bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterogeneity of the supramammillary–hippocampal pathways: evidence for a unique GABAergic neurotransmitter phenotype and regional differences
Authors: Soussi Rabia , Zhang Nianhui , Tahtakran Siroun , Houser Carolyn R. , Esclapez Monique 
Published: August 2010

AbstractThe supramammillary nucleus (SuM) provides substantial projections to the hippocampal formation. This hypothalamic structure is involved in the regulation of hippocampal theta rhythm and therefore the control of hippocampal‐dependent cognitive functions as well as emotional behavior. A major goal of this study was to characterize the neurotransmitter identity of the SuM–hippocampal pathways. Our findings demonstrate two distinct neurochemical pathways in rat. The first pathway originates from neurons in the lateral region of the SuM and innervates the supragranular layer of the dorsal dentate gyrus and, to a much lesser extent, the ventral dentate gyrus. This pathway displays a unique dual phenotype for GABAergic and glutamatergic neurotransmission. Axon terminals contain markers of GABAergic neurotransmission, including the synthesizing enzyme of GABA, glutamate decarboxylase 65, and the vesicular GABA transporter and also a marker of glutamatergic neurotransmission, the vesicular glutamate transporter 2. The second pathway originates from neurons in the most posterior and medial part of the SuM and innervates exclusively the inner molecular layer of the ventral dentate gyrus and the CA2/CA3a pyramidal cell layer of the hippocampus. The axon terminals from the medial part of the SuM contain the vesicular glutamate transporter 2 only. These data demonstrate for the first time the heterogeneity of the SuM–hippocampal pathways, not only from an anatomical but also a neurochemical point of view. These pathways, implicated in different neuronal networks, could modulate different hippocampal activities. They are likely to be involved differently in the regulation of hippocampal theta rhythm and associated cognitive functions as well as emotional behavior.
Functional subdivision of feline spinal interneurons in reflex pathways from group Ib and II muscle afferents; an update
Authors: Jankowska Elzbieta , Edgley Steve A. 
Published: August 2010

AbstractA first step towards understanding the operation of a neural network is identification of the populations of neurons that contribute to it. Our aim here is to reassess the basis for subdivision of adult mammalian spinal interneurons that mediate reflex actions from tendon organs (group Ib afferents) and muscle spindle secondary endings (group II afferents) into separate populations. Re‐examining the existing experimental data, we find no compelling reasons to consider intermediate zone interneurons with input from group Ib afferents to be distinct from those co‐excited by group II afferents. Similar patterns of distributed input have been found in subpopulations that project ipsilaterally, contralaterally or bilaterally, and in both excitatory and inhibitory interneurons; differences in input from group I and II afferents to individual interneurons showed intra‐ rather than inter‐population variation. Patterns of reflex actions evoked from group Ib and II afferents and task‐dependent changes in these actions, e.g. during locomotion, may likewise be compatible with mediation by premotor interneurons integrating information from both group I and II afferents. Pathological changes after injuries of the central nervous system in humans and the lineage of different subclasses of embryonic interneurons may therefore be analyzed without need to consider subdivision of adult intermediate zone interneurons into subpopulations with group Ib or group II input. We propose renaming these neurons ‘group I/II interneurons’.
A paradox: after stroke, the non‐lesioned lower limb motor cortex may be maladaptive
Authors: Madhavan Sangeetha , Rogers Lynn M. , Stinear James W. 
Published: August 2010

AbstractWhat are the neuroplastic mechanisms that allow some stroke patients to regain high‐quality control of their paretic leg, when others do not? One theory implicates ipsilateral corticospinal pathways projecting from the non‐lesioned hemisphere. We devised a new transcranial magnetic stimulation protocol to identify ipsilateral corticospinal tract conductivity from the non‐lesioned hemisphere to the paretic limb in chronic stroke patients. We also assessed corticospinal tract degeneration by diffusion tensor imaging, and used an ankle tracking task to assess lower limb motor control. We found greater tracking error during antiphase bilateral ankle movement for patients with strong conductivity from the non‐lesioned hemisphere to the paretic ankle than for those with weak or no conductivity. These findings suggest that, instead of assisting motor control, contributions to lower limb motor control from the non‐lesioned hemisphere of some stroke survivors may be maladaptive.
Cerebral oxygenation monitoring using near infrared spectroscopy during controlled hypotension
Authors: SHEAR TORIN , TOBIAS JOSEPH D. 
Published: August 2010

SummaryBackground:  Controlled hypotension (CH) is used to limit intraoperative blood loss and decrease the need for homologous transfusions. Despite the efficacy of the technique, hypotension has the potential to affect cerebral perfusion and oxygen delivery. There are no data providing a direct measurement of cerebral oxygenation during this technique.Methods:  The current study prospectively evaluated cerebral oxygenation during CH using near infrared spectroscopy. Nineteen patients ranging in age from 6 to 18 years were enrolled in the study. CH was provided using a combination of intravenous opioids and sevoflurane supplemented with labetolol as necessary.Results:  There were a total of 268 readings obtained from the cerebral oximeter. The baseline cerebral oximeter reading was 81 ± 8% on the right and 82 ± 7% on the left. During CH (mean arterial pressure of 65–69, 60–64, 55–59, and <54 mmHg), the right cerebral oximeter values were 80 ± 9, 78 ± 8, 78 ± 10, and 84 ± 9%, respectively while the left cerebral oximeter values were 79 ± 7, 80 ± 7, 78 ± 8, and 78 ± 8%, respectively. Of the 268 readings, there were 11 points (4%) at which either the left or right cerebral oximeter was 10–19 less than the baseline value and no points at which the reading was 20 or more from the baseline value.Conclusions:  Our preliminary data with a measurement of cerebral oxygenation demonstrates the safety of CH within the accepted mean blood pressure recommendations of 55–65 mmHg.
Nasal foreign bodies in children: a possible pitfall for the anesthesiologist
Authors: PIROTTE THIERRY , IKABU CORNEILLE 
Published: August 2010

SummaryBased on a recent surprising case in our institution, we analyze the possible dislodgment of an unknown foreign body in the nose during nasotracheal intubation in children. Nasal foreign bodies made of inert material can remain unnoticed for a long period of time. In addition to inserting a close‐fitting suction catheter into the TT during its passage through the nasopharynx, we now suggest performing a pharyngoscopy when intubation is completed.
Epidural abscess following epidural analgesia in pediatric patients
Authors: LIN YUAN‐CHI , GRECO CHRISTINE 
Published: August 2010

SummaryEpidural abscess following epidural analgesia is an unusual event especially in pediatric patients. Two patients presented with fever and local signs of infection without neurological deficit on day 4 after the initiation of epidural analgesia. Neuro‐imaging studies revealed epidural abscess. Both pediatric patients were treated successfully with intravenous antibiotics. One of the patients’ initial MRI was normal. However, the symptoms persisted and a followed‐up scan revealed epidural abscess. The other patient presented with worsening local indurations over the epidural insertion site and positive blood culture with Hemolytic streptococcus. Our experience suggests that neuro‐imaging study should be strongly considered to evaluate pediatric patients with suspicion of epidural abscess.
Isosulfan blue causes factitious methemoglobinemia in an infant1
Authors: BURGOYNE LAURA L. , W. JAY DENNIS , BIKHAZI GEORGE B. , DE ARMENDI ALBERTO J. 
Published: August 2010

SummaryA 9 month‐old girl was given subcutaneous isosulfan blue to outline lymphatic channels during surgery for thoracic duct ligation. Her pulse oximetry values rapidly declined to a nadir of 85%, 35 min after dye injection. Arterial blood gases revealed methemoglobinemia ([MetHb] = 6.5%). Although abnormal pulse oximetry has already been reported in association with isosulfan blue, methemoglobinemia has not previously been reported. The absorption spectrum for isosulfan blue was determined and when superimposed on that of methemoglobin it was found to have an overlying peak. Interference by the dye was postulated to have caused the abnormal methemoglobin result. The phenomenon was simulated in vitro by adding isosulfan blue to whole blood, and analysing it in the same blood gas analyser as was used for the case, as well as another for comparison. One blood gas analyser reported elevated methemoglobin concentration and the other did not. The samples were sent to a reference laboratory using a chemical method to detect methemoglobin to confirm that the elevated methemoglobin level was spurious.
Randomized controlled trial of sevoflurane for intubation in neonates
Authors: HASSID SOPHIE , NICAISE CLAIRE , MICHEL FABRICE , VIALET RENAUD , THOMACHOT LAURENT , LAGIER PIERRE , MARTIN CLAUDE 
Published: August 2010

SummaryBackground:  Our aim was to determine whether sevoflurane can be used with safety and efficacy for anesthesia during intubation in term and preterm neonates in a prospective randomized‐controlled nonblinded study in a tertiary neonatal intensive care unit.Methods:  Thirty‐three neonates were randomly allocated to receive sevoflurane (inspired concentrations varying from 2% to 5%) or no medication (preoxygenation with 100% oxygen alone) before intubation. Minute by minute heart rate (HR), mean arterial blood pressure, SpO2 and number of episodes of bradycardia (HR < 100 b·min−1) and desaturation (SpO2 < 85% for >30 s) were noted from 5 min before to 10 min after intubation. Operator experience, ease and number of attempts were noted.Results:  No major adverse events were noted in the study group compared with the control group [hypotension (37.5% vs 37.5%, NS), number of desaturations [37.5% vs 44.5%, NS)]. Hypertension (25%, vs 56.3%P = 0.04) and incidence of bradycardias (8.3% vs 44.4%, P < 0.01) were greater in the control group. Intubation was easier in the study group: no movements: 95.5% vs 28% (P < 0.005); good glottis visualization: 73% vs 33% (P = 0.013). The failure rate was lower in the study group (25% vs 39%), but this difference was not statistically significant.Conclusion:  Anesthesia for intubation with sevoflurane in neonates is well tolerated, even in the less mature. It facilitates the conditions for intubation and leads to fewer adverse events. Other studies are necessary to confirm these preliminary results.
Aprotinin and renal dysfunction after pediatric cardiac surgery
Authors: SZÉKELY ANDREA , SÁPI ERZSÉBET , BREUER TAMÁS , KERTAI MIKLÓS D. , BODOR GÁBOR , VARGHA PÉTER , SZATMÁRI ANDRÁS 
Published: August 2010

SummaryBackground: Aprotinin is a potent antifibrinolytic drug, which reduces postoperative bleeding and transfusion requirements. Recently, two observational studies reported increased incidence of renal dysfunction after aprotinin use in adults. Therefore, the aim of the study was to investigate the safety of aprotinin use in pediatric cardiac surgery patients.Methods: Data were prospectively and consecutively collected from 657 pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). The database was assessed with regard to a possible relationship between aprotinin administration and dialysis and between aprotinin and postoperative renal dysfunction [defined as 25% decrease in the creatinine clearance (Ccr) compared with the preoperative value] by propensity‐score adjustment and multivariable methods.Results: The incidence of dialysis (9.6% vs 4.1%;P = 0.005) and renal dysfunction (26.3% vs 16.1%;P = 0.019) was higher in patients who received aprotinin; however, propensity adjusted risk ratios were not significant [odds ratio (OR) of dialysis: 1.22; 95% confidence interval (CI) 0.46–3.22; OR of renal dysfunction 1.26; 95% CI: 0.66–1.92]. Aprotinin significantly reduced blood loss in the first postoperative 24 h. The main contributors of renal dysfunction were CPB duration, cumulative inotropic support, age, preoperative Ccr, amount of transfusion and pulmonary hypertension.Conclusions: Despite the higher incidences of renal dysfunction and failure in the aprotinin group, an independent role of the drug in the development of renal dysfunction or dialysis could not be demonstrated in pediatric cardiac patients undergoing CPB.
Total spinal in an infant: can ‘dry taps’ occur with 20G Tuohy needles?
Authors: JONMARKER CHRISTER , ROWELL JONATHAN C. , JONMARKER OLOF 
Published: August 2010

SummaryThe loss‐of‐resistance technique was used to place a 20G epidural needle in the lumbar region in an anesthetized and paralyzed infant. There was no cerebrospinal fluid (CSF) leakage and a 24G catheter was inserted through the needle. At end of surgery, when the patient was breathing spontaneously and a bupivacaine bolus was given through the catheter, a total spinal block was identified. A bench test demonstrated that CSF leakage from a 20G needle can be delayed if CSF pressure is low and if air bubbles are present in the needle.
Adverse events and behavioral reactions related to ketamine based anesthesia for anorectal manometry in children
Authors: DALAL PRITI G. , TAYLOR DAN , SOMERVILLE NICOLA , SETH NEENA 
Published: August 2010

SummaryBackground:  Pediatric patients undergoing anorectal manometry require ketamine anesthesia as other anesthetic agents affect the anorectal sphincter tone. The aim of this prospective observational audit was to evaluate our practice and report the occurrence of adverse events and behavioral reactions related to the use of ketamine, propofol, and midazolam combinations.Methods:  Eighty‐two consecutive pediatric patients (mean age 8.06 ± 3.43 years) undergoing anorectal manometry were audited over a 1‐year period. After a routine ketamine anesthetic some children were administered midazolam 0.1 mg·kg−1, at the discretion of the attending anesthetist. Children requiring anal stretch following manometry studies also received propofol 3–5 mg·kg−1. Intra‐ and postoperative adverse events, times to spontaneous awakening and discharge from the PACU were noted. Postoperative behavioral reactions were noted in the PACU and at follow‐up interviews on the first postoperative day and after a period of 1 month.Results:  Following completion of the audit, all patients fell into one of the four groups depending on the anesthetic agents they received: K (ketamine only, n = 16), KM (ketamine and midazolam, n = 10), KP (ketamine and propofol, n = 27), and KPM (ketamine, propofol, and midazolam, n = 29). There was no difference in the occurrence of behavioral reactions between the four groups at the three stages of follow‐up. Overall, five patients reported ‘new onset’ nightmares that had resolved completely at the 3‐month follow‐up. The time to spontaneous awakening was shorter for K group (17.8 min ± 20.2) vs KPM group (61.7 min ± 24.4; P < 0.001). The times to discharge in minutes was also shorter in the K group (54.5 min, IQR 30–75 vs 90 min IQR 78–120; P < 0.001). Administration of propofol appeared to have an antiemetic effect [odds ratio (OR) 0.1, 95% confidence intervals (CI) 0.02–0.58, P < 0.009] in the recovery unit.Conclusions:  Our study findings suggest that, besides significantly prolonging time to spontaneous awakening and PACU discharge, neither the use of midazolam, propofol, or combinations is beneficial in preventing the occurrence of behavioral reactions following ketamine anesthesia. Behavioral reactions were common but did not appear to be long‐term. Drug combinations with ketamine may have other benefits such as antiemesis.
Reversal of rocuronium‐induced neuromuscular blockade by pyridostigmine in patients with Duchenne muscular dystrophy
Authors: MUENSTER TINO , FORST JUERGEN , GOERLITZ PETER , SCHMITT HUBERT J. 
Published: August 2010

SummaryBackground:  The aim of this study was to investigate the effect and safety of pyridostigmine for the reversal of a neuromuscular block (NMB) in patients with Duchenne muscular dystrophy (DMD). In patients with DMD recovery from a rocuronium‐induced NMB is markedly delayed.Methods:  Fourteen DMD patients (aged between 11 and 19 years) scheduled for elective scoliosis repair were studied. Following tracheal intubation without muscle relaxant, all patients received a single dose of rocuronium 0.6 mg·kg−1. NMB was monitored by acceleromyography at the adductor pollicis muscle. When the first twitch height (T1) of the train‐of‐four (TOF) had recovered to 25% seven patients received either pyridostigmine 0.1 mg·kg−1 (the anticholinergic drug with a long duration of action) or saline in a blinded manner. The times to attain TOF ratio of 0.9 were recorded. For comparison the Mann–Whitney U‐test was used.Results:  Recovery to TOF ratio of 0.9 was significantly (P < 0.05) accelerated by pyridostigmine [84 (median), 57–141(range)] compared with controls (148, 84–243 min). The recovery time (time between T1 of 25% and TOF of 90%) was also significantly (P < 0.01) shortened by pyridostigmine (15, 8–49 vs 76, 43–144 min, respectively). Time to recovery of T1 to 90% was not different between the groups (108, 63–134 vs 169. 61–208 min, respectively).Conclusions:  Pyridostigmine 0.1 mg·kg−1 effectively reversed a rocuronium‐induced NMB in DMD patients.
Raynaud’s phenomenon in a child presenting as oxygen desaturation during transfusion with cold blood
Authors: ZHANG XIAOPENG , COTÉ CHARLES J. 
Published: August 2010

SummaryWe report a case of Raynaud’s phenomenon (RP) triggered by transfusion of cold blood to a pediatric burn patient under general anesthesia. The child was febrile so a decision was made to not use a blood warmer. When the blood was rapidly administered the child suddenly developed ‘desaturation’. The child was placed on 100% oxygen, adequate ventilation assured, and the color of his oral mucosa assessed as ‘pink’. Placement of the oximeter on the opposite hand revealed 100% saturation. To our knowledge, this is the first case of apparent RP reported in a pediatric patient triggered by transfusion of cold blood.
Continuous incisional infusion of local anesthetic in pediatric patients following open heart surgery
Authors: TIROTTA CHRISTOPHER F. , MUNRO HAMISH M. , SALVAGGIO JANE , MADRIL DANIELLE , FELIX DONALD E. , RUSINOWSKI LYNDA , TYLER CRISTI , DECAMPLI WILLIAM , HANNAN ROBERT L. , BURKE REDMOND P. 
Published: August 2010

SummaryAim:  To determine the efficacy and safety of a continuous subcutaneous local anesthetic (LA) infusion in pediatric patients following open heart surgery.Background:  The use of a continuous LA infusion has been shown to be beneficial following adult cardiac surgery. To date there are no studies in the pediatric population.Methods/Materials:  Using a prospective, randomized, and double blind design, we compared LA, either 0.25% levobupivacaine or bupivacaine (Treatment Group) to saline (Placebo Group) delivered subcutaneously via a continuous infusion for 72 h after open heart surgery in 72 patients. Requirements for postoperative analgesics and pain scores were recorded for 72 h and plasma levels of local anesthetic were measured. Secondary outcomes measures included time to first oral intake, time to first bowel movement, time to urinary catheter removal, length of stay, requirements for antiemetics and additional sedation.Results:  Total morphine requirements over the first 24 h were less in the Treatment Group than the Placebo Group (0.05 mg·kg−1 vs 0.2 mg·kg−1, P = 0.007); this was true for all patient groups except those patients weighing less than 6.3 kg. The number of patients requiring no morphine was greater in the Treatment Group (7/35 vs 1/37, P = 0.02). The Treatment Group also received less midazolam, lorazepam, and ketorolac than the Placebo Group over 72 h due to the reduced clinical need for these agents in patients weighing less than 31 kg. There were no differences in secondary outcomes.Conclusions:  A continuous incisional infusion of LA reduced postoperative analgesic requirement and sedative use in pediatric patients undergoing a median sternotomy incision. Dosed at a maximum rate of 0.4 mg·kg−1·h−1, a continuous incisional infusion of LA is effective and safe for up to 72 h, with plasma levels of local anesthetic well below the toxic threshold.
Evaluation of emergence delirium in Asian children using the Pediatric Anesthesia Emergence Delirium Scale
Authors: BONG CHOON L. , NG AGNES S.B. 
Published: August 2010

SummaryBackground:  Emergence delirium (ED) is a common problem in children recovering from general anesthesia. ED causes disruption in the postanesthetic care unit, making nursing and monitoring more difficult, and is potentially dangerous to the child. The greatest hindrance to understanding ED was the lack of a standardized tool to assess it. The Pediatric Anesthesia Emergence Delirium (PAED) Scale was recently described to measure the degree of ED in children. In this prospective observational study, we sought to evaluate the incidence of ED by grading emergence behavior using the PAED Score in healthy Asian children undergoing outpatient surgery.Methods:  Three hundred sixteen children aged 2–12 years undergoing general anesthesia for elective outpatient surgery were included. No premedication was administered. Induction behavior was graded using the induction compliance checklist, and the presence of any excitation on induction documented. Emergence behavior was recorded using the PAED Scale, and the children were separately assessed for clinical agitation.Results:  One hundred and thirty‐six children (43%) had PAED Scores >0 and 33 (10.4%) had PAED Scores of ≥10. Only 28 children (8.9%) had clinical agitation consistent with ED, the rest were agitated for other reasons. A score of ≥10 on the PAED Scale was the best discriminator between presence and absence of clinical agitation. The area under the receiver operating characteristic curve for PAED Score of ≥10 was 0.98, with a true‐positive rate (sensitivity) of 0.85 and a false‐positive rate (1‐specificity) of 0.041. Four factors were found to be predictive of ED. These include young age, poor compliance at induction, lack of intraoperative fentanyl use and rapid time to awakening.Conclusions:  The incidence of ED is approximately 10% in our population of healthy, unpremedicated Asian children undergoing day surgery. Young age, poor compliance at induction, lack of intraoperative fentanyl use and rapid time to awakening were predictive risk factors for ED in our population. A PAED Score of ≥10 was correlated with clinically significant ED and appeared to be the ideal cutoff score for ED.