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Two groups of 50 children were included in a study to examine the use of atracurium and vecuronium. In both groups, newborns and infants showed a shorter onset time and a longer clinical duration of the first dose of the neuromuscular blocking drug. The duration of subsequent doses in the various age groups was not significantly different. Atracurium and vecuronium both have a short recovery index, good cardiovascular stability and do not interfere with ICP. The Authors emphasise the importance of monitoring the use of neuromuscular blocking drugs.

The authors, following a report on cerebral physiology in childhood, report their experience of ICP and the administration of new drugs in anaesthesiologic practice. The effects of isoflurane, propofol, atracurium, vecuronium on ICP are reported.

A retrospective study in a pediatric population of 324 severe head trauma patients hospitalized at Santobone Children's Hospital has been carried out; diagnostic investigations and therapeutic aspects are stressed on the baw of pathophysiological features of such patients.

From 1974 through 1989, 36 patients with arteriovenous malformations were studied in the neurosurgical department of the Santobono Children's Hospital in Naples; 7 of these patients were younger than three years of age: 5 underwent surgery. The remaining 2 patients presented, respectively, an aneurysm of the vein of Galen and an arteriovenous malformation of the brain stem. Improvements in surgical and anesthesiological techniques allow to treat lesions considered as not amenable to surgery until recent years, with minimal occurrence of preoperative and postoperative complication and a significant amelioration of prognosis.

Background: The purpose of this study was to explore the renal acid-base response to acute protein load in patients with heart failure (HF). It was prompted by the fact that there are no data available regarding the role of renal tubules in maintaining acid-base balance following protein loading in HF patients.Methods and Results: Nine male patients with HF and 12 healthy subjects (controls) were enrolled in this study. In the HF patients, average blood pH was 7.42 (0.03), average PCO2 was 36.6 mmHg (6.3) and average bicarbonate was 24.2 mmol/L (4.3). The acid-base status of patients was unaffected by meat ingestion. The values at peak glomerular filtration rate (GFR) did not differ significantly from baseline levels. An oral protein load did not influence the urinary pH, titratable acidity (TA) and ammonium excretion in the patients with HF, contrary to the findings in the controls. On the other hand, ammonium excretion in patients with HF reduced significantly compared with values from controls at baseline and following oral protein loading. Filtered and reabsorbed bicarbonate increased significantly in HF patients following meat ingestion, whereas there was no change in absolute and fractional bicarbonate excretion and fractional bicarbonate reabsorbed.Conclusions: This study demonstrated that in patients with HF, bicarbonate reabsorption increases following an oral protein load without a significant enhancement in bicarbonate excretion. The difference can be explained by the presence of respiratory alkalosis leading to bicarbonate conservation.

Intracranial pressure (ICP) can be affected by cerebral blood volume changes, mostly in patients with decreased intracranial compliance. Volatile anaesthetic agents are potent cerebrovasodilators and have the potential to alter ICP. This limits the use of these anaesthetics in neurosurgical patients. Isoflurane, however, seems to be a less potent cerebrovasodilator (1), and its use has been advocated in neuroanaesthesia (2, 3).

In end-stage heart failure, various acid-base disorders can be discovered due to the renal loss of hydrogen ions and hydrogen ion movements into cells, the reduction of the effective circulating volume, hypoxemia and renal failure. This justifies the occurrence of metabolic alkalosis, metabolic acidosis, respiratory alkalosis, as well as respiratory acidosis alone or in combination. Several studies have been published on the acid-base state in heart failure. In a 1951 study, Squires et al analyzed the distribution of body fluid in congestive heart failure by taking into consideration the abnormalities in serum electrolyte concentration and in acid-base equilibrium. A recent study by Milionis et al, analyzed 86 patients with congestive heart failure receiving conventional treatment; the majority of these patients exhibited hypokalemia, hyponatremia, hypocalcemia and hypophosphatemia. Disorders in acid-base balance were noted in 37.2% of patients. In a recent study, 70 patients with severe congestive heart failure before heart transplantation showed high-normal pH, slightly reduced pCO 2 and a slight loss of hydrogen ions. After heart transplantation, stability of blood pH and hydrogen ion concentrations was found. In contrast, bicarbonate and pCO 2 increased significantly. The data led us to formulate the diagnosis of a mixed acid-base disorder that includes respiratory alkalosis and metabolic alkalosis before heart transplantation. In heart failure, the presence of acid-base imbalance associated with the activation of mechanisms that lead to salt and water retention reveals evidence concerning the pivotal role of the kidney in determining the outcome of these patients.