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2. Effect of minimizing preoperative fasting on perioperative blood glucose homeostasis in children

Author

Ramesh I. Patel, L. Broadman, Leila G. Welborn, Janet M. Norden, Raafat S. Hannallah, Urs E. Ruttimann, and N. Seiden

Subjects
Gastric fluid, business.industry, Outpatient surgery, Perioperative, Group B, Gastric ph, Anesthesiology and Pain Medicine, Anesthesia, Pediatrics, Perinatology and Child Health, Medicine, Glucose homeostasis, Preoperative fasting, business, Paediatric patients
Abstract

Summary Two hundred healthy, unpremedicated children, ages 1–10 years, scheduled for elective outpatient surgery were studied in order to examine the effect of minimizing preoperative fasting on perioperative blood glucose concentrations in paediatric patients. None of the patients ingested solids after midnight. On the day of surgery, the children were assigned to one of two groups. Group A children (n= 113) were not allowed any liquids for at least 6 h prior to surgery (NPO). Children in Group B (n= 87) ingested 10 ml·kg−1 of apple juice 2–4 h prior to the induction of anaesthesia. All patients received lactated Ringer's solution intraoperatively, unless BG at induction was 0.4 ml/kg. All patients in both groups had gastric pH < 2.5. This study shows that gastric fluid volume and pH following a 2–4 h fast are not different from the values measured in children who were subjected to a traditional fasting period of 6 h or longer. Moreover, apple juice consumed 2–4 h prior to surgery neither buffers gastric pH nor does it modify intraoperative glucose homeostasis in children.

Published
1993
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3. Abstracts

Author

Saiah Michèle, Borgeat Alain, Wilder-Smith Oliver, Orlando R. Hung, Charles E. Hope, Geoffrey Laney, Sara C. Whynot, Thomas J. Coonan, David S. Malloy, S. Patterson, A. Gelb, P. Manninen, D. Strum, B. Glosten, M. J. Spellman, E. I. Eger, R. A. Craen, A. W. Gelb, J. M. Murkin, K. Y. Chong, D. H. Penning, H. El-Behairy, J. F. Brien, J. W. Coh, R. Arellano, J. Correa, L. Fedorko, Z. Liu, J. F. Boylan, A. N. Sandler, H. Nierenberg, P. A. Sheiner, P. D. Greig, G. M. O’Leary, S. J. Teasdale, M. F. X. Glynn, B. A. Orser, L. -Y. Wang, J. F. MacDonald, C. W. Loomis, K. D. Arunachalam, D. Vyas, B. Milne, Daniel Gagnon, Josée Lavoie, Jean-Yves Dupuis, D. R. Miller, R. J. Martineau, D. Greenway, L. Olivaris, K. Hull, R. N. M. Tierney, J. E. Wynands, R. Martineau, B. St-Jean, J. Kitts, D. Miller, P. Lindsay, M. Curran, G. C. Allen, M. L. Crossan, Richard Wise, François Donati, David R. Bevan, J. F. Hardy, J. Desroches, J. Perrault, M. Carrier, D. Robitaille, D. M. Ansley, J. P. O’Connor, J. Dolman, G. E. Townsend, D. Ricci, D. J. Liepert, P. M. Browne, T. Hertz, M. Rooney, R. W. Yip, W. Code, A. A. Phillips, R. F. McLean, J. H. Devitt, E. M. Harrington, R. J. Byrick, P. Y. Wong, D. Wigglesworth, J. C. Kay, L. A. Sinclair, J. P. Koch, K. A. Deemar, G. K. Christakis, S. Belo, P. Angle, D. Cheng, J. Boylan, A. Sandler, C. Feindel, F. Carmichael, P. Boylen, L. G. R. DeLima, H. J. Nathan, M. S. Hynes, M. E. Bourke, G. N. Russell, C. Seyone, F. Chung, Daniel Chartrand, Lucie Roux, S. L. Dain, B. D. Smith, A. C. Webster, D. F. Wigglesworth, D. K. Rose, G. Caskennette, C. Mechetuk, D. John Doyle, Wilfred DeMajo, Frank van den Bosch, Mark Lee, K. M. McClenaghan, C. D. Mazer, R. Preston, E. T. Crosby, D. Kotarba, H. Dudas, R. D. Elliott, J. Enns, P. H. Manninen, J. K. Farrar, David L. Huzyka, L. Philip Lin, Susan Fossey, Brendan T. Finucane, M. Stockwell, S. Lozanoff, S. Lang, J. Hyssen, D. C. Campbell, M. J. Douglas, T. J. G. Pavy, M. L. Flanagan, G. H. McMorland, Colin Bands, Ch. B. Ffaracs, Catherine Lipsett, David Drover, Mark Stafford-Smith, Sarah Stevens, Kate Shields, Michael J. MacSween, J. D. McAllister, P. K. Morley-Forster, A. K. White, M. D. Taylor, H. M. Vandenberghe, D. Knoppert, H. Reimer, P. C. Duke, C. H. Kehler, M. W. Kepron, V. A. Taraska, J. Carstoniu, P. Norman, J. Katz, Medhat Hannallah, C. M. Cooney, J. B. Lyons, A. Hennigan, W. P. Blunnie, D. C. Moriarty, W. B. Dobkowski, F. S. Prato, N. A. Shannon, D. J. Drost, B. Arya, J. M. Wills, D. Bond, P. Morley-Forester, Mullen JB, I. Spahr-Schopfer, J. Lerman, E. Cutz, M. Dolovich, S. Kowalski, B. Ong, D. Bell, T. Ostryzniuk, C. Serrette, T. Wasylak, S. Coke, Takako Tsuda, Takashi Nakagawa, Norifumi Mabuchi, Hiroshi Ando, Osamu Nishida, Takafumi Azami, Hirotada Katsuya, Yukio Goto, N. Searle, M. Roy, null R. R. T., Charles E. Smith, Alfred C. Pinchak, Joan F. Hagen, Donald Hancock, Andrei V. Krassioukov, Lynne C. Weaver, I. R. Sutton, W. A. C. Mutch, J. M. Teskey, I. R. Thomson, M. Rosenbloom, D. Thiessen, S. Teasdale, H. Corbin, M. R. Graham, S. A. Lang, P. Chang, M. Gerard, J. E. Tetzlaff, M. Walsh, H. Yoon, Brian Warriner, Peter Fancourt-Smith, Jim McEwen, Judy Crane, N. H. Badner, R. Bhandari, W. E. Komar, S. Ganapathy, C. B. Warriner, J. P. McCormack, M. Levine, N. Glick, V. W. S. Chan, M. McQuestion, M. Gomez, C. Cruise, D. Evana, D. Shumka, R. J. Smyth, M. Graham, David Halpenny, Gerald V. Goresky, J. Eldon Zaretski, B. Kavanagh, S. Roger, A. Davies, M. Friedlander, M. M. Cohen, P. G. Duncan, W. D. B. Pope, D. Biehl, R. Merchant, W. A. Tweed, Michael J. Tessler, Mark Angle, Simcha Kleiman, B. P. Kavanagh, G. J. Doak, G. Li, R. I. Hall, J. A. Sulliyan, I. Yee, S. Halpern, R. Pittini, C. Huh, G. L. Bryson, R. Gverzdys, C. Perreault, L. Ferland, F. Gobeil, D. Girard, R. Smyth, B. Asokumar, M. Glynn, Sandra Silveira, Jeff Clark, Paul Milgram, W. M. Splinter, H. B. MacNeill, E. A. Ménard, E. J. Rhine, D. J. Roberts, G. M. Gould, G. G. Johnson, Daniel Quance, Saul Wiesel, Jane Easdown, N. Tien Truong, Normand Miller, Nathan Sheiner, L. Welborn, J. Norden, R. Hannallah, L. Broadman, N. Seiden, M. Iwai, R. Iwai, H. Horigome, M. Yamashita, Catherine E. Wood, Kim Klassen, S. Kleinman, S. Yentis, N. Sikich, T. A. Yemen, B. Mascik, W. Nelson, H. Ghantous, J. Gandolfi, Gordon Wood, Mohamed Ali, Kevin Inman, J. M. Karski, J. Carroll, D. Brooks, P. A. Oakley, P. M. Webster, J. Karski, T. Yao, J. Ivanov, P. Young, S. Carson, R. D. Weisel, Richard M. Cooper, David T. Wong, Douglas P. Wagner, William A. Knaus, Charul A. Munshi, John P. Kampine, I. D. Soutter, A. Mathieu, A. Gafni, A. Dauphin, L. Torsher, M. Tierney, H. S. Hopkins, G. J. Baylon, Elizabeth A. Peter, C. P. Bellhouse, Caroline Dore, T. W. Rachwal, D. T. Lanigan, Raymond Yip, J. B. Derdemezi, B. A. Britt, D. E. Withington, F. Reynolds, A. Patrick, W. Man, N. R. Searle, H. Ste-Marie, Mark A. Kostash, Richard Johnston, R. J. Bailey, M. D. Sharpe, R. P. Woda, M. Haug, P. Slugg, J. Lockrem, G. Barnett, B. A. Finegan, M. Robertson, D. Taylor, G. Frost, A. Koshal, Grant E. Rodney, Clayton C. Reichert, Desmond N. O’Regan, Derek Blackstock, David J. Steward, Richard Wenstone, Ellen Harrington, A. Wong, B. Braude, D. Fear, B. Bissonnette, Craig W. Reid, Kathryn A. Hull, S. Yogendran, G. McGuire, V. Chan, E. Hartley, K. Van Kessel, R. Weisel, N. Takla, N. A. Tremblay, F. E. Ralley, J. G. Ramsay, G. R. Robbins, F. C. Salevsky, S. Gandhi, N. Nimphius, Bernard Dionne, Christian Jodoin, Michel Lorange, Alain Lapointe, Geoffrey Hawboldt, G. A. Volgyesi, Guy Tousignant, R. Barnett, and B. Gallant

Subjects
Anesthesiology and Pain Medicine, General Medicine
Published
1992
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5. Erratum

Author

Saiah Michèle, Borgeat Alain, Wilder-Smith Oliver, Orlando R. Hung, Charles E. Hope, Geoffrey Laney, Sara C. Whynot, Thomas J. Coonan, David S. Malloy, S. Patterson, A. Gelb, P. Manninen, D. Strum, B. Glosten, M. J. Spellman, E. I. Eger, R. A. Craen, A. W. Gelb, J. M. Murkin, K. Y. Chong, D. H. Penning, H. El-Behairy, J. F. Brien, J. W. Coh, R. Arellano, J. Correa, L. Fedorko, Z. Liu, J. F. Boylan, A. N. Sandler, H. Nierenberg, P. A. Sheiner, P. D. Greig, G. M. O’Leary, S. J. Teasdale, M. F. X. Glynn, B. A. Orser, L. -Y. Wang, J. F. MacDonald, C. W. Loomis, K. D. Arunachalam, D. Vyas, B. Milne, Daniel Gagnon, Josée Lavoie, Jean-Yves Dupuis, D. R. Miller, R. J. Martineau, D. Greenway, L. Olivaris, K. Hull, R. N. M. Tierney, J. E. Wynands, R. Martineau, B. St-Jean, J. Kitts, D. Miller, P. Lindsay, M. Curran, G. C. Allen, M. L. Crossan, Richard Wise, François Donati, David R. Bevan, J. F. Hardy, J. Desroches, J. Perrault, M. Carrier, D. Robitaille, D. M. Ansley, J. P. O’Connor, J. Dolman, G. E. Townsend, D. Ricci, D. J. Liepert, P. M. Browne, T. Hertz, M. Rooney, R. W. Yip, W. Code, A. A. Phillips, R. F. McLean, J. H. Devitt, E. M. Harrington, R. J. Byrick, P. Y. Wong, D. Wigglesworth, J. C. Kay, L. A. Sinclair, J. P. Koch, K. A. Deemar, G. K. Christakis, S. Belo, P. Angle, D. Cheng, J. Boylan, A. Sandler, C. Feindel, F. Carmichael, P. Boylen, L. G. R. DeLima, H. J. Nathan, M. S. Hynes, M. E. Bourke, G. N. Russell, C. Seyone, F. Chung, Daniel Chartrand, Lucie Roux, S. L. Dain, B. D. Smith, A. C. Webster, D. F. Wigglesworth, D. K. Rose, G. Caskennette, C. Mechetuk, D. John Doyle, Wilfred DeMajo, Frank Bosch, Mark Lee, K. M. McClenaghan, C. D. Mazer, R. Preston, E. T. Crosby, D. Kotarba, H. Dudas, R. D. Elliott, J. Enns, P. H. Manninen, J. K. Farrar, David L. Huzyka, L. Philip Lin, Susan Fossey, Brendan T. Finucane, M. Stockwell, S. Lozanoff, S. Lang, J. Hyssen, D. C. Campbell, M. J. Douglas, T. J. G. Pavy, M. L. Flanagan, G. H. McMorland, Colin Bands, Ch. B. Ffaracs, Catherine Lipsett, David Drover, Mark Stafford-Smith, Sarah Stevens, Kate Shields, Michael J. MacSween, J. D. McAllister, P. K. Morley-Forster, A. K. White, M. D. Taylor, H. M. Vandenberghe, D. Knoppert, H. Reimer, P. C. Duke, C. H. Kehler, M. W. Kepron, V. A. Taraska, J. Carstoniu, P. Norman, J. Katz, Medhat Hannallah, C. M. Cooney, J. B. Lyons, A. Hennigan, W. P. Blunnie, D. C. Moriarty, W. B. Dobkowski, F. S. Prato, N. A. Shannon, D. J. Drost, B. Arya, J. M. Wills, D. Bond, P. Morley-Forester, Mullen JB, I. Spahr-Schopfer, J. Lerman, E. Cutz, M. Dolovich, S. Kowalski, B. Ong, D. Bell, T. Ostryzniuk, C. Serrette, T. Wasylak, S. Coke, Takako Tsuda, Takashi Nakagawa, Norifumi Mabuchi, Hiroshi Ando, Osamu Nishida, Takafumi Azami, Hirotada Katsuya, Yukio Goto, N. Searle, M. Roy, null R. R. T., Charles E. Smith, Alfred C. Pinchak, Joan F. Hagen, Donald Hancock, Andrei V. Krassioukov, Lynne C. Weaver, I. R. Sutton, W. A. C. Mutch, J. M. Teskey, I. R. Thomson, M. Rosenbloom, D. Thiessen, S. Teasdale, H. Corbin, M. R. Graham, S. A. Lang, P. Chang, M. Gerard, J. E. Tetzlaff, M. Walsh, H. Yoon, Brian Warriner, Peter Fancourt-Smith, Jim McEwen, Judy Crane, N. H. Badner, R. Bhandari, W. E. Komar, S. Ganapathy, C. B. Warriner, J. P. McCormack, M. Levine, N. Glick, V. W. S. Chan, M. McQuestion, M. Gomez, C. Cruise, D. Evana, D. Shumka, R. J. Smyth, M. Graham, David Halpenny, Gerald V. Goresky, J. Eldon Zaretski, B. Kavanagh, S. Roger, A. Davies, M. Friedlander, M. M. Cohen, P. G. Duncan, W. D. B. Pope, D. Biehl, R. Merchant, W. A. Tweed, Michael J. Tessler, Mark Angle, Simcha Kleiman, B. P. Kavanagh, G. J. Doak, G. Li, R. I. Hall, J. A. Sulliyan, I. Yee, S. Halpern, R. Pittini, C. Huh, G. L. Bryson, R. Gverzdys, C. Perreault, L. Ferland, F. Gobeil, D. Girard, R. Smyth, B. Asokumar, M. Glynn, Sandra Silveira, Jeff Clark, Paul Milgram, W. M. Splinter, H. B. MacNeill, E. A. Ménard, E. J. Rhine, D. J. Roberts, G. M. Gould, G. G. Johnson, Daniel Quance, Saul Wiesel, Jane Easdown, N. Tien Truong, Normand Miller, Nathan Sheiner, L. Welborn, J. Norden, R. Hannallah, L. Broadman, N. Seiden, M. Iwai, R. Iwai, H. Horigome, M. Yamashita, Catherine E. Wood, Kim Klassen, S. Kleinman, S. Yentis, N. Sikich, T. A. Yemen, B. Mascik, W. Nelson, H. Ghantous, J. Gandolfi, Gordon Wood, Mohamed Ali, Kevin Inman, J. M. Karski, J. Carroll, D. Brooks, P. A. Oakley, P. M. Webster, J. Karski, T. Yao, J. Ivanov, P. Young, S. Carson, R. D. Weisel, Richard M. Cooper, David T. Wong, Douglas P. Wagner, William A. Knaus, Charul A. Munshi, John P. Kampine, I. D. Soutter, A. Mathieu, A. Gafni, A. Dauphin, L. Torsher, M. Tierney, H. S. Hopkins, G. J. Baylon, Elizabeth A. Peter, C. P. Bellhouse, Caroline Dore, T. W. Rachwal, D. T. Lanigan, Raymond Yip, J. B. Derdemezi, B. A. Britt, D. E. Withington, F. Reynolds, A. Patrick, W. Man, N. R. Searle, H. Ste-Marie, Mark A. Kostash, Richard Johnston, R. J. Bailey, M. D. Sharpe, R. P. Woda, M. Haug, P. Slugg, J. Lockrem, G. Barnett, B. A. Finegan, M. Robertson, D. Taylor, G. Frost, A. Koshal, Grant E. Rodney, Clayton C. Reichert, Desmond N. O’Regan, Derek Blackstock, David J. Steward, Richard Wenstone, Ellen Harrington, A. Wong, B. Braude, D. Fear, B. Bissonnette, Craig W. Reid, Kathryn A. Hull, S. Yogendran, G. McGuire, V. Chan, E. Hartley, K. Kessel, R. Weisel, N. Takla, N. A. Tremblay, F. E. Ralley, J. G. Ramsay, G. R. Robbins, F. C. Salevsky, S. Gandhi, N. Nimphius, Bernard Dionne, Christian Jodoin, Michel Lorange, Alain Lapointe, Geoffrey Hawboldt, G. A. Volgyesi, Guy Tousignant, R. Barnett, and B. Gallant

Subjects
Anesthesiology and Pain Medicine, General Medicine
Published
1992
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7. Ropivacaine vs bupivacaine in major surgery in infants.

Author

Ivani G, Lampugnani E, De Negri P, Lonnqvist PA, and Broadman L

Subjects
Anesthesia, Epidural, Double-Blind Method, Hemodynamics drug effects, Humans, Infant, Pain, Postoperative drug therapy, Prospective Studies, Ropivacaine, Time Factors, Amides pharmacology, Anesthetics, Local pharmacology, Bupivacaine pharmacology
Abstract

Purpose: To assess and compare the onset time and duration of neuroblockade obtained after ropivacaine or bupivacaine in infants undergoing major abdominal surgery. We also evaluated the efficacy and safety of employing ropivacaine instead of bupivacaine to provide operative anesthesia and postoperative analgesia., Methods: In a prospective double blind study 28 infants, aged 1-12 months, undergoing elective major abdominal surgery, were randomly allocated to receive, after induction of general anesthesia, either 0.7 ml x kg(-1) bupivacaine 0.25% (group B) or ropivacaine 0.2% (group R) via lumbar epidural block. The onset time, total surgical time and duration of analgesia were recorded., Results: No differences were noted in demographic data, hemodynamic variables or duration of surgery. The onset time for sensory blockade was 13.1 min +/- 2.1 (group B) and 11.7 +/- 2.4 min (group R). The duration of analgesia was 491 +/- 291 (group R) and 456 min +/- 247 (group B). Eight patients in group B and six in group R needed codeine and acetaminophen rescue on at least one occasion during the 24 hr study period. No major side effects were noted in either groups., Conclusions: In infants undergoing major abdominal surgery under combined epidural/light general anesthesia, ropivacaine 0.2% produces sensory and motor blockade similar in onset, duration of action and efficacy to that obtained from an equal volume, 0.7 ml x kg(-1), of bupivacaine 0.25%.

Published
1999
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8. Isolated masseter muscle spasm versus generalized rigidity?

Author

Kaplan R, Becker M, and Broadman L

Subjects
Adenoidectomy, Child, Preschool, Diagnosis, Differential, Humans, Masseter Muscle physiopathology, Muscle Rigidity physiopathology, Myringoplasty, Spasm physiopathology, Halothane, Masseter Muscle drug effects, Muscle Rigidity chemically induced, Spasm chemically induced, Succinylcholine adverse effects
Published
1992
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10. A comparison between bupivacaine instillation versus ilioinguinal/iliohypogastric nerve block for postoperative analgesia following inguinal herniorrhaphy in children.

Author

Casey WF, Rice LJ, Hannallah RS, Broadman L, Norden JM, and Guzzetta P

Subjects
Child, Child, Preschool, Humans, Hypogastric Plexus, Ilium innervation, Inguinal Canal innervation, Time Factors, Anesthesia, Local standards, Bupivacaine, Hernia, Inguinal surgery, Nerve Block standards, Pain, Postoperative therapy
Abstract

This study compared the postoperative pain relief provided by simple instillation of bupivacaine into a hernia wound with that provided by ilioinguinal/iliohypogastric (IG/IH) nerve block. Sixty children undergoing inguinal hernia repair under general anesthesia were randomized to receive 0.25 ml/kg of 0.25% bupivacaine for either IG/IH nerve block or up to 0.5 ml/kg of the same solution for instillation nerve blocks. In the postanesthesia care unit (PACU), a trained blinded observer evaluated the patient's level of postoperative pain using a standardized 10-point objective pain scale. Fentanyl 1-2 micrograms/kg was administered intravenously to any child scoring 6 or more points on the pain scale. The difference in pain scores among the two groups were compared. The two groups were not significantly different in age, duration of surgery, or anesthesia. There was no significant difference between patients who received the two treatment modalities in their pain scores, analgesic requirements in the PACU, recovery times, and discharge times. These results demonstrate that the simple instillation of local anesthetics into a wound provides postoperative pain relief following hernia repair, which is as effective as that provided by intraoperative IG/IH nerve block.

Published
1990
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11. Fentanyl uptake by the scimed membrane oxygenator.

Author

Rosen D, Rosen K, Davidson B, and Broadman L

Subjects
Absorption, Cardiopulmonary Bypass, Humans, Fentanyl blood, Oxygenators, Membrane
Abstract

With the initiation of cardiopulmonary bypass (CPB), using a membrane oxygenator, the drop in circulating fentanyl concentration is greater than can be attributed to dilution alone. This study examined the Scimed brand (2A-800) membrane oxygenator as a site of fentanyl binding. Initial experiments used an assembled CPB circuit. Subsequent dissection and analysis of the oxygenator revealed that the silicone-based membrane sheets were the primary site of fentanyl binding. The silicone-containing waterproof wrapper was also responsible for 1% to 2% of fentanyl binding. Binding of fentanyl to the Scimed membrane oxygenator occurs at a rapid rate and continues until the membrane has taken up 130 ng/cm2 of membrane surface area. The interaction is complete by 15 to 30 minutes if suprasaturated concentrations are used. Samples of membrane material with a surface area of 1 cm2 were also studied. Isolated membrane squares in a nonmoving prime solution required two hours for saturation at the same fentanyl concentrations as the intact membrane with circulating prime. Introduction of motion to the priming solution accelerated the rate of fentanyl binding by the isolated membrane squares to a rate similar to the intact membrane. Motion also provided results similar to those previously reported using different analysis techniques. Therefore, this method of studying fentanyl-membrane interactions using samples of membrane and tritiated fentanyl is a valid model for the intact membrane oxygenator in the assembled bypass circuit. In addition to solution movement, fentanyl concentration of the priming solution was also found to affect the rate of fentanyl uptake. When fentanyl concentrations were used which were insufficient to achieve saturation of the membrane (10 ng/mL and 20 ng/mL), the rate of uptake was slowed. Binding of all available fentanyl under these conditions occurred within three hours. There is potential modification of this interaction by several clinically relevant factors, including temperature, pH, protein content of prime solution, and other drugs. These areas require further study before the saturation data are applied to clinical practice.

Published
1988
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12. Partial splenic ablation in preparation for renal transplantation in children.

Author

Guzzetta PC, Stolar CH, Potter BM, Broadman L, and Ruley EJ

Subjects
Azathioprine adverse effects, Child, Preschool, Graft Rejection, Humans, Neutropenia chemically induced, Preoperative Care, Risk, Embolization, Therapeutic, Kidney Transplantation, Splenectomy
Abstract

Patients with end-stage renal disease who develop hypersplenism, patients with mild neutropenia, and those patients whose WBC fails to increase in response to cortisol administration will develop significant neutropenia following transplantation with routine doses of azathioprine. This "intolerance" of azathioprine mandates a reduction in the dose of azathioprine often resulting in allograft rejection. Splenectomy will prevent azathioprine-induced neutropenia, but the hazards of splenectomy in these immunosuppressed patients have led to attempts to salvage at least part of the spleen. Partial splenic ablation by embolization has been utilized in adults prior to transplantation to prevent azathioprine-induced neutropenia while preserving the spleen's protective mechanisms against infection. Eight children in our series of transplant candidates required a reduction of splenic function to prevent azathioprine induced neutropenia. One child had a functioning renal allograft but had recurrent neutropenia limiting the azathioprine dose. Partial splenic embolization was attempted in four children and was initially successful in two. Both patients later developed recurrent neutropenia and needed partial splenectomy. The two patients in whom partial splenic embolization was unsuccessful and five further patients in whom embolization was not attempted also underwent partial splenectomy. Approximately 75% to 80% of the spleen was resected. Six children have since undergone renal transplantation and one child had a transplant with chronic rejection at the time of partial splenectomy. Routine doses of azathioprine have been used in these children with no episodes of neutropenia or sepsis observed. We recommend partial splenectomy in those children requiring renal transplantation who are at risk for development of azathioprine induced neutropenia.

Published
1983
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