After prolonged preoperative fasting, children younger than 36 months can present with ketoacidosis and (low) normal blood glucose concentrations. Actual fasting times should be optimised according to existing guidelines. In small infants, deviations from fasting guidelines should be as short as possible and not longer than 2 h.

Current methods of artificial ventilation cannot prevent diverse problems associated with mechanical ventilation. In contrast to all current forms of mechanical ventilation, electromagnetic stimulation can activate respiratory muscles directly. However, it is not known if and to what extent electromagnetic stimulation can ventilate humans. In 10 volunteers we stimulated the lateral neck using magnetic stimulators. Over 63 s we stimulated nine times with a frequency of 25 HZ for 1.1 s using 600 V, 900 V, and 1,200 V. The minimum stimulation time for each volunteer was 9 min. A Capnomac monitor measured minute ventilation. Electromagnetic stimulation was well tolerated and safe. Bilateral stimulation with 600 V achieved considerable minute ventilation (median +/- SD, 7.2 +/- 3.4 L/min) that increased at higher voltage levels (P < 0.0001). 900 V achieved sufficient minute ventilation in all volunteers (11.5 +/- 5.0 L/min; 1200 V, 14.0 +/- 4.9 L/min). This first evaluation of electromagnetic ventilation demonstrates that it can be used to ventilate humans sufficiently. This method may be developed to a new mode of ventilation.

IntroductionRecent experimental data suggest that continuous external negative-pressure ventilation (CENPV) results in better oxygenation and less lung injury than continuous positive-pressure ventilation (CPPV). The effects of CENPV on patients with acute respiratory distress syndrome (ARDS) remain unknown.MethodsWe compared 2 h CENPV in a tankrespirator ("iron lung") with 2 h CPPV. The six intubated patients developed ARDS after pulmonary thrombectomy (n = 1), aspiration (n = 3), sepsis (n = 1) or both (n = 1). We used a tidal volume of 6 ml/kg predicted body weight and matched lung volumes at end expiration. Haemodynamics were assessed using the pulse contour cardiac output (PiCCO) system, and pressure measurements were referenced to atmospheric pressure.ResultsCENPV resulted in better oxygenation compared to CPPV (median ratio of arterial oxygen pressure to fraction of inspired oxygen of 345 mmHg (minimum-maximum 183 to 438 mmHg) vs 256 mmHg (minimum-maximum 123 to 419 mmHg) (P < 0.05). Tank pressures were -32.5 cmH2O (minimum-maximum -30 to -43) at end inspiration and -15 cmH2O (minimum-maximum -15 to -19 cmH2O) at end expiration. NO Inspiratory transpulmonary pressures decreased (P = 0.04) and airway pressures were considerably lower at inspiration (-1.5 cmH2O (minimum-maximum -3 to 0 cmH2O) vs 34.5 cmH2O (minimum-maximum 30 to 47 cmH2O), P = 0.03) and expiration (4.5 cmH2O (minimum-maximum 2 to 5) vs 16 cmH2O (minimum-maximum 16 to 23), P =0.03). During CENPV, intraabdominal pressures decreased from 20.5 mmHg (12 to 30 mmHg) to 1 mmHg (minimum-maximum -7 to 5 mmHg) (P = 0.03). Arterial pressures decreased by approximately 10 mmHg and central venous pressures by 18 mmHg. Intrathoracic blood volume indices and cardiac indices increased at the initiation of CENPV by 15% and 20% (P < 0.05), respectively. Heart rate and extravascular lung water indices remained unchanged.ConclusionsCENPV with a tank respirator improved gas exchange in patients with ARDS at lower transpulmonary, airway and intraabdominal pressures and, at least initially improving haemodynamics. Our observations encourage the consideration of further studies on the physiological effects and the clinical effectiveness of CENPV in patients with ARDS.

BackgroundA high incidence of epileptiform activity in the electroencephalogram (EEG) was reported in children undergoing mask induction of anaesthesia with administration of high doses of sevoflurane for 5 minutes and longer. This study was performed to investigate whether reducing the time of exposure to a high inhaled sevoflurane concentration would affect the incidence of epileptiform EEG activity. It was hypothesized that no epileptiform activity would occur, when the inhaled sevoflurane concentration would be reduced from 8% to 4% immediately after the loss of consciousness.Methodology/Principal Findings70 children (age 7–96 months, ASA I–II, premedication with midazolam) were anaesthetized with 8% sevoflurane in 100% oxygen via face mask. Immediately after loss of consciousness, the sevoflurane concentration was reduced to 4%. EEGs were recorded continuously and were later analyzed visually with regard to epileptiform EEG patterns. Sevoflurane at a concentration of 8% was given for 1.2±0.4 min (mean ± SD). In 14 children (20%) epileptiform EEG patterns without motor manifestations were observed (delta with spikes (DSP), rhythmic polyspikes (PSR), epileptiform discharges (PED) in 10, 10, 4 children (14%, 14%, 6%)). 38 children (54%) had slow, rhythmic delta waves with high amplitudes (DS) appearing on average before DSP.Conclusions/SignificanceThe hypothesis that no epileptiform potentials would occur during induction of anaesthesia with a reduction of the inspired sevoflurane concentration from 8% to 4% directly after LOC was not proved. Even if 8% sevoflurane is administered only briefly for induction of anaesthesia, epileptiform EEG activity may be observed in children despite premedication with midazolam.

Zusammenfassung Hintergrund Pankreastumore im Kindes- und Jugendalter sind seltene Entitäten, die lange Zeit asymptomatisch verlaufen und häufig als Zufallsbefund bei bildgebenden Untersuchungen aus anderen Gründen oder durch abdominelle Schmerzen auffallen. Solide pseudopapilläre Pankreasneoplasien (SPN) sind seltene Vertreter dieser Gruppe. Die Therapie der SPN besteht in der primären R0 Resektion. Wir stellen vier Fälle von SPN vor und diskutieren das individualisierte diagnostische und therapeutische Vorgehen. Methode Retrospektive Fallstudie an Hand von vier Patientinnen mit SPNs, die in den Jahren 2015–2020 behandelt wurden. Ergebnisse Bei vier weiblichen Patienten (11–17 Jahre) wurde eine SPN diagnostiziert. Drei SPN waren im Pankreaskopf lokalisiert. Die histologische Sicherung erfolgte durch eine endosonographisch-, CT-gesteuerte oder offene Tumorbiopsie. Eine R0-Resektion wurde mittels pyloruserhaltender, partieller Duodenopankreatektomie nach Traverso-Longmire erzielt. In einem Fall war der Tumor im Pankreasschwanz lokalisiert. Es bestand zusätzlich eine Tumoradhärenz an den Milzgefäßen. Eine CT-gesteuerte Biopsie bestätigte den Verdacht auf eine SPN und es erfolgte eine Pankreasschwanzresektion mit Splenektomie. Im Follow-up (6–72 Monate, Median: 28,5 Monate) ergaben sich bei keinem Patienten Hinweise auf Tumorrezidive, Metastasen oder einen pankreopriven Diabetes. Schlussfolgerung Zur Therapieplanung ist eine präoperative histologische Diagnosesicherung von SPN notwendig. Aufgrund der individualisierten diagnostischen und therapeutischen Konzepte, ist eine Versorgung in Zentren mit spezialisierter Kinderchirurgie, Kinderonkologie, Kinder-Gastroenterologie, Kinderradiologie und Pathologie essentiell.