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Clobazam, a 1-5 benzodiazepine, was introduced
in the 1970s for the treatment of anxiety and agitation. Antiepileptic
properties were recognized, and efficacy in a number of epilepsy syndromes was
demonstrated in humans, with good tolerance. Recent reviews are generally favorable,
with a relative minimum of medication-related side effects. However, a number
of benzodiazepines have been associated with causing hypothermia. To date, this
side effect has not been reported with clobazam. We report two cases of
profound hypothermia associated with the use of this medication for the
treatment of epilepsy. Both children had significant cerebral dysgenesis and
were developmentally impaired, but neither had experienced hypothermia before.
Temperature dysregulation was resolved with medication withdrawal after an
extensive work-up for alternative causes. Hypothermia should
be considered as a possible side effect of clobazam, although the exact
mechanism is unknown. Appropriate monitoring of temperature is appropriate, and
precautions should be offered by caregivers.
Although concerns exist about the possibility of infecting a sternotomy wound by performing a tracheostomy early after cardiac surgery, it has been shown that tracheostomy performed before postoperative day 10 can improve outcomes for cardiovascular surgery patients who require long-term ventilation. We retrospectively reviewed all charts for patients who underwent cardiovascular surgery and required tracheostomy at a single-institution site from January 2005 to July 2012. Patients were divided into two groups based upon whether their tracheostomy was performed less than 10 days after their initial operation (early tracheostomy) or ≥10 days after their initial operation (late tracheostomy). Preoperative demographics and postoperative complications were studied. There were no new mediastinitis episodes following tracheostomy. Early tracheostomy was associated with higher 90-day (74.4% vs 56.8%) and 180-day (47.4% vs 28.7%, p < 0.047) survival when compared to late tracheostomy. Early tracheostomy after cardiovascular surgery does not seem to be associated with an increased rate of mediastinitis but is associated with improved survival.