Combined anaesthesia with epidural bupivacaine maintains the same Bispectral index values as Balanced anaesthesia during orthopaedic surgery in children without fentanyl and with a lower sevoflurane requirement.

SummaryA 13-year-old girl developed transverse myelitis 2 weeks after an uncomplicated, combined general and epidural anaesthetic for orthopaedic surgery. Since epidural anaesthesia had been used, a causal relationship might have been assumed. We review the aetiology and pathogenesis of acute transverse myelitis and the role of anaesthesia in this disorder. Although a causal relationship cannot be assumed and regional anaesthesia in children is considered safe, we would like to re-emphasise the management principles and practices that may improve the benefit-to-risk ratio of these techniques.

We report the case of an infant affected with congenital systemic juvenile xanthogranuloma scheduled for central venous access system implantation (Port-a-Cath) and a liver and bone marrow biopsy. The patient had impaired liver function, thrombocytopenia, and coagulopathy which was refractory to daily fresh-frozen plasma and platelet infusions: 80 microg x kg(-1) dose(-1) of recombinant factor VIIa (rFVIIa) was administered i.v. every 2 h starting 30 min before the procedure and ending 6 h afterwards. Very minor bleeding was observed during the procedure. In conclusion, rFVIIa therapy was effective as prophylaxis for both invasive procedures in this patient with a coagulopathy which was refractory to other different therapies.

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