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I am personally all for analgesia in all children...never made sense to me the old addage of giving kids a shot for pain medicine. 


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There was a?suggestion of?using ketamine in a newborn?for a spinal tap...would you do this to your newborn? Is there not good data that shows that po glucose/sucorse containing solutions are almost equivalent to Morphine in this age group. 


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I am a proponent of Ketamine use in the Peds ER, I think it is a great drug for Peds EM, but again, Ketamine, in a neonate, for a spinal tap...


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I would repsectfully suggest holding techniques and sweet-ease.


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-Todd







Dr. Todd 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** CONFIDENTIALITY NOTICE: This e-mail and its attachments may contain confidential, proprietary, and/or privileged information which is legally protected from disclosure. Any review, retransmission, dissemination, or other use of this information by persons or entities other than the intended recipient is strictly prohibited. If you received this e-mail in error, please notify the sender immediately and appropriately delete the material from your computer. Thank you.





-----Original Message-----

From: William Zempsky <[log in to unmask]>

To: [log in to unmask]

Sent: Mon, 26 Jan 2009 1:52 pm

Subject: Re: ketamine for septic w/u





I am disappointed and  dismayed at the numbers of members of this listserv who   continue to discount the importance of pain management whether in neonates or   children with sickle cell disease.  Despite years of accumulating evidence on   the negative impact of pain and the benefits of pain management, there are still   those who feel it is not necessary in many scenarios.  I am not sure what "a   normal" procedure is, or what the evolutionary benefit of the pain from lumbar   puncture might be that would suggest we don't do something to control it.  I   would ask those naysayers in the group to tell us...how do we change your mind?    If evidence based approaches don't work what does?  At St. Louis children's they   instituted IV practicums for nurses and residents so they could compare the pain   of IVs with and without anesthesia.  Perhaps a similar approach would work for   LP's.  Any volunteers to have an LP without anesthesia?......      Bill    William T. Zempsky, MD  Associate Director, Pain Relief Program  Medical Director, Clinical Trials  Connnecticut Children's Medical Center  282 Washington Street  Hartford, CT 06106  860-545-9041  Fax 860-545-9969  [log in to unmask]      >>> Fergus Thornton <[log in to unmask]> 1/26/2009 2:57 AM >>>  I'm not sure pain has much to do with this.  What bothers the baby is being held   down and doubled up to expose the back.  Not only would I not use PS (risk vs   benefit) but I don't use local.  If held well, the procedure is over in one to   two minutes or less.  I think the pendulum has swung too far to the "be nice"   extreme. It's time to recognize that those of us who experienced painful/normal   procedures/experiences haven't grown up with any particular psyche disorders. I   use PS to enable me to care for  people, not to protect them from a 2 minute   painful procedure. [BTW, the "holder" is much more important than the "needler"   in an LP; done well, it shouldn't take more than a minute.]     -----Original Message-----  >F


rom: "Chamberlain, Jim" <[log in to unmask]>  >Sent: Jan 20, 2009 10:36 AM  >To: [log in to unmask]   >Subject: Re: ketamine for septic w/u  >  >I am watching this post with fascination.   >  >We have moved from the use of "Brutane" for even the most painful procedures to   a much more compassionate, patient-centered approach to pain management. This is   great.  >  >However, we really need to ask ourselves whether the known and unknown risks of   procedural sedation are worth it for a procedure that is only painful for about   15 seconds of lidocaine injection. Even this pain can be minimized by use of a   topical anesthetic and by buffering the lidocaine.  >  >Nigovic LE et al showed that NON-use of local anesthetic is independently   associated with traumatic lumbar punctures (Ann Emerg Med 2007;49:762). This   echoes a previous study by Carraccio C et al (Arch Dis Pediatr Adol Med   1996:150;1044.  >  >Animal studies suggest that the young mammalian brain is especially susceptible   to neuronal apoptosis from some anesthetic agents. Ketamine does this as well.   Benzodiazepines potentiate the effect.  >  >Please review Steve Green's article on ketamine (reference posted here earlier   this week).  >  >Adequate local anesthesia should provide you with a non-squirming infant for an   LP, without the risks of procedural sedation.  >  >  >James Chamberlain, MD  >Division Chief, Emergency Medicine  >Children's National Medical Center  >111 Michigan Avenue, NW  >Washington, DC 20010  >   >202.476.3253 (O)  >202.476.3573 (F)  >202.476.5433 (Emergency Access)  >   >-----Original Message-----  >From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]]   On Behalf Of timothy hall  >Sent: Tuesday, January 20, 2009 5:55 AM  >To: [log in to unmask]   >Subject: Re: ketamine for septic w/u  >  >At what age would you give a child , who needs a full septic work up,  


>  >  >At what age would you give a child , who needs a full septic work up, a single   shot of im ketamine,to get the job done (lp etc) ,i start at 6 months.   >                                    Tim H  >  >  >________________________________  >From: Peter Antevy <[log in to unmask]>  >To: [log in to unmask]   >Sent: Tuesday, 20 January, 2009 2:56:00 AM  >Subject: Re: ketamine for septic w/u  >  >Don,  >  >Technically, obtaining an IV is a secondary issue in this well appearing child.    The blood work can be obtained sterilly, the urine via cath and the LP utilizing   first LMX4 then subQ lidocaine.  The rocephin IM and either admit or potentially   send home if all criteria are met.  >  >I personally use lidocaine on every LP no matter the age and it's worked well   for me.  A recent paper backs up the use for local anesthetic for infant LP's.    Along with using "sweeties" on the pacifier you'll soon find yourself obtaining   CSF on a sleeping infant.  Parents appreciate it too.  >  >Peter  >  >  >-----Original Message-----  >  >From:  don zweig <[log in to unmask]>  >Subj:  ketamine for septic w/u  >Date:  Sun Jan 18, 2009 8:11 pm  >Size:  823 bytes  >To:  [log in to unmask]   >  >Do any of you sedate kids to get a septic wu done?  I had a 4 week old    >(today he was 4weeks) with fever of 38.6 who looked quite good ,    >feeding bottle avidly, had hx cough and was rsv neg. no one could get    >iv (nicu nurses tried eight times) and i could not get lp due to xs    >squirming.  It would seem to be so much easier for me and prob for kid    >to give i m ketamine, get a line (groin if needed or ej) and do the lp    >on a stationary target.  Whaddya think?  whaddya do?  would everyone    >have done a complete work up?  we got cbc,crp and ua/cxr which were    >normal and the cx was pending of course.  >  >don  >  >For more information, send mail to LISTS


[log in to unmask] with the   message: info PED-EM-L  >The URL for the PED-EM-L Web Page is:  >                http://listserv.brown.edu/ped-em-l.html   >  >For more information, send mail to [log in to unmask] with the   message: info PED-EM-L  >The URL for the PED-EM-L Web Page is:  >                http://listserv.brown.edu/ped-em-l.html   >  >  >  >      Stay connected to the people that matter most with a smarter inbox. Take   a look http://au.docs.yahoo.com/mail/smarterinbox   >  >For more information, send mail to [log in to unmask] with the   message: info PED-EM-L  >The URL for the PED-EM-L Web Page is:  >                 http://listserv.brown.edu/ped-em-l.html   >  >Confidentiality Notice: This e-mail message, including any attachments, is for   the sole use of the intended   >recipient(s) and may contain confidential and privileged information. Any   unauthorized review, use, disclosure or distribution is prohibited.   >If you are not the intended recipient, please contact the sender by reply   e-mail and destroy all copies of the original message.  >  >For more information, send mail to [log in to unmask] with the   message: info PED-EM-L  >The URL for the PED-EM-L Web Page is:  >                 http://listserv.brown.edu/ped-em-l.html       Fergus Thornton  read my blog @ http://docdownunder.wordpress.com     For more information, send mail to [log in to unmask] with the message:   info PED-EM-L  The URL for the PED-EM-L Web Page is:                   http://listserv.brown.edu/ped-em-l.html    For more information, send mail to [log in to unmask] with the message:   info PED-EM-L  The URL for the PED-EM-L Web Page is:                   http://listserv.brown.edu/ped-em-l.html  


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