Multinucleated giant cells in areas of the brain stem necrosis after cardiac arrest in two infants.

A rare type of cellular reaction in the brain stem of two infants with cardiac arrest encephalopathy is presented. After cardiac arrest both newborns were resuscitated and put on artificial ventilation. Their survival time amounted to 16 and 18 days, respectively, in a deep coma with areflexia. At the postmortem examination a widespread hemispheric necrosis of the gray and white matter was observed as well as symmetrical necrosis of the tegmental part of the brain stem extending from the midbrain up to medulla. Striking proliferation of blood vessels and large number of multinucleated giant cells originating from monocyte/macrophage lineage was found in the areas of the brain stem necrosis. No evidence of inflammatory process was found. It seems that giant cells appeared as local reaction on disintegration of maturing structures.

[Naloxone as a drug for improving anesthesia results in children]. / Nalokson jako lek usprawniajacy anestezje u dzieci.

In anaesthesiology of today, due to the increased use of strong analgetics, it is necessary to have an effective antagonist for mini- mizing the danger of respiratory depression in postoperative period. Naloxone, ( Narcan , R-Endo Laboratories Inc., Subsidiary of E. J. du Pont de Nemours and Co., (Inc.), USA), a new narcotic antagonist was investigated in this study. It has been applied to 58 patients in cases of respiratory depression at the end of anaesthesia in which fentanyl was given, (these cases constituted 14% of all anaesthesias). Fentanyl was given intravenously in fractional doses, (fig 1), during NLA, and other general anaesthesias, for operation and diagnostic examination ( exeption of cardiosurgery), in children and adolescents from two month-to nineteen years of age, (tab. 1.). Naloxone was given intravenously, in fractional doses from 1 microgram to 5 micrograms/kg body weight. As a criterium of an antidepressive effect of Naloxone--in addition to clinical evaluation, blood gases analyses and continuous capnographic recording has been accepted. In all 58 cases diminition of respiratory depression was observed 2-3 min. after injected each dose of Naloxone. Respiratory rate increased from 15 to 22/min. concentration of CO2 in expired gases decreased from 5-6% to 4,5%, (fig. 2 and 3), and regain of consciousness, and return of intensive reaction to endotracheal tube stimulation was observed. Naloxone produced neither changes in the cardiovascular system, nor side effects. Based on these results Naloxone has been suggested as an effective narcotic antagonist. It increase of the possibility of applying strong analgetics in children--allowing to keep a steady level of anaesthesia with easy elimination respiratory depression in the desired period of time.

[General anesthesia in infants]. / Anestezja ogólna u noworodków.

It is generally accepted, that the progress in surgical treatment of congenital malformation is closely related to the progress in highly-specialised methods of newborn anaesthesia. The safe methods of anaesthesia have to be adapted to anatomical and physiological peculiarities of the earliest days of life as well as to different reaction to drugs and anaesthetics. The preoperative preparation in newborns used to be often very short, because most of the problems of the neonatal period are emergency surgical interventions and there is no time for treatment even of the serious disturbances of basic physiological functions. The purpose of this study was to estimate methods of general anaesthesia in newborns, which have been introduced in the Anaesthesiology Department of the National Research Institute of Mother and Child. The main element of these methods was general anaesthesia with muscle relaxants and controlled ventilation as a routine. The estimation was based on general analysis of 10 years practice when these methods of anaesthesia were used. During this time 515 anaesthesias to 408 both-sex newborns were given (Tab. I, Fig. 1). 85% of anaesthetized newborns were operated because of congenital malformations (Tab. I); 46% of operations were performed during their first week of life, 21% were operated in first 24 hours of life, mostly as an emergency (Fig. 3). 10% of operations were performed is prematures (body weight below 2500 g) (Fig. 4). The "routine" anaesthesia was given in 82% cases. Awake intubation in unpremedicated newborns was performed. Anaesthesia was maintained with nitrous oxide-oxygen mixture (1:1 or 2:1). D-tubocurarine in 95% of cases was used. The initial dose 0,5 with matures and 0,25 mg with premature babies was used. If necessary supplementary doses were given. During anaesthesia, intermittent positive pressure ventilation (IPPV) with frequency at least 60/min. was used. During this ventilation, hyperventilation and positive end-expiratory pressure (PEEP) were obtained. Precordial stetoscope and thermometer probe was used as a routine. In some special cases eCG, end-expired CO2 (capnography), pletysmography were also recorded; blood gas analyses were checked. All intra- and postoperative complications as well as postoperative mortality have been analysed in details. During 3,3% of operations some complications had been observed. The total incidence of early psotoeprative complications was 20%. In this group the most frequent were respiratory complications (16,1%). Serious disturbances in pulmonary gas exchange during operation and early postoperative period were not found.(ABSTRACT TRUNCATED AT 400 WORDS)