[Anesthetic management for laryngotracheal separation and tracheoesophageal diversion].

Patients with severe neurological impairment may develop recurrent pneumonia due to aspiration. Laryngotracheal separation and tracheoesophageal diversion are one of the surgical treatments to prevent salivaly aspiration. We report anesthetic management for laryngotracheal separation and tracheoesophageal diversion of five pediatric patients with severe cerebral palsy. Anesthetic problem was that all patients was repeating intractable pneumonia. And when the trachea was resected from esophageal mucosa, we experienced temporary ventilatory disturbance. So airway management was most important during anesthesia. Perioperative complications were postanesthetic seizure and postoperative brief apnea. Recurrent fever and aspiration pneumonia subsided in all of them. Our impression is that laryngotracheal separation and tracheoesophageal diversion are not so invasive surgical treatment for intractable pneumonia. But perioperative management should be concerned about both respiratory and neurological problems.

Accuracy of visual estimation of body height and weight in supine paediatric patients.

BACKGROUND: When it is impossible to measure the weight and height of paediatric patients, these are usually estimated. We undertook this study to see how accurate these estimates are in practice. METHODS: Five observers estimated body height and weight, and subsequently calculated body surface area, in 48 paediatric inpatients who were lying on surgical ward trolleys. RESULTS: Regression analysis of the data revealed that good correlations existed between estimated and actual body size in all the investigators. However, we found large percentage errors in estimation for infants and younger children with small physical size, and a variation in scatter distribution of estimation errors among the five investigators. CONCLUSIONS: These findings suggest the necessity to titrate drug doses for administration in this small paediatric population.

Effects of ondansetron, granisetron, ramosetron, and azasetron on human neutrophil functions.

Neutrophil functions play an important role in the antibacterial or antitumor host defense system. Ondansetron, granisetron, ramosetron, and azasetron are often used in gynecological patients as a prophylaxis against postoperative emesis or chemotherapy-induced emesis. In this study, using an ex vivo system, we have shown that these antiemetics at clinically relevant concentrations had no effect on superoxide (O(-)(2)) and hydrogen peroxide (H(2)O(2)) production of neutrophils, although high doses of these drugs significantly inhibited it to a similar degree. The drugs failed to impair chemotaxis or phagocytosis and to scavenge O(-)(2) or H(2)O(2) generated by an acellular system. Inhibition of the reactive oxygen species production may be due to attenuation of calcium elevation in neutrophils with these antiemetics. Our findings suggest that we are able to use these antiemetics in gynecological patients with cancer or those undergoing surgery without great caution.