AANA journal
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Pediatric surgical patients are a population at risk of inadequate pain management. The American Society of Anesthesiologists' 2012 Practice Guidelines for Acute Pain Management in the Perioperative Setting recommend a multimodal approach as the most effective way to prevent and treat pain in children. ⋯ Ketorolac and acetaminophen are the 2 nonopioid IV analgesics currently available for use in the United States. This article provides a review of the literature of IV ketorolac and IV acetaminophen regarding their pharmacology, analgesic efficacy, limitations, and practical considerations, with a focus on patients 16 years of age and younger.
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Obstructive sleep apnea (OSA) affects approximately 20% of Americans. Patients with undiagnosed OSA may experience obstructive episodes during conscious sedation for colonoscopy. The purpose of this investigation was to describe the risk of undiagnosed OSA using the Berlin Questionnaire and to identify the relationship between OSA risk and the number of provider interventions performed to relieve obstructive symptoms during sedation for colonoscopy. ⋯ The incidence of undiagnosed OSA was 40.4%. Patients with hypertension had a higher rate of a positive screen for OSA (70%) than those without hypertension (20.3%), chi2(1) = 3.87, P < .05. There was no statistical difference in the number of provider interventions between the 2 groups. Risk of undiagnosed OSA in this sample is large but it does not appear to be associated with episodes of obstructive symptoms requiring provider intervention.
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Transversus abdominis plane (TAP) blocks are a relatively new regional anesthetic technique used in a multimodal approach to provide postoperative analgesia of the anterolateral abdominal wall. The technique for placing TAP blocks has evolved from a landmark technique to an ultrasound-guided technique. There are 3 common approaches for accessing the TAP: subcostal, midaxillary, and ilioinguinal-iliohypogastric. ⋯ The approach used is contingent on the type and location of the surgical procedure. Overall, TAP blocks reduce postoperative pain and opioid requirements, resulting in fewer side effects such as nausea and vomiting, respiratory depression, and sedation. Future studies should examine which type, concentration, and volume of local anesthetics are most effective.