The degree of motor block was significantly less after ropivacaine and levobupivacaine during the first 2 h postoperatively.

ABSTRACT:We investigated total homocysteine (tHcy) concentrations and relations between tHcy and folate, cobalamin (Cbl), genetic polymorphisms (MTHFR 677CϾT, MTHFR 1298AϾC, MTHFR 1793GϾA), blood pressure (BP), body mass index (BMI), cholesterol, triglycerides, sports activities, family and individual history of cardiovascular disease (CVD) and lifestyle issues in 264 healthy children and adolescents (2-17 y). THcy concentrations significantly increased while folate and Cbl decreased with age without gender differences. Age, folate and Cbl were significant predictors for tHcy concentrations. THcy was higher but within normal ranges in MTHFR 677TT homozygotes (10.6%) and carriers of the MTHFR 1793A allele (8%). Only two individuals (0.8%), both with low tHcy concentrations, were homozygous for MTHFR 1793AA. THcy concentration correlated positively with creatinine, triglycerides, BMI and systolic BP and was not related to cholesterol, sports activities and family history of CVD.In conclusion, tHcy concentrations in this pediatric population were significantly influenced by age, folate and Cbl concentrations. No gender differences for tHcy, folate or Cbl concentrations were observed. Both the MTHFR 677TT genotype and the MTHFR 1793A allele were not associated with hyperhomocysteinemia. The prevalence of the MTHFR 1793AA genotype was too low for meaningful interpretation. (Pediatr Res 60: 764-769, 2006)

A case of multiple life-threatening postoperative apnoeas in a term neonate undergoing inguinal herniorrhaphy and orchidopexy who received light inhalation anaesthesia combined with caudal block with 1 ml.kg-1 ropivacaine 0.2% plus 2 microg.kg-1 clonidine is reported. The patient showed no apparent risk factors for postanaesthetic apnoea. Oxycardiorespirography five days after surgery only showed minor abnormalities. Clonidine though administered caudally in the usual dose of 2 microg.kg-1 appeared to be the most likely cause for postanaesthetic apnoea in this neonate.

A neonate with chromosomal 9 abnormality and omphalocele received a lumbar epidural catheter after laparotomy. Several attempts were needed to establish this catheter. Bleeding occurred from the operative wound after surgery. Using an epidural infusion with ropivacaine 0.1% for 48 h postoperative pain relief was sufficient. Four days after epidural catheter removal, dysfunction of the sacral parasympathetic nerves was noted. Motor and sensor function of the lower limbs were unaffected. Magnetic resonance imaging showed a localized intraspinal haematoma in the lower lumbar region.

The case of a 680 g premature baby who developed massive spontaneous liver haemorrhage during laparotomy for necrotizing enterocolitis is reported. The infant survived due to rapid and massive fluid administration, including transfusion of large volumes of blood and blood products, in combination with high dose inotropic support and the surgical use of packing with thrombostatic sponges. Good venous access, including two central venous lines, turned out to be very useful.