An up-to-date fact sheet reflecting the most current research on preventing, controlling and treating head lice.
A quick, easy-to-read fact sheet to help dispel myths and prepare parents before they experience an infestation. A simple step-by-step guide for parents and caregivers, including information about treating and removing head lice from the home.
These polymorphisms may result in varying analgesic results and toxicity. Respiratory comorbidities including unresolved apnea, asthma, bronchopneumonia, craniofacial disorders, obesity, and respiratory tract infections combined with swelling after surgery can further compound the respiratory effects of opioids.
Children with OSA are more sensitive to opioids and require lower doses of analgesia, likely because of hypoxemia-induced changes in opioid receptors. For many years, otolaryngologists were reluctant to use nonsteroidal anti-inflammatory drugs NSAIDs after tonsillectomy for fear of platelet inhibition and postsurgical hemorrhage. In , a Cochrane review update was published that found that NSAIDs other than aspirin and cyclooxygenase-2 [COX-2] inhibitors did not significantly alter postoperative bleeding compared with placebo or other analgesics.
A recent pediatric study by Liu and Ulualp advised that alternating doses of ibuprofen and acetaminophen provided an effective treatment for post-tonsillectomy pain in the majority of children and did not increase the rate of bleeding. Oxycodone and hydrocodone are commonly used oral opioids and, like codeine, are metabolized by CYP2D6. The clinical study of these drugs has been less extensive than that of codeine, but the use of hydrocodone in combination with acetaminophen e.
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Unlike codeine, a relatively weak mu agonist whose analgesic action depends significantly on metabolic conversion to morphine, hydrocodone is believed to be primarily responsible for its observed analgesic effects i. It is not known whether slow metabolizers will have reduced analgesia when treated with hydrocodone or if ultrarapid metabolizers may risk toxicity with normal doses.
Although both hydrocodone and oxycodone are used to manage pain in adult patients following tonsillectomy and adenoidectomy, there is limited evidence to support their use in the management of post-tonsillectomy pain in children. If oral opioids are prescribed for post-tonsillectomy pain, provider awareness and parental education are critical to ensure that early signs of overdose are immediately reported to the prescribing practitioner. Oxycodone is a choice that has a favorable profile for efficacy, side effects, and metabolism, and only a small percentage of the drug is metabolized via CYP2D6.
Recommendations for preventing and treating tonsillectomy pain in children involve both pharmacologic and nonpharmacologic therapy TABLE 1.
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Scheduled acetaminophen, rather than taken as needed, is highly recommended as the first-line medication in children after adenotonsillectomy. Statistically significant yet limited existing evidence suggests that ibuprofen is safe to use concomitantly or as a second-line medication.
Opioids including hydrocodone and oxycodone may be administered with caution in children with sleep-disordered breathing following tonsillectomy. The lowest possible dose should be chosen because children with sleep-disordered breathing are known to be particularly susceptible to respiratory depression from opioids.
For Patients & Families - AAAP
Following adenotonsillectomy, opioids should not be administered to any child who is excessively sleepy, lethargic, unarousable, or incoherent. In addition, any child who is having trouble breathing, including respiratory pauses while sleeping, should not receive opioids. A single intraoperative dose of IV dexamethasone 0. Inpatient and emergency room monitoring for IV hydration and monitored pain control are safe options for selected patients.
Ongoing monitoring of postoperative calls from families and review of possible increases in dehydration or bleeding are recommended to determine if adjustments to this guideline are needed.
Nonpharmacologic therapy to treat postoperative pain is an important adjunct therapy that nurses can initiate and control without medical orders. Common nonpharmacologic measures to assist in pain relief are having parents present, using effective distraction techniques, and offering cold foods. In pediatrics, the focus is on family-centered care. Traditionally, parents were not allowed into the post-anesthesia care unit PACU because of patient sensitivity, quick turnover, and possible adverse effects of anesthesia.
A drug confirmation is the measurement of the metabolization of a drug by a person's body using a specimen collected from the person. If the drug is present in the person's body at levels high enough to be metabolized, the possibility of accidental or second-hand exposure is ruled out. The confirmation also rules out false positives.
A drug screen is any test — whether performed by a caseworker, laboratory, or other facility that conducts screenings — to confirm the existence of a drug in a person's system. A drug screen does not show the level at which a drug is present and therefore cannot be relied on to rule out the possibility of second-hand or accidental exposure. An instant swab test is a test of a client's oral fluids performed by a caseworker to determine whether the client has used drugs recently. The results may be confirmed by a laboratory, if possible.
The results must be confirmed by a laboratory before being presented as evidence in a court hearing. If a worker has cause to believe, based on credible evidence, that a parent or someone who has direct access to the child has a substance abuse problem, including the abuse of alcohol or marijuana, and that problem threatens the child's safety, the worker must request a drug test for the client.
The table below shows the tests that may be conducted or ordered for a client by the caseworker or accepted from other sources, and the staff who may approve the orders. Each region may develop more stringent approval requirements. Oral fluid instant swab test, instant swab test with confirmation, or instant test lab confirmation. The usual test on the mother is a urine analysis. The following clients are eligible for substance abuse testing that is conducted by a laboratory under contract:. Children in open CPS cases, including children in DFPS conservatorship and children who are being placed for adoption, when these services are needed.