Daniel F. Dedrick

Life-threatening Apnea in Infants Recovering from Anesthesia

To determine whether prematurely born infants with a history of idiopathic apneic episodes are more prone than other infants to life-threatening apnea during recovery from anesthesia, the authors prospectively studied 214 infants (173 full term, 41 premature) who received anesthesia. Fifteen premature infants had a preanesthetic history of idiopathic apnea. Six of these required mechanical ventilation because of idiopathic apneic episodes during emergence from anesthesia. Two were ventilated for other reasons, and seven recovered normally. Infants ventilated for apnea were younger (postnatal age 1.6 +/- 1.2 months, mean +/- SD; conceptual age 38.6 +/- 3.0 weeks) than those who recovered normally (postnatal age 5.6 +/- 2.7 months; conceptual age 55.1 +/- 11.3 weeks) (P less than 0.01). No other premature or full-term infant was ventilated because of postoperative apneic episodes. The authors conclude that anesthetics may unmask a defect in ventilatory control of prematurely born infants younger than 41-46 weeks conceptual age who have a preanesthetic history of idiopathic apnea.

The Dose-Response Effects of Oral Cimetidine on Gastric pH and Volume in Children

The effects of preanesthetic oral cimetidine on gastric fluid pH and volume were studied in 97 infants and children. A dose-response curve was constructed using doses of 2.5, 5.0, 7.5, and 10 mg/kg. The ED50 of cimetidine that produces pH values higher than 2.5 was 3.0 mg/kg, and the ED95 was 7.5 mg/kg. Cimetidine exponentially reduced the volume of gastric fluid. Cimetidine was most effective between one and four hours after oral administration. In children who are at high risk of pulmonary aspiration, we recommend that oral cimetidine, 7.5 mg/kg, be given 1-3 hours preoperatively in order to protect the lungs from the accidental aspiration of acidic gastric secretions.

Haemodilution in an eight‐month‐old infant

Transient haemodilution was carried out in an 8‐month‐old infant whose parents were Jehovahs Witnesses during an abdominoperineal pull‐through procedure. Adult ACD blood packs were altered to suit the needs of the child. With judicious fluid management, the child was extubated and did well postoperatively.

Life-Threatening Apnea in Infants Recovering from Anesthesia

To determine whether prematurely born infants with a history idiopathic apneic episodes are more prone than other infants to life-threatening apnea during recovery from anesthesia, the authors prospectively studied 214 infants (173 full term, 41 premature) who received anesthesia. Fifteen premature infants had a preanesthetic history of idiopathic apnea. Six of these required mechanical ventilation because of idiopathic apneic episodes during emergence from anesthesia. Two were ventilated for other reasons, and seven recovered normally. Infants ventilated for apnea were younger (postnatal age 1.6 ± 1.2 months, mean ± SD; conceptual age 38.6 ± 3.0 weeks) than those who recovered normally (postnatal age 5.6 ± 2.7 months; conceptual age 55.1 ± 11.3 weeks) (P < 0.01). No other premature or full-term infant was ventilated because of post-operative apneic episodes. The authors conclude that anesthetics may unmask a defect in ventilatory control of prematurely born infants younger than 41–46 weeks conceptual age who have a preanesthetic history of idiopathic apnea.