scholarly journals Why do We Use the Concepts of Adult Anesthesia Pharmacology in Developing Brains? Will It Have an Impact on Outcomes? Challenges in Neuromonitoring and Pharmacology in Pediatric Anesthesia

2021 ◽  
Vol 10 (10) ◽  
pp. 2175
Author(s):  
Pablo O. Sepúlveda ◽  
Valeria Epulef ◽  
Gustavo Campos
Keyword(s):  
Clinical Pharmacology ◽  
Clinical Practice ◽  
Brain Development ◽  
Pediatric Population ◽  
Pediatric Anesthesia ◽  
Intraoperative Neuromonitoring ◽  
Development Times ◽  
Pediatric Sedation

Background: Pediatric sedation and anesthesia techniques have plenty of difficulties and challenges. Data on the pharmacologic, electroencephalographic, and neurologic response to anesthesia at different brain development times are only partially known. New data in neuroscience, pharmacology, and intraoperative neuromonitoring will impact changing concepts and clinical practice. In this article, we develop a conversation to guide the debate and search for a view more attuned to the updated knowledge in neurodevelopment, electroencephalography, and clinical pharmacology for the anesthesiologic practice in the pediatric population.

The metabolic syndrome in pediatrics: Do we have a reliable definition? A systemic review.

2021 ◽  
Author(s):  
Angelo Tropeano ◽  
Domenico Corica ◽  
Alessandra Li Pomi ◽  
Giorgia Pepe ◽  
Letteria Anna Morabito ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Clinical Practice ◽  
Pediatric Population ◽  
High Sensitivity ◽  
Systemic Review ◽  
Cochrane Library ◽  
Sample Population ◽  
Cross Sectional ◽  
The Metabolic Syndrome ◽  
Increased Risk

Objective: Metabolic syndrome is a cluster of cardio-metabolic risk factors associated with an increased risk of cardiovascular disease and type 2 diabetes. In the last two decades, several definitions of metabolic syndrome have been proposed for the pediatric population; all of them agree on the defining components but differ in the suggested criteria for diagnosis. This review aims to analyze the current diagnostic criteria of metabolic syndrome in pediatrics with a reference to their feasibility and reliability in clinical practice. Methods: The systemic research was conducted from January 2003 to June 2020 through MEDLINE via PubMed, Cochrane Library and EMBASE databases. Results: After the selection phase, a total of 15 studies (182 screened) met the inclusion and exclusion criteria and hence they were reported in the present review. Twelve studies were cross-sectional, 2 were longitudinal and 1 was a consensus report. The sample population consisted of multiethnic group or single ethnic group including Turkish, European, Asian and Hispanic subjects. Conclusions: To date, there is not a univocal, internationally accepted pediatric definition of metabolic syndrome, which guarantees a high sensitivity and stability of the diagnosis. The definition proposed by IDF results the most straightforward and easy to use in clinical practice, having the unquestionable advantage of requiring measurements quickly accessible in clinical practice, without the adoption of multiple reference tables. Further research is needed to validate a new version of such definition which includes the diagnostic cut-off points recently suggested by published guidelines.

Clinical pharmacology of pyrroxane (proroxane)

2020 ◽  
Vol 18 (4) ◽  
pp. 335-350
Author(s):  
Petr D. Shabanov
Keyword(s):  
Clinical Pharmacology ◽  
Clinical Practice ◽  
Ergot Alkaloids ◽  
Drug Action ◽  
Drug Consumption ◽  
Clinical Use ◽  
Review Of Literature ◽  
Ministry Of Health ◽  
Adrenergic Blocker ◽  
Adrenergic Blockers

Review of literature and own studies on the pharmacology and clinical pharmacology of the domestic -adrenergic blocker pyrroxan (INN: proroxane). The drug was developed in the 1970s at the Institute of Toxicology of the USSR Ministry of Health (Leningrad). Expectations from -blockers created during this period (phenoxybenzamine, phentolamine, tropafen, fepracet, dihydrogenated ergot alkaloids) were high, especially in terms of the treatment of hypertensive and ischemic conditions, however, only few drugs from this group were used in clinical practice for these purposes (prazosin, doxazosin and some others). For pyrroxan, this direction was not the main one, and it was positioned as a means of treating diencephalic disorders like vegetative crises, where the drug immediately gained popularity, and this direction of use was clearly fixed to it. In the same period, the anti-alcohol and anti-drug action of -adrenergic blockers was found, since both in the experiment and in the clinic they demonstrated the suppression of alcohol (drug) motivation and a decrease in alcohol and drug consumption. Thelatter served as an impetus to the use of pyrroxane mainly in psychiatry, narcology and, to a lesser extent, in neurology, and recently the drug has been positioned almost exclusively for use in these areas of medicine. Thearticle analyzes the current clinical use of pyrroxane.

scholarly journals Serum Creatinine Reference Limits in Pediatric Population—A Single Center Electronic Health Record-Based Database in Taiwan

2021 ◽  
Vol 9 ◽  
Author(s):  
Gwo-Tsann Chuang ◽  
I-Jung Tsai ◽  
Yong-Kwei Tsau
Keyword(s):  
Clinical Practice ◽  
Serum Creatinine ◽  
Creatinine Level ◽  
Pediatric Population ◽  
Function Evaluation ◽  
Medical Database ◽  
Specific Group ◽  
Baseline Serum ◽  
Reference Limits ◽  
Age And Sex

Objective: To assess age- and sex-specific serum creatinine levels in a pediatric population using a hospital-based database in Taiwan.Study Design: Data on serum creatinine levels were obtained from the National Taiwan University Hospital-integrated Medical Database (NTUH-iMD). Due to the possibility of having acute kidney injury or chronic kidney disease, individuals with multiple serum creatinine measurements were excluded, and outliers in each age- and sex-specific group were also subsequently removed. The remaining creatinine measurements in each group were analyzed, and 95% reference limits were established.Results: Serum creatinine data of individuals aged between 1 month and 18 years from May 2011 to January 2018 were retrieved. After applying the exclusion criteria, 27,911 individuals with a single corresponding serum creatinine measurement were enrolled. Creatinine level reference limits for each age- and sex-specific group were generated. The upper reference limits (URLs), which are particularly useful in clinical practice, followed the natural trend of increasing serum creatinine with age.Conclusion: We generated serum creatinine reference limits from a single hospital-integrated medical database in Taiwan for different age- and sex-specific groups of children. Our results will aid physicians in clinical practice regarding renal function evaluation, especially for patients without a recent baseline serum creatinine level.

scholarly journals Children undergoing anaesthesia: what are the rights of the child?

2021 ◽  
Keyword(s):  
Clinical Practice ◽  
United Nations ◽  
European Association ◽  
Pediatric Anesthesia ◽  
Clinical Use ◽  
Rights Of The Child ◽  
Safe Anesthesia ◽  
United Nations Convention ◽  
The United Nations

The United Nations Convention on the Rights of the Child (UNCRC) outlines the rights of the child and is the grounds on how we care for children in healthcare institutions. Anesthesiologists are obliged to respect the child’s rights when undertaking pediatric anesthesia. The Safe Anesthesia for every tot initiative (SAFETOTS) has translated the UNCRC and the EACH (European Association for Children in Hospitals) charter into 10 articles, which are operational for clinical use. This review aims to discuss each of these articles and how they are applied in clinical practice.

Improving pediatric experience of pain during vaccinations: a quality improvement project

2019 ◽  
Vol 32 (6) ◽  
pp. 1034-1040
Author(s):  
Terri MacDougall ◽  
Shawna Cunningham ◽  
Leeann Whitney ◽  
Monakshi Sawhney
Keyword(s):  
Quality Improvement ◽  
Clinical Practice ◽  
Pain Management ◽  
Practice Guidelines ◽  
Pediatric Population ◽  
Lessons Learned ◽  
Pediatric Pain ◽  
Topical Anesthetic ◽  
Content Type ◽  
Pain Scores

Purpose The purpose of this paper is to share lessons learned from a quality improvement (QI) project that studied pediatric pain assessment scores after implementing additional evidence-based pain mitigation strategies into practice. Most nurses will acknowledge they implement some practices to mitigate pain during injections. Addressing pain during vaccination is important to prevent needle fear, vaccine hesitancy and health care avoidance. The aim of this project was to reduce pain as evidenced by pain scores at the time of vaccination at the North Bay Nurse Practitioner-Led Clinic (NBNPLC). Design/methodology/approach The design for this study was quasi-experimental utilizing descriptive statistics and QI tools. The NBNPLC utilized the model for improvement to test change ideas. A validated observation tool to assess pain during vaccination with the pediatric population (revised Face Legs Activity Cry and Consolability) was used to test changes. The team deliberately planned improvements according to best practice guidelines to optimize use of strategies to mitigate pain during injections. QI tools and leadership skills were utilized to improve the pediatric experience of pain during vaccinations. Parents and clinicians provided qualitative and quantitative feedback to the project. Findings Nurses tested pain assessment tools and agreed to use a validated tool to assess pain during vaccinations. Parents agreed to use of topical anesthetic during vaccinations. Improved pain scores during vaccinations were demonstrated with the use of topical anesthetic. Parents agreed to use of standardized sucrose solution during vaccination. Reduced pain scores were observed with the use of standardized sucrose water. To sustain implementation of the guideline, a nursing documentation form was devised with nurses agreeing to ongoing use of the form. Research limitations/implications This is a QI project that examined the intricacies of moving clinical practice guidelines into clinical practice. The project validates guidelines for pain management during vaccinations. Leaders within clinics who want to improve pediatric pain during vaccinations will find this paper helpful as a guide. Practical implications Pain management in the pediatric population will be touched on in the context of parental expectations of pain. QI tools, lessons learned and suggestions for nurses will be outlined. Leadership plays an influential role in translating practice guidelines into practice. Originality/value This paper outlines how organizational supports were instrumental to give clinicians time to deliberately challenge practice to improve quality of care of children during vaccinations.

scholarly journals Pediatric Anesthesia Specialty Societies and Multi-Institutional Collaborations

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 233 ◽  
Author(s):  
Camila Walters ◽  
James Kynes ◽  
Srijaya Reddy ◽  
Christy Crockett ◽  
Hannah Lovejoy ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Interest Groups ◽  
Continuous Improvement ◽  
Pediatric Population ◽  
Pediatric Anesthesia ◽  
Education Quality ◽  
International Level ◽  
Research Education ◽  
Special Committees ◽  
Collaborative Efforts

Pediatric anesthesiology is a subspecialty of anesthesiology that deals with the high-risk pediatric population. The specialty has made significant advancement in large collaborative efforts to study and increase patient safety, including the creation of international societies, a dedicated journal, special committees and interest groups, and multi-institution databases for research and quality improvement. Readily available resources were created to help with the education of future pediatric anesthesiologists as well as continuing medical education. Conclusions: Specialty societies and collaborations in pediatric anesthesia are crucial for continuous improvement in the care of children. They promote research, education, quality improvement, and advocacy at the local, national, and international level.

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