Abstract
You are called to evaluate a 4-year-old healthy child who is in the postanesthesia care unit (PACU) and in severe pain after orthopedic surgery. You will need to answer questions as to how to evaluate a patient in pain in the PACU and the options available to control such pain. Regional analgesia vs. systemic analgesics are discussed. Issues concerning cardiopulmonary stability are reviewed in additional questions. Other issues confronting you are nausea and persistent vomiting in an adolescent female.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Llewellyn N, Moriarty A. The national pediatric epidural audit. Paediatr Anaesth. 2007;17:520–33.
Adams HA, Saatweber P, Schmitz CS, Hecker H. Postoperative pain management in orthopaedic patients: no differences in pain score, but improved stress control by epidural anaesthesia. Eur J Anaesthesiol. 2002;19:658–65.
Jorgensen H, Wetterslev J, Moiniche S, Dahl JB. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev. 2000;7:CD001893.
Monitto CL, Greenberg RS, Kost-Byerly S, et al. The safety and efficacy of parent−/nurse- controlled analgesia in patients less than six years of age. Anesth Analg. 2000;91:573–9.
Anghelescu DL, Burgoyne LL, Oakes LL, Wallace DA. The safety of patient-controlled analgesia by proxy in pediatric oncology patients. Anesth Analg. 2005;101:1623–7.
Gan TJ, Meyer T, Apfel CC, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg. 2003;97:62–71. table of contents
Gan TJ, Meyer TA, Apfel CC, et al. Society for ambulatory anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2007;105:1615–28.
Subramaniam B, Madan R, Sadhasivam S, et al. Dexamethasone is a cost-effective alternative to ondansetron in preventing PONV after paediatric strabismus repair. Br J Anaesth. 2001;86:84–9.
Gunter JB, McAuliffe JJ, Beckman EC, et al. A factorial study of ondansetron, metoclopramide, and dexamethasone for emesis prophylaxis after adenotonsillectomy in children. Paediatr Anaesth. 2006;16:1153–65.
Stead SW, Beatie CD, Keyes MA, Isenberg SJ. Effects of droperidol dosage on postoperative emetic symptoms following pediatric strabismus surgery. J Clin Anesth. 2004;16:34–9.
Domino KB, Anderson EA, Polissar NL, Posner KL. Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: a meta-analysis. Anesth Analg. 1999;88:1370–9.
Visser K, Hassink EA, Bonsel GJ, et al. Randomized controlled trial of total intravenous anesthesia with propofol versus inhalation anesthesia with isoflurane-nitrous oxide: postoperative nausea with vomiting and economic analysis. Anesthesiology. 2001;95:616–26.
Broadman LM, Ceruzzi W, Patane PS, et al. Metoclopramide reduces the incidence of vomiting following strabismus surgery in children. Anesthesiology. 1990;72:245–8.
Tang J, Wang B, White PF, et al. The effect of timing of ondansetron administration on its efficacy, cost-effectiveness, and cost-benefit as a prophylactic antiemetic in the ambulatory setting. Anesth Analg. 1998;86:274–82.
Apfel CC, Korttila K, Abdalla M, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350:2441–51.
Meert KL, Kannan S, Mooney JF. Predictors of red cell transfusion in children and adolescents undergoing spinal fusion surgery. Spine. 2002;27:2137–42.
Edler A, Murray DJ, Forbes RB. Blood loss during posterior spinal fusion surgery in patients with neuromuscular disease: is there an increased risk? Paediatr Anaesth. 2003;13:818–22.
Hedequist D, Emans J. Congenital scoliosis: a review and update. J Pediatr Orthop. 2007;27:106–16.
Nuwer MR, Dawson EG, Carlson LG, et al. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol. 1995;96:6–11.
Cervellati S, Bettini N, Bianco T, Parisini P. Neurological complications in segmental spinal instrumentation: analysis of 750 patients. Eur Spine J. 1996;5:161–6.
Koka BV, Jeon IS, Andre JM, et al. Postintubation croup in children. Anesth Analg. 1977;56:501–5.
Galante D, Pellico G, Federico A, et al. Postextubation adverse events in children undergoing general anesthesia. Paediatr Anaesth. 2007;17:192. author reply 3
Khalil SN, Mankarious R, Campos C, et al. Absence or presence of a leak around tracheal tube may not affect postoperative croup in children. Paediatr Anaesth. 1998;8:393–6.
Murat I. Cuffed tubes in children: a 3-year experience in a single institution. Paediatr Anaesth. 2001;11:748–9.
Downes JJ, Raphaely RC. Pediatric intensive care. Anesthesiology. 1975;43:238–50.
Anene O, Meert KL, Uy H, et al. Dexamethasone for the prevention of postextubation airway obstruction: a prospective, randomized, double-blind, placebo-controlled trial. Crit Care Med. 1996;24:1666–9.
Markovitz BP, Randolph AG, Khemani RG. Corticosteroids for the prevention and treatment of post-extubation stridor in neonates, children and adults. Cochrane Database Syst Rev. 2008;16:CD001000.
Brandom B. Malignant hyperthermia. In: Davis M, editor. Smith’s anesthesia for infants and children. 7th ed. Philadelphia: Mosby/Elsevier; 2006. p. 1015–31.
Mancuso T. Neuromuscular disorders. In: Holzman M, Polaner, editors. Practical aspects of pediatric anesthesia. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2008. p. 547–9.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Cravero, J.P. (2017). Postanesthesia Care Unit (PACU). In: Holzman, R., Mancuso, T., Cravero, J., DiNardo, J. (eds) Pediatric Anesthesiology Review. Springer, Cham. https://doi.org/10.1007/978-3-319-48448-8_49
Download citation
DOI: https://doi.org/10.1007/978-3-319-48448-8_49
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-48447-1
Online ISBN: 978-3-319-48448-8
eBook Packages: MedicineMedicine (R0)