Intraoperative administration of tranexamic acid significantly reduces blood loss during spinal surgery in children with scoliosis.

In preschool children undergoing sevoflurane anaesthesia for tonsillectomy and adenoidectomy, endtidal sevoflurane concentrations are more closely correlated with BIS than with MAP or heart rate.

A sleep-promoting factor was extracted from human urine. Intraventricular infusion of the purified material induced excess slow-wave sleep in rats and rabbits for 5--10 h after the infusion. Chemical properties of the urinary factor were similar to those of factor S derived from whole brains of sleep-deprived goats, sheep, and rabbits. The behavior of the urinary factor in two ion exchange chromatographic steps, high voltage electrophoresis, gel-filtration, and ultrafiltration was similar to that of factor S. Effects of the purified urinary factor on slow-wave sleep of rats and rabbits were similar in time-course and duration to those of factor S from brain. However, the factor obtained from human urine did not increase the amplitude of cortical slow waves to the same extent as did factor S from brains of sleep-deprived animals.

No abstract

The relationship between bispectral index (BIS) and purposeful intraoperative patient movement is consistent with previous BIS utility studies. We conclude that BIS may be a useful clinical monitor for predicting patient movement to command during the intraoperative wake-up test, particularly when controlled hypotension is used and hemodynamic responses to emergence of anesthesia are blunted.

We present a case of a neonate with an epidural catheter placed via the caudal route after induction of general anaesthesia in whom the test doses of epinephrine-containing local anaesthetic was positive on two occasions. Remarkable tachycardia was noted after each of two separate injections through the catheter. Blood was never aspirated from the catheter and placement was without difficulty. After the catheter was removed, blood was noted at the tip.

No abstract

The preoperative assessment of pediatric patients with myopathy begins with a description of which muscle groups are impacted and the degree of disability present. Particular focus on respiratory status is necessary, as weak muscles of respiration can cause ventilatory insufficiency. This is exacerbated by swallowing difficulty, poor clearance of secretions, inadequate cough, and spinal and rib cage deformity. Restrictive lung disease may be severe. Cardiac dysfunction often accompanies skeletal muscle disease. Cardiomyopathy and conduction defects are prevalent in patients with muscle disorders and require preoperative evaluation. There is wide phenotypic variability among patients with muscle disease. By grouping myopathies according to pathophysiology, we can understand both the presentation and the most significant comorbidities associated with specific types of muscle disease. Finally, we can consider the specific anesthesia considerations that are pertinent to each, highlighting the risks of malignant hyperthermia and anesthesia-induced rhabdomyolysis. This review contains 3 tables and 38 references.  Keywords: anesthesia considerations, congenital myopathy, malignant hyperthermia, mitochondrial disorders, muscular dystrophy, myotonia, succinylcholine, anesthesia-induced rhabdomyolysis