Search

In laboratory animals, exposure to most general anaesthetics leads to neurotoxicity manifested by neuronal cell death and abnormal behaviour and cognition. Some large human cohort studies have shown an association between general anaesthesia at a young age and subsequent neurodevelopmental deficits, but these studies are prone to bias. Others have found no evidence for an association. We aimed to establish whether general anaesthesia in early infancy affects neurodevelopmental outcomes.

Physicians should be especially careful when giving painkillers that contain codeine to children with a history of kidney failure. A 5-year-old boy with a history of kidney failure received a painkiller containing acetaminophen and codeine every 4 hours after he had his tonsils and adenoids removed. By the next morning, his parents found him blue and not breathing. He was rushed to a hospital where he was placed on a ventilator. Analysis of blood samples revealed that he had excessive levels of a metabolite of codeine because his kidneys could not eliminate it fast enough.

Pain in infants is often undertreated, A new synthetic opiate, a parenteral NSAID now approved for use in patients as young as 1 year, and improvements in the use of [...]

Pharmacology of infants is understudied and different from other populations.

La farmacología de los lactantes es poco estudiada y difiere de la farmacología de otras poblaciones.

Preclinical data suggest that general anaesthetics affect brain development. There is mixed evidence from cohort studies that young children exposed to anaesthesia can have an increased risk of poor neurodevelopmental outcome. We aimed to establish whether general anaesthesia in infancy has any effect on neurodevelopmental outcome. Here we report the secondary outcome of neurodevelopmental outcome at 2 years of age in the General Anaesthesia compared to Spinal anaesthesia (GAS) trial.

Have you ever experienced a poor quality voice-on-the-Net call and just attributed it to the vagaries of the Internet? Think again: there's more to Internet calling than the hobbyist $39.95 […]

ABSTRACTBackground:Emergence delirium may be experienced by 12–50 of children undergoing general anesthesia. Pharmacological interventions used for management of emergence delirium may result in sedation and longer recovery time from anesthesia.Objective:To evaluate the effectiveness of acupuncture therapy for prevention of emergence delirium.Design, Setting, and Patients:A retrospective review of the Seattle Children's Hospital anesthesiology department acupuncture database of children diagnosed with emergence delirium after general anesthesia who had acupuncture therapy with needle stimulation at SP 6, HT 7, LR 3, and magnets at ear Shenmen area in a subsequent anesthetic for the same procedure. Patients undergoing different anesthetic techniques or different procedures were excluded. The database included cases from July 2004 to January 2006.Main Outcome Measures:Symptoms of emergence deliriumResults:Twelve patients, aged 2 to 17 years (median, 4 years), 58 males, were included. The most common procedure (n 10) was lumbar puncture with administration of intrathecal chemotherapy and/or bone marrow aspirate done under total intravenous anesthesia with alfentanil and propofol. After the acupuncture intervention, 10 patients (83) did not exhibit symptoms of emergence delirium, and 2 patients (17) exhibited milder symptoms with crying and irritability but were able to communicate the source of distress. Additionally, in the total intravenous anesthesia group, patients received less propofol when comparing anesthetic requirements before and after the intervention. No complications were reported in any of the patients.Conclusion:Our experience suggests that acupuncture therapy is a safe, non-pharmacological option for prevention of emergence delirium in children undergoing general anesthesia.

Background: Previous studies show that the age of an infant affects morphine clearance but that ventilatory effects from morphine infusions are similar at the same morphine steady‐state concentration in infants and children after surgery. The presence of cyanotic heart disease in infants receiving postoperative morphine infusions was studied for its potential effect on ventilatory effort.

Abstract: One hundred and five children with congenital heart disease were monitored by pulse oximetry during cardiac catheterization. Excellent correlation (r = 0.95) was found between oxygen saturation values obtained with pulse oximetry and those obtained from arterial blood in 133 data pairs. This correlation was described by the regression equation y = 0.91 x + 8.1. The correlation was also excellent in 47 data pairs with saturation values of less than 90% (r = 0.94, y = 0.93x + 6.0) from 36 cyanotic children. The clinical usefulness of pulse oximetry in the early recognition of decreased pulmonary blood flow or partial airway obstruction was demonstrated. Early diagnosis of changes in oxygenation was especially helpful in children with cyanotic congenital heart disease, in whom small changes in arterial oxygen tension may cause large changes in oxygen saturation.

The interaction of the pulmonary surfactant protein SP-A fluorescently labeled with Texas Red (TR-SP-A) with monolayers of dipalmitoylphosphatidylcholine (DPPC) and DPPC/dipalmitoylphosphatidylglycerol 7:3 w/w has been investigated. The monolayers were spread on aqueous subphases containing TR-SP-A. TR-SP-A interacted with the monolayers of DPPC to accumulate at the boundary regions between liquid condensed (LC) and liquid expanded (LE) phases. Some TR-SP-A appeared in the LE phase but not in the LC phase. At intermediate surface pressures (10–20 mN/m), the protein caused the occurrence of more, smaller condensed domains, and it appeared to be excluded from the monolayers at surface pressure in the range of 30–40 mN/m. TR-SP-A interaction with DPPC/dipalmitoylphosphatidylglycerol monolayers was different. The protein did not appear in either LE or LC but only in large aggregates at the LC-LE boundary regions, a distribution visually similar to that of fluorescently labeled concanavalin A adsorbed onto monolayers of DPPC. The observations are consistent with a selectivity of interaction of SP-A with DPPC and for its accumulation in boundaries between LC and LE phase.

Pulmonary surfactant maintains a putative surface-active film at the air-alveolar fluid interface and prevents lung collapse at low volumes. Porcine lung surfactant extracts (LSE) were studied in spread and adsorbed films at 23±1°C using epifluorescence microscopy combined with surface balance techniques. By incorporating small amounts of fluorescent probe 1-palmitoyl-2-nitrobenzoxadiazole dodecanoyl phosphatidylcholine (NBD-PC) in LSE films the expanded (fluid) to condensed (gel-like) phase transition was studied under different compression rates and ionic conditions. Films spread from solvent and adsorbed from vesicles both showed condensed (probe-excluding) domains dispersed in a background of expanded (probe-including) phase, and the appearance of the films was similar at similar surface pressure. In quasistatically compressed LSE films the appearance of condensed domains occurred at a surface pressure (π) of 13 mN/m. Such domains increased in size and amounts as πwas increased to 35 mN/m, and their amounts appeared to decrease to 4% upon further compression to 45 mN/m. Above πof 45 mN/m the LSE films had the appearance of filamentous materials of finely divided dark and light regions, and such features persisted up to a πnear 68 mN/m. Some of the condensed domains had typical kidney bean shapes, and their distribution was similar to those seen previously in films of dipalmitoylphosphatidylcholine (DPPC), the major component of surfactant. Rapid cyclic compression and expansion of LSE films resulted in features that indicated a possible small (5%) loss of fluid components from such films or an increase in condensation efficiency over 10 cycles. Calcium (5mM) in the subphase of LSE films altered the domain distribution, decreasing the size and increasing the number and total amount of condensed phase domains. Calcium also caused an increase in the value of πat which the maximum amount of independent condensed phase domains were observed to 45 mN/m. It also induced formation of large amounts of novel, nearly circular domains containing probe above πof 50 mN/m, these domains being different in appearance than any seen at lower pressures with calcium or higher pressures in the absence of calcium. Surfactant protein-A (SP-A) adsorbed from the subphase onto solvent-spread LSE films, and aggregated condensed domains in presence of calcium. This study indicates that spread or adsorbed lung surfactant films can undergo expanded to condensed, and possibly other, phase transitions at the air-water interface as lateral packing density increases. These phase transitions are affected by divalent cations and SP-A in the subphase, and possibly by loss of material from the surface upon cyclic compression and expansion.

• OBJECTIVE. —To determine how early in childhood the clearance of morphine sulfate reaches that in adults. DESIGN. —Patient series. SETTING. —Children's Hospital and Medical Center, Seattle, Wash. PARTICIPANTS. —Forty-nine children aged 1 day to 2.5 years with normal renal and hepatic function. All children were receiving a constant rate intravenous infusion of morphine for postoperative analgesia for greater than 24 hours. INTERVENTIONS. —Blood and urine samples were collected during infusion and immediately after discontinuation of the morphine infusion. MEASUREMENTS. —Morphine concentrations were determined and clearance was calculated using the infusion data. Half-life and volume of distribution were calculated using the postinfusion data. The formation of metabolites was evaluated using the urine data. Morphine clearance increased with age, median clearances ranging from 5 mL/kg per minute in neonates aged 1 to 7 days to 21 mL/kg per minute in infants aged 6 months and older. This change in clearance correlated with age. The formation clearance of morphine glucuronide was correlated with age, whereas the formation clearance of morphine sulfate and the renal clearance of morphine were independent of age. CONCLUSIONS. —Morphine clearance reaches adult values by age 6 months to 2.5 years. In contrast to previous reports on the maturation of sulfate conjugation, it does not appear that morphine sulfate clearance is enhanced relative to glucuronidation in early infancy.(AJDC. 1992;146:972-976)

This study describes an observational system (modified infant pain scale, MIPS) with elements from a previously published observational scale and from assessments of video-recorded infant facial expressions. It was designed to allow rapid and repeated assessments of pain in infants after brief training by an observer without pediatric experience. Forty healthy term infants (17 ± 7 weeks) undergoing elective surgery had simultaneous independent assessment of pain using two scales: a naive observer used the MIPS and an experienced pediatric nurse used a 10-cm unmarked horizontal visual analogue scale (VAS). This validation of the MIPS included its division during analysis into partial (P-MIPS, without data on sleep or vital signs) and total scores. Infants had a broad range of MIPS scores, and the two scales categorized infants as "comfortable" or "not comfortable" with a high degree of concordance. The MIPS was easily incorporated into an infant's physical examination. We recommend its use for two-point clinical pain assessment.

We describe a laser-scanning two-photon fluorescence microscope that is capable of observing single molecules with excellent temporal resolution and three-dimensional spatial resolution. To demonstrate the capabilities of the instrument we present single-molecule fluorescence data obtained in several different scanning modes. In addition, a polarization-sensitive detection scheme can provide detailed three-dimensional information about the orientations of molecules in any of these scanning modes.

• We report two children who survived neurologic injury (near-drowning and Reye's syndrome) and adult respiratory distress syndrome and who required prolonged ventilatory support. Follow-up examination in both children showed steady neurologic recovery, but five months following discharge from their acute illness, profound hearing loss was diagnosed in both children. A review of the literature is reported and the hypothesis that combined aminoglycoside antibiotic and loop diuretic therapy caused the hearing loss is presented. Recommendation is made for audiologic assessment within six months of recovery from critical illness of pediatric patients in whom therapy has included loop diuretic and aminoglycoside antibiotic therapy.(AJDC 1985;139:464-466)

We describe the use of remifentanil in three infants with complex medical issues (hepatic failure, cyanotic heart disease and renal compromise). The short duration of opioid effect even after a long period of drug infusion (18 h) suggests this drug may be useful in some infants. Continued study is warranted.

The article offers step-by-step instructions for making Christmas cards.

The article offers step-by-step instructions for making Hanukkah cards.

The article reports on the camellia donation made by the American Camellia Society to the George T. Bagby State Park in Fort Gaines, Georgia. The camellias were donated by the society to jumpstart the grounds improvement project of the park. The project is set to begin with the installation of the irrigation system, selective clearing of undergrowth and ground preparation for the collection and planting of camellias.