Children undergoing major craniofacial surgery (MCFS) oftenHyperkalaemia is a recognized complication of massive blood transfusion with whole blood. Both the quantity of blood transfused and the rate of blood transfusion have been identified as risk factors.L-4Since the introduction of blood component therapy in the 1970's, all whole blood donations are separated into specific cellular and plasma components for storage. Therefore blood loss during surgery requires transfusion of each blood component. Massive transfusion with red blood cell concentrates (RBCconc) is not believed to carry the same risk of hyperkalaemia as does transfusion with whole blood because the amount of extracellular potassium per unit of RBCconc is believed to be small. 3'5 However, the plasma [K +] in units of RBCconc has been measured to be in excess of 30 mmol. L-1, and thus the extracellular mass of potassium in a unit of RBCconc may be of clinical importance even though the plasma volume in the unit is small. 6-8Our hypothesis was that massive blood transfusion with RBCconc presented a clinically important potassium load. Children undergoing major craniofacial surgery may require blood transfusion in excess of one blood volume. In addition some of these children have been observed to have high intraoperative plasma [K § Therefore children undergoing major craniofacial surgery (MCFS) were the focus of our investigation. The study is presented in two parts. The first is a retrospective chart CAN J ANAESTH 1990/ 37:4 /pp401-8

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SOON after it was shown by Rosner et al. (1965) and Tu and Zellweger (1965) that the whole blood serotonin level of children with Down's syndrome is depressed, Bazelon and her colleagues (1967, 1968) tried treating young infants with Down's syndrome with the serotonin precursor 5hydroxytryptophan. Although this produced little change in the blood serotonin level, there were marked increases in the total 5-hydroxyindoles in whole blood. These workers reported concomitant improvements in motor behaviour; muscle tone and motor activity were increased, tongue protrusion decreased and motor development accelerated in the first year of life.As a pilot study of this phenomenon, we have conducted a short, controlled trial of the effects of 5-hydroxytryptophan on the motor behaviour and serotonin metabolism of a small group of retarded children both with and without Down's syndrome.