No abstract

Limited evidence was noted, so ketamine CINs could be considered an adjunct therapy at this time. Further prospective studies should be conducted to determine ketamine's role in sedation and analgesia, withdrawal treatment, and bronchospasm treatment.

No abstract

A 9-year-old obese child with a history of ulcerative colitis was admitted to the intensive care unit for significant blood loss, hemorrhagic shock, and acute renal failure. Following complications from total colectomy secondary to multiple perforations, the patient developed heparin-induced thrombocytopenia (HIT) and subsequent portal vein thrombosis. Subcutaneous (SQ) fondaparinux therapy was initiated because the patient was unable to transition to oral anticoagulation. An anti-factor Xa assay was developed and used to adjust his fondaparinux therapy. Based on hemorrhagic complications and fondaparinux-based anti-factor Xa assay results, the fondaparinux was adjusted to a final dosage of 4.5 mg (0.066 mg/kg) SQ daily. In children unable to transition to oral anticoagulation, fondaparinux may be an alternative for the treatment of thrombosis associated with HIT. We noted that our patient required a lower dose per kilogram of fondaparinux than described in previous published reports. Despite this lower dosage per kilogram, our patient developed bleeding despite dosage reductions; subsequently, a few doses were held. It is unclear if this was related to his obesity, history of renal failure, or a combination of factors. Future studies should determine the optimal dose for special populations of children (e.g., those with obesity and renal failure). Until then, clinicians should routinely monitor and titrate fondaparinux therapy, ideally using a fondaparinux-specific anti-factor Xa assay.

A fatal case of Kawasaki disease with extensive cardiac involvement in an 11-week-old boy is described. Two-dimensional echocardiography revealed enlargement of the left ventricle, left atrium, and aortic root as well as dilatation of the left main coronary artery. Cardiac catheterization revealed both aortic and mitral regurgitation and fusiform dilatation of the proximal segments of the coronary arteries. The clinical course was characterized by multisystem failure and death on day 31 of the illness. Aortic regurgitation is a very rare complication of Kawasaki disease and has been previously reported in one Japanese infant. The pathogenesis of aortic regurgitation in this disease is not known but may be due to aortitis and/or valvulitis. Kawasaki disease should be included as a cause of aortic regurgitation in infants.