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Research paper thumbnail of Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

The Lancet. Respiratory medicine, May 28, 2017

Little is known about the incidence of severe critical events in children undergoing general anae... more Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered w...

Research paper thumbnail of Frühe Peristaltik nach epiduraler Anästhesie während eines abdominellen Eingriffs bei einem extrem untergewichtigen Frühgeborenen

Zeitschrift für Geburtshilfe und Neonatologie, 2007

Research paper thumbnail of Frühe Peristaltik nach epiduraler Analgesie während eines abdominellen Eingriffs bei einem extrem untergewichtigen Frühgeborenen

Zeitschrift für Geburtshilfe und Neonatologie, 2007

Research paper thumbnail of A single intravenous dose of prednisolone induces phosphatidylserine externalization, loss of surface marker expression and a 24-h net increase in human peripheral blood lymphocytes ex vivo

Rheumatology International, 2007

To understand how corticosteroids act; a characterization of their eVects on lymphocytes is neces... more To understand how corticosteroids act; a characterization of their eVects on lymphocytes is necessary. The eVect of in vivo corticosteroids on lymphocyte subpopulations, their surface molecules and externalization of phosphatidylserine (apoptosis) is examined. In a crossover study, a single, intravenous dose of 2 mg/kg prednisolone or saline was given to six male adult human volunteers. Blood samples were withdrawn before and 30 min, 2, 5, 23 and 29 h thereafter. Lymphocyte subsets were determined by FACS analysis. Externalization of phosphatidylserine was measured by Annexin-V; cell fragments were excluded by propidium iodide staining. Lymphocyte number decreased from 2,007 § 473 to 634 § 119 l after 5 h and rose to 3,112 § 436 l after 23 h. CD4, CD8 and B cell counts declined signiWcantly after 5 h (P • 0.01). The expression of CD28 or CD95 on T cells and the natural killer cells were unaVected. There was a signiWcant rebound of lymphocyte numbers above baseline 23 h after prednisolone. At baseline 9.9 § 3.8% of cells in the lymphocyte gate did not stain for CD3, CD20 or CD56 (referred to as "null cells"). 5 h after application of prednisolone, there was a signiWcant increase of "null cells" (28 § 12%, P = 0.018). The percentage of phosphatidylserine positive CD4 cells rose from 8.1 § 3.3 to 19.8 § 8% after intravenous prednisolone, while the percentage of phosphatidylserine positive CD8, B and NK cells remained largely unchanged. Prednisolone induces a most signiWcant depletion of CD4 cells, which to some degree is associated with apoptosis. The net increase of lymphocyte numbers 23 h after prednisolone application may be a beneWcial late eVect of a single i.v. prednisolone shot.

Research paper thumbnail of 247Sedation during spinal anaesthesia in infants

Regional Anesthesia and Pain Medicine, 2006

Research paper thumbnail of Memory B Cell Function in HIV-Infected Children—Decreased Memory B Cells Despite ART

Pediatric Research, 2009

B cell dysfunction is a well-studied complication of HIV infection in adults. Data on B cell diff... more B cell dysfunction is a well-studied complication of HIV infection in adults. Data on B cell differentiation in normal and HIV-infected children are lacking. We show the distribution of B cell subsets and immunoglobulin levels in HIV-infected children compared with controls. Furthermore, we observe the long-term B cell reconstitution of vaccine-specific immunity after antiretroviral therapy (ART). Phenotype of B cells (naive, non-switched memory, switched memory) was analyzed in 48 infected children and 62 controls. In nine HIV-infected children, functional reconstitution was quantified by tetanus-specific antibodies and by performing a lymphocyte transformation test (LTT) in a longitudinal approach. Switched memory B cells are significantly reduced in HIV-infected children. Vaccine-specific antibodies and response to LTT increase after initiation of ART. Our data indicate a significant dysfunction in the B cell system, despite effective ART. Partial reconstitution of humoral immunity may have therapeutic implications in a subset of HIV-infected children.

Research paper thumbnail of High spinal anaesthesia in a formerly preterm infant undergoing pyloromyotomy

Pediatric Anesthesia, 2001

1 Siegel JF, Reda E. Intracorporeal phenylephrine reduces thioridazine (Mellaril) induced priapis... more 1 Siegel JF, Reda E. Intracorporeal phenylephrine reduces thioridazine (Mellaril) induced priapism in a child. J Urol 1997; 157: 648. 2 Staerman F, Nouri M, Couerdacier P et al. Treatment of the intraoperative penile erection with intracavernous phenylephrine. J Urol 1995; 153: 478±1481. 3 de Meyer JM, De Sy WA. lntracavernous injection of noradrenaline to interrupt erections during surgical interventions. Eur Urol 1986; 12: 169±170. 4 Zappala SM, Howard PJ, Hopkins TB et al. Management of intraoperative penile erections with diluted epinephrine solution. Urology 1992; 40: 76±77. 5 Valley MA, Sang CN. Use of glycopyrrolate to treat intraopertive penile erection. Case report and review of the literature. Reg Anesth 1994; 19: 423±428. 6 Seftel AD, Resnick MI, Boswell MV. Dorsal nerve block for management of intraoperative penile erection. J Urol 1994; 151: 394±395. 7 Pertek JP, Coissard A, Artis M. Dorsal nerve block for intraoperative management of penile erection. Reg Anesth 1996; 21: 491±492. 8 Colombani JF, Peluchon P, Elana G et al. Priapism in a sickle cell prepubertal child. Eur J Pediatr Surg 2000; 10: 68±71.

Research paper thumbnail of Early peristalsis following epidural analgesia during abdominal surgery in an extremely low birth weight infant

Pediatric Anesthesia, 2007

SummaryThe inhibiting effect of opioids on intestinal motility is a cause of particular concern i... more SummaryThe inhibiting effect of opioids on intestinal motility is a cause of particular concern in extremely low birth weight (ELBW; birth weight <1000 g) infants with decreased peristalsis. An ELBW infant (birth weight 740 g) born after 26 + 1 week of gestation had an uneventful clinical course during the first few days of life. Sudden deterioration occurred on day 8 with metabolic acidosis, hyperglycemia and frequent apnea with secondary bradycardia. A chest X ray demonstrated the presence of air beneath the diaphragm. Intestinal perforation was suspected and the infant was taken to theater for laparotomy. For pain management, a 22 G epidural catheter was inserted via the caudal approach and threaded to a mid‐thoracic level. Epidural ropivacaine was administered intraoperatively and for 48 h postoperatively. The infant was extubated on the following day. Opioids were not required or given at any stage during or after surgery. Peristalsis was present on auscultation as early as ...

Research paper thumbnail of Terminally Differentiated CD8 Cells in HIV-Infected Children: HIV-GAG/POL Specificity and IFN-γ Production

Klinische Pädiatrie, 2011

CD8 cells are key to antiviral immunity and can be divided by phenotype into early (CD28+ CD27+),... more CD8 cells are key to antiviral immunity and can be divided by phenotype into early (CD28+ CD27+), intermediate (CD28-CD27+) and terminally differentiated subsets (CD28- CD27-). Despite effective HAART there is an unexplained expansion of CD8+CD28-CD27-T cells in HIV-infected children. The cytokine production and specificity of this terminally differentiated CD8 T cell subset in chronic virus infection is unclear. PATIENTS, METHODS &amp;amp;amp;amp;amp;amp;amp; RESULTS: In a cohort of 26 HIV-infected children the cytokine production of terminally differentiated CD8 cells was analyzed by intracellular staining and FACS analysis and was compared to children with chronic hepatitis B infection and to healthy children. The specificity of CD8 subsets was analyzed by staining with Gag/Pol tetramers in a cohort of 13 patients. We show that an increased production of interferon-γ in terminally and early/intermediate differentiated CD8 cell subsets after stimulation is specific for HIV-infection. The expanded population of terminally differentiated CD8+CD28-CD27- T cells does include HIV Gag/Pol specific T cells in adults but not in children. The expansion of terminally differentiated CD8 cells might be important for immunomodulation but in children it does not appear to play a role in HIV Gag and Pol specific immunity.

Research paper thumbnail of Characterization of anaesthetic target sites by fluorescence: acridine and methyl salicylate have anaesthetic properties and interact with albumin and octanol

European Journal of Anaesthesiology, 2000

Research paper thumbnail of Sympathetic nervous system in infants:skin temperature increases after spinal block

European Journal of Anaesthesiology, 2001

Research paper thumbnail of Cortical somatosensory-evoked potentials during spine surgery in patients with neuromuscular and idiopathic scoliosis under propofol–remifentanil anaesthesia

British Journal of Anaesthesia, 2007

Background. Intraoperative monitoring of the spinal cord via cortical somatosensory-evoked potent... more Background. Intraoperative monitoring of the spinal cord via cortical somatosensory-evoked potentials (SSEP) is a routine during spinal surgery. However, especially in neuromuscular scoliosis, the reliability of cortical SSEP has been questioned. Therefore, we compared the feasibility of cortical SSEP in idiopathic and neuromuscular scoliosis using anaesthetics known to have only minimal effect on SSEP recordings. Methods. Total intravenous anaesthesia with propofol and remifentanil as continuous infusion was standardized for all the patients. Median and tibial nerve cortical SSEP were monitored in 54 patients who underwent surgery for spinal deformity. Twenty-seven had idiopathic scoliosis and 27 had neuromuscular scoliosis. The portion of reproducible results and intraoperative changes were compared between the groups. Results. In both groups, cortical SSEP could be monitored with sufficient reliability. Only in two patients with idiopathic and four patients with neuromuscular scoliosis no reproducible traces could be obtained. The amplitudes in patients with neuromuscular scoliosis were lower than in those with idiopathic scoliosis, but not statistically significant. There were no postoperative neurological deficits. The number of false positive and true positive did not differ between the groups. Conclusions. Assessment of cortical SSEP during spine surgery was equally effective and reliable in patients with neuromuscular scoliosis and in patients with idiopathic scoliosis, possibly as a result of propofol-remifentanil anaesthesia.

Research paper thumbnail of Sedation during spinal anaesthesia in infants

British Journal of Anaesthesia, 2006

Background. Neuraxial anaesthesia in adults decreases the dose of i.v. or inhalational anaestheti... more Background. Neuraxial anaesthesia in adults decreases the dose of i.v. or inhalational anaesthetic needed to reach a desired level of sedation. Furthermore, spinal anaesthesia alone has a sedative effect. The mechanism behind this phenomenon is presumed to be decreased afferent stimulation of the reticular activating system after sympatholysis. We hypothesized that this mechanism is equally active in infants undergoing spinal anaesthesia. Methods. In total, 20 unpremedicated former preterm infants underwent surgery under spinal anaesthesia with hyperbaric bupivacaine 0.5% 1 mg kg À1 with epinephrine 10 mg kg À1. No additional sedatives or anaesthetics were administered. Sedation was evaluated using the bispectral index (BIS) score and the 95% spectral edge frequency (SEF 95). Results. After spinal anaesthesia, mean (SD) BIS began to decrease significantly from baseline 97.0 (1.1) to 83.9 (14.4) after 15 min (P=0.006). BIS decreased further, reaching the lowest values after 30 min [62.2 (14.0); P<0.00001]. Mean (SD) SEF 95 declined from baseline 26.1 (1.8) Hz to 24.3 (3.1) after 5 min (P=0.02) and further to 9.9 (3.8) after 30 min (P<0.00001). Mean arterial pressure also decreased significantly from 66.5 (4.7) mm Hg within 10 min to 56.1 (5.6) after spinal anaesthesia (P=0.0002), while heart rate remained stable. Conclusions. These results suggest that sedation after spinal anaesthesia in infants is at least as pronounced as in adults. The sedative effect of spinal anaesthesia should be kept in mind when additional sedatives are administered, especially in former preterm infants.

Research paper thumbnail of Muscle Weakness and Paresthesia Associated with Epidural Analgesia in a Patient with an Intrathecal Neurofibrolipoma as Part of a Tethered Cord Syndrome

Anesthesia & Analgesia, 2004

Research paper thumbnail of Increase in Skin Temperature After Spinal Anesthesia in Infants

Regional Anesthesia and Pain Medicine, 2006

Research paper thumbnail of Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe

The Lancet. Respiratory medicine, May 28, 2017

Little is known about the incidence of severe critical events in children undergoing general anae... more Little is known about the incidence of severe critical events in children undergoing general anaesthesia in Europe. We aimed to identify the incidence, nature, and outcome of severe critical events in children undergoing anaesthesia, and the associated potential risk factors. The APRICOT study was a prospective observational multicentre cohort study of children from birth to 15 years of age undergoing elective or urgent anaesthesia for diagnostic or surgical procedures. Children were eligible for inclusion during a 2-week period determined prospectively by each centre. There were 261 participating centres across 33 European countries. The primary endpoint was the occurence of perioperative severe critical events requiring immediate intervention. A severe critical event was defined as the occurrence of respiratory, cardiac, allergic, or neurological complications requiring immediate intervention and that led (or could have led) to major disability or death. This study is registered w...

Research paper thumbnail of Frühe Peristaltik nach epiduraler Anästhesie während eines abdominellen Eingriffs bei einem extrem untergewichtigen Frühgeborenen

Zeitschrift für Geburtshilfe und Neonatologie, 2007

Research paper thumbnail of Frühe Peristaltik nach epiduraler Analgesie während eines abdominellen Eingriffs bei einem extrem untergewichtigen Frühgeborenen

Zeitschrift für Geburtshilfe und Neonatologie, 2007

Research paper thumbnail of A single intravenous dose of prednisolone induces phosphatidylserine externalization, loss of surface marker expression and a 24-h net increase in human peripheral blood lymphocytes ex vivo

Rheumatology International, 2007

To understand how corticosteroids act; a characterization of their eVects on lymphocytes is neces... more To understand how corticosteroids act; a characterization of their eVects on lymphocytes is necessary. The eVect of in vivo corticosteroids on lymphocyte subpopulations, their surface molecules and externalization of phosphatidylserine (apoptosis) is examined. In a crossover study, a single, intravenous dose of 2 mg/kg prednisolone or saline was given to six male adult human volunteers. Blood samples were withdrawn before and 30 min, 2, 5, 23 and 29 h thereafter. Lymphocyte subsets were determined by FACS analysis. Externalization of phosphatidylserine was measured by Annexin-V; cell fragments were excluded by propidium iodide staining. Lymphocyte number decreased from 2,007 § 473 to 634 § 119 l after 5 h and rose to 3,112 § 436 l after 23 h. CD4, CD8 and B cell counts declined signiWcantly after 5 h (P • 0.01). The expression of CD28 or CD95 on T cells and the natural killer cells were unaVected. There was a signiWcant rebound of lymphocyte numbers above baseline 23 h after prednisolone. At baseline 9.9 § 3.8% of cells in the lymphocyte gate did not stain for CD3, CD20 or CD56 (referred to as "null cells"). 5 h after application of prednisolone, there was a signiWcant increase of "null cells" (28 § 12%, P = 0.018). The percentage of phosphatidylserine positive CD4 cells rose from 8.1 § 3.3 to 19.8 § 8% after intravenous prednisolone, while the percentage of phosphatidylserine positive CD8, B and NK cells remained largely unchanged. Prednisolone induces a most signiWcant depletion of CD4 cells, which to some degree is associated with apoptosis. The net increase of lymphocyte numbers 23 h after prednisolone application may be a beneWcial late eVect of a single i.v. prednisolone shot.

Research paper thumbnail of 247Sedation during spinal anaesthesia in infants

Regional Anesthesia and Pain Medicine, 2006

Research paper thumbnail of Memory B Cell Function in HIV-Infected Children—Decreased Memory B Cells Despite ART

Pediatric Research, 2009

B cell dysfunction is a well-studied complication of HIV infection in adults. Data on B cell diff... more B cell dysfunction is a well-studied complication of HIV infection in adults. Data on B cell differentiation in normal and HIV-infected children are lacking. We show the distribution of B cell subsets and immunoglobulin levels in HIV-infected children compared with controls. Furthermore, we observe the long-term B cell reconstitution of vaccine-specific immunity after antiretroviral therapy (ART). Phenotype of B cells (naive, non-switched memory, switched memory) was analyzed in 48 infected children and 62 controls. In nine HIV-infected children, functional reconstitution was quantified by tetanus-specific antibodies and by performing a lymphocyte transformation test (LTT) in a longitudinal approach. Switched memory B cells are significantly reduced in HIV-infected children. Vaccine-specific antibodies and response to LTT increase after initiation of ART. Our data indicate a significant dysfunction in the B cell system, despite effective ART. Partial reconstitution of humoral immunity may have therapeutic implications in a subset of HIV-infected children.

Research paper thumbnail of High spinal anaesthesia in a formerly preterm infant undergoing pyloromyotomy

Pediatric Anesthesia, 2001

1 Siegel JF, Reda E. Intracorporeal phenylephrine reduces thioridazine (Mellaril) induced priapis... more 1 Siegel JF, Reda E. Intracorporeal phenylephrine reduces thioridazine (Mellaril) induced priapism in a child. J Urol 1997; 157: 648. 2 Staerman F, Nouri M, Couerdacier P et al. Treatment of the intraoperative penile erection with intracavernous phenylephrine. J Urol 1995; 153: 478±1481. 3 de Meyer JM, De Sy WA. lntracavernous injection of noradrenaline to interrupt erections during surgical interventions. Eur Urol 1986; 12: 169±170. 4 Zappala SM, Howard PJ, Hopkins TB et al. Management of intraoperative penile erections with diluted epinephrine solution. Urology 1992; 40: 76±77. 5 Valley MA, Sang CN. Use of glycopyrrolate to treat intraopertive penile erection. Case report and review of the literature. Reg Anesth 1994; 19: 423±428. 6 Seftel AD, Resnick MI, Boswell MV. Dorsal nerve block for management of intraoperative penile erection. J Urol 1994; 151: 394±395. 7 Pertek JP, Coissard A, Artis M. Dorsal nerve block for intraoperative management of penile erection. Reg Anesth 1996; 21: 491±492. 8 Colombani JF, Peluchon P, Elana G et al. Priapism in a sickle cell prepubertal child. Eur J Pediatr Surg 2000; 10: 68±71.

Research paper thumbnail of Early peristalsis following epidural analgesia during abdominal surgery in an extremely low birth weight infant

Pediatric Anesthesia, 2007

SummaryThe inhibiting effect of opioids on intestinal motility is a cause of particular concern i... more SummaryThe inhibiting effect of opioids on intestinal motility is a cause of particular concern in extremely low birth weight (ELBW; birth weight <1000 g) infants with decreased peristalsis. An ELBW infant (birth weight 740 g) born after 26 + 1 week of gestation had an uneventful clinical course during the first few days of life. Sudden deterioration occurred on day 8 with metabolic acidosis, hyperglycemia and frequent apnea with secondary bradycardia. A chest X ray demonstrated the presence of air beneath the diaphragm. Intestinal perforation was suspected and the infant was taken to theater for laparotomy. For pain management, a 22 G epidural catheter was inserted via the caudal approach and threaded to a mid‐thoracic level. Epidural ropivacaine was administered intraoperatively and for 48 h postoperatively. The infant was extubated on the following day. Opioids were not required or given at any stage during or after surgery. Peristalsis was present on auscultation as early as ...

Research paper thumbnail of Terminally Differentiated CD8 Cells in HIV-Infected Children: HIV-GAG/POL Specificity and IFN-γ Production

Klinische Pädiatrie, 2011

CD8 cells are key to antiviral immunity and can be divided by phenotype into early (CD28+ CD27+),... more CD8 cells are key to antiviral immunity and can be divided by phenotype into early (CD28+ CD27+), intermediate (CD28-CD27+) and terminally differentiated subsets (CD28- CD27-). Despite effective HAART there is an unexplained expansion of CD8+CD28-CD27-T cells in HIV-infected children. The cytokine production and specificity of this terminally differentiated CD8 T cell subset in chronic virus infection is unclear. PATIENTS, METHODS &amp;amp;amp;amp;amp;amp;amp; RESULTS: In a cohort of 26 HIV-infected children the cytokine production of terminally differentiated CD8 cells was analyzed by intracellular staining and FACS analysis and was compared to children with chronic hepatitis B infection and to healthy children. The specificity of CD8 subsets was analyzed by staining with Gag/Pol tetramers in a cohort of 13 patients. We show that an increased production of interferon-γ in terminally and early/intermediate differentiated CD8 cell subsets after stimulation is specific for HIV-infection. The expanded population of terminally differentiated CD8+CD28-CD27- T cells does include HIV Gag/Pol specific T cells in adults but not in children. The expansion of terminally differentiated CD8 cells might be important for immunomodulation but in children it does not appear to play a role in HIV Gag and Pol specific immunity.

Research paper thumbnail of Characterization of anaesthetic target sites by fluorescence: acridine and methyl salicylate have anaesthetic properties and interact with albumin and octanol

European Journal of Anaesthesiology, 2000

Research paper thumbnail of Sympathetic nervous system in infants:skin temperature increases after spinal block

European Journal of Anaesthesiology, 2001

Research paper thumbnail of Cortical somatosensory-evoked potentials during spine surgery in patients with neuromuscular and idiopathic scoliosis under propofol–remifentanil anaesthesia

British Journal of Anaesthesia, 2007

Background. Intraoperative monitoring of the spinal cord via cortical somatosensory-evoked potent... more Background. Intraoperative monitoring of the spinal cord via cortical somatosensory-evoked potentials (SSEP) is a routine during spinal surgery. However, especially in neuromuscular scoliosis, the reliability of cortical SSEP has been questioned. Therefore, we compared the feasibility of cortical SSEP in idiopathic and neuromuscular scoliosis using anaesthetics known to have only minimal effect on SSEP recordings. Methods. Total intravenous anaesthesia with propofol and remifentanil as continuous infusion was standardized for all the patients. Median and tibial nerve cortical SSEP were monitored in 54 patients who underwent surgery for spinal deformity. Twenty-seven had idiopathic scoliosis and 27 had neuromuscular scoliosis. The portion of reproducible results and intraoperative changes were compared between the groups. Results. In both groups, cortical SSEP could be monitored with sufficient reliability. Only in two patients with idiopathic and four patients with neuromuscular scoliosis no reproducible traces could be obtained. The amplitudes in patients with neuromuscular scoliosis were lower than in those with idiopathic scoliosis, but not statistically significant. There were no postoperative neurological deficits. The number of false positive and true positive did not differ between the groups. Conclusions. Assessment of cortical SSEP during spine surgery was equally effective and reliable in patients with neuromuscular scoliosis and in patients with idiopathic scoliosis, possibly as a result of propofol-remifentanil anaesthesia.

Research paper thumbnail of Sedation during spinal anaesthesia in infants

British Journal of Anaesthesia, 2006

Background. Neuraxial anaesthesia in adults decreases the dose of i.v. or inhalational anaestheti... more Background. Neuraxial anaesthesia in adults decreases the dose of i.v. or inhalational anaesthetic needed to reach a desired level of sedation. Furthermore, spinal anaesthesia alone has a sedative effect. The mechanism behind this phenomenon is presumed to be decreased afferent stimulation of the reticular activating system after sympatholysis. We hypothesized that this mechanism is equally active in infants undergoing spinal anaesthesia. Methods. In total, 20 unpremedicated former preterm infants underwent surgery under spinal anaesthesia with hyperbaric bupivacaine 0.5% 1 mg kg À1 with epinephrine 10 mg kg À1. No additional sedatives or anaesthetics were administered. Sedation was evaluated using the bispectral index (BIS) score and the 95% spectral edge frequency (SEF 95). Results. After spinal anaesthesia, mean (SD) BIS began to decrease significantly from baseline 97.0 (1.1) to 83.9 (14.4) after 15 min (P=0.006). BIS decreased further, reaching the lowest values after 30 min [62.2 (14.0); P<0.00001]. Mean (SD) SEF 95 declined from baseline 26.1 (1.8) Hz to 24.3 (3.1) after 5 min (P=0.02) and further to 9.9 (3.8) after 30 min (P<0.00001). Mean arterial pressure also decreased significantly from 66.5 (4.7) mm Hg within 10 min to 56.1 (5.6) after spinal anaesthesia (P=0.0002), while heart rate remained stable. Conclusions. These results suggest that sedation after spinal anaesthesia in infants is at least as pronounced as in adults. The sedative effect of spinal anaesthesia should be kept in mind when additional sedatives are administered, especially in former preterm infants.

Research paper thumbnail of Muscle Weakness and Paresthesia Associated with Epidural Analgesia in a Patient with an Intrathecal Neurofibrolipoma as Part of a Tethered Cord Syndrome

Anesthesia & Analgesia, 2004

Research paper thumbnail of Increase in Skin Temperature After Spinal Anesthesia in Infants

Regional Anesthesia and Pain Medicine, 2006