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Biomedical subjects

T R Vetter

Publications and source records attributed to T R Vetter.

10 recordsLinked to original sources
PubMed1996

Discordance between patient self-reported visual analog scale pain scores and observed pain-related behavior in older children after surgery.

STUDY OBJECTIVE: To assess the correlation in an older pediatric population between patient self-reported visual analog scale (VAS) pain scores and observational pain-related behavior scores. DESIGN: Prospective, comparative study. SETTING: Inpatient surgical units of a free-standing children's hospital. PATIENTS: 30 ASA physical status I and II outpatients, 8 to 16 years of age, undergoing a variety of orthopedic, plastic, urologic, and general surgical procedures. INTERVENTIONS: Each patient underwent a single assessment of pain intensity on the first postoperative day. MEASUREMENTS AND MAIN RESULTS: Three health care providers (a clinical nurse specialist, a registered nurse with extensive pediatric experience, and a child life specialist) simultaneously generated an independent pain-related behavioral score (range of 0 = no pain to 100 = worst pain possible) based on their subjective perceptions of the patient's observed facial expression, activity level, and breathing pattern. The patient was then asked to provide a self-reported VAS pain score (range of 0 = "no pain" with a smiling face, to 100 = "worst pain ever" with a frowning face). A single set of such concurrent pain scores was obtained once from each study patient. The pain-related behavior scores displayed a satisfactory interrater reliability, with an observed interclass correlation coefficient (Cohen's kappa value) of 0.83. When compared with a patient's self-reported VAS score, the three pain related behavioral scores generated by each health care provider for a given patient exhibited both variable and minimal correlation. CONCLUSIONS: A tenuous relationship may exist between on older child's own perception of pain intensity and his or her behavioral expression of that pain as interpreted by a health care provider.

Activities of Daily Living↗
PubMed1995

A comparison of EMLA cream versus nitrous oxide for pediatric venous cannulation.

STUDY OBJECTIVE: To compare the analgesic and anxiolytic effects of nitrous oxide (N2O) when inhaled by face mask with those of a cutaneous application of a eutectic mixture of local anesthetics (EMLA) cream with lidocaine and prilocaine during pre-operative venous cannulation in children. DESIGN: Prospective, randomized study. SETTING: Outpatient presurgical area and operating rooms of a freestanding children's hospital. PATIENTS: 50 unpremedicated ASA status I and II outpatients, aged 6 to 12 years, undergoing an elective surgical procedure. INTERVENTIONS: Each patient received either 70% N2O in 30% oxygen (O2) administered by face mask for 120 seconds or an application of 2.5 g of EMLA cream under an occlusive dressing for a minimum of 60 minutes. All patients then underwent a single attempt at venous cannulation in the dorsum of the hand with a 22-gauge intravenous catheter. MEASUREMENTS AND MAIN RESULTS: A visual analog scale (VAS) pain score (0 to 100) was generated by the investigator and subsequently obtained from each patient immediately after the venous cannulation was completed. The pain scores generated by the investigator were significantly lower in the N2O group than the EMLA cream group (p = 0.001). When compared with the patients in the EMLA cream group, the patients in the N2O group also self-reported significantly lower VAS pain scores (p = 0.006). CONCLUSIONS: N2O administered by face mask appears to provide greater anxiolysis and attendant superior analgesia for pediatric venous cannulation than a cutaneous application of EMLA cream.

Administration, Topical↗
PubMed1993

The epidemiology and selective identification of children at risk for preoperative anxiety reactions.

This observational outpatient study was undertaken prospectively to assess the effect of age and gender on the frequency of children's difficulty with preoperative parental separation and to examine five simple clinical factors as predictors of problematic preoperative behavior. Although gender had no significant effect, 2- to 6-yr-old children were more likely than children 7 to 8 yr old to exhibit problematic behavior on parental separation (P < 0.05). In 2- to 6-yr-old children, three factors were significant predictors of problematic behavior: not taking a preoperative family tour (P < 0.05), having undergone previous surgery (P < 0.05), and preoperatively displaying a dependent or withdrawn affect (P < 0.05). Instead of implementing the routine use of a sedative, optimal management seems to involve sedating only 2- to 6-yr-old children who display one or more of these significant predictive risk factors.

Age Factors↗
PubMed1992

Pediatric patient-controlled analgesia with morphine versus meperidine.

To assess prospectively any difference in either analgesia or side effect frequency with morphine versus meperidine, 50 patients, ages 8-16 years, were randomly assigned to receive postoperative patient-controlled analgesia (PCA) with either morphine or meperidine. A numerical rating scale pain score was obtained from each patient twice a day, and any nausea, vomiting, pruritus, or urinary retention requiring catheterization was noted. No significant difference in the incidence of side effects was noted between the morphine and meperidine groups; however, pain scores during morphine PCA were significantly less than those during meperidine PCA (P less than 0.001). These results suggest that morphine is the better opioid for pediatric PCA.

Adolescent↗
PubMedDate not supplied

Anesthesia for pediatric laparoscopic cholecystectomy.

We report the general anesthetic events and clinical concerns encountered with a laparoscopic cholecystectomy in a 19-month-old toddler. Carbon dioxide was insufflated to create a pneumoperitoneum, with resulting intra-abdominal pressures ranging from 5 to 11 mmHg. The end-tidal partial pressure of carbon dioxide (PETCO2) rose as high as 48 mmHg (a 10 mmHg increase from baseline), requiring a 68% increase in minute ventilation to achieve preinsufflation values. Careful monitoring of ventilation, PETCO2, and intra-abdominal pressure are recommended for optimal anesthetic management of the pediatric laparoscopic cholecystectomy patient.

Anesthesia, Inhalation↗
PubMedDate not supplied

A comparison of midazolam, diazepam, and placebo as oral anesthetic premedicants in younger children.

STUDY OBJECTIVES: To validate the superiority of higher-dose oral midazolam as an anesthetic premedicant in children 6 years of age and younger, to determine whether less expensive diazepam is a viable alternative oral premedicant in this age-group, and to assess the preoperative oxygenation effects of both benzodiazepines. DESIGN: A prospective, randomized, double-blind study. SETTING: Outpatient surgery department and operating room (OR) of a freestanding children's hospital. PATIENTS: Seventy-five ASA physical status I and II outpatients 1 to 6 years of age. INTERVENTIONS: Patients were randomized to receive either midazolam 0.6 mg/kg, diazepam 0.3 mg/kg, or a placebo orally in a timely manner prior to surgery. MEASUREMENTS AND MAIN RESULTS: Each child's subsequent reaction to separation from his or her parents in the presurgical holding area was scored on a three-point behavioral scale. Once in the OR, an initial room air oxygen saturation by pulse oximeter (SpO2) was obtained. Each child's initial acceptance of the anesthetic induction mask was then scored on a four-point scale. No significant differences in parental separation scores, initial room air SpO2, or postanesthesia care unit admission time were observed among the three study groups. However, both midazolam and diazepam were observed to be superior to the placebo in facilitating the initial acceptance of the anesthetic induction mask. CONCLUSIONS: Even without premedication, a majority of children did not react negatively to an impending anesthetic. Therefore, neither midazolam nor diazepam appears to be necessary in most children younger than 6 years of age. Rather than implementing the routine use of an oral preoperative sedative, the challenge appears to be the selective identification of those children at risk for preanesthetic difficulties and psychological trauma.

Administration, Oral↗
PubMedDate not supplied

Intravenous ketorolac as an adjuvant to pediatric patient-controlled analgesia with morphine.

STUDY OBJECTIVE: To assess the effects of a single intraoperative dose of intravenous (i.v.) ketorolac on postoperative opioid dose requirements, quality of analgesia as assessed by the patient, and frequency of opioid-related side effects during pediatric patient-controlled analgesia (PCA) with morphine. DESIGN: Prospective, randomized, double-blind study. SETTING: Operating rooms, postanesthesia care unit (PACU), and inpatient care units of a freestanding children's hospital. PATIENTS: 50 ASA physical status I-II orthopedic surgical patients ages 8 to 16 years. INTERVENTIONS: Either 0.8 mg/kg of i.v. ketorolac or no additional analgesic was administered at the time of wound closure. After surgery, all patients were placed on PCA with morphine. MEASUREMENTS AND MAIN RESULTS: Individual morphine use during the first 12 hours of PCA therapy was recorded. A visual analog scale (VAS) pain score was obtained from the patient at the time of discharge from the PACU and at 4, 8, and 12 hours postoperatively. Any vomiting, pruritus, or urinary retention occurring during the first 12 postoperative hours was noted. The morphine plus ketorolac group administered significantly less PCA with morphine during the first 12 postoperative hours than did the morphine only group (p = 0.002). The morphine plus ketorolac group also reported significantly lower overall VAS pain scores (p < 0.01). Although similar frequencies of vomiting and pruritus were observed, the morphine plus ketorolac group experienced significantly less urinary retention than did the morphine group (p = 0.02). CONCLUSION: A single intraoperative dose of i.v. ketorolac appears to be opioid dose sharing, to provide superior analgesia, and to decrease the frequency of urinary retention during the first 12 hours of postoperative pediatric PCA with morphine.

Adolescent↗