Journal of pediatric surgery
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Experience with spinal opioids in children is limited but is expanding. Anatomy, pharmacology, technique, and results are reviewed. Complications and side effects are described.
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Malignant hyperthermia (MH) is a seemingly rare genetic myopathy. Hypermetabolic crisis accompanied by a rise in body temperature to as high as 44 degrees C, is its hallmark. Malignant hyperthermia is usually triggered by potent inhalation anesthetics and/or depolarizing muscle relaxants. ⋯ The contracture study result was positive in all patients studied. No anesthetic or surgical complications were encountered. This study shows that patients at risk for developing MH crisis can have pediatric surgical procedures performed safely with appropriately selected general anesthesia.
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A 5-year-old boy presented with a limp, fever, and right hip pain of 72 hours' duration. An intensive workup of right hip pain synovitis failed to diagnose any local pathology. Delayed diagnosis of psoas abscess was made on the 12th day of hospitalization. A rapid recovery with no further complications followed surgical evacuation of the abscess.
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The effects of ECMO on cerebral dynamics, particularly in the face of asphyxia, are largely unknown. We inquired as to whether carotid artery blood flow (CABF) and intracranial pressure (ICP) were affected by carotid artery/jugular vein ligation, asphyxia, ECMO, and ECMO with asphyxia. Lightly sedated newborn lambs (two to four days old, 3 to 4 kg) in four groups were monitored for mean ICP by an epidural sensor, mean CABF by a flow probe, and mean arterial pressure. ⋯ ECMO with asphyxia caused an even more severe decrease in ICP (P less than .001) combined with augmented CABF (P less than .03). The ICP decrease was limited to the duration of ECMO. Possible explanations include loss of cerebral autoregulation induced by hypoxia/hypercarbia and alterations in cerebral venous drainage necessitated by this method of cardiopulmonary bypass.
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In sling (retrotracheal) left pulmonary artery (SLPA), the tracheobronchial pattern is generally considered basically normal. Analysis of dissected specimens and/or bronchograms and other preparations from five studied and 32 reported patients suggests that there are two different forms of SLPA: (1) types 1A and B, with normal TB pattern [with (A) or without (B) a right pre-eparterial (tracheal bronchus)], and the aberrant left pulmonary artery causing TB compression. ⋯ Imperforate anus occurred in 8/58 (14%) of patients with SLPA types 2A or B, but possibly in none with SLPA type 1. SLPA type 2 is the predominant form of SLPA, with the incidence of type 2B being twice that of type 2A.(ABSTRACT TRUNCATED AT 250 WORDS)