Exposure to general anesthesia has been reported to induce neurotoxicity, impair learning, memory, attention, motor functions, as well as affect behavior in adult rodents and nonhuman primates. Though many have speculated similar effects in humans, previous literature has shown conflicting findings. To investigate the differences in risk of developmental delay among young children exposed to general anesthesia compared to matched unexposed individuals, a population-based cohort study was conducted with a longitudinal dataset spanning 2000 to 2013 from the Taiwan National Health Insurance Research Database (NHIRD). Procedure codes were used to identify children who received anesthesia. For each exposed child, two unexposed children matched by gender and age were enrolled into the comparison cohort. Neurocognitive outcome was measured by the presence of ICD-9-CM codes related to developmental delay (DD). Cox regression models were used to obtain hazard ratios of developing DD after varying levels of anesthesia exposure. After excluding 4,802 individuals who met the exclusion criteria, a total of 11,457 children who received general anesthesia before two years of age was compared to 22,914 children (matched by gender and age) unexposed to anesthesia. Increased risk of DD was observed in the exposure group with a hazard ratio (HR) of 1.320 (95% CI 1.143-1.522, P < 0.001). Subgroup analysis demonstrated further elevated risks of DD with multiple anesthesia exposures (1 anesthesia event:
The results suggest that ultra-low-dose naloxone might be clinical valuable for neuropathic pain management via regulating global histone modification.
Postoperative paraplegia secondary to spinal cord ischemia (SCI) is an extremely rare and devastating complication of endovascular repair in abdominal aortic aneurysm (AAA) surgery. The reported incidence is only 0.21 % worldwide. This case of postoperative paraplegia occurred in a 60-year-old man immediately following endovascular repair of an infrarenal AAA. Postoperative magnetic resonance imaging showed multiple foci of SCI involvement from C5 to L1. However, neither cerebral spinal fluid drainage nor steroid therapy was effective; he was eventually admitted with no improvement in his neurological status. The mechanism remains multifactorial until now and needs more attention in perioperative management. We report the first case involved in the most significantly extensive SCI after endovascular repair of an infrarenal AAA.
BACKGROUND Research on perioperative adverse events has been challenged by varying definitions, reporting failure, scarce incidence or incomplete data collection. Insights into patient mortality and causes of death might improve surgical safety and quality of care. The aim of the present study is to analyse the characteristics and factors associated with prognosis (inpatient mortality) of surgery related injuries. MATERIALS AND METHODS Data was sourced from the Taiwanese National Health Insurance Research Database for the period of 1997-2008; SPSS 18.0 software was used to carry out statistical analysis. Surgery-related injuries were categorised according to ICD-9-CM classifications. RESULTS Each year, an average of 797 people are hospitalised in Taiwan due to surgery-related injuries. Males and females accounted for 46.19% and 53.81% of these hospitalisations, respectively. The predominant surgery-related injury events occurred in medical centres (57.89%) and surgery departments (37.71%). The first leading cause of surgery-related injury events was "unintentional cut, puncture, perforation or haemorrhage" (70.59%), but the highest rate of inpatient mortality resulted from "mismatched blood, fluid or substance in transfusion" (4.12%). The average age of male patients (55.97 yrs.) was significantly higher than females (50.99 yrs.). The highest percentage of surgery-related injury events for males was surgery (1.45 per 100,000) and 3.09 times more than those in females that were obstetrics and gynaecology related (0.47 per 100,000). "Unintentional cut, puncture, perforation or haemorrhage" (OR= 6.486), "older patient" (OR +3.8% per increased age) and "younger doctor" (OR +3.3% per increased age) might increase the risk of inpatient mortality. CONCLUSION The rate of in-hospital surgery-related injury was 64.55 per 100,000 and exhibited an upward trend. We should make improvement plans for doctors with higher rates of incidences in order to improve the safety of patients.
BACKGROUND During dental sedation, control of the cough reflex is crucial for a safe and smooth procedure. Accumulated saliva is one of the predisposing factors for coughing. Therefore, extensive suction is very important. Using of standard saliva ejector may not be enough. We introduce handmade Adjustable Loop Suction (ALS) as an alternative solution. The features of this device are easy assembly, single use, effective suction, excellent moldability, and customised smaller sizes for young children. The suction orifice near the posterior oral cavity effectively removes the fluid and the bent suction loop assists stability in the patient's mouth. 1,2 In dental treatments, adequate removal of fluids accumulated in the oropharyngeal space is of critical importance. Failure to do so risks triggering the cough reflex, and predisposes choking of the patient, laryngospasm or oxygen desaturation. In these situations, the operator would be forced to remove the patient's mouth gag to allow the fluids to be expelled. Thus, an oral evacuation system which can effectively and efficiently drain fluids would not only greatly facilitate the procedure by providing clear visibility and lowering the frequency of interruptions, but more importantly improves patient safety by reducing stimulation of the cough reflex. Here, we introduce a handmade Adjustable Loop Suction Apparatus (ALSA) (Fig. 1 A-C) as an alternative solution to the conventional suctioning devices. It is easily assembled from materials accessible to medical providers. A common PAHSCO FR 14 (green) cap-cone suction catheter is used. Seven pairs of holes (1.0 x 1.0 mm) are perforated along the anterior portion of the suction catheter at 1.0 cm distance apart. A pliable surgical stainless-steel wire (20 gauge) is inserted as a stylet for shaping the curve of the loop. To complete the loop, the end of the suction catheter is inserted into the hole on its plastic cap-cone connector. Finally, the anterior part of the loopedsuction is bent to create a spacer, which can anchor to the opposite row of teeth. 3 The shape and curve of this ALSA can be easily adjusted as needed during the procedure.
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