CURRENT LITERATURE

Acute Maxillary Sinusitis in Children. Wald ER, Miloe GJ, Bowen A, Ledesma-Medina J. Salamon N, Bluestone

CA. N Engl J Med 13:749, 1981

This study was designed to correlate the clinical.

radiographic, and bacteriologic findings in maxillary

sinusitis in children. Thirty children who had both ab-

normal maxillary sinus radiographs and upper respiratory

tract symptoms were used. The most common symptoms

were cough, nasal discharge, and malodorous breath. Fever was occasionally present. Maxillary sinus aspira-

tions of 47 sinuses in 30 children yielded purulence in 31

cases, serous fluid in three. and bloody fluid in nine. The

most common species cultured were Streptowwtrs pllrrlr?lolrilrc~. tlrr~~m~phil~rs in,flrrermre, and Brmr~l~utnrll~~ cuttrrrhulis. No anaerobic bacteria were isolated, and vi-

ruses were isolated in only two cases. There was poor

correlation between the predominant species isolated

from the throat culture and the sinus aspirate.

The results of this study suggest that children with both abnormal maxillary sinus radiographs and upper respira-

tory tract infections frequently have bacteria and puru-

lence in their sinuses. suggesting bacterial sinusitis.-

PHYLLIS cl ARK

Massive Necrotizing Infections of the Neck. Krespi YP, Lawson W, Blaugrund SM. Biller HF. Head Neck

Surg 3:475. 19x1

Necrotizing hsciitis of the head and neck is a rare con-

dition; only seven cases have been recorded in the Iitera-

ture. Two cases are presented in which there was massive

necrosis of the soft tissues of the neck with extension into

the mediastinum. The offending organisms, a mixed

bacterial flora, produced gangrene accompanied by sub-

cutaneous emphysema. Both patients were successfully

treated with a regimen of intravenous antibiotics. fas-

ciotomy, radical debridement. and hyperbaric oxygena-

tion (one case). The clinical features, bacteriology, and

treatment of necrotizing fasciitis are reviewed.

Plasma Concentration and Clinical Effects of Loraze- pam After Oral Administration. Bradshaw EG. Ali AA.

Mulley BA. Rye RM. Br J Anaesth 53:517, 1981

Lorazepam has become a widely used premedicant be-

cause of its sedative and amnesic properties. This study

correlates amnesic, sedative, and anxiety-relieving ef-

fects with serum concentration following oral administra-

tion.

Lorazepam. 50 mgikg. was administered orally to pa-

tients six hours before surgery and to volunteers. Blood

samples were drawn at various time intervals, and serum

lorazepam concentrations were determined by gas-liquid chromatography. At the same time intervals. sedation and

anxiety were graded, and standard tests of short- and long-term recall were given.

Peak concentrations were generally obtained within 90

minutes. Sedation increased between one and six hours, peak sedation occurring three hours following adminis-

tration. Anxiety was reduced in patients during this time

period. Both short- and long-term recall were impaired in all subjects. Plasma concentrations between 30 and 50 n&ml produced maximal clinical effects, while concen- trations le5s than IO ngiml had little effect. Elimination

half-life ranged between 9.3 and 32. I hours. The average

plasma concentration after 24 hours was I4 n&ml.

This study, compared with similar studies involving in-

travenous lorazepam, indicates that oral administration

produces an equal degree of sedation with less rapid onset. The plasma concentration in some patients after 24

hours is sufficient to produce sedation and amnesia:

therefore, such patients, if discharged within 34 hours.

should be accompanied home and should avoid central

nervous system depressant drugs.-S-I-EVEN P. IRVING

The Effect of Diazepam on the Cerebral Metabolic State in Rats and Its Interaction with Nitrous Oxide. Carlsson C, Chapman AC. Anesthesiology 54:4X8. 1981

It has previously been shown in rats that diazepam alone has no effect on the cerebral metabolic rate (CMR,,,

but that it interacts with nitrous oxide to produce a 40%

reduction in the CMR,., value. In the present study. the

effect of sedative doses of diazepam on the cerebral

energy state, glycolysis, citric acid cycle. and amino acid

metabolism in rats was determined in the presence and

absence of a simultaneous administration of 70% nitrous

oxide, 45 seconds to 30 minutes after the diazepam injec-

tion. The metabolic response was very similar in the two

groups despite the differences in metabolic rates of oxy-

gen consumption. There were no changes in the cortical

concentrations of adenosine triphosphate. adenosine

diphosphate. and adenosine monophosphate phospho-

creatine, and creatine. The brain glycogen concentration was elevated during diazepam sedation, whereas brain

glucose levels remained close to normal values except 30

minutes after the administration of diazepam alone, when

the glucose level showed a 30? increase. The onset of

diazepam sedation was associated with an inhibition of

glycolysis at the phosphofructokinase step in both groups.

The reduced pyruvate concentration subsequently led to a reduction in the pool size of the citric acid cycle inter-

mediates. The concentrations of alanine and glutamate de-

creased during the period of diazepam sedation. while

those of aspartate and glutamine increased. Concentra-

tions of ammonia and gamma-aminobutyric acid remained

unchanged. Based on the cerebral metabolic response. the onhet of

diazepam sedation appears to be associated with an inhi-

bition of the rate of metabolism (glycolysis). in hoth the

presence and the absence of nitrous oxide. In that re-

spect, diazepam has a metabolic profile similar to those of

barbiturates.

Intravenous Fentanyl Kinetics. McClain DA. Hug CC

Jr. Surv Anesth. 35:216. 1981

Although fentanyl is a potent. short-acting narcotic

analgesic, prolonged and recurrent respiratory depression has been reported. This study was designed to determine

the kinetics of fentanyl disposition in human beings.

Studies were performed on seven men in good health

and free of significant drug intake. Each subject was given

a total “H-fentanyl dose of 3.2 or 6.4 mg/kg intravenously. Fentanyl levels were periodically determined from arterial

samples for eight hours, and urine and stool were analyzed for 72 hours.

In the study. 98.6G of the injected fentanyl dose was

eliminated from the plasma within 60 minutes. but the

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