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Shapiro JN, Mian SI. Nontraditional approaches to sedation for anterior segment surgery: a narrative review. Curr Opin Ophthalmol 2024; 35:298-303. [PMID: 38704652 DOI: 10.1097/icu.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
PURPOSE OF REVIEW Surgical and anesthetic technological advancement have made both cataract and noncataract anterior segment surgery significantly less invasive and time-intensive, facilitating the transition of some of these procedures from the operating room under monitored anesthesia care (MAC) to the office-based setting without MAC. This transition has been aided by the popularization of nonintravenous approaches to achieving patient sedation for these procedures. In this review, we discuss the literature surrounding traditional and nontraditional methods of achieving patient sedation for anterior segment surgery. RECENT FINDINGS Our survey of the literature suggests that nonintravenous (IV) approaches to sedation for these procedures may be just as safe, effective, and satisfactory to patients as traditional IV approaches. SUMMARY As anterior segment surgery becomes less invasive and less time-intensive, providers considering transitioning their cataract and anterior segment surgery out of the operating room and into the office-based setting without MAC anesthesia should consider the non-IV sedation options outlined in this review to achieve adequate patient sedation and comfort.
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Affiliation(s)
- Jeremy N Shapiro
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shahzad I Mian
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center
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Veger ML, van Iterson J, Bakx R, Ridderikhof ML. The Role of Nitrous Oxide in Minor Pediatric Procedures in the Emergency Department: A Systematic Review. J Pediatr Surg 2024; 59:1154-1162. [PMID: 38368199 DOI: 10.1016/j.jpedsurg.2023.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND Pediatric patients undergoing minor, but painful procedures in an Emergency Department (ED) need adequate relief of pain and distress to prevent long term negative effects and adversely impact procedures. Inhaled nitrous oxide (N2O) is a needle-free pain management option. We conducted a systematic review to determine whether N2O is as effective as local anesthesia in minor procedures. The purpose of this study was to evaluate available evidence regarding analgesic effectiveness of N2O in pediatric patients. METHODS We searched MEDLINE, Embase, Cochrane and Cinahl databases for controlled trials published in English with pediatric patients in an ED treated with N2O compared to local anesthesia and with pain as primary outcome. Adverse events was one of the secondary outcomes. The GRADE system was used to rate the overall quality of evidence. RESULTS We included seven studies with a total of 371 patients. Two studies showed N2O was equally effective in pain treatment as local anesthesia. Five studies showed N2O combined with local anesthesia is more effective in reducing pain than local anesthesia alone. None of the included studies reported major adverse effects. The quality of evidence is low. CONCLUSIONS N2O can have an important contribution in pain management, but should be combined with local anesthesia for optimal pain management in pediatric patients undergoing minor, but painful procedures in an ED. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marlies L Veger
- University of Amsterdam, Faculty of Medicine, Amsterdam UMC - Location AMC, 1105 AZ Amsterdam, the Netherlands.
| | - Jozua van Iterson
- University of Amsterdam, Faculty of Medicine, Amsterdam UMC - Location AMC, 1105 AZ Amsterdam, the Netherlands
| | - Roel Bakx
- Department of Pediatric Surgery, Amsterdam UMC - Location AMC, 1105 AZ Amsterdam, the Netherlands
| | - Milan L Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC - Location AMC, 1105 AZ Amsterdam, the Netherlands
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Dupeyron A, Dobija L, Castelli C, Petiot S, Tavares I, Gélis A, Coudeyre E. Nitrous oxide provided during intensive physiotherapy for shoulder adhesive capsulitis does not improve function: A randomised controlled trial. Ann Phys Rehabil Med 2024; 67:101803. [PMID: 38118247 DOI: 10.1016/j.rehab.2023.101803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/22/2023] [Accepted: 10/05/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND There is no consensus on treatment for adhesive capsulitis of the shoulder. Physiotherapy is often used to increase range of motion but individuals may experience pain during mobilisation. OBJECTIVES The objective of this study was to determine whether rehabilitation under N2O for shoulder AC improved pain and function more than rehabilitation alone (with placebo gas). METHOD A randomised, 1:1 parallel arm, double-blind study in 4 university hospital outpatient centres. Adults with adhesive capsulitis for at least 3 months with intact cartilage were included. Participants were randomised in blocks of 4 and stratified by centre to receive 20 sessions of intensive physiotherapy over 10 days; the 10 morning sessions were performed with either nitrous oxide (intervention) or sham gas (placebo). PRIMARY OUTCOME improvement in shoulder function at day 14 (D14) (Constant-Murley score). RESULTS Seventy-five participants were included, and data from 69 were analysed: 37 in the placebo group and 32 in the intervention group. Improvements occurred in both groups after the intervention. No significant difference in the Constant-Murley score was found between groups at D14 (median score increase of 12.0, IQR 5.6; 19.5 points in placebo group vs. 13.7, 5.2; 18.2 in the N20 group, p = 0.78). Pain score during sessions reduced in the intervention group from the first to final session (-11.6, p = 0.053) but not for the placebo group (-4.2, p = 0.414). Seven serious adverse events were recorded, 4 in the intervention group and 3 in the placebo group, with 11 minor adverse events only in the intervention group (mostly shortness of breath). CONCLUSION Nitrous oxide gas associated with intensive physiotherapy for shoulder adhesive capsulitis did not improve function, pain or quality of life more than physiotherapy alone. zHowever, pain experienced during physiotherapy sessions appeared lower. TRIAL REGISTRATION Clinical Trial registration number NCT01087229.
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Affiliation(s)
- Arnaud Dupeyron
- Department of Physical Medicine and Rehabilitation, CHU Nîmes, Univ Montpellier, Nîmes, France; EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France.
| | - Lech Dobija
- Department of Physical Medicine and Rehabilitation, CHRU de Clermont-Ferrand Université Clermont Auvergne, France
| | - Christel Castelli
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Sylvie Petiot
- Department of Physical Medicine and Rehabilitation, CHU Nîmes, Univ Montpellier, Le Grau du Roi, France
| | - Isabelle Tavares
- Department of Physical Medicine and Rehabilitation, CHRU Lapeyronie, Univ Montpellier, Montpellier, France
| | - Anthony Gélis
- Propara Neurologic Rehabilitation Centre, Parc Euromédecine, Montpellier, France
| | - Emmanuel Coudeyre
- Department of Physical Medicine and Rehabilitation, CHRU de Clermont-Ferrand Université Clermont Auvergne, France; INRA, Unité de Nutrition Humaine (UNH, UMR 1019), CRNH Auvergne, Clermont-Ferrand, France
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Jain R, Hudson S, Osmond MH, Trottier ED, Poonai N, Ali S. Nitrous oxide use in Canadian pediatric emergency departments: a survey of physician's knowledge, attitudes, and practices. CAN J EMERG MED 2024; 26:47-56. [PMID: 37855985 DOI: 10.1007/s43678-023-00602-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES Nitrous oxide (N2O) is an inhaled analgesic/ anxiolytic gas with evidence supporting its safety and efficacy for distressing procedures in children. Despite this, its use is not consistent across Canadian pediatric emergency departments (EDs). We aimed to characterize a) physicians' knowledge and practices with N2O and b) site-specific N2O protocols in Canadian pediatric EDs to help optimize its use nationally. METHODS This cross-sectional survey was distributed to physician members of Pediatric Emergency Research Canada (PERC) in early 2021. Survey items addressed practice patterns, clinician comfort, and perceived barriers/ facilitators to use. Further, a representative from each ED completed a site-specific inventory of N2O policies and procedures. RESULTS N2O was available in 40.0% of 15 pediatric EDs, with 83.3% of these sites having written policies in place. Of 230 distributed surveys, 67.8% were completed with mean (SD) attending experience of 14.7 (8.6) years and 70.1% having pediatric emergency subspecialty training. Of the 156 respondents, 48.7% used N2O in their clinical practice. The most common indications for use were digit fracture/ dislocation reduction (69.7%), wound closure (60.5%), and incision & drainage (59.2%). Commonly perceived facilitators were N2O equipment availability (73.0% of 156) and previous clinical experience (71.7% of 156). Of the 51.3% of physicians who reported not using N2O, 93.7% did not have availability at their site; importantly, the majority indicated a desire to acquire access. They identified concerns about ventilation/ scavenging systems (71.2% of 80) and unfamiliarity with equipment (52.5% of 80) as the most common barriers to use. CONCLUSIONS Despite evidence to support its use, only half of Canadian pediatric ED physicians surveyed use N2O in their clinical practice for treating procedure-related pain and distress. Increased availability of N2O equipment, protocols, and training may improve clinicians' abilities to better manage pediatric acute pain and distress in the ED.
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Affiliation(s)
- Rini Jain
- Faculty of Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
- Faculty of Medicine, Department of Pediatrics, Division of Emergency Medicine, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Summer Hudson
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Martin H Osmond
- Faculty of Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Evelyne D Trottier
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Naveen Poonai
- Departments of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Samina Ali
- Faculty of Medicine and Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, Edmonton, Alberta, Canada
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Rava A, Alberghina F, Cravino M, Canavese F, Andreacchio A. Closed reduction and cast immobilization of overriding distal forearm fractures under nitrous oxide as conscious sedation without the use of imaging control. Musculoskelet Surg 2023; 107:413-421. [PMID: 37273144 DOI: 10.1007/s12306-023-00785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 05/02/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE The management of overriding distal forearm fractures is still controversial. This study aimed to evaluate the efficacy of immediate closed reduction and cast immobilization (CRCI) at the emergency department (ED) using equimolar nitrous oxide (eN2O2) as conscious sedation, and without the use fluoroscopic assistance. METHODS Sixty patients with overriding distal forearm fracture were included in the study. All procedures were performed in the ED without fluoroscopic assistance. Antero-posterior and lateral wrist radiographs were taken after CRCI. Follow-up radiographs were taken 7 and 15 days post-reduction, and at cast removal to evaluate callus formation. Depending on the radiological outcome, two groups of patients could be identified: Group 1 (satisfactory reduction and maintenance of alignment) and Group 2 (poor reduction or secondary displacement requiring further manipulation and surgical fixation). Group 2 was additionally divided into Group 2A (poor reduction) and Group 2B (secondary displacement). Pain was assessed using Numeric Pain Intensity (NPI) score, while functional outcome was measured according to Quick DASH questionnaire. RESULTS Mean age at the time of injury was 9.2 ± 2.4 years (range, 5-14). Twenty-three (38%) patients were aged between 4 and 9 years old, 20 (33%) patients between 9 and 11, 11 (18%) patients between 11 and 13, and 6 (10%) patients between 13 and 14. The mean follow-up time was 45.6 ± 12 months (range, 24-63). Satisfactory reduction with maintenance of alignment was achieved in 30 (50%) patients (Group 1). Re-reduction was performed in the remaining 30 (50%) patients (Group 2) due to poor reduction (Group 2A) or secondary displacement (Group 2B). No complications related to the administration of eN2O were recorded. No statistically significant difference could be identified between the three groups for any clinical variable (Quick DASH and NPI). CONCLUSION Overriding distal forearm fractures may be safely treated with CRCI at ED using eN2O2 as conscious sedation. However, fluoroscopic assistance during CRCI might significantly improve the quality of reduction thus avoiding further treatment as the lack of relaxed muscle can restrain reduction.
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Affiliation(s)
- A Rava
- Orthopedic Surgery Department, Ospedale Degli Infermi, Via Rivalta 29, 10098, Rivoli, Italy
| | - F Alberghina
- Pediatric Orthopedic Surgery Department, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - M Cravino
- Pediatric Orthopedic Surgery Department, Regina Margherita Children's Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - F Canavese
- Dept. of Pediatric Orthopedic Surgery, Lille University Center, Jeanne de Flandre Hospital, Av. Eugène Avinée, 59000, Lille, France
| | - A Andreacchio
- Pediatric Orthopedic Surgery Department, Vittore Buzzi Children's Hospital, Via Lodovico Castelvetro 32, 20154, Milan, Italy.
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Wang Z, Wang F, Li Y, Xing Y, Jiang X, Li C, Ding Z, Tang L. Analgesic effect of nitrous oxide during manual therapy after anterior cruciate ligament reconstruction: a study protocol for a randomized controlled trial. Trials 2023; 24:764. [PMID: 38012761 PMCID: PMC10683199 DOI: 10.1186/s13063-023-07732-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Many patients during manual therapy after anterior ligament reconstruction will experience severe pain, which has a negative impact on their rehabilitation. However, there is rarely an analgesic method for these patients during rehabilitation. Nitrous oxide with rapid analgesic and sedative effects is often used to relieve pain in minor procedures. The purpose of this study is to determine whether or not nitrous oxide analgesia decreases pain compared to oxygen during manual therapy after anterior ligament reconstruction. METHODS/DESIGN This single-center, randomized, double-blind and controlled trial will recruit 120 patients. Patients ≥ 18 years old undergoing manual therapy after anterior ligament reconstruction (1 month post-operative) with acute pain (VAS ≥ 4) are included. The main exclusion criteria included the following: pulmonary embolism, intestinal obstruction, pneumothorax. Patients will be randomly allocated to the intervention group (A) and the control group (B) in a ratio of 1:1. Doctors, therapists, patients, and data collectors are all blind to the study. The manual therapy will be performed by therapists. Nurses who implemented the intervention handed the doctors envelopes containing the patients' codes and allocation of A or B. Group A will receive a pre-prepared nitrous oxide/oxygen mixture plus conventional treatment (no analgesic) given as 30-min treatment sessions, once daily, and group B will receive oxygen plus conventional treatment (no analgesic) under the same conditions. Assessments will be taken 2 min before the intervention (T0), 5 min after the beginning of the intervention (T1), and 5 min after the intervention finished (T2). The primary outcome is pain score. Secondary outcomes include vital signs, side effects, joint range of motion, adjuvant analgesia need, therapist and patient satisfaction, and whether willing to receive the same gas again. EXPECTED OUTCOMES We expect nitrous oxide inhalation to have a beneficial effect on the pain of patients who receive manual therapy after anterior ligament reconstruction. DISCUSSION If this treatment appears beneficial, it could improve patients' satisfaction and quality of life potentially and even be implemented widely in hospital and rehabilitation settings. TRIAL REGISTRATION ClinicalTrials.gov identifier, ChiCTR2200061175 (Version 2.0 June 15, 2022), https://www.chictr.org.cn .
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Affiliation(s)
- Ziyang Wang
- Department of Stomatology, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Fei Wang
- Department of Anesthesiology, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
| | - Yuxiang Li
- School of Nursing, Ningxia Medical University, Ningxia, Yinchuan, China
| | - Yihui Xing
- Department of Stomatology, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Xiaochen Jiang
- Department of Stomatology, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
- School of Nursing, Weifang Medical University, Weifang, Shandong, China
| | - Cui Li
- Department of Rehabilitation Medicine, the 960th Hospital of People's Liberation Army of China (PLA), Jinan, Shandong, China
| | - Zhiguo Ding
- Department of Hepatopancreatobiliary Surgery, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Lu Tang
- School of Nursing, Weifang Medical University, Weifang, Shandong, China.
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Camoni L, Santos A, Luporsi M, Grilo A, Pietrzak A, Gear J, Zucchetta P, Bar-Sever Z. EANM procedural recommendations for managing the paediatric patient in diagnostic nuclear medicine. Eur J Nucl Med Mol Imaging 2023; 50:3862-3879. [PMID: 37555902 PMCID: PMC10611649 DOI: 10.1007/s00259-023-06357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/23/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE The manuscript aims to characterize the principles of best practice in performing nuclear medicine procedures in paediatric patients. The paper describes all necessary technical skills that should be developed by the healthcare professionals to ensure the best possible care in paediatric patients, as it is particularly challenging due to psychological and physical conditions of children. METHODS We performed a comprehensive literature review to establish the most relevant elements of nuclear medicine studies in paediatric patients. We focused the attention to the technical aspects of the study, such as patient preparation, imaging protocols, and immobilization techniques, that adhere to best practice principles. Furthermore, we considered the psychological elements of working with children, including comforting and distraction strategies. RESULTS The extensive literature review combined with practical conclusions and recommendations presented and explained by the authors summarizes the most important principles of the care for paediatric patient in the nuclear medicine field. CONCLUSION Nuclear medicine applied to the paediatric patient is a very special and challenging area, requiring proper education and experience in order to be performed at the highest level and with the maximum safety for the child.
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Affiliation(s)
- Luca Camoni
- University of Brescia, 25123, Brescia, Italy.
- Nuclear Medicine Department, University of Brescia, ASST Spedali Civili Di Brescia, P.Le Spedali Civili 1, 25123, Brescia, Italy.
| | - Andrea Santos
- Nuclear Medicine Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Marie Luporsi
- Department of Nuclear Medicine, Institut Curie, PSL Research University, 75005, Paris, France
- LITO Laboratory INSERM U1288, Institut Curie, 91440, Orsay, France
| | - Ana Grilo
- H&TRC - Health and Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
| | - Agata Pietrzak
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
- Nuclear Medicine Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - Pietro Zucchetta
- Nuclear Medicine Department, Padova University Hospital, 35128, Padua, Italy
| | - Zvi Bar-Sever
- Department of Nuclear Medicine, Schneider Children's Medical Center, Tel-Aviv University, Petach Tikva, Israel
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Maiandi S, Ghizzardi G, Edefonti V, Giacchero R, Lusignani M, Giannì ML. Is the equimolar mixture of oxygen and nitrous oxide (EMONO) associated with audiovisuals effective in reducing pain and side effects during peripheral venous access placement in children? Protocol for a single-centre randomised controlled trial from Italy. BMJ Open 2023; 13:e067912. [PMID: 37419632 PMCID: PMC10335544 DOI: 10.1136/bmjopen-2022-067912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/31/2023] [Indexed: 07/09/2023] Open
Abstract
INTRODUCTION Nurses frequently place a peripheral venous catheter during children's hospitalisation. Many studies suggest treatment of venipuncture-related pain. The administration of an equimolar mixture of oxygen and nitrous oxide (EMONO) is employed for pain control; however, no studies have analysed the association between EMONO and audiovisuals.The purpose of the study is to evaluate the effect of EMONO administration when combined with audiovisuals (EMONO+Audiovisual) versus EMONO alone on perceived pain, side effects and level of cooperation during peripheral venous access placement in children aged 2-5 years. METHODS AND ANALYSIS The first 120 eligible children admitted to the paediatric ward of the Lodi Hospital and presenting the indication for peripheral venous access will be enrolled. Sixty children will be randomly assigned to the experimental group (EMONO+Audiovisual) and 60 to the control group (EMONO alone).The Face, Legs, Activity, Cry, Consolability scale will be used to assess pain in the children aged 2-years old; pain in the children aged 3-5 years will be assessed using the Wong-Baker scale. The cooperation throughout the procedure will be measured using the Groningen Distress Rating Scale. ETHICS AND DISSEMINATION The Milan Area 1 Ethics Committee approved the study protocol (Experiment Registry No. 2020/ST/295). The trial results will be presented at conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05435118.
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Affiliation(s)
- Stefano Maiandi
- Healthcare Professions Directorate - ASST di Lodi, Lodi, Italy
| | - Greta Ghizzardi
- Healthcare Professions Directorate - ASST di Lodi, Lodi, Italy
| | - Valeria Edefonti
- Department of Clinical Sciences and Community Health, Branch of Medical Statistics, Biometry and Epidemiology, "G.A. Maccacaro," University of Milan, Milano, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milano, Italy
| | - Maria Lorella Giannì
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neonatal Intensive Care Unit, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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Delgado-Miguel C, Miguel-Ferrero M, Ezquerra A, Díaz M, De Ceano-Vivas M, López-Gutiérrez JC. Sedoanalgesia in the Debridement of Pediatric Burns in the Emergency Department: Is It Effective and Safe? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1137. [PMID: 37508633 PMCID: PMC10378088 DOI: 10.3390/children10071137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The routine use of sedoanalgesia has increased the number of potential minor surgical procedures that can be performed in the Emergency Department (ED) without requiring general anesthesia and, thus, hospital admission. Our aim is to analyze the effectiveness and safety of the use of sedoanalgesia in childhood burns treated in the ED. METHODS A retrospective study was conducted in burned children in whom burn debridement was performed under sedoanalgesia in the ED between 2017 and 2021 in a tertiary referral center for burns. We collected demographic variables, burn features and the type of sedoanalgesia performed in each case, including its effectiveness and associated adverse effects. RESULTS A total of 227 patients (118 males, 109 females) were included, with a median age of 25 months. In total, 99.2% of the burns were thermal (69.2% scald burns), with a mean total body surface area (TBSA) burned of 4%. The most commonly used drugs were intravenous ketamine (35.7%), intravenous ketamine + midazolam (15.4%), intranasal fentanyl + midazolam (14.1%) and intranasal fentanyl (10.6%). The effectiveness of sedoanalgesia was considered satisfactory in 95.2% of the cases, with an adverse effect rate of 7.5%, without severe adverse effects reported. CONCLUSIONS The use of sedoanalgesia in the ED in the early treatment of childhood burns achieves high effectiveness and safety. It is postulated as a quality indicator; thus, it should be known by all pediatric healthcare practitioners.
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Affiliation(s)
- Carlos Delgado-Miguel
- Pediatric Burn Unit, Department of Pediatric Surgery, La Paz Children's Hospital, 28046 Madrid, Spain
- Institute for Health Research IdiPAZ, La Paz University Hospital, 28046 Madrid, Spain
| | - Miriam Miguel-Ferrero
- Pediatric Burn Unit, Department of Pediatric Surgery, La Paz Children's Hospital, 28046 Madrid, Spain
| | - Andrea Ezquerra
- Department of Pediatric Emergency, La Paz Children's Hospital, 28046 Madrid, Spain
| | - Mercedes Díaz
- Pediatric Burn Unit, Department of Pediatric Surgery, La Paz Children's Hospital, 28046 Madrid, Spain
| | - María De Ceano-Vivas
- Department of Pediatric Emergency, La Paz Children's Hospital, 28046 Madrid, Spain
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Clouet R, Dajean-Trutaud S, Grall-Bronnec M, Bray E, Victorri-Vigneau C, Prud'homme T. Objectivation of the Equimolar Mixture of Oxygen and Nitrous Oxide Anxiolytic Effect in Pediatric Dentistry: A Pilot Study. Int J Clin Pediatr Dent 2023; 16:270-275. [PMID: 37519986 PMCID: PMC10373781 DOI: 10.5005/jp-journals-10005-2540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Aim EMONO is an equimolar mixture of oxygen and nitrous oxide. Studies investigating its anxiolytic effect mostly used behavioral scales for assessing anxiolysis in children during dental care. Observing this effect objectively in a pediatric population could be very interesting. Materials and methods We conducted a prospective uncontrolled monocentric pilot study to assess the equimolar mixture of oxygen and nitrous oxide (EMONO) anxiolytic effect in children during dental care by monitoring heart rate (HR) variation. Results A statistically significant difference could be highlighted between the HR before the dental care and after 5 minutes of EMONO inhalation, illustrating the anxiolytic effect of EMONO in an objective way. HR variation also suggests that the effect of EMONO seems to prevent a return to the initial level of stress, even during anesthesia. Conclusion All of the data in the literature confirm the essential role of nitrous oxide in pediatric dental care. Demonstrating the effectiveness of EMONO by objective criteria is necessary. Trial registration Clinical Trials Unique Protocol ID: RC17_0275. How to cite this article Clouet R, Dajean-Trutaud S, Grall-Bronnec M, et al. Objectivation of the Equimolar Mixture of Oxygen and Nitrous Oxide Anxiolytic Effect in Pediatric Dentistry: A Pilot Study. Int J Clin Pediatr Dent 2023;16(2):270-275.
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Affiliation(s)
- Roselyne Clouet
- Department of Periodontology, Nantes Université, CHU Nantes, Service d’Odontologie, Nantes, France
| | - Sylvie Dajean-Trutaud
- Department of Periodontology, Nantes Université, CHU Nantes, Service d’Odontologie, Nantes, France
| | - Marie Grall-Bronnec
- Department of Periodontology, Nantes Université, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, Nantes, France
| | - Estelle Bray
- Department of Periodontology, Nantes Université, CHU Nantes, Service d’Odontologie, Nantes, France
| | - Caroline Victorri-Vigneau
- Department of Periodontology, Nantes Université, CHU Nantes, INSERM, MethodS in Patients-centered outcomes and HEalth Research, SPHERE, Nantes, France
| | - Tony Prud'homme
- Department of Periodontology, Nantes Université, CHU Nantes, Service d’Odontologie, Nantes, France
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11
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Brathen E, Boudewyns A, Verhulst S, Roete A, Verlooy J, van Meerbeeck N, Vanderveken O, van der Poel N. Effectiveness of nitrous oxide sedation for otolaryngologic examination in the outpatient clinic in uncooperative children. Int J Pediatr Otorhinolaryngol 2022; 162:111328. [PMID: 36195014 DOI: 10.1016/j.ijporl.2022.111328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/30/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study is to investigate the efficacy of equimolar mixture of 50% nitrous oxide and oxygen (EMONO) to obtain conscious sedation for otolaryngologic examinations and minor Ear-Nose-Throat (ENT) procedures in children with or without comorbidities. METHODS Retrospective analysis of patient records from all children who were uncooperative during routine ENT examination, and therefore underwent otomicroscopic examinations and/or minor ENT procedures sedated with EMONO in the outpatient ENT clinic. The following data were collected: patients characteristics, sedative effect, analgesic effect and adverse effects. Patients were divided into three subgroups: 1) no relevant comorbidities, 2) Down Syndrome and 3) other causes of behavioural problems or developmental delay. RESULTS Data were analyzed for 99 patients (170 procedures). Seven procedures failed. A good to excellent sedative and analgesic effect was obtained in most patients without a difference between subgroups. Minor and transient side effects were encountered in one third (34%) of the patients. CONCLUSIONS EMONO is an effective agent to achieve conscious sedation and to perform ENT examinations or minor procedures in otherwise uncooperative children with or without developmental delay.
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Affiliation(s)
- Elin Brathen
- Department of Urology, Antwerp University Hospital, Belgium
| | - An Boudewyns
- Department of Otorhinolaryngology, Antwerp University Hospital, Belgium; Faculty of Medicine and Translational Neurosciences, University of Antwerp, Belgium
| | - Stijn Verhulst
- Department of Paediatrics, Antwerp University Hospital, Belgium; Lab of Experimental Medicine and Pediatrics, University of Antwerp, Belgium
| | - Ann Roete
- Department of Paediatrics, Antwerp University Hospital, Belgium
| | - Joris Verlooy
- Department of Paediatrics, Antwerp University Hospital, Belgium
| | | | - Olivier Vanderveken
- Department of Otorhinolaryngology, Antwerp University Hospital, Belgium; Faculty of Medicine and Translational Neurosciences, University of Antwerp, Belgium
| | - Nicolien van der Poel
- Department of Otorhinolaryngology, Antwerp University Hospital, Belgium; Faculty of Medicine and Translational Neurosciences, University of Antwerp, Belgium.
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12
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Sasajima H, Zako M. Factors to Weigh in While Administering Nitrous Oxide Anesthesia [Response to Letter]. Clin Ophthalmol 2022; 16:3053-3054. [PMID: 36147999 PMCID: PMC9488606 DOI: 10.2147/opth.s388758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hirofumi Sasajima
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, 939-0243, Japan
- Correspondence: Hirofumi Sasajima, Department of Ophthalmology, Shinseikai Toyama Hospital, 89-10 Shimowaka, Imizu, Toyama, 939-0243, Japan, Tel +81-766-52-2156, Email
| | - Masahiro Zako
- Department of Ophthalmology, Asai Hospital, Seto, 489-0866, Japan
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13
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Sasajima H, Zako M, Ueta Y, Murotani K. Effects of Low-Concentration Nitrous Oxide Anesthesia on Patient Anxiety During Cataract Surgery: A Retrospective Cohort Study. Clin Ophthalmol 2022; 16:2803-2812. [PMID: 36042911 PMCID: PMC9420443 DOI: 10.2147/opth.s382476] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose We investigated the effects of 30% low-concentration nitrous oxide (N2O) anesthesia on anxiety, pain, and vital signs and the patient population that would benefit from low-concentration N2O anesthesia during cataract surgery. Patients and Methods Sixty-three patients who underwent cataract surgery due to visual impairment from cataracts were included in this single-center retrospective cohort study conducted at the Ophthalmology Department of Shinseikai Toyama Hospital, Japan. Fifty eyes of 39 patients received a combination of local and N2O anesthesia (N2O group), and 30 eyes of 24 patients received local anesthesia without N2O anesthesia (Air group). The primary outcome measures were visual analogue scale (VAS) scores for patient anxiety, pain, and vital signs. The secondary outcome measures were the patient population. Results The change in the VAS scores for anxiety and pain decreased significantly (p = 0.002 and p = 0.014, respectively) in the N2O group (−15.6 ± 22.9 and 12.4 ± 14.9, respectively) compared with that in the Air group (1.2 ± 20.6 and 24.2 ± 22.4, respectively). The systolic and diastolic blood pressure changes did not significantly differ between both groups (p = 0.093 and p = 0.23, respectively). The change in heart rate decreased significantly (p = 0.001) in the N2O group (−4.8 ± 4.8 bpm) compared with that in the Air group (−0.6 ± 5.8 bpm). Multivariate analyses demonstrated that the change in anxiety level in the N2O group correlated significantly with patient age (p = 0.045) and preoperative VAS score for anxiety (p = 0.0001), whereas the change in anxiety level in the Air group did not correlate with any factor. Conclusion Low-concentration N2O anesthesia showed beneficial effects on intraoperative anxiety and pain during cataract surgery; this may aid the stabilization of intraoperative vital signs. Moreover, low-concentration N2O anesthesia during cataract surgery could benefit young patients and patients with high levels of preoperative anxiety.
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Affiliation(s)
- Hirofumi Sasajima
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, 939-0243, Japan
- Correspondence: Hirofumi Sasajima, Department of Ophthalmology, Shinseikai Toyama Hospital, 89-10 Shimowaka, Imizu, Toyama, 939-0243, Japan, Tel +81-766-52-2156, Email
| | - Masahiro Zako
- Department of Ophthalmology, Asai Hospital, Seto, 489-0866, Japan
| | - Yoshiki Ueta
- Department of Ophthalmology, Shinseikai Toyama Hospital, Imizu, 939-0243, Japan
| | - Kenta Murotani
- Biostatistics Center, Kurume University, Kurume, 830-0011, Japan
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14
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Gupta N, Gupta A, Narayanan M R V. Current status of nitrous oxide use in pediatric patients. World J Clin Pediatr 2022; 11:93-104. [PMID: 35433304 PMCID: PMC8985494 DOI: 10.5409/wjcp.v11.i2.93] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/05/2021] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
Nitrous oxide is one of the most commonly used inhalational anesthetic agents used in practice. It is a cost-effective, pleasant, safe, and versatile anesthetic agent with many desirable properties like good quality analgesia, decreased awareness, accelerated induction and recovery from anesthesia, and reduced utilization of other expensive inhalational agents with potential cost savings. The use of nitrous oxide has been questioned by a lot of studies and case reports perceiving its adverse systemic, hematological, immune, and neurologic adverse effects. However, the literature in the recent past has tried to resolve the controversies related to its use. The concerns over an increase in cardiovascular complications and mortality following nitrous oxide use have been negated by recent data. However, its use in certain vulnerable populations like children with cobalamin and folate deficiency or defects in their metabolic pathways remains a cause of concern for its toxic effects. In this narrative review, we aim to discuss the pharmacological properties of nitrous oxide, the potential advantages and drawbacks of the use of nitrous oxide in children, address the neurodevelopmental and other systemic effects, and throw light on the evidence regarding the safety of nitrous oxide use and its current role in pediatric procedural sedation and anesthesia practice. The literature related to its use in the pediatric population for painful procedures and surgeries has been summarized.
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Affiliation(s)
- Nishkarsh Gupta
- Department of Onco-Anesthesiology and Palliative Medicine, AIIMS, New Delhi 110029, Delhi, India
| | - Anju Gupta
- Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi 110029, Delhi, India
| | - Vishnu Narayanan M R
- Department of Anesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi 110029, Delhi, India
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15
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Li S, Zhang W, Lin Y. Application of Intra-articular Corticosteroid Injection in Juvenile Idiopathic Arthritis. Front Pediatr 2022; 10:822009. [PMID: 35425732 PMCID: PMC9002113 DOI: 10.3389/fped.2022.822009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/11/2022] [Indexed: 11/29/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is one of the common rheumatic diseases in pediatrics. Persistent synovitis and joint pain cause reduced range of motion, deformity and gait interruption, which are important reasons for children's disability and a decline in their quality of life. Rheumatology experts have explored good treatment strategies, among which intra-articular corticosteroid injections (IACIs) targeting joints can greatly reduce these systemic adverse reactions while still obtaining local anti-inflammatory effects. Local inhibition of synovitis by the use of steroid hormones in a joint cavity can avoid or reduce adverse reactions of systemic therapy, prevent or treat leg length variance and joint contracture, solve Baker's cyst, improve tenosynovitis, promote physical therapy and rehabilitation, make gait change smoothly, relieve pain, and restore joint function. Given the importance of IACIs in treating JIA, this paper reviewed the case selection, drug injection, dose selection, current anesthesia and injection techniques, the efficacy, recurrence, and influencing factors of IACIs, the management of physiotherapy intervention post-injection, the application of ultrasound guidance and the safety and complications of IACIs in children with JIA. This study aims to guide the use of IACIs for the best approach throughout the review.
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Affiliation(s)
- Sha Li
- Department of Rheumatology, The Affiliated Women's and Children's Hospital, School of Medicine UESTC, Chengdu Women and Children's Central Hospital, Chengdu, China
| | - Wei Zhang
- Department of Rheumatology, The Affiliated Women's and Children's Hospital, School of Medicine UESTC, Chengdu Women and Children's Central Hospital, Chengdu, China
| | - Yan Lin
- Department of Outpatient, The Affiliated Women's and Children's Hospital, School of Medicine UESTC, Chengdu Women and Children's Central Hospital, Chengdu, China
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16
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Poggiali E, De Iaco F. The pain in the Emergency Department: Choosing and treating wisely before and during the COVID-19 era. EMERGENCY CARE JOURNAL 2021. [DOI: 10.4081/ecj.2021.9903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pain is a frequent reason for referral to the Emergency Department (ED). Adequate management of pain is a moral and ethical imperative. If not correctly treated, acute pain can cause physical and psychological complications, and become chronic with severe consequences such as anxiety, depression, and social isolation. As consequence, emergency clinicians should treat pain as soon as possible, avoiding delays even in case of acute abdominal pain. Pain management is particularly complex in the elderly and emergency clinicians should always consider AGS Beers criteria ® to avoid inappropriate medications, severe side-effects, and drug-drug interactions. Pain is also a common cause of delirium in older patients. The SARS CoV-2 infection not only can cause acute pain, but also exacerbate chronic pain, particularly in the elderly, who are at high risk to be infected. Looking at all this evidence, emergency clinicians should treat pain with different strategies according to their experience and cultural background, making the right choice for each patient. This work is a critical review of the pain management in the ED, with a particular attention on the effects of COVID-19 in the EDs. We conducted a systematic search of the following databases: PubMed, Google Scholar, Science Direct, Medline from 2000 to 2020, using the keywords of “pain”, “emergency”, “COVID19”, “elderly”, “palliative care”, “ketamine”, “dexmedetomidine”, and “post-traumatic stress disorder”. The aim of this review is to help emergency clinicians to correctly manage pain in the ED with a new point of view regarding the pain management in COVID-19 patients.
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17
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[Improving pain assessment of infants in paediatric emergency departments]. SOINS. PÉDIATRIE, PUÉRICULTURE 2021; 42:37-39. [PMID: 34489080 DOI: 10.1016/j.spp.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Not having access to language, the infant is deprived of an essential means of communicating its painful experience. The assessment of their pain in the emergency room is therefore quite complex. A study carried out in the paediatric emergency department of the Centre hospitalier intercommunal de Créteil shows that it is possible to improve this aspect thanks, among other things, to continuous training and the presence of experts in children's pain within the team.
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18
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Gao HX, Zhang JJ, Liu N, Wang Y, Ma CX, Gao LL, Liu Q, Zhang TT, Wang YL, Bao WQ, Li YX. A fixed nitrous oxide/oxygen mixture as an analgesic for patients with postherpetic neuralgia: study protocol for a randomized controlled trial. Trials 2021; 22:29. [PMID: 33407845 PMCID: PMC7787626 DOI: 10.1186/s13063-020-04960-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pain management of postherpetic neuralgia (PHN) remains a major challenge, with no immediate relief. Nitrous oxide/oxygen mixture has the advantages of quick analgesic effect and well-tolerated. The purpose of this study is to investigate the analgesic effect and safety of nitrous oxide/oxygen mixture in patients with PHN. METHODS/DESIGN This study is a single-center, two-group (1:1), randomized, placebo-controlled, double-blind clinical trial. A total of 42 patients with postherpetic neuralgia will be recruited and randomly divided into the intervention group and the control group. The control group will receive routine treatment plus oxygen, and the intervention group will receive routine treatment plus nitrous oxide/oxygen mixture. Data collectors, patients, and clinicians are all blind to the therapy. The outcomes of each group will be monitored at baseline (T0), 5 min (T1), and 15 min (T2) after the start of the therapy and at 5 min after the end of the therapy (T3). The primary outcome measure will be the pain intensity. Secondary outcomes included physiological parameters, adverse effects, patients' acceptance of analgesia, and satisfaction from patients. DISCUSSION Previous studies have shown that nitrous oxide/oxygen mixture can effectively relieve cancer patients with breakthrough pain. This study will explore the analgesic effect of oxide/oxygen mixture on PHN. If beneficial to patients with PHN, it will contribute to the pain management of PHN. TRIAL REGISTRATION Chinese Clinical Trial Register ChiCTR1900023730 . Registered on 9 June 2019.
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Affiliation(s)
- Hai-Xiang Gao
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
- Intensive Care Unit, The Second People’s Hospital of Yinchuan, 684 Bei Jing Street, Yinchuan, 750011 China
| | - Jun-Jun Zhang
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Ning Liu
- Department of Pharmacology, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Yi Wang
- Pain Department, General Hospital of Ningxia Medical University, 804 Sheng Li Street, Yinchuan, 750004 China
| | - Chun-Xiang Ma
- Pain Department, General Hospital of Ningxia Medical University, 804 Sheng Li Street, Yinchuan, 750004 China
| | - Lu-Lu Gao
- School of Public Health and Management, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Qiang Liu
- School of Preclinical Medical Sciences, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Ting-Ting Zhang
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
| | - Yi-Ling Wang
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
- Nursing Department, The First People’s Hospital of Yinchuan, 2 Li Qun Street, Yinchuan, 750004 China
| | - Wen-Qiang Bao
- Pain Department, General Hospital of Ningxia Medical University, 804 Sheng Li Street, Yinchuan, 750004 China
| | - Yu-Xiang Li
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004 China
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19
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Oral Ondansetron to Reduce Vomiting in Children Receiving Intranasal Fentanyl and Inhaled Nitrous Oxide for Procedural Sedation and Analgesia: A Randomized Controlled Trial. Ann Emerg Med 2020; 75:735-743. [DOI: 10.1016/j.annemergmed.2019.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 01/15/2023]
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20
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Prud'homme T, Allio A, Dajean-Trutaud S, Bulteau S, Rousselet M, Lopez-Cazaux S, Hyon I, Grall-Bronnec M, Victorri-Vigneau C. Assessment of an Equimolar Mixture of Oxygen and Nitrous Oxide: Effects in Pediatric Dentistry. Int J Clin Pediatr Dent 2020; 12:429-436. [PMID: 32440050 PMCID: PMC7229361 DOI: 10.5005/jp-journals-10005-1658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Many studies were conducted to assess the benefit/risk of equimolar mixture of oxygen and nitrous oxide (EMONO), but evaluating the appetite associated to its use is now getting very little attention in the literature. The purpose of this study was to investigate the effects present, felt, and sought during care by the child related with the 50% nitrous oxide/oxygen (EMONO) sedation used in pediatric dentistry. Materials and methods All patients in consultation with the Dental Service of Nantes hospital and in need of EMONO were included in the study. In this prospective single-center study, the effects present, felt, and sought during care by the child and the assessment of EMONO appreciation were recorded. The presence of clear signs that the child was trying to extend the duration of the EMONO use was also sought. Results Only 62% of the patients were presented with an anxiolytic effect, and 40% relative analgesia. Both effects were associated in 33% of children. Over the 76 patients assessed, 12 attempted to extend the duration of the EMONO use (16%). After a bivariate statistical analysis, none of the variables appeared significantly associated with the extension of the EMONO use duration. Conclusion The significant proportion of patients who have prolonged the EMONO use seems to indicate a real attraction for nitrous oxide. This is the first study to evaluate nitrous oxide appreciation on a child. How to cite this article Prud’homme T, Allio A, Dajean-Trutaud S, et al. Assessment of an Equimolar Mixture of Oxygen and Nitrous Oxide: Effects in Pediatric Dentistry. Int J Clin Pediatr Dent 2019;12(5):429–436.
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Affiliation(s)
- Tony Prud'homme
- Pediatric Dentistry Department, CHU/Université Nantes, France; UMR 1246 - SPHERE "Methods in Patient-centered outcomes and health research", Université Nantes et Tours, France
| | - Adrien Allio
- Pharmacology Department-Addictovigilance, CHU/Université Nantes, France
| | | | - Samuel Bulteau
- Addictology and Psychiatry Department, CHU/Université Nantes, France
| | - Morgane Rousselet
- Pharmacology Department-Addictovigilance, CHU Nantes, France; Addictology and Psychiatry Department, CHU/Université Nantes, France; UMR 1246 - SPHERE "Methods in Patient-centered outcomes and health research", Université Nantes et Tours, France
| | | | - Isabelle Hyon
- Pediatric Dentistry Department, CHU/Université Nantes, France
| | - Marie Grall-Bronnec
- Pharmacology Department-Addictovigilance, CHU Nantes, France; Addictology and Psychiatry Department, CHU/Université Nantes, France; UMR 1246 - SPHERE "Methods in Patient-centered outcomes and health research", Université Nantes et Tours, France
| | - Caroline Victorri-Vigneau
- Pharmacology Department-Addictovigilance, CHU/Université Nantes, France; UMR 1246 - SPHERE "Methods in Patient-centered outcomes and health research", Université Nantes et Tours, France
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21
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Functional and radiographic outcomes of Gartland type II supracondylar humerus fractures managed by closed reduction under nitrous oxide as conscious sedation. J Pediatr Orthop B 2020; 29:117-125. [PMID: 31651752 DOI: 10.1097/bpb.0000000000000679] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The management of Gartland type II supracondylar fractures remains controversial. This study aimed to evaluate the clinical, functional, and radiographic outcomes of Gartland type II supracondylar fractures treated by immediate closed reduction and casting in the emergency department using equimolar nitrous oxide as conscious sedation. All patients were treated non-operatively using equimolar nitrous oxide as conscious sedation during closed reduction and cast immobilization. Three out of 34 patients (three elbows; 8.8%) were lost during follow-up. The mean follow-up time was 26.4 months (range: 6-48). The mean Quick DASH score at cast removal was 22.4 (range: 19-40) and 2.3 (range: 0-9) at the last follow-up visit in patients without secondary displacement (n = 26; 76.5%). The mean Quick-DASH score of patients (n = 5; 16.1%) requiring closed reduction and percutaneous pinning under general anesthesia because of secondary displacement was 21.4 (range: 19-25) at cast removal and 0.9 (range: 0-2.3) at the last follow-up visit. No significant differences between the two groups were found at any time (P = 0.38 and P = 0.48, respectively). The two groups also showed a comparable radiographic outcome and similar Flynn's criteria. The mean Numeric Pain Intensity was three (range: 0-6). No complications related to the administration of equimolar nitrous oxide were recorded. The use of equimolar nitrous oxide as conscious sedation for closed reduction and casting appears to be a safe, inexpensive, and appropriate conservative method of treatment for displaced Gartland type II supracondylar fractures in children. A regular follow-up is mandatory to detect early secondary displacement, as 16.1% of fractures required additional closed reduction and percutaneous pinning under general anesthesia. Level IV, retrospective study.
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22
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Forster VJ, Bell G, Halsey C. Should nitrous oxide ever be used in oncology patients receiving methotrexate therapy? Paediatr Anaesth 2020; 30:9-16. [PMID: 31667903 DOI: 10.1111/pan.13760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/27/2022]
Abstract
Nitrous oxide (N2 O) is frequently used for short anesthesia/analgesia in children undergoing painful or repetitive procedures. Children with acute lymphoblastic leukemia (ALL) require repeated lumbar punctures with direct instillation of intrathecal chemotherapy, usually the anti-folate agent methotrexate, during their treatment. These procedures are frequently performed under anesthesia. Concerns have been intermittently raised about a drug interaction between methotrexate and N2 O that may potentiate the undesirable side effects of methotrexate, including neurotoxicity. However, the clinical evidence consists mainly of isolated case reports leading to a lack of consensus among pediatric anesthetists about the relative risk benefits of using N2 O in children with ALL. In this article, we review the biochemical basis and scientific observations that suggest a significant interaction between N2 O and methotrexate due to their dual inhibition of the key enzyme methionine synthase. The possible role of this interaction in potentiating neurotoxicity in children with cancer is discussed, and arguments and counterarguments about the clinical significance of this largely theoretical relationship are explored. Following comprehensive review of all the available data, we make the case for the circumstantial evidence being sufficiently compelling to prompt a review of practice by pediatric anesthetists and call for a precautionary approach by avoiding the use of N2 O in children receiving concurrent methotrexate.
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Affiliation(s)
- Victoria J Forster
- The Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Graham Bell
- Department of Anaesthetics, Royal Hospital for Children, Glasgow, UK
| | - Christina Halsey
- Institute of Cancer Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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23
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Zajtsev AY, Svetlov VA, Dubrovin KV, Nazaryan DN. [Practical aspects of sedation in dentistry]. STOMATOLOGII︠A︡ 2019; 98:96-102. [PMID: 31513159 DOI: 10.17116/stomat20199804196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In modern dental practice, the use of sedation to eliminate the fear and anxiety of the patient has become frequent. Unfortunately, according to the legislation, the concept of sedation is inseparable from anesthesia and it can only be performed by an anesthesiologist in a group or Department of Anesthesiology and Resuscitation. The article is devoted to a detailed comprehensive review of sedation in dental and surgical interventions in the maxillofacial area. It details the physiological and pathophysiological data of stress and psycho-emotional discomfort. The article indicates drugs for sedation, methods of their administration, features of application, possible complications. Such methods of parenteral sedation as intranasal, inhalation, intravenous are described in detail. Specific problems of sedation, for example, psychomotor agitation in the application of propofol or cough in deep sedation are indicated. It describes the modern data on intraoperative monitoring as an important component of patient safety during sedation. In addition to the Harvard standard the use of capnography and monitoring the depth of sedation by using bispectral index (BIS) is recommended.
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Affiliation(s)
- A Yu Zajtsev
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia; Boston Institute of Aesthetic Medicine, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - V A Svetlov
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - K V Dubrovin
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia; Boston Institute of Aesthetic Medicine, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - D N Nazaryan
- B.V. Petrovsky National Research Centre of Surgery, Moscow, Russia; Boston Institute of Aesthetic Medicine, Moscow, Russia
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24
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Delehaye F, Villarbu M, Salaun V, Bracquemart C, Goyer I, Bodet D. Psychiatric manifestation and pancytopenia during a sickle cell vaso-occlusive crisis: An unusual etiology. Pediatr Blood Cancer 2019; 66:e27758. [PMID: 31006965 DOI: 10.1002/pbc.27758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Fanny Delehaye
- Department of Pediatric Hematology and Oncology, University Hospital of Caen, Caen, France
| | | | - Véronique Salaun
- Laboratory of Hematology, University Hospital of Caen, Caen, France
| | | | - Isabelle Goyer
- Department of Pharmacy, University Hospital of Caen, Caen, France
| | - Damien Bodet
- Department of Pediatric Hematology and Oncology, University Hospital of Caen, Caen, France
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Dai YL, Chai XM, Zhu N, Wang KB, Bao WQ, Zhang XS, Gao LL, Liu Q, Bao DM, Wang LT, Wang YL, Zhang JJ, Li YX, Yu JQ. Analgesia effect of premixed nitrous oxide/oxygen during the rehabilitation after total knee arthroplasty: a study protocol for a randomized controlled trial. Trials 2019; 20:399. [PMID: 31272502 PMCID: PMC6610947 DOI: 10.1186/s13063-019-3472-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 05/27/2019] [Indexed: 11/23/2022] Open
Abstract
Background The morbidity of knee arthritis is increasing among aged people and total knee arthroplasty has been its mainstream treatment to date. Postoperative rehabilitation is an important part of the procedure. However, the intense pain during the functional exercise involved has always been a challenge for both patients and health care professionals. The aim of this study is to test the analgesic effect of a mixture of nitrous oxide/oxygeb (1:1) inhalation for patients who are doing functional exercise 1 month after total knee arthroplasty. Methods/design This double-blind, randomized, placebo-controlled study will be implemented in the Rehabilitation Department in the General Hospital of Ningxia Medical University. Patients aged between 50 and 75 years who underwent a primary unilateral total knee arthroplasty are eligible for inclusion. The key exclusion criteria include: epilepsy, pulmonary embolism, intestinal obstruction, aerothorax. The treatment group (A) will receive a pre-prepared nitrous oxide/oxygen mixture plus conventional treatment (no analgesics), and the control group (B) will receive oxygen plus conventional treatment (no analgesics). Patients, physicians, therapists, and data collectors are all blind to the experiment. Assessments will be taken immediately after functional exercise begins (T0), 5 min (T1) after functional exercise begins, and 5 min after functional exercise has finished (T2). Patients will be randomly allocated between a treatment group (A) and a control group (B) in a ratio of 1:1. Primary outcome, including pain severity in the procedure, will be taken for each group. Secondary outcomes include blood pressure, heart rate, oxygen saturation, side effects, knee joint range of motion, Knee Society Score (KSS), rescue analgesia need, and satisfaction from both therapists and patients. Discussion This study will focus on exploring a fast and efficient analgesic for patients who are doing functional exercise after total knee arthroplasty. Our previous studies suggested that the prefixed nitrous oxide/oxygen mixture was an efficacious analgesic for the management of burn-dressing pain and breakthrough cancer pain. The results of this study should provide a more in-depth insight into the effects of this analgesic method. If this treatment proves successful, it could be implemented widely for patients doing functional exercise in the rehabilitation department. Trial registration ChiCTR-INR-17012891. Registered on 6 October 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3472-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ya-Liang Dai
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004, China
| | - Xiao-Min Chai
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004, China
| | - Ning Zhu
- Rehabilitation Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Kai-Bin Wang
- Rehabilitation Department, Workers' Sanatorium, 581 Zheng Yuan Street, Yinchuan, 750004, China
| | - Wen-Qiang Bao
- Pain Department, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Xue-Sen Zhang
- Orthopedics, Wuzhong City People's Hospital, Wuzhong, 751100, China
| | - Lu-Lu Gao
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004, China
| | - Qiang Liu
- School of Preclinical Medical Sciences, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004, China
| | - Dong-Mei Bao
- Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Li-Ting Wang
- Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Yi-Ling Wang
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004, China
| | - Jun-Jun Zhang
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004, China
| | - Yu-Xiang Li
- School of Nursing, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004, China.
| | - Jian-Qiang Yu
- Department of Pharmacology, Ningxia Medical University, 1160 Sheng Li Street, Yinchuan, 750004, China
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Prud'homme T, Dajean-Trutaud S, Rousselet M, Feuillet F, Carpentier-Cheraud M, Bonnot O, Hyon I, Grall-Bronnec M, Lopez-Cazaux S, Victorri-Vigneau C. The MEOPAeDent trial protocol-an observational study of the Equimolar Mixture of Oxygen and Nitrous Oxide (EMONO) effects in paediatric dentistry. BMC Oral Health 2019; 19:42. [PMID: 30845960 PMCID: PMC6407269 DOI: 10.1186/s12903-019-0732-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many studies were conducted to assess the benefit/risk ratio of EMONO (Equimolar Mixture of Oxygen and Nitrous Oxide) in France before it was authorized for use outside the hospital setting in 2009. The main objective of this project is to evaluate the effects sought and felt by children when EMONO is used in paediatric dentistry. The secondary objectives are to (i) evaluate the appreciation of EMONO by the children, (ii) characterize children who experience both analgesia and anxiolysis, (iii) evaluate children's appetite for EMONO and characterize children with a high appetite and (iv) evaluate the impact of the difference in practice among the French dental service university hospitals on anxiety. The maintenance of a framework for the safe use of this drug, whose place in dental care is fundamental, is essential. Twelve of the 16 French dental service university hospitals agreed to participate in this study. METHODS MEOPAeDent is an observational, descriptive, transversal study that aims to evaluate the effects sought and felt by children when EMONO is used in paediatric dentistry. Subjects requiring dental care under EMONO are recruited by 12 French dental service university hospitals. Patients aged from 3 to 15 years are recruited for the study when they visit a dental service of a French university hospital requiring dental care under EMONO. The investigator collects the necessary data from the child's medical records, from his own observations and from questions posed to the child and his/her parents. A survey is completed at the first and final sessions of dental care under EMONO. DISCUSSION This study will provide an evaluation of the effects of EMONO on the French paediatric population in need of dental care as well as evaluate the appetite for the use of this substance. The results will first be used to provide additional data that is essential to monitor the use of a product with an authorization to use it outside of hospitals from 2009 in France, confirm its safety for use and justify its framework of application. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03453411 registered 2 March 2018.
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Affiliation(s)
- Tony Prud'homme
- Faculty of Dental Surgery, Pediatric Dentistry Department, CHU Nantes, 1 place Alexis Ricordeau, BP 84215, 44042, Nantes, Cedex 1, France. .,Université Nantes, Nantes, France. .,UMR 1246 - SPHERE "Methods in Patient-centered outcomes and health research", Université Nantes et Tours, Nantes, France.
| | - Sylvie Dajean-Trutaud
- Faculty of Dental Surgery, Pediatric Dentistry Department, CHU Nantes, 1 place Alexis Ricordeau, BP 84215, 44042, Nantes, Cedex 1, France.,Université Nantes, Nantes, France
| | - Morgane Rousselet
- Addictology and Psychiatry Department, CHU Nantes, Nantes, France.,Pharmacology Department - Addictovigilance, CHU Nantes, Nantes, France.,UMR 1246 - SPHERE "Methods in Patient-centered outcomes and health research", Université Nantes et Tours, Nantes, France
| | - Fanny Feuillet
- Addictology and Psychiatry Department, CHU Nantes, Nantes, France.,Pharmacology Department - Addictovigilance, CHU Nantes, Nantes, France.,UMR 1246 - SPHERE "Methods in Patient-centered outcomes and health research", Université Nantes et Tours, Nantes, France
| | - Marjorie Carpentier-Cheraud
- Faculty of Dental Surgery, Pediatric Dentistry Department, CHU Nantes, 1 place Alexis Ricordeau, BP 84215, 44042, Nantes, Cedex 1, France
| | - Olivier Bonnot
- Addictology and Psychiatry Department, CHU Nantes, Nantes, France
| | - Isabelle Hyon
- Faculty of Dental Surgery, Pediatric Dentistry Department, CHU Nantes, 1 place Alexis Ricordeau, BP 84215, 44042, Nantes, Cedex 1, France
| | - Marie Grall-Bronnec
- Addictology and Psychiatry Department, CHU Nantes, Nantes, France.,UMR 1246 - SPHERE "Methods in Patient-centered outcomes and health research", Université Nantes et Tours, Nantes, France
| | - Serena Lopez-Cazaux
- Faculty of Dental Surgery, Pediatric Dentistry Department, CHU Nantes, 1 place Alexis Ricordeau, BP 84215, 44042, Nantes, Cedex 1, France.,Université Nantes, Nantes, France
| | - Caroline Victorri-Vigneau
- Pharmacology Department - Addictovigilance, CHU Nantes, Nantes, France.,UMR 1246 - SPHERE "Methods in Patient-centered outcomes and health research", Université Nantes et Tours, Nantes, France
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Dupeyron A, Dénarié M, Richard D, Dobija L, Castelli C, Petiot S, Tavares I, Gelis A, Coudeyre E. Analgesic gas for rehabilitation of frozen shoulder: Protocol for a randomized controlled trial. Ann Phys Rehabil Med 2019; 62:43-48. [PMID: 30099150 DOI: 10.1016/j.rehab.2018.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 07/19/2018] [Accepted: 07/25/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is little evidence regarding the best way to treat adhesive capsulitis. Physical therapy can reduce pain and improve function and range of motion. However, we lack clear indications on the regimen, techniques or intensity of physical therapy to achieve better results. Intensive physical therapy seems to be confined to the later stages of adhesive capsulitis (chronic stage) given that rehabilitation-induced pain could worsen the outcomes. Here we describe a protocol for a study comparing the efficacy of a standardized program of intensive mobilization under analgesic gas to a similar program under placebo gas and questioning the impact of pain. METHOD/DESIGN A randomized, double-blind, multicenter study - the MEOPA Trial - was designed to include adults with strictly defined clinical adhesive capsulitis for a 14-day intensive physical rehabilitation program under an equimolar mixture of oxygen and nitrous oxide or sham gas administration. Efficacy will be assessed by the Constant-Murley score. Data for secondary criteria including pain, disability, quality of life and perceived efficacy by the patient or physiotherapist will be collected over 6 months. DISCUSSION This randomized controlled trial has been designed to test the effectiveness of intensive physical therapy under a simple and safe analgesic method. This study will also address the effect of pain during rehabilitation in adhesive capsulitis. Furthermore, results from the 6-month multidimensional follow-up of painful mobilization for this condition could be extrapolated to other musculoskeletal conditions. TRIAL REGISTRATION ClinicalTrials.gov No. NCT01087229.
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Affiliation(s)
- Arnaud Dupeyron
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire Carémeau, Place du Pr R. Debré, 30029 Nîmes cedex 09, France; Euromov, Université de Montpellier, Montpellier, France.
| | - Marie Dénarié
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire Carémeau, Place du Pr R. Debré, 30029 Nîmes cedex 09, France
| | - Dominique Richard
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire Carémeau, Place du Pr R. Debré, 30029 Nîmes cedex 09, France
| | - Lech Dobija
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Christel Castelli
- BESPIM, Département de Biostatistique, Epidémiologie, Santé Publique et Informatique Médicale, Centre Hospitalier Universitaire Carémeau, Nîmes, France
| | - Sylvie Petiot
- Fédération de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire Carémeau, Le Grau-du-Roi, France
| | - Isabelle Tavares
- Département de Médecine Physique et de Réadaptation, Centre Hospitalier Régional Universitaire Lapeyronie, Montpellier, France
| | - Anthony Gelis
- Centre Mutualiste Neurologique Propara, Montpellier, France
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire, Clermont-Ferrand, France; INRA, Université Clermont Auvergne, Clermont-Ferrand, France
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Gao LL, Yang LS, Zhang JJ, Wang YL, Feng K, Ma L, Yu YY, Li Q, Wang QH, Bao JT, Dai YL, Liu Q, Li YX, Yu QJ. A fixed nitrous oxide/oxygen mixture as an analgesic for trauma patients in emergency department: study protocol for a randomized, controlled trial. Trials 2018; 19:527. [PMID: 30268163 PMCID: PMC6162929 DOI: 10.1186/s13063-018-2899-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 09/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute pain is always the most common complaint in Emergency Department admissions and options for analgesia are limited. Nitrous oxide/oxygen possess many properties showing it may be an ideal analgesic method for the Emergency Department; it is quick-acting, well-tolerated, and does not mask signs and symptoms. The aim of this study is to evaluate the safety and analgesic effect of the fixed nitrous oxide/oxygen mixture for trauma patients in a busy emergency environment. METHODS The randomized, double-blind, prospective, placebo-controlled study will be carried out in the Emergency Department of General Hospital of Ningxia Medical University. The target research objects are trauma patients who present to the Emergency Department and report moderate to severe intensities of acute pain. A total of 90 patients will be recruited and randomly assigned into the treatment and control group. The treatment group will receive conventional pain treatment plus nitrous oxide/oxygen mixture and the control group will receive conventional pain treatment plus oxygen. Neither patients, nor investigators, nor data collectors will know the nature of the gas mixture in each cylinder and the randomization list. Outcomes will be monitored at baseline(T0), 5 min (T1), and 15 min (T2) after the beginning of intervention and at 5 min post intervention (T3) for each group. The primary outcome is the level of pain relief after the initial administering of the intervention at T1, T2, and T3. Secondary outcomes include adverse events, physiological parameters, total time of the gas administration, satisfaction from both patients and healthcare professionals, and the acceptance of patients. DISCUSSION Our previous studies suggested that a fixed nitrous oxide/oxygen mixture was an efficacious analgesic for the management of burning dressing pain and breakthrough cancer pain. The results of this study will provide a more in-depth understanding of the effect of this gas. If this treatment proves successful, it could help to generate preliminary guidelines and be implemented widely in trauma patients with pain in Emergency Departments. TRIAL REGISTRATION Chinese Clinical Trial Register, ChiCTR-INR-16007807 . Registered on 21 January 2016.
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Affiliation(s)
- Lu-Lu Gao
- School of Nursing, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004 China
| | - Li-Shan Yang
- Emergency Department, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Jun-Jun Zhang
- School of Nursing, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004 China
| | - Yi-Ling Wang
- School of Nursing, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004 China
| | - Ke Feng
- Emergency Department, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Lei Ma
- Emergency Department, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Yuan-Yuan Yu
- Emergency Department, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Qiang Li
- Emergency Department, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Qing-Huan Wang
- Emergency Department, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Jin-Tao Bao
- Emergency Department, General Hospital of Ningxia Medical University, Yinchuan, 750004 China
| | - Ya-Liang Dai
- School of Nursing, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004 China
| | - Qiang Liu
- School of Basic Medical Sciences, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004 China
| | - Yu-Xiang Li
- School of Nursing, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004 China
- Institute of Nursing Research, Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004 China
| | - Qiang-Jian Yu
- Department of Pharmacology, Pharmaceutical Institute of Ningxia Medical University, 1160 Shengli Street, Yinchuan, 750004 China
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Cheng DR, Elia S, Perrett KP. Immunizations under sedation at a paediatric hospital in Melbourne, Australia from 2012-2016. Vaccine 2018; 36:3681-3685. [PMID: 29753606 DOI: 10.1016/j.vaccine.2018.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/13/2018] [Accepted: 05/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sedation for immunizations is of particular importance in a subset of paediatric patients with anxiety disorders, needle phobia, developmental or behavioural disorders. The Royal Children's Hospital (RCH) Melbourne offers a unique immunization under sedation service for these patients. We aimed to evaluate the number and types of patients using inpatient sedation for immunizations, distraction and sedation techniques used, and outcomes of these procedures. METHODS A medical record review was conducted on all patients who had immunization under sedation between January 2012 to December 2016 in the RCH Day Medical Unit (DMU). RESULTS A total of 139 children and adolescents had 213 vaccination encounters. More than half of the vaccination encounters involved multiple vaccines. A total of 400 vaccines were administered. One third of patients (32.3%) had multiple DMU admissions for vaccinations. The median age of patients was 13 years. There were only 10 (4.7%) failed attempts at vaccination; all due to patient non-compliance with prescribed sedation. The majority of patients (58.9%) had a diagnosis of needle phobia. Sedation was most commonly adequately achieved with inhaled nitrous oxide (54.7% sole agent). Midazolam was often used as an adjunct therapy (42.8%). Local anaesthetic cream or play therapy, were used in only 5.9% and 3.9% of patients respectively, although this may reflect poor documentation rather than actual practice. CONCLUSIONS For a subset of paediatric patients for which standard immunization procedures have failed, distraction techniques and conscious sedation enable immunizations to be given safely and effectively. Future research will develop protocols to streamline immunization procedures under sedation.
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Affiliation(s)
- Daryl R Cheng
- Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Australia.
| | - Sonja Elia
- Immunisation Service, Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Kirsten P Perrett
- Department of General Medicine, Royal Children's Hospital Melbourne, Melbourne, Australia; Gastro and Food Allergy Research Group and Melbourne Children's Trial Centre, Murdoch Children's Research Institute and Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Abstract
BACKGROUND Many dermatologic procedures are painful and can be distressing to patients. OBJECTIVE To determine whether nitrous oxide has been used in dermatology and whether literature supports its use in terms of providing analgesia and anxiety associated with dermatologic procedures. METHODS A search of PubMed and Cochrane databases was conducted through July 15, 2016, to identify studies involving nitrous oxide use in dermatology. RESULTS Eight studies were identified and reviewed. The use of nitrous oxide/oxygen mixture resulted in a significant reduction in pain when used for photodynamic therapy, botulinum toxin therapy for hyperhidrosis of both the palms and axilla, aesthetic procedures involving various laser procedures, and in the treatment of bed sores and leg ulcers. However, pain scores were higher when nitrous oxide/oxygen was used in the debridement of chronic ulcers when compared with the use of topical anesthesia. In addition, nitrous oxide has been reported effective at reducing pain in hair transplants, dermabrasion, excision and repairs, and pediatric procedures. CONCLUSION Current literature provides some evidence that nitrous oxide, used alone or as adjunct anesthesia, is effective at providing analgesia for many dermatologic procedures. Nitrous oxide has many potential applications in dermatology; however, further evidence from randomized controlled trials is needed.
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Zafirova Z, Sheehan C, Hosseinian L. Update on nitrous oxide and its use in anesthesia practice. Best Pract Res Clin Anaesthesiol 2018; 32:113-123. [DOI: 10.1016/j.bpa.2018.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 01/22/2023]
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Chi SI. Complications caused by nitrous oxide in dental sedation. J Dent Anesth Pain Med 2018; 18:71-78. [PMID: 29744381 PMCID: PMC5932993 DOI: 10.17245/jdapm.2018.18.2.71] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/11/2018] [Accepted: 04/16/2018] [Indexed: 12/11/2022] Open
Abstract
The first clinical application of nitrous oxide (N2O) was in 1844, by an American dentist named Horace Wells who used it to control pain during tooth extraction. Since then, N2O has shared a 170-year history with modern dental anesthesia. N2O, an odorless and colorless gas, is very appealing as a sedative owing to its anxiolytic, analgesic, and amnestic properties, rapid onset and recovery, and, in particular, needle-free application. Numerous studies have reported that N2O can be used safely and effectively as a procedural sedation and analgesia (PSA) agent. However, N2O can lead to the irreversible inactivation of vitamin B12, which is essential for humans; although rare, this can be fatal in some patients.
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Affiliation(s)
- Seong In Chi
- Department of Pediatric Dentistry, Dankook University Sejong Dental Hospital, Sejong, South Korea
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Abstract
INTRODUCTION For a drug that has been omnipresent for nearly 200 years, nitrous oxide's (N2O) future seems less certain than its illustrious past. Environmental concerns are coming to the fore and may yet outweigh important clinical benefits. SOURCES OF DATA After determining the scope of the review, the authors used PubMed with select phrases encompassing the words in the scope. Both preclinical and clinical reports were considered. AREAS OF AGREEMENT The analgesic and anaesthetic advantages of N2O remain despite a plethora of newer agents. AREAS OF CONTROVERSY N2O greenhouse gas effect and its inhibition of key enzymes involved in protein and DNA synthesis have provided further fuel for those intent on eliminating its further clinical use. GROWING POINTS The use of N2O for treatment-resistant depression has gained traction. AREAS TIMELY FOR DEVELOPING RESEARCH Comparative studies for N2O role in combatting the prescription opioid analgesic epidemic may well provide further clinical impetus.
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Affiliation(s)
- V Lew
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA,USA
| | - E McKay
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA,USA
| | - M Maze
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA,USA
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Pain and Stress Response during Intravenous Access in Children with Congenital Adrenal Hyperplasia: Effects of EMLA and Nitrous Oxide Treatment. PAIN RESEARCH AND TREATMENT 2018; 2017:1793241. [PMID: 29464120 PMCID: PMC5804398 DOI: 10.1155/2017/1793241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 11/30/2017] [Indexed: 11/23/2022]
Abstract
Background Congenital adrenal hyperplasia (CAH) is an endocrine condition that requires regularly blood samples for optimal treatment. The management of CAH in children is complex when intravenous access is one of the most stressful procedures for children. The purpose of this pilot study was to investigate the effects of nitrous oxide inhalation (N2O) in combination with cutaneous application of local anesthetics (EMLA) for improving intravenous access in children with CAH. Method Ten children (7–14 years) were studied. The children received two intravenous procedures: one with EMLA and one with EMLA + N2O. The order of priority was randomized. The outcomes were the children's pain experience (0–10) and an evaluation of satisfaction (1–5) after the procedure. Heart rate, blood pressure, saturation, and analyses of 17-hydroxyprogesterone (17-OHP), norepinephrine, and glucose were analyzed. Results Higher pain scores, heart rate, and glucose levels were reported after EMLA, compared to EMLA + N2O, but 17-OHP levels remained unchanged. The children's satisfaction with the intravenous procedure was more positive for EMLA + N2O. Conclusions EMLA + N2O offers the possibility of improving the intravenous procedure for anxious children with CAH. Although the quality of care was better with N2O treatment, it was not possible to demonstrate that this is a prerequisite for valid 17-OHP measurements.
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Fauteux-Lamarre E, Babl FE, Davidson AJ, Legge D, Lee KJ, Palmer GM, Hopper SM. Protocol for a double blind, randomised placebo-controlled trial using ondansetron to reduce vomiting in children receiving intranasal fentanyl and inhaled nitrous oxide for procedural sedation in the emergency department (the FON trial). BMJ Paediatr Open 2018; 2:e000218. [PMID: 29637190 PMCID: PMC5843010 DOI: 10.1136/bmjpo-2017-000218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/22/2017] [Accepted: 12/27/2017] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Intranasal fentanyl and nitrous oxide (N2O) can be combined to create a non-parenteral procedural sedation regimen for children in the paediatric emergency department. This combination of intranasal fentanyl and N2O provides effective pain relief for more painful procedures, but is associated with a higher incidence of vomiting than N2O alone. Our aim is to assess whether ondansetron used preventatively reduces the incidence of vomiting associated with intranasal fentanyl and N2O for procedural sedation compared with placebo. METHODS AND ANALYSIS This study is a double blind, randomised placebo-controlled superiority trial. This is a single-centre trial of 442 children aged 3-18 years presenting to a tertiary care Paediatric Emergency Department at the Royal Children's Hospital (RCH), Melbourne, Australia, requiring procedural sedation with intranasal fentanyl and N2O. After written consent, eligible participants are randomised to receive ondansetron or placebo along with intranasal fentanyl, 30-60 min prior to N2O administration. The primary outcome is vomiting during or up to 1 hour after procedural sedation. Secondary outcomes include: number of vomits and retching during procedural sedation, vomiting 1-24 hours after procedural sedation, procedural sedation duration and associated adverse events, procedure abandonment, parental satisfaction and the value parents place on the prevention of vomiting. This trial will allow refinement of a non-parenteral sedation regimen for children requiring painful procedures. ETHICS AND DISSEMINATION This study has ethics approval at the RCH, Melbourne, protocol number 36174. The results from this trial will be submitted to conferences and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12616001213437).
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Affiliation(s)
- Emmanuelle Fauteux-Lamarre
- Emergency Department, The Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Franz E Babl
- Emergency Department, The Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Andrew J Davidson
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Australia.,Melbourne Children's Trials Centre, Melbourne, Australia
| | - Donna Legge
- Department of Pharmacy, The Royal Children's Hospital, Melbourne, Australia
| | - Katherine J Lee
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Melbourne Children's Trials Centre, Melbourne, Australia
| | - Greta M Palmer
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.,Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Melbourne, Australia
| | - Sandy M Hopper
- Emergency Department, The Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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Livingston M, Lawell M, McAllister N. Successful use of nitrous oxide during lumbar punctures: A call for nitrous oxide in pediatric oncology clinics. Pediatr Blood Cancer 2017; 64. [PMID: 28475231 DOI: 10.1002/pbc.26610] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/16/2017] [Accepted: 03/18/2017] [Indexed: 11/10/2022]
Abstract
Numerous reports describe the successful use of nitrous oxide for analgesia in children undergoing painful procedures. Although shown to be safe, effective, and economical, nitrous oxide use is not yet common in pediatric oncology clinics and few reports detail its effectiveness for children undergoing repeated lumbar punctures. We developed a nitrous oxide clinic, and undertook a review of pediatric oncology lumbar puncture records for those patients receiving nitrous oxide in 2011. No major complications were noted. Minor complications were noted in 2% of the procedures. We offer guidelines for establishing such a clinic.
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Affiliation(s)
- Mylynda Livingston
- Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | | | - Nancy McAllister
- Department of Oncology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
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Vilanova-Saingery C, Bailleul-Forestier I, Vaysse F, Vergnes JN, Marty M. Use and perception of nitrous oxide sedation by French dentists in private practice: a national survey. Eur Arch Paediatr Dent 2017; 18:385-391. [PMID: 29086891 DOI: 10.1007/s40368-017-0307-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 09/18/2017] [Indexed: 11/29/2022]
Abstract
AIM The aim of this national survey was to record the use of nitrous oxide and the perceptions of French dental practitioners to this form of sedation. The use of nitrous oxide sedation (NOS) has been authorised in private dental practice in France since December 2009 but, to date, no study implementing both quantitative and qualitative methods has explored such use. METHODS The data were collected using a Google Forms questionnaire. A mixed methodology was used for data analysis: a quantitative approach to explore the use of conscious sedation and a qualitative thematic approach (using Nvivo software) to determine the practitioner's perception of it. RESULTS Responses were collected from 225 practitioners (19% of the target population of 1185). Most of the responders were trained in NOS use in private dental clinics. Seventy-three percent of those who trained privately actually used NOS, compared to 53% of those trained at university (p-value = 0.0052). Above all, NOS was used for children requiring restorative dentistry. The average price of the sedation was 50 Euros and it lasted, on average, for 37 min. The qualitative and thematic analysis revealed the financial and technical difficulties of implementing NOS in private practice. However, it also showed the benefits and pleasure associated with NOS use. CONCLUSION This statistical survey of French dental practitioners offers an insight of the current state of the use of conscious sedation with nitrous oxide in private general dental practice in France. It also includes the first report of dental practitioners' perceptions of NOS use and may lead to a better understanding of the reasons why sedation is sometimes not used in private practice.
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Affiliation(s)
- C Vilanova-Saingery
- Perpignan Saint Jean Hospital, Paul Sabatier University, Toulouse, France.,Paul Sabatier University, Toulouse, France
| | - I Bailleul-Forestier
- Rangueil Teaching Hospital, Paul Sabatier University, Toulouse, France.,Paul Sabatier University, Toulouse, France
| | - F Vaysse
- Rangueil Teaching Hospital, Paul Sabatier University, Toulouse, France.,Paul Sabatier University, Toulouse, France
| | - J-N Vergnes
- Rangueil Teaching Hospital, Paul Sabatier University, Toulouse, France.,Paul Sabatier University, Toulouse, France
| | - M Marty
- Rangueil Teaching Hospital, Paul Sabatier University, Toulouse, France. .,LIRDEF, Montpellier III University, Montpellier, France. .,Dental Faculty, 3 Chemin des maraîchers, 31400, Toulouse, France.
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Wang Y, Liu Q, Yu JN, Wang HX, Gao LL, Dai YL, Jin X, Zuo F, Liu J, Bai CF, Mu GX, Chai XM, Zhang YJ, Li YX, Yu JQ. Perceptions of parents and paediatricians on pain induced by bone marrow aspiration and lumbar puncture among children with acute leukaemia: a qualitative study in China. BMJ Open 2017; 7:e015727. [PMID: 28939570 PMCID: PMC5623544 DOI: 10.1136/bmjopen-2016-015727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To obtain in-depth insight into the perceptions of parents and paediatricians in China regarding current procedural pain management on bone marrow aspirations and lumbar punctures in paediatric haemato-oncology department. DESIGN, SETTING AND PARTICIPANTS This qualitative study was conducted in a 4500-bed university hospital in northwest China. To collect data, in-depth semistructured interviews were conducted with parents of children with acute leukaemia (n=12) and haemato-oncology paediatricians (n=11) using purposive sampling. Interviews were audiotaped and transcribed and subjected to thematic analysis. RESULTS The suffering of procedural pain among paediatric patients was not adequately recognised and properly treated at the paediatric haemato-oncology department. The current paediatric procedural pain management is inadequate for paediatric patients. Crucial factors were identified including lack of awareness about the damage of uncontrolled pain in children, parents' low supportive ability, the limited capacity to provide general analgesia by anaesthetists, inadequate knowledge in the usage of analgesia and sedation and lack of efficient analgesic for children's procedural pain. The participants strongly expected optimal interventions to improve paediatric procedural pain management. CONCLUSIONS The result suggested a perceived and actual poor management of paediatric procedural pain in haemato-oncology department in northwest China. A relevant pain management education programme for paediatricians and parents as well as an effective pain medication are urgently needed in northwest China. TRIAL REGISTRATION Chinese Clinical Trial Registry. Identifier: ChiCTR-INR-16007989.
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Affiliation(s)
- Yu Wang
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Qiang Liu
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Jia-Ning Yu
- Department of Paediatric Hematology-Oncology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Hai-Xia Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu-Lu Gao
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Ya-Liang Dai
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Xin Jin
- Neurological Surgery Department, Ningxia People’s Hospital, Yinchuan, China
| | - Feng Zuo
- Department of Paediatric Hematology-Oncology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Juan Liu
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Cai-Feng Bai
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Guo-Xia Mu
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Xiao-Min Chai
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Yin-Juan Zhang
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Yu-Xiang Li
- Nursing School, Ningxia Medical University, Yinchuan, China
| | - Jian-Qiang Yu
- Department of Pharmacology, College of Pharmacy, Ningxia Medical University, Yinchuan, China
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Laughing Gas in a Pediatric Emergency Department-Fun for All Participants: Vitamin B12 Status Among Medical Staff Working With Nitrous Oxide. Pediatr Emerg Care 2016; 32:827-829. [PMID: 26569075 DOI: 10.1097/pec.0000000000000582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED The efficiency of nitrous oxide in an equimolar mixture with oxygen or in concentrations up to 70% is approved for short painful procedures. Evaluation of the vitamin B12 levels in anesthetic staff applying nitrous oxide showed reduced vitamin B12 plasma levels. This study examines the vitamin B12 status of medical staff working with nitrous oxide in a pediatric emergency department (ED). Medical staff of the ED at the University Children's Hospital Zurich participated. The vitamin B12 status was evaluated by measuring homocysteine, methylmalonic acid, vitamin B12, blood count, and the MTHFR C677T genotype. As a control group, medical personnel working in the "nitrous oxide-free" pediatric intensive care unit were recruited. RESULTS The parameters for the vitamin B12 status of all participants were in the reference range, and there were no significant differences for the 2 groups. By trend, the ED staff showed higher vitamin B12 levels. The ED staff members were slightly older (P = 0.07) and had higher hemoglobin levels (P < 0.04) compared with the pediatric intensive care unit staff. CONCLUSIONS The use of nitrous oxide (50%-70%) with a demand valve is safe for the vitamin B12 status of medical personnel in the ED.
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Franck LS. Nursing management of children's pain: Current evidence and future directions for research. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/136140960300800503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This critical literature review discusses the research evidence underpinning each of the pain standards in the National Service Framework for Children: Standard for hospital services. Relevant evidence-based reviews and clinical practice guidelines are highlighted, and aspects of children's pain management where the research evidence is particularly strong or weak are identified. Priorities are suggested for nurse-led research aimed at generating new knowledge to improve pain management for children.
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Affiliation(s)
- Linda S. Franck
- Great Ormond Street, Hospital for Children NHS Trust and Institute of Child Health
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Tsze DS, Mallory MD, Cravero JP. Practice Patterns and Adverse Events of Nitrous Oxide Sedation and Analgesia: A Report from the Pediatric Sedation Research Consortium. J Pediatr 2016; 169:260-5.e2. [PMID: 26547401 DOI: 10.1016/j.jpeds.2015.10.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/24/2015] [Accepted: 10/06/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To describe practice patterns and adverse events associated with nitrous oxide (N2O) administration as the primary sedative outside the operating room in varied settings by a diverse range of providers, and to identify patient and sedation characteristics associated with adverse events. STUDY DESIGN Data prospectively collected by the Pediatric Sedation Research Consortium, which is comprised of 40 children's and general/community hospitals, was retrospectively analyzed for children who received N2O as the primary sedative. Descriptive measures of patient and sedation characteristics and adverse events were reported. A multivariable regression model was used to assess potential associations between patient and sedation characteristics and adverse events. RESULTS A total of 1634 N2O administrations were identified. The majority was performed in sedation units, and most by advanced practice nurses or physician assistants. The most common adjunct medication was midazolam. There was a low prevalence of adverse events (6.5%), with vomiting as the most common (2.4%) and only 3 (0.2%) serious adverse events reported. The odds of vomiting increased when concomitant opioids were administered (OR 2.89, 95% CI 1.14, 7.32) and when nil per os (NPO) clear fluids <2 hours (OR 4.16, 95% CI 1.61, 10.76). NPO full meal <6 hours did not change the odds of vomiting (OR 1.42, 95% CI 0.57, 3.57). There were no aspiration events. CONCLUSIONS There was a very low prevalence of serious adverse events during N2O administration in children outside of the operating room and by nonanesthesiologists. The odds of vomiting increased when concomitant opioids were administered and NPO clear fluids <2 hours.
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Affiliation(s)
- Daniel S Tsze
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.
| | - Michael D Mallory
- Pediatric Emergency Medicine Associates, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, GA
| | - Joseph P Cravero
- Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital, Boston, MA
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do Vale AHB, Videira RLDR, Gomez DS, Carmona MJC, Tsuchie SY, Flório C, Vane MF, Posso IDP. Effect of nitrous oxide on fentanyl consumption in burned patients undergoing dressing change. Braz J Anesthesiol 2016; 66:7-11. [PMID: 26768923 DOI: 10.1016/j.bjane.2014.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/03/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Thermal injuries and injured areas management are important causes of pain in burned patients, requiring that these patients are constantly undergoing general anesthesia for dressing change. Nitrous oxide (N2O) has analgesic and sedative properties; it is easy to use and widely available. Thus, the aim of this study was to evaluate the analgesic effect of N2O combined with fentanyl in burned patients during dressing change. METHOD After approval by the institutional Ethics Committee, 15 adult burned patients requiring daily dressing change were evaluated. Patient analgesia was controlled with fentanyl 0.0005% administered by intravenous pump infusion on-demand. Randomly, in one of the days a mixture of 65% N2O in oxygen (O2) was associated via mask, with a flow of 10 L/min (N2O group) and on the other day only O2 under the same flow (control group). RESULTS No significant pain reduction was seen in N2O group compared to control group. VAS score before dressing change was 4.07 and 3.4, respectively, in N2O and control groups. Regarding pain at the end of the dressing, patients in N2O group reported pain severity of 2.8; while the control group reported 2.87. There was no significant difference in fentanyl consumption in both groups. CONCLUSIONS The association of N2O was not effective in reducing opioid consumption during dressing changes.
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Affiliation(s)
- Arthur Halley Barbosa do Vale
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, Instituto Central do HCFMUSP, São Paulo, SP, Brazil.
| | - Rogério Luiz da Rocha Videira
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, Instituto Central do HCFMUSP, São Paulo, SP, Brazil
| | - David Souza Gomez
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, Instituto Central do HCFMUSP, São Paulo, SP, Brazil
| | - Maria José Carvalho Carmona
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, Instituto Central do HCFMUSP, São Paulo, SP, Brazil
| | - Sara Yume Tsuchie
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, Instituto Central do HCFMUSP, São Paulo, SP, Brazil
| | - Cláudia Flório
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, Instituto Central do HCFMUSP, São Paulo, SP, Brazil
| | - Matheus Fachini Vane
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, Instituto Central do HCFMUSP, São Paulo, SP, Brazil
| | - Irimar de Paula Posso
- Discipline of Anesthesiology, Faculdade de Medicina, Universidade de São Paulo, Instituto Central do HCFMUSP, São Paulo, SP, Brazil
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Efeito do óxido nitroso sobre o consumo de fentanil em pacientes queimados submetidos à troca de curativo. Braz J Anesthesiol 2016; 66:7-11. [DOI: 10.1016/j.bjan.2014.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/03/2014] [Indexed: 11/21/2022] Open
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Ambrogi V, Tezenas du Montcel S, Collin E, Coutaux A, Bourgeois P, Bourdillon F. Care-related pain in hospitalized patients: severity and patient perception of management. Eur J Pain 2015; 19:313-21. [PMID: 25055764 DOI: 10.1002/ejp.549] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hospitalized patients commonly undergo painful procedures, but little is known about care-related pain (CRP) in the overall population of inpatients. We conducted a cross-sectional 1-day survey to assess the prevalence and characteristics of CRP and its management in all units of a university hospital in Paris and determined the factors linked to severe CRP. METHODS All patients who were able to communicate and were hospitalized for at least 24 h but not in a day-care or neonatal unit were included. RESULTS From 938 patients who completed the questionnaire, 554 patients reported pain within the previous 24 h, for a 59% prevalence of pain, and 540 (58%) had experienced CRP in the previous 15 days (51% males; mean [SD] age 54 [18] years). Of 907 procedures, 330 (37%) resulted in severe pain. The most-often reported painful procedures were vascular punctures and patient mobilization. Severe CRP was associated with long hospitalization; non-vascular invasive punctures, catheterization, mobilization or radiological examination; or pain during the previous 24 h due to surgery or treatment. Only half of the patients declared that they had received information regarding the painful procedure. Treatment for pain was proposed and delivered in less than one quarter of cases. CONCLUSIONS Our results of a survey of pain management in hospitalized patients relate to a wide variety of medical conditions and procedures. Health-care workers should be more systematic in managing CRP, and attention should be paid to patients at greatest risk of severe CRP.
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Affiliation(s)
- V Ambrogi
- Public Health Department, Pitié-Salpêtrière Hospital, Paris, France
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Oren-Ziv A, Hoppenstein D, Shles A, Uziel Y. Sedation methods for intra-articular corticosteroid injections in Juvenile Idiopathic Arthritis: a review. Pediatr Rheumatol Online J 2015; 13:28. [PMID: 26141717 PMCID: PMC4490620 DOI: 10.1186/s12969-015-0021-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 05/27/2015] [Indexed: 11/17/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children. Intra-articular corticosteroid injection (IASI), one of the cornerstones of treatment for this disease, is usually associated with anxiety and pain. IASI in JIA may be performed under general anesthesia, conscious sedation, or local anesthesia alone. Currently, there is no widely accepted standard of care regarding the sedation method for IASI. This review discusses the different methods of anesthesia and sedation in this procedure, emphasizing the advantages and shortcomings of each method.
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Affiliation(s)
- Amit Oren-Ziv
- Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel.
| | - David Hoppenstein
- Department of Anesthesiology and Intensive Care, Meir Hospital, Tel Aviv University, Sackler School of Medicine, Kfar Saba, Israel.
| | - Ayelet Shles
- Pediatric Emergency Unit, Department of Pediatrics, Meir Medical Center, Kfar Saba, Israel.
| | - Yosef Uziel
- Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Center, Tel-Aviv University, Sackler School of Medicine, Kfar Saba, 44281, Israel.
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Babl FE, Grindlay J, Barrett MJ. Laryngospasm With Apparent Aspiration During Sedation With Nitrous Oxide. Ann Emerg Med 2015; 66:475-8. [PMID: 26003005 DOI: 10.1016/j.annemergmed.2015.04.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/13/2015] [Accepted: 04/20/2015] [Indexed: 12/16/2022]
Abstract
Nitrous oxide and oxygen mixture has become increasingly popular for the procedural sedation and analgesia of children in the emergency department. In general, nitrous oxide is regarded as a very safe agent according to large case series. We report a case of single-agent nitrous oxide sedation of a child, complicated by laryngospasm and radiographically confirmed bilateral upper lobe pulmonary opacities. Although rarely reported with parenteral sedative agents, laryngospasm and apparent aspiration has not been previously reported in isolated nitrous oxide sedation. This case highlights that, similar to other sedative agents, nitrous oxide administration also needs to be conducted by staff and in settings in which airway emergencies can be appropriately managed.
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Affiliation(s)
- Franz E Babl
- Murdoch Children's Research Institute and the Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Department of Pediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
| | - Joanne Grindlay
- Murdoch Children's Research Institute and the Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Department of Pediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Joseph Barrett
- Murdoch Children's Research Institute and the Emergency Department, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Paediatric Emergency Research Unit, National Children's Research Centre, Dublin, Ireland
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Nitrous oxide procedural sedation in non-fasting pediatric patients undergoing minor surgery: a 12-year experience with 1,058 patients. Pediatr Surg Int 2015; 31:173-80. [PMID: 25385665 DOI: 10.1007/s00383-014-3608-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nitrous oxide's safety and efficacy for minor procedures is an alternative to general anesthesia, complex sedation protocols, or local anesthetic alone. METHODS A retrospective review of prospectively-collected data (2000-2012) identified 1,058 children who received single-agent nitrous oxide for minor surgery. RESULTS Children (n = 1,058, male 42 %, female 58 %) aged 1-23 years (mean = 9.8 + 5.1 years) were identified. Only nine children (0.9 %) fasted. ASA status was I-II in 1,053 (99.5 %) of patients; five (0.5 %) had an ASA III. There were no major complications (desaturation, emergency admission, apnea, airway obstruction, bradycardia) or aborted procedures. Minor complications occurred in 1.8 %; there was no association between these complications and ASA, fasting status or maximum nitrous oxide percentage administered (all p > 0.05). Post-operatively, 98 % of patients denied getting an injection. Eighty-two percent reported mild or no procedural pain. CONCLUSION This is the longest reported study using non-anesthesiologist-administered nitrous oxide as a single-agent for minor surgical procedures. The technique provides safe sedation and excellent amnesia, allowing pain and anxiety-reduced surgery with no fasting or postoperative monitoring.
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Procedural sedation for intra-articular corticosteroid injections in juvenile idiopathic arthritis (JIA) should be a standard of care. Eur J Pediatr 2014; 173:831. [PMID: 24384792 DOI: 10.1007/s00431-013-2246-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/11/2013] [Indexed: 10/25/2022]
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Évaluation des cathéters centraux à insertion périphérique en population pédiatrique. Arch Pediatr 2013; 20:1089-95. [DOI: 10.1016/j.arcped.2013.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/14/2013] [Accepted: 07/11/2013] [Indexed: 11/17/2022]
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