• Montgomery, Carolyne

    Titles
    Investigator, BC Children's Hospital
    Clinical Professor, Division of Pediatric Anesthesiology, Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia
    Fellowship Program Director, University of British Columbia
    Pediatric Anesthesiologist, BC Children's Hospital
    Degrees / Designations
    MD, FRCPC
    Primary Area of Research
    Evidence to Innovation
    Secondary Area(s) of Research
    Phone
    604-875-2711
    Fax
    604-875-3221
    Lab Phone
    Mailing Address
    BC Children's Hospital

    Room 1L7
    4480 Oak Street
    Vancouver, BC V6H 3V4

    Affiliate Websites
    Research Areas
    • Pediatric Anesthesia
    • Patient Safety
    • Total Intravenous Anesthesia
    • Acute Pain Management
    • Procedural Sedation
    Summary

    I am involved in a number of research projects in pediatric anesthesia. My primary focus is on pain management for children.

    Current Projects

    Emergence Delirium in Children
    Emergence delirium is defined as a dissociated state of consciousness in which a child, following emergence from anesthesia, is inconsolable, irritable, uncompromising or uncooperative, typically thrashing, crying, moaning, or incoherent. Experiencing and witnessing these behavioral disturbances can be dangerous and distressing for the child and upsetting for his/her parents.

    Based on the experience of physicians at BCCH, total intravenous anesthesia (TIVA) has a reduced incidence of ED compared to sevoflurane (SEVO) anesthesia. However, this clinical impression that TIVA is superior to SEVO has not been confirmed in a robustly conducted study. SEVO is currently the most commonly used anesthetic agent in pediatric anesthetic practice in Canada, North America and developed countries. Determining whether TIVA reduces the incidence and severity of ED as compared to SEVO would indicate that TIVA has a better recovery profile than SEVO. This will increase the evidence for its adoption as the new standard of care in pediatric anesthesia and increase the safety and wellbeing of patients.

    The aims of this study are to minimize the incidence of ED, reduce anesthetic morbidity in children, increase patient safety, and therefore reduce the distress experienced by parents.

    Ketamine and Hydromorphone PCA analgesia for Antineoplastic-Induced Pediatric Mucositis
    The treatment of cancer in children may result in an extremely painful condition called oral mucositis when the cells lining the mouth are injured due to the cancer medication. Patients with this condition are often unable to take anything by mouth or to swallow their own saliva.

    Ketamine is an established intravenous pain medicine used in children at BCCH in the emergency room and cancer clinic. In the last 10 years, several adult studies have looked at combining low—dose ketamine with morphine or hydromorphone to improve postoperative pain management and decrease the side effects of these opioid drugs, which include constipation, nausea and vomiting, itching, sleepiness, mood changes, trouble urinating and decreased breathing. The ketamine may reduce the amount of opioid needed by blocking different pain receptors.

    The purpose of this study is to determine which of 3 concentrations of ketamine to combine with hydromorphone to provide the best pain relief with minimum side effects. The results from this study will allow us to do a larger study to compare the best concentration found from this study to standard treatment. If successful, this combination of ketamine and hydromorphone will also be used to treat other pain problems in children.

    Medstorm
    To assess skin conductance fluctuations compared to self-report pain scales for the assessment of postoperative pain in children. The purpose of this study is to find out whether changes in sweating in the skin can accurately assess the intensity of a child’s pain after surgery.

    Selected Publications

    Refereed Papers 

    Velez de Mendizabal N, Jimenez-Mendez R, Cooke E, Montgomery CJ, Dawes J, Rieder MJ, Aleksa K, Koren G, Jacobo-Cabral CO, Gonzalez-Ramirez R, Castañeda-Hernandez G, Carleton BC. A Compartmental Analysis for Morphine and Its Metabolites in Young Children After a Single Oral Dose. Clin Pharmacokinet. 2015 Mar 13. [Epub ahead of print]. PMID: 25773480.

    Dawes J, Myers D, Görges M, Zhou G, Ansermino JM, Montgomery CJ. Identifying a rapid bolus dose of dexmedetomidine (ED50) with acceptable hemodynamic outcomes in children. Paediatr Anaesth. 2014 Dec;24(12):1260-7. doi: 10.1111/pan.12468. PMID: 25040186.

    Amari E, Vandebeek C, Montgomery CJ, Skarsgard E, Warnock F, Ansermino JM. Comparison of web- based and telephone questionnaires for assessing pediatric day surgery. International Journal of Healthcare Quality Assurance, accepted October 2008.

    Lam CW, Klassen AF, Montgomery CJ, LeBlanc JG, Skarsgard ED. Quality of life outcomes following surgical correction of pectus excavatum: A comparison of the Ravitch and Nuss Procedures. J Pediatric Surg 2008 May;43 (5):819-25. PMID: 18485946.

    Amari E, Murray D, Vandebeek C, Montgomery CJ, Skarsgard E, Warnock F, Ansermino JM. Brief Report: Development of pediatric day surgery quality measurement questionnaire. Journal for Healthcare Quality Nov/Dec 2007. 29 (6): 36-44.

    Nakatsuka N, Minogue 5, Lim J, Montgomery C, Court C, Malherbe 5, Csanyi-Fritz Y, Kearney R, Phillips L, Reid K, Kingsley J, Ansermino M. Intravenous nalbuphine 50 mcg/kg is ineffective for opioid-induced pruritus. Can J Anesth 2006;53: 1103-1110. PMID: 17079637.

    Chambers CT, Hardial J, Craig KD, Court C, Montgomery C. Faces Scales for the Measurement of Postoperative Pain Intensity in Children Following Minor Surgery. Clin J Pain 2005;21(3):277-285. PMID: 15818080.

    Evans D, Turnham L, Barbour K, Kobe J, Wilson L, Vandebeek C, Montgomery C, Rogers P. Intravenous ketamine sedation for painful oncology procedures. Paediatr Anaesth 2005;15(2):131-8. PMID: 15675930.

    Ansermino M, Basu R, Vandebeek C, Montgomery C. Nonopioid additives to local anaesthetics for caudal blockade in children: a systematic review. Paediatric Anaesthesia 2003;13: 561-73. PMID: 12950855.

    Book Chapters
    Pediatric Pain in: Managing Pain, The Canadian Healthcare Professional’s reference. RD Jovey, editor. 3rd Edition 2006 Purdue Pharma.

    Grants
    Honours & Awards
    Research Group Members

    The research manager, research assistants and research fellows of the Anesthesia Research Team.