Regional Anesthesia in the Pediatric Emergency Department

Pediatric facial trauma can present a challenge to even the more experienced plastic surgeon. Injuries to the head and neck may involve bone and soft tissues with an assortment of specialized organs and tissue elements involved. Because of the active nature of children, facial soft tissue injuries can be diverse and extensive as well as some of the more common injuries a plastic surgeon is asked to treat. In 2007, approximately 800,000 patients younger than 15 years presented to emergency departments around the country with significant open wounds of the head that required treatment...

OBJECTIVE: Seattle-King County (SKC) Washington is at risk for regional disasters, especially earthquakes. Of 1.8 million residents, >400,000 (22%) are children, a proportion similar to that of the population of the State of Washington (24%) and of the United States (24%). The county's large area of 2,134 square miles (5,527 km2) is connected through major transportation routes that cross numerous waterways; sub-county zones may become isolated in the wake of a major earthquake. Therefore, each of SKC's three subcounty emergency response zones must have ample pediatric medical response capabilities...

UNLABELLED: Müllerian adenosarcoma is a rare neoplasm usually found in postmenopausal women. It usually presents as a polypoid mass within the endometrium. It is a biphasic tumor, composed of a benign epithelial component and a malignant stromal component. To date, this neoplasm has been reported in only 16 adolescent girls. We present a case of a 10-year-old girl who was diagnosed with müllerian adenosarcoma arising from the endocervix, the youngest female ever reported. CASE REPORT: A 10-year-old previously healthy girl presented to the Emergency Department at the Children's Hospital of Eastern Ontario with a painless mass protruding from her vagina...

OBJECTIVE: There is a need to develop tools for the rapid diagnosis and treatment of fractures and intraosseous pathology in remote and austere environments. Several emergency and orthopedic studies have demonstrated ultrasound to be a reliable tool in diagnosing these conditions in both adult and pediatric patients. The purpose of this pilot study is to assess the ability of the ultrasound to assess in "real-time" the success of fracture reduction in adult patients in the emergency department (ED), in comparison with the accepted standard, plain film radiography, for the purposes of future application in austere environments...

BACKGROUND: Minidose intravenous regional anesthesia (IVRA) and modified forearm IVRA have been used for closed reduction of forearm fractures and for hand surgery in children. METHODS: Children (5-17 years old) with forearm fractures presenting to a pediatric emergency department were enrolled in a randomized controlled trial to test if modified forearm and minidose IVRA together would provide improved analgesia with reduced risk of anesthetic toxicity compared with conventional minidose IVRA...

In January 2000, Primary Children's Medical Center (PCMC) nurses and physicians of specific disciplines including hematology/oncology, surgery, Emergency Department (ED), and anesthesia, identified a need to provide general anesthesia for children undergoing procedures outside of the operating room. This need was based upon two factors: (a) limited availability of the operating room, and (b) lack of proper monitoring of children receiving conscious sedation for painful procedures in PCMC clinics. In September 2000, the Rapid Treatment Unit (RTU) service was developed to provide cost-effective, efficient, patient/family-centered care for a variety of procedures...

BACKGROUND: Although local anesthetic techniques (hematoma blocks, nerve blocks, intravenous regional anesthesia) for forearm fracture reduction are well described and commonly used in adults, it is unclear how often these techniques are used in children. OBJECTIVE: To characterize the use of local anesthesia for pediatric closed forearm fracture reduction by pediatric and orthopedic physicians practicing in teaching hospitals in Canada and the United States. METHODS: An on-line survey targeting physicians practicing in hospitals with pediatric emergency medicine (PEM) fellowships in Canada and the United States was sent to the PEM fellowship director and orthopedic department head at each hospital...

Our objective was to compare procedural distress during manipulation of forearm fractures in children receiving either axillary (brachial plexus) block regional anesthesia (20 children) or deep sedation with ketamine and midazolam (21 children). This was a prospective randomized unmasked controlled comparative trial conducted in an urban children's hospital emergency department. The 2 groups were similar in age (older than 8 years), fracture types, initial pain scores, narcotic analgesia received, and midazolam doses before fracture manipulation...

Orthopedic fractures and joint dislocations are among the most painful pediatric emergencies. Safe and effective management of fracture-related pain and anxiety in the emergency department reduces patient distress during initial evaluation and often allows definitive management of the fracture. No consensus exists on which pharmacologic regimens for procedural sedation/analgesia are safest and most effective. For some children, control of fracture pain is the primary goal, whereas for others, relief from anxiety is an additionally important objective...

BACKGROUND: Playground equipment resulted in >200 000 injuries from 1990 to 1994, according to the Consumer Product Safety Commission; 88% were attributable to climbers (monkeybars/jungle gyms [MB/JGs]), swings, and slides. Equipment-specific injury requiring emergency department (ED) evaluation has not been reported previously. OBJECTIVE: To describe the spectrum of significant MB/JG-related injuries. METHODS: A 2-year retrospective chart review was performed using the computerized charting system at a large urban Children's Hospital/Regional Pediatric Trauma Center with 50 000 ED visits per year...

Blunt traumatic injury to the urogenital region in the prepubescent girl is commonly evaluated in pediatric emergency departments (ED). The purpose of this study is: 1) to establish recommendations for an accurate, painless (both physically and psychologically), and timely diagnosis, and 2) to determine whether the ED examination can accurately determine the extent of the injury. Over a 24-month period (January 1991 through December 1992), 22 girls with blunt trauma to the urogenital region (mean age 5.7 years, range 2-9 years) were retrospectively evaluated...

A prospective, randomized study of intravenous (i.v.) regional anesthesia compared with nitrous oxide gas was performed in a group of 28 pediatric patients with forearm fractures requiring manipulation in the emergency department. The groups were compared in terms of pain perceived by the patients, success of manipulation, safety, and duration of procedure. The methods showed no significant difference in amount of pain perceived by the patient for the total pain experience. No medical complication was seen in either group...

The safety and effectiveness of the "mini-dose" Bier block, a technique of i.v. regional anesthesia using low-dose lidocaine (1.5 mg/kg) without routine premedication, was evaluated in the emergency department treatment of pediatric upper-extremity fractures and dislocations. We prospectively studied 69 patients, aged from 2 to 16 years, treated at a pediatric primary care/referral-based emergency department. Good to excellent anesthesia was achieved during closed reduction in 90% of the cases. All patients achieved an acceptable reduction, as demonstrated by follow-up radiographs...

This paper reports observations on 160 patients, aged between 1 and 30 days, submitted to general anaesthesia for surgery in the period within 1/1/81 and 31/12/84, at the Pediatric Surgery Department - Vicenza Regional Hospital. First we mentioned the main anatomo-physiological features in newborns, and on the grounds of the most recent bibliography and of our own experience, we propose a general anaesthesia record, as much as possible univocal, still bearing in mind the difficulty of this piece of advice, related to the various neonatal malformations, to the very poor conditions, and sometimes to dramatic emergency...

Operative and postoperative analgesia has become in a few years a major concern for pediatric anesthesiologists. The fact that pain can have dramatic metabolic and hemodynamic consequences has been well documented. This study shows the activity in our department in the field of analgesia during 1989. 82% of the 2,675 children having undergone surgery have received analgesia during the operative period either by the way of an i.v. narcotic or an regional block. No morbidity or mortality resulted from these techniques during the operative period...

Most patients who require emergency airway control receive drugs to induce rapidly sufficient anesthesia for direct laryngoscopy and endotracheal intubation, but there are no protocols that outline the use of specific drugs in general use. Drugs should safely and rapidly produce (1) unconsciousness; (2) paralysis; and (3) blunt intracranial pressure (ICP) responses to airway procedures. Consequences to be considered include increased ICP, hemorrhagic shock, and a full stomach. To refine the use of drugs used for airway procedures in pediatric trauma patients, the authors reviewed all cases of emergency endotracheal intubation over a recent 12-month period (1) to see whether medications used met the goals of producing unconsciousness and paralysis and blunting ICP responses were met safely; and (2) to identify potential drug-related complications...