We compared EMLA cream with nitrous oxide (N(2)O) for providing pain relief during venous cannulation in children. In a prospective, double-blinded, randomized study, 40 children, 6-11 yr, ASA status I or II, undergoing scheduled surgery received either EMLA cream and inhaled air and oxygen (Group EMLA) or a placebo cream and inhaled 70% N(2)O in oxygen (Group N(2)O) before venous cannulation. Pain was evaluated with a visual analog scale and the Objective Pain Scale. The ease of venous cannulation and the observer's assessment of its efficacy for preventing pain were assessed. Heart rate, blood pressure, respiratory rate, and oxygen saturation were compared before and after venous cannulation. Visual analog scale scores (4.4 +/- 7.5 vs 3.9 +/- 9.3 mm, P = 0.85), Objective Pain Scale scores (median 0 [0-6] vs 0 [0-1], P = 0.61), efficacy (median 0 [0-1] vs 0 [0-1], P = 0.59), and ease of venous cannulation (0 [0-2] vs 0 [0-1], P = 0.84) were not different between EMLA and N(2)O groups, respectively. There was no statistical difference between the groups for the physiologic variables. Minor side effects were significantly more common in the N(2)O group (11 of 20) than in the EMLA group (7 of 20) (P = 0.0248). We conclude that both techniques provided adequate pain relief during venous cannulation, as demonstrated by the low pain scores.
Abstract. Corticosterone concentrations and corticosterone binding in the serum were studied in immature female rats, using radioimmunoassay and batchwise gel equilibration techniques. A parallel developmental pattern was found for corticosterone levels and its serum binding with a neonatal drop, followed by low levels until 12 days of age and a rise between 12 and 28 days of age. Effects of adrenalectomy, of ovariectomy, of the combined operation and of sham-operations, performed at various ages, were also studied. Adrenalectomy performed at 5 days of age did not decrease serum corticosterone concentrations within a 6-day period whereas it did in older rats. Complete disappearance of corticosterone from the blood occurred only in adult rats after combined adrenalectomy/ovariectomy. Ovariectomy and sham-operations in the younger age groups (5–15 days) caused a gradual increase in corticosterone concentration with maximal values 6 days after operation or later. The response of corticosterone secretion to these operations became more moderate and quicker, i.e. more adult-like, at 28 days of age, the age where corticosterone concentrations in intact rats also seemed to reach a plateau at an adult-like level. Corticosterone binding changed only marginally after ovariectomy or sham-operations until 28 days of age, when an increase was induced by these operations. After adrenalectomy or combined adrenalectomy/ovariectomy, however, marked increases in serum binding of corticosterone were always seen. In summary: though a parallel developmental pattern of serum corticosterone levels and corticosterone binding was seen in the maturing rat, interference with the normal condition causes divergent responses in these two parameters. Moreover, the responses vary with maturational age.
The cortisol binding ability of transcortin (corticosteroid binding globulin or CBG) was found to be virtually absent from the sera of patients in a state of shock associated with high levels of antibodies to candida albicans.At the same time the serum proteins of the patients in shock displayed a number of the classical responses seen in acute inflammation: increased haptoglobin (28 \m=+-\10 vs 10.8 \m=+-\7.7 \g=m\m in normals), reduced prealbumin (1.7 \m=+-\ 0.6 vs 3.6 \m=+-\0.1 \g=m\m in normals) and albumin (485 \m=+-\78 vs 600 \ m=+-\200 \ g=m\ m in normals).The shock sera also showed increases in levels of endogenous cortisol (610 \ m=+-\ 260 vs 395 \ m=+-\ 192 nM in normals) and progesterone (2.40 \ m=+-\ 0.7 vs 1.4 \ m=+-\ 1.2 nM in normals) similar to those seen in inflammatory conditions.In sera from patients with superficial chronic candidiasis no significant variation of cortisol binding was observed. Haptoglobin was increased (26.4 \ m=+-\8.2 \g=m\m) and prealbumin decreased (2 \m=+-\0.8 \g=m\m), while the other serum indices tested retained essentially normal levels.Compared with previous studies from this laboratory which demonstrate a fall of CBG in septic shock of bacterial origin and lack of this response in acute inflammation, these results suggest that the loss of serum CBG acitivity is a specific marker for shock of fungal or bacterial aetiology. Possible endocrine or immune implications and clinical applications of our findings are discussed.Uow transcortin (CBG) values have been described in a few cases of liver, adrenal or renal disease (Brien 1981) or as a result of surgery (Hamanaka et al. 1970). Until recently, however, no consistent decrease of this corticosteroid binding activity has been reported in human disease states.Studies from this laboratory have shown that a severe and highly reproducible fall of CBG activity occurs in the rat as a result of turpentine-induced inflammation (Savu et al. 1980) and in man during the early phase of septic shock of bacterial aetiology (Savu et al. 1981). In man, this response resulted in virtual disappearence of the glucocorticoid binding activity of the serum ; this seemed specific for septic shock, since sera from patients with shock or acute inflammation displayed similar responses of their classical acute phase reactants (APRs), and endo¬ genous cortisol or progesterone levels, whereas the CBG fall was only seen in the shock sera.We have now extended our observations to shock associated with severe acute infection by the fungus candida albicans and shown that this dis¬ order brings about an almost complete loss of CBG activities similar to that caused by bacterial septic shock.In addition, to further delineate the specificity of the CBG fall in various shock and inflammatory conditions, we have examined the serum levels of typical APRs, steroids, and thyroid hormones, in patients with severe or superficial candidiasis.The physiological and practical implications of our findings are discussed.
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