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Heath C, Hii J, Thalayasingam P, von Ungern-Sternberg BS, Sommerfield D. Perioperative intravenous lidocaine use in children. Paediatr Anaesth 2022; 33:336-346. [PMID: 36424875 DOI: 10.1111/pan.14608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
Perioperative pain management impacts patient morbidity, quality of life, and hospitalization cost. In children, it impacts not only the child, but the whole family. Adjuncts for improved perioperative analgesia continue to be sought to minimize adverse side effects associated with opioids and for those in whom regional or neuraxial anesthesia is not suitable. The use of ketamine and alpha agonists may be useful in these settings but have noted adverse effects including hallucinations, hemodynamic instability, and excessive sedation. One alternative is intravenous lidocaine. Despite its off-label use, intravenous lidocaine has demonstrated anti-neuropathic, anti-hyperalgesic, and anti-inflammatory actions and is an emerging technique. Multiple studies in adults have demonstrated beneficial effects of perioperative intravenous lidocaine including improved perioperative analgesia with reduced postoperative opioid use, improved gastrointestinal function, earlier mobilization, and reduction in hospital length of stay. Despite the limited pediatric literature, some of these findings have been replicated. Large-scale trials providing evidence for the pediatric pharmacokinetics and high-quality safety data with respect to intravenous lidocaine are still however lacking. To date, dose ranges studied in the pediatric population have not been associated with serious side effects and current data suggests perioperative intravenous lidocaine in a subgroup of pediatric surgical patients seems well-tolerated and beneficial.
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Affiliation(s)
- Chloe Heath
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Justin Hii
- Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Anaesthesia, Joondalup Health Campus, Joondalup, WA, Australia
| | - Priya Thalayasingam
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
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Regli A, Sommerfield A, Thalayasingam P, von Ungern-Sternberg BS. N95 Masks to Protect Health Care Workers: Is the New Fast Fit-Test Protocol Cutting Corners? Chest 2022; 161:1606-1608. [PMID: 35131299 PMCID: PMC8840807 DOI: 10.1016/j.chest.2022.01.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/20/2022] [Accepted: 01/27/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Adrian Regli
- Intensive Care Unit, Fiona Stanley Hospital, Perth, WA, Australia; Medical School, The University of Western Australia, Perth, WA, Australia; Medical School, The University of Notre Dame, Fremantle, WA, Australia.
| | - Aine Sommerfield
- Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia; Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia
| | - Priya Thalayasingam
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia; Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
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Regli A, Thalayasingam P, Bell E, Sommerfield A, von Ungern-Sternberg BS. More than half of front-line healthcare workers unknowingly used an N95/P2 mask without adequate airborne protection: An audit in a tertiary institution. Anaesth Intensive Care 2021; 49:404-411. [PMID: 34325537 DOI: 10.1177/0310057x211007861] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Front-line staff routinely exposed to aerosol-generating procedures are at a particularly high risk of transmission of severe acute respiratory syndrome coronavirus 2. We aimed to assess the adequacy of respiratory protection provided by available N95/P2 masks to staff routinely exposed to aerosol-generating procedures. We performed a prospective audit of fit-testing results. A convenience sample of staff from the Department of Anaesthesia and Pain Medicine, who opted to undergo qualitative and/or quantitative fit-testing of N95/P2 masks was included. Fit-testing was performed following standard guidelines including a fit-check. We recorded the type and size of mask, pass or failure and duration of fit-testing. Staff completed a short questionnaire on previous N95/P2 mask training regarding confidence and knowledge gained through fit-testing. The first fit-pass rate using routinely available N95/P2 masks at this institution was only 47%. Fit-pass rates increased by testing different types and sizes of masks. Confidence 'that the available mask will provide adequate fit' was higher after fit-testing compared with before fit-testing; (median, interquartile range) five-point Likert-scale (4.0 (4.0-5.0) versus 3.0 (2.0-4.0); P<0.001). This audit highlights that without fit-testing over 50% of healthcare workers were using an N95/P2 mask that provided insufficient airborne protection. This high unnoticed prevalence of unfit masks among healthcare workers can create a potentially hazardous false sense of security. However, fit-testing of different masks not only improved airborne protection provided to healthcare workers but also increased their confidence around mask protection.
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Affiliation(s)
- Adrian Regli
- Intensive Care Unit, Fiona Stanley Hospital, Perth, Australia.,School of Human Sciences, The University of Western Australia, Perth, Australia.,Medical School, The University of Notre Dame Australia, Fremantle, Australia
| | - Priya Thalayasingam
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia
| | - Emily Bell
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Australia
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Nagarajan L, Ghosh S, Dillon D, Palumbo L, Woodland P, Thalayasingam P, Lethbridge M. Intraoperative neurophysiology monitoring in scoliosis surgery in children. Clin Neurophysiol Pract 2019; 4:11-17. [PMID: 30828671 PMCID: PMC6383123 DOI: 10.1016/j.cnp.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/24/2018] [Accepted: 12/29/2018] [Indexed: 02/08/2023] Open
Abstract
Objective Intraoperative neurophysiology monitoring (INM) is thought to reduce the risk of postoperative neurological deficits in children undergoing scoliosis and spine deformity surgery. INM is being used increasingly despite conflicting opinions, varied results, non-standard alarm criteria and concern regarding cost effectiveness. In this paper we present our experience with INM in scoliosis and spine deformation surgery in children, propose alert criteria and preferred anaesthetics in clinical practice. Methods We retrospectively analysed our experience with INM in 56 children who had 61 scoliosis and spine deformity surgeries. Results INM was successfully undertaken with transcranial electrical motor evoked potentials (TcMEP) and somatosensory evoked potentials. There were no injuries due to INM. Four children had 5 alerts during 4 surgeries. A postoperative deficit was seen in one child only. No new postoperative deficits were seen in any child who did not have an alert during INM. Total intravenous anaesthesia was better for INM compared to inhalational anaesthetics. Conclusions INM is useful in scoliosis surgery; it is likely to mitigate the risk of new deficits following surgery. We recommend alert criteria for TcMEPs that include multiple facets - amplitude, stimulus paradigm, morphology. We recommend propofol and remifentanil, in preference to sevoflurane and remifentanil for anaesthesia during INM. Significance Our study adds to the literature supporting the role of INM in scoliosis surgery in children. We provide guidelines for alarm criteria in clinical practice and recommend the use of total intravenous anaesthesia as the preferred anaesthetic option.
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Affiliation(s)
- Lakshmi Nagarajan
- Children's Neuroscience Service, Dept. of Neurology, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.,School of Medicine, University of Western Australia, Nedlands, WA 6009, Australia.,Telethon Kids Institute, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Soumya Ghosh
- Children's Neuroscience Service, Dept. of Neurology, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia.,Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Nedlands, WA 6009, Australia
| | - David Dillon
- Dept of Orthopaedics, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Linda Palumbo
- Children's Neuroscience Service, Dept. of Neurology, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Peter Woodland
- Dept of Orthopaedics, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Priya Thalayasingam
- Dept. of Anaesthetics, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
| | - Martyn Lethbridge
- Dept. of Anaesthetics, Perth Children's Hospital, Hospital Avenue, Nedlands, WA 6009, Australia
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Palmer GM, Thalayasingam P, McNally CM, Tingay DG, Smith KR, Clarnette TD, Penrose S, Dowden SJ, Chalkiadis GA. Audit of extrapleural local anaesthetic infusion in neonates following repair of tracheo-oesophageal fistulae and oesophageal atresia via thoracotomy. Anaesth Intensive Care 2012; 40:172-80. [PMID: 22313080 DOI: 10.1177/0310057x1204000122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In order to reduce postoperative opioid requirement, extrapleural local anaesthetic infusion dosing recommendations and guidelines for extrapleural catheter insertion were developed in our institution for 'extubatable' neonates requiring short-gap neonatal tracheo-oesophageal fistula/oesophageal atresia repair (via thoracotomy) and audited prospectively. Data audited included patient characteristics, analgesia details and ventilation duration. We divided patients into two groups: group 1 - term patients (=36 weeks gestational age) with birth-weights =2.5 kg; group 2 - pre-term patients (<36 weeks gestational age), with birth weights <2.5 kg and those with co-morbidities. There were 26 neonates in group 1 and 11 in group 2. All received extrapleural infusions of bupivacaine or levobupivacaine: the majority (90%) =300 µg.kg(-1).hour(-1) (median duration 43 hours, range 1.5 to 72 hours); 36% required morphine infusion and 39% were ventilated (median duration 34 hours, range 3 to 140 hours). In group 1, 24% required morphine infusion compared with 64% in group 2. Most group 1 patients (77%) were extubated immediately postoperatively; 20% had short duration ventilation (median 15 hours, range 11 to 37 hours); one required longer-term ventilation (231 hours). 82% of group 2 were ventilated for a median of 72 hours (range 3 to 140 hours). Review of patients' co-morbidities facilitated guideline revision. These now specify use in neonates requiring short-gap tracheo-oesophageal fistula/oesophageal atresia repair who are term at =36 weeks gestational age and =2.5 kg birth-weight, anticipated as ready for extubation either immediately or shortly after surgery.
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Affiliation(s)
- Greta M Palmer
- Department of Anaesthesia, Christchurch Hospital, Christchurch, New Zealand.
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Abstract
We present the case of an 11-year-old boy who suffered from an undefined tic disorder and incidentally sustained a traumatic fracture of the clavicle. The fracture healing course was complicated by the tic activity, and the frequency and intensity of the tics were worsened by the presence of clavicular pain. He underwent surgery and his management required the collaboration of orthopaedic surgeons, the Acute Pain Service, neurologists for tic management and rehabilitation physicians who performed the intramuscular injections of botulinum toxin. We recommend a multidisciplinary and multimodal approach to managing patients suffering from tic disorders and highlight the consideration of intramuscular injections of botulinum toxin, which were successful for this patient.
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Affiliation(s)
- Y Chen
- Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
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McDonnell C, Zaarour C, Hull R, Thalayasingam P, Pehora C, Ahier J, Crawford MW. Pre-treatment with morphine does not prevent the development of remifentanil-induced hyperalgesia. Can J Anaesth 2008; 55:813-8. [DOI: 10.1007/bf03034052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Southwick GJ, Pethick AJ, Thalayasingam P, Vijayasekaran VS, Hogg JJW. Australian doctors in Bali: the initial medical response to the Bali bombing. Med J Aust 2002; 177:624-6. [PMID: 12463981 DOI: 10.5694/j.1326-5377.2002.tb04987.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2002] [Accepted: 11/12/2002] [Indexed: 11/17/2022]
Abstract
Several Australian medical practitioners were holidaying in Bali at the time of the nightclub bombing on 12 October 2002. On learning of the disaster, they went to Sanglah Hospital to assist. With the very limited resources of the hospital, they helped in providing emergency treatment, stabilising patients, and preparing Australian patients for evacuation.
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Affiliation(s)
- Graeme J Southwick
- Melbourne Institute of Plastic Surgery, 253 Wattletree Road, Malvern, VIC.
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