Managing pain and Behavior guidance (Chapter 12) Flashcards
Why are infants and children more sensitive to pain?
Ascending pathways intact allowing full transmission of pain. Descending pathways modulating pathways poorly developed and unable to attenuate pain and do not have cognitive skills to modulate pain.
Theory of pain
descending pathway modify pain gate-activation of large fiber sensory neurons can modify pain perception.
Wong-baker FACES pain scale
Self reported pain w/faces validated for 3+
Visual Analogue pain scale
0-10 pain scale for 6+ on a numerical line.
Observational pain scale (FLACC)
Provider observes face, legs, arms, crying, consolability scale (FLACC) with a 0-2 scale.
Why does sucrose work to help manage pain?
Sucrose has same pathway as opioids; efficacy wanes at 6 months.
Benzocaine as a topical anesthetic
Up to 20%
Ester
Not for age 2 and under
Lidocaine as topical
Amide
5-10%
as ointment, patch or spray
Compound local topical anesthetics
High doses Tetracaine lidocaine benzocaine prilocaine phenylephrine Must consider systemic absorption when calculating total amount of anesthetic dosage administered.
What is the preservative in local anesthetics with epinephrine?
Bisulphate.
Use anesthetic w/o epinephrine for allergies to bisulphate
Articaine is metabolized where?
Liver and plasma.
Lidocaine metabolized by P450 cytochrome enzymes.
Which anesthetic has no epinephrine?
Mepivacaine.
Rule of 25
Can use 1 cartridge of any marked local anesthetic for every 25 pounds of body weight
Where is IAN foramen in children compared to adults?
More inferior and posterior in young children
What is phentolamine mesylate used for and MOA?
Local anesthetic reversal agent. Causes vasodilation by reversible nonselective alpha-adrenergic antagonist moving local anesthetic away from site for metabolism
