title: Pain management in intellectually disabled children: a survey of perceptions and current practices among Dutch anesthesiologists.
abstract: BACKGROUND
  Intellectually disabled children are more likely to undergo surgical interventions and almost all have comorbidities that need to be managed. Compared with controls, intellectually disabled children tend to receive less intraoperative analgesia and fewer of them are assessed for postoperative pain.
  
  
  OBJECTIVE
  To evaluate perceptions and practices of anesthesiologists in the Netherlands concerning pain management in intellectually disabled children.
  
  
  METHODS
  We surveyed members of the Section on Pediatric Anesthesiology of the Netherlands Society of Anesthesiology in 2005 and 2009, using a self-designed questionnaire.
  
  
  RESULTS
  The response rate was 47% in both years. In 2005, 32% of the anesthesiologists rated intellectually disabled children as 'more sensitive to pain' than nonintellectually disabled children--vs 25% in 2009. But no more than 7% in 2005 vs 6% in 2009 agreed with the statement 'children with intellectually disabled children need more analgesia'. Most anesthesiologists gave similar doses of intraoperative opioids for intellectually disabled and nonintellectually disabled children, 92% in 2005 vs 89% in 2009. In 2005, only 3% applied a pain assessment tool validated for intellectually disabled children, vs 4% in 2009.
  
  
  CONCLUSIONS
  Anesthesiologists in the Netherlands take a different approach when caring for intellectually disabled children and they were not aware of pain observation scales for these children. However, the majority think that intellectually disabled children are not more sensitive to pain or require more analgesia. These opinions did not change over the 4-year period. One way to proceed is to implement validated pain assessment tools and to invest in education.
authors.affiliation: Department of Pediatric Surgery, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands. a.valkenburg@erasmusmc.nl
authors.forename: Abraham J
authors.initials: AJ
authors.lastname: Valkenburg
authors.forename: Sylvia M
authors.initials: SM
authors.lastname: van der Kreeft
authors.forename: Tom G
authors.initials: TG
authors.lastname: de Leeuw
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stolker
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
authors.forename: Monique
authors.initials: M
authors.lastname: van Dijk
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000758:Anesthesia; D000776:Anesthesiology / Q000193:education / Q000639:trends; D002648:Child; D056805:Consciousness Monitors; D003627:Data Interpretation, Statistical; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use; D008607:Intellectual Disability / Q000150:complications*; D009426:Netherlands; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D010820:Physicians; D011182:Postoperative Care; D011300:Preoperative Care; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives