Background: Antifibrinolytics such as tranexamic acid and epsilon-aminocaproic acid are effective at reducing blood loss and transfusion in pediatric patients having craniofacial surgery. The Pediatric Craniofacial Collaborative Group has previously reported low rates of seizures and thromboembolic events (equal to no antifibrinolytic given) in open craniofacial surgery. Aims: To query the Pediatric Craniofacial Collaborative Group database to provide an updated antifibrinolytic safety profile in children given that antifibrinolytics have become recommended standard of care in this surgical population. Additionally, we include the population of younger infants having minimally invasive procedures. Methods: Patients in the Pediatric Craniofacial Collaborative Group registry between June 2012 and March 2021 having open craniofacial surgery (fronto-orbital advancement, mid and posterior vault, total cranial vault remodeling, intracranial LeFort III monobloc), endoscopic cranial suture release, and spring mediated cranioplasty were included. The primary outcome is the rate of postoperative complications possibly attributable to antifibrinolytic use (seizures, seizure-like activity, and thromboembolic events) in infants and children undergoing craniosynostosis surgery who did or did not receive antifibrinolytics.Results: Forty-five institutions reporting 6583 patients were included. The overall seizure rate was 0.24% (95% CI: 0.14, 0.39%), with 0.20% in the no Antifibrinolytic group and 0.26% in the combined Antifibrinolytic group, with no statistically reported difference. Comparing seizure rates between tranexamic acid (0.22%) and epsilon-aminocaproic acid (0.44%), there was no statistically significant difference (odds ratio = 2.0; 95% CI: 0.6, 6.7; p = .257). Seizure rate was higher in patients greater than 6 months (0.30% vs. 0.18%; p = .327), patients undergoing open procedures (0.30% vs. 0.06%; p = .141), and syndromic patients (0.70% vs. 0.19%; p = .009).

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Correlation between Cold Pressure Testing (CPT)/ 99 Tc MIBI-SPECT defects and intracoronary acetylcholine (ACH) paradoxical constriction was published by our group. The usefulness of CPT non -invasive diagnosis of dysfunction (ED) was demonstrated by our observation in coincidence with other authors. There is little information on ED incidence on moderate risk asymptomatic (MRA) patients according to ATP III/Framingham index. Objective: This study is aimed at analyzing the incidence and localization of 99 Tc MIBI/ SPECT myocardial perfusion (MP) defects during CPT as indicator of ED on MRA patients. Methods: 124 patients (78 female) currently compounding PARADIGMA Study Register were analyzed. PARADIGMA is a prospective multicenter study that will include once completed a total number of 450 MRA patients according to ATP III/ Framingham index (Ͻ 20% events at 10 years ), with normal exercise MP and no cardiovascular disease history. CPT-MP imaging was obtained in all these patients. MP extension score was used in a 17 segment model , reported by two observers on consensus. Mann-Whitney U Test statistical analysis was performed. l Results: positive CPT 25/113 patients (22,12 %). CPT extension perfusion score positive 5,77Ϯ2,38(pϽ0.0001). CPT was positive in 30,76 % men and 17,56 % women (pϽ0.001). Localization : anterior wall 4 3%,i n ferior wall 47 %, lateral wall 4,5% and anterior with inferior walls 4,5 %. Conclusion: These results suggest high incidence of ED on MRA patients, who are also free from exercise --related ischemia. There were no significant differences in clinical data and defects localization. Further studies will indicate whether this positive CPT population would have higher risk of cardiovascular events during follow-up Age, Bood Pressure and Cholesterol pns (*) AGE SBP DBP CHOLEST. HDL LDL TRIGL. CPT ( ϩ ) 55.9 Ϯ10 130Ϯ 12 84 Ϯ 5 245 Ϯ 90 48 Ϯ 19 156Ϯ 49 246 Ϯ143 CPT (-) 53.5 Ϯ 9 129 Ϯ 15 79 Ϯ9 228 Ϯ 45 51 Ϯ 12 157 Ϯ 34 160 Ϯ72 7.2Effects of percutaneous intramyocardial plasmid gene transfer of vascular endothelial growth factor (phVEGF-A165 ) on myocardial perfusion measured by N-13 ammonia-PET.

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In adults, the postoperative benefits of epidural analgesia are well established, but in children the literature is sparse and controversy exists about the benefits, risks, ideal placement technique, and dosage of medication infused epidurally. Little is known about the neurotoxicity of various medications currently administered in the epidural space or the long-term consequences of epidural analgesia. The management of epidural analgesia in children is complicated by the narrow therapeutic window of epidural drugs, especially in neonates and young infants, and the difficulties of evaluating patients with developmental or cognitive limitations. When its indications are carefully chosen, and with meticulous care provided by all perioperative team members (anesthesiologists, surgeons, intensivists, and nurses), epidural analgesia remains a gold standard of postoperative pain management in children.