The Journal of pediatrics
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Local anesthetics are extremely useful for providing anesthesia and analgesia for infants and children of all ages. Despite the toxicity issues raised here, the overall safety record of local anesthetic use in pediatrics has been very good, and local anesthetic administration within safe guidelines should be encouraged. In the great majority of cases, toxic reactions have been associated with either inadvertent intravascular injection or unintentional overdosage by physicians who did not adequately consider issues related to systemic drug uptake, distribution, or clearance. Unlike opioids, which can be titrated according to clinical signs to a wide range of doses, local anesthetic administration must be strictly limited "by the numbers." Pediatricians, surgeons, emergency room physicians, and anesthesiologists need to be informed regarding limits for the administration of local anesthetics and management of toxic reactions.
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The Journal of pediatrics · May 1993
Case ReportsSelective and sustained pulmonary vasodilation with inhalational nitric oxide therapy in a child with idiopathic pulmonary hypertension.
Low doses of inhaled nitric oxide caused selective and sustained pulmonary vasodilation in an infant with pulmonary hypertension without causing systemic hypotension, despite the failure of treatment with other vasodilators.
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The Journal of pediatrics · May 1993
Case ReportsMalposition of extracorporeal membrane oxygenation cannulas in patients with congenital diaphragmatic hernia.
We describe two infants with congenital diaphragmatic hernia who underwent extracorporeal membrane oxygenation and in whom the venous cannula was in the left atrium instead of the right. The routine radiograph of the chest failed to demonstrate the malposition. We recommend using the echocardiogram to confirm the position of the cannula or to guide the surgeon during the cannulation of patients with congenital diaphragmatic hernia.