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Blood-glucose concentrations during anaesthesia in children. Effects of Starvation and perioperative fluid therapy
INTERNATIONAL ABSTRACTS
456
Elevation of Cerebrospinal Fluid Substance P Concentrations in Spins Bifida ......................... 470
internal jugular vein on the ipsilateral side. The authors briefly discuss the implications in the infant with jugular obstruction or indwelling jugular catheter.--Randall W. Powell
Neoplasms
Accidental Ingestion of Sterilizing Tablets by Children. M.Z.
Wilms' Tumor in Horseshoe Kidneys .................. Occult Neuroblastoma Presenting with Opsomyoclonus ......................................................... Alveolar Rhabdomyosarcoma of the Female Genitalia ........................................................... Rhabdomyosarcoma of the Biliary Tree in Childhood ................................................................... Cancer of the Gallbladder in a Nine-Year-Old Girl .................................................................... Bile Duct Carcinoma in an Adolescent ................ Fibromatosis of Infancy and Childhood ............... Synovial Sarcoma in Childhood ........................... Turcot Syndrome ..................................................
470 470 470 470 470 471 471 471 471
Siodlak, M.J. Gleeson, and C.L. Wengraf. Br Med J 290:17071708, (June), 1985.
Tablets used for preparing sterilizing solutions for bottles and feeding utensils for infants contain sodium dichloroisocyanurate, which acts by releasing chlorine when dissolved in water. As a precautionary measure, they are packed individually in foil but this does not prevent children from swallowing them. One Poisons Information Centre answered 119 calls for advice in 8 months. The solution produced is of neutral pH but the chemical action and the chlorine released cause pharyngeal and laryngeal corrosion and bronchial oedema. Two children, one aged 1 year and the other aged 7 months, who swallowed these tablets are reported. Both eventually recovered without long-term effects but the latter only after 3 months in the hospital, requiring tube feeding because of pharyngeal incoordination.--James Dickson ANESTHESIA AND INHALATION THERAPY
GENERAL CONSIDERATIONS Human Bites in Children. P. Schweih and G. Fleisher. Pediatr
Emerg Care 1:51-53, (June), 1985. Emergency room records of a busy pediatric hospital were examined over a four-month period, and 40 human bites were found to have been treated. Follow-up was available for 83%. The most common location was the face, and only 18.2% were on the hands. Approximately half were given antibiotics. Four of the bites were considered infected upon presentation and one of these was admitted to the hospital for intravenous antibiotics. Two thirds were considered abrasions or very superficial lacertations. Treatment was usually sought within 12 hours of the bite. The human bite in the child is considered less serious than the usual adult human bite. Prophylactic use of antibiotics is not recommended except for extensive wounds, hand wounds, or wounds greater than 12 hours old.--Thomas V. Whalen Severe Extravasation Injury. D.C. Davidson and J. Gilbert. Br Med
J 291:217, (July), 1985. Tissue necrosis following extravasation of IV infusions, particularly those from intravenous feeding regimens administered through peripheral veins to small infants, are a worrisome problem in most units. This report describes a very simple method of treatment, which is claimed "to limit scarring and reduce the need for grafting." If the tissues are tense, the limb is gently massaged until they are soft and a good capillary flush is seen in all potentially viable tissue. This is repeated every 15 minutes for 2 to 3 hours; then every 2 to 3 hours until the tissues remain soft. Thereafter, the wound is kept dry and the skin stretched to separate the in-growing epithelium from the eschar until it separates and epithelialisation is complete. This simple technique looks harmless and well worth trying.--James Diekson Jugular Vein Obstruction Caused by Turning of the Head. C.A.
Gooding and G.K. Stimac. Am J Roentgenol 142:403-406, (February), 1984.
After clinical problems with two premature infants with episodes of increased intracranial pressure after insertion of jugular vein catheters, the authors evaluated the effect of head turning on the internal jugular vein in an infant monkey and human infant cadaver. In both models, turning the head resulted in obstruction of the
The Effect of Paralysis on Oxygen Consumption in Normoxic Children After Cardiac Surgery. B.W. Palmisano, D.M. Fisher, M.
Wills, et al. Anesthesiology 61:518-522, (November), 1984.
Seventeen infants, aged 10 days to 20 months, who were recovering within 48 hours of definitive surgical repair of congenital heart lesions, underwent determination of oxygen consumption. All of the patients were mechanically ventilated, sedated (morphine and diazepare), and cardiovascularly stable. The patients were paralyzed with a nondepolarizing muscle relaxant, (pancuronium) for oxygen consumption measurements. In eight patients, who were moving before paralysis, there was a 13% decrease in oxygen consumption. In nine patients, who were not moving, there was no change in oxygen consumption. However, in each group there was one patient whose oxygen consumption rose above baseline. The authors conclude that paralysis does reduce oxygen consumption in those infants who are active before paralysis, but the reduction of muscle activity and its effect on oxygen consumption does not justify the use of muscle relaxants. Rather, administration of narcotic analgesia and a sedative-hypnotic is recommended.--Richard K. Raker Blood-Glucose Concentrations During Anaesthesia in Children. Effects of Starvation and Perioperative Fluid Therapy. K. Nilsson,
L.E. Larsson, S. Andreasson, et al. Br J Anaesth 56:375-378, (April), 1984.
Seventy children, aged 2 weeks to 22 months were examined for the presence and metabolic effects of hypoglycemia before and during surgery. The duration of perioperative starvation was between 4 and 9 hours. The patients were divided into two groups: one received Ringer's acetate solution and the other Ringer's with 2.5% glucose during surgery. Although hypoglycemia was not found at the beginning of surgery, there was a tendency for mild metabolic acidosis in both groups (venous pH 7.31 to 7.35). Acidosis did not progress during surgery. Both groups of patients had significant elevation of blood sugar postoperatively and, in particular, the group that received glucose containing intravenous solution. The authors indicate that glucose containing solutions are not necessary to maintain adequate blood glucose homeostasis during surgery in this studied age group even after preoperative starvation. However, neonates and prematures undergoing any period of starvation followed by surgery rely upon other methods of glucose utilization and do require glucose infusions to prevent intraoperative hypoglycemia.--Riehard K. Raker
456
Elevation of Cerebrospinal Fluid Substance P Concentrations in Spins Bifida ......................... 470
internal jugular vein on the ipsilateral side. The authors briefly discuss the implications in the infant with jugular obstruction or indwelling jugular catheter.--Randall W. Powell
Neoplasms
Accidental Ingestion of Sterilizing Tablets by Children. M.Z.
Wilms' Tumor in Horseshoe Kidneys .................. Occult Neuroblastoma Presenting with Opsomyoclonus ......................................................... Alveolar Rhabdomyosarcoma of the Female Genitalia ........................................................... Rhabdomyosarcoma of the Biliary Tree in Childhood ................................................................... Cancer of the Gallbladder in a Nine-Year-Old Girl .................................................................... Bile Duct Carcinoma in an Adolescent ................ Fibromatosis of Infancy and Childhood ............... Synovial Sarcoma in Childhood ........................... Turcot Syndrome ..................................................
470 470 470 470 470 471 471 471 471
Siodlak, M.J. Gleeson, and C.L. Wengraf. Br Med J 290:17071708, (June), 1985.
Tablets used for preparing sterilizing solutions for bottles and feeding utensils for infants contain sodium dichloroisocyanurate, which acts by releasing chlorine when dissolved in water. As a precautionary measure, they are packed individually in foil but this does not prevent children from swallowing them. One Poisons Information Centre answered 119 calls for advice in 8 months. The solution produced is of neutral pH but the chemical action and the chlorine released cause pharyngeal and laryngeal corrosion and bronchial oedema. Two children, one aged 1 year and the other aged 7 months, who swallowed these tablets are reported. Both eventually recovered without long-term effects but the latter only after 3 months in the hospital, requiring tube feeding because of pharyngeal incoordination.--James Dickson ANESTHESIA AND INHALATION THERAPY
GENERAL CONSIDERATIONS Human Bites in Children. P. Schweih and G. Fleisher. Pediatr
Emerg Care 1:51-53, (June), 1985. Emergency room records of a busy pediatric hospital were examined over a four-month period, and 40 human bites were found to have been treated. Follow-up was available for 83%. The most common location was the face, and only 18.2% were on the hands. Approximately half were given antibiotics. Four of the bites were considered infected upon presentation and one of these was admitted to the hospital for intravenous antibiotics. Two thirds were considered abrasions or very superficial lacertations. Treatment was usually sought within 12 hours of the bite. The human bite in the child is considered less serious than the usual adult human bite. Prophylactic use of antibiotics is not recommended except for extensive wounds, hand wounds, or wounds greater than 12 hours old.--Thomas V. Whalen Severe Extravasation Injury. D.C. Davidson and J. Gilbert. Br Med
J 291:217, (July), 1985. Tissue necrosis following extravasation of IV infusions, particularly those from intravenous feeding regimens administered through peripheral veins to small infants, are a worrisome problem in most units. This report describes a very simple method of treatment, which is claimed "to limit scarring and reduce the need for grafting." If the tissues are tense, the limb is gently massaged until they are soft and a good capillary flush is seen in all potentially viable tissue. This is repeated every 15 minutes for 2 to 3 hours; then every 2 to 3 hours until the tissues remain soft. Thereafter, the wound is kept dry and the skin stretched to separate the in-growing epithelium from the eschar until it separates and epithelialisation is complete. This simple technique looks harmless and well worth trying.--James Diekson Jugular Vein Obstruction Caused by Turning of the Head. C.A.
Gooding and G.K. Stimac. Am J Roentgenol 142:403-406, (February), 1984.
After clinical problems with two premature infants with episodes of increased intracranial pressure after insertion of jugular vein catheters, the authors evaluated the effect of head turning on the internal jugular vein in an infant monkey and human infant cadaver. In both models, turning the head resulted in obstruction of the
The Effect of Paralysis on Oxygen Consumption in Normoxic Children After Cardiac Surgery. B.W. Palmisano, D.M. Fisher, M.
Wills, et al. Anesthesiology 61:518-522, (November), 1984.
Seventeen infants, aged 10 days to 20 months, who were recovering within 48 hours of definitive surgical repair of congenital heart lesions, underwent determination of oxygen consumption. All of the patients were mechanically ventilated, sedated (morphine and diazepare), and cardiovascularly stable. The patients were paralyzed with a nondepolarizing muscle relaxant, (pancuronium) for oxygen consumption measurements. In eight patients, who were moving before paralysis, there was a 13% decrease in oxygen consumption. In nine patients, who were not moving, there was no change in oxygen consumption. However, in each group there was one patient whose oxygen consumption rose above baseline. The authors conclude that paralysis does reduce oxygen consumption in those infants who are active before paralysis, but the reduction of muscle activity and its effect on oxygen consumption does not justify the use of muscle relaxants. Rather, administration of narcotic analgesia and a sedative-hypnotic is recommended.--Richard K. Raker Blood-Glucose Concentrations During Anaesthesia in Children. Effects of Starvation and Perioperative Fluid Therapy. K. Nilsson,
L.E. Larsson, S. Andreasson, et al. Br J Anaesth 56:375-378, (April), 1984.
Seventy children, aged 2 weeks to 22 months were examined for the presence and metabolic effects of hypoglycemia before and during surgery. The duration of perioperative starvation was between 4 and 9 hours. The patients were divided into two groups: one received Ringer's acetate solution and the other Ringer's with 2.5% glucose during surgery. Although hypoglycemia was not found at the beginning of surgery, there was a tendency for mild metabolic acidosis in both groups (venous pH 7.31 to 7.35). Acidosis did not progress during surgery. Both groups of patients had significant elevation of blood sugar postoperatively and, in particular, the group that received glucose containing intravenous solution. The authors indicate that glucose containing solutions are not necessary to maintain adequate blood glucose homeostasis during surgery in this studied age group even after preoperative starvation. However, neonates and prematures undergoing any period of starvation followed by surgery rely upon other methods of glucose utilization and do require glucose infusions to prevent intraoperative hypoglycemia.--Riehard K. Raker