Ebook Atlas of practical neonatal and pediatric procedures: Part 2
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Ebook Atlas of practical neonatal and pediatric procedures: Part 2
Pain ManagementAs the practice of anesthesiology extends itself beyond perioperative medicine, the anesthesiologist's knowledge and expertise in pain Ebook Atlas of practical neonatal and pediatric procedures: Part 2 assessment and management is highly valued. There is growing evidence that pediatric patients of all ages, even the extremely premature neonates, are capable of experiencing pain as a result of tissue injuries due to various causes.There are several physiological consequences and behavioral respons Ebook Atlas of practical neonatal and pediatric procedures: Part 2es of pain in children and therefore they need to be addressed (Table 3.1).Table 3.1: Physiological consequences of pain In childrenIncreased blood prEbook Atlas of practical neonatal and pediatric procedures: Part 2
essure increased heart rate Hypermetabolism Hyperglycemia Protein catabolism LipolysisIncreased cardiac output Hypercoagulability Increased fibrinolysPain ManagementAs the practice of anesthesiology extends itself beyond perioperative medicine, the anesthesiologist's knowledge and expertise in pain Ebook Atlas of practical neonatal and pediatric procedures: Part 2 immune functionAssessment of PainPain is a subjective experience, so assessment of degree of pain remains a challenging task in children because of communication barrier. Pain assessment is the first step in management of pain. The Joint Commission of Accreditation of Health Care Organization (JCAH Ebook Atlas of practical neonatal and pediatric procedures: Part 2O) considers pain to be the fifth vital sign.Apart from physiological response to pain, several pain measurement tools can be broadly classified intoEbook Atlas of practical neonatal and pediatric procedures: Part 2
behavioral measures, composite measures and self report (Table 3.2).PHYSIOLOGICAL PARAMETERSIncrease in heart rate, respiratory rate, blood pressure aPain ManagementAs the practice of anesthesiology extends itself beyond perioperative medicine, the anesthesiologist's knowledge and expertise in pain Ebook Atlas of practical neonatal and pediatric procedures: Part 2mia, and fever which are unrelated to pain.90 Atlas of Practical Neonatal and Pediatric ProceduresTabic 3.2: Pain assessment methodAge-group Preverbal (Neonates and infants)Self-reportBehavioral NIPS FLACCComposite PIPP* (Table 3.3) CRIES COMFORTPre-schoolersFACES pain scale* (Figs 3.1A and 8) Poker Ebook Atlas of practical neonatal and pediatric procedures: Part 2 chip tool Ladder scale Eland color scaleFLACC CHEOPSOPS COMFORTSchoolersVAS' (Fig. 3.2) NRS - 11, 101 Modified McGill pain questionnaireCOMFORT' TheEbook Atlas of practical neonatal and pediatric procedures: Part 2
most commonly used scale in each group is described belowTable 3.3: Premature infant pain profile (PIPP)Indicators0Score 123Gestational age> 36 weeks3Pain ManagementAs the practice of anesthesiology extends itself beyond perioperative medicine, the anesthesiologist's knowledge and expertise in pain Ebook Atlas of practical neonatal and pediatric procedures: Part 2open No facial movementActive/sleep Eyes closed Facial movementQuiet/sleep Eyes closed No facial movementDuring painful stimulusChange in HR Change in SaO2T 0-4 bpm J- 0-2.4%T 5-14 bpm ị 2.5-4.9%T 15-24 bpm 1 5-7.4%T i 25 bpm 1 > 7.5%Brow bulgeNone < 9% of timeMinimal 10-39%Moderate 40-69%Maximum > Ebook Atlas of practical neonatal and pediatric procedures: Part 270%Eye squeezeNone <_ 9% of timeMinimal 10-39%Moderate 40-69%Maximum _> 70%Nasolabial furrowNone <_ 9% of timeMinimal 10-39%Moderate 40-69%Maximum > 7Ebook Atlas of practical neonatal and pediatric procedures: Part 2
0%•Score = 0-21•Higher the score, the greater is the pain behavior0246810No Hurt Hurts Hurts Hurts Hurts Hurts little bit little more even more whole Pain ManagementAs the practice of anesthesiology extends itself beyond perioperative medicine, the anesthesiologist's knowledge and expertise in pain Ebook Atlas of practical neonatal and pediatric procedures: Part 2t IS unidimensional and measures only intensity of pain0 = no painPain ManagementAs the practice of anesthesiology extends itself beyond perioperative medicine, the anesthesiologist's knowledge and expertise in painGọi ngay
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