CLINICAL EXPERIENCE AND PLASMA LAUDANOSINE CONCENTRATIONS DURING THE INFUSION OF ATRACURIUM IN THE INTENSIVE THERAPY UNIT

Twenty patients in the intensive care unit received an infusionof atracurium to permit mechanical ventilation. The durationof infusion ranged from 38 to 219 h and the average rate ofinfusion during the study was 0.76 mg kg^–1 h^–1.In 14 patients an increase in atracurium requirement occurredwithin the first 72 h of the infusion. Recovery from neuromuscularblockade after a prolonged infusion was sufficiently rapid toavoid pharmacologically induced reversal. In six patients maximumplasma concentrations of laudanosine were 1.9–5 µgml^–1 and there was no evidence of cerebral excitation.     

Short-term outcome of mechanically ventilated infants weighing more than 2499 g at birth: A population based study*

Abstract: Very little data exist describing the neonatal outcome of infants of birthweight 2500 g or more who require mechanical ventilation. Our aim was to collect population-based data on such infants in New South Wales (NSW), and to monitor their neonatal morbidity, mortality to 1 year of age and the associated risk factors. The study group (NICUS infants) comprised all 341 infants weighing >2499 g who were admitted to the seven neonatal intensive care units in New South Wales and mechanically ventilated for 4 h or more between 1 January and 31 December, 1987. Two groups of infants emerged: those who were preterm and mostly had hyaline membrane disease, and term and post-term infants for whom the most common problem was ‘perinatal asphyxia’. The most important factors associated with dying were a birthweight of over 3499 g (OR = 2.6; CI 1.03–6.6) and a 1 min Apgar score <4 (OR = 4.8; C11.4–16.9). Study group mothers were significantly more likely than all NSW mothers to have had a spontaneous abortion in the previous pregnancy (P<0.01), a pre-existing medical condition or an obstetric complication in this pregnancy, or a Caesarean section for this delivery (P<0.001). This is the first population-based study of high-risk neonates without congenital anomalies to clearly document the worsening prognosis associated with a birthweight over 3499 g. Further research should be directed towards identifying prenatal and perinatal factors which might minimize the morbidity and mortality in this group of babies.     

EFFECTS OF THE RECTAL ADMINISTRATION OF DIAZEPAM: Diazepam Concentrations in Children Undergoing General Anaesthesia

Diazepam 1 mg/kg body weight was administered rectally to 14children (11–22.5 kg) before minor surgery under generalanaesthesia. Administration in solution (n = 7) resulted ina rapid increase in serum concentrations which were maintainedfor 8 h. Administration by suppository (n = 7) resulted in significantlylower serum concentrations at 10 and 20 min, but higher concentrationsat 2 h. At other intervals the concentrations did not differfrom those reached after administration of diazepam in rectalsolution. These results favour the use of a solution when rectaldiazepam is used for premedication in children.     

Peliosis Hepatis Due to Oxymetholone—A Clinically Benign Disorder

Peliosis hepatis is a rare hepatic disorder mainly diagnosed at surgery or autopsy. Clinical outcome is thus frequently poor. We report a patient in whom the diagnosis was established by percutaneous needly biopsy. Withdrawal of the steroid medication was followed by a prompt clinical improvement. Although histologic proof of regression is not available, this experience suggests a more favorable prognosis than previously thought possible.