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Ebook Atlas of practical neonatal and pediatric procedures: Part 2

(BQ) Part 2 book “Atlas of practical neonatal and pediatric procedures” has contents: Assessment of pain, subarachnoid block, epidural analgesia, infraorbital nerve block, neonatal resuscitation, post-resuscitation care, steps of resuscitation, post-resuscitation stabilization, and other contents. | 3 Pain Management As the practice of anesthesiology extends itself beyond perioperative medicine, the anesthesiologist’s knowledge and expertise in pain 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 responses of pain in children and therefore they need to be addressed (Table 3.1). Table 3.1: Physiological consequences of pain in children Increased blood pressure Increased O2 consumption Increased heart rate Decreased tidal volume Hypermetabolism Decreased FRC Hyperglycemia V/Q mismatch Protein catabolism Decreased cough Lipolysis Decreased gut motility Increased cardiac output Sodium and water retention Hypercoagulability Altered immune function Increased fibrinolysis Assessment of Pain Pain 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 (JCAHO) considers pain to be the fifth vital sign. Apart from physiological response to pain, several pain measurement tools can be broadly classified into behavioral measures, composite measures and self report (Table 3.2). PHYSIOLOGICAL PARAMETERS Increase in heart rate, respiratory rate, blood pressure and palmar sweating are some of the physiological measures used to measure pain. These parameters may be influenced by factors like hypoxemia, hypovolemia, and fever which are unrelated to pain. 90 Atlas of Practical Neonatal and Pediatric Procedures Table 3.2: Pain assessment method Age-group Self-report Preverbal (Neonates and infants) Pre-schoolers FACES pain scale* (Figs 3.1A and B) Poker chip tool Ladder scale Eland color .