Postoperative Pain Management in children: guidance from the Pain Committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative) Part II.

The ESPA Pain Management Ladder Initiative is a clinical practice advisory based upon expert consensus supported by the current literature to help ensure a basic standard of perioperative pain management for all children. In 2018 the perioperative pain management of six common pediatric surgical procedures was summarised. The current Pain Management Ladder recommendations focus on five more complex pediatric surgical procedures and suggest basic, intermediate, and advanced pain management methods.

Laser acupuncture treatment of neuropathic pain in a boy with brain tumour.

Neuropathic pain occurrence is associated with some cytostatic and antibiotics use. Pharmacological therapy for the treatment of neuropathic pain is sometimes unsuccessful, and complementary methods like acupuncture are included. In this case report, a 14-year-old boy with cerebral tumour and neuropathic pain in his feet after chemotherapy and linezolid use is presented.

[THE SCALP AS A SPLIT-THICKNESS GRAFT DONOR IN THE TREATMENT OF A MASSIVE THERMAL INJURY].

We are presenting our initial experience with the utilization of the scalp as a donor for split thickness skin grafting in the treatment of massive thermal injuries. Rapid donor reepithelization, absence of hypertrophic scarring in the donor area, inconspicuous donor area and a large area for the procurement of grafts in the pediatric population are the advantages that are emphasized in the literature. The outcome in a 3-year-old boy who suffered a burn injury from an open fire in the family house on the 57% of his total body surface area (48% full thickness burn) showed that the “take rate”, in the absence of a massive local infection, was around 80% and that the scalp can be utilized again as a donor area after a period of 14 days.

[Delirium incidence in pediatric intensive care unit].

Delirium is a serious neuropsychiatric disorder and pediatric delirium (PD) is a similarly serious condition. PD is understudied and very often misdiagnosed, especially in pediatric intensive care units (PICU). It is important to early diagnose PD, so that early psychosocial interventions and therapy can be introduced.

Reversal of thrombocytopenia and bleeding tendency in a preterm neonate with recombinant activated factor VII: case report.

A male neonate, born at 26 weeks of postmenstrual age, with intracranial hemorrhage grade IV and thoracic drainage for artificial tension pneumothorax on day 6 of his life is presented. Despite prior transfusions, the preprocedural hemogram showed marked anemia and thrombocytopenia. To reverse thrombocytopenia and to avoid volume overload, the patient was administered 110 microg kg(-1) of recombinant activated factor VII (rFVIIa) and drainage of the pneumothorax was performed uneventfully.

[Acute childhood pancreatitis caused by valproate].

Signs of pancreatitis in children are simmilar to those in adults: disturbed general condition, abdominal pain, vomitting, elevated amylase level. Mainstays in intensive therapy and indications for surgical interventions are also sim-milar. Contrary to adults, in childhood pancreatitis adverse effects of various drugs are common causes.

Central venous catheters for chemotherapy of solid tumors--our results in the last 5 years.

Central venous catheters provide an easy access for intravenous medications. Having a central line in place will relieve a child from the discomfort and danger of multiple regular intravenous lines for chemotherapy. The use of indwelling central venous catheters has become commonplace in the management of children undergoing oncological treatment.

Comparison of a preincisional and postincisional small dose of ketamine for postoperative analgesia in children.

Background: The aim of this randomized, double blind, placebo controlled prospective study was to investigate the preventive action of N-methyl-D-aspartate (NMDA) receptor antagonist ketamine on postoperative analgesia by comparing its administration preincisionally, at the end of operation and placebo in the management of postoperative pain in children.

Methods: 90 children ASA I or II, scheduled for hernia repairs, circumcisions and orchydopexy, aged 4.5-14 years were randomly assigned in three groups: first received low dose ketamine 0.

Postoperative analgesia with intravenous fentanyl PCA vs epidural block after thoracoscopic pectus excavatum repair in children.

Background: The aim of this prospective, randomized trial was to compare analgesia, sedation, and cardiorespiratory function in children after thoracoscopic surgery for pectus excavatum repair, using two types of analgesia--epidural block with bupivacaine plus fentanyl vs patient-controlled analgesia (PCA) with fentanyl.

Methods: Twenty-eight patients scheduled for thoracoscopic pectus excavatum surgery were randomly assigned to receive either thoracic epidural block or i.v.

Hirschsprung's disease and Rehbein's procedure--our results in the last 30 years.

Hirschsprung's disease is congenital anomaly of the intestine and Harald Hirschsprung gave the first description of this disease'. The aim of this follow-up study was to evaluate the results of Rehbein's procedure in the treatment of Hirschsprung's disease in the last 30 years in Children's Hospital Zagreb. Hirschsprung's disease is congenital intestinal aganglionosis as the results of arrested fetal development of the myenteric nervous system.

Ovarian dysgerminoma and acute abdomen.

Background: Ovarian dysgerminoma cases are very rarely presented together with acute abdomen. The purpose of this study is to present dysgerminoma ovarii with abdominal pain in lower right abdominal part after abdominal trauma as an abdominal emergency.

Patients And Methods: Our 12-year old female patient was admitted to our hospital after traffic accident with abdominal trauma.

Experience with gabapentin for neuropathic pain in adolescents: report of five cases.

Summary Gabapentin is an antiepileptic drug indicated for the treatment of partial seizures in children. Many studies have proved its analgesic action in the treatment of neuropathic pain in adults and we have noticed an analgesic action of gabapentin in neuropathic pain in children. Five patients treated in the Children's Hospital Pain Control Service for intractable neuropathic pain were included in gabapentin treatment.

Comparison of laser acupuncture and metoclopramide in PONV prevention in children.

Background: Postoperative nausea and vomiting (PONV) are frequent side effects of general anesthesia in children. The aim of this study was to compare the effectiveness of laser acupuncture with metoclopramide in prevention of PONV in children after sevoflurane anesthesia.

Methods: A total of 120 children ASA I and II, scheduled for hernia repair, circumcision or orchidopexy were randomly assigned into three groups: group I, received laser acupuncture on P6 point and saline infusion; group II, metoclopramide 0.

[Doppler echocardiography in the evaluation of pulmonary hypertension in chronic obstructive pulmonary disease].

Systolic pulmonary arterial pressure (PAPs) at rest and during submaximal exercise using bicycle ergometer was estimated in 80 patients with clinical stable obstructive pulmonary disease (COPD). Systolic pulmonary arterial pressure was estimated by using continuous Doppler from maximal velocity of the tricuspid regurgitant jet by applying the modified Bernoulli equation and regression: PAPs = 1.23 x 4 Vmax2-0.

Respiratory function in workers employed in the glassblowing industry.

A group of 80 men employed in the glassblowing industry was studied in order to investigate the effect of this occupational exposure on respiratory function. Eighty nonexposed workers were included in the study as a control group. Glassblowers had a significantly higher prevalence of chronic bronchitis, nasal catarrh, chronic sinusitis, and nasal bleeding than control workers; length of employment in the industry did not affect the prevalence of symptoms.

[Respiratory function in glass blowers].

The prevalence of chronic and acute respiratory symptoms and diseases and changes in lung function in a group of 80 glass blowers have been investigated. In addition a group of 80 not exposed workers was used as a control group for respiratory symptoms and diseases. In glass blowers, there was significant increase in prevalence of chronic bronchitis, nasal catarrh, and sinusitis than in the controls.

[Ventilatory function of the lungs in patients with ankylosing spondylitis].

The ventilatory function of the lung was studied in 100 patients (85 men and 15 women) suffering from ankylosing spondylitis. The mean age of the patients was 48 years (range: 29-72) and the mean duration of the disease was 18 years (range: 4-37). In 74% of the cases there was evidence of impaired ventilatory function of the lung.

Bronchial reactivity in green coffee exposure.

Respiratory symptoms and lung function were studied in nine coffee workers who complained of job related respiratory symptoms. Six described symptoms characteristic of occupational asthma. Lung function data showed obstructive changes mostly in the smaller airways with no impairment in diffusing capacity.

Respiratory response to tobacco dust exposure.

Results of a study of the respiratory responses of 318 nonsmoking female workers to long-term tobacco dust exposure are reported. The mean total tobacco dust concentrations ranged from 0.9 to 27.

Lung function in textile workers.

Acute changes in ventilatory function during a workshift with exposure to hemp, flax, and cotton dust were measured on Mondays in a group of 61 textile workers, all working on carding machines. In addition, single-breath diffusing capacity (DLCOSB) was measured before dust exposure on Monday in 30 of the 61 workers. Large acute reductions during dust exposure were recorded in maximum expiratory flow rate at 50% VC (MEF50%), ranging from 38 to 22%.