IntroductionCongenital hyperinsulinism [CHI] is a rare disorder characterised by hypoglycaemia secondary to excessive insulin secretion from the pancreas. The aim of management of CHI is to prevent severe and persistent hypoglycaemia which can lead to poor neurodevelopmental outcomes. Pancreatic surgery can play a role in the improvement of glycaemic safety in focal and diffuse CHI. Continuous glucose monitoring [CGM] is increasingly used in diabetes management, yet its application in CHI, particularly during perioperative settings, remains underexplored.ObjectiveThis study aimed to evaluate the utility and accuracy of CGM during pancreatic surgery in CHI patients.Research design and methodsA mixed methods observational study was conducted over three years involving 13 patients undergoing either focal lesionectomy or subtotal pancreatectomy. CGM was performed using the Dexcom G6 device, paired with point-of-care capillary blood glucose measurements to assess accuracy. Qualitative feedback from healthcare professionals and quantitative analysis of CGM data were collected.ResultsHyperglycaemia was observed in 8 patients, influenced by surgical stress and dextrose administration. CGM analysis revealed a median perioperative glucose level of 9.2 mmol/L, with a mean absolute relative difference [MARD] of 19.3% compared to capillary samples. The majority of professionals [94%] reported CGM as helpful in the perioperative period, highlighting its role in guiding prompt adjustment of dextrose infusions and reducing blood sampling frequency.ConclusionCGM demonstrates utility in monitoring glycaemic trends and managing hyperglycaemia during pancreatic surgery in CHI patients. The integration into perioperative care may further enhance surgical safety, extending the range of clinical applications of CGM.

Pediatric AnesthesiaVolume 19, Issue 6 p. 623-624 Correspondence Sedation of neonates with chloral Oliver R Dearlove, Oliver R Dearlove Manchester Children’s Hospital, Pendlebury, Manchester, UK (email: o.dearlove@man.ac.uk)Search for more papers by this authorBenoit Beauve, Benoit Beauve Manchester Children’s Hospital, Pendlebury, Manchester, UK (email: o.dearlove@man.ac.uk)Search for more papers by this author Oliver R Dearlove, Oliver R Dearlove Manchester Children’s Hospital, Pendlebury, Manchester, UK (email: o.dearlove@man.ac.uk)Search for more papers by this authorBenoit Beauve, Benoit Beauve Manchester Children’s Hospital, Pendlebury, Manchester, UK (email: o.dearlove@man.ac.uk)Search for more papers by this author First published: 06 May 2009 https://doi.org/10.1111/j.1460-9592.2009.03033.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume19, Issue6June 2009Pages 623-624 RelatedInformation

Objective: To assess the temporal relationship between ICU-acquired infection (IAI) and the prevalence and severity of organ dysfunction or failure (OD/F). Design and setting: Observational, single center study in a mixed intensive care unit of a university hospital. Patients: We analyzed 1,191 patients hospitalized for more than 2 days during a 2-year observation period: 845 did not acquire IAI, 306 of whom had infection on admission (IOA); 346 did acquire IAI, 125 of whom had IOA. Measurements and results: The SOFA score was calculated daily, both SOFAmax, the sum of the worst OD/F during the ICU stay, and SOFApreinf, the sum of the worst OD/F existing before the occurrence of the first IAI. The SAPS II and SOFA score of the first 24 h were significantly higher in patients with than in those without IAI. SOFApreinf of IAI patients was also higher than the SOFAmax of patients without IAI both in patients with (12.1 +/- 4.6 vs. 8.9 +/- 4.7) and those without IOA (9.2 +/- 4.0 vs. 6.7 +/- 3.5). SOFApreinf represented 85.7% of the value of SOFAmax in patients with IAI. SOFApreinf increased significantly with the occurrence of sepsis, severe sepsis, or septic shock during ICU stay. Severe sepsis and septic shock during ICU stay as well as SOFApreinf were part of the factors associated with hospital mortality. Conclusions: IAI is significantly associated with hospital mortality; however, its contribution to OD/F is minor. Moreover, severity of IAI seems to be related to previous health status.

Hassid et al. (1) should be commended for highlighting the need for anesthesia ⁄ sedation to facilitate intubation in the neonatal population. Several surveys show that many neonatal intensive care units do not administer any anesthesia ⁄ sedation for this procedure (2,3). Awake intubations may result in other complications as described in their report. I am concerned with the the authors’ use of sevoflurane to facilitate intubation. Sevoflurane is a drug which most non-anesthesiologists are unfamiliar with. It can cause myocardial and respiratory depression, laryngospasm and airway obstruction. MAC for term infants is approximately 3.3%. MAC of sevoflurane has also not been determined in the preterm population but is most likely lower than in term infants. In this study, the patients received 2–5% sevoflurane. Due to their decreased myocardial reserve, neonates are at significant risk to develop hypotension with high concentrations of volatile agents, and it is likely that preterm infants pose an even higher risk. The most recent report of the Pediatric Perioperative Cardiac Arrest (POCA) registry showed sevoflurane, laryngospasm and airway obstruction to be responsible for 3%, 6% and 3% of cardiac arrests respectively (4). The authors conclude that sevoflurane ‘facilitates the conditions for intubation...’ They support this statement by showing a significant difference in lack of movement (95.5% vs 28%) and a lower incidence of bradycardia (8.3 vs 44.4%) in the sevoflurane group. However in spite of better intubating conditions, the intubation failure rate in the study and control groups were not statistically different (25% vs 39%). Any pediatric anesthesiologist would consider such intubation failure rates to be abysmal. The duration of desaturation was also longer in the sevoflurane group although this too was not statistically significant. It is concerning to note that the mean duration of desaturation was 115 s in the sevoflurane group. While I would agree that with the authors that administering sevoflurane may be more humane, their data do not show an improvement in intubation. Moreover, there are inherent risks associated with the use of moderate concentrations of volatile agents in untrained hands in this very fragile population of children. Tetsu Uejima Department of Pediatric Anesthesia, Children’s Memorial Hospital, Children’s Plaza, Chicago, Illinois, USA (email: tuejima@childrensmemorial.org)

Pediatric AnesthesiaVolume 18, Issue 9 p. 892-893 Sedation of children under 4 weeks of age for MRI examination Benoit Beauve, Benoit Beauve Royal Manchester Children's Hospital, Pendlebury, Manchester M27 4HA, UK(email: o.dearlove@man.ac.uk)Search for more papers by this authorOliver Dearlove, Oliver Dearlove Royal Manchester Children's Hospital, Pendlebury, Manchester M27 4HA, UK(email: o.dearlove@man.ac.uk)Search for more papers by this author Benoit Beauve, Benoit Beauve Royal Manchester Children's Hospital, Pendlebury, Manchester M27 4HA, UK(email: o.dearlove@man.ac.uk)Search for more papers by this authorOliver Dearlove, Oliver Dearlove Royal Manchester Children's Hospital, Pendlebury, Manchester M27 4HA, UK(email: o.dearlove@man.ac.uk)Search for more papers by this author First published: 28 July 2008 https://doi.org/10.1111/j.1460-9592.2008.02580.xCitations: 16Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume18, Issue9September 2008Pages 892-893 RelatedInformation