Pain management in infants and children

Recommended Reading

Chapter 39: Pain Management in Infants and Children
Pages 265 - 270 (Tintinalli's Emergency Medicine, 7th Edition)

Key Points

• Pediatric procedures should be performed with pharmacological and nonpharmacological adjuncts to minimize pain (analgesia), decrease anxiety (anxiolysis), and provide sedation.
• Fasting status has no correlation with aspiration. Preprocedural fasting is not required and only prevents a theoretical risk of aspiration, though no evidence supports this risk.

Reading Quiz

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Quiz

1 Versed (midazolam) is an ANXIOLYTIC. Match weight-based dosing with its route:

Oral (PO)	Intranasal (IN)	Intravenous (IV)
			0.5 mg/kg
			0.2 mg/kg
			0.05-0.1 mg/kg

2 Which of the following medications for TOPICAL ANALGESIA is best for open wounds:

	EMLA (lidocaine 2.5% + prilocaine 2.5%)
	LET (lidocaine 4% + epinephrine 0.1% + tetracaine 0.4%)
	Ametop (tetracaine 4%)
	LMX (lidocaine 4% or 5%)

3 Which SYSTEMIC ANALGESIC may cause rigid chest phenomenon in high doses in young patients?

	Midazolam (standard IV dose 0.05-0.1 mg/kg; reverse with flumazenil)
	Ketorlac (standard IM dose 1 mg/kg)
	Acetaminophen (standard PO dose 15 mg/kg; reverse with N-acetylcysteine)
	Fentanyl (standard IV dose 1-2 mcg/kg; reverse with naloxone)

4 Which dissociative anesthetic (which also provides a degree of analgesia) used for SEDATION works in "threshold" dosing? This medication is emetogenic and may increase intracranial pressure, intraocular pressure, and salivation (though it does have a bronchodilatory affect).

	Morphine (0.1-0.3 mg/kg IV)
	Hydromorphone (0.015-0.02 mg/kg IV)
	Ketamine (1-1.5 mg/kg IV)
	Propofol (1-2 mg/kg IV)