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Biomedical subjects

G F Kasian

Publications and source records attributed to G F Kasian.

13 recordsLinked to original sources
PubMed1991

Chloral hydrate disposition following single-dose administration to critically ill neonates and children.

Although the metabolism and pharmacokinetics of chloral hydrate (CH) have been studied in healthy adults, no comprehensive studies have been done in neonates and young infants. Major physiological differences between these groups could greatly affect drug disposition. In this study the patient population (22 patients) was divided into three groups according to postconceptual age: group 1 = preterm infants (31-37 weeks), group 2 = fullterm infants (38-42 weeks) and group 3 = toddler-child patients (57-708 weeks). After receiving one 50 mg/kg oral dose of CH, the parent drug and its metabolites were determined by gas chromatography utilizing an electron capture detector. CH, contrary to what has been reported in the adult, was detectable for several hours after oral administration to patients in all three groups. A highly significant negative correlation was observed amongst the three groups for the half-life (t1/2) and area-under-the-curve for 0 to infinity values for trichloroethanol (TCE), the active metabolite responsible for the sedation effect. The t1/2 value for TCE in group 3 (9.67 h) was similar to that reported for the adult population, but in the less mature subjects it was approximately three (group 2: 27.8 h) to four times (group 1: 39.8 h) greater. Trichloroacetic acid had a remarkably long residence time in the study population after a single dose of CH. The concentration of this metabolite failed to decline even 6 days after dose. These issues should be carefully considered when CH administration is contemplated for clinical use in neonates, infants and children.

Administration, Oral↗
PubMed1989

Bacterial tracheitis in children.

We examined the records of 14 patients aged 7 months to 10 1/4 years who were treated for bacterial tracheitis from May 1982 to December 1987; the management protocol for 13 of the patients included the use of nasotracheal intubation. The infection was caused by Staphylococcus aureus in seven, Haemophilus influenzae in three, Branhamella catarrhalis in one and Streptococcus pneumoniae in one. Both H. influenzae and B. catarrhalis were isolated in another patient, and no organism was found in the remaining patient. In addition to the bacteria, viruses were cultured from the tracheal secretions of two patients. The mean duration of intubation was 7.6 days and of hospital stay 9.2 days. Twelve of the cases occurred during the cold months of the year (October to March). Of the three deaths only one occurred in the pediatric intensive care unit and was due to severe bronchospasm and an air leak that caused bilateral pneumothorax and pneumomediastinum. In one patient subglottic stenosis developed that necessitated tracheostomy. Healing began 5 to 9 days after the onset of symptoms, as demonstrated with the use of repeated fibreoptic bronchoscopy. We found that the airway could be safely managed with the use of a nasotracheal tube. Bronchoscopy helped to confirm the diagnosis, to remove adherent secretions and to monitor the course of the disease. The ventilation tube can be removed after the patient's temperature returns to normal, if there is an air leak around the tube, if the quantity and viscosity of the secretions decrease and if healing is observed at bronchoscopy.

Airway Obstruction↗
PubMed1989

Branhamella catarrhalis bronchopulmonary isolates in PICU patients.

Branhamella catarrhalis is commonly considered a respiratory commensal but has recently been implicated as a pathogen, particularly in adults. Over a 28 month period, B. catarrhalis was isolated from bronchopulmonary secretions of 14 PICU patients with acute respiratory infections. Twelve patients had pneumonia and two had tracheitis. The mean age was 3.5 years. Seven patients had chronic cardiopulmonary disease including two who were immunosuppressed. Three had an acute underlying condition and four had no complicating medical problem. Polymorphs and Gram-negative diplococci on Gram stain were found in respiratory secretions of all patients. Twelve of 14 isolates produced beta-lactamase, and six patients had a second potentially pathogenic bronchopulmonary isolate. All patients were treated for B. catarrhalis infection and none died. When isolated in pure culture from bronchopulmonary secretions in symptomatic patients, B. catarrhalis should be considered a pathogen. When isolated in mixed culture, its pathogenic role is uncertain. We conclude that B. catarrhalis can be a bronchopulmonary pathogen in critically ill children with otherwise normal cardiopulmonary function as well as in those with chronic cardiopulmonary dysfunction. When administering antibiotics the high frequency of beta-lactamase-producing strains must be taken into consideration.

Adolescent↗
PubMed1989

Chloral hydrate sedation in neonates and infants--clinical and pharmacologic considerations.

Chloral hydrate has been used clinically for over 100 years. There is significant paucity of information regarding chloral hydrate metabolism in neonates and infants. Chloral hydrate and its various metabolites were quantitated in 12 neonates and 2 infants at prescribed time intervals. The analysis of the data indicates accumulation of trichloroacetic acid and trichloroethanol in tissue of compromised infants. There is indirect evidence of competition for hepatic glucuronidation for bilirubin with trichloroethanol in ill preterm infants. Multiple dosing of chloral hydrate in preterm infants should be used with caution and frequent monitoring of serum bilirubin concentrations is indicated in such cases. The mechanism of chloral hydrate metabolism is discussed in detail.

Bilirubin↗
PubMed1988

Bacteriologic surveillance of indwelling urinary catheters in pediatric intensive care unit patients.

Daily cultures were obtained from the proximal tubing port on 108 indwelling urinary catheters in 100 pediatric ICU (PICU) patients aged 1 month to 17 yr to establish the risk of acquiring bacteriuria. Group 1 patients (58 catheters) were catheterized in the PICU and group 2 patients (50 catheters) were catheterized in the operating room. Group 1 patients had a significantly (p less than .03) greater risk of bacteriuria than group 2 during the early days of surveillance, but the final cumulative risk in both groups was similar (27% in group 1 and 37% in group 2). Combined, the overall cumulative risk was 29.1%. The risk of acquiring a urinary tract infection was not related to sex or prior antibiotic use. There was a significantly greater risk (p less than .025) in children under 1 yr of age.

Adolescent↗
PubMed1988

Treatment of pulmonary hypertension with diltiazem in a child with bronchopulmonary dysplasia.

A two-year-old child dying of pulmonary hypertension and cor pulmonale secondary to bronchopulmonary dysplasia, was demonstrated to have reactive pulmonary hypertension in response to 100% oxygen and isoproterenol infusion. In an attempt to find an oral medication to maintain pulmonary vasodilatation, experimental trials were done using hydralazine, salbutamol, nifedipine and diltiazem. Cardiac index, pulmonary and systemic vascular resistances and intrapulmonary shunts were monitored during the trials. Hydralazine, salbutamol and nifedipine were ineffective. Diltiazem 2.0 mg given every 6 h resulted in a profound and sustained decrease in pulmonary pressures and resistance, and a reversal of the cor pulmonale.

Albuterol↗
PubMed1986

Elective orotracheal intubation and aspiration for microbiologic diagnosis in children.

Endotracheal intubation is generally performed to facilitate the treatment of respiratory failure or to control the airway during general anesthesia. We electively intubated 14 children with undiagnosed pneumonia to obtain tracheobronchial secretions for microbiologic diagnosis. Three were intubated awake, three with sedation, and eight with sedation and neuromuscular blockade. Mycobacterium tuberculosis was isolated in four of six patients suspected of having tuberculosis. Other bacterial pathogens were isolated in three patients and viral pathogens in three patients. The procedure proved useful in 11 (79%) of the 14 patients, with no complications. We conclude that elective orotracheal intubation is a safe, simple, fast, and effective method of obtaining secretions for the culture of organisms responsible for lower airway and lung parenchymal infections in children.

Bacteriological Techniques↗
PubMed1985

Congenital tracheal occlusion in neonates--a minireview.

Congenital tracheal occlusion, though seemingly rare, is generally fatal if not attended to immediately. A high index of suspicion should help to make the diagnosis in a neonate when there are respiratory distress at birth and no audible cry and an endotracheal tube cannot be advanced beyond the vocal cords. We present our experience with cases of congenital tracheal obstruction due to various causes during a period of four years.

Female↗
PubMed1982

Family outbreak of yersiniosis.

Yersinia enterocolitica biotype 1, serotype O:21 was isolated from feces or rectal washings of three members of one family in northwestern Saskatchewan. The three isolates gave positive pathogenicity tests in guinea pigs with cultures grown at 22 degrees C as inoculum. All three cases showed clinical symptoms consistent with yersiniosis. All three cases had symptoms of diarrhea and abdominal pain, and two cases had recorded fever. In two cases, appendicitis was initially suspect. One case with ileitis and peritonitis was fatal. The environmental source of the infection was not found, but river water, milk, and person-to-person spread are discussed as possible sources of the infections. The need for microbiology laboratories to culture stool specimens specifically for Y. enterocolitica, using cold-enrichment techniques is emphasized. This family outbreak of yersiniosis provides further evidence that certain biotype 1 strains of Y. enterocolitica are pathogenic.

Adult↗
PubMedDate not supplied

Elective oro-tracheal intubation to diagnose sleep apnea syndrome in children with Down's syndrome and ventricular septal defect.

Three children with Down's syndrome, ventricular septal defect, pulmonary hypertension and clinical evidence of upper airway obstruction had the trachea electively intubated while pulmonary artery pressures were monitored. In two, the pulmonary pressures immediately decreased and systemic arterial oxygen saturations increased. Both of these children showed dramatic clinical improvement after tonsillectomy. These cases indicate that elective tracheal intubation is a valuable diagnostic procedure to demonstrate the role of upper airway obstruction in the maintenance of reversible pulmonary hypertension in children with Down's syndrome and right to left shunts.

Airway Obstruction↗