[Anesthetic Management for Pacemaker Implantation in a Child with Mitochondrial Diseases and Complete Atrioventricular Block].

A 12-year-old boy with mitochondrial encephalomy- opathy underwent pacemaker implantation for com- plete atrioventricular block. He was hospitalized as his general condition deteriorated. Furthermore, Holter electrocardiogram revealed rapid atrioventricular con- duction defect Anesthesia was induced with propofol, fentanyl, and rocuronium and maintained with continuous infusion of propofol and remifentanil with administration of fen- tanyl and rocuronium under neuromuscular monitoring during surgery. Bispectral index was monitored and maintained at approximately 40. He could not commu- nicate and had unstable circulation. Therefore, we pro- longed the anesthesia induction time. In addition, for the purpose of decreasing the amount of anesthetic required, an ultrasound-guided transversus abdominis plane block was performed. Throughout the periopera- tive period, neither cardiovascular instabilities nor pro- gression of metabolic acidosis and sudden body tem- perature increases were observed. Many important points must be considered when administering anesthesia to a child with mitochondrial disease. When we plan the anesthetic strategy, moni- toring, and so on properly, the appropriate anesthesia management can be performed.

[Perioperative Management for Atlantoaxial Rotatory Fixation in a Child with Down Syndrome].

Atlantoaxial instability is a relatively common com- plication in children with Down syndrome. Atlantoaxial rotatory fixation (AARF) is a condition in which the atlantoaxial joint is fixed at the position of rotation deformity accompanied by pain. We report a 10-year-old girl with Down syndrome who developed AARF postoperatively. No symptoms had been present prior to surgery. During anesthesia induction and then surgery, her neck was maintained at rest However, there was intense body movement during extubation. On postoperative day 8, she experi- enced sudden onset of neck pain and neck exercise restrictions, and a neck sprain was thus diagnosed. The symptoms gradually improved with analgesic administration and rehabilitation, but complete recovery was not obtained. Therefore, on postoperative day 23, cervical radiography and computed tomography were performed. These imaging studies revealed AARF. She was given conservative treatment We conclude that preoperative evaluation and peri- operative protection of the cervical spine are important Considering the mental retardation characteristic of Down syndrome, it is essential to diagnose and treat AARF at the earliest possible stage based on careful observation.

Remifentanil prevents increases of blood glucose and lactate levels during cardiopulmonary bypass in pediatric cardiac surgery.

INTRODUCTION: Cardiopulmonary bypass (CPB) can cause stress response that increases levels of cytokine and catecholamine in plasma, resulting in hyperglycemia. In adults, it has been demonstrated that remifentanil infusion during CPB could prevent increases of cytokine, catecholamine, and blood glucose levels, but such effects of remifentanil in children have not been elucidated. AIM: In this study, we investigated the preventive effects of remifentanil on blood glucose and lactate levels during CPB in children. MATERIALS AND METHODS: This retrospective study included children who underwent ventricular septal defect or atrial septal defect closure. Data for patients who did not receive, during CPB period, remifentanil infusion (non-Remi group) and patients who received remifentanil infusion at 0.5 µg/kg/min (Remi group) during CPB were used for analysis. Primary outcomes were lactate and blood glucose levels just before and after CPB. Data are presented as medians and interquartile ranges. Data were analyzed by the Mann-Whitney U-test and Chi-square test. A P < 0.05 was considered statistically significant. RESULTS: During CPB, 13 and 11 patients were allocated into Remi and non-Remi groups, respectively. Pre-CPB lactate and blood glucose levels were not significantly different between the two groups, but post-CPB lactate and blood glucose levels in the Remi group were significantly lower than that in the non-Remi group. CONCLUSION: 0.5 µg/kg/min remifentanil infusion during CPB suppresses the increases of blood glucose and lactate levels in children.