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Published ahead of print May 4, 2017.

The pharmacokinetics and time course of action of vecuronium in normal children and children receiving anticonvulsant drugs for prolonged periods were characterized. A bolus dose of vecuronium 0.15 mg kg(-1) was administered i.v. to 10 non-epileptic children and to 10 children on phenytoin and 10 children on carbamazepine, who were matched for age and weight. Plasma concentrations of vecuronium, 3-OH desacetylvecuronium (the primary metabolite of vecuronium) and alpha1-acid glycoprotein (AAG) were determined. Pharmacokinetic variables were derived from plasma samples collected before and after administration of vecuronium. Neuromuscular transmission was monitored by evoked compound electromyography. Recovery of the first twitch of the train-of-four (T1/T0) and the recovery index (RI), the time for 25-75% recovery of T1/T0, were determined. The elimination half-life of vecuronium was significantly reduced in both anticonvulsant groups compared with control [control 48.2 (SD 40.3), phenytoin 23.5 (13.1), carbamazepine 18.4 (16.6) min, P<0.05]. Vecuronium clearance was increased in both anticonvulsant groups [control 9.0 (3.6), phenytoin 15.1 (8.9), carbamazepine 18.8 (13.1) ml kg(-1) min(-1), 0.05

Precordial ultrasonic Doppler devices are effective monitors for detecting venous air emboli VAE. However, placing an ultrasonic probe on the anterior part of the chest of a prone patient can lead to dislodgment or pressure sores and makes the probe inaccessible to the anesthesiologist. The purpose of this study was to compare placement of a Doppler probe on the patient's back with the traditional precordial site for the ability to detect VAE. We enrolled infants and children undergoing neurosurgical procedures in the prone position in the study. After establishment of general anesthesia and endotracheal intubation, we applied an ultrasonic Doppler probe to the right sternal border of the patient's chest. Anterior insonation was performed with the patient in the supine position. Saline was rapidly injected to verify the efficacy of the monitor injection test. The patient was turned to the prone position and we placed the Doppler probe between the right scapula and spine. Posterior insonation with saline injection was performed with the patient in the prone position. We obtained positive tests in all patients from the anterior site. Positive tests were obtained from the posterior site in 23 of 24 96 children <10 kilograms group I, 28 of 39 72 children between 10 and 20 kg group II, and 6 of 22 27 children >20 kilograms group III.This study demonstrates that a posterior Doppler probe can be effective for monitoring infants at risk of VAE. However, this method is not reliable in children weighing > 10 kg.

No abstract available.