bluuebunny/crossref_metadata_2025_split huggingface dataset:
A marked decrease in l‐selectin expression by leucocytes in infants with Bordetella pertussis infection: leucocytosis explained?
Authors: HODGE Greg , HODGE Sandy , MARKUS Corey , LAWRENCE Andrew , HAN Ping 
Published: May 2003

Objective:  Infants with Bordetella pertussis infection (whooping cough) have an unexplained lymphocytosis and leucocytosis characterized by an increase in small lymphocytes with convoluted and cleaved nuclei. To characterize these cells immunophenotyping using multiparameter flow cytometry was performed on leucocytes from a group of 11 infants aged 3–6 months with proven pertussis and from uninfected control subjects.Methodology:  The panel of monoclonal antibodies used to elucidate leucocyte subtypes included activation, adhesion, costimulatory, memory, T‐helper (Th) 1 and Th2 markers.Results:  Patients with pertussis showed an increase in absolute numbers of neutrophils, monocytes, T lymphocytes (both CD4 and CD8), B lymphocytes (including CD10+/CD19+ haematogones) and natural killer (NK) cells. All leucocyte subgroups showed a marked decrease in l‐selectin (CD62L) expression. The expression of other adhesion molecules CD11a, CD44 and CD54 on all leucocyte subgroups was unchanged. Expression of costimulatory molecules, CD49D and CD28 on T cells and CD80 and CD86 on monocytes, was unchanged. Lymphocyte activation markers CD69, CD25 and HLA‐DR were unchanged. There was an increase in CD45RA+/CD45RO+/CD4+ cells (activated) and CD62L–/CD45RO+/CD4+ cells (Th1‐like) but no increase in CD7–/CD4+ T cells (Th2‐like).Conclusions:  l‐Selectin expression mediates extravasation of leucocytes into tissues and is important for homing of peripheral blood lymphocytes to lymph nodes. The significant down‐regulation of l‐selectin on leucocytes in pertussis infection may prevent leucocyte migration to areas of infection and homing and adhesion of T and B cells to peripheral lymphoid tissues. The increase in lymphocytes with Th1 phenotype may be required for effective immune response to the infective organism. These data provide a possible explanation for the absolute leucocytosis observed in this disease.
Brain injury in children with congenital heart disease
Authors: Scallan Michael J. H. 
Published: May 2003

SummaryThe incidence of neurodevelopmental impairment in children with congenital heart disease is high. Its aetiology is multiple and complex. Prevention and treatment must start during the preoperative period and continue through the intra‐ and postoperative periods. Research has resulted in a clearer understanding of the relationship between congenital heart disease and the brain, and of the effects of cardiopulmonary bypass, hypothermia and circulatory arrest. This has led to modifications in management which may improve neurological outcome in the future.
Increased incidence of postoperative nausea and vomiting without additional analgesic effects when a low dose of intravenous fentanyl is combined with a caudal block
Authors: Kokinsky E. , Nilsson K. , Larsson L. E. 
Published: May 2003

SummaryBackground: The use of opioids is known to increase the incidence of postoperative nausea and vomiting (PONV). In spite of this, administration of low doses of an opioid during anaesthesia is common practice, even if a regional anaesthetic technique is used. This study was designed to estimate the effects of intraoperative intravenous administration of fentanyl on PONV in paediatric daycase surgery.Methods: PONV and pain were evaluated in 29 boys during the first 24 h after daycase penile surgery. Anaesthesia was standardized. The patients were allocated to two groups. Fentanyl 1 µg·kg−1i.v. or placebo was administered in a randomized, double‐blind design. A caudal block with ropivacaine 2 mg·ml−1, 0.5 ml·kg−1was performed preoperatively and topical lidocaine gel 20 mg·ml−1was applied over the wound area immediately after surgery.Results: The total incidence of PONV in hospital and at home during the first 24 h was 36% (5/14) when fentanyl was used, whereas no PONV was reported when placebo was given (P < 0.05). The median time to first administration of analgesics after the caudal block was approximately 6 h. It did not differ between groups. Intraoperative fentanyl did not result in any reduction in pain scores nor the incidence of pain. Fentanyl caused apnoea in one‐half of the cases and decreased the breathing rates during the first 10 min of surgery.Conclusions: Intraoperative use of i.v. fentanyl 1 µg·kg−1combined with a regional anaesthetic block is associated with an increased incidence of PONV without any significant contribution to the postoperative pain relief.
Side‐effects of postoperative epidural analgesia in children: a randomized study comparing morphine and clonidine
Authors: Cucchiaro G. , Dagher C. , Baujard C. , Dubousset A. M. , Benhamou D. 
Published: May 2003

Summary Background: Morphine is widely used in association with local anaesthetics for postoperative epidural analgesia. There are no data on the prolonged use of clonidine for postoperative analgesia in children. The primary outcome of this randomized, double‐blind trial was to compare the incidence of side‐effects after epidural infusion of clonidine or morphine, in association with ropivacaine in children. Methods: After institutional approval, 26 children, aged 3–12 years, who were scheduled for abdominal surgery, had an epidural catheter placed after induction of general anaesthesia. Patients were then randomized to two different groups. After an initial bolus of 2.5 mg·kg−1 0.25% ropivacaine with either 40 µg·kg−1 morphine (group M, n = 14) or 1 µg·kg−1 clonidine (group C, n = 12), an epidural infusion was started at a rate of 0.4 ml·kg−1·h−1. The patients in the M group received an infusion of 0.08% ropivacaine with 10 µg·ml−1 morphine, those in the group C an infusion of 0.08% ropivacaine with 0.6 µg·ml−1 clonidine. Results: The two groups were similar with respect to age, sex and weight. One patient in the C group was excluded for misplacement of the epidural catheter. The incidence of vomiting and pruritus was significantly higher in the M group compared with the C group (64% and 85% versus 0%, respectively). The incidence of pain was significantly higher in the C group compared with the M group (73% versus 29%) as well as the need for rescue analgesia medications. Conclusions: Epidural clonidine is followed by a significantly lower incidence of side‐effects. However, its analgesic effects, at least at the doses used in this study, are less potent than those of epidural morphine.
Caudal neostigmine for postoperative analgesia in paediatric surgery
Authors: MemiŞ Dilek , Turan Alparslan , Karamanlioğlu Beyhan , Kaya Gaye , Süt Necdet , Pamukçu Zafer 
Published: May 2003

Summary Background: This study was conducted to evaluate analgesia and side‐effects of caudal neostigmine coadministered with bupivacaine in paediatric surgery. Methods: We studied children, aged 1–5 years, undergoing elective surgery (inguinal hernia and hypospadias). After standard induction of anaesthesia, caudal anaesthesia was performed. Group 1 received 0.25% bupivacaine 0.5 ml·kg−1 and Group 2 received 0.25% bupivacaine 0.5 ml·kg−1 with 1 μg·kg−1 neostigmine via the caudal route. Heart rate, mean arterial pressure, peripheral oxygen saturation were recorded before induction, after induction but before caudal anaesthesia, and then every 5 min after caudal anaesthesia. Haemodynamic, Toddler, Preschooler, Postoperative Pain Scale (TPPPS) pain score and sedation score values were recorded 30 min after extubation and at hours 2, 4, 6, 12 and 24. A pain score >3/10 resulted in administration of rectal paracetamol. The duration of postoperative analgesia was defined as the time between caudal drug injection and the first rectal paracetamol administration. Results: There were no differences between the groups in demographic and haemodynamic date, duration of surgery and anaesthesia, time to extubation or sedation scores. The duration of postoperative pain relief did not differ between the two groups; 15.40 ± 10.97 h for group 1 vs. 15.45 ± 10.99 h for group 2 (P > 0.05). The incidence of nausea (three patients in group 2 and one patient in group 1) was not statistically significant. No other side‐effects were seen. Conclusions: We found that a single caudal injection of 1 μg·kg−1 neostigmine mixed with bupivacaine offers no significant advantage over bupivacaine alone for postoperative pain relief in children undergoing genitourinary surgery.
Dorsal penile nerve block
Authors: Soh C. R. , Ng S. B. A. , Lim S. L. 
Published: May 2003

Summary Background: The dorsal penile nerve block (DPNB) is a common form of regional anaesthesia for circumcisions in children. The safety of this block has been questioned following several case reports of potentially serious complications. Methods: We performed a retrospective review of all the incidents related to the conduct of this block in our institution over a period of 53 months. Results: A total of 3909 circumcisions were performed under DPNB and nine incidents were recorded. This included two cases of bleeding from the prepuce, two urethral injuries, three haematomas and two drug errors. Two cases required further surgical intervention but all of the patients recovered with no apparent long‐term sequelae. Conclusions: We feel that the DPNB is a safe technique for circumcisions in infants and children.
Life threatening subcutaneous emphysema following surgical repair of tracheocutaneous fistula
Authors: Mohan Virender Kumar , Kashyap Lokesh , Verma Sanjay 
Published: May 2003

SummaryA 9‐year‐old male child posted for closure of tracheocutaneous fistula developed extensive subcutaneous emphysema resulting in acute respiratory distress immediately after transfer to recovery room. The clinical management, precautions and other complications of closure of tracheocutaneous fistula are discussed.
Difficult airway in a child with spinal muscular atrophy type I
Authors: Arima Hajime , Sobue Kazuya , Tanaka Sayuki , Morishima Tetsuro , Ando Hiroshi , Katsuya Hirotada 
Published: May 2003

SummarySpinal muscular atrophy (SMA) type I is a relatively common inherited neuromuscular disease of hypotonic newborns, but is not associated with craniofacial abnormalities. There is nothing in the literature about difficult intubation in patients affected by this disease. We report a case of 34‐month‐old girl with SMA type I who was scheduled for emergency endoscopic laser treatment of tracheal stenosis caused by granulations. Tracheostomy was performed at 17 months of age and before this, the orotracheal tube was changed periodically without difficulty. For this laser treatment, orotracheal intubation was required. Preoperative physical examination revealed micrognathia and class II malocclusion. Opening her mouth was not difficult. Although difficult orotracheal intubation was predictable, we attempted to intubate her trachea as usual, but could not visualize the epiglottis. We decided to proceed with retrograde intubation, one of the standard techniques employed in a child with a difficult airway, via the tracheostome. A feeding nasogastric catheter was used as a guide catheter, and our strategy was successful. In this study we report a case of difficult airway in a child with SMA type I. The relationship between SMA type I with a tracheostome and difficult airway are discussed.
Complete staged palliation of hypoplastic left heart syndrome in a child with cystic fibrosis
Authors: Stuth Eckehard A. E. , Stucke Astrid G. , Fedderly Raymond T. , Tweddell James S. 
Published: May 2003

SummaryIn recent years, the palliative treatment of Hypoplastic Left Heart Syndrome (HLHS) with a three‐staged surgical repair has gained widespread acceptance in North America and elsewhere and has significantly improved the life‐expectancy of these children. We report on a child in whom the diagnosis of cystic fibrosis (CF) was made shortly after the first‐stage palliation (modified Norwood procedure), and in which surgical palliation was successfully completed with second‐ (bidirectional Glenn) and third‐stage (fenestrated Fontan) procedures. During this period, the child suffered several CF‐related complications, i.e. repeated respiratory failure, meconium ileus and coagulation abnormalities, which required adjustment of the anaesthesia, surgical and intensive care management. Considering the trend to perform surgical corrections of major cardiac defects in the early neonatal period, before concomitant genetic diseases are discovered, paediatric cardiac anaesthesiologists, surgeons and intensivists may be confronted with more cases of open heart surgery in infants with CF in the future.
A combined stage 1 and 2 repair for hypoplastic left heart syndrome: anaesthetic considerations
Authors: Müller Matthias , Akintürk Hakan , Schindler Ehrenfried , Bräu Michael , Scholz Stefan , Valeske Klaus , Michel‐Behnke Ina , Thul Josef , Schranz Dietmar , Hempelmann Gunter 
Published: May 2003

SummaryTherapy of hypoplastic left heart syndrome (HLHS) consists of the staged Norwood procedure or cardiac transplantation. Stenting the ductus arteriosus and subsequent banding of the pulmonary arteries allows the combination of neoaortic reconstruction with the establishment of a bidirectional cavopulmonary connection (combined stage 1 and 2 procedure) in a later session. We report the anaesthetic management in eight infants ranging from 107 to 195 days undergoing a combined stage 1 and 2 procedure. Nonselective pulmonary vasodilators and nitric oxide were needed in all cases to improve oxygen saturation in the postbypass period. Phosphodiesterase inhibitors and epinephrine were required in all patients for inotropic support during and after weaning off cardiopulmonary bypass. The procedure was successful in seven patients. One patient died intraoperatively because of right heart failure. The physiological changes of this new surgical strategy for palliation of HLHS offers a challenge for the anaesthetist primarily in the early postbypass period.
A randomized trial of caudal block with bupivacaine 4 mg·kg−1 (1.8 ml·kg−1) plus morphine (150 μg·kg−1) vs general anaesthesia with fentanyl for cardiac surgery
Authors: Rojas‐Pérez Eduardo , Castillo‐Zamora Carlos , Nava‐Ocampo Alejandro A. 
Published: May 2003

SummaryBackground: Regional anaesthesia has been used effectively in paediatric patients undergoing cardiac surgery and is thought to be safe.Methods: Thirty patients ASA physical status II–III undergoing scheduled palliative or corrective cardiac surgery, receiving premedication with midazolam and anaesthetic induction with sevoflurane, fentanyl and pancuronium were randomly allocated to two groups. In group 1, patients received bupivacaine 0.22% 4 mg·kg−1 (1.8 ml·kg−1) and morphine 150 μg·kg−1 by the caudal route. After a 20‐min period for the block to take effect, sevoflurane 0.5–1.0% and fentanyl 5 μg·kg−1 were administered for maintenance of anaesthesia. In group 2, the anaesthetic technique was the same as in group 1, without a caudal block and fentanyl 25 μg·kg−1 was administered at the moment of surgical incision.Results: Cardiovascular and haemodynamic responses of patients receiving caudal block showed minor variations during the 20‐min period between caudal and general anaesthesia. Fentanyl requirements during surgery were lower (P = 0.001) in patients with caudal block than patients with general anaesthesia. Extubation time was shorter (P = 0.034) in the caudal group. Two patients in the general anaesthesia group and one in the caudal group died because of postoperative complications.Conclusions: Caudal block with bupivacaine 0.22% 4 mg·kg−1 (1.8 ml·kg−1) and morphine 150 μg·kg−1 was safe and effective for paediatric patients undergoing cardiac surgery. However, patients might have a better outcome with a reduction of morphine dosage and administration of a muscle relaxant of shorter duration of action than pancuronium.
The dynostatic algorithm accurately calculates alveolar pressure on‐line during ventilator treatment in children
Authors: Sondergaard Soren , Kárason Sigurbergur , Hanson Angela , Nilsson Krister , Wiklund Jan , Lundin Stefan , Stenqvist Ola 
Published: May 2003

Summary Background: Monitoring of respiratory mechanics during ventilator treatment in paediatric intensive care is currently based on pressure and flow measurements in the ventilator or at the Y‐piece. The characteristics of the tracheal tube will modify the pressures affecting the airways and alveoli in an unpredictable manner. The dynostatic algorithm (DSA), based on a one‐compartment lung model, calculates the alveolar pressure during on‐going ventilation. The DSA is based on accurate measurement of tracheal pressure. The purpose of this study was to test the validity of the DSA in a paediatric lung model and to apply the concept in an observational clinical study in children. Methods: We validated the DSA in a paediatric lung model with linear, nonlinear pressure flow and frequency‐dependent characteristics by comparing calculated dynostatic (alveolar) pressures with directly measured alveolar pressures in the model and proximal plateau pressure with maximum alveolar pressure. Sixty combinations of ventilation modes, positive end expiratory pressures, inspiratory : expiratory ratios, volumes and frequencies were studied. A 0.25‐mm fibreoptic pressure transducer in the tube lumen was used in combination with volume and flow from ventilator signals.Clinical measurements were performed in eight patients during anaesthesia and postoperative ventilator treatment. Results: In the lung model we found a correlation coefficient between calculated and measured alveolar pressure of 0.93–0.99 with root mean square median values of 1 cm H2O. Distal plateau pressure agreed well with maximum alveolar pressure. In the clinical situation, the algorithm provided a breath‐by‐breath display of the volume‐dependent lung compliance and the temporal course of alveolar pressure during uninterrupted ventilation. Conclusions: Fibreoptic measurement of tracheal pressure in combination with the dynostatic calculation of alveolar pressure provides an on‐line monitoring of the effects of ventilatory mode in terms of volume‐dependent compliance, tracheal peak pressure and true positive end expiratory pressure.
Flumazenil is innocuous in a paroxysmal supraventricular tachycardia and radiofrequency ablation: a paediatric case report and review of the literature
Authors: Weinbroum Avi A. , Glick Aharon , Belhassen Bernard 
Published: May 2003

SummaryThe efficacy and safety of flumazenil in reversing midazolam‐induced paradoxical reaction in a child suffering from paroxysmal supraventricular tachycardia (PSVT) and undergoing radiofrequency ablation procedure has not been described before. We report a boy who had suffered for years from poorly controlled PSVT because of noncompliance to medications and was being sedated by midazolam and morphine (4 mg each) and prepared for radiofrequency ablation when he began attempting to speak, writhing and flailing his arms, for which physical restraint was required. We also review the current knowledge on the subject.Two doses of flumazenil 0.05 mg i.v. swiftly halted the untoward episode. The child opened his eyes and was calm, coherent and able to answer simple questions. All haemodynamic and respiratory parameters remained stable throughout this event, except for a temporary increase in heart rate (from 68 to 83 b·min−1). The aberrant behaviour did not resume when he was allowed to fall asleep during the ablation of a concealed left lateral accessory pathway. After that procedure, he awoke calm and pain free with no recollection of the aggressive episode. He was kept for 24 h in an intermediate cardiac care unit and was then discharged home.This apparent first report on the efficacious use of flumazenil for the reversal of a paradoxical reaction to midazolam during an electrophysiological study suggests that it neither induces abnormal heart rate nor interferes with the electrophysiological study or the ablation procedure.
Bispectral Index in a 3‐year old undergoing deep hypothermia and circulatory arrest
Authors: Zabala Luis , Ahmed Mohammed Iqbal , Denman William T. 
Published: May 2003

SummaryWe report a 3‐year‐old girl who presented with Scimitar syndrome and underwent hypothermic circulatory arrest for correction of anomalous pulmonary veins and an atrial septal defect. In this case the Bispectral Index (BIS) correlated significantly with the gradual onset of hypothermia and circulatory arrest. However, BIS remained low during the rewarming phase of cardiopulmonary bypass, in spite of adequate pump flows and stable haemodynamics. We postulate that this significant lag in BIS during the rewarming phase of deep hypothermic circulatory arrest may represent neuronal bewilderment or perhaps stunning, and differs from previous studies that show significant increase in BIS during rewarming from mild hypothermia.
Increased respiratory symptoms following surgery in children exposed to environmental tobacco smoke
Authors: Drongowski Robert A , Lee Donald , Reynolds Paul I , Malviya Shobha , Harmon Carroll M , Geiger James , Lelli Joseph L , Coran Arnold G 
Published: May 2003

Summary Objective: The aim of this study was to determine if children exposed to environmental tobacco smoke (ETS) via parental smoking (ETS+) developed more respiratory symptoms resulting in longer recovery times following surgical outpatient procedures compared with children of nonsmoking parents (ETS−). Methods: One hundred and forty six children (4.9 ± 3 years) undergoing inguinal hernia repair were prospectively studied. Parental smoking behaviour was determined by survey and urine analysis. Seven respiratory symptoms were evaluated during induction and emergence from anaesthesia and during the recovery room (RR) stay. Results: Fifty‐seven (39%) families admitted a smoking history while 89 (61%) denied it. This strongly correlated with the cotinine/creatinine ratio (Pearson correlation coefficient = 0.76; P = 0.01). ETS exposure was associated with an increased frequency of RR symptoms (ETS+: 56%; ETS−: 31%; P = 0.007). Conclusions: In children undergoing general anaesthesia for inguinal hernia repair, ETS exposure was associated with an increased frequency of respiratory symptoms during emergence from anaesthesia and during postoperative recovery.
Dominant species maintain ecosystem function with non‐random species loss
Authors: Smith Melinda D. , Knapp Alan K. 
Published: May 2003

AbstractLoss of species caused by widespread stressors, such as drought and fragmentation, is likely to be non‐random depending on species abundance in the community. We experimentally reduced the number of rare and uncommon plant species while independently reducing only the abundance of dominant grass species in intact, native grassland. This allowed us to simulate a non‐random pattern of species loss, based on species abundances, from communities shaped by natural ecological interactions and characterized by uneven species abundance distributions. Over two growing seasons, total above‐ground net primary productivity (ANPP) declined with reductions in abundance of the dominant species but was unaffected by a threefold decline in richness of less common species. In contrast, productivity of the remaining rare and uncommon species decreased with declining richness, in part due to loss of complementary interactions among these species. However, increased production of the dominant grasses offset the negative effects of species loss. We conclude that the dominant species, as controllers of ecosystem function, can provide short‐term resistance to reductions in ecosystem function when species loss is nonrandom. However, the concurrent loss of complementary interactions among rare and uncommon species, the most diverse component of communities, may contribute to additional species loss and portends erosion of ecosystem function in the long term.