Journal of pediatric surgery
-
Twenty-five adolescents receiving chronic steroid therapy for inflammatory bowel disease underwent major intestinal surgery and each experienced vasodilation during induction of anesthesia. Systemic hypotension occurred in each patient and was treated by large volumes of intravenous crystalloid solution which caused intraoperative and postoperative water retention with resultant hypertension as well as occasional pulmonary edema and seizures. ⋯ Intravenous fluid administration in excess of maintenance requirements and calculated fluid losses should be given with caution to children receiving high-dose steroids who undergo major intestinal surgery. Perioperative fluid retention under those circumstances may be best treated with early diuretic administration.
-
A 1-year-old child developed fatal septic pulmonary embolism upon removal of a central intravenous catheter. Histologically identical material was found in the pulmonary arteries and in the inferior vena cava at the catheter tip site. The pathophysiology of pulmonary embolism occurring during childhood is reviewed.