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24 - Pediatric Trauma and Anesthesia

Published online by Cambridge University Press:  18 January 2010

By
Jocelyn Loy
Edited by
Charles E. Smith
Jocelyn Loy
Affiliation:
Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
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Summary

Objectives

  1. Describe the differences between pediatric and adult trauma.

  2. Explain the initial evaluation and management priorities in an injured pediatric patient.

  3. Describe the developing physiologic and anatomical characteristics of infants and children.

  4. Identify anatomical characteristics of the pediatric airway and describe the associated implications for airway management after trauma with potential cervical spine injury.

  5. Describe fluid options and blood product resuscitation for a bleeding pediatric patient.

  6. Explain the anesthetic considerations applicable to the care of an injured child, and how trauma influences the choice of medications and other elements of the anesthetic plan.

  7. Describe the physiology and pharmacology of drugs used in the management of injured infants and children.

  8. List alternatives available for the management of pediatric acute postoperative pain, and explain the advantages and disadvantages of each.

Trauma remains the leading cause of mortality and serious long-term morbidity in the pediatric population. A significant majority of pediatric trauma occurs in motor vehicle accidents. Injuries related to falls and sports comprise the second largest group. Other causes include drowning, child abuse, and burns. Falls from heights are most common in toddlers, while older children sustain more traumatic injuries from motor vehicle and bicycle accidents [1]. Homicide is the leading cause of traumatic death in infants, 50 percent occurring in the first four months after birth [2]. Pediatric injuries vary from minor and isolated, to severe, multiple, and potentially fatal, involving several organ systems.

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Trauma Anesthesia , pp. 367 - 390
Publisher: Cambridge University Press
Print publication year: 2008

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References

Ross, AK. Pediatric trauma: Anesthetic management. Anesthesiol Clin N Am 2001;19:309–37.CrossRefGoogle Scholar
Christian, C. Assessment and evaluation of the physically abused child. Clin Fam Practice 2003;5(1):21–46.CrossRefGoogle Scholar
American Academy of Pediatrics and American Heart Association. Basic life support for the PALS healthcare provider. In PALS Provider Manual. Dallas, TX: American Heart Association, 2002, pp 43–80.
Herzenberg, JE, Hensinger, RN, Dedrick, DK, et al. Emergency transport and positioning of young children who have an injury of the cervical spine. The backboard may be hazardous. J Bone Joint Surg 1989;71-A:15–22.CrossRefGoogle Scholar
American College of Surgeons. Extremes of age: A pediatric trauma. In Advanced Trauma Life Support (ATLS) for Doctors, 7th edition. Student Course Manual. Chicago, IL: American College of Surgeons, 2004, pp 243–62.
Finucane, BT. Principles of Airway Management. Philadelphia: FA Davis, 1988.Google Scholar
Cote CJ. Pediatric anesthesia. In Miller, RD, ed. Miller's Anesthesia, 6th edition. Philadelphia: Churchill Livingstone, 2005, pp 2367–407.Google Scholar
Motoyama EK. Endotracheal intubation. In Motoyama, EK, Davis, PJ, ed. Smith's Anesthesia for Infants and Children, 5th edition. St. Louis, MO: C.V. Mosby, 1990, pp 269–75.Google Scholar
Fisher DM. Anesthesia equipment for pediatrics. In Gregory, GA, ed. Pediatric Anesthesia, 3rd edition. New York: Churchill Livingstone, 1994, pp 197–225.Google Scholar
Joshi, VV, Mandavia, SG, Stern, L, Wiglesworth, FW. Acute lesions induced by endotracheal intubation. Am J Dis Child 1972;124:646–49.CrossRefGoogle ScholarPubMed
Stocks, JG. Prolonged intubation and subglottic stenosis. BMJ 1966;2:1199–200.CrossRefGoogle Scholar
Stamm, D, Floret, D, Stamm, C et al. Subglottic stenosis following intubation in children. Arch Fr Pediatr 1993;50:21–5.Google Scholar
Hawkins, DB. Glottic and subglottic stenosis from endotracheal intubations. Laryngoscope 1977;87:339–46.CrossRefGoogle Scholar
Honig, EG. Persistent tracheal dilatation: onset after brief mechanical ventilation with a “soft-cuff” endotracheal tube. South Med J 1979;72:487–90.CrossRefGoogle ScholarPubMed
Deakers, TW, Reynolds, G. Cuffed endotracheal tubes in pediatric intensive care. J Pediatr 1994;125:57–62.CrossRefGoogle ScholarPubMed
Khine, HH, Corddry, DH, Kettrick, RG, et al. Comparison of cuffed and uncuffed endotracheal tubes in young children during general anesthesia. Anesthesiology 1997;86:627–31.CrossRefGoogle ScholarPubMed
Fine, GF, Borland, LM. The future of the cuffed endotracheal tube. Pediatr Anesth 2004;14:38–42.CrossRefGoogle ScholarPubMed
Weiss, M, Gerber, AC. Cuffed tracheal tubes in children – things have changed (Editorial). Pediatr Anesth 2006;16:1005–7.CrossRefGoogle Scholar
Browning, DH, Graves, SA. Incidence of aspiration with endotracheal tubes in children. J Pediatr 1983;102:582–4.CrossRefGoogle ScholarPubMed
Lau, N, Playfor, SD, Rashid, A Dhanarass. New formulae for predicting tracheal tube length. Pediatr Anesth 2006;16:1238–43.CrossRefGoogle ScholarPubMed
Okuyama, M, Imai, M, Sugawara, K, Okuyama, A, Kemmotsu, O. Finding appropriate tube position by the cuff palpation method in children. Masui 1995;44(6):845–8.Google ScholarPubMed
Bloch, EC, Ossey, K, Ginsberg, B. Tracheal intubation in children: A new method for assuring correct depth of tube placement. Anesth Analg 1988;67:590–2.CrossRefGoogle ScholarPubMed
Roth, B, Magnusson, J, Johansson, I, et al. Jaw lift – A simple and effective method to open the airway in children. Resuscitation 1998;39:171–4.CrossRefGoogle ScholarPubMed
Bruppacher, H, Reber, A, Keller, JP, et al. The effects of common airway maneuvers on airway pressure and flow in children undergoing adenoidectomies. Anesth Analg 2003;97:29–34.CrossRefGoogle ScholarPubMed
European Resuscitation Council. Part 9: Pediatric Basic Life Support. Resuscitation 2000, 46:301–41.CrossRef
Proctor, MR. Spinal cord injury. Crit Care Med 2002;30(11 Suppl):S489–99.CrossRefGoogle ScholarPubMed
Cantor, RM, Leaming, JM. Evaluation and management of pediatric major trauma. Emerg Med Clin N Am 1998;16:229–56.CrossRefGoogle ScholarPubMed
Schwaitzberg, SD, Bergman, KS, Harris, BH. A pediatric trauma model of continuous hemorrhage. J Pediatr Surg 1988;23:605–9.CrossRefGoogle ScholarPubMed
Losek, JD, Szewczuga, D, Glaeser, PW. Improved prehospital pediatric ALS care after an EMT-paramedic clinical training course. Am J Emerg Med 1994;12(4):429–32.CrossRefGoogle ScholarPubMed
Fiser, DH. Intraosseous infusion. N Engl J Med 1990;322 (22):1579–81Google ScholarPubMed
Badgwell, MJ. The traumatized child. Anesthesiol Clin N Am 1996;14(1): 151–71.CrossRefGoogle Scholar
Lieh-Lai, MW. Limitations of the Glasgow-Coma Scale in predicting outcome in children with traumatic brain injury. J Pediatr 1992;120:195.CrossRefGoogle ScholarPubMed
Sessler, DI, Moayeri, A. Skin surface warming: Heat flux and central temperature. Anesthesiology 1990;73:218–24.CrossRefGoogle ScholarPubMed
Jurkovich, GJ, Greiser, WB, Luterman, A, Curreri, PW. Hypothermia in trauma victims: An ominous predictor of survival. J Trauma 1987;27:1019–24.CrossRefGoogle ScholarPubMed
Michard, F. Changes in arterial pressure during mechanical ventilation (Review). Anesthesiology 2005;103:419–28.CrossRefGoogle Scholar
Cormack, RS, Lehane, J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984;39:1105–11.CrossRefGoogle Scholar
Rosen, M. Anaesthesia for obstetrics (Editorial). Anaesthesia 1981;36:145–6.CrossRefGoogle Scholar
Standards and guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). JAMA 1985;255:2905–84.
Schwartz, , Cohen, NH. Questionable effectiveness of cricoid pressure in preventing aspiration (Letter). Anesthesiology 1995;83:432.CrossRefGoogle Scholar
Kronn, SS. Questionable effectiveness of cricoid pressure in preventing aspiration (Letter). Anesthesiology 1995;83:431.CrossRefGoogle Scholar
Brimacrombe, JR, Berry, AM. Cricoid pressure. Can J Anesth 1997;44(4):414–25.CrossRefGoogle Scholar
Howells, TH, Chamney, AR, Wraight, WJ, Simons, RS. The application of cricoid pressure. An assessment and a survey of its practice. Anaesthesia 1983;38;457–60.Google Scholar
Sellick, BA. Cricoid pressure to prevent regurgitation of stomach contents during induction of anaesthesia. Lancet 1961;2:404–6.CrossRefGoogle Scholar
Cowling, J. Cricoid pressure- a more comfortable technique (Letter)Anaesth Intensive Care 1982;10:93–4.Google Scholar
Yoshikawa, K, Murai, Y. The effect of ketamine on intraocular pressure in children. Anesth Analg 1971;50:199–202.CrossRefGoogle ScholarPubMed
Gardner, AE, Olson, BE, Lichtiger, M. Cerebrospinal fluid pressure during dissociative anesthesia with ketamine. Anesthesiology 1971;35:226.CrossRefGoogle ScholarPubMed
Wagner, RL, White, PF. Etomidate inhibits adrenocortical function in surgical patients. Anesthesiology 1984;61(6):647–51.CrossRefGoogle ScholarPubMed
Longnecker, . Stress-free: to be or not to be?Anesthesiology 1984;61:643–4.CrossRefGoogle ScholarPubMed
Williams, CH, Deutsch, S, Linde, HW, Bullough, JW, Dripps, RD. The effects of intravenously administered succinylcholine on cardiac rate, rhythm and arterial blood pressure in anesthetized man. Anesthesiology 1961;22:947–54.CrossRefGoogle ScholarPubMed
Green, DW, Bristow, AS, Fisher, M. Comparison of i.v. glycopyrrolate and atropine in the prevention of bradycardia and arrhythmias following repeated doses of suxamethonium in children. Br J Anaesth 1984;56(9):981–5.CrossRefGoogle ScholarPubMed
Robinson, AL, Jerwood, DC, Stokes, MA. Routine suxamethonium in children. A regional survey of current usage. Anaesthesia 1996;51(9):874–8.CrossRefGoogle ScholarPubMed
McAuliffe, G, Bissonnette, B, Boutin, C. Should routine use of atropine before succinylcholine in children be reconsidered?Can J Anesth 1995;42(8):724–9.CrossRefGoogle ScholarPubMed
Shorten, GD, Bissonette, B, Hartley, E, Nelson, W, Carr, AS. It is not necessary to administer more than 10 micrograms.kg-1 of atropine to older children before succinylcholine. Can J Anaesth 1995;42(1):8–11.CrossRefGoogle ScholarPubMed
Das, G, Talmers, FN, Weissler, AM. New observations on the effects of atropine on the sinoatrial node and atrioventricular nodes in man. Am J Cardiol 1975;36:281–5.CrossRefGoogle ScholarPubMed
Goudsouzian, NG. Turbe del ritmo cardiaco durante intubazione tracheale nei bambini. Acta Anaesthesiol Ital 1981;32:393–6.Google Scholar
Hirsch, EF. Innervation of the vertebrate heart. Springfield, IL: Charles C Thomas, 1970, pp 125–33.Google Scholar
McAuliffe, G, Bissonnette, B, Boutin, C. Should atropine be routine in children?Can J Anesth 1996;43(7):754.CrossRefGoogle Scholar
McGowan FX Jr, Steven JM. Cardiac physiology and pharmacology. In Cote CJ, Todres ID, Goudsouzian NG, Ryan JF, ed. A Practice of Anesthesia for Infants and Children, 3rd edition. Philadelphia: W.B. Sanders Company, 2001, pp 353–90.
Parnis, SJ, Walt, Jr. A national survey of atropine by Australian anaesthetists. Anaesth Intensive Care 1994;22(1):61–5.Google ScholarPubMed
Jonsson, M, Dabrowski, M, Gurley, DA, Larsson, O, Johnson, EC, Fredholm, BB, Eriksson, LI. Activation and inhibition of human muscular and neuronal nicotinic acetylcholine receptors by succinylcholine. Anesthesiology 2006;104:724–33.CrossRefGoogle ScholarPubMed
Naguib M, Lien CA. Pharmacology of muscle relaxants and their antagonists. In Miller, RD, ed. Anesthesia, 6th edition. Philadelphia: Elsevier Churchill Livingston, 2004, pp 481–572.Google Scholar
Seiber, FE, Smith, DS, Traystman, RJ, Wollman, H.Glucose: A reevaluation of its intraoperative use. Anesthesiology 1987;67:72–81.CrossRefGoogle Scholar
Lam, AM, Winn, HR, Cullen, BF, et al. Hyperglycemia and neurological outcome in patients with head injury. J Neurosurg 1991:75:545–51.CrossRefGoogle ScholarPubMed
Soderlind, M, Salvignol, Izard P, Lonnqvist, PA. Use of albumin, blood transfusion and intraoperative glucose by APA and ADARPEF members: A postal survey. Pediatr Anesth 2001;11:685–9.CrossRefGoogle ScholarPubMed
Robertson, NR. Use of albumin in neonatal resuscitation. Eur J Pediatr 1997;156:428–31.CrossRefGoogle Scholar
Greenough, A. Use and misuse of albumin infusions in neonatal care. Eur J Pediatr 1998;157:699–702.CrossRefGoogle ScholarPubMed
Treib, J, Haass, A, Pindur, G. Coagulation disorders caused by hydroxyethyl starch. Thromb Haemost 1997;78:974–83.Google ScholarPubMed
Gan, TJ, Bennett-Guerrero, E, Phillips-Bute, B, et al. Hextend, a physiologically balanced plasma expander for large volume use in major surgery: A randomized phase III clinical trial. Hextend Study Group. Anesth Analg 1999;88:992–8.CrossRefGoogle ScholarPubMed
Martin, G, Bennett-Guerrero, E, Wakeling, H, et al. A prospective, randomized comparison of thromboelastographic coagulation profile in patients receiving lactated Ringer's solution, 6% hetastarch in balanced-saline vehicle, or 6% hetastarch in saline during major surgery. J Cardiothorac Vasc Anesth 2002;16(4):441–6.CrossRefGoogle ScholarPubMed
Roche, AM, James, MF, Grocott, MP, Mythen, MG. Coagulation effects of in vitro serial haemodilution with a balanced electrolyte hetastarch solution compared with a saline-based hetastarch solution and lactated Ringer's solution. Anaesthesia 2002;57:950–5.CrossRefGoogle ScholarPubMed
Roche, AM, James, MF, Bennett-Guerrero, Mythen MG. A head-to-head comparison of the in vitro coagulation effects of saline-based and balanced electrolyte crystalloid and colloid intravenous fluids. Anesth Analg 2006;102:1274–9.CrossRefGoogle ScholarPubMed
Paul, M, Dueck, M, Herrmann, J, Holzki, J. A randomized, controlled study of fluid management in infants and toddlers during surgery: hydroxyethyl starch 6% (HES 70/0.5) vs. lactated Ringer's solution. Pediatr Anesth 2003;13:603–8.CrossRefGoogle ScholarPubMed
Brutocao, D, Bratton, SL, Thomas, JR, et al. Comparison of hetastarch with albumin for postoperative volume expansion in children after cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1996;10(3):348–51.CrossRefGoogle ScholarPubMed
Berry, FA. Practical Aspects of fluid and electrolyte therapy. In Berry, FA, ed. Anesthetic Management of Difficult and Routine Pediatric Patients, 2nd edition. New York: Churchill Livingstone, 1990, pp 89–120.Google Scholar
Morenski, JD, Tobias, JD, Jimenez, DF. Recombinant activated factor VII for cerebral injury-induced coagulopathy in pediatric patients: report of three cases and review of literature. J Neurosurg 2003;98(3):611–6.CrossRefGoogle Scholar
Kulkarni, R, Daneshmand, A, Guertin, S, et al. Successful use of activated recombinant factor VII in traumatic liver injuries in children. J Trauma 2004:56:1348–52.CrossRefGoogle ScholarPubMed
Heisel, M, Nagib, M, Madsen, L, et al. Use of recombinant factor VIIa (rFVIIa) to control intraoperative bleeding in pediatric brain tumor patients. Pediatr Blood Cancer 2004;43(6):703–5.CrossRefGoogle ScholarPubMed
Tofil, NM, Winkler, MK, Watts, RG, Noonan, J. The use of recombinant factor VIIa in a patient with Noonan syndrome and life-threatening bleeding. Pediatr Crit Care Med 2005;6(3):352–4.CrossRefGoogle Scholar
Tobias, JD. Synthetic factor VIIa to treat dilutional coagulopathy during posterior spinal fusion in two children. Anesthesiology 2002;96:1522–25.CrossRefGoogle ScholarPubMed
Tobias, JD, Berkenbosch, JW, Russo, P. Recombinant factor VIIa to treat bleeding after cardiac surgery in an infant. Pediatr Crit Care Med 2003:4(1):49–51.CrossRefGoogle ScholarPubMed
Cote, CJ, Liu, LM, Szyfelbein, SK, et al. Changes in serial platelet counts following massive blood transfusion in pediatric patients. Anesthesiology 1985;62:197–201.CrossRefGoogle ScholarPubMed
Tepas, JJ III, DiScala, DL, Ramenofsky, ML, Barlow, B. Mortality and head injury: The pediatric perspective. J Pediatr Surg 1990;25(1):92–6.CrossRefGoogle ScholarPubMed
Lam, WH, Mackersie, A. Paediatric head injury: Incidence, aetiology and management. Paediatr Anaesth 1999;9:377–85.CrossRefGoogle ScholarPubMed
Bruce, DA, Alavi, A, Bilaniuk, L, et al. Diffuse cerebral swelling following head injuries in children: The syndrome of “malignant of brain edema.”J Neurosurg 1981;54:170–8.CrossRefGoogle Scholar
Schutzman, SA, Greenes, DS. Pediatric minor head trauma. Ann Emerg Med 2001;37:65–74.CrossRefGoogle ScholarPubMed
Welch, K. The intracranial pressure in infants. J Neurosurg 1980;52:693–9.CrossRefGoogle ScholarPubMed
White, JR, Dalton, HJ. Pediatric trauma: Post-injury care in the pediatric intensive care unit. Crit Care Med 2002;30(11 Suppl):S478–88.CrossRefGoogle Scholar
Pigula, FA, Wald, SL, Shackford, SR, Vane, DW. The effect of hypotension and hypoxia on children with severe head injuries. J Pediatr Surg 1993;28:310–4.CrossRefGoogle ScholarPubMed
Mazzola, CA, Adelson, PD. Critical care management of head trauma in children. Crit Care Med 2002;30 (11 Supp)l:S393–401.CrossRefGoogle ScholarPubMed
Muizelaar, JP, Marmarou, A, Ward, JD, et al. Adverse effects of prolonged hyperventilation in patients with severe head injury. A randomized clinical trial. J Neurosurg 1991;75:731–9.CrossRefGoogle ScholarPubMed
Bullock, R, Chestnut, R, Clifton, G, et al. Guidelines for management of severe traumatic brain injury. J Neurotrauma 2000;17:451–553.Google Scholar
Adelson, PD, Bratton, SL, Carney, NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents. Chapter 12: Use of hyperventilation in the acute management of severe pediatric traumatic brain injury. Pediatr Crit Care Med 2003;4(3 Suppl):S45–8.Google ScholarPubMed
Adelson, PD, Bratton, SL, Carney, NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents. Chapter 11: Use of hyperosmolar therapy in the acute management of severe pediatric traumatic brain injury. Pediatr Crit Care Med 2003;4(3 Suppl):S40–4.Google ScholarPubMed
Adelson, PD, Bratton, SL, Carney, NA, Chestnut, RM, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children and adolescents. Chapter 19: The role of anti-seizure prophylaxis following severe pediatric traumatic brain injury. Pediatr Crit Care Med 2003:4(3 Suppl):S72–4.Google Scholar
Albenese, J, Arnaud, S, Rey, M, et al. Ketamine decreases intracranial pressure and electroencephalographic activity in traumatic brain injury patients during propofol sedation. Anesthesiology 1997;87(6):1328–34.CrossRefGoogle Scholar
Wade, JG, Stevens, WC. Isoflurane: An anesthetic for the eighties?Anesth Analg 1981;60:666–82.CrossRefGoogle ScholarPubMed
Newberg, , Michenfelder, JD. Cerebral protection by isoflurane during hypoxemia and ischemia. Anesthesiology 1983; 59:29–35.CrossRefGoogle ScholarPubMed
Saxena AK, Nance ML, Lutz N, Stafford PW. Abdominal Trauma. Available at: www.emedicine.com/ped/topic3045.htm (last accessed February 4, 2007).
Gaines, BA, Ford, HR. Abdominal and pelvic trauma in children. Crit Care Med 2002;30:11(Suppl):S416–23.CrossRefGoogle ScholarPubMed
Powell, M, Courcoulas, A, Gardner, M, et al. Management of splenic trauma: Significant differences between adults and children. Surgery 1997;122:654–60.CrossRefGoogle ScholarPubMed
Thourani, VH, Pettitt, BJ, Schmidt, JA, et al. Validation of surgeon-performed emergency abdominal ultrasonography in pediatric trauma patients. J Pediatr Surg 1998;33:322–8.CrossRefGoogle ScholarPubMed
Furnival, R. Controversies in pediatric thoracic and abdominal trauma. Clin Pediatr Emerg Med 2001;2:48–62.CrossRefGoogle Scholar
Othersen HB Jr. Cardiothoracic injuries. In Touloukian, JR, ed. Pediatric Trauma, 3rd edition. St. Louis, MO: Mosby, 1990, pp 266–311.Google Scholar
Peterson, RJ, Tiwary, AD, Kissoon, N, Tepas, JJ III, Ceithaml, EL, Pieper, P. Pediatric penetrating thoracic trauma: A five-year experience. Pediatr Emerg Care 1994;10:129–31.CrossRefGoogle ScholarPubMed
Peterson, RJ, Tepas, JJ III, Edwards, FH, Kissoon, N, Pieper, P, Ceithaml, EL. Pediatric and adult thoracic trauma: Age-related impact on presentation and outcome. Ann Thoracic Surg 1994;58:14–8.CrossRefGoogle ScholarPubMed
Zwass MS, Polaner DM, Berde CB. Postoperative pain management. In Cote, CJ, Todres, ID, Goudsouzian, NG, Ryan, JF, ed. Practice of Anesthesia for Infants and Children, 3rd edition. Philadelphia: W.B. Sanders Company, 2001, pp 675–97.Google Scholar
Wong, DL. Whaley and Wong's Essential of Pediatric Nursing, 5th edition. St. Louis, MO: Mosby Inc., 1997, pp 1215–6.Google Scholar
Brislin, RP, Rose, JB. Pediatric acute pain management. Anesthesiol Clin N Am 2005;23:789–814.CrossRefGoogle ScholarPubMed
Gerstenfeld, LC, Thiede, M, Seibert, K, et al. Differential inhibition of fracture healing by nonselective and cyclo-oxygenase-2 selective nonsteroidal anti-inflammatory drugs. J Orthop Res 2003;21(4):670–5.CrossRefGoogle Scholar
Gunter, JB, Vaurghese, AM, Harrington, JF. Recovery and complications after tonsillectomy in children: A comparison of ketorolac and morphine. Anesth Analg 1995;81:1136–41.Google Scholar
Berde, CB, Lehn, BM, Yee, JD, et al. Patient-controlled analgesia in children and adolescents: A randomized, prospective comparison with intramuscular administration of morphine for postoperative analgesia. J Pediatr 1991;118:460–6.CrossRefGoogle ScholarPubMed
Monitto, CL, Greenberg, RS, Kost-Beyerly, 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.CrossRefGoogle ScholarPubMed
Rose JB. Acute pain management in children. In Litman, RS, ed. Pediatric Anesthesia: The Requisites in Anesthesiology. Philadelphia: Mosby, Inc., 2004, pp 212–8.Google Scholar
Krane, EJ, Dalens, BJ, Murat, I, et al. The safety of epidurals placed during general anesthesia. Reg Anesth Pain Med 1998;23:433–8.CrossRefGoogle ScholarPubMed
Giaufre, E, Dalens, B, Gombert, A. Epidemiology and morbidity of regional anesthesia in children: A 1-year prospective survey of the French Language Society of Pediatric Anesthesiologists. Anesth Analg 1996;83:904–12.CrossRefGoogle Scholar

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  • Pediatric Trauma and Anesthesia
    • By Jocelyn Loy, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.027
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  • Pediatric Trauma and Anesthesia
    • By Jocelyn Loy, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.027
Available formats
×

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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Pediatric Trauma and Anesthesia
    • By Jocelyn Loy, Department of Anesthesiology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.027
Available formats
×