- Email: [email protected]
Pharmacology and use of muscle relaxants in the infants and children
856
ABSTRACTS
g / k g in pediatric patients. The abnormal lipoprotem (LPX-LS) was proved to be very similar to lipoprotem X (LP-X) LP-X is known as an abnormal lipoprotein found m the plasma of pauents with obstructivejaundice and has been used in the differential between obstructwe and nonobstructive jaundice This substance was not found in a matched control of 43 patients who did not recewe lntrahpid The imphcations as to these interesting findings are not discussed by the authors who suggest further stud=ed m patients recewing these emulsions Eugene S. Wtener
adminlstratmn of pancuronium. Changes m oxygenauon were unrelated to changes in arterml carbon d,oxide tension in most infants. Peak transpulmonary pressures after paralysis were lower than during spontaneous breathing, and may explain the low incidence of pneumothorax (3 of 35) during paralysis Since those who improved could not be distinguished by birth weight, gestauonal age, or diagnosis, pancuronium might be worthy of trml in a mechamcally ventilated infant with severe lung disease who is at risk for pneumothorax.--George Holcomb, Jr
Utilization of O-Methionine During Total Parenteral Nutrition In Postsurgical Patients. K. J Prmten, M C. Brummell,
Orally Administered Dantrolene for Prophylaxis of Malignant Hyperthermia. S K. Pandtl, S. P. Kothary, and P J
E. S. Cho, and L. K. Stegmk, Am J Clin Nutr 32.12001205, 1979.
Cohen. Anesthesiology 50:156-158, (February), 1979.
The utdization of the essential a m m o acid Methlonme admimstered intravenously as the d-l.(Freamine) or L form (Ammosyn) during total parenteral nutrluon was compared m 9 obese adult surgical pat=ents Pat=ents recewing the I_ morner experienced neghglble urmary losses of mcthionme One-third of the refused d-L meth~onme was lost in the urine; over 90% of it m the I form. Plasma levels of methionme (normal 2-2-5/~mole/dl) were 4.1 + I.I m the 1 methionlnc and 9 9 + 1.9 in the d-L methlonine group. Erythryocytc meth~onme levels were comparably elevated. Th~s study supports the concept the d-methlonme is poorly utihzed by human subjects Four soluuons containing only the t.-isomer appear to result in more physiologic phlsma levels and present less risk for potential methionme toxicity. Rus=~ell J. Merritt
ANESTHESIA AND INHALATION THERAPY Pharmacology and Use of Muscle Relaxants in the Infants and
Children. S K ]Vugent. R Laravuso, and M C Rogers 3 Pediatr 94"481--487, (March), 1979
Knowledge of the pharmacology and applicat=ons of muscle relaxants is imperative for the pedmtrlc surgeon working with patients with respiratory problems The concepts of neuromuscular blockade are discussed and this information should be of help when decisions are made on the merits of using these agents m appropriate climcal situations.--George Holcomh, Jr Muscle Relaxation in Mechanically Ventilated Infant..'t
/~
Stark, R. Bascorn, and I D. Frantz. J Pediatr 94'439 443, (March), 1979. The authors evaluated the effect of muscle paralysis on gas exchange and incidence of pneumothorax m 35 severly dl infants on mechanical ventilaUon Pancuromum (0. I m g / k g ) was given repeatedly until spontaneous respirauons ceased m infants with inadequate gas exchange with FIO, - 0 60, or peak inspiratory pressure > 30 cm H,0, or who were breathmg out of phase with the respirator Of 27 infants who had an alveolar-arterial oxygen gradient (A,DO2) _- 300 torr before paralysis, AaDO2 improved by ~ 100 torr within I hr of paralysis in only 2 infants, it worsened in 2 infants within the same period By 6 hr postparalysls, 12 of 27 infants had improved, five of whom had had a worsening A a D O , before
Malignant hyperthermia, characterized by a rapid increase in body temperature with or without muscle rigidity is a rare but often fatal condiuon associated with anesthesia. H~story of hyperpyrexm or muscle rigidity during previous anesthesia or a famdy history of such condit=on provides valuable informaUon, since there ts no simple, noninvasive test to idenUfy the suscepuble individuals. For prevention and treatment of mahgnant hyperthermia Dantrolene sodium, a hydantom dcrwatc has been shown to be highly effectwe. It acts by uncouphng the excitation---contraction mechanism possibly by decreasing release of calcium from the sarcoplasmauc reuculum, it does not affect smooth muscle. The recommended dose by the FDA Advisory Committee on anesthetic agents is 2 3 m g / k g three times a day for at least one day for protection from malignant hyperthermm. The drug for intravenous use is not yet approved by the FDA K Bark); Rationale for Dantrolene Versus Procainamide for Treatment of Malignant Hypertherm=a. T. E Nelson and E H.
Flewellen, Anesthesiology 2 118-122, (February), 1979. In this study, effects of procalnamide and dantrolene were compared in mahgnant hypcrthermia--susceptible pigs in vivo and on malignant hyperthermia-susceptible muscle from human patients m v~tro. Dantrolene was effective in preventmg or reversing the abdominal halothane-mduced contracture response of human M H S muscle strips. Procamamlde in clinical doses had no effect m vivo or m vitro on basal twitch response or on the abnormal response to halothane. These results conwrm the effectiveness of dantrolene and the lack of effectiveness of procamamlde in the prophylaxis and treatment of mahgnant hypcrthermia.--K. Barkey
INTEGUMENT AND CONNECTIVE TISSUE Burns in Childhood. A M. Clarke.
World J Surg 2.175-183,
(March), 1978 The aims of burn treatment in children include prevention and treatment of burn shock, prevention of infection, early skin coverage, restoration of function, correction of cosmetic defects and reintroduction and integration into society. Initial therapy includes proper assessment of the extent of the burn wound and proper fluid management. Dr. Clarke utdizes maintenance fluid on a per kilogram basis depending on the child's age (ranges from 50 m l / k g to 90 ml/kg) plus 3 ml/kg per percent body surface burn for the first 24 hr One
ABSTRACTS
g / k g in pediatric patients. The abnormal lipoprotem (LPX-LS) was proved to be very similar to lipoprotem X (LP-X) LP-X is known as an abnormal lipoprotein found m the plasma of pauents with obstructivejaundice and has been used in the differential between obstructwe and nonobstructive jaundice This substance was not found in a matched control of 43 patients who did not recewe lntrahpid The imphcations as to these interesting findings are not discussed by the authors who suggest further stud=ed m patients recewing these emulsions Eugene S. Wtener
adminlstratmn of pancuronium. Changes m oxygenauon were unrelated to changes in arterml carbon d,oxide tension in most infants. Peak transpulmonary pressures after paralysis were lower than during spontaneous breathing, and may explain the low incidence of pneumothorax (3 of 35) during paralysis Since those who improved could not be distinguished by birth weight, gestauonal age, or diagnosis, pancuronium might be worthy of trml in a mechamcally ventilated infant with severe lung disease who is at risk for pneumothorax.--George Holcomb, Jr
Utilization of O-Methionine During Total Parenteral Nutrition In Postsurgical Patients. K. J Prmten, M C. Brummell,
Orally Administered Dantrolene for Prophylaxis of Malignant Hyperthermia. S K. Pandtl, S. P. Kothary, and P J
E. S. Cho, and L. K. Stegmk, Am J Clin Nutr 32.12001205, 1979.
Cohen. Anesthesiology 50:156-158, (February), 1979.
The utdization of the essential a m m o acid Methlonme admimstered intravenously as the d-l.(Freamine) or L form (Ammosyn) during total parenteral nutrluon was compared m 9 obese adult surgical pat=ents Pat=ents recewing the I_ morner experienced neghglble urmary losses of mcthionme One-third of the refused d-L meth~onme was lost in the urine; over 90% of it m the I form. Plasma levels of methionme (normal 2-2-5/~mole/dl) were 4.1 + I.I m the 1 methionlnc and 9 9 + 1.9 in the d-L methlonine group. Erythryocytc meth~onme levels were comparably elevated. Th~s study supports the concept the d-methlonme is poorly utihzed by human subjects Four soluuons containing only the t.-isomer appear to result in more physiologic phlsma levels and present less risk for potential methionme toxicity. Rus=~ell J. Merritt
ANESTHESIA AND INHALATION THERAPY Pharmacology and Use of Muscle Relaxants in the Infants and
Children. S K ]Vugent. R Laravuso, and M C Rogers 3 Pediatr 94"481--487, (March), 1979
Knowledge of the pharmacology and applicat=ons of muscle relaxants is imperative for the pedmtrlc surgeon working with patients with respiratory problems The concepts of neuromuscular blockade are discussed and this information should be of help when decisions are made on the merits of using these agents m appropriate climcal situations.--George Holcomh, Jr Muscle Relaxation in Mechanically Ventilated Infant..'t
/~
Stark, R. Bascorn, and I D. Frantz. J Pediatr 94'439 443, (March), 1979. The authors evaluated the effect of muscle paralysis on gas exchange and incidence of pneumothorax m 35 severly dl infants on mechanical ventilaUon Pancuromum (0. I m g / k g ) was given repeatedly until spontaneous respirauons ceased m infants with inadequate gas exchange with FIO, - 0 60, or peak inspiratory pressure > 30 cm H,0, or who were breathmg out of phase with the respirator Of 27 infants who had an alveolar-arterial oxygen gradient (A,DO2) _- 300 torr before paralysis, AaDO2 improved by ~ 100 torr within I hr of paralysis in only 2 infants, it worsened in 2 infants within the same period By 6 hr postparalysls, 12 of 27 infants had improved, five of whom had had a worsening A a D O , before
Malignant hyperthermia, characterized by a rapid increase in body temperature with or without muscle rigidity is a rare but often fatal condiuon associated with anesthesia. H~story of hyperpyrexm or muscle rigidity during previous anesthesia or a famdy history of such condit=on provides valuable informaUon, since there ts no simple, noninvasive test to idenUfy the suscepuble individuals. For prevention and treatment of mahgnant hyperthermia Dantrolene sodium, a hydantom dcrwatc has been shown to be highly effectwe. It acts by uncouphng the excitation---contraction mechanism possibly by decreasing release of calcium from the sarcoplasmauc reuculum, it does not affect smooth muscle. The recommended dose by the FDA Advisory Committee on anesthetic agents is 2 3 m g / k g three times a day for at least one day for protection from malignant hyperthermm. The drug for intravenous use is not yet approved by the FDA K Bark); Rationale for Dantrolene Versus Procainamide for Treatment of Malignant Hypertherm=a. T. E Nelson and E H.
Flewellen, Anesthesiology 2 118-122, (February), 1979. In this study, effects of procalnamide and dantrolene were compared in mahgnant hypcrthermia--susceptible pigs in vivo and on malignant hyperthermia-susceptible muscle from human patients m v~tro. Dantrolene was effective in preventmg or reversing the abdominal halothane-mduced contracture response of human M H S muscle strips. Procamamlde in clinical doses had no effect m vivo or m vitro on basal twitch response or on the abnormal response to halothane. These results conwrm the effectiveness of dantrolene and the lack of effectiveness of procamamlde in the prophylaxis and treatment of mahgnant hypcrthermia.--K. Barkey
INTEGUMENT AND CONNECTIVE TISSUE Burns in Childhood. A M. Clarke.
World J Surg 2.175-183,
(March), 1978 The aims of burn treatment in children include prevention and treatment of burn shock, prevention of infection, early skin coverage, restoration of function, correction of cosmetic defects and reintroduction and integration into society. Initial therapy includes proper assessment of the extent of the burn wound and proper fluid management. Dr. Clarke utdizes maintenance fluid on a per kilogram basis depending on the child's age (ranges from 50 m l / k g to 90 ml/kg) plus 3 ml/kg per percent body surface burn for the first 24 hr One