We tested the hypothesis that term and preterm infants exposed to maternal infection at the time of delivery are at increased risk of developing cerebral palsy (CP). STUDY DESIGN:A population-based case-control study was conducted using Washington State birth certificate data linked to hospital discharge data. Cases (688) were children r6 years old, singleton births, hospitalized during 1987 to 1999 with an ICD-9 diagnosis code for CP. Controls were 3068 singleton birth infants randomly selected from birth records for the same years without CP-related hospitalizations. Infection information was available only for the birth hospitalization. RESULTS:Infants of women who had any infection during their hospitalization for delivery were at increased risk of CP (odds ratio (OR) 3.1, 95% confidence interval (CI) 2.3 to 4.2). This was observed for term deliveries (OR 1.8, 95% CI 1.1 to 2.8) and preterm deliveries (OR 2.3, 95% CI 1.3 to 4.2). CONCLUSIONS:Our results suggest that maternal infection is a risk factor for CP in both term and preterm infants.

High inspired oxygen fraction during anesthesia is associated with CSF hyperintensity in the basilar cisterns and the cerebral sulcal subarachnoid space on FLAIR imaging in children and young adults. Physicians should be aware of this finding to avoid misinterpreting this artifact as an abnormality.

These findings are consistent with the hypothesis that increased arterial oxygen tension and consequently increased CSF Po(2) resulting from administration of high Fio(2) during general anesthesia are responsible for the increased CSF signal intensity noted on brain FLAIR MR images.

We report a case of a subserosal small bowel hematoma following an ilioinguinal-iliohypogastric nerve block for an appendicectomy in a 6-year-old girl. The bowel hematoma was noted in the wall of the terminal ileum after opening the peritoneum. The hematoma was nonobstructing and the child remained asymptomatic. We discuss the technical aspects of this block.

Although we recognize that it is possible that there were changes in care not related specifically to the introduction of a dedicated APS that occurred in our institution that resulted in improvements in general postoperative care and in length of stay, our study did show that having an organized APS allowed to significantly decrease the incidence of postoperative oxygen desaturation and to decrease the hospital length of stay by 1 day.

Purpose: To compare isobaric with hyperbaric 9.75 mg bupivacaine injected intrathecally, and to evaluate the effects of subsequent injection of lidocaine 2% into the epidural space.Methods: Patients in group 1 (n=30) received isobaric 9.75 mg bupivacaine and in group 2 (n=30) hyperbaric 9.75 mg bupivacaine injected into the subarachnoid space in a combined spinal-epidural technique. They were undergoing urological, gynecological, orthopedic, gastro-intestinal or vascular surgery. Using a double blind technique, the followings parameters were measured: cutaneous analgesia to pinprick, motor blockade, time for two segment regression, time for complete regression of the motor block, quality of anesthesia. In 12 patients the effect of epidural injections of 3 ml lidocaine 2% was observed.Results: Motor and sensory block developed more rapidly (five minutes) in the isobaric group ( P < 0.05) . Maximum upper level (T7 ± 2 ), two-segment regression (52 min in both groups), motor recovery (160 vs 157 min), and quality of anesthesia did not differ between the two groups. Thirty nine epidural injections of 3 ml lidocaine 2% were given in 12 patients 10 min after spinal injection, 28 were in the hyperbaric group (P < 0.05). Twenty six of the epidural injections produced an increase in sensory block of 0 or 1 dermatome, and 13, of 2 or more. Conclusion:The block developed more rapidly in the isobaric group, but both isobaric and hyperbaric 9.75 mg bupivacaine produced adequate upper levels of analgesia for surgery. The effect of epidural injections of 3 ml lidocaine 2% was usually minimal.Objectif : Comparer 9,75 mg de bupivacaïne isobare et hyperbare injectés en sous-arachnoïdien, et évaluer l'effet, quand nécessaire, de la lidocaïne 2 % injectée subséquemment dans l'espace épidural.Méthode : Les patients du groupe 1 (n=30) ont reçu 9,75 mg de bupivacaïne isobare et ceux du groupe 2 (n=30) 9,75 mg de bupivacaïne hyperbare en injection sous-arachnoïdienne selon une technique combinée rachi-épidurale. Des interventions chirurgicales urologiques, gynécologiques, orthopédiques, gastro-intestinales et vasculaires ont été faites. En utilisant une technique de double insu, on a mesuré les paramètres suivants : analgésie cutanée à la piqûre, bloc moteur, temps de régression de 2 niveaux, temps de régression complète du bloc moteur, qualité d'anesthésie. Chez 12 patients qui ont eu besoin d'injections épidurales de 3 ml de lidocaïne 2 %, l'effet de l'injection a été observé.Résultats : Les blocs moteur et sensitif se sont développés plus rapidement (5 min) dans le groupe isobare (P < 0,05). Les niveaux supérieurs d'analgésie (D7 ± 2), les temps de régression de 2 segments (52 min), la récupération motrice (160 vs 157 min), et la qualité de l'anesthésie ont été similaires. Trente-neuf injections épidu-rales de 3 ml de lidocaïne 2 % ont été faites chez 12 patients, 10 min après l'injection sous-arachnoïdienne. Vingthuit des réinjections l'ont été dans le groupe hyperbare (P < 0,05); vingt-six ont produit une augmentation de 0 ou 1 de...

We present a case of a 10-month-old girl with familial dysautonomia, who was scheduled for the insertion of a gastrotomy tube via laparoscopy under general anaesthesia. We used a total i.v. anaesthetic technique including dexmedetomidine and titrated the drug to patients' haemodynamic status and BIS value. Vital signs remained virtually unchanged during the entire procedure, and the tracheal tube was removed at the end of the procedure. Postoperative course was uneventful. Careful planning of the anaesthetic management, understanding the physiological consequences, and being able to titrate the medications utilized are key to the decrease of complications encountered in these patients. We report the safe use of dexmedetomidine in an infant with this extremely rare condition.

Background: Adenotonsillectomy is associated with severe postoperative pain. The parent's postoperative pain measure (PPPM), a 15-item instrument to measure a child's pain at home, has been validated with a seven-point faces scale in children 7-12 years and with the parents' global report of pain in children 2-6 years.Aims: Our primary objective was to validate the PPPM with a recommended ageappropriate pain scale in children 2-12 years after adenotonsillectomy. Our secondary objective was to reduce the PPPM components and validate this reduced PPPM. Methods: We recruited 319 children out of the 563 adenotonsillectomies performed between December 19, 2017, and December 18, 2018. Parents recorded administration of analgesics and their child's pain scores twice daily for 14 days: PPPM for all children and either the face, legs, arms, crying, consolability (FLACC) pain scale for children 2-3 years or the faces pain scale-revised (FPS-R) for children 4-12 years. In addition, parents recorded analgesics.Results: Among the 354 eligible children, 9% of parents declined. 252 (79%) families submitted pain diaries. The median age was 2.9 [2.5-3.3] years for FLACC (n = 114) and 5.6 [4.5-7.2] years for FPS-R (n = 138). Across the 14-day recovery period, Cronbach's alpha for PPPM was 0.77 to 0.87. Generalized linear mixed models evaluated the association between PPPM and reference pain scales after adjustment for potential confounders. Time of day and postoperative days were included as predictors in the models. PPPM was strongly associated with FLACC and FPS-R (beta coefficient = 0.4; p < 0.0001). The association decreased over time, and the reduction was more significant for FPS-R than FLACC (beta coefficient = −0.13 vs. −0.04, respectively; p < 0.0001). There was a positive association between PPPM and the use of analgesics. A reduction analysis eliminated items from the original PPPM: four for FLACC and five for FPS-R, suggesting age-related differences. The reduced PPPM instruments achieved similar associations with their respective reference pain scales (beta coefficient = 0.5; p < 0.0001).