BACKGROUND: Many children recovering from anesthesia experience pain that is severe enough to warrant intravenous (IV) opioid treatment within moments of admission to the postanesthesia care unit (PACU). Postoperative pain has several negative consequences; therefore, preventing significant PACU pain in children is both a major clinical goal and a moral/ethical imperative. This requires identifying patient-level and perioperative factors that may be used to predict PACU IV opioid requirement. This should allow for the development of personalized care protocols to prevent clinically significant PACU pain in children. Our objective was to develop prediction models enabling practitioners to identify children at risk for PACU IV opioid requirement after various painful ambulatory surgical procedures. METHODS: After Institutional Review Board approval, clinical, demographic, and anthropometric data were prospectively collected on 1256 children 4–17 years of age scheduled for painful ambulatory surgery (defined as intraoperative administration of analgesia or local anesthetic infiltration). Three multivariable logistic regression models to determine possible predictors of PACU IV opioid requirement were constructed based on (1) preoperative history; (2) history + intraoperative variables; and (3) history + intraoperative variables + PACU variables. Candidate predictors were chosen from readily obtainable parameters routinely collected during the surgical visit. Predictive performance of each model was assessed by calculating the area under the respective receiver operating characteristic curves. RESULTS: Overall, 29.5% of patients required a PACU IV opioid, while total PACU analgesia requirement (oral or IV) was 41.1%. Independent predictors using history alone were female sex, decreasing age, surgical history, and non-Caucasian ethnicity (model area under the receiver operating characteristic curve [AUROC], 0.59 [95% confidence interval {CI}, 0.55–0.63]). Adding a few intraoperative variables improved the discriminant ability of the model (AUROC for the history + intraoperative variables model, 0.71 [95% CI, 0.67–0.74]). Addition of first-documented PACU pain score produced a substantially improved model (AUROC, 0.85 [95% CI, 0.82–0.87]). CONCLUSIONS: Postoperative pain requiring PACU IV opioid in children may be determined using a small set of easily obtainable perioperative variables. Our models require validation in other settings to determine their clinical usefulness. Accepted for publication July 3, 2018. Funding: National Institute of General Medical Sciences grant number K23 GM104354 supported O.O.N.'s work. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Olubukola O. Nafiu, MD, FRCA, MS, Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan Health System, 1500 E Medical Centre Dr, Room UH 1H247, Ann Arbor, MI 48109. Address e-mail to onafiu@med.umich.edu. © 2018 International Anesthesia Research Society
https://ift.tt/2MRuPUX
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00302841026182
00306932607174
alsfakia@gmail.com
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- Comments on “Applications and limitations of using...
- Current practice in the surgical management of par...
- Perception of Pulmonary Function in Children with ...
- Flexible Bronchoscopy Under Bronchoscopist-Adminis...
- Perception of Pulmonary Function in Children with ...
- Flexible Bronchoscopy Under Bronchoscopist-Adminis...
- Development of a UHPLC-FLD method for the analysis...
- FDA Approval Summary: Midostaurin for the Treatmen...
- Randomized, Open‐Label Phase II Study Comparing Ca...
- A Phase Ib/II Study of the JAK1 Inhibitor, Itaciti...
- Rectal perforation following paclitaxel and carbop...
- A quadricuspid aortic valve in an asymptomatic 40-...
- Low-grade inflammation in the relationship between...
- Two siblings with PRKDC defect who presented with ...
- Generation of Pancreatic β-cells From iPSCs and th...
- Biomatrix for upper and lower airway biomarker in ...
- FPIES in Adults
- Chimeric antigen receptor (CAR) T cells targeting ...
- Generation of trichogenic adipose-derived stem cel...
- How to Use Oral and Topical Cosmeceuticals to Prev...
- Mesothelial Stem Cells and Stromal Vascular Fracti...
- Research Grant for Study of Resistance to Precisio...
- Research Grant to Determine the Genes Responsible ...
- Research Grant to Determine the Genes Responsible ...
- Research Grant for Study of Resistance to Precisio...
- Research Grant Focused on Identifying T3-Forming S...
- Research Grant to Determine How Specific Drugs Wor...
- Research Grant to Identify the Source and Mechanis...
- Research Grant to Study Common Resistance to Papil...
- Research Grant to Study the Action of T-Regulatory...
- Research Grant to Determine How Specific Drugs Wor...
- Research Grant to Study Common Resistance to Papil...
- Research Grant to Study the Action of T-Regulatory...
- FPIES in Adults
- Sinonasal pleomorphic adenoma: A single institutio...
- Clinical efficacy of anti-IL-5 monoclonal antibody...
- A correlative study between diffusion and perfusio...
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- Artificial Saliva vs Saline Solution and Suture De...
- Catastrophizing and Dizziness-Related Disability A...
- Physician Adherence to Guidelines for Benign Parox...
- Prevalence and Risk Factors for Olfactory Hallucin...
- Factors Associated With Phantom Odor Perception Am...
- Tumoren der Nasennebenhöhlen mit Übergreifen auf d...
- Restrictions in Communicative Participation
- Spontaneous Recovery Rates in Patients With Idiopa...
- August 2018 Issue Highlights
- Consensus-Based Attributes for Identifying Patient...
- Outcomes in Head and Neck Resections That Require ...
- Association Between Portable Music Player Use and ...
- Can Your Smartphone Save Your Hearing?
- Association of Vertigo With Hearing Outcomes in Su...
- The Role of Migraine in Hearing and Balance Symptoms
- Speech and Communicative Participation in Patients...
- The Pathogenesis of Choanal Atresia
- Association of Video Head Impulse Test With Improv...
- Classifying and Diagnosing Laryngeal Dystonia
- Transcutaneous Osseointegrated Implants for Pediat...
- Vertigo as a Prognostic Indicator of Outcome in Su...
- Association of Tinnitus and Other Cochlear Disorde...
- Trend Toward the Use of Transcutaneous Osseointegr...
- Characteristics and Treatment Response of Older Ad...
- Multiple-Flap Reconstruction of Head and Neck Defects
- Antibiotic Prescription Patterns for Management of...
- 3-Dimensional Printed Haptic Simulation Model To T...
- Facial vein thrombophlebitis: A Case Report and li...
- Cloning, expression analysis and functional charac...
- Tail-of-the-Curve Evaluation With the American Soc...
- Missing Conflict of Interest Disclosure
- Tail-of-the-Curve Evaluation With the American Soc...
- Redefining the Value Proposition of Precision Onco...
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- Alemtuzumab, a Monoclonal Antibody to CD52, Freque...
- Macro-TSH May Cause a Spurious Diagnosis of Subcli...
- Concurrent Differentiated Thyroid Carcinoma (DTC) ...
- Hypothyroidism Is Associated with Increased Mortal...
- Patients with Differentiated Thyroid Cancer Who Un...
- There Is No Evidence for Any Effects of TSH on Bon...
- Berberine promotes glucose uptake and inhibits glu...
- The 2015 ATA Guidelines for the Prediction of Thyr...
- What Is the Clinical Importance of TSH Staining in...
- Multimodality Therapy Is Needed for Anaplastic Thy...
- Gallium-68-PSMA-PET/CT Outperforms Radioiodine Sci...
- Protective effect and related mechanisms of curcum...
- Challenging the conventional treatment of colon ca...
- Epithelial-myoepithelial carcinoma: a population-b...
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