Recurrent Hypoxemia in Young Children with Obstructive Sleep Apnea Is Associated with Reduced Opioid Requirement for Analgesia

Background: Obstructive sleep apnea (OSA) in children is often associated with recurrent hypoxemia during sleep. In developing animals, central opioid neuropeptide content is high, and opioid receptors are up-regulated after recurrent hypoxia. The authors hypothesized that children with recurrent hypoxemia due to OSA might have altered central opioid functionality that could affect their responsiveness to opioid drugs. Using a retrospective database, we assessed the relation of age and preoperative oxygen saturation to the cumulative postoperative morphine dose administered for analgesia in children with OSA undergoing adenotonsillectomy.

Methods: Inclusion criteria were (1) adenotonsillectomy for OSA; (2) no concomitant pathology; (3) intraoperative administration of short-acting opioid drugs; (4) endotracheal extubation on awakening in the operating room; and (5) morphine as the parenteral, postoperative analgesic.

Results: Forty-six children (16 girls) fulfilled the inclusion criteria. Age and preoperative arterial oxygen saturation (Sao2) nadir, either individually (P = 0.023, P = 0.0003, respectively) or in combination (P = 0.00009), exhibited a significant correlation to the morphine dose required for analgesia. Four of these children, aged 26.5 +/- 13.2 months, with a preoperative Sao2 nadir of 70.3 +/- 12.9%, did not require any postoperative morphine for analgesia at all.     

Dynamic CT scanning of the normal canine liver: interpretation of time density curves resulting from an intravenous bolus injection of contrast material

Seven adult male mongrel dogs were monitored by electromagnetic flow probes and string occluders around the hepatic artery and portal vein. Then, time density curves of the liver, aorta and portal vein were recorded using dynamic CT scanning following the bolus injection of contrast material into a peripheral vein (n = 7) and a mesenteric vein branch (n = 5). Information on total hepatic blood flow could not be obtained from the mesenteric vein injection. The hepatic time density curve could, however, be broken into its two components, hepatic arterial and portal venous flow contribution, by selective ligation of the hepatic artery or portal vein. It could be demonstrated that the arterial component of liver enhancement reached its peak at the end of the aortic wash-out of contrast material. Thus, the hepatic time-density curve could be broken in its two components by superimposing the aortic time density curve onto the hepatic curve. An attempt was made to estimate relative portal venous blood flow by using the slopes or the peaks of both components of the hepatic curve. Using the slopes of the hepatic curve resulted in a consistent underestimation of portal venous blood flow, whereas the peaks gave an estimate of portal venous flow with an accuracy within +/- 8%.     

Identification of monounsaturated fatty acids of Aerococcus viridans with dimethyl disulfide derivatives and combined gas chromatography-mass spectrometry.

Location of the double-bond position of monounsaturated fatty acids of Aerococcus viridans was accomplished by combined gas chromatography (GC)-mass spectrometry analysis of dimethyl disulfide (DMDS) derivatives. The monoenoic fatty acids from whole bacterial cells were converted to methyl esters and then to DMDS adducts and analyzed by capillary GC-mass spectrometry. The mass spectra of DMDS adducts gave an easily recognizable molecular ion (M+) and two major diagnostic ions attributable to fragmentation between the two CH3S groups located at the original site of unsaturation. Two relatively novel acids that distinguish aerococci from bacteria of closely related genera were identified as C16:1 omega 9c and C16:1 omega 9t from their mass spectrometry fragmentation patterns and retention characteristics on nonpolar capillary GC columns.     

Dopaminergic neurons in the mediobasal hypothalamus of old rats: Evidence for decreased affinity of tyrosine hydroxylase for substrate and cofactor

Acute, uncontrollable stress increases norepinephrine (NE) turnover in the rat's brain (thereby depleting NE) and diminishes the animal's subsequent tendency to explore a novel environment. We determined whether supplemental dietary tyrosine could prevent some of these changes. Rats given a control diet or diets enriched with tyrosine or tyrosine plus valine were exposed to tail-shock stress or to no stress over a 60-min period. Exposure to the stress caused an increase in NE turnover, decreasing NE and increasing 3-methoxy-4-hydroxy-phenylethylene glycol sulfate (MHPG-SO4) concentrations within the locus coeruleus, hypothalamus and hippocampus. No changes were detected in serotonin (5-HT) levels or turnover. Behavioral deficits following the stress were observed using measures of locomotion and of exploration in a novel open-field environment: stressed animals displayed much less spontaneous motor activity, hole-poking or frequency of standing on their hind legs than control animals. Animals receiving the tyrosine-enriched diet displayed neither the stress-induced depletion of NE nor the behavioral depression. These preventive effects of tyrosine were abolished by co-administration of valine, a large neutral amino acid that competes with tyrosine for transport across the blood-brain barrier. Since tyrosine alone, in animals not subjected to stress, did not change NE turnover nor the behaviors studied, our observations affirm that catecholaminergic neurons respond to the precursor amino acid only when they are physiologically active. Supplementary tyrosine may be useful therapeutically in people exposed chronically to stress.     

Threat to place a child

The threat to place a child is a common theme in clinical work with parents and children. While most parents do not follow through with their threat to place, the threat itself is an important issue. This paper discusses the conditions that often precipitate a parent's decision to threaten a child with placement, as well as the responses to that threat by both parent and child.