@article {10750, title = {Administering analgesia sublingually is a suitable option for children with acute abdominal pain in the emergency department.}, journal = {Acta Paediatr}, volume = {108}, year = {2019}, month = {2019 Jan}, pages = {143-148}, abstract = {

AIM: Acute abdominal pain is a frequent complaint in children attending emergency departments. The aim of this study was to investigate the pain score reductions when children with acute abdominal pain received medication sublingually.

METHODS: We carried out a multicentre randomised controlled trial in three children{\textquoteright}s hospitals in Italy between March 2015 and June 2017. Children from four to 18~years of age with acute abdominal pain were recruited if their self-reported pain was at least six on a scale from 0-10. The children were randomised to receive ketorolac 0.5~mg/kg (n~=~70) or tramadol 2~mg/kg (n~=~70) sublingually or a melt in the mouth powder of 20~mg/kg paracetamol (n~=~70). The main study outcome was the pain scores for the three drugs after two hours.

RESULTS: The 210 children (58.6\% girls) had a median age of 12~years with an interquartile range of 9-14.3. The median pain scores at two hours were not significantly different between ketorolac 2.0 (interquartile ranges, IQR 0.0-4.3) and tramadol 3.0 (IQR 1.0-5.0) vs paracetamol 3.0 (IQR 0.8-5.0). The median pain reductions were all 5.0 points.

CONCLUSION: Delivering analgesia sublingually was a suitable option for pain relief in children with acute abdominal pain in the emergency department.

}, issn = {1651-2227}, doi = {10.1111/apa.14514}, author = {Cozzi, Giorgio and Zanchi, Chiara and Chiaretti, Antonio and Tipo, Vincenzo and Cernich, Marta and D{\textquoteright}Anna, Carolina and Fantacci, Claudia and Conversano, Ester and Zanon, Davide and Ronfani, Luca and Barbi, Egidio} } @article {1775, title = {Comparison of propofol versus propofol-ketamine combination in pediatric oncologic procedures performed by non-anesthesiologists.}, journal = {Pediatr Blood Cancer}, volume = {57}, year = {2011}, month = {2011 Dec 15}, pages = {1163-7}, abstract = {

BACKGROUND: Limited data are available on the best option (short acting sedatives, opioids, or ketamine) in oncologic procedural sedation performed by non-anesthesiologists. The aim of the present prospective study is to compare the safety and efficacy of propofol-ketamine versus propofol alone, managed by trained pediatricians, in children with cancer undergoing painful procedures.

PROCEDURES: Data on 121 children with acute lymphatic leukemia (ALL) undergoing procedural sedations (lumbar punctures and bone marrow aspirations) were prospectively collected and included drug doses, side effects, pain assessment, and sedation degree. Children were randomly assigned to one of the two groups: P (n = 62) receiving propofol alone and K (n = 59) in whom a ketamine-propofol combination was used.

RESULTS: In group K, the total dose of propofol required was significantly lower than in group P (3.9 {\textpm} 3.6 mg/kg vs. 5.1 {\textpm} 3.6 mg/kg; P < 0.001). The incidence of hypotension was also significantly lower (11\% vs. 39\%; P < 0.001). Major O(2) desaturations (defined as SatO(2) < 88\%) occurred principally in group P (7 vs. 1; P = 0.05). Both best analgesia and shorter recovery time were obtained with the propofol-ketamine association. No differences were observed in the degree of sedation and in the awakening quality score between the two groups.

CONCLUSIONS: The combination of propofol and ketamine produced statistically significant clinical advantages combined with a higher profile of safety in children with cancer undergoing painful procedures.

}, keywords = {Biopsy, Needle, Bone Marrow Examination, Child, Conscious Sedation, Female, Humans, Hypnotics and Sedatives, Ketamine, Male, Neoplasms, Pediatrics, Physicians, Propofol, Spinal Puncture}, issn = {1545-5017}, doi = {10.1002/pbc.23170}, author = {Chiaretti, Antonio and Ruggiero, Antonio and Barbi, Egidio and Pierri, Filomena and Maurizi, Palma and Fantacci, Claudia and Bersani, Giulia and Riccardi, Riccardo} } @article {1603, title = {Concentrated midazolam for intranasal administration: a pilot study.}, journal = {Pediatr Emerg Care}, volume = {27}, year = {2011}, month = {2011 Mar}, pages = {245-7}, keywords = {Administration, Intranasal, Child, Child, Preschool, Conscious Sedation, Dose-Response Relationship, Drug, Female, Humans, Hypnotics and Sedatives, Infant, Male, Midazolam, Pain, Pilot Projects, Preoperative Care}, issn = {1535-1815}, doi = {10.1097/PEC.0b013e31820db93b}, author = {Calligaris, Lorenzo and Davide, Zanon and Alessandra, Maestro and De Bortoli, Romina and Chiaretti, Antonio and Barbi, Egidio} } @article {1599, title = {Intranasal lidocaine and midazolam for procedural sedation in children.}, journal = {Arch Dis Child}, volume = {96}, year = {2011}, month = {2011 Feb}, pages = {160-3}, abstract = {

OBJECTIVE: To evaluate the safety and efficacy of a sedation protocol based on intranasal lidocaine spray and midazolam (INM) in children who are anxious and uncooperative when undergoing minor painful or diagnostic procedures, such as peripheral line insertion, venipuncture, intramuscular injection, echocardiogram, CT scan, audiometry testing and dental examination and extractions.

PATIENTS AND DESIGN: 46 children, aged 5-50 months, received INM (0.5 mg/kg) via a mucosal atomiser device. To avoid any nasal discomfort a puff of lidocaine spray (10 mg/puff) was administered before INM. The child{\textquoteright}s degree of sedation was scored using a modified Ramsay sedation scale. A questionnaire was designed to evaluate the parents{\textquoteright} and doctors{\textquoteright} opinions on the efficacy of the sedation. Statistical analysis was used to compare sedation times with children{\textquoteright}s age and weight.

RESULTS: The degree of sedation achieved by INM enabled all procedures to be completed without additional drugs. Premedication with lidocaine spray prevented any nasal discomfort related to the INM. The mean duration of sedation was 23.1 min. The depth of sedation was 1 on the modified Ramsay scale. The questionnaire revealed high levels of satisfaction by both doctors and parents. Sedation start and end times were significantly correlated with age only. No side effects were recorded in the cohort of children studied.

CONCLUSIONS: This study has shown that the combined use of lidocaine spray and atomised INM appears to be a safe and effective method to achieve short-term sedation in children to facilitate medical care and procedures.

}, keywords = {Administration, Intranasal, Anesthetics, Local, Anxiety, Child, Preschool, Conscious Sedation, Diagnostic Techniques and Procedures, Female, Humans, Hypnotics and Sedatives, Infant, Lidocaine, Male, Midazolam, Minimally Invasive Surgical Procedures, Nebulizers and Vaporizers, Nose Diseases, Prospective Studies}, issn = {1468-2044}, doi = {10.1136/adc.2010.188433}, author = {Chiaretti, Antonio and Barone, Giuseppe and Rigante, Donato and Ruggiero, Antonio and Pierri, Filomena and Barbi, Egidio and Barone, Giovanni and Riccardi, Riccardo} }