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Avoiding injection pain during induction in children
- William Q Smith (21 May 2007)
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William Q Smith, Consultant Anaesthetist Sunderland Royal Hospital
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It has been shown repeatedly that propofol, when used as an induction agent in paediatric anaesthesia, causes an unacceptable incidence of substantial pain on injection. Researchers and clinicians have tried in vain to eradicate this unpleasant experience that is traumatic not only for children but also for their accompanying parents. Though certain techniques have reduced the incidence of pain on injection of propofol they still come nowhere near eliminating it. (1, 2) When one considers that it is simply the pain of injection that we seek to avoid, the measures that some clinicians have proposed, at times exposing children to controversial and unnecessary risks, seem inappropriate. (3) An agent such as propofol, that has advantages in adult anaesthesia is not, by inference, necessarily an ideal agent in paediatric anaesthesia. There is, however, an induction agent that has a great deal to offer our paediatric patients, but is overlooked by many anaesthetists. It always provides a painless and smooth induction of anaesthesia with a predictable and reproducible end point that is unparalleled. Furthermore, it boasts a clinical experience and safety profile that spans seven decades. For smooth and painless induction of anaesthesia in children we need look no further than thiopentone. Primum non nocere (Galen). References 1. Kam E, Abdul-Latif M-S, McCluskey A. Comparison of Propofol- Lipuro with propofol mixed with lidocaine 10mg on propofol injection pain. Anaesthesia 2004;59 (12):1167-9. 2. Soltesz-Stefan, Silomon-Malte, Graf-Gerhard, Mencke-Thomas, Boulaadass-Sabiha, Molter-Gerd-P. Effect of 0.5% dilution of propofol on pain on injection during induction of anaesthesia in children. Anesthesiology 2007;106(1):80-4. 3. Nyman Y, Von Hoftsen K, Palm C, Eksborg S, Lonnqvist PA. Etomidate-Lipuro is associated with considerably less injection pain in children compared with propofol with added lignocaine. Br J Anaesth 2006;97:536-9. Conflict of Interest:None declared |
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