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.

[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.

[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.