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ASPS Vlog Ep. 3 – Gender Affirmation Top Surgery

To summarize recent data related to the safety and efficacy of postoperative analgesia in children that influence clinical practice recommendations. Postoperative pain continues to be experienced by hospitalized children and following discharge after short stay or ambulatory surgery. ated recommendations for post-tonsillectomy analgesia exclude codeine and suggest regular administration of paracetamol and NSAID, but evidence for the most appropriate dose and type of opioid for rescue analgesia is limited. Persistent postsurgical pain is increasingly recognized following major surgery in adolescents. Evaluation of potential predictive factors in clinical studies, and investigation of underlying mechanisms in laboratory studies, can identify targets for both pharmacological and non-pharmacological interventions. Recommendations for postoperative pain in children continue to evolve, with data incorporated from randomized controlled trials, case series and large audits. Management of pain following surgery in children needs to encompass not only efficacy and safety in the immediate perioperative period, but also consider pain following discharge after ambulatory surgery, and the potential risk of persistent postsurgical pain following major surgery.

Footnotes Conflicts of interest There are no conflicts of interest. Pain prevalence, intensity, assessment and management in a hospitalized pediatric population. Pain Manag Nurs. Effective postoperative pain management in children after ambulatory surgery, with a focus on tonsillectomy: barriers and possible solutions.

Paediatr Anaesth. Developmental and cultural perspectives on children's postoperative pain management at home. Pain Manag. Treating perioperative anxiety and pain in children: a tailored and innovative approach.

Anesth Analg. Cote CJ. Anesthesiological considerations for children with obstructive sleep apnea. Lauder G, Emmott A. Confronting the challenges of effective pain management in children following tonsillectomy. Int J Pediatr Otorhinolaryngol. A single institution's effort to translate codeine knowledge into specific clinical practice. J Pain Symptom Manage. What is the best non-codeine postadenotonsillectomy pain management for children?

Pharmacogenetics of codeine metabolism in an urban population of children and its implications for analgesic reliability. Br J Anaesth. A meta-analysis of the use of nonsteroidal antiinflammatory drugs for pediatric postoperative pain. Opioid-sparing effects of perioperative paracetamol and nonsteroidal anti-inflammatory drugs NSAIDs in children. Association of Paediatric Anaesthetists of Great Britain and Ireleand Good practice in postoperative and procedural pain management, 2nd edition.

Morphine or Ibuprofen for post-tonsillectomy analgesia: a randomized trial. Ibuprofen with acetaminophen for postoperative pain control following tonsillectomy does not increase emergency department utilization. Otolaryngol Head Neck Surg. Perioperative ketorolac increases post-tonsillectomy hemorrhage in adults but not children. Clin Otolaryngol.

Sex reassignment surgery for male-to-female involves reshaping the male genitals into a form with the appearance of, and, as far as possible, the function of female genitalia. Before any surgery, patients usually undergo hormone replacement therapy (HRT), and, depending on the age at which HRT begins, facial hair removal. Apr 01,   Andrew Yang was a Democratic candidate for president and is founder of Humanity Forward. Last week I was shopping for groceries and preparing . In performing a phalloplasty for a FTM transsexual, the surgeon should reconstruct an aesthetically appealing neophallus, with erogenous and tactile sensation, which enables the patient to void while standing and have sexual intercourse like a natural male, in a one-stage procedure. 17, 18 The reconstructive procedure should also provide a normal scrotum, be predictably reproducible without Cited by:

Nonsteroidal anti-inflammatory drugs and perioperative bleeding in paediatric tonsillectomy. Cochrane Database Syst Rev.

Postoperative analgesia using diclofenac and acetaminophen in children. Critical incidents related to opioid infusions in children: a five-year review and analysis. Can J Anaesth. Nurse-controlled analgesia NCA following major surgery in 10, patients in a children's hospital. Morton NS, Errera A.

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APA national audit of pediatric opioid infusions. Risk predictors of opioid-induced critical respiratory events in children: naloxone use as a quality measure of opioid safety. Pain Med. Anderson BJ, van den Anker J. Why is there no morphine concentration-response curve for acute pain? Neuraxial analgesia in neonates and infants: a review of clinical and preclinical strategies for the development of safety and efficacy data. Intraoperative local anaesthesia for reduction of postoperative pain following general anaesthesia for dental treatment in children and adolescents.

Regional anaesthesia to improve pain outcomes in paediatric surgical patients: a qualitative systematic review of randomized controlled trials. While noting the safety of regional techniques no significant morbidity in more than patients examine the authors also highlight the need for further evidence and factors to improve study design. Epidural analgesia versus intravenous patient-controlled analgesia following minimally invasive pectus excavatum repair: a systematic review and meta-analysis.

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J Pediatr Surg. Best Pract Res Clin Anaesthesiol. Perioperative epidural analgesia in children undergoing major abdominal tumor surgery-a single center experience. Transversus abdominis plane block in children: a multicenter safety analysis of cases from the PRAN Pediatric Regional Anesthesia Network database. Interscalene brachial plexus blocks under general anesthesia in children: is this safe practice?

The effectiveness of ambulatory continuous peripheral nerve blocks for postoperative pain management in children and adolescents. Anesthesia and the developing brain: a way forward for clinical research.

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Walker SM. Biological and neurodevelopmental implications of neonatal pain. Clin Perinatol. Neuropathic pain other than CRPS in children and adolescents: incidence, referral, clinical characteristics, management, and clinical outcomes. Katz J, Seltzer Z. Transition from acute to chronic postsurgical pain: risk factors and protective factors. Dolasetron Dose is Granisetron Dose 3 mg IV in combination with dexamethasone 8 mg IV is more effective than either drug alone.

Tropisetron Dose is 2 mg IV at the end of surgery. Ramosetron Dose 0. Palonosetron It is the second generation 5-HT 3 receptor antagonist with a longer half-life of 40 h. Side effects are visual disturbances, dry mouth, and dizziness. Histamine receptor antagonists These drugs block acetylcholine receptors in the vestibular apparatus and histamine receptors in the nucleus tractus solitarius. Promethazine Dose is Neurokinin-1 receptor antagonists It is a new group of drugs used for PONV treatment thought to prevent both acute and delayed emesis.

Aprepitant Dose is 40 mg PO h prior to surgery. Cospitant Dose is mg PO plus ondansetron 4 mg, not yet approved for use. Rolapitant Dose is mg PO and has not been approved for use. Corticosteroids Dexamethasone It blocks the synthesis of prostaglandins, which sensitizes nerves to other commonly involved neurotransmitters in emesis control.

Butryphenones Droperidol It is a relatively selective D 2 receptor antagonist, administered toward the end of the surgery.

Alphaagonists These possess a direct antiemetic effect along with opioid-sparing effect. Mirtazepine It is a specific serotonergic and noradrenergic antidepressant. Midazolam Midazolam 2 mg when administered 30 min before the end of the surgery was as effective against PONV as ondansetron 4 mg.

Combination antiemetic therapy Combination therapy for PONV prophylaxis is preferable to using a single drug alone. Pharmacologic combination therapy that can be used are as follows:[ 7 ] Droperidol and dexamethasone 5-HT 3 receptor antagonist and dexamethasone 5-HT 3 receptor antagonist and droperidol 5-HT 3 receptor antagonist and dexamethasone and droperidol.

Multimodal approach Multimodal approach combines nonpharmacologic and pharmacologic prophylaxis along with interventions that reduce baseline risk. Postoperative nausea and vomiting prophylaxis and rescue Depending on the level of risk, prophylaxis should be initiated with monotherapy or combination therapy using interventions that reduce baseline risk, nonpharmacologic approach, and antiemetics.

Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Ondansetron, ramosetron, or palonosetron: Which is a better choice of antiemetic to prevent postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy? Unanticipated admission after ambulatory surgery - A prospective study. Can J Anaesth. Unanticipated admission to the hospital following ambulatory surgery. Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo.

Strategies for postoperative nausea and vomiting. Best Pract Res Clin Anaesthesiol. Islam S, Jain P. Consensus guidelines for the management of postoperative nausea and vomiting.

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Anesth Analg. Current concepts in the management of postoperative nausea and vomiting. Anesthesiol Res Pract An increased body mass index is no risk factor for postoperative nausea and vomiting. A systematic review and results of original data. Acta Anaesthesiol Scand. Meta-analytic comparison of prophylactic antiemetic efficacy for postoperative nausea and vomiting: Propofol anaesthesia vs omitting nitrous oxide vs total i.

Br J Anaesth. Omitting nitrous oxide in general anaesthesia: Meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Jenkins LC, Lahay D. Central mechanisms of vomiting related to catecholamine response: Anaesthetic implication. Can Anaesth Soc J. Middle ear pressure variations during nitrous oxide and oxygen anaesthesia. Hazards of nitrous oxide anesthesia in bowel obstruction and pneumothorax.

Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: A randomized controlled trial of factorial design. Kestin IG, Dorje P. Anaesthesia for evacuation of retained products of conception. Comparison between alfentanil plus etomidate and fentanyl plus thiopentone. Experiences with outpatient anesthesia. Can postoperative nausea and vomiting be predicted? Comparative evaluation of general, epidural and spinal anaesthesia for extracorporeal shockwave lithotripsy.

Ann R Coll Surg Engl. Postoperative vomiting: Incidence, analysis, and therapeutic measures in 3, patients.

Postanesthetic nausea, retching and vomiting; evaluation of cyclizine marezine suppositories for treatment. Concerning nausea and vomiting during spinal anesthesia.

A study of factors concerned in emesis during spinal anaesthesia. White PF, Shafer A. Seminars in Anesthesia. Philadelphia, PA: Saunders; Nausea and vomiting: Causes and prophylaxis; pp.

Parkhouse J. The cure for postoperative vomiting. Palazzo MG, Strunin L. Anaesthesia and emesis. I: Etiology. Is the prophylactic use of antiemetics in surgical patients justified? Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Moon YE. Korean J Anesthesiol. A survey of postoperative nausea and vomiting. A simplified risk score for predicting postoperative nausea and vomiting: Conclusions from cross-validations between two centers.

Efficacy of orally disintegrating ondansetron in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy: A randomised, double-blind placebo controlled study.

The efficacy of postoperative ondansetron Zofran orally disintegrating tablets for preventing nausea and vomiting after acoustic neuroma surgery. Single-dose aprepitant vs ondansetron for the prevention of postoperative nausea and vomiting: A randomized, double-blind phase III trial in patients undergoing open abdominal surgery. A randomized, double-blind trial of palonosetron compared with ondansetron in preventing postoperative nausea and vomiting after gynaecological laparoscopic surgery.

J Int Med Res. A randomized comparison of droperidol, metoclopramide, tropisetron, and ondansetron for the prevention of postoperative nausea and vomiting. Gynecol Obstet Invest.

Apr 25,   Arthritis pain and post-op recovery don't have to diminish your sex life. Find out how side effects will be managed in your case, and what precautions you'll need to take post-surgery. For. Postoperative nausea and vomiting (PONV) is one of the complex and significant problems in anesthesia practice, with growing trend toward ambulatory and day care surgeries. This review focuses on pathophysiology, pharmacological prophylaxis, and rescue therapy for . Apr 09,   Here's a thought: Give up!!!! Yes, even smushed together with the kids 24/7, there is simply no way a parent can be hovering, helping or doing that "High five, little buddy!" thing all day long.

Effect of ramosetron on patient-controlled analgesia related nausea and vomiting after spine surgery in highly susceptible patients: Comparison with ondansetron. Spine Phila Pa ; 33 :E Neurokinin-1 and novel serotonin antagonists for postoperative and postdischarge nausea and vomiting. Curr Opin Anaesthesiol. Palonosetron: A novel approach to control postoperative nausea and vomiting in day care surgery.

Saudi J Anaesth.

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A randomized, double-blind study to evaluate the efficacy and safety of three different doses of palonosetron versus placebo in preventing postoperative nausea and vomiting over a hour period.

A randomized, double-blind study to evaluate the efficacy and safety of three different doses of palonosetron versus placebo for preventing postoperative nausea and vomiting. Transdermal hyoscine with patient-controlled analgesia. Gender identities. Health care and medicine. Rights issues. Society and culture. Theory and concepts. By country. See also. This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources.

Unsourced material may be challenged and removed. Main article: Vaginoplasty. Main article: Facial feminization surgery. Main article: Chondrolaryngoplasty. Transgender portal. Archived from the original on Retrieved NBC News. Elsevier Health Sciences.

Retrieved January 8, Goldberg Sage Publications. Bigner, Joseph L. Wetchler Retrieved February 29, Van Trostenburg stresses the need to maintain dilation and hygiene for the newly created vagina and tissues left vulnerable to infections that may result from surgery. He further notes that transgender women and their male sexual partners have to be advised about vaginal intercourse, since the newly created vagina is physiologically different than a biological vagina.

Vaginoplasty surgery increases the size of the vagina, though not without surgical complications, and often requires repeated dilation of the vaginal opening so that it remains open. Oxford University Press. The surgeon will also provide a set of vaginal dilators, used to maintain, lengthen, and stretch the size of the vagina. Dilators of increasing size are regularly inserted into the vagina at time intervals according to the surgeon's instructions.

Dilation is required less often over time, but it may be recommended indefinitely. Transgender topics.

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