European Journal of Pain



RESUMENES HASTA JUNIO 6

|Aspiration in pediatric anesthesia: is there a higher incidence compared with adults? | |

Randall P. Flick; Gregory J. Schears; Mark A. Warner

Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA

CURRENT OPINION IN ANAESTHESIOLOGY 2002;15:323-327

Purpose of review Recent data in both adults and children have suggested that the incidence and severity of the pulmonary aspiration of gastric contents has declined. Previous studies have indicated that aspiration is more common in children than in adults. This review will examine the available data to compare the incidence and severity of aspiration in adults and children.

Recent findings There are several studies, some of which have been published recently, that have provided an epidemiologic perspective on the problem of aspiration.

Summary Based on the available data, aspiration appears to be slightly more common in children than in adults. The difference, however, is less than that previously reported. Morbidity associated with aspiration is rare in all age groups. This is especially true for children.

Keywords pulmonary aspiration; anesthesia; complications; pediatric

Correspondence to Randall P. Flick MD, Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel: +1 507 255 4235; fax: +1 507 255 6463; e-mail: flick.randall@mayo.edu

|Anesthesia for patients with diabetes mellitus | |

Stephen F. Dierdorf

Indiana University School of Medicine, Indianapolis, Indiana, USA

CURRENT OPINION IN ANAESTHESIOLOGY 2002;15:351-357

[pic]

Purpose of review Diabetes mellitus has diverse effects on all organ systems of the body. Insulin physiology and metabolic control are far more complex than previously thought. Research continues to reveal more information about the central role of insulin in metabolism. The treatment of hypertension and nephropathy as well as hyperglycemia in patients with diabetes has emerged as being critical for prevention of long-term diabetic complications. The issue of primary importance to the anesthesiologist is whether strict glycemic and hemodynamic control during the perioperative period affect outcome.

Recent findings Maintenance of euglycemia and physiologic control of insulin responses to changes in glucose levels have been shown to prolong life and reduce complications from diabetes mellitus. The identification and treatment of prediabetic patients may significantly delay the onset of overt diabetes. Perioperative control of glucose has become tighter, but the optimum level of glucose and ideal method of insulin delivery during surgery remain controversial. Perioperative control of blood pressure and vascular responses may be as important as glucose control for prevention of adverse perioperative events.

Summary Tight long-term control of glucose and blood pressure improve outcome in patients with diabetes. The same philosophy of management is being applied to the perioperative period. Routine measurement of intraoperative blood glucose levels and appropriate insulin administration are now standard practice, but the ideal regimen for insulin administration remains to be determined.

Keywords diabetes mellitus; anesthesia; diabetic nephropathy

Nitrous oxide does not improve sevoflurane induction of anesthesia in adults

C. Siau a *

AE.H.C. Liu a †

Singapore 119074.

A Address correspondence and requests for reprints to Dr. Siau at the Department of Anesthesia, National University Hospital, 5 Lower Kent Ridge Road,

[a]Department of Anesthesia, National University Hospital, Singapore

Manuscript received 4 October 2001 Revised 30 January 2002 Accepted 30 January 2002;

Study Objective: To compare the characteristics of sevoflurane induction with and without the addition of nitrous oxide (N2O) using tidal breathing inhalation induction without priming of the breathing circuit.

Design: Randomized, double-blind study.

Setting: Operating rooms of an ambulatory surgery suite at a university hospital.

Patients: 60 ASA physical status I and II adult patients undergoing elective surgery.

Interventions: Patients were randomized into two groups. During induction, Group 1 received 8% sevoflurane in N2O 4L/min and oxygen (O2) 2L/min; Group 2 received 8% sevoflurane in O2 6L/min. The time to cessation of finger tapping was used as the main index for induction time. Any adverse effects such as coughing, apnea, excessive oral secretions, laryngospasm, excitatory movements, and hemodynamic changes were also noted.

Measurements and Main Results: There were no significant differences in the induction times (Group 1: 62.0 vs. Group 2: 60.0 sec), number of breaths taken to this time (15.0 vs. 14.0), expired sevoflurane concentration at this time (3.4 vs. 3.2%), and time to Laryngeal Mask Airway[pic] insertion (160.0 vs. 195.0 sec). The frequencies of induction-related adverse events were similar in both study groups.

Conclusion: The addition of N2O does not confer any clinically significant advantage in this method of sevoflurane induction in adults.

|Pain Medicine |

|Volume 3 Issue 1 Page 39 - March 2002 |

|  |

|Does the Conscious Exaggeration Scale Detect Deception Within Patients with Chronic Pain Alleged to Have Secondary Gain? |

|David A. Fishbain, MSc, MD, FAPA,* Robert B. Cutler, PhD,* Hubert L. Rosomoff, MD, DMedSc, and Renee Steele-Rosomoff, BSN, MBA |

|Objectives.[pic]The illness behavior questionnaire (IBQ) is a test battery developed by Pilowsky to detect what he has termed abnormal illness behavior, which includes|

|malingering [4]. The IBQ has been widely utilized in patients with chronic pain (PWCP). Clayer developed a 21-item scale out of the IBQ, which he termed the conscious |

|exaggeration (CE) scale [7]. He proposed that the CE scale could detect conscious deception, i.e., malingering. The purpose of the present study is to test the CE |

|scale in PWCP alleged to have secondary gain and thereby at greater risk for poor pain treatment outcome. It was postulated that the CE scale should generate scores in|

|these groups significantly different from a comparison group and should predict treatment outcome in the secondary gain groups. |

|Design.[pic]A total of 96 PWCP completed the CE scale at admission and after completion of a 1-month pain facility treatment regimen. Other relevant pain variables, |

|such as pain, depression, and anxiety, were measured and the data collected at admission and treatment completion. Work status was determined at 1, 3, 6, 12, 18, 24, |

|and 30 months posttreatment. PWCP secondary gain subgroups (Workers' Compensation patients, patients in litigation, patients having a lawyer) were compared to the |

|comparison group (no secondary gain factors) for treatment CE scale change scores. In order to control for the effects of pain, an analysis of covariance with pain |

|level statistically removed was performed on admission and discharge CE scores utilizing the above patient subgroups. Pearson product correlations were utilized to |

|determine the relationships between CE scores and psychological variables. Stepwise regression analyses were utilized to predict return to work with the CE scale score|

|as a potential predictor. |

|Setting.[pic]Pain facility. |

|Patients.[pic]PWCP treated for 1 month in a pain facility. |

|Results.[pic]Overall, the analyses did not support the main hypothesis. For example, CE scale scores did not predict return to work. There was a significant degree of |

|correlation between the variables of pain, depression, anxiety, and CE scale scores. |

|Conclusions.[pic]PWCP characterized by the alleged secondary gain variables of Workers' compensation status, litigation, and having a lawyer did not differentially |

|respond to the CE scale versus the comparison group. The CE scale, therefore, does not appear to be a valid instrument for identifying exaggeration in PWCP |

|Pain Medicine |

|Volume 3 Issue 1 Page 56 - March 2002 |

|  |

|How Well is Chronic Pain Managed? Who Does it Well? |

|Carmen R. Green, MD, John R.C. Wheeler, PhD,* Frankie LaPorte, BS, Beverly Marchant, RN, and Eloisa Guerrero, PhD |

|Background.[pic]The variability in physician attitudes and goals for chronic pain relief and satisfaction with chronic pain management is unknown. |

|Objectives.[pic]To provide quantitative data regarding the status of chronic pain management by Michigan physicians. To relate physician's goals for pain management to|

|physician confidence, preferences, and satisfaction with their chronic pain care. |

|Research Design.[pic]A prospective cohort study utilizing a survey with four chronic pain vignettes. |

|Subjects.[pic]Three hundred and sixty-eight Michigan physicians who provide clinical care. |

|Measures.[pic]Evaluate differences in chronic pain decision making based upon physician demographic characteristics, knowledge, and attitudes. |

|Results.[pic]The respondents reported a high frequency of treating patients with chronic pain. However, many expressed generally low satisfaction and confidence in |

|their treatment of chronic pain, as well as low goals for the relief of chronic pain. A large number of respondents selected the worst or a poor treatment option for |

|the chronic pain vignettes. In particular, prescriptions of opioid analgesics were infrequent. Younger physicians and those with pain education were more likely to |

|choose the best responses to the vignettes. |

|Conclusion.[pic]Low pain relief goals and satisfaction with the management of chronic pain suggests the potential for its undertreatment. Our data highlight the |

|variability in pain decision making and provide insight into the educational needs of physicians regarding chronic pain management. |

European Journal of Pain

Tables of Contents and Abstracts Online Issue Contents

Children's pain at home following (adeno) tonsillectomy

Jan P.H. Hamers, Huda Huijer Abu-Saad

p 213-219, Volume 6, Number 3, May 2002

Abstract

The aim of this study was to evaluate the prevalence and severity of children's pain at home following (adeno)tonsillectomies. The subjects were parents of 161 children (86 boys, 75 girls) undergoing myringotomies, adenoidectomies and (adeno)tonsillectomies. The mean age of the children was 5.5 years (SD=2.4; range 1-14). Parents were asked to assess the child's average pain on the day of operation and 7 days after the operation, using a 100 mm Visual Analogue Scale (VAS). Parents from (adeno)tonsillectomy patients were also interviewed by phone on day 7.

The mean VAS pain intensity scores by period (day of operation until 7th day after operation) differed between the myringotomy (3.2), adenoidectomy (10.6), and (adeno)tonsillectomy (22.1) group (F2,133=31.65; p7

as significant predictors for TR. Applying these three predictors to our population identified 48

patients (21 with TR, 18 without TR, and nine who died on the ventilator without TR) with a

sensitivity of 60 per cent, a specificity of 87 per cent, a positive predictive value of 44 per cent, and

a negative predictive value of 93 per cent. Patients with TR had lower presenting GCS and higher

ventilator, ICU, and hospital days (P < 0.05). Pneumonia rates were similar. Time to neurologic

recovery (GCS ≥9) was longer for the TR patients as compared with the patients without TR. We

conclude that patients with TBI presenting with a GCS ≤8, an ISS ≥25, and ventilator days >7 are

more likely to require TR. Performing TR late did not reduce pneumonia rates or ventilator, ICU,

or hospital days. By identifying the at-risk population early TR could be performed in an attempt

to decrease morbidity and length of stay. American Surgeon 68:324;2002

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