Martin Shirley D, John Lauri D
J Perianesth Nurs. 2019 Dec;34(6):1106-1119. doi: 10.1016/j.jopan.2019.03.015. Epub 2019 Jul 12.
An estimated 100,000 obese (OB) and overweight (OW) children undergo tonsillectomy each year in the United States. Pain management in this population is particularly challenging because of weight-based dosing, clinician fears, potential for airway obstruction, and genetic differences. A framework is proposed to explain factors involved in the post-tonsillectomy pain (PTP) experience in OB and OW children. The tonsillectomy, the body's inflammatory state, and mechanical stressors comprise influencing factors in PTP progression. Clinician-delivered medication doses, genetic variants of drug metabolism, and soothing factors serve as mediating factors in the progression of PTP. Postanesthesia care unit (PACU) nurses may use this framework to better understand PTP progression in OB and OW children. PACU nurses may manipulate certain mediating factors discussed in this framework to moderate PTP progression in OB and OW children. Researchers may use this framework to support future research to improve PTP management in OB and OW children.
在美国，估计每年有10万名肥胖（OB）和超重（OW）儿童接受扁桃体切除术。由于基于体重的给药方式、临床医生的担忧、气道阻塞的可能性以及基因差异，对这一群体的疼痛管理尤其具有挑战性。本文提出了一个框架，用以解释肥胖和超重儿童扁桃体切除术后疼痛（PTP）体验所涉及的因素。扁桃体切除术、身体的炎症状态和机械应激源是PTP进展的影响因素。临床医生给予的药物剂量、药物代谢的基因变异以及舒缓因素是PTP进展的中介因素。麻醉后护理单元（PACU）的护士可以使用这个框架来更好地理解肥胖和超重儿童的PTP进展情况。PACU护士可以操控本框架中讨论的某些中介因素，以减轻肥胖和超重儿童的PTP进展。研究人员可以使用这个框架来支持未来的研究，以改善肥胖和超重儿童的PTP管理。
