Skip to Main Content

++

YOUR PATIENT

++

A 15-year-old male is scheduled for an elective colectomy secondary to ulcerative colitis. The family has refused an epidural for postoperative pain management.

++

PREOPERATIVE CONSIDERATIONS

++

  • Intravenous patient-controlled analgesia (IV PCA) is a method of analgesia administration involving a computer-programmable pump activated by the patient to receive small doses of opioid within defined limits. Titration of the opioid dose should be done after appropriate patient assessment. The settings of the PCA may include a demand dose with a specified lockout interval and a clinician bolus dose at a specified time interval to a maximum dose allowable at a specified frequency, as shown in Table 89.1. A continuous infusion may be prescribed if the patient is unable to push a demand dose button independently or if there is unremitting pain. Cognitively normal children over 8 years old are typically deemed appropriate for a demand dose PCA unless there are other medical or developmental issues.

  • IV PCA allows for patients to feel more in control of their pain management.

  • Children less than 1 year of age and those with serious medical conditions may have altered pharmacokinetics.

  • Be careful with premature infants and infants in general, patients with decreased cardiac output or relative hypoxia (decreased respiratory reserve), patients with a history of central or obstructive sleep apnea, patients who are at risk for increased intracranial pressure, patients with renal or liver insufficiency, patients who are morbidly obese, and patients who have a history of opioid tolerance or dependence or who have a history of hypersensitivity to opioids.

++
Table Graphic Jump Location
TABLE 89-1

INTRAVENOUS PATIENT CONTROLLED ANALGESIA INITIAL OPIOID INFUSION ORDERS

++

POSTOPERATIVE CONSIDERATIONS

++

  • In general, equianalgesic doses of opioid produce similar degrees of respiratory depression, except in premature infants or in patients who have disordered breathing secondary to central or obstructive apnea.

  • Sedation typically precedes respiratory depression.

  • Patients who are receiving methadone or those with obstructive ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessAnesthesiology Full Site: One-Year Subscription

Connect to the full suite of AccessAnesthesiology content and resources including procedural videos, interactive self-assessment, real-life cases, 20+ textbooks, and more

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessAnesthesiology

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.