A case of cerebrospinal fluid leak in an infant after spinal anesthesia.

A 2 month old, 51 kg female infant underwent neuraxial anesthesia for repair of a right inguinal hernia. After two unsuccessful attempts at obtaining free-flowing cerebrospinal fluid (CSF) in the L(3)-L(4) lumbar interspace with a 25-gauge (G) neonatal spinal needle, clear CSF was obtained using a Quincke 22-G needle. After easy aspiration, a total of 0.

Perioperative care of a child with non-ketotic hyperglycinemia.

Non-ketotic hyperglycinemia (NKGH) is an autosomal recessive disorder of glycine metabolism. Defective glycine cleavage results in elevated concentrations of glycine in plasma, urine and cerebrospinal fluid. The accumulation of glycine, an inhibitory neurotransmitter, leads to a clinical presentation of apnea, lethargy, hypotonia, seizures, and severe psychomotor retardation.

Dexmedetomidine controls the hemodynamic manifestations of tourniquet pain.

Dexmedetomidine is an α2-adrenergic agonist that is Food and Drug Administration-approved for the provision of short-term (less than 24 hours) sedation of adults during mechanical ventilation. Given its beneficial physiological effects, including sedation and anxiolysis, various applications have been reported in the perioperative period. We report the use of dexmedetomidine to control the hemodynamic consequences of tourniquet pain in three patients having either orthopedic or plastic surgical procedures requiring the use of tourniquets.

Clevidipine controls intraoperative blood pressure in an adolescent with renal failure.

In pediatric-aged patients, various factors may result in perioperative hypertension including renal failure or insufficiency, volume overload, or other factors that activate the sympathetic nervous system including pain and agitation. Perioperative blood pressure control may be even more difficult to achieve and maintain in patients with pre-existing hypertension. We present a 16-year-old adolescent with renal failure and hypertension who presented for anesthetic care during placement of a peritoneal dialysis catheter.

Juvenile hormone is required to couple imaginal disc formation with nutrition in insects.

In starved larvae of the tobacco hornworm moth Manduca sexta, larval and imaginal tissues stop growing, the former because they lack nutrient-dependent signals but the latter because of suppression by juvenile hormone. Without juvenile hormone, imaginal discs form and grow despite severe starvation. This hormone inhibits the intrinsic signaling needed for disc morphogenesis and does so independently of ecdysteroid action.