Neuroleptic malignant syndrome in a child

Neuroleptic malignant syndrome (NMS) is an uncommon condition, characterized by the insidious onset of fever, muscle rigidity, elevated creatine kinase, tachycardia, haemodynamic instability, altered level of consciousness, tachypnoea, diaphoresis and leucocytosis over a period of days to weeks. This condition occurs almost exclusively in patients receiving antipsychotic medications. We present a case of an eight-year-old boy who developed a condition that was suggestive of neuroleptic malignant syndrome after receiving oral haloperidol for control of athetoid movements. NMS is of particular importance to the anaesthetist since its clinical presentation may be confused with malignant hyperthermia (MH). Patients who had been treated for NMS have been reported as having a muscle biopsy positive for MH.     

局麻下修复楔状缺损恢复牙齿美容

目的 :牙齿楔状缺损 ,局麻备洞后 ,直接用光固化复合材料充填后不易脱落 ,维持牙齿美容 ,保护牙髓活力。方法 :将浅深两种类型的楔缺牙齿在局部麻醉下制备成稍带倒凹的洞形 ,用光敏修复牙体外形。结论 :楔缺牙齿特别是牙本质过敏者 ,单纯局部处理 ,不制备洞形 ,光敏充填后容易脱落 ,局麻下备洞光敏修复 ,固位良好 ,既保证了牙形态美 ,又防治牙髓病 ,是一种牙齿美容和防治牙病的好方法     

Pain after vasectomy

We studied the influence of the timing of injection of bupivacaine into the vas deferens on the intensity and duration of scrotal pain following vasectomy. Forty-two patients undergoing vasectomy under general anaesthesia were randomly allocated to have the operation performed on either the left or the right side first. On the first side to be operated upon, 5 ml bupivacaine 0.5% was infiltrated along the line of the scrotal incision. The vas deferens was identified and 1 ml bupivacaine 0.5% was injected into its lumen, with 0.5 ml directed proximally and 0.5 ml directed distally. After completion of the procedure on that side, the operation continued on the other side. On this occasion, the same dose of bupivacaine was injected into the vas deferens after division and ligation, and subcutaneously along the scrotal incision after skin closure. Median [interquartile range] visual analogue pain scores on the first side to be operated upon were significantly lower than on the second side on day 1 (7 [1.5–19] vs. 11 [2.5–47]) (p < 0.01) and day 7 (0 [0–8.5] vs. 0 [0–18.8]) (p < 0.05) postoperatively. The median [interquartile range] duration of postoperative discomfort was less on the first side operated upon than on the second (3 [1–7] vs. 6 [2–7]) (p < 0.01). Although statistically significant differences occurred between the treatment groups, the actual differences were small and may not be clinically significant.     

小儿胃镜检查前使用局麻药效果的比较

目的探讨小儿口服盐酸利多卡因胶浆的局麻效果。方法将我院 2 0 0 2年 1～ 12月胃镜检查患儿 2 19例 ,随机分为采用喷壶给患儿咽部喷 2 %地卡因 116例和口服盐酸利多卡因胶浆 10 3例 ,观察患儿术中的临床表现 ,找出最佳的方案。结果喷壶给 116例患儿咽部喷 2 %地卡因和 10 3例口服盐酸利多卡因胶浆 ,临床比较差异有显著意义 (P <0 .0 5 ) ,2组病人在胃镜检查过程中出现呛咳、恶心、呕吐、哭闹不合作及插管情况均有差异 ,总有效率A组为 90 .3% ,B组为 6 9.0 % ,两组之间效果比较差异有显著意义 (P <0 .0 5 )。结论术前口服盐酸利多卡因胶浆能有效地缓解患儿胃镜检查过程中呛咳、恶心、呕吐、哭闹不合作、插管困难 ,胃肠道内泡沫减少 ,幽门交替开放与关闭良好 ,能有效地减轻患儿的痛苦     

The influence of atropine premedication on the induction of anaesthesia with isoflurane in children

Airway irritability often occurs during induction of anaesthesia with isoflurane and may be accompanied by substantial reductions in oxygen saturation. The aim of this study was to determine the influence of atropine pre-anaesthetic medication on the induction characteristics of isoflurane. The incidence and severity of airway complications were significantly reduced in children who received atropine, both the oral and intra-muscular routes being equally effective. However, almost half the children receiving no premedication had saturation levels less than 90%.     

Vasopressinergic innervation of the mouse suprachiasmatic nucleus: an immuno-electron microscopic analysis

Attempts are being made to unravel the local circuitry of the suprachiasmatic nucleus, with a view toward eventually correlating specific neuronal systems with circadian events. Hence, the vasopressinergic innervation of this nucleus in the laboratory mouse has been analyzed immunocytochemically at the light and electron microscopical levels. Monoclonal antineurophysin and polyclonal antivasopressin were used on aldehyde-fixed brains. Serial vibratome sections of the appropriate forebrain region were prepared for pre-embedding immunoperoxidase staining and/or postembedding immunogold labeling. Immunoreactive somata, processes, varicosities, and synaptic terminals were found throughout the suprachiasmatic nucleus, their ratio and density varying at different locations. The predominant type of vasopressinergic soma was ovoid to rounded (7-10 microns), containing secretory granules (85-120 nm), a large proportion of which were immunoreactive. Axon terminals, both nonimmunoreactive and immunoreactive, impinged upon vasopressinergic somata and processes, often displaying synaptic specializations. Vasopressinergic terminals, containing secretory granules and microvesicles, were found throughout the nucleus, particularly within the dorsomedial neuropil. These labeled terminals varied in size (0.4-3.4 microns 2) and shape, ranging from compact boutons to pleomorphic profiles, some deeply indented by postsynaptic spines, either dendritic or somatic. Approximately 65% of the vasopressin-containing terminals were axodendritic and 30% axosomatic; about 5% appeared to be axoaxonic. At least a quarter of all vasopressinergic synaptic terminals were axospinous. Other forms of interneuronal contact involving vasopressinergic elements (somata, dendrites) included extensive membrane to membrane appositional sites, and multiple puncta adhaerentia. The versatility of interconnections between vasopressin-containing neurons in the mouse suprachiasmatic nucleus suggests a highly active and coordinated network, which contributes substantially to local intranuclear circuitry. In addition, a dense efferent vasopressinergic output is directed dorsally towards the periventricular hypothalamus, where direct associations may be established with diverse hypothalamic neuroendocrine systems.     

5.21Gy软X线局部照射后伤口组织细胞凋亡的时相变化及其与创伤愈合的关系

目的研究5.21Gy软X线局部照射后大鼠伤口组织细胞凋亡的时相变化及其与创伤愈合速度的关系.方法采用大体观察、图像分析等方法观察大鼠伤口愈合速度变化.采用PI染色,结合流式细胞术(FCM)检测细胞凋亡.结果 5.21Gy软X线局部照射后,照射侧愈合速度明显下降,3～6天时段最显著;9天以后逐渐增加,12～15天时愈合速度最快.在3～9天时间段内,照射侧伤口组织细胞凋亡百分数明显高于对照侧;与之相反,在12～22天时间段内,照射侧伤口组织细胞凋亡百分数明显低于对照侧.结论 5.21Gy软X线局部照射后,伤口组织细胞凋亡率增加可能是影响创伤愈合早期的机制之一.     

Use of diphenhydramine for local anesthesia in “caine”-sensitive patients

Emergency physicians regularly encounter patients who require local or topical anesthesia in the course of their emergency department (ED) treatment for lacerations, abrasions, or mucosal surface pain. Rarely, patients disclose a history of allergy to lidocaine and its chemical analogues, and the physician is faced with the problem of achieving adequate anesthesia without the use of these drugs. Research studies and anecdotal reports have suggested that diphenhydramine hydrochloride (Benadryl®) may be useful as a substitute.

We describe three cases of patients with histories of “caine” allergy who required local anesthesia for laceration repair. Infiltration with a 1% diphenhydramine solution provided adequate anesthesia without noticeable adverse effects. We feel that diphenhydramine has a place in emergency medicine practice as a second-line local anesthetic agent.     

Am I blind? The fear of a 4-year-old boy after total intravenous anaesthesia with propofol

A transient inability to open the eyes after total intravenous anaesthesia with propofol is described in a 4-year-old child. The possible mechanisms of the production of this complication are discussed.     

Dose-response in infants receiving caudal anaesthesia with bupivacaine*

Caudal epidural anaesthesia was performed in 25 awake or sedated infants, the sensory levels measured and the dose-response determined (bupivacaine dose [ml kg^?1] v. sensory level). The infants were divided into two groups based on body weight, group 1 (1.9–2.6 kg) and group 2 (3.4–7.0 kg). There was a significant difference between the dose-response when comparing group 1 to group 2 (P < 0.01). Smaller infants require a larger volume (ml kg^?1) of local anaesthetic to achieve mid-thoracic sensory levels than larger infants. In small infants, we recommend increasing the volume of local anaesthetic while still limiting the total bupivacaine dose to 3.25 mg kg^?1 by using 1.6 ml kg^?1 of bupivacaine 0.20% (3.20 mg kg^?1) instead of 1.3 ml kg^?1 of bupivacaine 0.25% (3.25 mg kg^?1).