Safety of Cochlear Implantation in Children 12 Months or Younger: Systematic Review and Meta-analysis

Objective To systematically review the literature to determine safety of cochlear implantation in pediatric patients 12 months and younger. Data Source Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from inception to March 20, 2021. Review Methods Studies that involved patients 12 months and younger with report of intraoperative or postoperative complication outcomes were included. Studies selected were reviewed for complications, explants, readmissions, and prolonged hospitalizations. Two independent reviewers screened all studies that were selected for the systematic review and meta-analysis. All studies included were assessed for quality and risk of bias. Results The literature search yielded 269 studies, of which 53 studies underwent full-text screening, and 18 studies were selected for the systematic review and meta-analysis. A total of 449 patients and 625 cochlear implants were assessed. Across all included studies, major complications were noted in 3.1% of patients (95% CI, 0.8-7.1) and 2.3% of cochlear implantations (95% CI, 0.6-5.2), whereas minor complications were noted in 2.4% of patients (95% CI, 0.4-6.0) and 1.8% of cochlear implantations (95% CI, 0.4-4.3). There were no anesthetic complications reported across all included studies. Conclusion The results of this systematic review and meta-analysis suggest that cochlear implantation in patients 12 months and younger is safe with similar rates of complications to older cohorts.

Cardiac Arrest during Cesarean Section – A Case Report and Review of the Differential Diagnosis

Aim According to the World Health Organization, approximately 810 pregnant women die every day as a consequence of peripartum complications. A large proportion of deaths happen in developing countries. Peripartum cardiac arrest is a rare event that must be treated immediately. It is important to consider the differential diagnoses in order to save lives. Methods In this review, we discuss a differential diagnosis of cardiac arrest according to the BEAU-CHOPS scheme of the American Heart Association in the relation to the case report of our 40-year-old G5/P3 patient who went into cardiac arrest during cesarean delivery. Results Typical differentials for cardiac arrest during labor are bleeding, embolism, anesthetic complications, cardiovascular diseases, eclampsia, and sepsis. All of them were considered and ruled out in this patient. In the end, we suspect that physiological cardio-inhibitory reflexes triggered by sudden profound hypovolemia after placental separation along with the patientʼs risk factors, especially obesity and maternal age, and the administration of spinal anesthesia all potentially contributed to the cardiac arrest. Conclusions This review highlights that the cardiac arrest during labor can be triggered by the multifactorial etiology, but firstly the typical differential diagnosis needs to be excluded.

Features of monitoring the bispectral index in young children with hydrocephalus

Background. Millions of children with neurological di­seases are subjected to general anesthesia every year. The conditions under which surgeries are done in these patients depend on a number of interrelated factors that arise in conditions of neurological deficiency and are often the cause of anesthetic complications. The possibility of using the monitoring of bispectral index in pediat­ric patients with neurological disorders is of particular interest, specifically in those with hydrocephalus against the background of ventriculomegaly. The purpose was to evaluate of the dynamics of bispectral index monitoring in young children with hydrocephalus during ventriculoperitoneal shunting. Materials and methods. The study included 109 children: 59 with acquired form of hydrocephalus who underwent ventriculoperitoneal shunting and 50 without neurological disorders who underwent reconstructive surgery. The study had 5 stages: initial, induction into anesthesia, tracheal intubation, traumatic stage of the operation, awakening. Results. Electroencephalographic analysis in children with hydrocephalus showed the homogeneity of the rearrangements of the bioelectric pattern, which reflected the wide and stable involvement in the pathological process of various cerebral systems with dysfunction of mesencephalic-diencephalic formations, inclu­ding hypothalamic ones, in combination with impaired cortical-subcortical-brainstem interrelations. When analyzing the baseline bispectral index in patients with hydrocephalus, significantly lower values were found compared to neurologically healthy children (89.25 ± 2.52 and 94.80 ± 1.55, respectively). Analysis of changes in the intraoperative bispectral index showed that in the group with hydrocephalus using propofol, during induction upon reaching the first surgical stage of anesthesia according to clinical indications, the bispectral index significantly decreased to 36.00 ± 2.74, which is 30 % less than in children without neurological disorders and 29 % less when using sevoflurane. The groups where propofol was used showed a significant difference in bispectral index between patients with hydrocephalus and neurologically healthy children at all stages of the operation. This indicated that the intraoperative sleep pattern in individuals with hydrocephalus is at abnormal low levels. Conclusions. Hypoperfusion of the medulla, together with impaired cortical-subcortical relationships, affect the value of the bispectral index. The use of propofol in children with hydrocephalus can lead to the development of cerebral ischemia with a decrease in the electrical activity of the brain.

Analytic Study of Indications and Complications Associated with Cesarean Section in Omar AL-Mukhtar Hospital

Cesarean section (C-section) is a surgical procedure designed to ensure the safety of the mother and the child when vaginal delivery is not possible. There is a progressive increase in cesarean deliveries across the world. C-section is associated with increased morbidity and mortality in pregnant mothers and infants, particularly in developing countries. The aim of the current study was designed to determine the rate and identify the indications and find out complications associated with C-sections in Omar AL-Mukhtar hospital. The descriptive retrospective study was carried out with data retrieved from statistics files from January 2018 to December 2018. A total of 754 births during the study period, out of the 226 were delivered by C-section. The overall C-section rate was 29.9%. The maximum number of C-sections was in the age group of 31-40 years (42%) followed by 41.2% of women in the age group of 21-30 years. The most common indication was elective repeated C-section (17%) followed by previous one C-section with other causes (10.6%), fetal distress (9.29%). The complications in our study were about 47 cases and were less accounted for (20.79%), like, postpartum and intraoperative hemorrhage, and anesthetic complications, which represented 5.75%, and 10.62% respectively. In conclusion: The cesarean delivery rate in this study was higher than the WHO recommendation, and elective repeat cesarean delivery was a major common indicator. Keywords: C-section; Indication; Complication of C- section

Evaluation of transanesthetic complications comparing epidural versus analgesic continuous infusion in dogs submitted to neurosurgeries

Neurosurgeries have become more frequent in veterinary hospitals, however, there are some questions regarding anesthetics protocols and analgesic techniques. Thus, patient analgesia and hemodynamic stability play a key role in pre, post, and perioperative moments favoring an adequate recovery. This study aimed to evaluate the transanesthetic complications reported on anesthetic records of dogs submitted to hemilaminectomies in the university veterinary hospital of the Federal University of Santa Maria (UFSM) between January 2016 and August 2017, and compare three different analgesic protocols most commonly used in the routine for this surgery. In addition, transanesthetic parameters for each dog were equally recorded in five-minute intervals: cardiac frequency (FC), respiratory frequency (f) blood oxygen saturation (SpO2), mean artery pressure (PAM), temperature and end tidal CO2 (EtCO2). The patients were divided into three groups: Group M: animals receiving epidural analgesia with morphine 0.1mg/kg diluted in 0.26 ml/kg of saline solution 0.9%; Group FLK: bolus of fentanyl 2 μg/kg, lidocaine 1 mg/kg, and ketamine 1 mg/kg followed by infusion of fentanyl 0.1 μg/kg/min, lidocaine 50 μg/kg/min and ketamine 10 μg/ kg/min; and Group F: bolus of fentanyl 2 μg/kg followed by infusion of fentanyl 0.1 μg/kg/min. ANOVA was used to evaluate the anesthetic protocols complications, followed by Tukey’s post-hoc test with a significance level of 5% (p <0.05), comparing the mean of each parameter. Among the anesthetic complications that were found hypotension, bradycardia and hypercapnia were the most frequent. When 22.22% of the patients presented hypotension more evident on the first 10 minutes of anesthesia, 22.22% presented bradycardia, requiring the use of atropine (0.022 mg/kg) and 83.33% had hypercapnia on at least one of the times (EtCO2 > 45mmHg). With this study, it was observed that the use of continuous infusions of FLK, fentanyl, and epidural analgesia with morphine, in the used doses, were effective and safe in the dogs submitted to neurosurgeries, however, it was noticed that the use of morphine caused a greater reduction in temperature during the intraoperative period.

Partial Penectomy in a Horse with Paraphimosis

Background: In horses, an increase in the volume of penis and foreskin can be caused by trauma. The resultant edema interferes with the retraction of the penis and cause paraphimosis. Surgical intervention through penectomy is indicated in cases wherein an alternative treatment is not feasible. Partial penectomy can prolong the life and reproductive function of many stallions. The present study aims to report on the methodological, functional, and economic feasibility of a successful case of the use of Williams technique for partial penectomy performed in the field in a horse with paraphimosis, preserving urinary, productive, and reproductive functions.Case: A 10-year-old horse weighing 500 kg had clinical signs of paraphimosis due to the formation of granulomatous tissue following trauma to the glans region. A surgical intervention, namely a partial penectomy was decided to be performed to prevent injury from priapism. Due to the limited resources provided by the owner and the impossibility of moving the animal to a surgical center in a veterinary hospital, the procedure was performed in the field, with prior sanitization and preparation of the environment used to perform surgery. The horse was tranquilized with intravenous xylazine hydrochloride and acepromazine, with subsequent induction of anesthesia with ready-to-use (RTU) guaifenesin bolus and maintenance of anesthesia with an intravenous association of RTU guaifenesin, xylazine hydrochloride, and ketamine. The distal third of the penis was amputated using the recommended Williams technique. Although the complications like dehiscence and emergence of granulation tissue occurred after surgery, these were controlled in the daily follow-up of the animal and post-surgical treatment.Discussion:Paraphimosis predisposed the horse to abrasions and edema of the exposed portion of the penis. However, there was no urine retention, which suggested that the urethral ostium and the urethra had no lesions. Because the granulomatous lesions were located in the distal third of the penis and the extent of penile exposure was small, the partial penectomy technique proved effective in solving the permanent exposure of the penis. The anesthetic protocol used was inexpensive, easy to execute, and effective, and no anesthetic complications occurred, proving this protocol to be efficient for the anesthetic induction of animals in the field.In addition to being reliable and widespread, the Williams technique was recommended to prevent possible urethral stenosis and the development of contact dermatitis by urine. This technique makes a rapid recovery of the animal possible, with improvement of its physiological parameters, and due to ease of being able to be done in the field, it is also inexpensive. The edema and the granulation tissue that occurred after surgery were controlled with medication. In general, post-penectomy animals are not used for reproduction. This makes the present report an important contribution, because in cases in which the lesions present a distal disposition and the penile exposure is small, stallions have a chance of maintaining reproductive function after surgery, even with a long period of evolution before surgical treatment. This was demonstrated in the present case, as the animal in this case later impregnated a mare, with the pregnancy confirmed by ultrasound examination. Partial penectomy is a resolution technique for cases of traumatic paraphimosis, in which exuberant granulation tissue is formed in the distal third of the penis, with a long period of evolution. The surgery can be done in the field, with a low surgical cost to the owner, and a good productive and reproductive prognosis for the animal.Keywords: partial penectomy, paraphimosis, Williams technique, horse.Descritores: penectomia parcial, parafimose, técnica de William, equino.Título: Penectomia em equino com parafimose

Analysis of early and late maternal complications associated with delivery using propensity score

ABSTRACT: Objective: To analyze early and late maternal complications associated with the mode of delivery in a birth cohort in Brazil, using the propensity score technique for analysis. Methods: This is a prospective cohort study, using data from the Pelotas Birth Cohort, RS, 2004. A total of 4,189 women were included and a descriptive analysis of the data and subsequent calculation of the propensity and pairing score of vaginal delivery women and cesarean delivery women with similar scores (1,366 pairs). We then assessed the difference in outcome risk between the groups. Results: Women in the cesarean group had 2.9 percentage points (pp) more risk of postpartum infection, 1.13 p.p. more risk of urinary infection, 1.10 p.p. more risk of anesthetic complications and 1.24 p.p. higher risk of headache compared to vaginal delivery, but less risk of anemia (-2.43 pp) and hemorrhoids (-1.24 p.p.). The use of propensity scores is extremely useful for reducing bias and increasing accuracy in observational studies when experimental studies cannot be performed. Conclusion: Cesarean sections have been associated with a higher prevalence of postpartum and urinary tract infections, anesthetic complications and headache and lower prevalence of anemia and hemorrhoids, so they should be performed with clear indications and when their benefits outweigh potential risks.