1,898 results match your criteria Pediatrics Sedation


Reevaluating a Standardized Sedation Weaning Protocol for Pediatric Laryngotracheal Reconstruction for Continuous Quality Improvement.

JAMA Otolaryngol Head Neck Surg 2019 Feb 14. Epub 2019 Feb 14.

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Masschusetts.

Importance: Health care organizations are complex and evolving systems. To date, longitudinal evaluation to ensure the sustainability of quality improvement (QI) initiatives has been missing from the otolaryngology literature. We sought to reassess perioperative management of laryngotracheal reconstruction, which requires adequate sedation. Read More

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http://dx.doi.org/10.1001/jamaoto.2018.4348DOI Listing
February 2019

Safety and efficacy of a propofol and ketamine based procedural sedation protocol in children with cerebral palsy undergoing botulinum toxin A injections.

PM R 2019 Feb 13. Epub 2019 Feb 13.

Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.

Background: Pediatric patients with cerebral palsy (CP) often undergo intramuscular botulinum toxin (BoNT-A) injections. These injections can be painful and may require procedural sedation. An ideal sedation protocol has yet to be elucidated. Read More

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http://dx.doi.org/10.1002/pmrj.12146DOI Listing
February 2019

Volumetric Assessment of Pediatric Vascular Malformations Using a Rapid, Hand-Held Three-Dimensional Imaging System.

J Digit Imaging 2019 Jan 31. Epub 2019 Jan 31.

George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.

The effect of percutaneous, surgical, and medical therapies for vascular malformations (VMs) is often difficult to quantify volumetrically using cross-sectional imaging. Volumetric measurement is often estimated with serial, expensive MRI examinations which may require sedation or anesthesia. We aim to explore whether a portable 3D scanning device is capable of rapid, accurate volumetric analysis of pediatric VMs. Read More

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http://link.springer.com/10.1007/s10278-019-00183-6
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http://dx.doi.org/10.1007/s10278-019-00183-6DOI Listing
January 2019
1 Read

First-Line Diagnostic Evaluation with MRI of Children Suspected of Having Acute Appendicitis.

Radiology 2019 Feb 12:181959. Epub 2019 Feb 12.

From the Departments of Medical Imaging (R.M., S.M.D., F.M., D.G., S.V., B.K., D.R.M., U.K.U.), Pediatrics (G.G.), and Pediatric Emergency Medicine (A.L.), University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724.

Background Advances in abdominal MRI have enabled rapid, free-breathing imaging without the need for intravenous or oral contrast material. The use of MRI as the primary imaging modality for suspected appendicitis has not been previously studied. Purpose To determine the diagnostic performance of MRI as the initial imaging modality in children suspected of having acute appendicitis. Read More

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http://dx.doi.org/10.1148/radiol.2019181959DOI Listing
February 2019
1 Read

Clinical Practice Guideline for Emergency Department Procedural Sedation With Propofol: 2018 Update.

Ann Emerg Med 2019 Feb 4. Epub 2019 Feb 4.

Division of Emergency Medicine, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA.

We update an evidence-based clinical practice guideline for the administration of propofol for emergency department procedural sedation. Both the unique considerations of using this drug in the pediatric population and the substantial new research warrant revision of the 2007 advisory. We discuss the indications, contraindications, personnel requirements, monitoring, dosing, coadministered medications, and adverse events for propofol sedation. Read More

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http://dx.doi.org/10.1016/j.annemergmed.2018.12.012DOI Listing
February 2019
3 Reads

Carbon dioxide versus room air for colonoscopy in deeply sedated pediatric patients: a randomized controlled trial.

Endosc Int Open 2019 Feb 30;7(2):E290-E297. Epub 2019 Jan 30.

Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Ulm, Germany.

 Use of carbon dioxide (CO ) instead of room air (RA) during colonoscopy in adults revealed significantly less flatulence and abdominal pain in several studies. The objectives of this study were to investigate the effects of CO usage on post-interventional pain, abdominal discomfort, abdominal girth, pCO levels, and narcotic requirement in deeply sedated pediatric patients. A total of 97 children and adolescents aged 4 years to 17 years undergoing colonoscopy were randomized to RA or CO in a prospective, randomized, controlled trial. Read More

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http://dx.doi.org/10.1055/a-0806-7060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353645PMC
February 2019
2 Reads

Necessity of Intracranial Imaging in Infants and Children With Macrocephaly.

Pediatr Neurol 2018 Nov 22. Epub 2018 Nov 22.

Department of Pediatrics, Sanford USD Medical Center, Sanford Children's Hospital, Sioux Falls, South Dakota; University of South Dakota Sanford School of Medicine, Vermillion, South Dakota. Electronic address:

Background: Macrocephaly is frequently encountered in pediatrics and often leads to imaging. There are no recommendations from the American Academy of Pediatrics or the American College of Radiology providing imaging guidelines for macrocephaly. The goal of this study is to identify risk factors for pathologic macrocephaly and to aid the clinician in identifying patients that would benefit from imaging. Read More

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http://dx.doi.org/10.1016/j.pediatrneurol.2018.10.018DOI Listing
November 2018

Is Orally Administered Pentobarbital a Safe and Effective Alternative to Chloral Hydrate for Pediatric Procedural Sedation?

J Pediatr Pharmacol Ther 2018 Nov-Dec;23(6):460-465

Objectives: Chloral hydrate had been extensively used for children undergoing sedation for imaging studies, but after the manufacturer discontinued production, pediatric sedation providers explored alternative sedation medications. Those medications needed to be at least as safe and as effective as chloral hydrate. In this study, we examined if pentobarbital is a suitable replacement for chloral hydrate. Read More

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http://dx.doi.org/10.5863/1551-6776-23.6.460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336170PMC
January 2019
2 Reads

Cannabinoid toxicity in pediatrics.

Curr Opin Pediatr 2019 Jan 28. Epub 2019 Jan 28.

Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA.

Purpose Of Review: The advent of legalized cannabis in multiple regions of the United States has rendered the drug more accessible to pediatric patients. Pediatricians and Pediatric Emergency Medicine Providers face new challenges in counseling both patients and their parents, diagnosing exploratory ingestions of cannabinoids in toddlers, and managing complications of prolonged, heavy cannabis use in adolescents. The purpose of this review article is to provide clinicians a succinct summary of recent literature regarding tetrahydrocannabinol (THC) pharmacokinetics, pharmacodynamics, impacts on development, as well as presentations of acute and chronic toxicity. Read More

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http://Insights.ovid.com/crossref?an=00008480-900000000-9889
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http://dx.doi.org/10.1097/MOP.0000000000000739DOI Listing
January 2019
12 Reads

Factors affecting same-day cancelation of outpatient pediatric oncologic procedural sedation.

Pediatr Hematol Oncol 2019 Jan 25:1-7. Epub 2019 Jan 25.

a Department of Pediatrics, Division of Critical Care Medicine , Emory University School of Medicine and Children's Healthcare of Atlanta at Egleston , Atlanta , GA , USA.

Background: Children with cancer undergo serial invasive, painful procedures as a part of their diagnosis, treatment, and surveillance regimens that require procedural sedation (PS). Some may have a delay in their treatment plan due to same-day cancelation (SDC) of the procedure due to issues related to sedation or other factors. The objective of this report was to evaluate the factors resulting in the SDC of hematology and oncology patients in an outpatient pediatric sedation service. Read More

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http://dx.doi.org/10.1080/08880018.2018.1526990DOI Listing
January 2019
2 Reads

Midazolam Dose Optimization in Critically Ill Pediatric Patients With Acute Respiratory Failure: A Population Pharmacokinetic-Pharmacogenomic Study.

Crit Care Med 2019 Jan 21. Epub 2019 Jan 21.

Metrum Research Group, Tariffville, CT.

Objectives: To develop a pharmacokinetic-pharmacogenomic population model of midazolam in critically ill children with primary respiratory failure.

Design: Prospective pharmacokinetic-pharmacogenomic observational study.

Setting: Thirteen PICUs across the United States. Read More

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http://dx.doi.org/10.1097/CCM.0000000000003638DOI Listing
January 2019
1 Read

Use of ketamine by paediatricians in Italian paediatric emergency departments: a missed opportunity?

Eur J Pediatr 2019 Jan 22. Epub 2019 Jan 22.

Department of Pediatrics, Institute for Maternal and Child Health-IRCCS 'Burlo Garofolo', Trieste, Italy.

Procedural sedation and analgesia with ketamine are part of daily practice for children undergoing painful procedures in the paediatric emergency department (ED) of North America. A massive number of studies demonstrate ketamine's safety and efficacy in the hands of trained ED paediatricians, with few severe adverse events (SAEs) recorded. Since there are no data on ketamine's usage in Italian paediatric EDs, we created a survey to examine procedural sedation with ketamine in the EDs of the Italian PIPER (Pain in Paediatric Emergency Room) group, which includes 36 paediatric EDs providing 1. Read More

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http://link.springer.com/10.1007/s00431-019-03320-z
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http://dx.doi.org/10.1007/s00431-019-03320-zDOI Listing
January 2019
2 Reads

Deep Learning Based Attenuation Correction of PET/MRI in Pediatric Brain Tumor Patients: Evaluation in a Clinical Setting.

Front Neurosci 2018 7;12:1005. Epub 2019 Jan 7.

Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark.

Positron emission tomography (PET) imaging is a useful tool for assisting in correct differentiation of tumor progression from reactive changes. O-(2-18F-fluoroethyl)-L-tyrosine (FET)-PET in combination with MRI can add valuable information for clinical decision making. Acquiring FET-PET/MRI simultaneously allows for a one-stop-shop that limits the need for a second sedation or anesthesia as with PET and MRI in sequence. Read More

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http://dx.doi.org/10.3389/fnins.2018.01005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6330282PMC
January 2019
2 Reads

The impact of a quality improvement project to standardize pain, agitation, and withdrawal assessments on the use of morphine and midazolam in the Pediatric Intensive Care Unit.

Paediatr Anaesth 2019 Jan 21. Epub 2019 Jan 21.

Division of Pediatric Critical Care, Department of Pediatrics, McGill University, Montreal, Canada.

Objectives: This study aims to assess the impact of a quality improvement initiative to increase assessments of pain, agitation, and iatrogenic withdrawal syndrome, on the use of sedative and analgesic medication in a pediatric intensive care unit.

Design And Setting: This is a retrospective pre- and post, observational, quality improvement study conducted in an eighteen-bed medical-surgical-cardiac, tertiary intensive care unit.

Patients: We included patients consecutively admitted from October 1- March 31 (pre period 2015-2016, post period 2016-2017) who were mechanically ventilated beyond 48 hours. Read More

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http://dx.doi.org/10.1111/pan.13591DOI Listing
January 2019
3 Reads

An improved ultra-high-performance liquid chromatography-tandem mass spectrometric method for the quantitation of dexmedetomidine in small volume of pediatric plasma.

Biomed Chromatogr 2019 Jan 21:e4487. Epub 2019 Jan 21.

Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.

Dexmedetomidine (Dex), a highly selective α -adrenergic agonist, is used primarily for the sedation and anxiolysis of adults and children in the intensive care setting. A sensitive and selective assay for Dex in pediatric plasma was developed by employing ultra-high-performance liquid chromatography-tandem mass spectrometry with d4-Dex as an internal standard. Dex was extracted from 0. Read More

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http://dx.doi.org/10.1002/bmc.4487DOI Listing
January 2019
2 Reads

Efficacy and Safety of Fentanyl in Combination with Midazolam in Children on Mechanical Ventilation.

J Korean Med Sci 2019 Jan 7;34(3):e21. Epub 2019 Jan 7.

Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

Background: To evaluate the efficacy and safety of fentanyl for sedation therapy in mechanically ventilated children.

Methods: This was a double-blind, randomized controlled trial of mechanically ventilated patients between 2 months and 18 years of age. Patients were randomly divided into two groups; the control group with midazolam alone, and the combination group with both fentanyl and midazolam. Read More

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http://dx.doi.org/10.3346/jkms.2019.34.e21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335121PMC
January 2019
1 Read
1.253 Impact Factor

Continuous Deep Sedation and Euthanasia in Pediatrics: Does One Really Exclude the Other for Terminally Ill Patients?

J Med Philos 2019 Jan;44(1):50-70

University of Basel, Basel, Switzerland.

Debates on morally acceptable and lawful end-of-life (EOL) practices in pediatrics were reignited by the recent amendment in Belgian law to allow euthanasia for minors of any age who meet the criteria for capacity. Euthanasia and its legalization in pediatrics are often opposed based on the availability of aggressive palliative sedation. For terminally ill patients, this type of sedation is often identified as continuous and deep sedation until death (CDS). Read More

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https://academic.oup.com/jmp/article/44/1/50/5289341
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http://dx.doi.org/10.1093/jmp/jhy033DOI Listing
January 2019
3 Reads

Determination of blood dexmedetomidine in dried blood spots by LC-MS/MS to screen therapeutic levels in paediatric patients.

PLoS One 2019 14;14(1):e0210391. Epub 2019 Jan 14.

Pharmacology Laboratory, National Institute of Paediatrics, Mexico City, Mexico.

Dexmedetomidine is an imidazole derivative, with high affinity for α2 adrenergic receptors, used for sedation, analgesia and adjuvant anaesthesia. In this study, an analytical method for the quantification of dexmedetomidine in dried blood spots was developed, validated and applied. The drug was extracted from dried blood spot by liquid extraction; the separation was carried out by ultra high-resolution liquid chromatography in reverse phase coupled to tandem mass spectrometry method. Read More

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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210391PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331108PMC
January 2019
1 Read

Self-reported cumulative medical opioid exposure and subjective responses on first use of opioids predict analgesic and subjective responses to placebo-controlled opioid administration.

Reg Anesth Pain Med 2019 Jan;44(1):92-99

Department of Behavioral Science, Rush University, Chicago, Illinois, USA.

Background And Objectives: To expand the evidence base needed to enable personalized pain medicine, we evaluated whether self-reported cumulative exposure to medical opioids and subjective responses on first opioid use predicted responses to placebo-controlled opioid administration.

Methods: In study 1, a survey assessing cumulative medical opioid exposure and subjective responses on first opioid use was created (History of Opioid Medical Exposure (HOME)) and psychometric features documented in a general sample of 307 working adults. In study 2, 49 patients with chronic low back pain completed the HOME and subsequently rated back pain intensity and subjective opioid effects four times after receiving saline placebo or intravenous morphine (four incremental doses) in two separate double-blinded laboratory sessions. Read More

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http://dx.doi.org/10.1136/rapm-2018-000008DOI Listing
January 2019
2 Reads

Evaluations of Morphine and Fentanyl for Mechanically Ventilated Patients With Respiratory Disorders in Intensive Care: A Systematic Review of Methodological Trends and Reporting Quality.

Value Health Reg Issues 2019 Jan 8;19:7-25. Epub 2019 Jan 8.

College of Pharmacy, Qatar University, Doha, Qatar. Electronic address:

Background: Mechanically ventilated patients with respiratory disorders may require sedatives, such as opioids.

Objectives: To define methodological trends, gaps, and the reporting quality of the comparative clinical and economic evaluations of fentanyl and morphine in ventilated patients in the intensive care unit.

Methods: We conducted a literature review of the MEDLINE, Embase, OVID, ScienceDirect, Springer Link, and EconLit databases, comparing studies in the management of ventilated patients with respiratory disorders in the intensive care unit using either fentanyl or morphine, or both. Read More

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http://dx.doi.org/10.1016/j.vhri.2018.11.001DOI Listing
January 2019
1 Read

Combined nitrous oxide 70% with intranasal fentanyl for procedural analgosedation in children: a prospective, randomised, double-blind, placebo-controlled trial.

Emerg Med J 2019 Jan 10. Epub 2019 Jan 10.

Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.

Objective: Nitrous oxide 70% (NO 70%) is an excellent medication for procedural analgosedation (PAS), yet the limit of its analgesic power remains uncertain; therefore, a combination with intranasal fentanyl (INF) was suggested. However, this combination seems to result in a higher rate of vomiting and deeper sedation. This study aimed at assessing the analgesic efficacy, sedation depth and rate of adverse events of PAS with NO 70% with and without INF. Read More

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http://emj.bmj.com/lookup/doi/10.1136/emermed-2018-207892
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http://dx.doi.org/10.1136/emermed-2018-207892DOI Listing
January 2019
9 Reads

Correction to: Methods in the design and implementation of the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) clinical trial.

Trials 2019 01 7;20(1):17. Epub 2019 Jan 7.

Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.

AbstractFollowing publication of the original article [1], the authors notified us of a typing error in spelling Dr. Asario's name. The original publication has been corrected. Read More

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http://dx.doi.org/10.1186/s13063-018-3154-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323764PMC
January 2019
2 Reads

Appendicitis: Role of MRI.

Authors:
Manoj K Mittal

Pediatr Emerg Care 2019 Jan;35(1):63-66

Attending Physician, Pediatric Emergency Medicine, Children's Hospital of Philadelphia; Associate Professor of Clinical Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

The diagnosis of pediatric appendicitis can be difficult, with a substantial proportion misdiagnosed based on clinical features and laboratory tests alone. Accordingly, advanced imaging with ultrasound (US), computed tomography (CT), and/or magnetic resonance imaging has become routine for most children undergoing diagnostic evaluation for appendicitis. There is increasing interest in the use of US as the primary imaging modality and reserving CT as a secondary diagnostic modality in equivocal cases. Read More

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http://dx.doi.org/10.1097/PEC.0000000000001710DOI Listing
January 2019
1 Read

Utilization of Neurally Adjusted Ventilatory Assist (NAVA) Mode in Infants and Children Undergoing Congenital Heart Surgery: A Retrospective Review.

Pediatr Cardiol 2019 Jan 2. Epub 2019 Jan 2.

Advocate Children's Hospital, Advocate Children's Heart Institute, 4440 West 95th Street, Oak Lawn, IL, 60453, USA.

We assessed the feasibility and the impact of NAVA compared to conventional modes of mechanical ventilation in ventilatory and gas exchange parameters in post-operative children with congenital heart disease. Infants and children (age < 18 years) that underwent congenital heart surgery were enrolled. Patients were ventilated with conventional synchronized intermittent mechanical ventilation (SIMV) and subsequently transitioned to NAVA during their cardiovascular intensive care unit (CVICU) stay. Read More

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http://link.springer.com/10.1007/s00246-018-2027-0
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http://dx.doi.org/10.1007/s00246-018-2027-0DOI Listing
January 2019
5 Reads

Multi-modal Educational Curriculum to Improve Richmond Agitation-sedation Scale Inter-rater Reliability in Pediatric Patients.

Pediatr Qual Saf 2018 Sep-Oct;3(5):e096. Epub 2018 Aug 7.

Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, N.C.

Introduction: The Richmond Agitation-sedation Scale (RASS) is a reliable and valid scale for assessing sedation in critically ill pediatric patients. This investigation evaluates the inter-rater reliability of the RASS in mechanically ventilated pediatric patients before and after an educational intervention.

Methods: This prospective, interventional quality improvement study was completed in a 20-bed pediatric intensive care unit from July 2013 to July 2014. Read More

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http://dx.doi.org/10.1097/pq9.0000000000000096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221595PMC

Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use.

Children (Basel) 2018 Dec 5;5(12). Epub 2018 Dec 5.

Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Palo Alto, CA 94304, USA.

As awareness increases about the side effects of opioids and risks of misuse, opioid use and appropriate weaning of opioid therapies have become topics of significant clinical relevance among pediatric populations. Critically ill hospitalized neonates, children, and adolescents routinely receive opioids for analgesia and sedation as part of their hospitalization, for both acute and chronic illnesses. Opioids are frequently administered to manage pain symptoms, reduce anxiety and agitation, and diminish physiological stress responses. Read More

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http://dx.doi.org/10.3390/children5120163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306833PMC
December 2018
1 Read

Intranasal midazolam and fentanyl for procedural sedation and analgesia in infants in the neonatal intensive care unit.

J Neonatal Perinatal Med 2018 Dec 11. Epub 2018 Dec 11.

Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Duke University Medical Center, Durham, NC, USA.

Background: The intranasal route is a minimally invasive method for rapidly delivering midazolam and fentanyl to provide short-term analgesia and sedation in infants. However, intranasal use of midazolam and fentanyl is not labeled for infants and safety data are sparse. The objective of this study is to evaluate the safety of intranasal midazolam and intranasal fentanyl in infants admitted to the Neonatal Intensive Care Unit (NICU). Read More

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http://dx.doi.org/10.3233/NPM-17149DOI Listing
December 2018
1 Read

Methods in the design and implementation of the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) clinical trial.

Trials 2018 12 17;19(1):687. Epub 2018 Dec 17.

Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.

Background: Few papers discuss the pragmatics of conducting large, cluster randomized clinical trials. Here we describe the sequential steps taken to develop methods to implement the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial that tested the effect of a nurse-implemented, goal-directed, comfort algorithm on clinical outcomes in pediatric patients with acute respiratory failure.

Methods: After development in a single institution, the RESTORE intervention was pilot-tested in two pediatric intensive care units (PICUs) to evaluate safety and feasibility. Read More

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http://dx.doi.org/10.1186/s13063-018-3075-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296093PMC
December 2018

The Incidence and Nature of Allergic and Anaphylactic Reactions During Pediatric Procedural Sedation: A Report From the Pediatric Sedation Research Consortium.

Hosp Pediatr 2019 Jan 12;9(1):16-23. Epub 2018 Dec 12.

Department of Pediatrics, Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, Maryland.

Background And Objectives: Anaphylaxis is rare but life-threatening. Its incidence during pediatric procedural sedation outside of the operating room is unknown. We used data from the Pediatric Sedation Research Consortium (PSRC) to determine the incidence and nature of allergic and anaphylactic reactions in this practice. Read More

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http://dx.doi.org/10.1542/hpeds.2018-0089DOI Listing
January 2019
1 Read

Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial.

Contraception 2018 Dec 7. Epub 2018 Dec 7.

Dept. of Obstetrics and Gynecology, Columbia University Irving Medical Center (CUIMC), NY, NY; Heilbrunn Dept. of Population & Family Health, Mailman School of Public Health, CUIMC. Electronic address:

Objectives: To assess pain-management using auricular acupuncture as an adjunct to ibuprofen and paracervical block during first trimester uterine aspiration, and to assess auricular acupuncture's effect on anxiety.

Study Design: This randomized, double-blinded, three-arm trial enrolled women undergoing uterine aspiration for spontaneous or induced abortion. Study participants were randomized 1:1:1 to receive auricular acupuncture, placebo, or usual care alone. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S00107824183051
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http://dx.doi.org/10.1016/j.contraception.2018.11.016DOI Listing
December 2018
14 Reads

Procedural sedation in children with autism spectrum disorders in the emergency department.

Am J Emerg Med 2018 Oct 16. Epub 2018 Oct 16.

Wayne State University School of Medicine, Carman and Ann Adams Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI 48201, United States of America.

Background And Objectives: Children with autism spectrum disorder (ASD) present more frequently to the emergency department (ED) than children with normal development, and frequently have injuries requiring procedural sedation. Our objective was to describe sedation practice and outcomes in children with ASD in the ED.

Methods: We performed a retrospective chart review of children with ASD who underwent sedation at two tertiary care EDs between January 2009-December 2016. Read More

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http://dx.doi.org/10.1016/j.ajem.2018.10.025DOI Listing
October 2018
1 Read

Availability of Common Pediatric Radiology Studies: Are Rural Patients at a Disadvantage?

J Surg Res 2019 Feb 27;234:26-32. Epub 2018 Sep 27.

Division of Urology, Seattle Children's Hospital, Seattle, Washington; University of Washington, Seattle, Washington. Electronic address:

Background: Many families wish to have radiologic tests performed locally, especially when obtaining these tests in specialized pediatric centers would require long-distance travel with associated costs and inconveniences. The differential availability of specialized and common pediatric uroradiographic tests in rural and urban areas has not been described. We undertook this study to describe the availability of common radiographic tests ordered by pediatric urologists, and to identify disparities in the availability of radiographic tests between urban and rural locations. Read More

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http://dx.doi.org/10.1016/j.jss.2018.08.047DOI Listing
February 2019

Analysis of 17 948 pediatric patients undergoing procedural sedation with a combination of intranasal dexmedetomidine and ketamine.

Paediatr Anaesth 2019 Jan 28;29(1):85-91. Epub 2018 Nov 28.

Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.

Background: Intranasal procedural sedation using dexmedetomidine is well described in the literature. The combination of intranasal dexmedetomidine and ketamine is a novel approach for which there are little data on the rate of successful sedation or adverse events.

Objectives: The aim of this study is to evaluate the rate of successful sedation and adverse events of intranasal procedural sedation using a combination of dexmedetomidine and ketamine for diagnostic examination in children. Read More

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http://dx.doi.org/10.1111/pan.13526DOI Listing
January 2019
2 Reads

Protocol-directed sedation versus non-protocol-directed sedation in mechanically ventilated intensive care adults and children.

Cochrane Database Syst Rev 2018 11 12;11:CD009771. Epub 2018 Nov 12.

School of Health Sciences, City, University of London, Myddelton Street, London, UK, EC1V 0HB.

Background: The sedation needs of critically ill patients have been recognized as a core component of critical care that is vital to assist recovery and ensure humane treatment. Evidence suggests that sedation requirements are not always optimally managed. Suboptimal sedation, both under- and over-sedation, have been linked to short-term (e. Read More

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http://doi.wiley.com/10.1002/14651858.CD009771.pub3
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http://dx.doi.org/10.1002/14651858.CD009771.pub3DOI Listing
November 2018
10 Reads

Intravenous magnesium sulphate infusion as first-line therapy in the control of spasms and muscular rigidity in childhood tetanus.

Paediatr Int Child Health 2018 Nov 21:1-7. Epub 2018 Nov 21.

c Department of Paediatrics , Lokmanya Tilak Municipal Medical College and General Hospital , Sion, Mumbai , India.

Background: Reports suggest that, in tetanus, magnesium sulphate (MgSO) alone may control muscle spasms, thereby avoiding sedation and mechanical ventilation.

Aim: To study the efficacy and safety of intravenous MgSO in controlling spasms and rigidity in children with tetanus.

Methods: All children with tetanus consecutively admitted over a 2-year period in a tertiary-care teaching hospital were recruited. Read More

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http://dx.doi.org/10.1080/20469047.2018.1542884DOI Listing
November 2018
8 Reads

Intrathecal administration of nusinersen in adolescent and adult SMA type 2 and 3 patients.

J Neurol 2019 Jan 20;266(1):183-194. Epub 2018 Nov 20.

Department of Orthopedic Surgery, RKU-University and Rehabilitation Clinics, Ulm University, Ulm, Germany.

Spinal muscular atrophy is a genetic motor neuron disease that leads to progressive muscular atrophy and muscle weakness. In December 2016, the Food and Drug Administration, and in June 2017, the European Medicines Agency approved the antisense oligonucleotide nusinersen for treatment of spinal muscular atrophy. Nusinersen has to be repeatedly administered intrathecally. Read More

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http://dx.doi.org/10.1007/s00415-018-9124-0DOI Listing
January 2019
16 Reads

Validation of the SOS-PD scale for assessment of pediatric delirium: a multicenter study.

Crit Care 2018 Nov 20;22(1):309. Epub 2018 Nov 20.

Intensive Care Unit, Departments of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Office Sb-2704, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.

Backgrounds: Reports of increasing incidence rates of delirium in critically ill children are reason for concern. We evaluated the measurement properties of the pediatric delirium component (PD-scale) of the Sophia Observation Withdrawal Symptoms scale Pediatric Delirium scale (SOS-PD scale).

Methods: In a multicenter prospective observational study in four Dutch pediatric ICUs (PICUs), patients aged ≥ 3 months and admitted for ≥ 48 h were assessed with the PD-scale thrice daily. Read More

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http://dx.doi.org/10.1186/s13054-018-2238-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247513PMC
November 2018
16 Reads

Pain assessment in paediatric intensive care: the Italian COMFORT behaviour scale.

Nurs Child Young People 2018 09;30(5):27-33

Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

Background: Assessment of pain in paediatric intensive care units (PICUs) is crucial to minimise the risks of inadequate sedation.

Aim: To translate and validate the Italian version of the COMFORT behaviour scale (CBS) in a PICU in terms of its psychometric, construct, feasibility and reproducibility properties.

Method: Before and after tracheal suctioning, 71 observations were performed on 35 sedated and mechanically ventilated patients in three PICUs. Read More

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https://journals.rcni.com/doi/10.7748/ncyp.2018.e1081
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http://dx.doi.org/10.7748/ncyp.2018.e1081DOI Listing
September 2018
26 Reads

Sedation effects of intranasal dexmedetomidine combined with ketamine and risk factors for sedation failure in young children during transthoracic echocardiography.

Paediatr Anaesth 2019 Jan 19;29(1):77-84. Epub 2018 Nov 19.

Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, China.

Background: Sedation is often required for young children during transthoracic echocardiography. Dexmedetomidine and ketamine are two sedatives that are commonly used in children for procedural sedation, but they have some disadvantages when they are used alone.

Aims: The aim of this retrospective study was to analyze the effects and safety of intranasal sedation with a combination of dexmedetomidine and ketamine during transthoracic echocardiography in young children and to analyze risk factors for sedation failure. Read More

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http://doi.wiley.com/10.1111/pan.13529
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http://dx.doi.org/10.1111/pan.13529DOI Listing
January 2019
14 Reads

Evaluating the Need for Pediatric Procedural Sedation Training in Pediatric Critical Care Medicine Fellowship.

Pediatr Crit Care Med 2018 Nov 13. Epub 2018 Nov 13.

Pediatric Critical Care Medicine, Yale School of Medicine, New Haven, CT.

Objectives: Pediatric procedural sedation has been increasingly performed by pediatric intensivists over the past decade. Pediatric Critical Care Medicine fellowship guidelines do not specify how fellows obtain proficiency in pediatric procedural sedation. We sought to survey the state of pediatric procedural sedation training during fellowship and whether fellows thought it was sufficient. Read More

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http://dx.doi.org/10.1097/PCC.0000000000001809DOI Listing
November 2018
1 Read

Lithium treatment in bipolar adolescents: a follow-up naturalistic study.

Neuropsychiatr Dis Treat 2018 17;14:2749-2753. Epub 2018 Oct 17.

Clinic of Child and Adolescent Neuropsychiatry, Department of Medicine and Surgery, University of Salerno, Salerno, Italy.

Background: Although lithium is currently approved for the treatment of bipolar disorders in youth, long term data, are still scant. The aim of this study was to describe the safety and efficacy of lithium in referred bipolar adolescents, who were followed up at the 4th (T1) and 8th (T2) month of treatment.

Methods: The design was naturalistic and retrospective, based on a clinical database, including 30 patients (18 males, mean age 14. Read More

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https://www.dovepress.com/lithium-treatment-in-bipolar-adole
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http://dx.doi.org/10.2147/NDT.S172654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200433PMC
October 2018
14 Reads

Prolonged central apnoea after intravenous morphine administration in a 12-year-old male with a UGT1A1 loss-of-function polymorphism.

Br J Clin Pharmacol 2019 Jan 12;85(1):258-262. Epub 2018 Nov 12.

Division of Emergency Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA.

Adverse Event: Repeated and prolonged episodes of central apnoea and hypoxia after receiving intravenous morphine for analgesia and ketamine for sedation.

Drug Implicated: Intravenous morphine sulfate.

The Patient: Previously healthy 12-year-old male with no history of sleep apnoea who presented with distal tibia and fibula fracture. Read More

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http://doi.wiley.com/10.1111/bcp.13779
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http://dx.doi.org/10.1111/bcp.13779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6303239PMC
January 2019
8 Reads

Repeat Intravenous Ketamine Dosing in Children Undergoing Emergency Department Procedural Sedation.

J Emerg Med 2019 Jan 8;56(1):1-6. Epub 2018 Nov 8.

Division of Pediatric Emergency Medicine, Saint Louis University School of Medicine, Saint Louis, Missouri.

Background: Patients undergoing procedural sedation with intravenous ketamine often receive repeat doses to maintain dissociation; however, data between doses are lacking.

Objectives: The purpose of this study was to characterize the frequency, time interval, and dosages of ketamine received by children undergoing procedural sedation and to explore the effects of age and body mass index on these parameters.

Methods: This was a retrospective study of patients 1 to 18 years of age undergoing procedural sedation with intravenous ketamine in a pediatric emergency department between October 2016 and June 2017. Read More

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https://linkinghub.elsevier.com/retrieve/pii/S07364679183096
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http://dx.doi.org/10.1016/j.jemermed.2018.09.047DOI Listing
January 2019
12 Reads

Efficacy of cannabinoids in paediatric epilepsy.

Dev Med Child Neurol 2019 01 6;61(1):13-18. Epub 2018 Nov 6.

Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.

There are hundreds of compounds found in the marijuana plant, each contributing differently to the antiepileptic and psychiatric effects. Cannabidiol (CBD) has the most evidence of antiepileptic efficacy and does not have the psychoactive effects of ∆ -tetrahydrocannabinol. CBD does not act via cannabinoid receptors and its antiepileptic mechanism of action is unknown. Read More

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https://onlinelibrary.wiley.com/doi/abs/10.1111/dmcn.14087
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http://dx.doi.org/10.1111/dmcn.14087DOI Listing
January 2019
13 Reads

Cardiotoxicity Associated with Midazolam in a Patient with Diphtheria.

Curr Drug Saf 2019 ;14(1):57-59

Pediatrics Department, Government Medical College, Sir T. General Hospital, Bhavnagar, Gujarat, India.

Background: Adverse cardiorespiratory events are associated with midazolam continuous IV infusion, used for sedation.

History: Here we are reporting a case of 5 year old male child suffering from diphtheria induced airway obstruction, and myocarditis, who received midazolam in the form of IV infusion for sedation while undergoing mechanical ventilation for respiratory failure. Adverse Event: Six hours after starting midazolam infusion he started developing pulsus bigeminus and bradycardia and eventual death after two hours. Read More

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http://dx.doi.org/10.2174/1574886313666181105122154DOI Listing
January 2019
4 Reads

Prolonged sedation in critically ill children: is dexmedetomidine a safe option for younger age? An off-label experience.

Minerva Anestesiol 2019 Feb 30;85(2):164-172. Epub 2018 Oct 30.

Unit of Pediatric Intensive Care, Department of Woman's and Child's Health, University Hospital of Padua, Padua, Italy.

Background: Dexmedetomidine (DEX) is an alpha-2-adrenergic agonist, recently approved by Italian-Medicines-Agency for difficult sedation in pediatrics, but few data exist regarding prolonged infusions in critically-ill children, especially in younger ages. Aim of our study was to evaluate DEX use and safety for prolonged sedation in Pediatric Intensive Care Units (PICUs).

Methods: Patients receiving DEX for ≥24 hours were retrospectively evaluated to analyze DEX indications, dosages, use of analgesics or sedatives, adverse events (AEs), withdrawal syndrome or delirium. Read More

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https://www.minervamedica.it/index2.php?show=R02Y9999N00A181
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http://dx.doi.org/10.23736/S0375-9393.18.13062-8DOI Listing
February 2019
9 Reads

Pediatric Emergency Care Research Networks: A Research Agenda.

Acad Emerg Med 2018 Dec 5;25(12):1336-1344. Epub 2018 Dec 5.

Departments of Emergency Medicine and Pediatrics, University of California at Davis, School of Medicine, and UC Davis Health, Sacramento, CA.

Background: Pediatric emergency care research networks have evolved substantially over the past two decades. Some networks are specialized in specific areas (e.g. Read More

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http://doi.wiley.com/10.1111/acem.13656
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http://dx.doi.org/10.1111/acem.13656DOI Listing
December 2018
19 Reads

A Prospective Study of the Safety and Effectiveness of Droperidol in Children for Prehospital Acute Behavioural Disturbance.

Prehosp Emerg Care 2018 Oct 31:1-26. Epub 2018 Oct 31.

Study Objective: Although uncommon, children (<16 years) with acute behavioural disturbance are a significant issue for emergency medical service providers. In this study we aimed to investigate the safety and effectiveness of droperidol in children with prehospital acute behavioural disturbance.

Methods: This was a prospective observational study over 1 year investigating the use of droperidol (0. Read More

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https://www.tandfonline.com/doi/full/10.1080/10903127.2018.1
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http://dx.doi.org/10.1080/10903127.2018.1542473DOI Listing
October 2018
31 Reads

The power of N-PASS, aEEG, and BIS in detecting different levels of sedation in neonates: A preliminary study.

Paediatr Anaesth 2018 Dec 29;28(12):1096-1104. Epub 2018 Oct 29.

Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Vienna, Austria.

Background: Sedatives are essential drugs in every intensive care unit in order to ensure the patient's optimal level of comfort. Avoiding conditions of over- and under-sedation is a challenge in a neonatal intensive care setting. Drug administration could be optimized by the concomitant use of objective methods to assess the level of sedation. Read More

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http://dx.doi.org/10.1111/pan.13509DOI Listing
December 2018
1 Read

"Full Stomach" Despite the Wait: Point-of-care Gastric Ultrasound at the Time of Procedural Sedation in the Pediatric Emergency Department.

Acad Emerg Med 2018 Oct 29. Epub 2018 Oct 29.

Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI.

Objectives: The objective was to use gastric point-of-care ultrasound (POCUS) to assess gastric contents and volume, summarize the prevalence of "full stomach," and explore the relationship between fasting time and gastric contents at the time of procedural sedation.

Methods: This was a prospective study of patients aged 2 to 17 years fasting prior to procedural sedation. A single sonographer scanned each patient's gastric antrum in two positions: supine with the upper body elevated and right lateral decubitus (RLD). Read More

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http://doi.wiley.com/10.1111/acem.13651
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http://dx.doi.org/10.1111/acem.13651DOI Listing
October 2018
7 Reads