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ABSTRACT. Background. Previous reports have suggested that healthy, full-term newborn infants who are in more aroused behavioral states tend to respond more robustly to painful events. Others have shown that [...]

Ketamine and midazolam (K/M) appear to be more effective than fentanyl and midazolam (F/M) in preventing pain in children who are treated for fractures and joint dislocations. Researchers compared the two drug combinations in 260 children with fractures or dislocated joints. Children receiving K/M were less distressed but had slightly longer recovery times. They also required less oxygen than children receiving F/M, but they were more likely to vomit., Objective. Emergency management of pediatric fractures and dislocations requires effective analgesia, yet children's pain is often undertreated. We compared the safety and efficacy of fentanyl- versus ketamine-based protocols. Methodology. Patients 5 to 15 years of age needing emergency fracture or joint reduction (FR) were randomized to receive intravenous midazolam plus either fentanyl (F/M) or ketamine (K/M). Measures of efficacy were observational distress scores and self- and parental-report. Measures of safety were frequency of abnormalities in and need for support of cardiopulmonary function and other adverse effects. Results. During FR, K/M subjects (n = 130) had lower distress scores and parental ratings of pain and anxiety than did F/M subjects (n = 130). Although both regimens equally facilitated reductions, deep sedation, and procedural amnesia, orthopedists favored K/M. Recovery was 14 minutes longer for K/M. Fewer K/M subjects had hypoxia (6% vs 25%), needed breathing cues (1% vs 12%), or required oxygen (10% vs 20%) than did F/M subjects. Two K/M subjects required assisted ventilation briefly. More K/M subjects vomited. Adverse emergence reactions were rare but equivalent between regimens. Conclusions. During emergency pediatric orthopedic procedures, K/M is more effective than F/M for pain and anxiety relief. Respiratory complications occurred less frequently with K/M, but respiratory support may be needed with either regimen. Both regimens facilitate reduction, produce amnesia, and rarely cause emergence delirium. Vomiting is more frequent and recovery more prolonged with K/M. Pediatrics 1998;102:956-963; ketamine, fentanyl, midazolam, pediatric procedure sedation., ABBREVIATIONS. ED, emergency department; F/M, fentanyl/ midazolam; K/M, ketamine/midazolam; FR, fracture reduction/ joint relocation; ASA, American Society of Anesthesiologists; FAS, Facial Affective Scale; VAS, Visual Analog Scale; OSBD-R, Observational Scale [...]

Many doctors and nurses believe infants feel pain similarly to adults and think that pain relieving measures are not adequately provided during painful nursery procedures. A total of 374 doctors and nurses were surveyed to determine how painful 12 common procedures were perceived to be, and how often pain relieving medicines or comfort measures were employed. Nine of the twelve procedures were considered to be at least moderately painful, and both doctors and nurses agreed that drugs and comfort measures were not used as often as they should be., Background. Despite an increased awareness among clinicians regarding pain and pain management for infants undergoing surgery, pain associated with procedures performed outside the operating room may not be adequately managed. Purpose. To examine the beliefs and self-described behavior of physicians and nurses regarding the management of procedural pain in newborn infants. Methods. A survey was distributed to 467 clinicians (nurses and physicians) working in 11 level II and 4 level III nurseries in a large metropolitan area. Respondents were asked to rate the painfulness of 12 common bedside nursery procedures and how often pharmacologic and nonpharmacologic (comfort) measures are currently used and should be used for those procedures. Demographic data were also collected. Results. Surveys were completed by 374 clinicians (80% response rate). Physicians and nurses believe infants feel as much pain as adults and that 9 of the 12 listed procedures are moderately to very painful. Neither pharmacologic nor comfort measures are believed to be used frequently, even for the most painful procedures. Physicians and nurses believe both pharmacologic and comfort measures should be used more frequently, but nurses believe comfort measures should be used more frequently than do physicians. Beliefs about infant pain and procedural pain were related to pain management preferences. Physicians' but not nurses' ratings were associated with significant personal pain. Conclusions. Despite their beliefs that infants experience significant procedure-related pain, clinicians believe pain management for infants remains below optimal levels. Barriers to more consistent and effective pain management need to be identified and surmounted. Pediatrics 1997;100:626-632; pain, infant, bedside procedures, anesthesia, comfort., Pain has a long history of being undermanaged across the lifespan.[1-4] However, it has been recognized as being particularly inferior for infants. Various reasons for poor pain management in infants [...]

Newborns can experience physiologic instability, or wide variations in measures of biologic function, when they are exposed to medical procedures or environmental factors. It has been suggested that some of the physiologic instability may result from pain associated with invasive procedures such as surgery, and can be reduced by pain-relieving drugs or anesthesia. Information about pain and its control in the newborn is limited. The effectiveness of local anesthesia in reducing physiologic instability associated with lumbar puncture was assessed in 77 newborns. Lumbar puncture involves inserting a needle into the lower back and into the space between membranes of the spinal cord to obtain fluid for diagnosis or to administer anesthetic agents. This procedure was performed after the administration of the local anesthetic lidocaine in 38 infants, and without lidocaine in the remaining infants. Lidocaine did not diminish physiologic instability associated with lumbar puncture in newborn or cause adverse effects, but prolonged the period of lumbar puncture. Physiologic instability developed during the preparation for lumbar puncture and was not worsened by administration or lidocaine or by the lumbar puncture itself. These findings suggest that local anesthesia does not improve physiologic instability associated with lumbar puncture. Furthermore, physiologic instability is greater during preparation for lumbar puncture than during administration of local anesthetic or during lumbar puncture. Efforts should focus on reducing the adverse effects of handling procedures on physiologic stability of the newborn. (Consumer Summary produced by Reliance Medical Information, Inc.)

Against centuries of framing gender relations on the basis of so-called biblical 'hard passages', I offer an expansive three-fold way of reading the New Testament that is both feminist and Anabaptist. Using both hermeneutics of suspicion about power and Christocentric biblical interpretation, I seek to counter women's inequality, disadvantage, and subordination. I argue for: taking a broad look at the text when thinking about gender relations to uncover the story of gender in unlikely places that I argue should become the most likely places; paying attention to the diversity of early Christian location, experience, and expression in the context of the politics and society of the ancient world; and within this framework revisiting specific texts predominantly associated with a gender hierarchy to encounter exhortations of moral agency, behaviour, and activity. This approach maintains vigilance about gender power relations, while simultaneously providing a critique of gendered approaches to scripture. [ABSTRACT FROM AUTHOR]

Presents several commentaries on studies on pediatrics. Position for lumbar punctures; Predictor of children at risk for the development of nursing bottle caries; Advantages of disposable diapers over cloth diapers.