Parental factors influencing postoperative pain in children : a systematic review

Context: Postoperative pain after surgery in children is an underestimated and complex problem. Several predictors which contribute to this poor outcome are linked to child, system, medication or parental factors. Parents are important partners in an efficient postoperative pain management. Objective: To examine which specific parental factors might be associated with postoperative pain of children. Data sources: Pubmed/MEDLINE, Web of Science, Cochrane database, Embase and PsycARTICLES Study selection: Inclusion of studies written in english which examine specific parental related predictors for increased postoperative pain in children aged up to 18 years. Randomized controlled trials, observational, cohort, case-control, case series, cross sectional were included from January 1995 up until April 2021. Data extraction and Data synthesis: A data extraction form was used and due to clinical and methodological heterogeneity the findings are presented in a narrative form. Results: Out of 647 search results, 22 studies were withheld in the final analysis. The parental related predictors can be grouped in five categories: culture; lack of knowledge; attitude; anxiety and parental pain catastrophizing. Limitations: The results indicate a high level of heterogeneity. Conclusions: Parental related risk factors found seem to be associated with worse child postoperative pain scores but additional studies are needed

The adsorption of dabigatran is as efficient as addition of idarucizumab to neutralize the drug in routine coagulation assays

INTRODUCTION: The direct thrombin inhibitor dabigatran interferes with thrombophilia screening and with the diagnosis of hemostasis disorders that develop during treatment with the anticoagulant. In vitro addition of idarucizumab, a humanized antibody fragment that binds dabigatran, to plasma samples containing dabigatran fully neutralizes the drug. This study was carried out to determine whether binding of dabigatran on selected insoluble commercial adsorbent material, DOAC-STOPR , was as efficient as idarucizumab to neutralize the anticoagulant activity of the drug in vitro. METHODS: Coagulation assays sensitive to dabigatran were carried out with patient and control plasma samples spiked with dabigatran and supplemented with idarucizumab or incubated with adsorbent material. RESULTS: In samples containing upto 10 000 ng/mL dabigatran, the adsorption procedure was at least as efficient as the addition of idarucizumab to neutralize the activity of the anticoagulant drug. Neither the adsorption procedure nor the addition of idarucizumab did impair routine coagulation assays carried out with plasma devoid of dabigatran, such as the activated partial thromboplastin time, prothrombin time, fibrinogen Clauss, and the thrombophilia screening assays used to detect antiphospholipid antibodies or activated protein C resistance. In addition, the adsorption procedure did not interfere with the detection of lupus anticoagulant samples. CONCLUSIONS: Adsorption of dabigatran in plasma samples containing the drug neutralizes its activity as efficiently as the addition of idarucizumab. This method allows the evaluation of thrombophilia markers without interruption of anticoagulation therapy or the detection of hemostasis disorders in patients treated with the drug.status: publishe