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Background Endotracheal intubation (EI) is currently required for surfactant administration. However, EI is associated with adverse physiologic effects, including bradycardia and hypoxia. The laryngeal mask airway (LMA) may provide a more practical and less invasive alternative to EI for surfactant administration. Aim Determine feasibility of LMA placement in neonates by investigating the time, number of attempts and physiologic stability during placement of the device. Methods Infants ≥1250 g who required surfactant administration were eligible. Videotape of the LMA placement procedure was reviewed to determine number of attempts, duration of attempts, total procedure time, and heart rate and oxygen saturation change from baseline. Results Twenty-two infants were included in analysis. Mean total procedure time was 129 seconds (±187). Duration of attempts was 59 seconds (±81). Successful placement was achieved on the first attempt in 73% of cases. Two attempts were required in 14% of cases and all procedures were successful in ≤3 attempts. As compared to baseline, heart rate increased 3 beats per minute on average (±4, range: -3 to 11) and oxygen saturation decreased by 7% on average (±8, range: -24 to 1), as shown in Figure 1. Conclusions Successful placement was achieved in the majority of patients in one attempt with an average total procedure time of approximately 2 min. Physiologic parameters were maintained close to baseline with minimal fluctuation in heart rate and oxygen saturation. Placement of the LMA device is feasible in neonates.

Background PSS is characterized by pain, fatigue, lack of a cure, uncertainty and chronicity. Psychological factors are known to modulate health status in persons with chronic illness, but little data is available in PSS. Illness perceptions (especially perceived consequence and perceived control) are important factors influencing medical, psychological and behavioral outcomes in patients with rheumatic disorders. Objectives The aim of this study was to use a validated instrument: the Illness Perceptions Questionnaire (IPQ-R) to investigate potential links between illness perceptions and functional outcomes in patients with primary Sjogren’s syndrome (PSS) and to compare illness representations in patients with different disease characteristics. We compared seropositive and seronegative PSS patients to assess the effects of serologic status and illness perceptions on key outcomes including fatigue, pain and health status. Methods Demographics, clinical characteristics (sicca symptoms and objective sicca measures), health outcomes: fatigue (FSS), pain(BPI), sleep quality(PSQI), mood (HADS), generic health status (SF-12) and illness perceptions (IPQ-R) were evaluated by survey. Relationships between illness perceptions, clinical characteristics and SF-12 domains were assessed by spearman rank correlation. Psychological and clinical characteristics were compared in the two groups by t test and Pearson’s Chi-Squared Test. Results PSS patients (N=123) by AECG criteria were compared based on serologic status (SSA/and or SSB positive vs. SSA/SSB negative) Seronegative (N=45) and seropositive subjects (N=78) were similar in gender (95% F), education (77% college), ethnicity (95% Caucasian), whereas seronegative patients were slightly older (63 yrs. vs. 58 yrs., p=.004). The seronegative group reported greater pain severity (p=.003) and had more negative physical domain SF-12 scores (p=.021) despite a trend toward less severe sicca and similar illness perceptions in all domains of the IPQ-R. Pessimistic beliefs about the consequences of illness were associated with fatigue, with pain severity and with reduced physical function in both patient groups. Mental domain SF-12 scores were negatively associated with fatigue and depression in the seropositive and with fatigue and anxiety in the seronegative group. Conclusions In other chronic illnesses in which fatigue and pain are prominent, coping styles, self-efficacy and catastrophizing are predictive of health outcome. We found that psychological factors, particularly pessimistic beliefs about the consequences of illness, contribute to fatigue and pain as well as to health status in PSS. Assessment of illness perceptions and appropriately designed cognitive behavioral interventions could be helpful to reduce fatigue, pain and psychological distress. Disclosure of Interest None Declared

Background Anxiety and depression are frequently associated with Sjogren’s syndrome and pain is a common complaint. Patients who experience these problems find their symptoms frightening and possibly more disabling than the sicca symptoms for which PSS is better known. Unfortunately the precise etiology of pain symptoms and the influence of psychological symptoms on pain perception is unknown. Objectives We investigated 1) the differential effect of depressive symptoms, anxiety, and catastrophizing on pain intensity and health status and 2) compared patients with neuropathic and non-neuropathic pain symptoms. Methods PSS patients who met AECG criteria (N=95) completed a survey to assess pain intensity: the Brief Pain Inventory1: BPI-S (0-10 scale), neuropathic pain symptoms: the Neuropathic Pain Questionnaire2 (NPP) and affective components of pain: the Pain Anxiety Symptom Scale3 (PASS) and the Pain Catastrophizing Scale4 (PCS). Health status was assessed with the SF-12, perceived stress with a visual analog scale. Linear regression was used to investigate the relationship between pain severity, pain catastrophizing and pain phenotype. Results PSS subjects were classified into those with neuropathic pain (NP, N=25) and those without neuropathic symptoms (Non-NP, N=59; 11 missing NP status). Daily pain for greater than 3 months was reported by 80% of NP and 49% of Non-NP patients. Based on weekly pain ratings, patients were also divided into: mild pain (N=49) and moderate-severe pain (N=42; 4 missing BPI score) groups. Perceived stress (p=0.015) was associated with more severe pain as were PASS (p=0.015) and PCS (p≤0.001). Pain severity correlated with physical domain of the SF-12(r=-.55), with HAD anxiety (r=0.38), HADs depression (r=0.48) and w/ PASS (r=0.48) and PCS (r=.61). The relationship between pain severity and pain catastrophizing was significant in PSS patients with a history of neuropathy(p=0.027) and in those with a diagnosis of FM (p=0.008). PCS also correlated with musculoskeletal pain severity (r=0.54) and with neuropathic pain symptoms (r=0.58). Conclusions Pain anxiety and pain catastrophizing are associated with increasing pain severity in PSS patients with different pain phenotypes. This study is consistent with psychological studies that have shown that “pain captures attention” and that patients with pain are hypervigilant for somatic sensations at the expense of other activities. Further study is needed to develop to develop discriminatory classifications of “central pain”, “nociceptive pain” and “neuropathic pain” which could provide insight into mechanistic pathways and a framework for more rationale therapy. References Cleeland CS, Syrjala KL. How to Assess Cancer Pain. In: Turk DC, Melzack R editors. Handbook of Pain Assessment. New York: the Guilford Press, 1992. p 362-287 Krause SJ, Backonja MM. Development of a neuropathic pain questionnaire. Clin J Pain 2003; 19: 306-414. McCracken LM, Zayfert C, Gross RT. The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain. Pain 1992;50:67-73. Sullivan MJL, Bishop S, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess 1995; 7: 432-524 Disclosure of Interest None Declared