[Propofol in general anesthesia in children]. / Propofol u opstoj anesteziji dece.

For a long period of time propofol has been in use for total intravenous anesthesia in adults. In our literature there are no data on the use of propofol in pediatric anesthesia. The aim of the study was to compare effects of propofol for the induction of anesthesia, maintenance and recovery after anesthesia, with barbiturate, that is, inhalation anesthesia during spontaneous breathing. 50 children underwent propofol anesthesia. A control group comprised 50 children who underwent thiopentone and halothane anesthesia. The average propofol dose was 2.38 mg/kg/tt. Monitoring of cardiovascular parameters revealed statistically significant variations in systolic and diastolic pressure in both groups, but a more significant decrease was recorded in the propofol group. The decrease, recorded only during the initiation of anesthesia, stabilized afterwards. Side effects (pain during the initiation, apnea, spontaneous movements) were present in the propofol anesthesia, while in the halothane group they were reduced. In the propofol group period of recovery was short, indicating advantages of this anesthetic in day care centers.

[Malignant epilepsy in children: therapy with high doses of intravenous immunoglobulin]. / Maligne epilepsije dece: terapija visokim dozama intravenskog imunoglobulina.

22 children with intractable childhood epilepsy (ICE) showing no response to conventional drugs of hormone (ACTH, Synacten) therapy were administered i.v. immunoglobulin (ENDOBULIN immuno) at a dosage of 400 mg/kg on the first and 15th day and subsequently every 3 weeks for 6 months. 12/22 patients showed IgG2 subclass deficiency. A significant reduction in attacks, or even absence of attacks was observed in 13/22 children after 6 months of i.v. immunoglobulin therapy. Most of this children showed IgG2 subclass deficiency. The reduction of attacks after i.v. immunoglobulin therapy correlated with the improvement or normalization of the EEG finding. As for the psychomotor development, no major changes were noticed with respect to the condition prior to the therapy, but in children with IgG2 deficiency, there is no further psychomotor deterioration. 6 months after the last i.v. immunoglobulin dose positive therapeutic effect remained in 5/22 children, with 3 children the therapy was repeated because of recidive attacks and worse EEG findings, and proved effective. Light worsening of the EEG findings was found in 3/22 children, 2/22 dropped out, 1/22 child died of intercurrent infection, and in girl the attacks ceased entirely 4 months after the last i.v. immunoglobulin dose. With other children the condition remained unchanged. According to the authors opinion, i.v. immunoglobulin has its own place in ICE treatment, and it is evident in all cases where the classical antiepileptic and/or hormone therapy was unsuccessful, especially in children with IgG2 subclass deficiency, that is, in all the epilepsy cases where a great number of attacks is imperilling the psychomotor development in children, independently of type.

[Intravenous immunoglobulin in the treatment of malignant epilepsy in children]. / Intravenöses Immunoglobulin bei der Behandlung von malignen Epilepsien bei Kindern.

15 children with malignant epilepsy showing no response to conventional antiepileptic drugs or hormone therapy were administered intravenous immunoglobulin (Endobulin, Immuno) at a dosage of 400 mg/kg per day on the 1st and 15th day and subsequently every three weeks for 6 months. 7 of these 15 patients showed IgG2 subclass deficiency. A significant reduction in attacks, or even absence of attacks was observed in 10 out of 15 children after six months of intravenous immunoglobulin therapy. Apart from one patient with ringchromosomopathy, all the children with IgG2 subclass deficiency responded to this therapy. The reduction of attacks after i.v. immunoglobulin therapy correlates with the improvement or normalization of the EEG findings. At present, the authors consider the number of patients still too small to make a final assessment, but they believe that intravenous immunoglobulin holds an important position in the treatment of malignant epilepsy in childhood.

[3 case reports of patients with malignant epilepsy treated with high doses of intravenous immunoglobulin]. / Prikaz tri bolesnika sa malignim epilepsijama lecenih visokim dozama intravenskog imunoglobulina.

Three patients with malignant epilepsia were presented. They were treated by i.v. immunoglobulin in the dose of 400 mgr/kg/bw at O, 15-day and 3-week intervals. Duration of treatment lasted 5 weeks in one child and 6 months in two children. One child had normal values of IgG2 subclass while two children showed the deficiency of this subclass. In all three children i.v. immunoglobulin therapy led to a remarkable improvement in respect both to the reduction of attacks and EEG. Due to the aggravation observed 6 months after the last dose of i.v. immunoglobulin, the therapy was repeated and led to the improvement in two children. It was pointed out in conclusion that i.v. immunoglobulin had its place in the treatment of malignant epilepsia in children.