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Introduction: Providing anesthesia for pediatric orthopedic patients poses unique challenges for anesthesiologists. The approach must consider the psychological development of the child and the prevalence of respiratory infections. Pain management, management of concomitant diseases, and risk reduction for adverse events are crucial aspects of anesthetic care. This blog post will review the perioperative concerns specific to pediatric orthopedic procedures, discuss pain control methods used, and highlight anesthetic considerations for certain surgeries.
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Select Pediatric Perioperative Concerns:
- Upper Respiratory Tract Infections (URI): Pediatric patients presenting for orthopedic surgery with current or recent URIs pose a challenge for anesthesiologists and surgeons. Children commonly experience URIs with symptoms like a runny nose, cough, and fever. While the viral infection may reside in the nasopharynx, the lower respiratory tract remains sensitive for up to 6 weeks after URI symptoms have resolved. This increased sensitivity puts patients at risk for perioperative complications like laryngospasm, bronchospasm, and oxygen desaturation. Delaying surgery for 6 weeks after URI resolution is often impractical, as another URI is likely to occur. For elective surgery, severe symptoms and complications warrant postponing surgery, but clear nasal discharge in an otherwise healthy patient may proceed with elective surgery. Clinical decision-making becomes challenging for cases falling between these extremes. Factors such as patient age, comorbidities, prior cancellations, surgery complexity, and urgency are considered when deciding whether to postpone surgery. If elective surgery is delayed, most clinicians would wait 2 to 4 weeks after URI symptom resolution.
- Anxiety in the Pediatric Patient: Pediatric patients undergoing orthopedic surgery often experience varying levels of anxiety and distress. Preoperative stressors can include unfamiliar environments, procedures, hunger, fear of pain, and separation from parents. Certain risk factors contribute to preoperative anxiety, such as ages 1 to 5 years, shy temperament, prior negative medical experiences, high cognitive levels, and parental anxiety. Unaddressed anxiety can lead to postoperative behavioral changes, including generalized anxiety, separation anxiety, aggression, and nighttime crying. It can also result in higher pain scores and increased pain medication requirements after surgery. Strategies to mitigate preoperative anxiety include presurgical preparation programs involving site visits, videos, books, and child-life interventions. Allowing parental presence during anesthesia induction can help alleviate separation anxiety. Pharmacologic interventions like oral midazolam can improve compliance and reduce negative behavioral changes in the short term.
Anesthetic Management for Orthopedic Procedures:
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Anesthetic Considerations for Select Pediatric Orthopedic Surgeries: Scoliosis Surgery: Anesthetic concerns during scoliosis surgery include optimizing neuromonitoring signals, managing blood loss, preventing positioning-related injuries, and minimizing the risk of postoperative visual loss.
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Pain Management: Pain control for pediatric orthopedic patients involves a multimodal pharmacologic approach to minimize opioid requirements. This approach includes non-opioid analgesics, local anesthetics, and regional anesthesia techniques. Regional anesthesia, such as peripheral nerve blocks and caudal anesthesia, is particularly valuable for postoperative pain control. Recent studies have confirmed the safety of regional anesthesia in the pediatric population.
Pediatric orthopedic surgeries present unique challenges for anesthesiologists. Effective management of preoperative anxiety, careful consideration of upper respiratory tract infections, and appropriate pain control strategies are essential for successful outcomes. Anesthesiologists must tailor their approach to the specific needs of pediatric patients undergoing orthopedic procedures to ensure their safety and well-being.
Reference
Wu JP. Pediatric Anesthesia Concerns and Management for Orthopedic Procedures. Pediatr Clin North Am. 2020 Feb;67(1):71-84. doi: 10.1016/j.pcl.2019.09.006. PMID: 31779838; PMCID: PMC7172179.
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References
Lin, Chia-Shiang, et al. "Interventional treatments for postherpetic neuralgia: a systematic review." Pain physician22.3 (2019): 209.
David Rosenblum, MD, creator of PainExam.com, AnesthesiaExam.com, PMRExam.com, NRAP Academy and International Pain Academy Co-Founder presents an excerpt from Grand Rounds Given on January 2, 2023 to the Metropolitan Hospital Physical Medicine and Rehabilitation Department.
Reflect on Ultrasound Guided Interventional Spine Procedures and Claim CME Credit
Agenda:
- Ultrasound Guided Cluneal Nerve Blocks
- Ultrasound Guided Stellate Ganglion Block
- Ultrasound Guided Facet Joint Injection
- Ultrasound Guided Medial Branch Blocjks
- Ultrasound Guided Sacroiliac Joint Inejction
- Ultrasound Guided Caudal Epidural Injections
Dr. Rosenblum offers live regional anesthesia, regenerative medicine, board review and interventional pain management CME courses in NY and around the world. For more information, go to www.NRAPpain.org or PainExam.com/events
Patients can schedule a consultation by going to www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Great Neck Office 516 482 7246
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Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- Dec 3, 2022
Regenerative Interventional Pain Course NYC- Jan, 28, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023
Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023
Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023
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Larry Kobak, Esq. on CDC Guidelines: What You Need to Know!
What you need to know: The Updated CDC Clinical Practice Guideline for Prescribing Opioids for Pain
Monday, November 21 at 6:00 pm EDT
NYSPS Legal Briefs
New 2022 CDC Guidelines on
OPIOID USE FOR TREATMENT OF PAIN
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The Guidelines state very clearly: “Nonopioid therapies are preferred for subacute and chronic pain.” If you are using opioids for subacute or chronic pain, which including both terms, means treating pain for 1 month or more, your chart must contain some justification for the use of opioids. This is an extremely important matter. Appropriate reasons, such as a prior treater, attempted various nonopioid treatments of some kind that failed. There must be a very good reason why opioids were tried. It must be documented.
Larry Kobak, Esq.
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Reference
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Glossopharyngeal Neuralgia, Anatomy, Pathophysiology, Diagnosis, and Treatment-
Dr. Rosenblum reviews Neuralgia and Compression of CN IX pathology, discusses the management, treatment and more. David Rosenblum MD, pain physician in Great Neck, Long Island discusses the different approaches to treating patients with medications and interventional pain procedures such as nerve blocks, neurolysis and radiofrequency lesioning...
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Join us for our a cool session of networking with your colleagues. Our last event hit the mark, and our docs left happy and excited for the next one. So we've planned it. As always, there will be food and drinks served. Come prepared to speak to others about medicine, healthcare. side gigs, new opportunities for career growth, innovation, fun activities, and more.
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A new application of an old therapy-
Dr. Rosenblum reports his experience with a patient who reported long term relief of anosmia and parosmia with a unilateral stellate ganglion block. Dr. Rosenblum discusses the pathophysiology of the imbalances between the Sympathetic, parasympathetic nervous system, and feedback loops in the Neuro-immune system.
For more information see attached texts.
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Stellate ganglion block reduces symptoms of Long Covid- A Case Series- Click here to download
Regulation of acute reflectory hyperinflammation in viral and other diseases by SGB- Click here to download
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Interview with attorney Ken Falcon-
Is Malpractice insurance enough? Dr. Rosenblum sits down and asks Ken Falcon about protecting assets, trusts, and more. Ken is an attorney practicing in Rockville Center, NY. For more information, see his contact information below.
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CMS’s Push into Remote Patient Care-
Dr. Rosenblum interviews PainExam Podcast Sponsor, Rachel Trobman. Rachel Trobman is a digital health executive and leader in the remote care space. Her company, Upside Health, is dedicated to transforming pain care and has helped clinicians, health systems and tens of thousands of patients through their product, Branch Health. She is actively involved in legislation surrounding remote billing codes and collaborates with the AMA, CMS and leading law firms...
Find out more about Upside Health! https://Upside.health
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NYNJ-PS 2022 Annual Symposium- Nov. 3rd-6th, 2022!
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Doctors on Social Media, Physician Entrepreneurship and more! -
Dr Rosenblum welcomes his friend and Colleague Dana Corriel, MD. Dana runs the Facebook group SoMeDocs and has over 40,000 followers across her platform.
Her website doctorsonsocialmedia.com is a platform to help physicians network, showcase and develop their brands.
Follow Dana on Facebook at SoMeDocs and get updates on all of her online and offline events and projects.
Upcoming Events...
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NRAP’s Acute and Chronic Pain Ultrasound CME Workshop in NYC- Sept. 10th, 2022
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NRAP’s Blocks and Brunch Ultrasound CME Workshop- NYC Oct. 8th, 2022
Advanced Ultrasound Guided Injection Training Workshop!
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IPA Israel: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Oct 27, 2022
Advanced Ultrasound Guided Injection Training Workshop!
Lock in Your Spot Today!
Register Now!
NYNJ-PS 2022 Annual Symposium- Nov. 3rd-6th, 2022!
NYSIPP/ NJSIPP's Annual Pain Medicine Symposium
Come and join us in New Jersey in November | NYNJ-PS 2022
Save the Date! Nov. 3rd-6th, 2022
IPA Costa Rica: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Feb. 19, 2023
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Maxallure Mastermind Physician Coaching -
Dr. Rosenblum discusses business, coaching, work life balance and more with Dr. Myrdalis Diaz-Ramirez.
To find out more about her physician coaching program, go to https://www.maxallure.com/affiliate_users/sign_up
Upcoming Events...
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NRAP’s Acute and Chronic Pain Ultrasound CME Workshop in NYC- Sept. 10th, 2022
Advanced Ultrasound Guided Injection Training Workshop!
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Register Now!
NRAP’s Blocks and Brunch Ultrasound CME Workshop- NYC Oct. 8th, 2022
Advanced Ultrasound Guided Injection Training Workshop!
Lock in Your Spot Today!
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IPA Israel: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Oct 27, 2022
Advanced Ultrasound Guided Injection Training Workshop!
Lock in Your Spot Today!
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NYNJ-PS 2022 Annual Symposium- Nov. 3rd-6th, 2022!
NYSIPP/ NJSIPP's Annual Pain Medicine Symposium
Come and join us in New Jersey in November | NYNJ-PS 2022
Save the Date! Nov. 3rd-6th, 2022
IPA Costa Rica: Ultrasound Guided Chronic Pain and Regional Anesthesia Course, Feb. 19, 2023
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Being Prepared...
Life and Disability Insurance, What You Need to Know...
Dr. Rosenblum interviews financial planner, Greg Alerte as they discuss disability, life insurance and more!
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Justin Harvey & THE PRACTICE ACCELERATOR.
Thinking About Starting a Pain Practice?
In the latest PainExam podcast episode Dr. David Rosenblum dissects the many intricacies of starting a pain practice with expert Justin Harvey. Everything from planning, to practice set up and infrastructure, funding or financing the venture, and much more!
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Dr. Rosenblum interviews a local accupuncturist about his approach to pain and immune optimization. Chinese Herbalists approaches to viral outbreaks.
Preparing a Pain Office for COVID-19
Dr. Rosenblum discusses measures that the CDC recommends to protect an outpatient facility, patients, and staff from the Coronavirus Pandemic
https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/guidance-hcf.html
Dr. Rosenblum discusses recent in advances in Neuromodulation.
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DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.
You should regularly consult a physician in matters relating to yours or another’s health. You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.
Copyright © 2018 QBazaar.com, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.
references
Best Practices in Spinal Cord Stimulation
Sitzman, B. Todd, MD, MPH∗; Provenzano, David A., MD†
Comparison of Tonic vs. Burst Spinal Cord Stimulation During Trial Period
The Neurostimulation Appropriateness Consensus Committee (NACC): Recommendations on Bleeding and Coagulation Management in Neurostimulation Devices
An overview of fentanyl...
Reference
https://en.wikipedia.org/wiki/Fentanyl
AnesthesiaExam Podcast App For iPhone
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DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.
You should regularly consult a physician in matters relating to yours or another’s health. You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.
Copyright © 2018 QBazaar.com, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.
ABAStagedExams.com (Review for the Basic and Advanced Anesthesia Exams)
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Anesthesia Board Prep Instructor, David Rosenblum, MD discusses diagnosis, pathology, prevention and treatment of Postherpetic Neuralgia.
Discussed:
Pathology of the Varicella Zoster infection
Gabapentin
Lyrica
Amitriptyline
Capsaicin
Lidocaine patch
Valacyclovir
Zostavax- zoster vaccine
References
Nagel MA, Postherpetic Neuralgia: New Perspectives on Pathogenesis and Treatment. Pain Medicine News, 2015
Dworkin RH, Schmader KE. Herpes Zoster and Postherpetic Neuralgia. Essentials of Pain Medicine and Regional Anesthesia. Second Edition. 2005 p. 386-393
DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.
You should regularly consult a physician in matters relating to yours or another’s health. You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.
Copyright © 2015 QBazaar.com, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.
A review of the various Pain scales used to measure pain.
Podcast includes, VAS, VRS, McGill, Pain Questionnaire, FACES, FLACC, etc.
For more info go to AnesthesiaExam.com (CME Credits-MOC)
ABAStagedExams.com
(Basic and Advanced Board Prep)
For information on Children's Book Welwyn Ardsley and the Cosmic Ninjas: Preparing your Child and yourself for Anesthesia and Surgery
Go to Amazon.com or MyKidsSurgery.com
References
Stites M. Observational Pain Scales in Critically Ill AdultsCrit Care Nurse June 2013 vol. 33 no. 3 68-78
von Bayer CL. Children’s self-reports of pain intensity: Scale selection, limitations and interpretation. Pain Res Manag. 2006 Autumn; 11(3): 157–162.
Benzon H. Essentials of Pain Medicine and Regional Anesthesia. Second ediciton. 2005. p.29-33
DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment.
You should regularly consult a physician in matters relating to yours or another’s health. You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional.
Copyright © 2015 QBazaar.com, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.