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Dipyrone has analgesic, spasmolytic, and antipyretic effects and is used to treat pain. Due to a possible risk of agranulocytosis with the use of dipyrone, it has been banned in a number of countries. The most commonly used data for the use of dipyrone are related to adults. Information relating to the use of dipyrone in children is scarce. Given the potential added value of dipyrone in the treatment of pain, a review of the literature was conducted to obtain more insight into the analgesic efficacy of dipyrone in children as well as the safety of dipyrone in terms of adverse events. A literature search was done for original articles (in English, German, or Spanish language) which met the following criteria: the use of dipyrone for pain and children up to the age of 17 years old. All titles and abstracts retrieved were reviewed, independently, by two of the authors, for their suitability for inclusion. The references of the selected articles were also checked for additional relevant papers. The publications were categorized into case reports, observational studies, or randomized controlled trials. To assess the methodological quality of the studies, the Jadad score was used. In the limited available data, the analgesic efficacy of intravenous dipyrone appears similar to that of intravenous paracetamol. Evidence is lacking to support the claim that dipyrone is equivalent or even superior to Non-Steroid-Anti-Inflammatory-Drugs in pediatric pain. While the absolute risk of agranulocytosis with dipyrone in children, based on available literature, cannot be determined, case reports suggest that this risk is not negligible. [ABSTRACT FROM AUTHOR]

Background The aep EX is a measure of depth of hypnosis (DoH), derived from processed mid-latency auditory evoked potentials. Objectives To evaluate the aep EX as a measure of DoH in children receiving sevoflurane-remifentanil anesthesia. Methods aep EX and bispectral index ( BIS) were recorded simultaneously in 75 children, (1-3, 3-6, and 6-18 years), receiving sevoflurane at endtidal concentrations ( ETsevo) between 1.5 and 0.5 MAC. The ETsevo at which the aep EX and BIS had a value of 50 ( EC50aep EX and EC50 BIS) was calculated by nonlinear regression analysis. The accuracy of aep EX and BIS to predict the DoH was assessed by prediction probability (Pk) and receiver operating characteristics ( ROC) analysis. Results Seventy-four children were included for analysis. The EC50aep EX (2.68%) and EC50 BIS (2.10%) were comparable; the same accounts for the EC50aep EX of the different age groups and the EC50aep EX and EC50 BIS of corresponding age groups. The EC50 BIS in children aged 1-3 years was lower than in the older age groups ( P < 0.05). Pk values of the aep EX (0.32, CI 95% 0.08-0.56) and BIS (0.47, CI 95% 0.19-0.75) were comparable. The area under the ROC curve was 0.72 ( CI 95%: 0.62-0.82) and 0.67 ( CI95%: 0.56-0.77) for the aep EX and BIS, respectively ( P = 0.54). Optimal cutoff values were >60 (aep EX) and >68 ( BIS), with corresponding specificities 91%, CI 95%: 80-97% (aep EX) and 66%, CI 95%: 52-77% ( BIS). Conclusions In this study with children receiving sevoflurane anesthesia, the aep EX outperformed the BIS in distinguishing unconsciousness from consciousness. Both indices performed equally bad in differentiating different levels of DoH. [ABSTRACT FROM AUTHOR]

Background The aep EX Plus monitor (aep EX) utilizes a mid-latency auditory evoked potential-derived index of depth of hypnosis ( Do H). Objective This observational study evaluates the performance of the aep EX as a Do H monitor for pediatric patients receiving propofol-remifentanil anesthesia. Methods aep EX and BIS values were recorded simultaneously during surgery in three groups of 25 children (aged 1-3, 3-6 and 6-16 years). Propofol was administered by target-controlled infusion. The University of Michigan Sedation Scale ( UMSS) was used to clinically assess the Do H during emergence. Prediction probability ( Pk) and receiver operating characteristics ( ROC) analyses were performed to assess the accuracy of both Do H monitors. Nonlinear regression analysis was used to describe the dose-response relationships for the aep EX, the BIS, and propofol plasma concentrations ( Cp). Results The Pk for the aep EX and BIS was 0.36 and 0.21, respectively ( P = 0.010). ROC analysis showed an area under the curve of 0.77 and 0.88 for the aep EX and BIS, respectively ( P = 0.644). At half-maximal effect ( EC50), Cp of 3.13 μg·ml−1 and 3.06 μg·ml−1 were observed for the aep EX and BIS, respectively. The r2 for the aep EX and BIS was 0.53 and 0.82, respectively. Conclusion The aep EX performs comparable to the BIS in differentiating between consciousness and unconsciousness, while performing inferior to the BIS in terms of distinguishing different levels of sedation and does not correlate well with the Cp in children receiving propofol-remifentanil anesthesia. [ABSTRACT FROM AUTHOR]