Glucose analgesia?

[kohlerrf]

melclin coodos"s great topic. this is somthing so ,new and fresh I have never heard of this, thank you! Everyday I learn how much more I dont know!

[fireflymedic]

I was going to give replying a good go, but I simply could not agree on a meaning for most of what you wrote. I have come to expect a certain amount of illiteracy from Americans (beyond what is normally acceptable on internet forums), but this goes beyond that.

I'll try again tomorrow when I'm rested and can be bothered trying to make sense of you and your mood ring. Or maybe I'll just choose not to bother; we shall see.

Mood ring? I thought those went out in the 70's I gotta go and get me one ! Who in the city is selling them? Hook me up ! In all honesty, it was difficult to discern exactly what type of response you were attempting to provoke. You received documented answers from intelligent people along with links to research from established medical centers yet you only choose to comment on the "mood" of the responses. Perhaps if you chose to listen, read, and educate yourself on the links provided you could maintain an intelligent conversation instead of joining into a peeing match. Instead of adding to the discussion (which could have really led to some great insights - it wasn't a bad topic) you left me going

[melclin]

Yeah I was tired and grumpy last night, and I didn't really realize how non-specific and overly nasty my last comment seemed. It was directed at tnuiqs. The mood ring reference is from one of his posts.

Nope Referring to Lumbar Punctures and Circumcision without local, I personally enjoy my foreskin and if someone sticks a needle in my spinal space ... without major analgesia ... I do kick like a mule, just saying.

Well I'm certainly glad to hear how you feel about your foreskin, but what has that got to do with sucrose's efficacy for analgesia in minor procedural pain. Again we were talking primarily about heel pricks and venupuncture. If the point you are trying to make is that sucrose is being extended to procedures for which it is not appropriate, then say it. Stop with the sarcastic examples and condescending rhetoric.

I showed you a reference to the fact that it is accepted that it should be combined with other analgesia/sedation where appropriate, and the article we are discussing mentions it too. Morphine infusions, acetaminophen etc. Why do you continue to argue on the premise that we are suggesting a little sucrose is enough sedation for intubation?

Bottom line in the practice of Paramedicine look to the I.O as I.V. access in Critical care neonate or Peds patient, chase lollipops if you so feel its necessary.

I don't necessarily disagree. What astounds me is that after having said, "The point of my question was simply to establish whether or not anyone else had heard of it being accepted practice, and any discussion that grew from there was a bonus. I simply thought it was an interesting idea, and wanted to know more about it, regardless of its applications in paramedic practice", That you still feel it necessary to repeat that point.

As an aside, I won't have either kind of access on paeds when graduate, and maybe the glucose issue is worth some further investigation - more likely is that we will just get IO. But I certainly, won't be instituting a new treatment modality because I read some links in forum thread.

I am so pleased, So will you be putting a bottle of Glucose in your Kit?

Now this is what I'm getting at when I talk about condescending rhetoric. Obviously we already have glucose paste in the kits (I think it's actually sucrose) and if we didn't, I certainly don't have the authority to go adding drugs to the bag. You know this. So what is the point of that question if not to sarcastically infer that I'm stupid enough to change my practice and add junk to my whacker bag, based on an afternoon spent on an internet forum?

FIRFLYMEDIC: It was numerous comments with that attitude, and a confusing inability to structure sentences, and indeed, entire posts, which lead to my ill-considered grumpy reply. Few things rile me like condescension and poor grammar.

The study did, and I quoted it to demonstrate my perspective and I read it with not only an critical eye but added personal experience to the subject at hand.

Where does the study talk about sucrose being the only sedative/analgesic used for vent pt? The study looked at a number of practices that were not necessarily associated. One was sucrose analgesia for minor procedures, another was pain management and sedation in vent pts. Not once under the heading you posted is the word sucrose used, nor its use recommended. Even if the two sets intersect somewhere, it does not mean they were using sucrose to sedate intubated pts. Even in the section on circumcision, it is clear the sucrose is co-prescirbed with acetaminophen.

Am I missing something? Is it the NPO pts? If all your experience affords you the ability to read between the lines, then you will need to explain that. It is not simply enough to post a sub-heading of an unrelated topic in the same paper and then condescendingly tell others to 'read the paper', if we don't understand your point.

http://pediatrics.aa...cetype=HWCIT://

[fireflymedic]

Yeah I was tired and grumpy last night, and I didn't really realize how non-specific and overly nasty my last comment seemed. It was directed at tnuiqs. The mood ring reference is from one of his posts.

Well I'm certainly glad to hear how you feel about your foreskin, but what has that got to do with sucrose's efficacy for analgesia in minor procedural pain. Again we were talking primarily about heel pricks and venupuncture. If the point you are trying to make is that sucrose is being extended to procedures for which it is not appropriate, then say it. Stop with the sarcastic examples and condescending rhetoric.

I showed you a reference to the fact that it is accepted that it should be combined with other analgesia/sedation where appropriate, and the article we are discussing mentions it too. Morphine infusions, acetaminophen etc. Why do you continue to argue on the premise that we are suggesting a little sucrose is enough sedation for intubation?

I don't necessarily disagree. What astounds me is that after having said, "The point of my question was simply to establish whether or not anyone else had heard of it being accepted practice, and any discussion that grew from there was a bonus. I simply thought it was an interesting idea, and wanted to know more about it, regardless of its applications in paramedic practice", That you still feel it necessary to repeat that point.

As an aside, I won't have either kind of access on paeds when graduate, and maybe the glucose issue is worth some further investigation - more likely is that we will just get IO. But I certainly, won't be instituting a new treatment modality because I read some links in forum thread.

Now this is what I'm getting at when I talk about condescending rhetoric. Obviously we already have glucose paste in the kits (I think it's actually sucrose) and if we didn't, I certainly don't have the authority to go adding drugs to the bag. You know this. So what is the point of that question if not to sarcastically infer that I'm stupid enough to change my practice and add junk to my whacker bag, based on an afternoon spent on an internet forum?

FIRFLYMEDIC: It was numerous comments with that attitude, and a confusing inability to structure sentences, and indeed, entire posts, which lead to my ill-considered grumpy reply. Few things rile me like condescension and poor grammar.

Where does the study talk about sucrose being the only sedative/analgesic used for vent pt? The study looked at a number of practices that were not necessarily associated. One was sucrose analgesia for minor procedures, another was pain management and sedation in vent pts. Not once under the heading you posted is the word sucrose used, nor its use recommended. Even if the two sets intersect somewhere, it does not mean they were using sucrose to sedate intubated pts. Even in the section on circumcision, it is clear the sucrose is co-prescirbed with acetaminophen.

Am I missing something? Is it the NPO pts? If all your experience affords you the ability to read between the lines, then you will need to explain that. It is not simply enough to post a sub-heading of an unrelated topic in the same paper and then condescendingly tell others to 'read the paper', if we don't understand your point.

http://pediatrics.aa...cetype=HWCIT://

I'm sorry but had you read the entire study you would have noticed the one heading specifically titled "sucrose use consensus study" and it specifically addressed the use of it for heel sticks. I would copy and paste, but the amount is too exhaustive to place within a thread and I feel those motivated to do the research can read the paper for themelves. As I understood the discussion to be focused towards the overall use of sucrose for pain management of minor procedures and other alternative methods of controlling pain. Please correct me if I am wrong in that understanding and if so, please direct me in the proper direction. Are you looking for studies involving the use of sucrose for intubated patients? My assumption was that you were looking at the efficacy of it for heel sticks, IV starts, etc. As I stated if I am wrong, direct me in the right way and I'll try to find research into your exact question. I'm just not quite sure what your request is.

[melclin]

I'm sorry but had you read the entire study you would have noticed the one heading specifically titled "sucrose use consensus study" and it specifically addressed the use of it for heel sticks. I would copy and paste, but the amount is too exhaustive to place within a thread and I feel those motivated to do the research can read the paper for themelves. As I understood the discussion to be focused towards the overall use of sucrose for pain management of minor procedures and other alternative methods of controlling pain. Please correct me if I am wrong in that understanding and if so, please direct me in the proper direction. Are you looking for studies involving the use of sucrose for intubated patients? My assumption was that you were looking at the efficacy of it for heel sticks, IV starts, etc. As I stated if I am wrong, direct me in the right way and I'll try to find research into your exact question. I'm just not quite sure what your request is.

My last two paragraphs were directed more at tnuiqs. I wasn't asking anything of you.

Maybe we're looking at two different studies, because I am about as close to certain as any person should be, that the heading "sucrose use consensus study" doesn't exist in the one I'm looking at. I've read it. I've scanned over it a dozen times since looking for the heading, and the text search of the articles turns up nothing in either the pdf or HTML versions. We're talking about "Implementation and Case-Study Results of Potentially Better Practices to Improve Pain Management of Neonates" right? There's a heading in there called "sucrose consensus protocol", is that what you were talking about?. In any case, I know the article addresses heel sticks. We've got a our wires crossed I think. What I said in my second two paragraphs was directed at tnuiqs regarding his insistence on the idea that there was some suggestion that sucrose should be used as the sole sedative/analgesic in intubated pt to maintain their intubation.

The study was entirely relevant, thank you for finding it. My problem is that, as I see it, tnuiqs has taken a part of that study that does not have anything to do with sucrose analgesia, suggesting that it does, and then making statements about sucrose's efficacy/utility based on it. If I've misunderstood, I apologise, its entirely possible that I got the wrong end of the stick, but I feel like I could be forgiven; some tnuiqs posts are not exactly crystal clear in their meaning.

The passage quoted was: "Ongoing Analgesia for the Mechanically Ventilated Infant" which went on to talk about the following,

the physician staff decided to prescribe morphine infusions (2–3 g/kg per hour in preterm infants, 5 g/kg per hour in term infants) for all newly intubated neonates. Doses were calculated using gestational age–based clearance values to achieve an estimated serum level of 20 ng/mL associated with effective analgesia for postoperative pain. (30,31) During the next 3-month observation period, 22 of 23 intubated patients received morphine infusions (96% compliance).

[Aussieaid]

In realm of the Paramedic there are generally 3 category's that one will be called for, respiratory, cardiovascular and sepsis/quote]

I thought they were stubbed toe, minor pain at 3am that's lasted longer than 3 weeks and "I'm in pain but allergic to anything but Opiates"!

[fireflymedic]

[medic0surgeon]

I was speaking with a paramedic recently who mentioned a practice common at the children's hospital: using glucose paste (or maybe sucrose, if that makes any difference) as a mild analgesic for babies and toddlers. Apparently there isn't any literature on the matter, although I've not looked myself, but its common practice.

Anyone heard of this/seen this/ done this before? Opinions?

When you say "Glucose as an analgesic," in what way is it used? What is the route of delivery or even the indications?

Edited December 18, 2009 by medic0surgeon

[chbare]

If you go through the first couple of pages, you should find the answers to your questions and even a study comparing oral glucose to EMLA cream in the setting of invasive procedures.

Take care,

chbare.