BACKGROUND. Extreme hormonal and metabolic responses to stress are associated with increased morbidity and mortality in sick adults. We hypothesized that administering deep opioid anesthesia to critically ill neonates undergoing cardiac surgery would blunt their responses to stress and might improve clinical outcomes. METHODS. In a randomized trial, 30 neonates were assigned to receive deep intraoperative anesthesia with high doses of sufentanil and postoperative infusions of opiates for 24 hours; 15 neonates were assigned to receive lighter anesthesia with halothane and morphine followed postoperatively by intermittent morphine and diazepam. Hormonal and metabolic responses to surgery were evaluated by assay of arterial blood samples obtained before, during, and after the operations. RESULTS. The neonates who received deep anesthesia (with sufentanil) had significantly reduced responses of beta-endorphin, norepinephrine, epinephrine, glucagon, aldosterone, cortisol, and other steroid hormones; their insulin responses and ratios of insulin to glucagon were greater during the operation. The neonates who received lighter anesthesia (with halothane plus morphine) had more severe hyperglycemia and lactic acidemia during surgery and higher lactate and acetoacetate concentrations postoperatively (P less than 0.025). The group that received deep anesthesia had a decreased incidence of sepsis (P = 0.03), metabolic acidosis (P less than 0.01), and disseminated intravascular coagulation (P = 0.03) and fewer postoperative deaths (none of 30 given sufentanil vs. 4 of 15 given halothane plus morphine, (P less than 0.01). CONCLUSIONS. In neonates undergoing cardiac surgery, the physiologic responses to stress are attenuated by deep anesthesia and postoperative analgesia with high doses of opioids. Deep anesthesia continued postoperatively may reduce the vulnerability of these neonates to complications and may reduce mortality.
Source Information
Department of Medicine, Children's Hospital, Boston, MA.
This article has been cited by other articles:
Aucott, S. W., Watterberg, K. L., Shaffer, M. L., Donohue, P. K., for the PROPHET Study Group,
(2008). Do Cortisol Concentrations Predict Short-Term Outcomes in Extremely Low Birth Weight Infants?. Pediatrics
122: 775-781
[Abstract][Full Text]
Gjerstad, A. C., Wagner, K., Henrichsen, T., Storm, H.
(2008). Skin Conductance Versus the Modified COMFORT Sedation Score as a Measure of Discomfort in Artificially Ventilated Children. Pediatrics
122: e848-e853
[Abstract][Full Text]
Stuth, E.
(2007). Phenoxybenzamine Is Indicated in Treatment of Hypoplastic Left Heart Syndrome: Pro. Anesth. Analg.
105: 307-309
[Full Text]
Murphy, G. S., Szokol, J. W., Marymont, J. H., Avram, M. J., Vender, J. S.
(2007). The Effects of Morphine and Fentanyl on the Inflammatory Response to Cardiopulmonary Bypass in Patients Undergoing Elective Coronary Artery Bypass Graft Surgery. Anesth. Analg.
104: 1334-1342
[Abstract][Full Text]
American Academy of Pediatrics, , Committee on Fetus and Newborn and Section on Surg, , Canadian Paediatric Society, , Fetus and Newborn Committee,
(2006). Prevention and Management of Pain in the Neonate: An Update. Pediatrics
118: 2231-2241
[Abstract][Full Text]
Cao, J., Cetrulo, C. L., Theoharides, T. C.
(2006). Corticotropin-Releasing Hormone Induces Vascular Endothelial Growth Factor Release from Human Mast Cells via the cAMP/Protein Kinase A/p38 Mitogen-Activated Protein Kinase Pathway. Mol. Pharmacol.
69: 998-1006
[Abstract][Full Text]
Chaney, M. A.
(2006). Intrathecal and Epidural Anesthesia and Analgesia for Cardiac Surgery. Anesth. Analg.
102: 45-64
[Abstract][Full Text]
Sanders, R. D., Patel, N., Hossain, M., Ma, D., Maze, M.
(2005). Isoflurane exerts antinociceptive and hypnotic properties at all ages in Fischer rats. Br J Anaesth
95: 393-399
[Abstract][Full Text]
Lee, S. J., Ralston, H. J. P., Drey, E. A., Partridge, J. C., Rosen, M. A.
(2005). Fetal Pain: A Systematic Multidisciplinary Review of the Evidence. JAMA
294: 947-954
[Abstract][Full Text]
Davis, P. J.
(2005). Goldilocks: The Pediatric Anesthesiologist's Dilemma. Anesth. Analg.
100: 650-652
[Full Text]
Parlow, J. L., Steele, R. G., O'Reilly, D.
(2005). Low dose intrathecal morphine facilitates early extubation after cardiac surgery: results of a retrospective continuous quality improvement audit: [L'administration intrathecale d'une faible dose de morphine facilite l'extubation precoce apres la cardiochirurgie : resultats d'un audit retrospectif continu sur l'amelioration de la qualite]. Canadian J. Anesthesia
52: 94-99
[Abstract][Full Text]
Simons, S H P, van Dijk, M, van Lingen, R A, Roofthooft, D, Boomsma, F, van den Anker, J N, Tibboel, D
(2005). Randomised controlled trial evaluating effects of morphine on plasma adrenaline/noradrenaline concentrations in newborns. Arch. Dis. Child. Fetal Neonatal Ed.
90: F36-F40
[Abstract][Full Text]
Groban, L., Vernon, J. C., Butterworth, J.
(2004). Intrathecal Morphine Reduces Infarct Size in a Rat Model of Ischemia-Reperfusion Injury. Anesth. Analg.
98: 903-909
[Abstract][Full Text]
Hoffman, G. M., Tweddell, J. S., Ghanayem, N. S., Mussatto, K. A., Stuth, E. A., Jaquis, R. D. B., Berger, S.
(2004). Alteration of the critical arteriovenous oxygen saturation relationship by sustained afterload reduction after the norwood procedure. J. Thorac. Cardiovasc. Surg.
127: 738-745
[Abstract][Full Text]
Weale, N. K., Rogers, C. A., Cooper, R., Nolan, J., Wolf, A. R.
(2004). Effect of remifentanil infusion rate on stress response to the pre-bypass phase of paediatric cardiac surgery. Br J Anaesth
92: 187-194
[Abstract][Full Text]
Hoffman, G. M., Stuth, E. A., Jaquiss, R. D., Vanderwal, P. L., Staudt, S. R., Troshynski, T. J., Ghanayem, N. S., Tweddell, J. S.
(2004). Changes in cerebral and somatic oxygenation during stage 1 palliation of hypoplastic left heart syndrome using continuous regional cerebral perfusion. J. Thorac. Cardiovasc. Surg.
127: 223-233
[Abstract][Full Text]
Schwann, N. M., Chaney, M. A.
(2003). No pain, much gain?. J. Thorac. Cardiovasc. Surg.
126: 1261-1264
[Full Text]
Simons, S. H. P., van Dijk, M., Anand, K. S., Roofthooft, D., van Lingen, R. A., Tibboel, D.
(2003). Do We Still Hurt Newborn Babies?: A Prospective Study of Procedural Pain and Analgesia in Neonates. Arch Pediatr Adolesc Med
157: 1058-1064
[Abstract][Full Text]
Weatherstone, K. B., Franck, L. S., Klein, N. J.
(2003). Are There Opportunities to Decrease Nosocomial Infection by Choice of Analgesic Regimen?: Evidence for Immunity and Pain Interactions. Arch Pediatr Adolesc Med
157: 1108-1114
[Abstract][Full Text]
Golden, S.
(2003). Surgical Stress Response in Neonates and Premature Infants. Anesth. Analg.
96: 1526-1526
[Full Text]
Pirat, A., Akpek, E., Arslan, G.
(2002). Intrathecal Versus IV Fentanyl in Pediatric Cardiac Anesthesia. Anesth. Analg.
95: 1207-1214
[Abstract][Full Text]
Berkenbosch, J. W., Fichter, C. R., Tobias, J. D.
(2002). The Correlation of the Bispectral Index Monitor with Clinical Sedation Scores During Mechanical Ventilation in the Pediatric Intensive Care Unit. Anesth. Analg.
94: 506-511
[Abstract][Full Text]
Mollhoff, T., Herregods, L., Moerman, A., Blake, D., MacAdams, C., Demeyere, R., Kirno, K., Dybvik, T., Shaikh, S., Remifentanil Study Group, t.
(2001). Comparative efficacy and safety of remifentanil and fentanyl in fast track' coronary artery bypass graft surgery: a randomized, double-blind study. Br J Anaesth
87: 718-726
[Abstract][Full Text]
Bouwmeester, N. J., Anand, K. J. S., van Dijk, M., Hop, W. C. J., Boomsma, F., Tibboel, D.
(2001). Hormonal and metabolic stress responses after major surgery in children aged 0-3 years: a double-blind, randomized trial comparing the effects of continuous versus intermittent morphine{dagger}. Br J Anaesth
87: 390-399
[Abstract][Full Text]
Committee on Psychosocial Aspects of Child and Fam, , Task Force on Pain in Infants, Children, and Adole,
(2001). The Assessment and Management of Acute Pain in Infants, Children, and Adolescents. Pediatrics
108: 793-797
[Abstract][Full Text]
Debillon, T, Zupan, V, Ravault, N, Magny, J-F, Dehan, M, ABU-SAAD, H H
(2001). Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. Arch. Dis. Child. Fetal Neonatal Ed.
85: F36-41
[Abstract][Full Text]
Foster, E., Graham, T. P. Jr., Driscoll, D. J., Reid, G. J., Reiss, J. G., Russell, I. A., Sermer, M., Siu, S. C., Uzark, K., Williams, R. G., Webb, G. D.
(2001). Task Force 2: special health care needs of adults with congenital heart disease. J Am Coll Cardiol
37: 1176-1183
[Full Text]
Gruber, E. M., Laussen, P. C., Casta, A., Andrew Zimmerman, A., Zurakowski, D., Reid, R., Odegard, K. C., Chakravorti, S., Davis, P. J., McGowan, F. X. Jr, Hickey, P. R., Hansen, D. D.
(2001). Stress Response in Infants Undergoing Cardiac Surgery: A Randomized Study of Fentanyl Bolus, Fentanyl Infusion, and Fentanyl-Midazolam Infusion. Anesth. Analg.
92: 882-890
[Abstract][Full Text]
Black, M. D., Pike, N., Koransky, M., Humel, M., McCarthy, P. J., Smith, R., Boltz, G. M., Wellis, V., Uezono, S., Hammer, G. B.
(2001). Innovations and Future Directions in Pediatric Cardiac Anesthesia and Surgery. SEMIN CARDIOTHORAC VASC ANESTH
5: 113-116
[Abstract]
Hoffman, G. M., Ghanayem, N. S., Kampine, J. M., Berger, S., Mussatto, K. A., Litwin, S. B., Tweddell, J. S.
(2000). Venous saturation and the anaerobic threshold in neonates after the Norwood procedure for hypoplastic left heart syndrome. Ann. Thorac. Surg.
70: 1515-1520
[Abstract][Full Text]
Hall, R., Adderley, N., MacLaren, C., McIntyre, A., Barker, R., Imrie, D., Allen, C., Glenn, J., Fairhurst, K., McLaren, R.
(2000). Does intrathecal morphine alter the stress response following coronary artery bypass grafting surgery?. Canadian J. Anesthesia
47: 463-466
[Abstract][Full Text]
Steven, J. M., McGowan, F. X. Jr.
(2000). Neuraxial Blockade for Pediatric Cardiac Surgery: Lessons Yet to Be Learned. Anesth. Analg.
90: 1011-1013
[Full Text]
Munoz, R., Laussen, P. C., Palacio, G., Zienko, L., Piercey, G., Wessel, D. L.
(2000). CHANGES IN WHOLE BLOOD LACTATE LEVELS DURING CARDIOPULMONARY BYPASS FOR SURGERY FOR CONGENITAL CARDIAC DISEASE: AN EARLY INDICATOR OF MORBIDITY AND MORTALITY. J. Thorac. Cardiovasc. Surg.
119: 155-162
[Abstract][Full Text]
Greenberg, R. S., Billett, C., Zahurak, M., Yaster, M.
(1999). Videotape Increases Parental Knowledge About Pediatric Pain Management. Anesth. Analg.
89: 899-899
[Abstract][Full Text]
Berens, R. J.
(1999). Noise in the Pediatric Intensive Care Unit: Berens RJ Noise in the pediatric intensive care unit J Intensive Care Med 1999,14 118-129. J Intensive Care Med
14: 118-129
Tweddell, J. S., Hoffman, G. M., Fedderly, R. T., Berger, S., Thomas, J. P. Jr, Ghanayem, N. S., Kessel, M. W., Litwin, S. B.
(1999). Phenoxybenzamine improves systemic oxygen delivery after the Norwood procedure. Ann. Thorac. Surg.
67: 161-167
[Abstract][Full Text]
Kieburtz, K., Simpson, D., Yiannoutsos, C., Max, M. B., Hall, C. D., Ellis, R. J., Marra, C. M., McKendall, R., Singer, E., Dal Pan, G. J., Clifford, D. B., Tucker, T., Cohen, B., AIDS Clinical Trial Group 242 Protocol Team*,
(1998). A randomized trial of amitriptyline and mexiletine for painful neuropathy in HIV infection. Neurology
51: 1682-1688
[Abstract][Full Text]
Venkataraman, S., Alexander, M., Gnanamuthu, C.
(1998). Postinfectious pandysautonomia with complete recovery after intravenous immunoglobulin therapy. Neurology
51: 1764-1765
[Full Text]
Dalakas, M. C.
(1998). Mechanism of Action of Intravenous Immunoglobulin and Therapeutic Considerations in the Treatment of Autoimmune Neurologic Diseases. Neurology
51: S2-S8
[Abstract][Full Text]
Sater, R. A., Rostami, A.
(1998). Treatment of Guillain-Barre Syndrome with Intravenous Immunoglobulin. Neurology
51: S9-S15
[Abstract][Full Text]
Dalakas, M. C.
(1998). Controlled Studies with High-Dose Intravenous Immunoglobulin in the Treatment of Dermatomyositis, Inclusion Body Myositis, and Polymyositis. Neurology
51: S37-S45
[Abstract][Full Text]
Marra, C. M., Castro, C. D., Kuller, L., Dukes, A. C., Centurion-Lara, A., Morton, W. R., Lukehart, S. A.
(1998). Mechanisms of clearance of Treponema pallidum from the CSF in a nonhuman primate model. Neurology
51: 957-961
[Abstract][Full Text]
Jacobs, B. C., Rothbarth, P. H., van der Meche, F.G.A., Herbrink, P., Schmitz, P. I.M., de Klerk, M. A., van Doorn, P. A.
(1998). The spectrum of antecedent infections in Guillain-Barre syndrome: A case-control study. Neurology
51: 1110-1115
[Abstract][Full Text]
Bowsher, D.
(1998). Pain after thalamic stroke: Right diencephalic predominance and clinical features in 180 patients. Neurology
51: 927-927
[Full Text]
Canavero, S., Bonicalzi, V.
(1998). Pain after thalamic stroke: Right diencephalic predominance and clinical features in 180 patients. Neurology
51: 927-927
[Full Text]
Nasreddine, Z. S., Saver, J. L.
(1998). Pain after thalamic stroke: Right diencephalic predominance and clinical features in 180 patients. Neurology
51: 927-928
[Full Text]
Barr, R. G
(1998). Reflections on measuring pain in infants: dissociation in responsive systems and "honest signalling". Arch. Dis. Child. Fetal Neonatal Ed.
79: 152F-156
[Full Text]
Sorensen, P. S., Wanscher, B., Jensen, C. V., Schreiber, K., Blinkenberg, M., Ravnborg, M., Kirsmeier, H., Larsen, V. A., Lee, M. L.
(1998). Intravenous immunoglobulin G reduces MRI activity in relapsing multiple sclerosis. Neurology
50: 1273-1281
[Abstract][Full Text]
Quinn, M W, de Boer, R C, Ansari, N, Baumer, J H
(1998). Stress response and mode of ventilation in preterm infants. Arch. Dis. Child. Fetal Neonatal Ed.
78: 195F-198
[Abstract][Full Text]
Ferguson, J. H.
(1998). Breast implants redux: This time with data. Neurology
50: 849-852
[Full Text]
Howard, C. R., Howard, F. M., Garfunkel, L. C., de Blieck, E. A., Weitzman, M.
(1998). Neonatal Circumcision and Pain Relief: Current Training Practices. Pediatrics
101: 423-428
[Abstract][Full Text]
Lai, E. C., Felice, K. J., Festoff, B. W., Gawel, M. J., Gelinas, D. F., Kratz, R., Murphy, M. F., Natter, H. M., Norris, F. H., Rudnicki, S. A., The North America ALS/IGF-I Study Group*,
(1997). Effect of recombinant human insulin-like growth factor-I on progression of ALS: A placebo-controlled study. Neurology
49: 1621-1630
[Abstract][Full Text]
Al-Lozi, M. T., Pestronk, A., Choksi, R.
(1997). A skeletal muscle-specific from of decorin is a target antigen for a serum IgM M-protein in a patient with a proximal myopathy. Neurology
49: 1650-1654
[Abstract][Full Text]
Wen, P. Y., Alyea, E. P., Simon, D., Herbst, R. S., Soiffer, R. J., Antin, J. H.
(1997). Guillain-Barre syndrome following allogeneic bone marrow transplantation. Neurology
49: 1711-1714
[Abstract][Full Text]
Cheifetz, I. M., Kern, F. H., Schulman, S. R., Greeley, W. J., Ungerleider, R. M., Meliones, J. N.
(1997). Serum Lactates Correlate With Mortality After Operations for Complex Congenital Heart Disease. Ann. Thorac. Surg.
64: 735-738
[Abstract][Full Text]
Hatherill, M, Sajjanhar, T, Tibby, S M, Champion, M P, Anderson, D, Marsh, M J, Murdoch, I A
(1997). Serum lactate as a predictor of mortality after paediatric cardiac surgery. Arch. Dis. Child.
77: 235-238
[Abstract][Full Text]
Swenson, J. D., Bailey, P. L.
(1997). Opioids in Cardiovascular Anesthesia. SEMIN CARDIOTHORAC VASC ANESTH
1: 146-163
Dalakas, M. C.
(1997). Experience with IVIg in the treatment of patients with myasthenia gravis. Neurology
48: 64S-69S
[Full Text]
Barohn, R. J.
(1997). The therapeutic dilemma of inclusion body myositis. Neurology
48: 567-568
[Full Text]
Ho, T. W., Li, C. Y., Cornblath, D. R., Gao, C. Y., Asbury, A. K., Griffin, J. W., McKhann, G. M.
(1997). Patterns of recovery in the Guillain-Barre syndromes. Neurology
48: 695-700
[Abstract][Full Text]
Dalakas, M. C., Sonies, B., Dambrosia, J., Sekul, E., Cupler, E., Sivakumar, K.
(1997). Treatment of inclusion-body myositis with IVIg: A double-blind, placebo-controlled study. Neurology
48: 712-716
[Abstract][Full Text]
Sun, L. S., Du, F., Schechter, W. S., Quaegebeur, J. M., Vulliemoz, Y.
(1997). PLASMA NEUROPEPTIDE Y AND CATECHOLAMINES IN PEDIATRIC PATIENTS UNDERGOING CARDIAC OPERATIONS. J. Thorac. Cardiovasc. Surg.
113: 278-284
[Abstract][Full Text]
Galer, B. S., Jensen, M. P.
(1997). Development and preliminary validation of a pain measure specific to neuropathic pain: The Neuropathic Pain Scale. Neurology
48: 332-338
[Abstract][Full Text]
Cornford, M. E., McCormick, G. F.
(1997). Adult-onset temporal lobe epilepsy associated with smoldering herpes simplex 2 infection. Neurology
48: 425-430
[Abstract][Full Text]
Leigh, P. N., Meldrum, B. S.
(1996). Excitotoxicity in ALS. Neurology
47: 221S-227S
[Abstract][Full Text]
Hugon, J.
(1996). ALS therapy: Targets for the future. Neurology
47: 251S-254S
[Abstract][Full Text]
Tandan, R., Bromberg, M.B., Forshew, D., Fries, T.J., Badger, G.J., Carpenter, J., Krusinski, P.B., Betts, E.F., Arciero, K., Nau, K.
(1996). A controlled trial of amino acid therapy in amyotrophic lateral sclerosis: I. Clinical, functional, and maximum isometric torque data. Neurology
47: 1220-1226
[Abstract][Full Text]
Kornberg, A. J., Pestronk, A., Blume, G. M., Lopate, G., Yue, J., Hahn, A.
(1996). Selective staining of the cerebellar molecular layer by serum IgG in Miller-Fisher and related syndromes. Neurology
47: 1317-1320
[Abstract][Full Text]
Curti, D., Malaspina, A., Facchetti, G., Camana, C., Mazzini, L., Tosca, P., Zerbi, F., Ceroni, M.
(1996). Amyotrophic lateral sclerosis: Oxidative energy metabolism and calcium homeostasis in peripheral blood lymphocytes. Neurology
47: 1060-1064
[Abstract][Full Text]
Miller, R. G., Bouchard, J. P., Duquette, P., Eisen, A., Gelinas, D., Harati, Y., Munsat, T. L., Powe, L., Rothstein, J., Salzman, P., Sufit, R. L.
(1996). Clinical trials of riluzole in patients with ALS. Neurology
47: 86S-92S
[Abstract][Full Text]
Visser, L. H., van der Meche, F.G.A., Meulstee, J., Rothbarth, P., Jacobs, B. C., Schmitz, P. I.M., van Doorn, P. A.
(1996). Cytomegalovirus infection and Guillain-Barre syndrome: The clinical, electrophysiologic, and prognostic features. Neurology
47: 668-673
[Abstract][Full Text]
Brannagan, T. H. III, Nagle, K. J., Lange, D. J., Rowland, L. P.
(1996). Complications of intravenous immune globulin treatment in neurologic disease. Neurology
47: 674-677
[Abstract][Full Text]
Bain, P. G., Motomura, M., Newsom-Davis, J., Misbah, S. A., Chapel, H. M., Lee, M. L., Vincent, A., Lang, B.
(1996). Effects of intravenous immunoglobulin on muscle weakness and calcium-channel autoantibodies in the Lambert-Eaton myasthenic syndrome. Neurology
47: 678-683
[Abstract][Full Text]
Sorensen, P. S., Wanscher, B., Szpirt, W., Jensen, C. V., Ravnborg, M., Christiansen, P., Schreiber, K., Nordenbo, A.
(1996). Plasma exchange combined with azathioprine in multiple sclerosis using serial gadolinium-enhanced MRI to monitor disease activity: A randomized single-masked cross-over pilot study. Neurology
46: 1620-1625
[Abstract][Full Text]
Eisen, A., Entezari-Taher, M., Stewart, H.
(1996). Cortical projections to spinal motoneurons: Changes with aging and amyotrophic lateral sclerosis. Neurology
46: 1396-1396
[Abstract][Full Text]
Crisp, D., Ashby, P.
(1996). Lyme radiculoneuritis treated with intravenous immunoglobulin. Neurology
46: 1174-1175
[Full Text]
Velvis, H., Hines, M. H., Klopfenstein, H. S., Berry, D. D., Vinten-Johansen, J.
(1996). DEPRESSION OF CARDIAC FUNCTION AFTER DEEP HYPOTHERMIC CIRCULATORY ARREST IN DEEPLY ANESTHETIZED NEONATAL LAMBS. J. Thorac. Cardiovasc. Surg.
111: 359-366
[Abstract][Full Text]
Rosenberg, N. L.
(1996). The neuromythology of silicone breast implants. Neurology
46: 308-314
[Abstract][Full Text]
Oomes, P. G., van der Meche, F.G.A., Kleyweg, R. P.
(1996). Liver function disturbances in Guillain-Barre syndrome: A prospective longitudinal study in 100 patients. Neurology
46: 96-100
[Abstract][Full Text]
Bril, V., Ilse, W. K., Pearce, R., Dhanani, A., Sutton, D., Kong, K.
(1996). Pilot trial of immunoglobulin versus plasma exchange in patients with Guillain-Barre syndrome. Neurology
46: 100-103
[Abstract][Full Text]
Rowbotham, M. C.
(1995). Chronic pain: From theory to practical management. Neurology
45: S5-S10
[Abstract][Full Text]
Galer, B. S.
(1995). Neuropathic pain of peripheral origin: Advances in pharmacologic treatment. Neurology
45: S17-S25
[Abstract][Full Text]
Eisendrath, S. J.
(1995). Psychiatric aspects of chronic pain. Neurology
45: S26-S34
[Abstract][Full Text]
Mosca, R. S., Bove, E. L., Crowley, D. C., Sandhu, S. K., Schork, M. A., Kulik, T. J.
(1995). Hemodynamic Characteristics of Neonates Following First Stage Palliation for Hypoplastic Left Heart Syndrome. Circulation
92: 267-271
[Abstract][Full Text]
van Schaik, I.N., Bossuyt, P.M.M., Brand, A., Vermeulen, M.
(1995). Diagnostic value of GM1 antibodies in motor neuron disorders and neuropathies: A meta-analysis. Neurology
45: 1570-1577
[Abstract][Full Text]
Weldner, P. W., Myers, J. L., Gleason, M. M., Cyran, S. E., Weber, H. S., White, M. G., Baylen, B. G.
(1995). The Norwood operation and subsequent Fontan operation in infants with complex congenital heart disease. J. Thorac. Cardiovasc. Surg.
109: 654-662
[Abstract][Full Text]
Khella, S. L., Frost, S., Hermann, G. A., Leventhal, L., Whyatt, S., Sajid, M. A., Scherer, S. S.
(1995). Hepatitis C Infection, Cryoglobulinemia, and Vasculitic Neuropathy. Treatment With Interferon Alfa: Case Report and Literature Review. Neurology
45: 407-411
[Abstract][Full Text]
Wernovsky, G., Mayer, J. E. Jr., Jonas, R. A., Hanley, F. L., Blackstone, E. H., Kirklin, J. W., Castaneda, A. R.
(1995). Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries. J. Thorac. Cardiovasc. Surg.
109: 289-302
[Abstract][Full Text]
Fenton, K. N., Heinemann, M. K., Hickey, P. R., Klautz, R. J. M., Liddicoat, J. R., Hanley, F. L.
(1994). Inhibition of the fetal stress response improves cardiac output and gas exchange after fetal cardiac bypass. J. Thorac. Cardiovasc. Surg.
107: 1416-1422
[Abstract][Full Text]
(1994). Treating moderate and severe pain in infants. DTB
32: 21-24
[Abstract][Full Text]
Tobias, J. D., Flannagan, J.
(1992). Regional Anesthesia in the Preterm Neonate. CLIN PEDIATR
31: 668-671
[Abstract]
(1992). DEEP ANESTHESIA FOR NEWBORNS. JWatch General
1992: 3-3
[Full Text]
