According to the World Health Organization, life-threatening infectious diseases, even in remote and vulnerable locations, can be minimised through immunisation. Vaccines interact with the immune system to produce an immune response similar to that produced by natural infection. However, about 10% of the population avoid vaccination and other needle procedures because of “needle fear”. Because of the prevalence of injection pain and more concern about the adequacy of pain management, and with the steadily increasing number of recommended childhood immunisation, we identified a need for evidence-based guidelines on pain management to be developed in our local setting through translational nursing practice. After a critical appraisal of randomised controlled trials and systematic reviews, it is highly recommended that “topical anaesthetics are effective in reducing vaccination pain” (Grade A recommendation, based on level I evidence by SIGN). In order to facilitate practice from evidence, the implementation potential, transferability, feasibility and cost-benefit ratio - has been examined, and an evidence-based guideline has been developed simultaneously for the new practice. With the identification of stakeholders and the development of a communication plan, potential users of the guideline and pilot testing are discussed. Innovation outcomes and their effectiveness are examined and explored. It is expected that, through this translational nursing practice, vaccination induced pain and distress among healthy children can be managed well, according to the best evidence and up-to-date recommendations. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Thesis (MSc.(Anatomy)--Faculty of Health Sciences)-University of Pretoria, 2004. / Summary in English and Afrikaans. Includes bibliographical references.

Übergewicht und Adipositas im Kindes- und Jugendalter sind Gesundheitsprobleme, die auch auf dem Gebiet der Anästhesie zunehmend relevant werden. In der vorliegenden Dissertationsschrift wurde untersucht, inwiefern übergewichtige Kinder und Jugendliche, im Vergleich zu nicht-übergewichtigen, Komplikationen des Atemwegsmanagementes und der Oxygenierung während einer Allgemeinanästhesie aufweisen und welche Bedeutung die Thematik in der deutschen Population für die Kinderanästhesie hat. Mit Hilfe spezieller Erfassungsbögen wurden folgende Parameter ermittelt und die übergewichtigen mit den nicht-übergewichtigen Studienteilnehmern verglichen: der Mallampati Score, schwierige Maskenventilation und Intubation, die Verwendung eines Atemwegshilfsmittels, der Cormack-Lehane Score und die Anzahl der Intubationsversuche. Daneben wurde die Inzidenz von Atemwegsobstruktionen (Broncho- und Laryngospasmen), Husten als Zeichen der Atemwegsirritation und Sauerstoffsättigungsabfälle um mehr als 10 % des Ausgangswertes erfasst. Es zeigte sich ein signifikant höherer Mallampati Score und ein signifikant häufigeres Auftreten von Husten (p < 0,05). Alle weiteren Parameter blieben ohne statistisch relevanten Unterschied, obwohl Atemwegshilfsmittel prozentual häufiger bei Übergewichtigen eingesetzt wurden. Bei einer gesonderten Analyse der in die Studie eingeschlossenen Untergewichtigen zeigte sich eine überraschend gehäufte Inzidenz hinsichtlich der schwierigen Laryngoskopie und einer Reintubation. Die verschiedenen Ursachen für die vorliegenden Ergebnisse werden in der Promotionsschrift detailliert diskutiert. Es wird insgesamt deutlich, dass nicht alleine Übergewicht und Adipositas ausschlaggebend für Atemwegskomplikationen sind, aber durchaus einen Risikofaktor darstellen. Darüber hinaus scheinen auch untergewichtige Kinder ein erhöhtes Risiko für Atemwegskomplikationen zu habe.

Thesis (M.S.)--University of Michigan, 1997. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 2006. / Includes bibliographical references (leaves 116-122).

Orientador: Leandro Gobbo Braz / Banca: Norma Sueli Pinheiro Módolo / Banca: Eduardo Toshiyuki Moro / Banca: Marco Aurélio Marangoni / Banca: Artur Udelsmann / Resumo: A população pediátrica apresenta incidência mais elevada de parada cardíaca e de óbito perioperatório em relação à adulta. O objetivo do presente estudo foi avaliar a incidência, os fatores desencadeantes e as causas de parada cardíaca e de óbito em pacientes pediátricos durante a anestesia em hospital universitário de atendimento terciário no período de 2005 a 2010. Por meio de um Banco de Dados, o estudo prospectivo identificou a incidência de parada cardíaca e de óbito em 10.649 anestesias pediátricas. As incidências foram calculadas em relação aos atributos: faixa etária, sexo, estado físico segundo a ASA, tipo de atendimento, especialidade cirúrgica, técnica anestésica empregada e fatores desencadeantes (doença/condição do paciente, cirurgia e anestesia como fator principal ou fator contributivo). Foram identificadas 22 paradas cardíacas na sala de operações em crianças sendo que 11 evoluíram ao óbito. Maiores incidências de parada cardíaca ocorreram em pacientes neonatais e lactentes com estado físico ASA IV e V, em cirurgia de emergência durante anestesia geral ou em cuidados de monitorização e suporte e durante cirurgias cardíaca e vascular. A doença/condição do paciente foi o principal fator de parada cardíaca e de óbito. O índice de letalidade foi maior em crianças de 31 dias a um ano de idade, com estado físico ASA V, em cirurgia de emergência e em pacientes ASA V sob cuidados de monitorização e suporte e relacionado ao fator doença/condição do paciente. Ocorreram três paradas cardíacas por fator anestésico contributivo (2,81:10.000) todas em razão de causas respiratórias. Não houve óbito por fator anestésico. Em hospital de ensino de atendimento terciário, a incidência de parada cardíaca (20,65:10.000 anestesias) e de óbito (10,32:10.000 anestesias) em pacientes pediátricos durante a anestesia foi elevada. A incidência de parada cardíaca ... / Abstract: Perioperative cardiac arrest and mortality incidences in children are higher than in adults. This study aimed to evaluate the incidence, causes, and outcomes of cardiac arrest and death in a pediatric surgical population during anesthesia in a tertiary care university hospital from 2005 to 2010. Cardiac arrest and death incidences during anesthesia in 10,649 anesthetics performed in children were identified from an anesthesia database. Cardiac arrest and death rates were calculated in relation to age, gender, ASA physical status classification, anesthesia provider information, surgical speciality, type of procedure and triggering factors (totally anesthesia-related; partially anesthesia-related; totally surgery-related; or totally child disease/condition-related). There were 22 cardiac arrests and 11 deaths in children during anesthesia. Major cardiac arrest and death incidences were observed in children under one year age; emergency surgery; ASA physical status IV or V; monitoring care and support in ASA V patients; and in cardiac and vascular procedures. Child disease/condition was the major cause of cardiac arrest or death. Lethality calculated rates were higher in 31 days - 1 year age children; emergency surgery; ASA V physical status; monitoring care and support in ASA V patients; and child disease/condition related. There were three cardiac arrests partially anesthesia-related (2,81:10.000). There were no anesthesia-related deaths. Respiratory classified events were the most common causes of anesthesia-related cardiac arrest. Cardiac arrest (20.65 per 10,000 anesthetics) and mortality (10.32 per 10,000 anesthetics) incidences were increased over a 6-year period in a tertiary teaching hospital. Anesthesia-related cardiac arrest incidence was 2.81 per 10,000 anesthetics. There were no anesthesia-related deaths. Major cardiac arrest and death incidences were in children under 1 year age; ASA IV or V ... / Doutor

Made available in DSpace on 2014-06-11T19:35:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-25Bitstream added on 2014-06-13T18:46:10Z : No. of bitstreams: 1 000738127.pdf: 2515853 bytes, checksum: b14e7ea0ddd1cbbc1ade96ae04a05861 (MD5) / A população pediátrica apresenta incidência mais elevada de parada cardíaca e de óbito perioperatório em relação à adulta. O objetivo do presente estudo foi avaliar a incidência, os fatores desencadeantes e as causas de parada cardíaca e de óbito em pacientes pediátricos durante a anestesia em hospital universitário de atendimento terciário no período de 2005 a 2010. Por meio de um Banco de Dados, o estudo prospectivo identificou a incidência de parada cardíaca e de óbito em 10.649 anestesias pediátricas. As incidências foram calculadas em relação aos atributos: faixa etária, sexo, estado físico segundo a ASA, tipo de atendimento, especialidade cirúrgica, técnica anestésica empregada e fatores desencadeantes (doença/condição do paciente, cirurgia e anestesia como fator principal ou fator contributivo). Foram identificadas 22 paradas cardíacas na sala de operações em crianças sendo que 11 evoluíram ao óbito. Maiores incidências de parada cardíaca ocorreram em pacientes neonatais e lactentes com estado físico ASA IV e V, em cirurgia de emergência durante anestesia geral ou em cuidados de monitorização e suporte e durante cirurgias cardíaca e vascular. A doença/condição do paciente foi o principal fator de parada cardíaca e de óbito. O índice de letalidade foi maior em crianças de 31 dias a um ano de idade, com estado físico ASA V, em cirurgia de emergência e em pacientes ASA V sob cuidados de monitorização e suporte e relacionado ao fator doença/condição do paciente. Ocorreram três paradas cardíacas por fator anestésico contributivo (2,81:10.000) todas em razão de causas respiratórias. Não houve óbito por fator anestésico. Em hospital de ensino de atendimento terciário, a incidência de parada cardíaca (20,65:10.000 anestesias) e de óbito (10,32:10.000 anestesias) em pacientes pediátricos durante a anestesia foi elevada. A incidência de parada cardíaca... / Perioperative cardiac arrest and mortality incidences in children are higher than in adults. This study aimed to evaluate the incidence, causes, and outcomes of cardiac arrest and death in a pediatric surgical population during anesthesia in a tertiary care university hospital from 2005 to 2010. Cardiac arrest and death incidences during anesthesia in 10,649 anesthetics performed in children were identified from an anesthesia database. Cardiac arrest and death rates were calculated in relation to age, gender, ASA physical status classification, anesthesia provider information, surgical speciality, type of procedure and triggering factors (totally anesthesia-related; partially anesthesia-related; totally surgery-related; or totally child disease/condition-related). There were 22 cardiac arrests and 11 deaths in children during anesthesia. Major cardiac arrest and death incidences were observed in children under one year age; emergency surgery; ASA physical status IV or V; monitoring care and support in ASA V patients; and in cardiac and vascular procedures. Child disease/condition was the major cause of cardiac arrest or death. Lethality calculated rates were higher in 31 days - 1 year age children; emergency surgery; ASA V physical status; monitoring care and support in ASA V patients; and child disease/condition related. There were three cardiac arrests partially anesthesia-related (2,81:10.000). There were no anesthesia-related deaths. Respiratory classified events were the most common causes of anesthesia-related cardiac arrest. Cardiac arrest (20.65 per 10,000 anesthetics) and mortality (10.32 per 10,000 anesthetics) incidences were increased over a 6-year period in a tertiary teaching hospital. Anesthesia-related cardiac arrest incidence was 2.81 per 10,000 anesthetics. There were no anesthesia-related deaths. Major cardiac arrest and death incidences were in children under 1 year age; ASA IV or V ...

Orientadores: Artur Uldesmann, Antônio Gonçalves de Oliveira Filho / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-19T05:11:13Z (GMT). No. of bitstreams: 1 Bassanezi_BetinaSilviaBeozzo_D.pdf: 847548 bytes, checksum: c9637586230bf2f7cf661864b073a7fd (MD5) Previous issue date: 2011 / Resumo: A incidência de vômitos pós-operatórios em pediatria ainda é alta, apesar dos avanços da anestesia. A ocorrência de vômitos pós-operatórios gera grande insatisfação nos pacientes e seus familiares, pois compromete a qualidade de vida e recuperação das crianças neste período. A profilaxia de vômitos pós-operatórios tem como primeiro passo identificar os pacientes de risco e o grau deste através de uma pontuação. Até o momento existe apenas uma escala de risco proposta para a população pediátrica a escala de Eberhart baseada numa análise estatística de regressão logística. A lógica fuzzy é uma teoria matemática que reconhece não somente duas possibilidades, verdadeiro ou falso como na lógica clássica, mas graus diferentes de falso e verdadeiro, o que permite uma melhor análise de varáveis contínuas como: idade e tempo de anestesia. Este estudo teve como objetivo desenvolver uma nova escala utilizando a teoria fuzzy para predizer a probabilidade de vômitos pósoperatórios em pacientes pediátricos oncológicos a partir da determinação dos fatores de risco. Foram coletados e analisados dados de 198 pacientes menores de 19 anos. Estes dados foram submetidos inicialmente ao teste qui-quadrado e regressão logística para determinar quais variáveis eram estatisticamente significativas para o risco de vômitos pós-operatórios. Destacaram-se quatro fatores de risco: idade, tempo de anestesia, uso de opióides para analgesia pósoperatória e tipo de cirurgia. A partir destes fatores foi criado um sistema para o cálculo de risco baseado na lógica fuzzy com uma interface computacional. O modelo fuzzy desenvolvido foi comparado com o proposto por Eberhart e mostrou-se mais efetivo para esta população. A interface computacional está disponível para acesso na internet (www.hc.unicamp.br/downloads/VPO/) e é de fácil utilização, sendo capaz de predizer a probabilidade de VPO em crianças com câncer com boa acurácia, possibilitando um melhor planejamento da profilaxia anti-emética / Abstract: Despite impressive advances in the field of anaesthesia, postoperative vomiting (POV) has a higher incidence in children. PONV may decrease children and parental satisfaction after surgeries, and impact on quality of living during recovery. The first rule for rational approach of PONV control is identify the patient at risk using predictive factors. There is only one specific score that predicts POV in children, the Eberhart's score. Fuzzy logic is a mathematical theory that has emerged as a type of logic that recognizes more than simple true and false values and takes into account levels of continuous variables such as age or duration of the surgery. In this study, we developed a fuzzy model to predict the probability of POV in pediatric oncologic patients who underwent surgery. Preoperative potential risk factors for POV in 198 children (0-19 yr old) with malignancies were collected and analyzed. Data analysis was performed with the chi-square test and logistic regression to evaluate probable risk factors for POV. This study found four risk factors: age, time of anesthesia, use postoperative opioids and type of surgery. A system based on fuzzy logic was developed with the risk factors found in the logistic regression, and a computational interface was created to calculate the probability of POV. After the analysis, the model was compared with Eberhart's score in the same population and showed a better performance. The use of the computational interface is available through the internet(www.hc.unicamp.br/downloads/VPO/), it is very easy to use and can predict the chance of POV in children with cancer with good accuracy, allowing better planning for postoperative prophylaxis of vomiting / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

Bakgrund: Att vårda barn perioperativt ställer höga krav på personalens kompetens. Barn skall inom vården inte betraktas som små vuxna. Anestesisjuksköterskan behöver ha särskilda kunskaper om andning, cirkulation och farmakokinetik vid olika åldrar. Syfte: Undersöka vilka faktorer anestesisjuksköterskan betraktar som mest utmanande inför generell anestesi på mindre barn på en allmän operationsavdelning, samt undersöka sambandet mellan de betraktade utmaningarna och bakgrundsfaktorer. Metod: Kvantitativ tvärsnittsstudie med enkäter som distribuerades till anestesisjuksköterskor. Deskriptiv och statistisk analys har genomförts. Resultat: 97% av respondenterna känner någon grad av oro i samband med generell anestesi på barn. De faktorer som upplevs som mest utmanande är laryngospasm och hypoxi. Kvinnor upplever oro i högre utsträckning än män, yngre upplever mer oro än äldre och de med kortare arbetserfarenhet upplever oro i större utsträckning än dem med längre arbetserfarenhet. Konklusion: Laryngospasm och hypoxi är allvarliga tillstånd som kan förekomma vid generell anestesi på barn. Den unga och/eller oerfarne ser detta som mer utmanande än den äldre och/eller erfarne. Det är av betydelse att den erfarne medarbetaren sprider sin kunskap genom teamarbete för att den oerfarne kollegan ska kunna ge en god och säker vård / Background: Caring for children perioperatively places high demands on the staff's competence. Children should not be regarded as small adults. The nurse anesthetist needs special knowledge of breathing, circulation and pharmacokinetics at different ages. The aim: Investigate which factors the nurse anesthetist considers most challenging before general anesthesia in smaller children in a general operating department and investigate the connection between the consider challenger and background factors. Method: Quantitative cross-sectional study with questionnaires that was distributed to nurse anesthetists. Descriptive and statistical analysis has been carried out. Results: 97% of the respondents feel some degree of anxiety in connection with general anesthesia in children. The factors perceived as most challenging are laryngospasm and hypoxia. Women experience anxiety to a greater extent than men, younger experience more anxiety than elder and those with shorter work experience feel anxiety to a greater extent than those with longer experience. Conclusion: Laryngospasm and hypoxia are serious conditions that can occur during general anesthesia in children. The young and/ or inexperienced see this as more challenging than the older and/ or experienced. It is important that the experienced employee spreads their knowledge through teamwork so that the inexperienced colleague can provide good and safe care.

Emergence delirium (ED), also known as emergence agitation, is a postoperative condition characterized by aberrant cognitive and psychomotor behaviors following general anesthesia. The incidence of ED is 3 to 8 times higher in children 5 years of age or less. There is no standard of nursing practice for managing ED symptoms in the pediatric surgical population. The purpose of this quality improvement project was to address a gap in knowledge needed to inform clinical decision-making when managing ED in the postoperative setting. Using an educational presentation for post anesthesia care unit (PACU) nurses, this project introduced the use of non-pharmacological interventions to mitigate symptoms of ED in the pediatric population as inspired by The Green Star Initiative, an Army program at Fort Carson. The project aim was to describe the effectiveness of ED-specific interventions from the nursing perspective. Using tenets of the Iowa model, this quality improvement project included a needs assessment survey, PowerPoint presentation, parent education leaflet, ED cheat sheet, and a post-intervention survey. Applying the context, input, process, product model for evaluation, this project increased knowledge of ED-specific interventions used by nurses that demonstrates a change in clinical decision-making. PACU nurses rated the interventions 43% effective on pediatric patients. This project addressed the gap in practice by providing structured education on ED, inspiring the use of ED-specific interventions, and promoting readiness to care for the pediatric surgical population. Outcomes add to the nursing literature by introducing ED-specific interventions to manage pediatric ED in facilities nationwide. A social implication of this project is to improve the care of pediatric surgical patients.