Update on complications in pediatric anesthesia.

Complications in pediatric anesthesia can happen, even in our modern hospitals with the most advanced equipment and skilled anesthesiologists. It is important, albeit in a tranquil and reassuring way, to inform parents of the possibility of complications and, in general, of the anesthetic risks. This is especially imperative when speaking to the parents of children who will be operated on for minor procedures: in our experience, they tend to think that the anesthesia will be a light anesthesia without risks. Often the surgeons tell them that the operation is very simple without stressing the fact that it will be done under general anesthesia which is identical to the one we give for major operations. Different is the scenario for the parents of children who are affected by malignant neoplasms: in these cases they already know that the illness is serious. They have this tremendous burden and we choose not to add another one by discussing anesthetic risks, so we usually go along with the examination of the child without bringing up the possibility of complications, unless there is some specific problem such as a mediastinal mass.

Bilateral ultrasound transversus abdominis plane block in a patient affected from Menkes disease.

This case report demonstrates the utility and safety of ultrasound transversus abdominis plane (TAP) block in a paediatric patient suffering from Menkes disease. Anaesthetists, and particularly paediatric and neonatal anaesthetists, have to make a careful assessment of these patients, who are subjected to frequent surgeries, despite their tender years. These operations are often necessary in order to improve the patient's quality of life as much as possible. The choice of anaesthetic technique must take the particular nature of the disease and the patient's medical history into consideration, while careful preparation and preoperative evaluations make it possible to administer the general or local anaesthetic safely. Official literature on the subject does not provide sufficient information about the use of local anaesthetic techniques. Moreover, the use of ultrasound TAP block in patients affected by Menkes disease has never been published in literature. In our experience, ultrasound TAP block has provided positive results, although the rarity of this childhood disease makes a detailed study difficult.

[Antileukotrienes in the therapy of bronchial asthma]. / Gli antileucotrienici nella terapia dell'asma bronchiale.

Cysteinyl-leukotrienes (Cys-LTs) are mediators released in bronchial asthma and are both direct bronchoconstriction and proinflammatory substances that mediated several steps in the pathophysiology of chronic asthma, including inflammatory cells recruitment, vascular leakage, and possibly airway remodelling. Available evidence from clinical trials and real-word experience derived from managing patients with asthma justifies a broader role for antileukotriene drugs (anti-LTs) in asthma management than that recommended in the National Asthma Education and Prevention Program and National Institute of Health treatment guidelines. Anti-LTs seem to be effective alternatives to inhaled corticosteroids (ICS) either as monotherapy or as adjunctive therapy that reduces the need for higher doses of ICS in patients with mild-to-moderate persistent asthma. This class of drugs may be used as adjunctive therapy for all levels of disease severity because they are effective in combination with ICS during long-term maintenance therapy. The anti-LTs seem especially effective in preventing aspirin-induced asthma providing an additional advantage of reducing nasal congestion in patients with both asthma and rhinitis and in the treatment of exercise induced-asthma. This class of drugs have several features that are likely to promote adherence to treatment and are generally well tolerated. The available clinical data suggest that anti-LTs should be considered as a therapeutic option or as additive therapy in patients with mild to severe asthma.