No abstract

Purpose Ponseti clubfoot management requires percutaneous tenotomy in 90% of cases, typically with local anesthesia. We report two light sedation protocols for outpatient tenotomy. Methods Operating room protocol: 24 patients (36 club feet; mean age at tenotomy, 70 days) underwent mask induction with oxygen/nitrous oxide. Pediatric intensive care unit protocol: five patients (eight club feet; mean age at tenotomy, 119 days) underwent intravenous propofol infusion with supplemental oxygen. Results All patients were discharged several hours after surgery with no complications. Anesthesia that is administered intravenously might have less risk of bronchial reaction than anesthesia that is administered by inhalation. Conclusions Our light sedation protocols offer safe alternatives to general anesthesia. Disadvantages include increased cost when compared with local anesthesia. Light sedation can be used effectively and has advantages when treating older infants who might struggle while under local anesthesia.

Previous investigation demonstrated the potential of L-cysteine (L-Cys) at high concentrations to cause hypoglycemia in mice totally deprived of insulin. For further elucidation of the glucose-lowering mechanism, glucose uptake and quantity of glucose transporters (GLUTs 3 and 4) in mouse soleus muscle and C2C12 muscle cells, as well as in human SH-SY5Y neuroblastoma cells, were investigated. A marked enhancement of glucose uptake was demonstrated, peaking at 5.0 mM L-Cys in soleus muscle (P < 0.05) and SH-SY5Y cells (P < 0.001), respectively. In contrast, glucose uptake was not affected in the C2C12 muscle cells. Kinetic analysis of the SH-SY5Y glucose uptake showed a 2.5-fold increase in maximum transport velocity compared with controls (P < 0.001). In addition, both GLUT3 and GLUT4 levels were increased following exposure to L-Cys. Our findings point to a possible hypoglycemic effect of L-Cys.

Previous investigation demonstrated the potential of beta-phenylpyruvate at high concentration to cause hypoglycemia in mice totally deprived of insulin. For further elucidation of the glucose-lowering mechanism, glucose uptake, and quantity of glucose transporters (GLUT1 and GLUT4) in mouse soleus muscle and C2C12 muscle cell lines were investigated following incubation with beta-phenylpyruvate in various concentrations. A marked enhancement of glucose uptake was demonstrated that peaked at 0.5 and 1.0 mM beta-phenylpyruvate in soleus muscle (P<0.01) and C2C12 cells (P<0.001), respectively. Kinetic analysis in C2C12 cells showed a twofold increase in Vmax compared with controls (P<0.001). In addition, both GLUT1 and GLUT4 levels were increased following exposure to beta-phenylpyruvate. Our findings point to a peripheral hypoglycemic effect of beta-phenylpyruvate.