Pharmacology and use of muscle relaxants in infants and children.

Succinylcholine is a short-acting depolarizing neuromuscular blocker used to facilitate intubation; pancuronium is a longer-acting, nondepolarizing agent commonly employed to control ventilation in pediatric patients. The neuromuscular block produced by both drugs may be modified by patient age, acid-base and electrolyte status, body temperature, and drugs such as aminoglycoside antibiotics; adjustment in dose or in technique of administration may be required. Cardiovascular side-effects, primarily arrhythmias, are occasionally associated with the use of either agent. In contrast to that of succinylcholine, the paralysis from pancuronium is pharmacologically reversible with the combination of atropine and neostigmine.     

Pharmacology of sleep disorders in children and adolescents

There is a high prevalence of sleep disorders in children and an apparent increasing need for pharmacologic management. However, because of the paucity of data available with regards to dosing, efficacy, tolerability, and safety profiles of medications as well as a lack of adequate well-designed clinical trials, medications are currently not approved for the pediatric population by the US Food and Drug Administration. There are no pharmacologic guidelines for the specific sleep disorders or the different pediatric age ranges. Additional research is needed for evidence-based pediatric sleep pharmacotherapy. This article reviews pediatric sleep disorders and the pharmacologic therapeutic options.     

Intussusception in infants and children

Summary Seventy-five cases of intussusception seen over a period of 5 years (1968–1972) are reported. A peak monthly incidence was noted in the months of May and June, when the incidence of gestroenteritis was high. 73% of the cases were in the age group of 1 month to 1 year. The male: female ratio was 3∶1. The average duration of symptoms was 2.43 days. The clinical features, the diagnostic difficulties and the aetiology have been discussed. Of the 75 cases, 61 were operated upon. Hydrostatic reduction by barium enema was not tried in any case. The overall mortality in 61 operated cases was 27.8 per cent. From the Department of Surgery and Pediatric Surgery, Lady Hardinge Medical College and Hospital, New Delhi-1.     

Hemangiopericytoma in infants and children

Seven cases of hemangiopericytoma in infants and children were managed in the past 10 yr at our Institute. All the children were males and presented with a painless tumor of varying duration, over the extremities or head and neck region. Five of them had the tumors present since birth. Five patients were treated by surgical excision, one received radiotherapy and an other received chemotherapy as the primary treatment. These children were followed for period varying from 1–10 yr. One child died and another had local recurrence in this series. Wide local excision of the tumor is the choice of treatment of these rare tumors. If the histology is suggestive of malignancy or if the tumor is incompletely excised, postoperative radiotherapy is advocated, Chemotherapy is not effective for these tumors.     

Diarrhoea in infants and children

Summary Observations on 938 children below 5 years of age treated for acute diarrhoeal disease from April 1963 to March 1967 in a Delhi hospital are analysed. 92·6% cases occurred in children below 2 years of age. The incidence of diarrhoea was high from April to September. Extra-intestinal infections were present in 36·5% of cases, but only 11·4% of patients had serious systemic illness. 36·6% of children had protein-calorie malnutrition, 68·8% were dehydrated. Hyponatremia was more frequent than hypernatremia. 25% of patients were hypokalemic and 20.6% had severe biochemical acidosis. EnteropathogenicE. coli were isolated from stools in 14·5% of cases, Shigella in 2·6% and Salmonella in 0·3%. Organisms of doubtful enteropathogenecity were cultured from stools in 26·2% of cases. 87% of cases recovered, 6·7% died and 6·3% of the patients left against medical advice. From the Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 16.