Pain: Postoperative Analgesia in Infants and Neonates

Pain affects almost everyone at some point in his or her life. A definition drawn up by the International Association for the Study of Pain (IASP) has it that pain is always subjective This would seem to imply that the way in which pain is perceived varies from person to person and may also be influenced by the setting and previous experiences. The same definition states that “inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment”. This truth has a bearing on neonates and children with profound cognitive impairment, who are not able to verbally express their pain, anxiety or other sources of distress. Therefore caregivers in the hospital setting need to find other ways to recognize pain. Early recognition is important because pain requires prompt and adequate treatment, also to prevent possible long-term sequelae. Stress hormone levels have been studied in premature neonates who underwent surgery without perioperative analgesia; levels of cortisol, aldosterone, and other corticosteroids were markedly increased, signifying high stress. In the intensive care unit (ICU) setting, stress and agitation resulting from pain and anxiety can lead children to accidentally remove medical devices endangering the child’s safety. Pain (and therefore stress) is a common condition on the ICU. Previous studies have shown that children in the ICU setting daily undergo many painful procedures, including IV canula insertion or removal, suctioning and heelstick. What’s more, a 2008 survey showed that 80% of these procedures are performed without analgesics

Quantifying the pharmacodynamics of morphine in the treatment of postoperative pain in preverbal children

While the pharmacokinetics of morphine in children have been studied extensively, little is known about the pharmacodynamics of morphine in this population. Here, we quantified the concentration-effect relationship of morphine for postoperative pain in preverbal children between 0 and 3 years of age. For this, we applied item response theory modeling in the pharmacokinetic/pharmacodynamic analysis of COMFORT-Behavior (COMFORT-B) scale data from 2 previous clinical studies. In the model, we identified a sigmoid maximal efficacy model for the effect of morphine and found that in 26% of children, increasing morphine concentrations were not associated with lower pain scores (nonresponders to morphine up-titration). In responders to morphine up-titration, the COMFORT-B score slowly decreases with increasing morphine concentrations at morphine concentrations >20 ng/mL. In nonresponding children, no decrease in COMFORT-B score is expected. In general, lower baseline COMFORT-B scores (2.1 points on average) in younger children (postnatal age 10 days. These findings support a dosing regimen previously suggested by Krekels et al, which would put >95% of patients within this morphine target concentration range at steady state. Our modeling approach provides a promising platform for pharmacodynamic research of analgesics and sedatives in children.Pharmacolog

Upside down you're turning me: inverted Takotsubo pattern cardiomyopathy

Perioperative Medicine: Efficacy, Safety and Outcom

Evidence-Based Morphine Dosing for Postoperative Neonates and Infants

AnesthesiologyPerioperative Medicine: Efficacy, Safety and Outcom

Ageing in the LHCb outer tracker: Phenomenon, culprit and effect of oxygen

The LHCb Outer Tracker (OT) detector has shown to suffer from gain loss after irradiation in the laboratory at moderate intensities. Under irradiation an insulating layer is formed on the anode wire. The ageing is caused by contamination of the counting gas due to outgassing of the glue used in construction namely araldite AY103-1. The gain loss is concentrated upstream the gas flow, and at moderate irradiation intensity only. The ageing rate is reduced by longterm flushing and by the addition of a few percent of O2 to the gas mixture. Furthermore, applying a large positive high voltage (beyond the amplification regime) removes the insulating deposits without damaging the wire surface. This paper presents both the characteristics of the ageing phenomenon and the beneficial treatments