A5071252297- Pediatric Pain Management Techniques
- Anesthesia and Pain Management
- Pain Management and Opioid Use
- Anesthesia and Sedative Agents
- Cardiac, Anesthesia and Surgical Outcomes
- Anesthesia and Neurotoxicity Research
- Diet and metabolism studies
- Pharmacological Effects and Toxicity Studies
- Neuroscience of respiration and sleep
- Opioid Use Disorder Treatment
- Child and Adolescent Health
- Musculoskeletal pain and rehabilitation
- Airway Management and Intubation Techniques
- Obstructive Sleep Apnea Research
- Pharmacogenetics and Drug Metabolism
- Spine and Intervertebral Disc Pathology
- Pectus Deformity Diagnosis and Treatment
- Cannabis and Cannabinoid Research
- Pain Mechanisms and Treatments
- Restraint-Related Deaths
- Gastroesophageal reflux and treatments
- Epilepsy research and treatment
- Drug Transport and Resistance Mechanisms
- Infant Development and Preterm Care
- Scoliosis diagnosis and treatment
Cincinnati Children's Hospital Medical Center
2016-2025
University of Cincinnati Medical Center
2012-2023
University of Cincinnati
2012-2022
Wright-Patterson Air Force Base
2022
Pediatrics and Genetics
2017
Brookdale University Hospital and Medical Center
2006
Interindividual variability in pain perception and analgesic response is a major problem perioperative practice. Adult studies suggest management influenced by patient's race. The objective of this study to evaluate the influence race on treatment children.Prospective observational evaluating effect analgesia opioid related adverse effects after tonsillectomy African American Caucasian children. A sample 194 healthy children between 6 15 years age were included. Race was self-identified...
Abstract Background Chronic postsurgical pain ( CPSP ) affects half a million children annually in the United States, with dire socioeconomic consequences, including long‐term disability into adulthood. The few studies of are limited by sample size, follow‐up duration, non‐homogeneity surgical procedure and factors evaluated. Methods In prospective study 144 adolescents undergoing single major surgery (spine fusion), we evaluated demographic, perioperative, psychosocial as predictors...
Posterior spinal fusion (PSF) surgery for correction of idiopathic scoliosis is associated with chronic postsurgical pain (CPSP). In this multicenter study, we describe perioperative multimodal analgesic (MMA) management and characterize postoperative pain, disability, quality life over 12 months after PSF in adolescents young adults. Subjects (8-25 years) undergoing were recruited at 6 sites the United States between 2016 2023. Data collected on opioid consumption (intravenous morphine...
Large interindividual variability in morphine disposition could contribute to unpredictable analgesia and adverse events. Caucasian children have more effects slower clearance than African-American children. To study variations intravenous pharmacokinetics children, we examined the influence of genetic polymorphisms OCT1.In 146 undergoing adenotonsillectomy, concentration-time profiles (2-4 measurements per patient) were available. Population pharmacokinetic analysis characterized NONMEM(®)...
Effective perioperative analgesia is lacking for children owing to interindividual variations and underdosing of opioids caused by fear adverse effects. We investigated the role COMT SNPs on postoperative pain management in children.One hundred forty nine undergoing adenotonsillectomy were enrolled. The associations four (rs6269, rs4633, rs4818 rs4680) with analyzed outcome measures included maximum scores, need opioid interventions morphine requirements.We detected an association...
Aim: Large interindividual variability in morphine pharmacokinetics could contribute to analgesia and adverse events. Methods: Influence of weight, genetic polymorphisms, race sex on clearance metabolite formation from 220 children undergoing outpatient adenotonsillectomy was studied. A nonlinear mixed effects model developed NONMEM describe glucuronide pharmacokinetics. Results: Children with ABCC3 -211C>T polymorphism C/C genotype had significantly higher levels morphine-6-glucuronide...
Objective: Interindividual variability in analgesic response and adverse effects of opioids because narrow therapeutic indices are major clinical problems. Morphine is an opioid commonly used children to manage perioperative pain. Although size age often considered primary covariates for morphine pharmacokinetic models, the impact other factors important personalizing care such as race genetic variations on disposition not well documented.Design: Genotype blinded observational study. One...
The perioperative pain experience shows great interindividual variability and is difficult to predict. mu-1 opioid receptor gene (OPRM1) known play an important role in opioid-pain pathways. Since deoxyribonucleic acid (DNA) methylation a potent repressor of expression, DNA was evaluated at the OPRM1 promoter, as predictor preoperative, acute, chronic postsurgical (CPSP).A prospective observational cohort study conducted 133 adolescents with idiopathic scoliosis undergoing spine fusion under...
Opioid-induced respiratory depression (OIRD) is a life-threatening complication of opioid therapy in children. Naloxone administration triggered by OIRD has been used to monitor safety adults. We this trigger as quality measure hospitalized children identify risk predictors OIRD.We retrospectively reviewed medical records 38 patients identified from the hospital management database requiring naloxone for critical events between January 2010 and June 2012 demographics, comorbidities, surgery,...
Aim: Oxycodone is partly metabolized to the active metabolite oxymorphone by hepatic CYP2D6 in liver. Significant genetic variability activity affects formation. This study aimed associate genotype and oxycodone's metabolism. Methods: 30 children were administered oral oxycodone postoperatively. Plasma levels of oxymorphone, analyzed. metabolism phenotype determined based on total score (TAS) phenotype: poor metabolizer (PM), intermediate (IM), extensive (EM) or ultrarapid (UM). Results:...
Aim: Large interindividual variability in morphine pharmacokinetics (PK) could contribute to analgesia and adverse events. Respiratory depression (RD) postoperative nausea vomiting (PONV) are significant drug response of intravenous the perioperative setting limiting its efficacy achieving adequate surgical pain relief. OCT1 is a transporter liver that transports from bloodstream into hepatocytes. Earlier we reported association genetic polymorphisms with PK, lower clearance Caucasian...
To evaluate the effect of ketamine, as an adjunct to fentanyl, on postoperative analgesia and duration Postoperative Care Unit (PACU) stay, in children undergoing tonsillectomy. Ketamine, N-methyl-d-aspartate antagonist, has been recognized have opioid sparing effect. In addition, it does not depress respiration or affect airway tone. Hence, addition ketamine could be potentially beneficial tonsillectomy, due high incidence sleep apnea these patients. a double blinded, randomized trial, 60...
Although commonly performed, tonsillectomy is not necessarily a low-risk procedure for litigation. We have reviewed malpractice claims involving fatal and nonfatal injuries following with an emphasis on anesthesia- opioid-related their characteristics.Tonsillectomy-related jury verdict reports from the United States (US) between 1984 2012 found in LexisNexis MEGA™ Jury Verdicts Settlements database were by two independent reviewers. collects nationwide surgical, anesthesia, other claims....
Unpredictable interindividual variability in response to opioids results inadequate analgesia and opioid-related adverse effects. The effects of the child's sex on opioid have not been well studied. aim this study is determine children undergoing tonsillectomy. Prospective observational clinical study. Outpatient pediatric surgery. Two hundred seventy five between 6 15 years age outpatient All received standard perioperative care with a intraoperative dose morphine. Opioid-related safety...