Purpose: Two modalities of epidural analgesia in children with two types of cerebral palsy (CP) were compared for differences in the incidence of common complications (inadequate analgesia, hypopnea, hypoxaemia, sedation, vomiting, pruritus, urinary retention, and seizures). Methods: Demographic, procedural and postoperative complication data were collected on children with CP receiving epidural analgesia. Information was recorded contemporaneously with the child's care by one of the authors on 92 consecutive children with CP (age, 107 ___ 50. I mo; weight, 26 ___ 14.2 kg) who had undergone infraumbilical orthopaedic or Nissen fundoplication procedures between December 1994 and December 1996. The first 44 patients received intermittent bolus (IB) epidural morphine and the next 48 received continuous infusion ( (21) bupivacaine and fentanyl. Two forms of CP (spastic diplegia and quadriplegia) and the two modalities of analgesia were compared. Results: Excellent analgesia was obtained in 91192 patients. Excessive sedation occurred in six patients (6.5%) but only in IB patients, (P < 0.02 vs Cl). Emesis occurred in 52% of patients, and was more common in diplegic than in quadriplegic patients (68% v~ 38%, P < 0.01). Pruritus was observed in 29% of patients and was more common in diplegia than quadriplegia (48% vs 12.5%, P < 0.00 I). The incidences of hypopnea, hypoxaemia, urinary retention and seizures were not affected by the types of CP or analgesia and no difference in sedation was observed between spastic diplegic and quadriplegic patients. Cx)nck~ions: Continuous infusion of epidural bupivacaine and fentanyl provided excellent analgesia for children with CP without serious complications. Intermittent bolus epidural morphine was associated with a high incidence of excessive sedation and should be avoided in this. population. l~]t~ts: Une excellente analg&ie a ~t~ obtenue chez 91 des 92 patients. Une s~dation excessive a ~t~ not& chez six patients (6,S %) mais clans le groupe BI seulement, (P < 0,02 vs CP). Chez 52 % des patients, il y a eu des vomissements qui ~taient plus frequents chez les enfants dipl~giques que chez les quadriplEgiques (68 % vs 38 %, P < 0,01). On a observ~ du prurit chez 29 % des enfants et surtout chez les diplEgiques par rapport aux quadripl~giques (48 % vs 12,5 %, P < 0,00 I). l'incidence de l'hypopn~e, de l'hypox~mie, de la r&ention urinaire et des convulsions n'~tait pas influenc~e par le type d'IMC ou d'analg&ie et aucune diff&ence de s~dation n'a ~t~ observ~e entre les patients dipl~giques et les patients quadripl~giques. C~nd~sion : La perfusion continue de bupivacaine et de fentanyl p&iduraux a fourni une excellente analg&ie, sans complications importantes, ~ des enfants atteints d'IHC. Les bolus intermittents de morphine p&idurale ont ~t~ associ& ~ une plus forte incidence de s~dation excessive et on devrait ~viter de les utiliser aupr& de cette population.From the

We have used optically detected magnetic resonance (ODMR) to characterize the degree of solvent availability of the tryptophan residues in lysozyme that are likely to be responsible for the observed phosphorescence. From the phosphorescence spectra, ODMR zero-field splittings (zfs), and ODMR line widths, we concur with the X-ray structure [Blake, C. C., Mair, G. A., North, A. C. T., Phillips, D. C., & Sarma, V. R. (1967) Proc. R. Soc. London, ser. B 167, 365-377] that Trp-62 behaves as an exposed residue and Trp-108 is buried. In addition, we present evidence that ODMR can be used in conjunction with conventional phosphorescence to evaluate the degree of order in the microenvironments of tryptophan in a protein containing several tryptophans. By the specific modification of residues Trp-62 and Trp-108, we have identified those portions of the ODMR lines in the native enzyme that are due to those specific residues. Barring major enzyme conformational changes in the vicinity of unmodified tryptophan residues when Trp-62 or Trp-108 are selectively modified, we find that Trp-108 dominates both the phosphorescence and the ODMR signals in native lysozyme. The results are discussed in view of previous fluorescence findings.