Lasting Developmental Effects of Neonatal Fentanyl Exposure in Preweanling Rats

The present study aimed to determine whether neonatal treatment with fentanyl has lasting effects on stressed developing brain. Six-day-old rats were assigned to one of three groups (10 males/group): (1) fentanyl (incision+fentanyl), (2) saline (incision+0.9% saline), and (3) unoperated (unoperated sham). Pups with a plantar paw incision received repetitive subcutaneous injections of fentanyl or vehicle through postnatal days (PNDs) 6 to 8. A nonoperated sham group served as nonstressed control. Studies included assessment of development from PND 6 to PND 21 (growth indices and behavioral testing). Fentanyl administered twice daily for three days after surgical incision had no impact on early growth and development, as measured on PND 9, but showed a lasting impact on later growth, enhanced behavioral development, and lower anxiety, as measured through PNDs 10–21. While this does not completely support a benefit from such treatment, our findings may contribute to support the neonatal use of fentanyl, when indicated, even in premature newborns

Anestesia Pediátrica em Período de Imaturidade Cerebral e Perturbações do Neurodesenvolvimento

INTRODUCTION: Several experimental and clinical studies suggest that drugs used in pediatric anesthesia may exert undesirable effects on the developing central nervous system. The objective of this review was to assess the results and conclusions of published studies on long lasting neurodevelopment disorders following exposure to anesthetics in children in a phase of brain immaturity. MATERIAL AND METHODS: We performed a literature search in several sources (PubMed, SciELO and Cochrane Library) using the terms 'Pediatric anesthesia OR Pediatric anesthetic OR Developing brain anesthetic OR Developing brain anesthesia AND behavior disorders'. We selected human studies, referring to long lasting neurodevelopment effects after exposure to anesthetics in the first four years of life. RESULTS: Ten retrospective studies met the inclusion criteria. Of these, seven suggest risk of neurobehavioral disorders after exposure of small children to anesthetics, as opposed to the results obtained by the other three. DISCUSSION: Although mostly using large databases, the studies found are retrospective, vary in test groups, include sometimes avoidable confounders and some present inaccuracies in the choice of the test and control populations that can compromise the reliability of the results. CONCLUSION: Because of the numerous limitations of the few studies available, the reported results are still deemed insufficient to change current clinical practice. However, although it is undisputable that anesthesia should be provided when needed, regardless of age, the warnings found in literature are worrisome, therefore whenever surgery is unavoidable in small children, alternatives that may help reduce the risks of anesthetic exposure should be sought.info:eu-repo/semantics/publishedVersio

Techniques of intestinal transplantation in rat

Two surgical models of intestinal transplantation in the rat are described. One is the implantation of fetal and newborn intestine as free grafts into the omentum of adult recipients, the other the adult intestine transplantation as an accessory graft using vascular anastomoses. A hundred and sixteen small-bowel transplantations were done; 36 of which were fetal intestine (group I), 40 of newborn intestine (group II), and 40 of adult intestine (group III). In the fetal and newborn intestinal transplantation, we emphasize the practices that allowed us to avoid ischemic and traumatic injury to the graft. In the adult intestine transplantation with vascular anastomoses, we heighten the modifications in the surgical technique that made the operation easier and the strategies used to prevent hypothermia and hypovolemic shock. Once experienced with the two chosen surgical techniques, transplantation using an avascular segment became much easier and quicker than transplantation with vascular anastomoses. © 1998 Wiley-Liss, Inc. MICROSURGERY 18:424-429, 199

Juvenile polyposis of infancy in a child with deletion of BMPR1A and PTEN genes: Surgical approach

Abstract Juvenile polyposis of infancy is the most severe and life-threatening form of juvenile polyposis. This disease typically presents in the first two years of life with gastrointestinal bleeding, diarrhea, inanition, and exudative enteropathy. In very few reports concerning this entity, a large deletion in the long arm of chromosome 10 (10q23), encompassing the PTEN and BMPR1A genes, was found. The authors report a case of delayed diagnosis of juvenile polyposis of infancy at 6 years of age. A 3.34 Mb long de novo deletion was identified at 10q23.1q23.31, encompassing the PTEN and BMPR1A genes. The disease course was severe with diarrhea, abdominal pain, inanition, refractory anemia, rectal bleeding, hypoalbuminemia, and exudative enteropathy. A sub-total colectomy, combined with intraoperative endoscopic removal of ileal and rectal stump polyps, was required for palliative disease control

Cirurgia da atrésia do esófago : especial referência à preservação do esófago nativo no hiato-longo : estudo clínico e experimental

Tese de doutoramento em Medicina, na especialidade de Clínica Pediátrica (Cirurgia Pediátrica) apresentada à Fac. de Medicina de CoimbraO tratamento da atrésia do esófago de hiato-longo é controverso. Os objectivos principais visaram avaliar o estado actual do tratamento da atrésia do esófago de hiato-longo em Portugal (Estudo A), testar a hipótese da aplicabilidade da técnica de conservação do esófago nativo para reparação de todo o espectro de severidade da atrésia do esófago de hiato-longo (Estudo B) e avaliar, no rato, a evolução cronológica da morfologia e função de dois tipos distintos de esofagoplastia com enxerto de submucosa intestinal de porco (Estudo C). Estudo A: Estudo multicêntrico que incluiu 19 crianças com atrésia do esófago de hiato-longo tratadas em Portugal entre 1998 e 2002. Concluiu-se que embora com distribuição nacional desajustada, existiram condições para o tratamento de qualidade desta malformação, com recursos estruturais e humanos abundantes. Estudo B: Estudo longitudinal de casos-controlo, integrou as crianças com atrésia do esófago reparada por anastomose esofágica no Hospital Pediátrico de Coimbra entre 1 de Janeiro de 2000 e 31 de Dezembro de 2003. Este estudo demonstrou o sucesso e adequação técnica das estratégias desenvolvidas para preservação do esófago nativo em 20 casos sucessivos de atrésia do esófago, correspondentes a diferentes graus de gravidade. O esófago nativo pôde ser conservado mesmo nos casos de extrema gravidade. Nestes, a utilização do método de Foker foi decisivo para o sucesso conseguido. Estudo C: Usando um retalho ou um tubo de submucosa intestinal do porco (SIS), na reparação de defeitos do esófago cervical do rato, demonstrou-se que ao contrário da esofagoplastia com SIS em tubo, em que ocorreu grave disfunção, na esofagoplastia em retalho atingiu-se uma boa qualidade de regeneração do tecido esofágico e houve funcionamento eficaz. Palavras chave: Cirurgia da atrésia do esófago. Atrésia do esófago de hiato-longo. Regeneração de tecido esofágico. Submucosa intestinal do porco. Esofagoplastia em retalho. Esofagoplastia em tubo. Rat

Lasting Developmental Effects of Neonatal Fentanyl Exposure in Preweanling Rats

The present study aimed to determine whether neonatal treatment with fentanyl has lasting effects on stressed developing brain. Six-day-old rats were assigned to one of three groups (10 males/group): (1) fentanyl (incision+fentanyl), (2) saline (incision+0.9% saline), and (3) unoperated (unoperated sham). Pups with a plantar paw incision received repetitive subcutaneous injections of fentanyl or vehicle through postnatal days (PNDs) 6 to 8. A nonoperated sham group served as nonstressed control. Studies included assessment of development from PND 6 to PND 21 (growth indices and behavioral testing). Fentanyl administered twice daily for three days after surgical incision had no impact on early growth and development, as measured on PND 9, but showed a lasting impact on later growth, enhanced behavioral development, and lower anxiety, as measured through PNDs 10-21. While this does not completely support a benefit from such treatment, our findings may contribute to support the neonatal use of fentanyl, when indicated, even in premature newborns

Protective perioperative strategy using a third generation hydroxyethyl starch during surgery in a murine model of liver reperfusion injury Estratégia protetora perioperatória usando um hidroxietilamido de terceira geração para expansão volêmica durante a cirurgia em modelo murino de lesão de reperfusão hepática

PURPOSE: To investigate whether a third generation colloid, hydroxyethyl starch (HES 130/0.4), used for perioperative fluid therapy, protects the rat liver against the late-phase response of ischemia/reperfusion injury (IRI) and if inhibition of neutrophil hepatic infiltration plays a part in this mechanism. METHODS: Wistar rats were used (8 in each group). Three groups had IRI induced by lobar vascular occlusion (60 minutes) and reperfusion (24 hours) and received HES (13 mL/kg iv), 7.5% saline (HS) (13 mL/kg iv) or no fluid. Three other groups were sham-operated and received the same fluid as the test groups. After 24 hours of reperfusion, blood was drawn for alanine aminotransferase (ALT) quantification and ischemic liver samples were taken for histological study (hematoxylin and eosin and chloroacetate staining of neutrophils). RESULTS: HES treatment attenuated the elevation in serum ALT (P=0.001) and reduced the extent of hepatocellular necrosis (P<0.01) compared with the IRI controls. HES-mediated cytoprotection was associated with a decrease of infiltration of neutrophils in the necrotic areas (P<0.05) compared with the untreated IRI rats, but not with the volume control IRI rats (P>0.05). CONCLUSION: Hydroxyethyl starch suppresses inflammatory response and ameliorates the late-phase response of hepatic ischemia/reperfusion injury.<br>OBJETIVO: Investigar se um colóide de terceira geração (HES 130/0.4), utilizado para fluidoterapia perioperatória, protege o fígado de rato contra a resposta da fase tardia de isquemia/reperfusão e se a inibição da infiltração hepática de neutrófilos desempenha um papel neste mecanismo. MÉTODOS: Foram utilizados ratos Wistar (8 em cada grupo). Três grupos tiveram lesão de isquemia/reperfusão (IRI) induzida por oclusão vascular lobar (60 minutos) e reperfusão (24 horas) e receberam HES (13 ml / kg iv), soro fisiológico a 7,5% (HS) (13 ml / kg iv) ou nenhum fluido. Três outros grupos foram sham-operados e receberam o mesmo tipo de fluido dos grupos de teste. Após 24 horas de reperfusão, o sangue foi retirado para quantificação da alanina aminotransferase (ALT) e amostras de fígado isquêmico foram retiradas para estudo histológico (hematoxilina e eosina e coloração cloroacetato para neutrófilos). RESULTADOS: O tratamento com HES atenuou a elevação da ALT sérica (P = 0,001) e reduziu a extensão da necrose hepatocelular (P<0,01) em comparação com os controles da IRI. A citoproteção mediada por HES foi associada a uma diminuição da infiltração de neutrófilos nas áreas de necrose (P<0,05) em comparação com os ratos não tratados IRI, mas não com os ratos controlo IRI (P> 0,05). CONCLUSÃO: HES suprime a resposta inflamatória e melhora a resposta na fase tardia da isquemia/reperfusão hepática

Perioperative morbidity and mortality in the first year of life: a systematic review (1997-2012)

ABSTRACTBACKGROUND AND OBJECTIVES: Although many recognize that the first year of life and specifically the neonatal period are associated with increased risk of anesthetic morbidity and mortality, there are no studies directed to these pediatric subpopulations. This systematic review of the scientific literature including the last 15 years aimed to analyze the epidemiology of morbidity and mortality associated with general anesthesia and surgery in the first year of life and particularly in the neonatal (first month) period.CONTENT: The review was conducted by searching publications in Medline/PubMed databases, and the following outcomes were evaluated: early mortality in the first year of life (<1 year) and in subgroups of different vulnerability in this age group (0-30 days and 1-12 months) and the prevalence of cardiac arrest and perioperative critical/adverse events of various types in the same subgroups.CONCLUSIONS: The current literature indicates great variability in mortality and morbidity in the age group under consideration and in its subgroups. However, despite the obvious methodological heterogeneity and absence of specific studies, epidemiological profiles of morbidity and mortality related to anesthesia in children in the first year of life show higher frequency of morbidity and mortality in this age group, with the highest peaks of incidence in the neonates' anesthesia