain coping strategies. Finally, they show mental imaging skills and are able to recall autobiographical memories. These new data suggest that such children and adolescents could be candidates to for hypno-analgesia protocols and behavioral relaxation.

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Intraoperative opioid dosing in children with and without cerebral palsy

Cited by 26 publications

References 15 publications

Pain management in intellectually disabled children: a survey of perceptions and current practices among Dutch anesthesiologists

Pain management in intellectually disabled children: a survey of perceptions and current practices among Dutch anesthesiologists

My child is unique; the pharmacokinetics are universal

Beyond Misconceptions: Assessing Pain in Children with Mild to Moderate Intellectual Disability

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