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Post-Op Pain in Pediatric Urology

Post-Op Pain in Pediatric Urology

Management of pain is a critical aspect of postoperative care in pediatric urology. Currently, clinicians who aim to control postoperative pain in children use a combination of both opioids and anti-inflammatory drugs. Regional anesthesia with a caudal block is another effective pain management technique that is used in pediatric urology, but these blocks only last 6 to 8 hours unless an indwelling caudal catheter is used. Having an indwelling caudal catheter in place often limits patients’ mobility and requires a hospital admission after surgery. An Evolution in Care Continuous infusion of site-specific analgesia is a more evolved way to provide prolonged pain management. Continuous infusion has been found to result in fewer side effects and better postoperative recovery. This treatment approach has been shown to lead to earlier mobilization and earlier discharge than standard therapy. One FDA-approved device that currently is used to provide continuous infusion of analgesia is the ON-Q® pump (I-Flow/Kimberly-Clark). The device is an elastomeric pump that delivers 0.25% bupivacaine at the incision site via a flexible silver-coated catheter. The catheter, which is tunneled subcutaneously at the completion of a patient’s surgery, is attached to the elastomeric pump, which has a flow-limiting valve. The local anesthetic is delivered at a constant flow rate (0.4mg/kg) for the entire duration of use. The pump functions automatically and doesn’t require any manipulation by patients or their families. The pump is carried in a small pouch, which allows patients to maintain mobility and be discharged home. Supporting Data In a recent prospective randomized controlled trial conducted at Children’s Hospital of Orange County, my colleagues and I confirmed the efficacy of...

Wisconsin Bill: Cameras in the OR

A legislator in Wisconsin is proposing a bill that would require facilities to record both video and audio of any operation requiring general anesthesia if requested by a patient. The focus is apparently on the actions of personnel in the OR and not the procedure itself. The bill was drafted in response to a campaign by the family of a woman who died after a cardiac arrest in an operating room in 2003. It’s a tragic case, and the family has every right to be upset and want to do something to prevent a similar incident happening to someone else. However, this law is not the answer. Here is why. The woman, who was 38 years old when she died, underwent breast augmentation surgery by an oral and maxillofacial surgeon who was both a dentist and an M.D. He was not board-certified in plastic surgery or anything else. He billed himself as a Fellow of the American Academy of Cosmetic Surgeons–an entity not recognized by the American Board of Medical Specialties. The operation took place in the doctor’s office in Sarasota, Florida. According to a recent article on the Outpatient Surgery magazine website, the patient had been given a massive overdose of propofol—a short-acting intravenous anesthetic, the physician’s office manager [not a medical professional] was monitoring her pulse, and after she suffered a cardiac arrest, the doctor waited several minutes to begin chest compressions. The Florida Board of Medicine revoked the doctor’s license, but he is now practicing in Pennsylvania. Most of those facts were omitted from the Milwaukee Journal Sentinel story about the new law. Questions about the...
Perioperative AF: Assessing Long-Term Stroke Risks

Perioperative AF: Assessing Long-Term Stroke Risks

Studies have shown that atrial fibrillation (AF) and flutter affect more than 33 million people throughout the world, and the presence of chronic AF has been associated with a three-fold greater risk of stroke. When stroke occurs in patients with AF, these individuals are at greater risk of longer hospital stays, worse disability, and higher mortality. New-onset perioperative AF is one of the most common perioperative arrhythmias, but its incidence ranges widely because studies have included different populations in terms of the type of surgery performed and patient characteristics. “Although it’s well known that AF raises the risk of stroke in general, there is increasing interest to fully understand the clinical burden of perioperative AF,” says Hooman Kamel, MD. “It’s possible that even brief perioperative episodes of AF can increase the risk of stroke.” Studies have shown a strong association between perioperative AF and length of stay, hospital costs, and mortality. Furthermore, the condition has been repeatedly associated with a higher short-term risk of perioperative stroke in the setting of cardiac surgery. However, data are scarce with regard to long-term stroke risks from perioperative AF in patients undergoing other types of surgery. Some research has suggested that perioperative AF may result as a transient response to the physiological stress of surgery itself. Overall, the long-term risks of stroke after patients experience perioperative AF are unclear. Taking a Closer Look Dr. Kamel and colleagues conducted a study to determine the long-term risk of ischemic stroke after perioperative AF of patients undergoing a variety of surgeries. Published in JAMA, the analysis used a population-based sample of more than 1.7 million patients...
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