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January 1997
Patient-controlled analgesia for mucositis pain in children: A three-period crossover study comparing morphine and hydromorphone.
Collins JJ, Geake J, Grier HE, Houck C, Thaler HT, Weinstein HJ, Twum-Danso NY, Berde CB J Pediatr 1996:129:722-8
[ no abstract available ]
Patients undergoing bone marrow transplantation (BMT) offer a distinct, relatively homogeneous population in which to assess the characteristics of analgesic drugs. Most patients develop (usually oral) mucositis from the high-dose chemotherapy they receive prior to transplantation. Oral mucositis is usually associated with substantial continuous pain which is exacerbated by swallowing and mouth care and requires the use of intravenous opioids.
The amount of drug required escalates more quickly and is stays high substantially longer than that needed for most patients with post operative pain. This double-blind, three-period study of 10 patients was designed to evaluate a clinical protocol for PCA use in children, evaluates the potency, efficacy, pharmacokinetic and side-effect profiles of morphine and hydromorphone.
The relatively small number of patients in this study obviously limits the power of its conclusions, but it serves as a template for a successful protocol for PCA in children and adolescents and methods for comparing opioid side effects.
Recognition of sleep-disordered breathing in children.
Guilleminault C, Pelayo R, Leger D, Clerk A, Bocian RCZ. Pediatrics 1996: 98:871-882.
[ no abstract available ]
The importance of this paper for most anesthesiologists lies more in the well-written descriptions of the physical characteristics and symptoms of children who have sleep-disordered breathing than in the study itself. The paper emphasizes the fact that even in the absence of documented apnea and oxygen desaturation (obstructive sleep apnea syndrome, OSAS), increased upper airway resistance (upper airway resistance syndrome, UARS) may disrupt natural sleep.
Sometimes children, like those scheduled for T&A for obstruction present for anesthesia and surgery with documented airway obstruction. More commonly, this is a finding elicited during history-taking in children scheduled for a procedure unrelated to the airway. Until it is documented to be otherwise, which seems unlikely, those of us who anesthetize children must assume that children with UARS are at greater risk for perioperative respiratory complications than children without OSAS or UARS.
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