The use of conscious sedation for pain control during forearm fracture reduction in children: does race matter?
Child; Female; Humans; Male; Pain Measurement; Cohort Studies; Logistic Models; Follow-Up Studies; Risk Assessment; Multivariate Analysis; Probability; Chi-Square Distribution; Emergency Service; adolescent; Preschool; Non-U.S. Gov't; Research Support; PedPal Lit; Comparative Study; retrospective studies; Analgesia/methods; Hospital; Fractures; Attitude to Health/ethnology; African Americans/statistics & numerical data; Bone/ethnology/radiography/surgery; Conscious Sedation/methods; European Continental Ancestry Group/statistics & numerical data; Forearm Injuries/ethnology/radiography/surgery; Fracture Fixation/methods; Injury Severity Score
Recent reports in the medical literature indicate that certain racial disparities have been identified in healthcare. The authors sought to identify the potential relationship between the use of pain medications in African-American and Caucasian children undergoing forearm fracture reduction. This retrospective cohort study was performed at a university-affiliated tertiary care children's hospital emergency department. All Caucasian and African-American patients who underwent a closed reduction of a fractured ulna or radius over the 2-year observational period were enrolled. Patients were excluded from the study if they were admitted to the hospital for an open reduction or had multiple injuries. The relationship between race, gender, insurance status, time of admission, length of stay in the emergency department, fracture characteristics, and the use of conscious sedation was analyzed. t tests, chi-square tests, and stepwise logistic regression were used for data analysis. A total of 503 patients were included, 83% Caucasian and 17% African-American. Four hundred four patients received conscious sedation as part of their fracture reduction procedure and 99 did not. Univariate analysis showed that African-American and Caucasian children had different forearm fracture patterns (P = 0.0116) and different severities of angulation (P = 0.0094). Multivariate statistical analysis revealed that higher amounts of fracture translation (P < 0.0001) and angulation (P < 0.0027) and younger age of the patient (P = 0.0059) were significant predictors of conscious sedation use. Race was not found to be significantly associated with the use of conscious sedation (P = 0.0606 in univariate analysis, P = 0.1678 in multivariate analysis). The authors found that the decision to use conscious sedation for pediatric forearm fractures was not influenced by race, but was influenced by certain fracture characteristics and patient age.
2006
VanderBeek BL; Mehlman CT; Foad SL; Wall EJ; Crawford AH
Journal of Pediatric Orthopaedics
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Sedation for procedures in children: a guide for the non-anaesthetist
Child; Humans; PedPal Lit; Body Weight; Analgesia/methods; Conscious Sedation/methods; Anesthesia/methods; Pain/prevention & control
2006
British Journal of Hospital Medicine
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
Use of methadone in the morphine-tolerant burned paediatric patient
Child; Female; Humans; Analgesics; Respiration; Methadone; Morphine; infant; Drug Tolerance; Opioid; Artificial; Burns/therapy; Conscious Sedation/methods; Intensive Care/methods
We describe the successful use of methadone in the restoration of sedation and provision of analgesia in two morphine-tolerant, paediatric patients who had suffered significant thermal injuries and were undergoing mechanical ventilation. Both patients had exhibited escalating requirements for sedative drugs while undergoing ventilation yet remained inadequately sedated. The introduction of i.v. methadone in place of i.v. morphine in the sedative regimen rapidly and effectively restored a state of sedation. Hyperalgesia and morphine tolerance appear to be associated; it is proposed that methadone acts primarily, under these circumstances, by re-establishing the analgesic state. Such use of methadone in the morphine-tolerant patient also afforded a concomitant sedative-sparing effect.
1998
Williams PI; Sarginson RE; Ratcliffe JM
British Journal Of Anaesthesia
1998
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1093/bja/80.1.92" target="_blank" rel="noreferrer">10.1093/bja/80.1.92</a>