There were 146 patients with a median age of 4.6 years (range, 0.18-17.1 years), 46.6% were male, 80.8% were light skin colored, and 15.7% were younger than 2 years. The first-attempt success rates were 75% (95% CI, 63.8-84.2%) using AV300 and 73% (95% CI, 61.9-81.9%) using the standard method (P = 0.85). Patients with dark or medium skin color were 0.38 times less likely to have a successful first attempt than patients with light skin color. The difference between the two treatment groups in number of skin punctures and the time to insertion was not significant. Although the AV300 was easy to use and improved visualization of the veins, we found no evidence that it was superior to the standard method of intravenous cannulation in unselected pediatric patients under anesthesia.

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Objective Methadone prolongs cardiac conduction, from mild corrected QT (QTc) prolongation to torsades de pointes and ventricular fibrillation, in adults. However, methadone use for pain and its effects on cardiac conduction have not been investigated in pediatric populations. Methods A retrospective review of QTc intervals in patients receiving methadone analgesia was conducted. Medical records from a 4-year period (September 2006 to October 2010) at a pediatric oncology institution were reviewed, and correlations were tested between cardiac conduction and methadone dosage and duration of therapy, electrolyte levels, renal and hepatic dysfunction, and concurrent medications. Results Of the 61 patients who received methadone, 37 met our inclusion criteria and underwent 137 electrocardiograms (ECGs). During methadone treatment, the mean QTc was longer than that at baseline (446.5 vs 437.55 ms). The mean methadone dose was 27.0 ± 24.3 mg/d (range, 5–125 mg/d; median, 20 mg/d) or 0.47 ± 0.45 mg/kg per day (range, 0.05–2.25 mg/kg per day; median, 0.37 mg/kg per day), and the mean duration of therapy was 49 days. The authors identified a correlation between automated and manual ECG readings by two cardiologists (Pearson r = 0.649; p < 0.0001), but the authors found no correlations between methadone dose or duration and concurrent QTc-prolonging medications, sex, age, electrolyte abnormalities, or renal or hepatic dysfunction. Conclusion At a clinically effective analgesic dose, methadone dosage and duration were not correlated with QTc prolongation, even in the presence of other risk factors, suggesting that methadone use may be safe in pediatric populations. The correlation between automated and manual ECG readings suggests that automated ECG readings are reliable for monitoring cardiac conductivity during the reported methadone-dosage regimens.

BackgroundDyslipidaemias result from the interaction between genetic and environmental factors, including diet disequilibrium and physical inactivity. Among the genetic factors associated with serum lipids, the Taq1B CETP polymorphism has been investigated. The B1 allele has been considered as a risk factor for dyslipidaemia because of its association with greater CETP levels and higher serum triglycerides. The present study aimed to determine the role of the Taq1B polymorphism with lipid and anthropometric variables and its interaction with diet and physical activity.MethodsIn total, 215 subjects were enrolled in this cross‐sectional study. Diet intake was evaluated using a 3‐day food consumption record and physical activity was determined in accordance with World Health Organization recommendations. The Taq1B CETP polymorphism was determined by allelic discrimination.ResultsSubjects with the B1B2/B2B2 genotype, who had a sucrose consumption ≥5% of the total kcal day−1, had higher levels of total cholesterol (TC) [165.55 (142.21–188.89) mg dL−1 versus 200.19 (184.79–215.60) mg dL−1; P for interaction = 0.034] and low‐density lipoprotein [99.29 (75.52–123.05) mg dL−1 versus 128.64 (113.59–143.69) mg dL−1; P for interaction = 0.037] than subjects with the B1B1 genotype. Subjects who did not perform physical activity and had the B1B2/B2B2 genotype showed significantly higher levels of TC [177.48 (161.36–193.60) mg dL−1 versus 194.49 (185.43–203.56) mg mL−1; P for interaction = 0.033] than subjects with the B1B1 genotype.ConclusionsWe provide evidence that subjects with inadequate environmental factors carriers of the polymorphic genotype had higher serum lipid levels than subjects with the B1B1 genotype.

Background Patient controlled anesthesia (PCA) is increasingly used to manage pain in pediatric cancer patients and is important in the treatment of escalating pain at the end of life. The description of the use of opioid PCA in this population has been limited. Procedure This retrospective chart review of the last 2 weeks of life addressed the following objectives: 1) to describe the patient population treated with opioid PCA; 2) to describe the morphine-equivalent doses (MED) (mg/kg/day); and 3) to describe the pain scores (PS). Results Twenty-eight percent of inpatients used opioid PCA for pain control during the last 2 weeks of life. The mean MED (mg/kg/day) (SD) at 2 weeks prior and the day of death were 10.7 (17.9) and 19 (25.8). The mean MED increased over the last 2 weeks of life for all patients and across age groups and cancer diagnoses (all p<0.05). The mean MED was significantly higher in the younger age group (age <13 vs. age ≥13) on the day of death (p<0.04). There was a significant change in mean PS over the last 2 weeks of life (p<0.001), with the highest PS on the day before death. The most frequently used concurrent medications were benzodiazepines (91%). Conclusions Children and young adults with cancer experience high opioid requirements and significant dose increases during the last 2 weeks of life. Additionally PS increase toward the end of life. Opioid rotation and addition of adjuvant medications merit consideration in the context of escalating opioid requirements.