The Effect of Ibuprofen Dosing Interval on Post-Tonsillectomy Outcomes in Children: A Quality Improvement Study

2020 ◽  
Vol 129 (12) ◽  
pp. 1210-1214
Author(s):  
Grayson Mast ◽  
Krysta Henderson ◽  
Michele M. Carr
Keyword(s):  
Clinical Trial ◽  
Quality Improvement ◽  
Emergency Room ◽  
Randomized Clinical Trial ◽  
Postoperative Analgesia ◽  
Dose Interval ◽  
Dosage Interval ◽  
Dosing Interval ◽  
Phone Calls ◽  
Dosing Intervals

Objective: In this Quality Improvement (QI project) it was hypothesized that an increase in dosing intervals for postoperative analgesia when alternating Ibuprofen and Acetaminophen would reduce post-tonsillectomy hemorrhage (PTH) rates for those undergoing tonsillectomies with or without adenoidectomy, while maintaining the standard of postoperative analgesia and reducing visits to the Emergency Room (ER) for reasons other than PTH. Data was collected from 353 children. Utilizing run chart analysis, it was determined that patients experiencing the 4-hour dosing interval had lower rates of PTH, fewer ER visits, and no increase in postoperative phone calls from caregivers. Patients and Methods: Patients were treated with standing Acetaminophen 15 mg/kg q6h and Ibuprofen 10 mg/kg q6h for postoperative analgesia from July of 2017 until January of 2018. Starting January of 2018 through November of 2018, the dosage interval was lengthened 1 hour. Data relating to PTH, ER visits for reasons other than bleeding, and phone calls from caregivers was collected. Results: Run charts were used to assess outcomes regarding PTH, postoperative visits to the ER for reasons other than PTH, and phone calls from caregivers. Our results suggest that a standing protocol of alternating Acetaminophen and Ibuprofen given every 4 hours improves the post-tonsillectomy hemorrhage rate without increasing ER visits or calls about pain. Conclusions: This data shows promise in reducing PTH and ER visits with a longer dose interval when alternating Acetaminophen and Ibuprofen for postoperative analgesia in tonsillectomy patients. A randomized clinical trial should be carried out to further validate these claims.

A randomized clinical trial comparing six techniques of postoperative analgesia for elective total hip arthroplasty under subarachnoid anesthesia with opioids

2021 ◽  
Vol 87 (6) ◽  
Author(s):  
José R. ORTIZ-GÓMEZ ◽  
Marta PEREPÉREZ-CANDEL ◽  
Arantxa PAVÓN-BENITO ◽  
Berta TORRÓN-ABAD ◽  
María DORRONSORO-AUZMENDI ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Total Hip Arthroplasty ◽  
Randomized Clinical Trial ◽  
Hip Arthroplasty ◽  
Postoperative Analgesia ◽  
Total Hip

scholarly journals Comparison between erector spinal plane block and epidural block techniques for postoperative analgesia in open cholecystectomies: a randomized clinical trial

2020 ◽  
Vol 70 (1) ◽  
pp. 22-27
Author(s):  
Thiago Mamoru Sakae ◽  
Luiz Henrique Ide Yamauchi ◽  
Augusto Key Karazawa Takaschima ◽  
Julio C. Brandão ◽  
Roberto Henrique Benedetti
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Postoperative Analgesia ◽  
Epidural Block

scholarly journals Using the Social Robot NAO for Emotional Support to Children at a Pediatric Emergency Department: Randomized Clinical Trial (Preprint)

2021 ◽  
Author(s):  
Silvia Rossi ◽  
Silvano Junior Santini ◽  
Daniela Di Genova ◽  
Gianpaolo Maggi ◽  
Alberto Verrotti ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Emergency Department ◽  
Emergency Room ◽  
Randomized Clinical Trial ◽  
Effect Size ◽  
Salivary Cortisol ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Cortisol Levels ◽  
The Impact

BACKGROUND Social robots (SRs) have been used for improving anxiety in children in stressful clinical situations, such as during painful procedures. However, no studies have yet been performed to assess their effect in children while waiting for emergency room consultations. OBJECTIVE This study aims to assess the impact of SRs on managing stress in children waiting for an emergency room procedure through the assessment of salivary cortisol levels. METHODS This was an open randomized clinical trial in children attending a pediatric emergency department. Children accessing the emergency room were randomized to 1 of 3 groups: (1) playing with a NAO SR, (2) playing with a study nurse, or (3) waiting with parents. The salivary cortisol levels of all children were measured through a swab. Salivary cortisol levels before and after the intervention were compared in the 3 groups. We calculated the effect size of our interventions through the Cohen <i>d</i>-based effect size correlation (<i>r</i>). RESULTS A total of 109 children aged 3-10 years were enrolled in the study, and 94 (86.2%) had complete data for the analyses. Salivary cortisol levels significantly decreased more in the group exposed to robot interaction than in the other two groups (<i>r</i>=0.75). Cortisol levels decreased more in girls (<i>r</i>=0.92) than in boys (<i>r</i>=0.57). CONCLUSIONS SRs are efficacious in decreasing stress in children accessing the emergency room and may be considered a tool for improving emotional perceptions of children and their families in such a critical setting. CLINICALTRIAL ClinicalTrials.gov NCT04627909; https://clinicaltrials.gov/ct2/show/study/NCT04627909

Abstract 17573: Epinephrine Dosing Interval and Survival Outcomes During Pediatric In-hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Derek B Hoyme ◽  
Sonali S Patel ◽  
Ricardo A Samson ◽  
Tia T Raymond ◽  
Vinay M Nadkarni ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Heart Association ◽  
Dose Interval ◽  
Coronary Perfusion ◽  
Epinephrine Administration ◽  
Dosing Interval ◽  
Vasoactive Medication ◽  
Dosing Intervals ◽  
Hospital Cardiac Arrest

Background: American Heart Association (AHA) guidelines recommend administration of epinephrine (epi) every 3 to 5 minutes during CPR to improve systemic blood pressure and coronary perfusion pressure. In adults with in-hospital cardiac arrest (IHCA), longer dosing intervals are associated with improved survival to hospital discharge. The purpose of this study is to investigate whether longer epi dosing intervals are associated with improved survival to hospital discharge after pediatric IHCA. Methods: A retrospective review of the AHA Get With The Guidelines-Resuscitation registry identified 1,260 pediatric IHCAs that met our inclusion criteria: index IHCA event; no vasoactive infusion in place or alternate vasoactive medication boluses; > 1 dose of epi administered; not located in delivery room, nursery, NICU or obstetrical units. For each arrest, an epi dosing interval was defined by dividing the duration of resuscitation after the first dose of epi by the total doses given. This was necessary as the database does not provide time of individual epi doses. For analysis, epi dosing intervals were categorized as 1 to <5 minutes/dose, 5 to <8 minutes/dose, and 8 to 10 minutes/dose. Multivariable logistic regression models were constructed controlling for age, gender, illness category, location of arrest, and arrest duration to evaluate the relationship of epi dosing intervals on survival to discharge. Odds ratios were calculated using the 1 to <5 minutes/dose interval as the reference. Results: Table 1 displays the descriptive characteristics of the patients and subsequent events. Adjusted odds ratio for survival to hospital discharge for dosing interval of 5 to <8 minutes was 1.454 (95% CI 1.014-2.084) and for 8 to 10 minutes was 1.945 (95% CI 1.094-3.459). Conclusions: Longer dosing intervals than those currently recommended by the AHA guidelines for epinephrine administration during pediatric IHCA are associated with improved survival to hospital discharge.

scholarly journals Care Plan for Community-Acquired Pneumonia

2000 ◽  
Vol 11 (suppl d) ◽  
pp. 22D-26D
Author(s):  
Thomas Marrie ◽  
Keyword(s):  
Clinical Trial ◽  
Emergency Room ◽  
Randomized Clinical Trial ◽  
Severity Of Illness ◽  
Community Acquired Pneumonia ◽  
Care Plan ◽  
Early Administration ◽  
Critical Pathway ◽  
Admission Decision

This paper presents a critical pathway for the treatment of pneumonia that has been shown to be effective in a randomized clinical trial. The pathway uses a pneumonia-specific severity of illness score to guide the admission decision. Early administration of antibiotics (within 8 h of arrival at the emergency room) is stressed.

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