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Midazolam enhances anterograde but not retrograde amnesia in pediatric patients
The Journal of Emergency Medicine
652
Editor’s Comment: We may be uniquely qualified to participate strategies.
in educating the public about these prevention
0 ACUTE CONJUNCTIVITIS IN CHILDHOOD. Weiss A, Brinser JH, Nazar-Stewart V. J of Pediatr. 1993;122: 10-14. This paper was designed to study the efficacy of Gram staining, Giemsa staining and bacterial cultures of the conjunctiva and eyelids in children with acute conjunctivitis. The authors obtained cultures from the eyelids and conjunctiva of 95 patients ranging in age from 4 months to 12 years diagnosed with acute conjunctivitis. The control group consisted of 91 patients of similar age. By obtaining separate specimens from the lids and the conjunctiva, the authors could distinguish blepheritis from conjunctivitis. The results confirmed previous data suggesting that acute conjunctivitis is bacterial in origin 78% (76 patients) of the time, as proven by positive culture results. A viral etiology was suspected in 12% (12 patients) of the patients by a negative bacterial culture and a Giemsa stain revealing lymphocyte predominance. In the remaining children, allergic conjunctivitis was suspected in 2, and no etiology was found in 5. The predominant organism causing an acute conjunctivitis was identified as Hemophilus influenza, isolated in 43 of the patients. Streptococcus pneumoniae and Moraxella catarrhalis were also frequent causes of acute conjunctivitis. The predominant organisms found to cause an acute blepheritis were Staphylococci, corynebacteria, and alpha-hemolytic streptococci. The Gram staining proved to be a valuable diagnostic tool and correlated well with the culture results. The majority of the control group had normal conjunctival cytologic findings. Clinically, it is difficult to distinguish viral from bacterial conjunctivitis. Of the clinical findings observed, a purulent discharge was seen in 80% of the confirmed bacterial infections, but was also seen in 25% of the culture negative (suspected viral) infections. The results of this study confirm that the early use of antibiotic therapy for acute conjunctivitis is war[Susan Taylor, MD] ranted.
0 MIDAZOLAM ENHANCES ANTEROGRADE BUT NOT RETROGRADE AMNESIA IN PEDIATRIC PATIENTS. Twersky R, Hartung J, Berger B, McClain J, Beaton C. Anesthesiology. 1993;78:51-55. This article investigates the effect of aerosolized intranasal midazolam on both anterograde and retrograde memory in children. Forty children, aged 4-10 years, were randomized to receive either midazolam (0.2 mg/kg) or placebo intranasally via an atomizer. They were then given general anesthesia with nitrous oxide and halothane as well as a muscle relaxant. Memory testing was performed prior to any treatments, 10 minutes after receiving midazolam or placebo, and again postoperatively using picture cards.
Six patients were excluded from the study due to low baseline memory scores, clerical errors, or complicated operation. Results showed that there was a significant difference between the midazolam group versus placebo group in both recall and recognition when assessing postoperative memory occurring subsequent to the administration of treatment with midazolam or placebo (anterograde effect). There was no significant difference between the groups in memory prior to treatment (retrograde effect). The authors conclude that midazolam significantly reduces a child’s postoperative ability to recall and recognize cards shown subsequent to its administration without affecting pretreatment memory. Therefore midazolam is an excellent choice for premeditation in children. [Kenneth Ahonen, MD]
0 ACUTE APPENDICITIS IN CHILDREN: VALUE OF SONOGRAPHY IN DETECTING PERFORATION. Quillin SP, Siegel MJ, Coffin CM. Am J Roentgenol. 1992; 159:1265-1268. The use of sonography as a sensitive modality in the diagnosis of acute appendicitis is well established. However, there is some controversy over its usefulness in differentiating perforating from nonperforating appendicitis. This study reports sonographic signs identified retrospectively in children with appendicitis and correlates these with surgical and pathologic findings. Statistical analysis was performed using a Fisher exact two-tailed test. Sonograms of 79 children with surgically-proved appendicitis were reviewed. The sonographic signs evaluated included the presence or absence of an appendix, an echogenic submucosal layer, increased periappendiceal echogenicity, free or loculated periappendiceal or pelvic fluid collections, and appendicoliths. Abnormal signs were identified in 71 of the 79 patients; surgery was performed within 36 hours of sonographic evaluation in all but two patients. Appendiceal perforations were found in 26 of these patients. A visible appendix with a diameter greater than 6 mm was seen in all 45 patients with non-complicated appendicitis but only 38% of patients with perforation. An echogenic submucosa was present sonographically in 60% with nonperforated appendicitis and 33% with perforation and a recognizable appendix @ < 0.05). Loculated periappendiceal or pelvic fluid collections were visualized in 73% of patients with perforated appendix but in none of the patients with nonperforating appendicitis (p < 0.05). No statistically significant association was found between presence or absence of perforation and free pelvic fluid, prominent periappendiceal fat, or an appendicolith. These results support the value of sonography in distinguishing perforating versus nonperforating appendicitis and suggest that the presence of loculated fluid collection and absence of echogenic submucosal layer are the most sensitive sonographic findings. [Gordon Hardenbergh, MD]
652
Editor’s Comment: We may be uniquely qualified to participate strategies.
in educating the public about these prevention
0 ACUTE CONJUNCTIVITIS IN CHILDHOOD. Weiss A, Brinser JH, Nazar-Stewart V. J of Pediatr. 1993;122: 10-14. This paper was designed to study the efficacy of Gram staining, Giemsa staining and bacterial cultures of the conjunctiva and eyelids in children with acute conjunctivitis. The authors obtained cultures from the eyelids and conjunctiva of 95 patients ranging in age from 4 months to 12 years diagnosed with acute conjunctivitis. The control group consisted of 91 patients of similar age. By obtaining separate specimens from the lids and the conjunctiva, the authors could distinguish blepheritis from conjunctivitis. The results confirmed previous data suggesting that acute conjunctivitis is bacterial in origin 78% (76 patients) of the time, as proven by positive culture results. A viral etiology was suspected in 12% (12 patients) of the patients by a negative bacterial culture and a Giemsa stain revealing lymphocyte predominance. In the remaining children, allergic conjunctivitis was suspected in 2, and no etiology was found in 5. The predominant organism causing an acute conjunctivitis was identified as Hemophilus influenza, isolated in 43 of the patients. Streptococcus pneumoniae and Moraxella catarrhalis were also frequent causes of acute conjunctivitis. The predominant organisms found to cause an acute blepheritis were Staphylococci, corynebacteria, and alpha-hemolytic streptococci. The Gram staining proved to be a valuable diagnostic tool and correlated well with the culture results. The majority of the control group had normal conjunctival cytologic findings. Clinically, it is difficult to distinguish viral from bacterial conjunctivitis. Of the clinical findings observed, a purulent discharge was seen in 80% of the confirmed bacterial infections, but was also seen in 25% of the culture negative (suspected viral) infections. The results of this study confirm that the early use of antibiotic therapy for acute conjunctivitis is war[Susan Taylor, MD] ranted.
0 MIDAZOLAM ENHANCES ANTEROGRADE BUT NOT RETROGRADE AMNESIA IN PEDIATRIC PATIENTS. Twersky R, Hartung J, Berger B, McClain J, Beaton C. Anesthesiology. 1993;78:51-55. This article investigates the effect of aerosolized intranasal midazolam on both anterograde and retrograde memory in children. Forty children, aged 4-10 years, were randomized to receive either midazolam (0.2 mg/kg) or placebo intranasally via an atomizer. They were then given general anesthesia with nitrous oxide and halothane as well as a muscle relaxant. Memory testing was performed prior to any treatments, 10 minutes after receiving midazolam or placebo, and again postoperatively using picture cards.
Six patients were excluded from the study due to low baseline memory scores, clerical errors, or complicated operation. Results showed that there was a significant difference between the midazolam group versus placebo group in both recall and recognition when assessing postoperative memory occurring subsequent to the administration of treatment with midazolam or placebo (anterograde effect). There was no significant difference between the groups in memory prior to treatment (retrograde effect). The authors conclude that midazolam significantly reduces a child’s postoperative ability to recall and recognize cards shown subsequent to its administration without affecting pretreatment memory. Therefore midazolam is an excellent choice for premeditation in children. [Kenneth Ahonen, MD]
0 ACUTE APPENDICITIS IN CHILDREN: VALUE OF SONOGRAPHY IN DETECTING PERFORATION. Quillin SP, Siegel MJ, Coffin CM. Am J Roentgenol. 1992; 159:1265-1268. The use of sonography as a sensitive modality in the diagnosis of acute appendicitis is well established. However, there is some controversy over its usefulness in differentiating perforating from nonperforating appendicitis. This study reports sonographic signs identified retrospectively in children with appendicitis and correlates these with surgical and pathologic findings. Statistical analysis was performed using a Fisher exact two-tailed test. Sonograms of 79 children with surgically-proved appendicitis were reviewed. The sonographic signs evaluated included the presence or absence of an appendix, an echogenic submucosal layer, increased periappendiceal echogenicity, free or loculated periappendiceal or pelvic fluid collections, and appendicoliths. Abnormal signs were identified in 71 of the 79 patients; surgery was performed within 36 hours of sonographic evaluation in all but two patients. Appendiceal perforations were found in 26 of these patients. A visible appendix with a diameter greater than 6 mm was seen in all 45 patients with non-complicated appendicitis but only 38% of patients with perforation. An echogenic submucosa was present sonographically in 60% with nonperforated appendicitis and 33% with perforation and a recognizable appendix @ < 0.05). Loculated periappendiceal or pelvic fluid collections were visualized in 73% of patients with perforated appendix but in none of the patients with nonperforating appendicitis (p < 0.05). No statistically significant association was found between presence or absence of perforation and free pelvic fluid, prominent periappendiceal fat, or an appendicolith. These results support the value of sonography in distinguishing perforating versus nonperforating appendicitis and suggest that the presence of loculated fluid collection and absence of echogenic submucosal layer are the most sensitive sonographic findings. [Gordon Hardenbergh, MD]