THE PEDIATRIC GAP.

Not long ago, a three-year-old boy fell off a jungle gym in Boston and lacerated his cheek. His parents rushed him to the emergency room of a nearby hospital. A nurse restrained the screaming boy while a surgeon cleaned his cheek and injected it with a small dose of bupivacaine, a local anesthetic that is widely used in adults. When the surgeon began to suture the wound, the child had a seizure and his blood pressure suddenly dropped; he was on the verge of going into shock. He was transferred to the intensive-care unit, where doctors tried to account for his symptoms. A cat scan taken to see if the fall had caused cerebral hemorrhage showed no evidence of brain damage.