IMPORTANCE Rituximab is among the most frequently used immunotherapies in pediatrics. Few studies have reported long-term adverse events associated with its use for children. OBJECTIVE To describe the use of rituximab and to assess whether its use is associated with shortor long-term adverse events, infections, or time to immune reconstitution in a diverse group of young people. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 468 patients aged younger than 21 years who received rituximab for diverse indications between October 1, 2010, and December 31, 2017, at Texas Children's Hospital, a large pediatric referral hospital. Patterns of adverse events, infections, and immune recovery are described. Data analyses were conducted from December 2019 to June 2020. EXPOSURE One or more doses of rituximab. MAIN OUTCOMES AND MEASURES Adverse drug events (eg, anaphylaxis), incidence of mild and severe infections, and time to recovery of B lymphocyte subset counts and immunoglobulin levels. Survival models and logistic regression analyses and were used to identify associated risk factors of infectious and noninfectious adverse drug events. RESULTS We identified 468 patients receiving at least 1 dose of rituximab. The total follow-up time was 11 713 person-months. Of the 468 patients, 293 (62.6%) were female, the median (interquartile range) age at receipt of dose was 14.3 (9.9-16.8) years, and 209 (44.7%) were self-reported White Hispanic. Adverse events associated with rituximab infusion occurred in 72 patients (15.4%), and anaphylaxis occurred in 17 patients (3.6%). Long-term adverse events, such as prolonged neutropenia and leukoencephalopathy, were absent. Infections occurred in 224 patients (47.9%); 84 patients (17.9%) had severe infections, and 3 patients (0.6%) had lethal infections. Concurrent use of intravenous chemotherapy, treatment of systemic lupus erythematosus, neutropenia, and use of intravenous immunoglobulin were associated with increased risk of infection. Among 135 patients (28.8%) followed up to B cell count recovery, CD19 + or CD20 + cell numbers normalized in a median of 9.0 months (interquartile range, 5.9-14.4 months) following rituximab use; 48 of 95 patients (51%) evaluated beyond a year had low-forage B cell counts. Recovery of CD27 + memory B cell number occurred in a median of 15.7 months (interquartile range, 6.0-22.7 months). Among patients with normal baseline values, low immunoglobulin G (IgG) levels developed in 67 of 289 patients (23.2%) and low IgM levels in 118 of 255 patients (40.8%); of these patients evaluated beyond 12 months from rituximab, 16 of 117 (13.7%) had persistently low IgG and 37 (33.9%) of 109 had persistently low IgM.

Attention is drawn to the degree of contamination of anaesthetic equipment and the responsibility resting upon anaesthetists for disinfecting all apparatus between cases. Possible methods of disinfection are briefly reviewed. Reasons of efficiency, convenience, cost and practicability are given for suggesting that a domestic washing-up machine is the best form of disinfection so far devised.

Two hundred anaesthetics have been given in which tetrahydroaminacrine has been used to modify the action of suxamethonium given by intermittent injection. Tetrahydroaminacrine extends the time scale of the intermittent suxamethonium technique, making this more convenient and successful in practice. Furthermore, suxamethonium afterpains are reduced to insignificant proportions. The arousal time seems to be lessened. The risk of dual block is diminished. Tetrahydroaminacrine combined with intermittent suxamethonium is found to be an excellent technique for Caesarean section and for forceps delivery and for emergency abdominal surgery especially in poor-risk patients.

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It has been suggested that children undergoing tonsillectomy would benefit from an intravenous infusion, to counteract the period of pre-operative fasting combined with the blood loss at operation. A prospective study of 50 children undergoing tonsillectomy was undertaken. The children were randomly allocated into two groups, one to receive an infusion and a control group. There were no significant differences between the two groups, although the children with an infusion had a longer mean post-operative stay. There would seem to be no role for routine intravenous fluid replacement in children undergoing uncomplicated tonsillectomy.