scholarly journals 1552. Correlation Between Vancomycin Serum Trough Concentrations and Area Under the Curve in Pediatric Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S566-S567
Author(s):  
Krista Weaver ◽  
Madan Kumar ◽  
Allison Nelson ◽  
Palak Bhagat
Keyword(s):  
Pediatric Patients ◽  
Retrospective Chart Review ◽  
Primary Study ◽  
Pharmacokinetic Parameters ◽  
Optimal Method ◽  
Study Objective ◽  
Serum Trough ◽  
Trough Concentrations ◽  
Group 2 ◽  
Group 1

Abstract Background Despite years of experience with vancomycin (VAN), the optimal method to monitor VAN therapy in pediatric patients is still unknown. Recent pediatric data indicate serum trough concentrations lower than 10–20 mg/L or 15–20 mg/L based on indication may achieve an AUC24> 400 mg hours/L. The primary study objective was to compare AUC24 to goal VAN serum trough concentrations (STC). Methods A retrospective chart review of pediatric patients who received intravenous VAN June 1, 2018 to December 31, 2018 was completed. AUC24 was calculated using a trapezoidal method with 2 steady-state serum concentrations. A serum peak concentration was drawn 1 hour and 15 minutes following the end of infusion and an STC was drawn 30 minutes prior to infusion. Results During 25 admissions, 12 patients had a first AUC24 at goal and 13 patients had a first AUC24 below goal. Of 41 AUC24 calculations, 27 AUC24s were ≥400 mg hours/L (group 1), and 14 AUC24s were <400 mg hours/L (group 2). Median AUC24 was 561 mg hours/L for group 1 vs. 344.5 mg hours/L for group 2 (P < 0.001). Correlating Cmin and Ctrough (Ctr) for group 1 and group 2 were 12 mg/L and 13.5 mg/L vs. 6.4 mg/L and 7.3 mg/L, respectively (P < 0.001). Figure 1 shows the pharmacokinetic parameters for each group. Spearman correlation between AUC24 and Cmin was 0.87. Of the 35 subtherapeutic VAN STCs, 20 (57.1%) achieved an AUC24 ≥400 mg hours/L (P = 0.08). Subgroup analysis of AUC24 400–600 mg hours/L showed a median AUC24 of 519 mg hours/L with correlating Cmin and Ctr of 10.6 mg/L and 11.9 mg/L, respectively. The MIC was <1 in 90.9% of cases (Figure 2). The mean VAN dose required to achieve an AUC24 ≥400 mg hours/L was 77.7 mg/kg/day; dosing frequency did not appear to affect AUC24 outcome. Time to culture clearance was 2 days in group 1 and 6.5 days in group 2 (P = 0.24). No cases of nephrotoxicity were identified despite AUC24 values ranging from 265–1294 mg hours/L. Conclusion AUC24 monitoring using a 2-sample trapezoidal method was successfully implemented at this institution. The results of this study align with previous pediatric studies, supporting the use of lower serum trough concentration goals of 10–15 mg/L. Disclosures All authors: No reported disclosures.

Vancomycin Pharmacokinetics in Neonates and Infants: A Retrospective Evaluation

1993 ◽  
Vol 27 (4) ◽  
pp. 490-496 ◽  
Author(s):  
Michael D. Reed ◽  
William H. Asbury ◽  
Edress H. Darsey ◽  
W. Brian Rose ◽  
John E. Murphy ◽  
...  
Keyword(s):  
Body Weight ◽  
Steady State ◽  
Pharmacokinetic Parameters ◽  
Serum Concentrations ◽  
Vancomycin Dosage ◽  
Trough Concentrations ◽  
The Mean ◽  
Group 2 ◽  
Current Loading ◽  
Group 1

OBJECTIVE: To evaluate the frequency with which current loading and maintenance vancomycin dosages achieve target serum concentrations based on pharmacokinetic parameters obtained after the initial dose. Also, to identify the daily vancomycin dosage necessary to achieve target serum concentrations at steady-state and to determine if any relationships exist between vancomycin pharmacokinetic parameters and various patient characteristics. SETTING: Neonatal intensive care unit (NICU) at Georgia Baptist Medical Center. PATIENTS/METHODS: Twenty-three infants with suspected or documented gram-positive infection who received intravenous vancomycin between July 1990 and November 1991 were included in this retrospective analysis. Gestational age ranged from 23 to 41 weeks and postconceptional age (PCA) at the time of the study ranged from 26 to 46 weeks. Vancomycin therapy was initiated with a loading dose of 15 mg/kg, followed by a maintenance dosage of 20–30 mg/kg/d, which was usually given as 10 mg/kg q8–12h. All vancomycin doses were administered using a syringe pump. Peak and trough serum concentrations were obtained following the first dose. Vancomycin pharmacokinetic parameters were determined using a one-compartment model. Infants receiving indomethacin within two weeks prior to study were analyzed separately (group 2, n=4). All other infants were included in group 1 (n=19). RESULTS: For group 1, vancomycin clearance (CI), volume of distribution (Vd), and half-life were (mean ± 1 SD) 0.072 ± 0.032 L/kg/h, 0.52 ± 0.08 L/kg, and 5.6 ± 1.6 hours, respectively. For both groups, loading doses provided 1-hour postinfusion peak concentrations of 25–35 mg/L in one of every two infants studied, whereas only three percent of initial maintenance doses were projected to provide desired peak and trough concentrations at steady-state. For group 1, the mean daily dosage necessary to provide target peak (25–35 mg/L) and trough (5–10 mg/L) concentrations at steady-state was larger than that initially prescribed (29.6 ± 13.1 vs. 22.2 ± 4.7 mg/kg/d). For group 2, the mean daily dosage required to achieve target peak and trough concentrations at steady-state was smaller than that initially prescribed (14.8 ± 4.3 vs. 20.0 ±0.1 mg/kg/d) and was exactly half of that required for group 1. Excellent correlations were observed between PCA and vancomycin Cl (L/h) (r=0.92; p<0.0001), body weight and Vd (L) (r=0.94; p<0.0001), body weight and vancomycin Cl (L/h) (r=0.85; p<0.0001), PCA and Vd (L) (r=0.89; p<0.0001), and body surface area and Vd (L) (r=0.93; p<0.0001) for group 1. Moderate correlations were also noted between PCA and Cl relative to body weight (L/kg/h), postnatal age and Cl (L/kg/h), and PCA and vancomycin dosage requirements (mg/kg/d). No linear correlation was observed between any patient characteristic and Vd standardized for body weight. CONCLUSIONS: Our data demonstrate the need for a more accurate method of estimating initial vancomycin dosage requirements in this NICU population. Although some of the relationships revealed in this study could be used to determine vancomycin dosage for infants in the range of approximately 30–36 weeks PCA, we hesitate to suggest this approach presently because of the potential limitations of our study design. Further prospective study is needed to confirm these observations. In addition, further study is necessary to describe the time course of the interaction between vancomycin and indomethacin in infants with successful and unsuccessful closure of their patent ductus arteriosus.

Single-Stage Repair of Coarctation of the Aorta and Ventricular Septal Defect: A Comparison of Surgical Strategies and Resource Utilization

2017 ◽  
Vol 8 (5) ◽  
pp. 559-563 ◽  
Author(s):  
Connor Callahan ◽  
David Saudek ◽  
Amanda Shillingford ◽  
Sara Creighton ◽  
Garick Hill ◽  
...  
Keyword(s):  
Ventricular Septal Defect ◽  
Resource Utilization ◽  
Septal Defect ◽  
Coarctation Of The Aorta ◽  
Retrospective Chart Review ◽  
Single Stage ◽  
Surgical Approaches ◽  
Off Pump ◽  
Group 2 ◽  
Group 1

Background: We sought to compare clinical outcomes and resource utilization for two surgical approaches for single-stage repair of coarctation of the aorta and ventricular septal defect (VSD). Methods: This was a retrospective chart review of 21 consecutive neonates and infants undergoing single-stage repair of coarctation of the aorta and VSD. Group 1 included 13 patients with both arch repair and VSD repair completed via sternotomy. Group 2 included eight patients with off-pump arch repair via left thoracotomy followed by repositioning and VSD repair via sternotomy. Primary clinical outcome was arch reintervention. Secondary outcomes included various measures of resource utilization. Results: Group 1 patients demonstrated younger age at repair (median of 10 days vs 57 days for group 2; P = .05) and lower proximal arch z scores (−4.2 vs −2.3 for group 2; P = .003). Arch reintervention occurred in 0 of 8 patients in group 2 and 1 (7.7%) of 13 patients in group 1 ( P = nonsignificant). Group 2 was associated with lower total charges (US$68,301 vs US$211,723 for group 1; P = .0007), shorter length of stay (8 days vs 23 days for group 1; P = .004), and shorter duration of postoperative mechanical ventilation (0.5 days vs 4.0 days for group 1; P = .0008). Group 2 was also associated with shorter total cardiopulmonary bypass time (86 minutes vs 201 minutes for group 1; P = .0009). Conclusion: Single-stage two-incision repair of coarctation and VSD in appropriately selected patients may be associated with higher value of care. Confirmation of this finding will require further study based on larger numbers of patients.

scholarly journals Sperm DNA fragmentation in men of different age

2019 ◽  
Vol 20 (4) ◽  
pp. 39-44
Author(s):  
S. Sh. Khayat ◽  
E. E. Bragina ◽  
E. A. Arifulin ◽  
E. M. Lazareva ◽  
T. M. Sorokina ◽  
...  
Keyword(s):  
Dna Fragmentation ◽  
Sperm Count ◽  
Semen Analysis ◽  
Terminal Deoxynucleotidyl Transferase ◽  
Sperm Dna Fragmentation ◽  
Dna Breaks ◽  
Study Objective ◽  
Fragmented Dna ◽  
Group 2 ◽  
Group 1

The study objective is to analyze the content of spermatozoa with single and double-stranded DNA breaks in different age groups.Materials and methods. The level of DNA fragmentation was studied in 300 ejaculate samples obtained from 266 sub- or infertile men. The group 1 included 150 samples obtained from 131 patients under the age of 45 (21–44 years), the group 2 included 150 samples obtained from 135 patients above the age of 45 (45–68 years). Mean ages were 34.8 ± 3.9 and 48.6 ± 3.1 years, respectively. The number of sperm with fragmented DNA was evaluated using the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) method on ejaculate smears. The number of spermatozoa with >15 % of fragmented DNA was considered elevated. Standard semen analysis was performed in 117 and 97 men from the groups 1 and 2, respectively.Results. The number of sperm with fragmented DNA varied in ejaculated samples from 1.5 to 64.5 %. Mean number of sperm with DNA breaks in the group 1 (12.0 ± 6.0 %) was significantly lower than in the group 2 (16.1 ± 8.3 %, p <0.05). Mean sperm count in the ejaculate of the group 1 (267.0 ± 198.7 million) was significantly higher than in the group 2 (201.0 ± 162.9 million, p = 0.02).Conclusion. We revealed that in men over the age of 45 years, the percentage of spermatozoa with DNA fragmentation is higher than in men under 45 years of age, it may indirectly indicate an increased level of reactive oxygen species in the seminal plasma in older patients. 

Effect of Cryotherapy & Active Stretching Together and Active Stretching Alone for Improving Hamstring Flexibility in Asymptomatic Individuals

2021 ◽  
Vol 11 (6) ◽  
pp. 342-348
Author(s):  
Nishat Tabassum ◽  
Sanghamitra Jena
Keyword(s):  
Control Group ◽  
Test Results ◽  
Post Intervention ◽  
Study Objective ◽  
Significant Difference ◽  
Group 2 ◽  
Hamstring Flexibility ◽  
Asymptomatic Individuals ◽  
Post Assessment ◽  
Group 1

Study Objective: To know about the effects of cryotherapy and active stretching together and active stretching alone for improving hamstring flexibility in asymptomatic individuals. Method: 22 subjects were participated in study of the age 18 to 40. Subjects were randomly and equally assigned to static stretching and cryotherapy (group 1) and only active stretching (group 2). Subjects in each group were given stretching and cryotherapy for three weeks. Pre and post assessment of ROM was measured by the KEA, SLR and Sit and reach test. Results: After three weeks of intervention there was a significant difference between pre intervention and post intervention score in both the group but in group 1 showed significant difference between KEA, SLR and SRT variables. Conclusion: Subject who received active stretching and cryotherapy showed better improvement than the control group who received only active stretching. Hence it can be concluded that active stretching along with cryotherapy can improve hamstring flexibility than the active stretching only. Key words: Cryotherapy, flexibility, ROM, active stretching.

Abstract 15472: The Utility of Isoproterenol Testing in Pediatric Patients Following Atrioventricular Nodal Reentry Ablation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tahmina Samad ◽  
Eric S Silver ◽  
Leonardo Liberman
Keyword(s):  
Catheter Ablation ◽  
Pediatric Patients ◽  
Common Mechanism ◽  
Slow Pathway ◽  
Significant Cost ◽  
Prior Use ◽  
Acute Success ◽  
Group 2 ◽  
Procedural Success ◽  
Group 1

Intro: AVNRT is a common mechanism of SVT in pediatric patients. Catecholamines such as isoproterenol (ISO) are routinely given during post ablation (ABL) testing to confirm acute success. In light of its recent significant cost increase, the aim of our study was to determine if ISO is necessary in all pediatric patients after AVNRT ablation to ensure acute procedural success. Method: Retrospective study of patients <21 years with AVNRT from 1/06-12/18 who had undergone catheter ablation. We excluded patients with congenital heart disease (CHD), prior ABL, without inducible tachycardia (presumed AVNRT), unsuccessful ABL and those who required ISO to induce tachycardia (TACHY) prior to ABL lesions. All patients were tested after ABL without ISO and if AVNRT was not induced they were retested while on ISO. Result: We identified 232 patients with AVNRT of whom 65 (28%) met the study criteria; 123 (53%) were excluded for requiring ISO to induce AVNRT prior to ABL, 23 (10%) for CHD, 12 (5%) with presumed AVNRT and 9 (4%) with an unsuccessful ABL. The average age was 14.4 yrs (±3.5) and 54% were female. All patients received anesthesia, 40/65 were intubated (62%). Evidence of slow pathway conduction (Spath) (AH jump with atrial extrastimulus testing, presence of AV nodal echo beats or PR>RR) was seen in 35/65 patients (54%). Patients were divided into 2 groups: group 1 (n= 57, 88%) consisted of patients without inducible TACHY post ABL while receiving ISO, group 2 (n = 8, 12%) of patients in whom TACHY was inducible with ISO thus required further ABL. There was no difference between the groups with regards to sex, age, intubation status, prior use of antiarrhythmic meds, or in the incidence of Spath (31/57, 54% vs. 4/8, 50%, p=1). Four of the 8 patients in group 2 with no evidence of Spath had inducible TACHY with ISO. Conclusion: We found that 12% of pediatric patients who did not require ISO to induce AVNRT prior to ABL had inducible TACHY only with ISO after AVNRT ABL. Presence of dual AV nodal physiology after ABL lesions did not predict inducibility of AVNRT on ISO, and 50% of the patients with no evidence of slow pathway conduction by conventional testing had inducible AVNRT with ISO. ISO testing is useful in all pediatric patients to test for inducibility following catheter ablation of AVNRT.

scholarly journals Herb-Drug Interaction: Effects of Relinqing® Granule on the Pharmacokinetics of Ciprofloxacin, Sulfamethoxazole, and Trimethoprim in Rats

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Yuan Lu ◽  
ZiPeng Gong ◽  
YuMin Xie ◽  
Jie Pan ◽  
Jia Sun ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Pharmacokinetic Parameters ◽  
Control Group ◽  
Urinary System ◽  
Blood Samples ◽  
Sd Rats ◽  
Chinese Patent ◽  
Group 2 ◽  
And Control ◽  
Group 1

Relinqing granule (RLQ) is the best-selling Chinese patent drug for treatment of urinary system diseases. In this study, the effects of RLQ on the pharmacokinetics of ciprofloxacin, sulfamethoxazole, and trimethoprim in SD rats were investigated. Rats were randomly divided into control group 1, control group 2, RLQ group 1, and RLQ group 2. RLQ group 1 and RLQ group 2 were treated orally with RLQ for 7 days, and rats were treated with the same volume of water in control group 1 and control group 2. Then, RLQ group 1 and control group 1 were given intragastrically ciprofloxacin on day 8, while RLQ group 2 and control group 2 were given intragastrically sulfamethoxazole and trimethoprim on day 8. Blood samples were collected and determined. There was no significant influence of pharmacokinetic parameters of trimethoprim on two groups. But some pharmacokinetic parameters of ciprofloxacin and sulfamethoxazole in RLQ pretreated rats were evidently altered (P < 0.05), which indicated that absorption of ciprofloxacin and sulfamethoxazole in RLQ pretreated rats was significantly affected. It indicated the coadministration of RLQ would have an influence on the efficacy of ciprofloxacin and sulfamethoxazole, and the doses of ciprofloxacin tablet and compound sulfamethoxazole tablet need adjustment.

Analysis of the Incidence and Characteristics of Venoocclusive Disease (VOD) of the Liver in Pediatric Hematopoietic Progenitor Cell Transplant (HPCT) Patients with Heparin Alone Vs. Heparin and Ursodiol Prophylaxis at the Medical College of Wisconsin.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4306-4306
Author(s):  
Julie-An Talano ◽  
Jessica Brown ◽  
Jennifer McArthur ◽  
Mollie Mulberry ◽  
Daniel Eastwood ◽  
...  
Keyword(s):  
Medical Records ◽  
Low Dose ◽  
Pediatric Patients ◽  
Hematologic Malignancy ◽  
Post Transplant ◽  
Dose Heparin ◽  
Group I ◽  
Group 2 ◽  
Low Dose Heparin ◽  
Group 1

Abstract Abstract 4306 VOD is a serious and potentially life-threatening complication of HPCT as a result of liver injury from the effect of chemotherapy and/or radiation. The reported incidence rate in pediatric HPCT patients varies widely from 5% to 40%. Previous studies have shown the beneficial effects of post-transplant pharmacological therapies such as ursodeoxyholic acid (ursodiol), heparin, and defibrotide at preventing VOD. However, the combined effect of heparin and ursodiol prophylaxis in preventing VOD in pediatric patients has yet to be determined. This study evaluated retrospectively whether there was a benefit of such combined therapy in pediatric HPCT patients. Our center adopted as standard practice for all HPCT patients the initiation of low dose heparin at 4 units/kg/hour with the commencement of conditioning for HPCT until day +28 post transplant. In 2003, we combined ursodiol 10 mg/kg TID to start with HPCT conditioning and to continue until day + 100 post transplant with low dose heparin through day + 28 for all pediatric HPCT patients. We performed a retrospective chart review and compared the characteristics and the incidence of VOD in patients who underwent transplantation from 1996-2002 and received heparin alone compared to 2003-2008 when the patients received the combination of heparin and ursodiol prophylaxis. Patients were identified through medical records with the ICD diagnosis of VOD. The medical records were reviewed and those patients who did not meet the Baltimore criteria for the diagnosis of VOD were excluded. Only patients who developed VOD with their first transplants were included. Group I = Heparin (216) Group II = Heparin + Ursodiol (220) Allogeneic 187 (86.5%) 160 (72.7%) Autologous 29 (13.5%) 60 (27.3%) Median Age 9 yrs 8 yrs Male 123 (57%) 135 (62%) Female 93 (43%) 85 (38%) Non-malignant 34 (15.7%) 50 (22.8%) Hematologic malignancy 143 (66.2%) 109 (49.5%) Non-hematologic malignancy 39 (18.1%) 61 (27.7%) # VOD 13 5 The 100 day incidence of VOD was 0.0605 (SE 0.01618) in group 1 and 0.0227 (SE 0.01002) in group 2. The difference is 0.0377 (SE 0.0190) and based on a standard normal distribution with a p = 0.0473. The estimated risk of VOD for patients receiving Heparin + Ursodiol is 0.94 (risk or hazard ratio) that of the risk with Heparin alone, with a 95% confidence interval of (0.918, 0.960). This represents about a 6% reduction in risk for those receiving Heparin + Ursodiol. The day 100 survival in the VOD patients was 6 out of 13 in group 1 and 3 out of 5 in group 2. In conclusion, low dose heparin and ursodiol prophylaxis appears to be an effective strategy in VOD prevention in pediatric patients. The combination appeared to be more effective than heparin alone. However, this study is limited in that it is retrospective in nature. Disclosures: Off Label Use: heparin and ursodiol as VOD prophylaxis.

scholarly journals Exercise in a Healthy Heart Program: A Cohort Study

2013 ◽  
Vol 7 ◽  
pp. CMC.S12654 ◽  
Author(s):  
J. Meikle ◽  
A. Al-Sarraf ◽  
M. Li ◽  
K. Grierson ◽  
J. Frohlich
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Lipid Profile ◽  
Retrospective Chart Review ◽  
Secondary Outcome ◽  
The Mean ◽  
Group 2 ◽  
Prevention Clinic ◽  
Group 1

Objective To assess the effects of exercise on resting heart rate (RHR), weight, lipid profile, and blood pressure. We hypothesized that the participants who increased their physical activity would show improvement in their cardiovascular risk factors compared to those who did not. Design Retrospective chart review over the mean duration of 4.9 years of follow-up. Setting Healthy Heart Program Prevention Clinic at St. Paul's Hospital, Vancouver, British Columbia, Canada. Participants We reviewed 300 charts of patients randomly selected from those who attended the Prevention Clinic between 1984 and 2009. 248 (82.7%) patients were referred for primary prevention and 52 (17.3%) for secondary prevention. Primary and secondary outcome measures Weight, RHR, lipid profile, and blood pressure were recorded at the initial and last visit. Results During a mean of 4.9 years of follow-up, 55% of participants improved their exercise. The mean decrease in the RHR for these patients (group 1) was 5.9 beats per minute (bpm) versus the mean increase of 0.3 bpm for the “no change” group (group 2) ( P < 0.01). The mean net weight increase in group 1 was 0.06 kg/year versus 0.25 kg/year in group 2. Because of medications, all patients had a significant improvement in their lipid profiles. Furthermore, there was a statistically significant greater reduction in Framingham Risk Score (FRS) in group 1 versus group 2 (11.8% versus 15.1%, P < 0.01). Conclusion Participation in the program significantly reduces modifiable risk factors for cardiovascular disease. Improved exercise regimen results in lower RHR and greater reduction in FRS. However, even in a Prevention Program, despite strong advocacy of the importance of exercise, a significant percentage of participants does not improve their exercise habits.

Cyclosporine Dose, Serum Trough Levels, and Allograft Preservation in a Rat Model of Laryngeal Transplantation

2003 ◽  
Vol 112 (6) ◽  
pp. 506-510 ◽  
Author(s):  
Marcus Haug ◽  
Michael Fritz ◽  
Olivia Dan ◽  
Robert R. Lorenz ◽  
Sophie Wimberley ◽  
...  
Keyword(s):  
Rat Model ◽  
High Performance ◽  
Group 4 ◽  
Serum Trough ◽  
Group 3 ◽  
The Mean ◽  
Group 5 ◽  
Group 2 ◽  
Trough Levels ◽  
Group 1

Using a rat model of laryngeal transplantation, we sought to define the relationships between acute laryngeal rejection grade (RG) and cyclosporin A (CSA) concentration and CSA dosage. Five recipient Lewis rat groups (N = 10 per group) were administered intramuscular CSA doses of 1.0 (group 1), 2.5 (group 2), 5.0 (group 3), 7.5 (group 4), and 10 mg/kg per day (group 5) for 14 days. Immediately before sacrifice, 5 mL of whole blood was obtained to assay CSA trough levels by high-performance liquid chromatography. The specimens were graded microscopically by blinded reviewers by day of RG, 0 to 14 days after transplantation, as described in earlier reports. Despite high intragroup variability in CSA levels, significantly different mean CSA concentrations were achieved among all CSA dosage groups: 1,2,3,4, and 5 (.0001 < p < .02). The mean laryngeal RGs did not test significantly different from each other with groups 3, 4, and 5 (RG, 2.3 ± 1.3 versus 1.9 ± 1.1 versus 1.7 ±0.3, respectively, .2 < p < .6). The RG for group 1 was significantly greater than those for groups 2 through 5 (p < .001), and the group 2 RG was greater (p < .02) than those for groups 3, 4, and 5. Polynomial fitting was used to determine the continuous relationship between each individual specimen's CSA concentration and the RG. Significant pathological allograft rejection correlated with CSA concentrations below 250 ng/mL.

Lumbar Plexus in Children

2004 ◽  
Vol 101 (2) ◽  
pp. 445-450 ◽  
Author(s):  
Lukas Kirchmair ◽  
Birgit Enna ◽  
Gottfried Mitterschiffthaler ◽  
Bernhard Moriggl ◽  
Manfred Greher ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Age Groups ◽  
Posterior Part ◽  
Lumbar Plexus ◽  
Ultrasound Guided ◽  
Psoas Major Muscle ◽  
Group 3 ◽  
Group 2 ◽  
Paravertebral Region ◽  
Group 1

Background Pediatric regional anesthesia has gained increasing interest over the past decades. The current study was conducted to investigate the lumbar paravertebral region and the lumbar plexus at L3-L4 and L4-L5 by means of sonography to obtain fundamentals for the performance of ultrasound-guided posterior lumbar plexus blocks. Methods Thirty-two children (12 boys, 20 girls) with American Society of Anesthesiologists physical status I or II were enrolled in the current study. The lumbar paravertebral region was visualized at L3-L4 and L4-L5 on two corresponding posterior sonograms (longitudinal, transverse). The lumbar plexus had to be delineated, and skin-plexus distances were measured. In a series of five pediatric patients undergoing inguinal herniotomy, ultrasound-guided posterior lumbar plexus blocks at L4-L5 were performed. Results The children were stratified into three age groups (group 1: &gt; 3 yr and &lt;/= 5 yr; group 2: &gt; 5 yr and &lt;/= 8 yr; group 3: &gt; 8 yr and &lt;/= 12 yr). The lumbar plexus could be delineated at L3-L4 and L4-L5 in 19 of 20 cases in group 1, in 17 of 20 cases in group 2, in 22 of 24 cases at L3-L4 in group 3, and in 16 of 24 cases at L4-L5 in group 3. In all patients, the lumbar plexus was situated within the posterior part of the psoas major muscle. Skin-plexus distances showed statistical significant differences between groups 1 and 3 and between groups 2 and 3. The strongest positive correlation existed between skin-plexus distances and the children's weight. Ultrasound guidance enabled safe und successful posterior approaches to the lumbar plexus, thus resulting in effective anesthesia and analgesia of the inguinal region. Conclusions Sonography of the lumbar plexus in children proved to be feasible. Skin-plexus distances correlated with the children's weight rather than with their age. The sonographic findings were fundamental for the performance of successful ultrasound-guided posterior approaches in a small group of pediatric patients.

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