University of Rochester, Rochester, New York, United States


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Publications (3)1.85 Total impact

  • R S Litman · B A Zerngast
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    ABSTRACT: An 11-year-old, 25-kg girl with congenital myelomeningocele was scheduled for posterior spinal fusion because of progressive scoliosis. After induction of general anesthesia and administration of a standard dose of intravenous esmolol hydrochloride, her cardiac rhythm progressed to asystole. Although given ephedrine, epinephrine, and atropine sulfate, the patient's normal heart rhythm could not be restored until calcium chloride was administered. A review of the medical literature indicates that the optimal treatment for acute beta-blocker toxicity is intravenous glucagon. Calcium administration should also be considered. Acute esmolol toxicity may be self-limiting because of its extremely short half-life.
    No preview · Article · Nov 1996 · The Journal of the American Osteopathic Association
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    ABSTRACT: Atlantoaxial subluxation (AAS) is a form of cervical spine instability predominantly found in persons with Trisomy-21. Several case reports describe the occurrence of acute AAS in the perioperative period. Some authors have recommended cervical spine radiographs prior to elective surgery in all children with Trisomy-21. The objective of this study was to determine practice patterns of North American members of the Society of Pediatric Anesthesia with regard to the perioperative evaluation and management of potential cervical spine instability in patients with Trisomy-21. Of 171 respondents, a minority of respondents (18%) obtain preoperative radiographs and/or subspecialty consultation (9%) in asymptomatic children with Trisomy-21. For symptomatic children the majority of respondents would obtain radiographs (64%) and/or preoperative consultation (74%). Approximately half of the respondents would attempt to maintain the head and neck in a neutral position for either asymptomatic (42%) or symptomatic (55%) patients. We conclude that the majority of respondents base their preoperative evaluation of the cervical spine on the signs and symptoms of the patient. This is supported by the literature reviewed, but is contrary to the recommendations made in some case reports.
    No preview · Article · Oct 1995 · Pediatric Anesthesia
  • RS Litman · AA Berger · BA Zerngast · A Chhibber
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    ABSTRACT: The objective of this study was to determine the efficacy of intravenous (iv), low-dose propofol for the treatment of postoperative emesis in children. We performed a randomized, prospective, double-blind, placebo-controlled investigation in the ambulatory surgical unit on 90 healthy children, aged 1–16 yr following elective, outpatient surgery. After an episode of postoperative vomiting, patients were randomized to receive iv propofol, 0.25 mg kg−1, or an equivalent volume of 10% lipid emulsion (Intralipid®). A second dose of study drug was administered if emesis recurred. All episodes of emesis and postinjection sedation scores following study drug administration were recorded. The study was terminated after analysing the results of 45 children in each group. There were no complications in either study group. We concluded that propofol 0.25 mg kg−1 was not an effective treatment for postoperative emesis in healthy children undergoing elective outpatient surgery. It is possible that increasing the dose and/or the duration of administration may improve propofol's ability to treat postoperative emesis in children.
    No preview · Article · Sep 1995 · Ambulatory Surgery