Neurophysiologic Complexity in Children Increases with Developmental Age and Is Reduced by General Anesthesia

2021 ◽  
Author(s):  
Michael P. Puglia ◽  
Duan Li ◽  
Aleda M. Leis ◽  
Elizabeth S. Jewell ◽  
Chelsea M. Kaplan ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Spectral Power ◽  
Cross Sectional Study ◽  
Brain Network ◽  
Postoperative Recovery ◽  
State Transitions ◽  
Similar Reduction ◽  
Cross Sectional ◽  
Developmental Age ◽  
American Society

Background Neurophysiologic complexity in the cortex has been shown to reflect changes in the level of consciousness in adults but remains incompletely understood in the developing brain. This study aimed to address changes in cortical complexity related to age and anesthetic state transitions. This study tested the hypotheses that cortical complexity would (1) increase with developmental age and (2) decrease during general anesthesia. Methods This was a single-center, prospective, cross-sectional study of healthy (American Society of Anesthesiologists physical status I or II) children (n = 50) of age 8 to 16 undergoing surgery with general anesthesia at Michigan Medicine. This age range was chosen because it reflects a period of substantial brain network maturation. Whole scalp (16-channel), wireless electroencephalographic data were collected from the preoperative period through the recovery of consciousness. Cortical complexity was measured using the Lempel–Ziv algorithm and analyzed during the baseline, premedication, maintenance of general anesthesia, and clinical recovery periods. The effect of spectral power on Lempel–Ziv complexity was analyzed by comparing the original complexity value with those of surrogate time series generated through phase randomization that preserves power spectrum. Results Baseline spatiotemporal Lempel–Ziv complexity increased with age (yr; slope [95% CI], 0.010 [0.004, 0.016]; P < 0.001); when normalized to account for spectral power, there was no significant age effect on cortical complexity (0.001 [–0.004, 0.005]; P = 0.737). General anesthesia was associated with a significant decrease in spatiotemporal complexity (median [25th, 75th]; baseline, 0.660 [0.620, 0.690] vs. maintenance, 0.459 [0.402, 0.527]; P < 0.001), and spatiotemporal complexity exceeded baseline levels during postoperative recovery (0.704 [0.642, 0.745]; P = 0.009). When normalized, there was a similar reduction in complexity during general anesthesia (baseline, 0.913 [0.887, 0.923] vs. maintenance 0.851 [0.823, 0.877]; P < 0.001), but complexity remained significantly reduced during recovery (0.873 [0.840, 0.902], P < 0.001). Conclusions Cortical complexity increased with developmental age and decreased during general anesthesia. This association remained significant when controlling for spectral changes during anesthetic-induced perturbations in consciousness but not with developmental age. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Postoperative Pain in Children After Dentistry Under General Anesthesia

2015 ◽  
Vol 62 (4) ◽  
pp. 140-152 ◽  
Author(s):  
Michelle Wong ◽  
Peter E. Copp ◽  
Daniel A. Haas
Keyword(s):  
Postoperative Pain ◽  
General Anesthesia ◽  
Severe Pain ◽  
Correlation Coefficients ◽  
Cross Sectional Study ◽  
Pain Scale ◽  
Rank Test ◽  
Cross Sectional ◽  
Dental Procedures ◽  
American Society

The objective of this study was to determine the prevalence, severity, and duration of postoperative pain in children undergoing general anesthesia for dentistry. This prospective cross-sectional study included 33 American Society of Anesthesiology (ASA) Class I and II children 4–6 years old requiring multiple dental procedures, including at least 1 extraction, and/or pulpectomy, and/or pulpotomy of the primary dentition. Exclusion criteria were children who were developmentally delayed, cognitively impaired, born prematurely, taking psychotropic medications, or recorded baseline pain or analgesic use. The primary outcome of pain was measured by parents using the validated Faces Pain Scale-Revised (FPS-R) and Parents' Postoperative Pain Measure (PPPM) during the first 72 hours at home. The results showed that moderate-to-severe postoperative pain, defined as FPS-R ≥ 6, was reported in 48.5% of children. The prevalence of moderate-to-severe pain was 29.0% by FPS-R and 40.0% by PPPM at 2 hours after discharge. Pain subsided over 3 days. Postoperative pain scores increased significantly from baseline (P < .001, Wilcoxon matched pairs signed rank test). Moderately good correlation between the 2 pain measures existed 2 and 12 hours from discharge (Spearman rhos correlation coefficients of 0.604 and 0.603, P < .005). In conclusion, children do experience moderate-to-severe pain postoperatively. Although parents successfully used pain scales, they infrequently administered analgesics.

scholarly journals The effect of low dose pethidine and diazepam for sedation in Cesarean Section under Sub-Arachnoid Block on mothers’ satisfaction

1970 ◽  
Vol 24 (1) ◽  
pp. 10-13
Author(s):  
Dilip Kumar Saha ◽  
Mazibar Rahman ◽  
Paresh Chandra Sarkar ◽  
Debasish Banik ◽  
Quamrul Hudaak ◽  
...  
Keyword(s):  
Cesarean Section ◽  
General Anesthesia ◽  
Low Dose ◽  
Cross Sectional Study ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Chi Square Test ◽  
American Society ◽  
Sedation Group

Objective: Cesarean Section (CS) is usually performed when a vaginal delivery would put the baby's or mother's life at risk. Regional anesthesia has the advantage over general anesthesia by allowing mother to remain awake during operation. However, some women prefer general anesthesia as they want to be asleep during the operation. Aim of our study was to see the effect of mild sedation on mothers' satisfaction during CS.Materials and methods: A prospective cross sectional study was undertaken in the department of Anesthesiology, Institute of Child and Mother Health from January 2009 to December 2009. Sixty patients of singletone pregnancy with ASA(American Society of Anesthesiology)-I were randomized into two groups I&II of which one group received sedation with low dose pethidine and diazepam and other group did not get any sedation.Results: Data were analyzed between the groups and within the groups using students'‘t' test and Chi-Square test. A p-value of <0.05 was considered as significant. Patient's parameters like heart rate and blood pressure were not statistically significant between groups, but SpO2 fall was statistically significant. Mother's satisfaction is significantly high (76%) in sedation group than non sedation group.Conclusion: By sedation with low dose pethidine and diazepam, mothers' satisfaction was better achieved without affecting the hemo-dynamic stability. Keywords: sedation; cesarean section; sub-arachnoid block; mothers' satisfaction. DOI: 10.3329/bjog.v24i1.6320 Bangladesh J Obstet Gynaecol, 2009; Vol. 24(1) : 10-13

scholarly journals Short-term complications of anesthetic technique used in hip fracture surgery in elderly people

2018 ◽  
Vol 28 (3) ◽  
Author(s):  
Afsaneh Norouzi ◽  
Fozhan Behrouzibakhsh ◽  
Alireza Kamali ◽  
Bijan Yazdi ◽  
Babak Ghaffari
Keyword(s):  
Hip Fracture ◽  
Vital Signs ◽  
Cross Sectional Study ◽  
Anesthetic Technique ◽  
Sectional Study ◽  
Short Term ◽  
Cross Sectional ◽  
Hip Fracture Surgery ◽  
American Society ◽  
Fracture Surgery

Postoperative complications of fracture are one of the main problems in older patients with hip fracture. In this study, complications were observed 48 hours after surgery in different anesthetic procedures. This prospective cross sectional study was carried out over a 12-month period. All subjects over 55 years of age undergoing hip fracture surgery were selected for study with ASA class (American Society of Anesthesiology: one, two and three). After determining the vital signs in the operating room, anesthesia type (general, spinal and epidural) and various variables were recorded. It was observed that the spinal anesthesia method had the lowest level of postoperative disturbances of consciousness and had the shortest duration in terms of duration of time. On the other hand, general anesthesia was the least in terms of blood transfusion. Finally, epidural anesthetic method showed the least amount of pain 48 hours after operation and the least changes in blood pressure and heart rate.

scholarly journals Incidence and associated factors of laryngospasm among pediatric patients who undergone surgery under general anesthesia, in university of Gondar Compressive Specialized Hospital, Northwest Ethiopia, 2019: Cross sectional study

2019 ◽  
Author(s):  
Wubie Birlie Chekol ◽  
Debas Yaregal Melese
Keyword(s):  
General Anesthesia ◽  
Associated Factors ◽  
Pediatric Patients ◽  
Multivariable Analysis ◽  
Cross Sectional Study ◽  
Northwest Ethiopia ◽  
Induction Phase ◽  
Upper Respiratory Tract ◽  
Cross Sectional ◽  
Airway Devices

Abstract Objective: this study was aimed to assess the incidence and associated factors of laryngospasm among pediatric patients who undergone surgery under general anesthesia (GA). Results : The incidence of laryngospasm among pediatric patients who undergone surgery under GA was 57 (18.39%) . Of this 34 (59.6%) were happened during emergence, 12 (21.1%) during maintenance and 11 (19.3%) during induction phase of GA. In multivariable analysis, airway anomalies (AOR : 14.64,95%CI:1.71,125.04) , orophyrangeal secretion (AOR : 2.45,95%CI:1.19,5.06), attempts of airway devices insertion (AOR : 2.47,95%CI:1.16,5.22) , upper respiratory tract infection (AOR : 2.91,95%CI:1.008,8.41) and inadequate depth of anesthesia (AOR : 7.92,95%CI:2.7,23.22) were significantly associated with incidence of laryngospasm .

scholarly journals Relationship between the Severity of Endometriosis Symptoms (Dyspareunia, Dysmenorrhea and Chronic pelvic pain) with the Spread of the Disease on Ultrasound

2020 ◽  
Author(s):  
Elham Kor ◽  
Seyed Reza Saadat Mostafavi ◽  
Zahra Ahmadian Mazhin ◽  
Adeleh Dadkhah ◽  
Anis Kor ◽  
...  
Keyword(s):  
Pelvic Pain ◽  
Chronic Pelvic Pain ◽  
Cross Sectional Study ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Cross Sectional ◽  
Present Cross Sectional Study ◽  
American Society ◽  
The Relationship ◽  
Douglas Pouch

Abstract Objectives: About 10-15% of women of childbearing age have endometriosis. The present study aimed to investigate the relationship between the severity of symptoms of endometriosis and the spread as well as the stage of the disease on ultrasonography. The present cross-sectional study evaluates the relationship between the severity of endometriosis symptoms and the spread of disease on ultrasonography in patients with endometriosis.Results: Considering different analyses, the cumulative size of posterior Deep Infiltrative Endometriosis (DIE) (less than 1 cm) is significantly correlated with minimal severity of dyspareunia and chronic pelvic pain. The incidence of dyspareunia was more prevalent in patients with complete stenosis of Douglas pouch than those with incomplete stenosis. Furthermore, the incidence of severe and very severe pain in patients with Douglas pouch stenosis is relatively higher than that in patients without stenosis. Only dyspareunia is related to the stage of endometriosis, and patients with dyspareunia are five times more at risk of a higher stage of the disease. The severity of dyspareunia is related to the stage of endometriosis and the severity of Douglas pouch stenosis. The results showed a correlation between chronic pelvic pain and r-ASRM score (revised American Society for Reproductive Medicine score).

scholarly journals Financial ties between leaders of influential US professional medical associations and industry: cross sectional study

BMJ ◽  
2020 ◽  
pp. m1505 ◽  
Author(s):  
Ray Moynihan ◽  
Loai Albarqouni ◽  
Conrad Nangla ◽  
Adam G Dunn ◽  
Joel Lexchin ◽  
...  
Keyword(s):  
Clinical Oncology ◽  
American Psychiatric Association ◽  
The United States ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medical Associations ◽  
The Us ◽  
American Society ◽  
Financial Relationships

AbstractObjectiveTo investigate the nature and extent of financial relationships between leaders of influential professional medical associations in the United States and pharmaceutical and device companies.DesignCross sectional study.SettingProfessional associations for the 10 costliest disease areas in the US according to the US Agency for Healthcare Research and Quality. Financial data for association leadership, 2017-19, were obtained from the Open Payments database.Population328 leaders, such as board members, of 10 professional medical associations: American College of Cardiology, Orthopaedic Trauma Association, American Psychiatric Association, Endocrine Society, American College of Rheumatology, American Society of Clinical Oncology, American Thoracic Society, North American Spine Society, Infectious Diseases Society of America, and American College of Physicians.Main outcome measuresProportion of leaders with financial ties to industry in the year of leadership, the four years before and the year after board membership, and the nature and extent of these financial relationships.Results235 of 328 leaders (72%) had financial ties to industry. Among 293 leaders who were medical doctors or doctors of osteopathy, 235 (80%) had ties. Total payments for 2017-19 leadership were almost $130m (£103m; €119m), with a median amount for each leader of $31 805 (interquartile range $1157 to $254 272). General payments, including those for consultancy and hospitality, were $24.8m and research payments were $104.6m—predominantly payments to academic institutions with association leaders named as principle investigators. Variation was great among the associations: median amounts varied from $212 for the American Psychiatric Association leaders to $518 000 for the American Society of Clinical Oncology.ConclusionsFinancial relationships between the leaders of influential US professional medical associations and industry are extensive, although with variation among the associations. The quantum of payments raises questions about independence and integrity, adding weight to calls for policy reform.

Analysis of stress ulcer prophylaxis drug regimentation in surgical patients

2021 ◽  
Vol 32 (4) ◽  
pp. 645-649
Author(s):  
Dhani Wijaya ◽  
Suharjono ◽  
Fendy Matulatan ◽  
Elfri Padolo
Keyword(s):  
Stress Ulcer ◽  
Frequency Standard ◽  
Cross Sectional Study ◽  
Stress Ulcer Prophylaxis ◽  
World Health ◽  
Cross Sectional ◽  
Injection Dose ◽  
Ulcer Prophylaxis ◽  
American Society ◽  
Health Organization

Abstract Objectives The World Health Organization (WHO) estimated that more than 50% of drugs were prescribed incorrectly, including stress ulcer prophylaxis (SUP) drugs. Prescribing SUP drugs in incorrect doses and frequencies are considered irrational, and may affects to the effectivity of the therapy. This research aimed to assess the appropriateness of the SUP drugs regimentation in the inpatient surgery room at Dr. Soetomo Hospital, Surabaya, Indonesia. Methods This research was cross-sectional study and conducted for 4 weeks in 2019 in the inpatient surgery room of Dr. Soetomo Hospital. The population was SUP drugs that were prescribed in inpatient surgery room. Those SUP drugs with indications for the prevention of stress-induced ulcers that complied to the terms listed on the American Society of Health-System Pharmacists (ASHP) were included as the samples, and vice versa. The samples then assessed for their regimentation appropriateness using the dose and frequency standard of ASHP. Results There were 224 dose units taken as sample, from the total population of 1,404 SUP drugs. The result showed that as much as 48.2% of SUP medications were given to the patients in inappropriate regimentation. Of that number, all ranitidine injection were inappropriately regimented. On the contrary all omeprazole injection dose units were appropriately regimented, meanwhile the amount of appropriate regimentation of sucralfate suspension were 74.6%. Conclusions According to ASHP standard, the SUP drugs in the inpatient surgery room at Dr. Soetomo Hospital were mostly given in inappropriate regimentation. Further research is needed to explore how will those inappropriate regimentation affect on the efficacy of therapy in the patients.

Reevaluation of Rectal Ketamine Premedication in Children

2000 ◽  
Vol 93 (5) ◽  
pp. 1217-1224 ◽  
Author(s):  
Makoto Tanaka ◽  
Masayoshi Sato ◽  
Atsushi Saito ◽  
Toshiaki Nishikawa
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
General Anesthesia ◽  
Peak Plasma ◽  
Peak Plasma Concentration ◽  
Postoperative Recovery ◽  
Healthy Children ◽  
Oxyhemoglobin Saturation ◽  
Sedative Effects ◽  
American Society

Background Results of previous studies of rectal ketamine as a pediatric premedication are clouded because of lack of dose-response relation, inappropriate time of assessing sedative effects, and previous administration or coadministration of benzodiazepines. Therefore, the authors reevaluated the efficacy of rectally administered ketamine in comparison with 1 mg/kg rectal midazolam. Methods Sixty-six infants and children (age, 7-61 months) who were American Society of Anesthesiologists physical status I and who were undergoing minor surgeries as in-patients were randomized to receive 5 mg/kg ketamine (n = 16), 7 mg/kg ketamine (n = 16), 10 mg/kg ketamine (n = 17), or 1 mg/kg midazolam (n = 17) via rectum. A blinded observer scored sedation 45 min and 15 min after administration of ketamine and midazolam, respectively, when children were separated from parent(s) for inhalational induction. All children underwent standardized general anesthesia with sevoflurane, nitrous oxide, and oxygen with endotracheal intubation. Blood pressure, heart rate, and oxyhemoglobin saturation were determined before, during, and after anesthesia. Postoperative recovery characteristics and incidence of adverse reactions were also assessed. Results Most children (88%) who received rectally 10 mg/kg ketamine or 1 mg/kg midazolam separated easily from their parents compared with those (31%) who received 7 or 5 mg/kg rectal ketamine (P &lt; 0.05). Similarly, more children who received 10 mg/kg ketamine or 1 mg/kg midazolam underwent mask induction without struggling or crying compared with those who received 7 or 5 mg/kg ketamine (P &lt; 0.05). There were no clinically significant changes in blood pressure, heart rate, and oxyhemoglobin saturation after administration of either drug. Immediately after surgery, more children receiving midazolam or 5 mg/kg ketamine were agitated compared with 7 or 10 mg/kg ketamine. Ketamine, 7 and 10 mg/kg, provided postoperative analgesia, but the largest dose of ketamine was associated with delayed emergence from general anesthesia. Conclusions The results indicate that rectally administered ketamine alone produces dose-dependent sedative effects in children, when evaluated at its predicted peak plasma concentration. Ketamine, 10 mg/kg, has a delayed onset but is as effective as 1 mg/kg midazolam for sedating healthy children before general anesthesia. However, 10 mg/kg rectal ketamine is not recommended for brief surgeries because of prolonged postoperative sedation.

scholarly journals A Study on Extent of Counseling by Hospital Pharmacists

2018 ◽  
Vol 4 (2) ◽  
pp. 99-109 ◽  
Author(s):  
Raj Kumar Thapa ◽  
Isha Joshi ◽  
Prakriti Thapa ◽  
Nashreen Bajracharya ◽  
Joshika Neupane ◽  
...  
Keyword(s):  
Drug Information ◽  
Complete Information ◽  
The United States ◽  
Cross Sectional Study ◽  
Urban Region ◽  
Cross Sectional ◽  
Hospital Pharmacists ◽  
Qualified Personnel ◽  
Minimum Requirements ◽  
American Society

  Pharmacists can improve adherence to drug therapy in order to help patients participate in their own health care decision. The study aimed to observe the problems faced during dispensing and counseling. A cross-sectional study was carried out in two different hospitals of Nepal. ASHP (American Society of Health-System Pharmacy) 1997 and USP (The United States Pharmacopoeia) 1997 guidelines were used to ensure the completeness of the contents of the counseling. The extent of counseling fulfilled by the pharmacists was observed and recorded. Collected data was compiled, managed and analysed using SPSS and MS Excel. Counseling was observed in total 400 cases (200 from each hospital). It was found that complete information from the guidelines was not provided in both the hospitals. Hospital pharmacists of urban region had provided maximum 5 categories of drug information while it was 6 in sub-urban region out of 14 categories given by USP and 16 categories given by ASHP guidelines. Besides this, none of them had received any counseling regarding precaution, side effects/adverse effects, interactions, contraindication, sensitivity and storage of the medications. Further, it was found that poly-pharmacy, language, lack of qualified personnel in pharmacy, inadequate time, lack of space in the pharmacy were some of the barriers to counseling found in the study. The minimum requirements of the guidelines were met in both the hospitals. However, the safety aspects of drug information were not provided to the patients. Prioritizing the safe and effective use of medicines should be the first consideration of the pharmacists.

scholarly journals Perception of Pain, Attitude and Satisfaction of Pain Management among Postoperative Patients

2021 ◽  
Author(s):  
Uma Venkatesan ◽  
Sruthi Kamal ◽  
Jasmine Viswanathan
Keyword(s):  
Pain Management ◽  
General Surgery ◽  
Pain Perception ◽  
Pearson Correlation ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Pain Scale ◽  
Postoperative Recovery ◽  
Cross Sectional ◽  
Urological Surgery

Introduction: Pain is considered as a fifth vital sign. Pain management and patients satisfaction with the treatment decreases early postoperative recovery. Aim: The study aim was to assess the satisfaction of pain management among postoperative patients. Materials and Methods: A cross-sectional study was used to conduct a study among 180 postoperative patients’ undergone surgeries (General surgery patients, ortho-paedic surgery and urological surgery patients) at selected hospitals, Puducherry. The purpose of the study was to associate the pain level with satisfaction. The patients were selected based on purposive sampling technique. After obtaining consent, the researcher used numerical pain scale to assess the pain perception of the patient, closed ended questionnaire to assess attitude level and modified short assessment questionnaire for patient satisfaction towards pain management. The study was analysed using Statistical Package for the Social Science (SPSS) software version 20.0. The descriptive statistics was used to assess the level of pain and attitude and inferential statistics like Pearson correlation coefficient were carried out to find the correlation between pain and satisfaction. Results: Severe pain was felt by nearly all (70%) among general surgery patients, 60% in orthopaedic surgery patients and 50% had moderate pain in urological surgery patients respectively. Regarding attitude, majority (78%, 88% and 83%) of the patients had positive attitude towards pain management in General surgery, Orthopaedic and Urology surgery patients. Most (74%) of them were satisfied with their pain management in general surgery patients, whereas in orthopaedic and urological patients, nearly all 90%, 96% of the clients were very satisfied towards pain management. Conclusion: The study concluded, optimal satisfaction toward pain management will increase quality of early postoperative recovery.

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