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Massive necrotizing infections of the neck
CURRENT LITERATURE Acute Maxillary Sinusitis in Children. Wald ER, Miloe GJ, Bowen A, Ledesma-Medina J. Salamon N, Bluestone CA.
N Engl J Med
13:749,
half-life ranged between 9.3 and 32. I hours. The average plasma concentration after 24 hours was I4 n&ml. This study, compared with similar studies involving intravenous lorazepam, indicates that oral administration produces an equal degree of sedation with less rapid onset. The plasma concentration in some patients after 24 hours is sufficient to produce sedation and amnesia: therefore, such patients, if discharged within 34 hours. should be accompanied home and should avoid central nervous system depressant drugs.-S-I-EVEN P. IRVING
1981
This study was designed to correlate the clinical. radiographic, and bacteriologic findings in maxillary sinusitis in children. Thirty children who had both abnormal maxillary sinus radiographs and upper respiratory tract symptoms were used. The most common symptoms were cough, nasal discharge, and malodorous breath. Fever was occasionally present. Maxillary sinus aspirations of 47 sinuses in 30 children yielded purulence in 31 cases, serous fluid in three. and bloody fluid in nine. The most common species cultured were Streptowwtrs pllrrlr?lolrilrc~. tlrr~~m~phil~rs in,flrrermre, and Brmr~l~utnrll~~ cuttrrrhulis. No anaerobic bacteria were isolated, and viruses were isolated in only two cases. There was poor correlation between the predominant species isolated from the throat culture and the sinus aspirate. The results of this study suggest that children with both abnormal maxillary sinus radiographs and upper respiratory tract infections frequently have bacteria and purulence in their sinuses. suggesting bacterial sinusitis.PHYLLIS
cl
Necrotizing
It has previously been shown in rats that diazepam alone has no effect on the cerebral metabolic rate (CMR,,, but that it interacts with nitrous oxide to produce a 40% reduction in the CMR,., value. In the present study. the effect of sedative doses of diazepam on the cerebral energy state, glycolysis, citric acid cycle. and amino acid metabolism in rats was determined in the presence and absence of a simultaneous administration of 70% nitrous oxide, 45 seconds to 30 minutes after the diazepam injection. The metabolic response was very similar in the two groups despite the differences in metabolic rates of oxygen consumption. There were no changes in the cortical concentrations of adenosine triphosphate. adenosine diphosphate. and adenosine monophosphate phosphocreatine, and creatine. The brain glycogen concentration was elevated during diazepam sedation, whereas brain glucose levels remained close to normal values except 30 minutes after the administration of diazepam alone, when the glucose level showed a 30? increase. The onset of diazepam sedation was associated with an inhibition of glycolysis at the phosphofructokinase step in both groups. The reduced pyruvate concentration subsequently led to a reduction in the pool size of the citric acid cycle intermediates. The concentrations of alanine and glutamate decreased during the period of diazepam sedation. while those of aspartate and glutamine increased. Concentrations of ammonia and gamma-aminobutyric acid remained unchanged. Based on the cerebral metabolic response. the onhet of diazepam sedation appears to be associated with an inhibition of the rate of metabolism (glycolysis). in hoth the presence and the absence of nitrous oxide. In that respect, diazepam has a metabolic profile similar to those of barbiturates.
ARK
Massive Necrotizing Infections YP, Lawson W, Blaugrund SM. Surg 3:475.
The Effect of Diazepam on the Cerebral Metabolic State in Rats and Its Interaction with Nitrous Oxide. Carlsson C, Chapman AC. Anesthesiology 54:4X8. 1981
of the Biller
Neck.
HF.
Head
Krespi Neck
19x1 hsciitis
of the head and neck is a rare con-
dition; only seven cases have been recorded in the Iiterature. Two cases are presented in which there was massive necrosis of the soft tissues of the neck with extension into the mediastinum. The offending organisms, a mixed bacterial flora, produced gangrene accompanied by subcutaneous emphysema. Both patients were successfully treated with a regimen of intravenous antibiotics. fasciotomy, radical debridement. and hyperbaric oxygenation (one case). The clinical features, bacteriology, and treatment of necrotizing fasciitis are reviewed.
Plasma Concentration and Clinical Effects of Lorazepam After Oral Administration. Bradshaw EG. Ali AA. Mulley
BA.
Rye RM.
Br J Anaesth
53:517,
1981
Lorazepam has become a widely used premedicant because of its sedative and amnesic properties. This study correlates amnesic, sedative, and anxiety-relieving effects with serum concentration following oral administration. Lorazepam. 50 mgikg. was administered orally to patients six hours before surgery and to volunteers. Blood samples were drawn at various time intervals, and serum lorazepam concentrations were determined by gas-liquid chromatography. At the same time intervals. sedation and anxiety were graded, and standard tests of short- and long-term recall were given. Peak concentrations were generally obtained within 90 minutes. Sedation increased between one and six hours, peak sedation occurring three hours following administration. Anxiety was reduced in patients during this time period. Both short- and long-term recall were impaired in all subjects. Plasma concentrations between 30 and 50 n&ml produced maximal clinical effects, while concentrations le5s than IO ngiml had little effect. Elimination
Intravenous
Fentanyl
Jr. Surv Anesth.
35:216.
Kinetics.
McClain
DA.
Hug CC
1981
Although fentanyl is a potent. short-acting narcotic analgesic, prolonged and recurrent respiratory depression has been reported. This study was designed to determine the kinetics of fentanyl disposition in human beings. Studies were performed on seven men in good health and free of significant drug intake. Each subject was given a total “H-fentanyl dose of 3.2 or 6.4 mg/kg intravenously. Fentanyl levels were periodically determined from arterial samples for eight hours, and urine and stool were analyzed for 72 hours. In the study. 98.6G of the injected fentanyl dose was eliminated from the plasma within 60 minutes. but the
191
N Engl J Med
13:749,
half-life ranged between 9.3 and 32. I hours. The average plasma concentration after 24 hours was I4 n&ml. This study, compared with similar studies involving intravenous lorazepam, indicates that oral administration produces an equal degree of sedation with less rapid onset. The plasma concentration in some patients after 24 hours is sufficient to produce sedation and amnesia: therefore, such patients, if discharged within 34 hours. should be accompanied home and should avoid central nervous system depressant drugs.-S-I-EVEN P. IRVING
1981
This study was designed to correlate the clinical. radiographic, and bacteriologic findings in maxillary sinusitis in children. Thirty children who had both abnormal maxillary sinus radiographs and upper respiratory tract symptoms were used. The most common symptoms were cough, nasal discharge, and malodorous breath. Fever was occasionally present. Maxillary sinus aspirations of 47 sinuses in 30 children yielded purulence in 31 cases, serous fluid in three. and bloody fluid in nine. The most common species cultured were Streptowwtrs pllrrlr?lolrilrc~. tlrr~~m~phil~rs in,flrrermre, and Brmr~l~utnrll~~ cuttrrrhulis. No anaerobic bacteria were isolated, and viruses were isolated in only two cases. There was poor correlation between the predominant species isolated from the throat culture and the sinus aspirate. The results of this study suggest that children with both abnormal maxillary sinus radiographs and upper respiratory tract infections frequently have bacteria and purulence in their sinuses. suggesting bacterial sinusitis.PHYLLIS
cl
Necrotizing
It has previously been shown in rats that diazepam alone has no effect on the cerebral metabolic rate (CMR,,, but that it interacts with nitrous oxide to produce a 40% reduction in the CMR,., value. In the present study. the effect of sedative doses of diazepam on the cerebral energy state, glycolysis, citric acid cycle. and amino acid metabolism in rats was determined in the presence and absence of a simultaneous administration of 70% nitrous oxide, 45 seconds to 30 minutes after the diazepam injection. The metabolic response was very similar in the two groups despite the differences in metabolic rates of oxygen consumption. There were no changes in the cortical concentrations of adenosine triphosphate. adenosine diphosphate. and adenosine monophosphate phosphocreatine, and creatine. The brain glycogen concentration was elevated during diazepam sedation, whereas brain glucose levels remained close to normal values except 30 minutes after the administration of diazepam alone, when the glucose level showed a 30? increase. The onset of diazepam sedation was associated with an inhibition of glycolysis at the phosphofructokinase step in both groups. The reduced pyruvate concentration subsequently led to a reduction in the pool size of the citric acid cycle intermediates. The concentrations of alanine and glutamate decreased during the period of diazepam sedation. while those of aspartate and glutamine increased. Concentrations of ammonia and gamma-aminobutyric acid remained unchanged. Based on the cerebral metabolic response. the onhet of diazepam sedation appears to be associated with an inhibition of the rate of metabolism (glycolysis). in hoth the presence and the absence of nitrous oxide. In that respect, diazepam has a metabolic profile similar to those of barbiturates.
ARK
Massive Necrotizing Infections YP, Lawson W, Blaugrund SM. Surg 3:475.
The Effect of Diazepam on the Cerebral Metabolic State in Rats and Its Interaction with Nitrous Oxide. Carlsson C, Chapman AC. Anesthesiology 54:4X8. 1981
of the Biller
Neck.
HF.
Head
Krespi Neck
19x1 hsciitis
of the head and neck is a rare con-
dition; only seven cases have been recorded in the Iiterature. Two cases are presented in which there was massive necrosis of the soft tissues of the neck with extension into the mediastinum. The offending organisms, a mixed bacterial flora, produced gangrene accompanied by subcutaneous emphysema. Both patients were successfully treated with a regimen of intravenous antibiotics. fasciotomy, radical debridement. and hyperbaric oxygenation (one case). The clinical features, bacteriology, and treatment of necrotizing fasciitis are reviewed.
Plasma Concentration and Clinical Effects of Lorazepam After Oral Administration. Bradshaw EG. Ali AA. Mulley
BA.
Rye RM.
Br J Anaesth
53:517,
1981
Lorazepam has become a widely used premedicant because of its sedative and amnesic properties. This study correlates amnesic, sedative, and anxiety-relieving effects with serum concentration following oral administration. Lorazepam. 50 mgikg. was administered orally to patients six hours before surgery and to volunteers. Blood samples were drawn at various time intervals, and serum lorazepam concentrations were determined by gas-liquid chromatography. At the same time intervals. sedation and anxiety were graded, and standard tests of short- and long-term recall were given. Peak concentrations were generally obtained within 90 minutes. Sedation increased between one and six hours, peak sedation occurring three hours following administration. Anxiety was reduced in patients during this time period. Both short- and long-term recall were impaired in all subjects. Plasma concentrations between 30 and 50 n&ml produced maximal clinical effects, while concentrations le5s than IO ngiml had little effect. Elimination
Intravenous
Fentanyl
Jr. Surv Anesth.
35:216.
Kinetics.
McClain
DA.
Hug CC
1981
Although fentanyl is a potent. short-acting narcotic analgesic, prolonged and recurrent respiratory depression has been reported. This study was designed to determine the kinetics of fentanyl disposition in human beings. Studies were performed on seven men in good health and free of significant drug intake. Each subject was given a total “H-fentanyl dose of 3.2 or 6.4 mg/kg intravenously. Fentanyl levels were periodically determined from arterial samples for eight hours, and urine and stool were analyzed for 72 hours. In the study. 98.6G of the injected fentanyl dose was eliminated from the plasma within 60 minutes. but the
191