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Placebo analgesia is the occurrence of an analgesic drug effect without drugs. The response is learned through conditioning and mediated by expectancy. It lies on the up-regulation of the pain-modulating areas and the down-regulation of the pain-encoding regions. A further mechanism is the retrieval of the brain circuit activity previously excited by drugs. We describe the case of an infant affected by a tracheal agenesis who underwent a series of operative and diagnostic bronchoscopies for which she received midazolam and fentanyl. After 61 procedures the infant showed a somatosensory response which in our interpretation reflected a placebo effect. Ontogenetic considerations and specific observations indicate that the infant had the appropriate competences in her learning and memory systems and nociceptive and antinociceptive circuits for the placebo effect to take place. Generalizing, the introduction of placebo manipulation in infant pain management may be taken into consideration; its approach through observational and experimental studies is the preliminary target. [ABSTRACT FROM AUTHOR]

BACKGROUND: The primary aim of the study was to confirm the increase of plasmatic IR ?-endorphin material during the perioperative period in children. The second was to search for the factors responsible for this increment. METHODS: Seventy-two consecutive children undergoing a surgical procedure were recruited. Pre-anaesthesia and anaesthesia were standardised. Plasmatic IR ?-endorphin material was measured at three timepoints: at baseline (t 0), before induction (t 1), and at the end of anaesthesia (t 2). Two general linear models were set up to analyse the influence of demographics and clinics on the IR ?-endorphin variation between t 0and t 1. A third model was established to process the possible surgical factors contributing to the IR ?-endorphin variation between t 1and t 2. RESULTS: ANOVA showed that IR ?-endorphin concentrations increased significantly across the three timepoints (p < 0.0001). Wilcoxon test proved that the difference was significant both for t 0vs. t 1and for t 1vs. t 2. None of the factors taken into account in the pre-operative period influenced the increase in IR ?-endorphin between t 0and t 1. Of the factors taken into account in the surgical period, only the type of procedure was significant (p = 0.005). The t-test showed that IR ?-endorphin significantly increased during spermatic and epigastric anastomosis (p = 0.000), orchidopexy (p = 0.02), Van der Meulen urethroplasty (p = 0.004), and Duckett urethroplasty (p = 0.003). CONCLUSION: Plasmatic ?-endorphin increases during the perioperative period in children. The site of surgery is responsible for this increment during intervention. [ABSTRACT FROM AUTHOR]

Background and objective: This study was performed to determine the individual exposure of paediatric operating theatre personnel to sevoflurane and to evaluate the impact of inhalation induction and various airway approaches on exposure to airborne sevoflurane. Methods: Mean individual environmental (workplace air) exposure to sevoflurane and a biomarker of exposure (urinary sevoflurane) were monitored in 36 subjects (10 anaesthetists, 10 surgeons, 12 nurses and 4 auxiliary personnel) working in two paediatric operating rooms. Results: Environmental and urinary values were significantly greater in anaesthetists compared with other groups, with median values of 0.65 ppm (interquartile range 1.36; 95th percentile 4.36) for breathing zone sevoflurane and 2.1 μg L-1 urine (interquartile range 2.6; 95th percentile 7.6) lot urinary sevoflurane. Anaesthetists exceeded the 2 ppm maximum allowed environmental concentration recommended by the National Institute for Occupational Safety and Health in 4 of 22 cases (18.1 %). A positive correlation was found between the number of patients undergoing inhalational induction each day and mean values of breathing zone and urinary sevoflurane. An increase in the number of daily laryngeal mask insertions, or the use of rigid bronchoscopy, are statistically related to higher environmental and urinary values (P <0.01 and <0.00001 for breathing zone sevoflurane, P < 0.05 and <0.01 for urinary sevoflurane, respectively). Conclusions: Anaesthesia with sevoflurane can pose a hazard of chronic exposure with anaesthetists having the highest risk. Endotracheal intubation offers considerable protection against exposure. Routine anaesthesia using a standard facemask, a laryngeal mask or rigid bronchoscopy are risk factors for increased anaesthetic exposure. [ABSTRACT FROM AUTHOR]

This report describes the case of two newborns who suffered unusual complications after peripheral insertion of a central venous catheter. In one baby a fragment of the catheter tip became embolized in a peripheral branch of the left pulmonary artery. In the other baby, the catheter perforated a peripheral branch of the pulmonary artery, giving rise to chemical pneumonitis with extensive pleural effusion. The outcome was positive for both babies. A large clinical series is necessary to establish the complications of this procedure, their prevention and management. [ABSTRACT FROM AUTHOR]

Presents a study which analyzed the relationship between the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and Faces scale scores and plasma beta-endorphin (B-END) levels. Discussion on B-END and CHEOPS; Materials and methods; Results and discussion.