Pain score guided morphine titration is risky and inappropriate

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106691/1/pan12367.pd

Can pain assessment tools accurately measure pain experience of disabled individuals?

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147096/1/dmcn14033_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147096/2/dmcn14033.pd

Postsurgical behaviors in children with and without symptoms of sleep-disordered breathing

Abstract Background Although some children undergo formal preoperative testing for obstructive sleep apnea, it is likely that many children present for surgery with undetected sleep-related disorders. Given that these children may be at increased risk during the perioperative period, this study was designed to compare postoperative behaviors between those with and without symptoms of sleep-disordered breathing (SDB). Methods This study represents a secondary analysis of data from a study examining the effect of SDB on perioperative respiratory adverse events in children. Parents of children aged 2–14 years completed the Sleep-Related Breathing Disorder (SRBD) subscale of the Pediatric Sleep Questionnaire prior to surgery. Children were classified as having SDB if they had a positive score (≥0.33) on the SRBD subscale. Seven to ten days following surgery, the SRBD subscale was re-administered to the parents who also completed the Children’s Post Hospitalization Behavior Questionnaire. Children were classified as exhibiting increased problematic behaviors if their postoperative behaviors were considered to be “more/much more” relative to normal. Results Three hundred thirty-seven children were included in this study. Children with SDB were significantly more likely to exhibit problematic behaviors following surgery compared with children without SDB. Logistic regression identified adenotonsillectomy (OR 9.89 [3.2–30.9], P < 0.01) and posthospital daytime sleepiness (OR 2.8 [1.3–5.9], P < 0.01) as risk factors for postoperative problematic behaviors. Conclusions Children presenting for surgery with symptoms of SDB have an increased risk for problematic behaviors following surgery. These results are potentially important in questioning whether the observed increase in problematic behaviors is biologically grounded in SDB or simply a response to poor sleep habits/hygiene.http://deepblue.lib.umich.edu/bitstream/2027.42/109540/1/13741_2014_Article_36.pd

Pediatric cardiopulmonary arrest in the postanesthesia care unit: analysis of data from the American Heart Association Get With The Guidelines ® ‐Resuscitation registry

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98202/1/pan12154.pd

Reply to Engelhardt, Thomas; Wolf, Andy, regarding their comment ‘Surveys and all – the role of pediatric anesthetic societies’

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/115909/1/pan12779.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/115909/2/pan12779_am.pd

Response to: comments on attention-deficit/hyperactivity disorders and anesthesia

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79269/1/j.1460-9592.2010.03392.x.pd

Survey research: it's just a few questions, right?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111977/1/pan12680.pd

The STBUR questionnaire for predicting perioperative respiratory adverse events in children at risk for sleep‐disordered breathing

Background In the absence of formal polysomnography ( PSG ), many children with symptoms of sleep‐disordered breathing ( SDB ) go unrecognized and thus may be at risk for perioperative respiratory adverse events ( PRAE ). Objectives To develop a simple practical tool to identify children with symptoms consistent with SDB who may be at risk for PRAE . Methods Three‐hundred and thirty‐seven parents of children scheduled for surgery completed the Sleep‐Related Breathing Disorder ( SRBD ) questionnaire. Data regarding the incidence and severity of PRAE including airway obstruction and laryngospasm, were collected prospectively. Results Thirty‐two (9.5%) children had a confirmed diagnosis of SDB by PSG and 90 (26.7%) had symptoms consistent with SDB based on the SRBD questionnaire. Principal component analysis identified five symptoms from the SRBD questionnaire that were strongly predictive of PRAE and which were incorporated into the STBUR tool (Snoring, Trouble Breathing, Un‐Refreshed). The likelihood of PRAE was increased by threefold (positive likelihood ratio 3.06 [1.64–5.96] in the presence of any 3 STBUR symptoms and by tenfold when all five symptoms were present (9.74 [1.35–201.8]). In comparison, the likelihood of PRAE based on a PSG ‐confirmed diagnosis of SDB was 2.63 (1.17–6.23). Conclusions Children presenting for surgery with symptoms consistent with SDB may be at risk for PRAE . It is important therefore that anesthesia providers identify these individuals prior to surgery to avoid potential complications. The STBUR questionnaire appears promising as a simple, clinically useful tool for identifying children at risk for PRAE . Further studies to validate the STBUR questionnaire as a diagnostic tool may be warranted.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98131/1/pan12155.pd

A retrospective description of anesthetic medication dosing in overweight and obese children

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/108075/1/pan12396.pd

Parentsí Analgesic Decision Dilemmas: Trading Childrenís Pain Relief for Risk Reduction.

Background: Effective pain management requires analgesic decisions that balance the need to maximize pain relief and safety. However, reports of unrelieved childhood pain, analgesic misuse, and serious analgesic-related adverse drug effects (ADE) suggest that parental analgesic trade-off decisions are often inadequate. Based on decision theory, this dissertation examined parents’ analgesic decisions and explored factors that influenced their responsiveness to varying pain and ADE signals. Methods: Parents of children undergoing painful, short-stay surgery (N=468) completed surveys regarding their understanding of the possible opioid-related ADEs (gist knowledge), their perceptions of ADE seriousness, and their preferences for providing pain relief versus avoiding ADEs. Analyses compared both responses to hypothetical scenarios and real postoperative opioid decisions to see how parents responded to varying pain and ADE signals and to explore how gist analgesic understanding and preferences influenced their decisions to give opioids. Results: Parents were more likely to give opioids (hypothetically and postoperatively) when faced with higher pain and to withhold opioids when presented with ADEs, suggesting a general recognition of pain and ADE signals. However, parents were more likely to withhold the prescribed opioid dose for symptoms of nausea/vomiting than oversedation (odds ratio 0.68; p = 0.018), suggesting that oversedation symptoms may be less salient than nausea/vomiting. Perceived seriousness, but not gist possibility knowledge, influenced the decision to withhold opioids for oversedation, demonstrating that gist awareness of ADEs in itself may be insufficient to influence safe opioid use. Strong preference for pain relief over ADE avoidance weakened the effect of analgesic knowledge/perception on the decision to withhold opioids for oversedation, showing how preferences may interfere with knowledge when symptoms are less salient. Conclusion: Many parents lack a critical understanding of serious analgesic-related ADEs, such as oversedation, placing them at risk for making unsafe or ineffective treatment decisions. Parents need a clearer understanding of possible ADEs, their potential seriousness and consequences in order to safely and effectively manage pain postoperatively. These findings should be used to guide the development of interventions to optimize parent decision-making and symptom surveillance regarding pain medications and, in turn, enhance children’s comfort and safety.PhDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/102433/1/terriv_1.pd