ABSTRACT
Compartment syndromes have not been reported in association with femoral artery cannulation for invasive blood pressure monitoring in children. We report a case that presented atypically in a child admitted in extremis due to small bowel obstruction and who had a 20 G femoral arterial cannula sited during resuscitation. The compartment syndrome was diagnosed after repeated measurements of compartment pressures.
Subject(s)
Anterior Compartment Syndrome/etiology , Catheterization, Peripheral/adverse effects , Femoral Artery , Anterior Compartment Syndrome/diagnosis , Child, Preschool , Humans , Intestinal Obstruction/surgery , Intestinal Obstruction/therapy , Male , Monitoring, Physiologic , ResuscitationABSTRACT
The dose requirements of atracurium were determined in 12 children who required an infusion of atracurium to facilitate mechanical ventilation in the intensive care unit. The mean duration of infusion was 98 h (range 36-284 h) during which an increasing dose requirement was observed in all patients. The mean infusion rate was 1.60 (SEM 0.08) mg kg-1 h-1, and in seven patients a mean infusion rate of 1.72 (0.15) mg kg-1 h-1 was observed at 72 h. These rates are greater than those reported previously in adults. Cessation of neuromuscular block occurred promptly upon discontinuing the infusion. No side effects were observed which could be attributed to the infusion of atracurium.
Subject(s)
Atracurium/administration & dosage , Critical Care , Adolescent , Atracurium/pharmacology , Child , Child, Preschool , Humans , Infusions, Intravenous , Neuromuscular Junction/physiology , Respiration, Artificial , Synaptic Transmission/drug effectsABSTRACT
The Basenji greyhound (BG) has been proposed as a model of atopic disease because of its chronic relapsing atopic dermatitis as well as airway hyperresponsiveness. We attempted to characterize this model further by comparing its skin wheal-and-flare responses to morphine sulfate and histamine with those of control, nonatopic mongrel dogs. We found that BG dogs had significantly smaller skin responses than did the control dogs to all but two concentrations of histamine used. In contrast, BG dogs demonstrated greater skin response to morphine at the three lowest concentrations used but had a significantly smaller skin response at the highest dose of morphine. Skin punch biopsy specimens revealed decreases in histamine content after morphine exposure but no difference in histamine content of the unexposed skin or of morphine-exposed skin for the two groups of dogs. When percent histamine release was compared, however, BG dogs were found to release a significantly greater proportion of histamine in response to morphine than control dogs. Although there was no significant difference in total mast cell counts for the two groups, the BG dogs had significantly fewer formalin-insensitive mast cells in unexposed skin than control dogs. We conclude that skin responses in BG dogs are characterized by decreased end organ responsiveness and greater releasability of mast cells in response to nonimmunologic stimulation.
Subject(s)
Dermatitis, Atopic/physiopathology , Mast Cells/metabolism , Skin/metabolism , Animals , Dogs , Histamine Release/drug effects , Morphine/pharmacology , Skin TestsABSTRACT
Methacholine and citric acid responses were assessed before, during, and after 6 wk of oral treatment with either placebo or methylprednisolone (2 mg.kg-1.day-1) in 12 Basenji-Greyhound dogs. Bronchoalveolar lavage was performed in three dogs in each group before, during, and after pretreatment. Base-line airway resistance and dynamic compliance did not change with treatment in any of the groups. Placebo treatment had no demonstrable effect on methacholine and citric acid responsiveness. Methylprednisolone treatment abolished the constrictor response to citric acid during the 4th and 6th wk of treatment and significantly reduced methacholine responsiveness during the 3rd and 5th wk of treatment. Methylprednisolone treatment was associated with a marked reduction in the percent of eosinophils, but not mast cells, in the bronchoalveolar lavage fluid during the 7th wk. Blood eosinophil counts were also markedly reduced in the methylprednisolone-treated group compared with the placebo-treated group during the 7th wk. The decrease in numbers of eosinophils in blood and bronchoalveolar lavage fluid suggests interference with the inflammatory process as a possible mechanism for the observed reduction in airway hyperresponsiveness in the Basenji-Greyhound dog.
Subject(s)
Asthma/physiopathology , Citrates , Methacholine Compounds , Methylprednisolone/therapeutic use , Aerosols , Animals , Asthma/drug therapy , Citrates/administration & dosage , Disease Models, Animal , Dogs , Female , Leukocyte Count/drug effects , Lung Compliance , Male , Methacholine Compounds/administration & dosage , RespirationABSTRACT
Two patients presenting for removal of phaeochromocytoma are described. Vecuronium was used to provide neuromuscular blockade by two different methods of administration: an infusion and a large bolus dose. Both gave satisfactory results and we suggest that vecuronium may be the neuromuscular blocking agent of choice for patients with phaeochromocytoma.
