PRISM is a reliable tool for evaluating the prognosis of multiple, severely traumatized children. Its relative simplicity and the fact that it is extremely widespread as a general prognosis score in PICUs represent other arguments for its use. Due to the leading influence of head trauma on mortality, GCS, a score even simpler than PRISM, showed identical accuracy regarding survival prediction.

A 3-yr-old boy received valproic acid (VPA) for recurrent seizures. He developed coma and acute liver failure that were attributed to VPA toxicity, and underwent emergency orthotopic liver transplantation (OLTx). Despite good graft function, his neurological state worsened and led to death a few months later. The diagnosis of Alpers-Huttenlocher Syndrome (AHS) was suspected, subsequently to liver Tx, in view of ongoing neurologic deterioration and magnetic resonance imaging (MRI) findings. The syndrome, recessively inherited, associates brain degeneration with liver failure, and is now considered a mitochondrial disease. Enzyme activity deficiencies of the respiratory chain were identified in muscle mitochondria, as well as morphologic abnormalities of mitochondria in the explanted liver. Guidelines for diagnosis are presented, in order to differentiate the liver failure in AHS from that induced by genuine VPA toxicity. It is recommended to avoid liver Tx in patients with AHS given the fatal neurological course of the disease.

In this study, we have shown that, in children, continuous fascia iliaca compartment block, a technique providing neural blockade of the thigh and the anterior part of the knee, was associated with safe plasma bupivacaine concentrations, was well tolerated, and provided satisfactory pain scores in most cases.

As free water excretion is altered for all children in the postoperative period, it is necessary to reduce the volume of maintenance fluid therapy to half the previously recommended volume. The choice of an isotonic solution should be more pertinent to that of a hypotonic solution, but evidence is lacking for a definitive answer.

Purpose: To determine the effect of infusion rate, tubing length and fluid composition on the temperature of the infusate reaching the distal end of an infusion tubing with and without active fluid warming.Methods: Warmed normal saline (W-NS) and packed red blood cells (W-PRBC), were infused with a fluid warmer through a modified infusion set. The fluids were delivered at eight infusion rates from 50 to 999 mL·hr -1 . The infusate temperature was monitored at 20 cm intervals on the iv tubing. The same temperature monitoring protocol was applied to PRBC without warmer (NoW-PRBC).Results: In W-NS and W-PRBC groups, there was a decrease in the infusate temperature, at each flow rate, from the drip chamber to the distal end of tubing ( P <0.001). In NoW-PRBC group, there was a rapid increase in the infusate temperature from the bag to the drip chamber ( P <0.001). Thereafter, there was no change in temperature, except at the 999 mL·hr -1 infusion rate, where a slight increase in the infusate temperature throughout the tubing was shown. In W-NS and W-PRBC groups increasing the flow rate produced a significant increase in the infusate temperature, at each measurement point ( P <0.001). In the NoW-PRBC group, increasing the flow rate did not alter the infusate temperature. The fluid composition did not influence the infusate temperature.Conclusion: There is an important heat exchange within the tubing, which is aggravated at low flow rates. At infusion rates appropriate for pediatric anesthesia the clinical and economic value of fluid warming without the use of heated extension tubing is questionable.Objectif : Déterminer l'effet de la vitesse de perfusion, de la longueur de la tubulure et de la composition du liquide sur la température de la solution intraveineuse à la partie distale de la tubulure, le liquide étant soumis ou non à un réchauffement actif. Méthode : Une solution salée (SS-R) et un concentré de globules rouges réchauffés (CGR-R) ont été perfusés avec un ensemble à perfusion modifié comprenant un réchauffeur de liquide. Les liquides ont été administrés selon huit vitesses de perfusion, de 50 à 999 mL·h -1 . La température du soluté a été mesurée à des intervalles de 20 cm sur la tubulure iv. Le même protocole de surveillance de la tempéra-ture a été appliqué au CGR non réchauffé (CGR-NonR). Résultats : Dans les groupes SS-R et CGR-R, la température du liquide perfusé a baissé pour toutes les vitesses de perfusion, entre la chambre compte-gouttes et la partie distale de la tubulure (P < 0,001). Dans le groupe CGR-NonR, elle a augmenté rapidement, entre le sac et la chambre compte-gouttes (P < 0,001). Par la suite, il n'y a pas eu