The impact of meteorological parameters on the scrub typhus incidence in Baoshan City, western Yunnan, China.

Background: Scrub typhus has become widespread across various regions in China in recent decades, causing a considerable burden on residents. While meteorological variables significantly impact the spread of scrub typhus, there is insufficient quantitative evidence illustrating this association in known high-endemic areas. Methods: A distributed lag non-linear model was applied to explore the relationship between meteorological parameters and scrub typhus incidence from 2010 to 2019 in Baoshan City, western Yunnan Province, China. Results: High monthly mean (20°C) and maximum (30°C) temperatures were associated with a peak risk of scrub typhus in the current month. Higher minimum temperatures and higher relative humidity were followed by increasing cumulative risks over the ensuing 3 months. Higher precipitation was followed by increasing cumulative risk over the ensuing 2-month period, peaking at around 30 cm. Conclusion: The non-linear lag associations between meteorological parameters and scrub typhus incidence suggest that higher monthly minimum temperature and relative humidity could be associated with an increased risk of scrub typhus in the subsequent several months, while warm temperature is more likely to impact the occurrence of scrub typhus in the current month.

Reliability of a computerized system for strabismus screening.

AIM: To evaluate the reliability of Photo-Hirschberg screening for global strabismus performed by non-specialized personnel. METHODS: Participants at three sites were enrolled. One person at each site was trained in visual acuity measurement and use of the computerized system. Visual acuity was measured, and strabismus testing was performed using two flash photographs. All data from the three primary observers were sent to an experienced assistant researcher, who was blinded to the primary results, for re-evaluation. The primary and re-evaluation results of the Photo-Hirschberg screenings using weighted kappa for agreement were compared. RESULTS: The study included 181 participants (88 males and 93 females) and the results for primary and re-evaluation screenings were corresponded. Ten participants with contrasting results presented with unclear corneal light reflex. Sensitivity and specificity were 100% [95% confidence interval (CI): 29.0%-100%] and 99.4% (95%CI: 96.6%-100%), respectively, based on the Agresti test of the primary evaluation, considering the re-evaluated classification as true. CONCLUSION: The computerized system can be used for primary strabismus screening by non-specialized personnel, with 98.8% agreement with specialists. However, it cannot be used as a substitute for professional examination.

Vulnerability of NCDs and Mediating Effect of Risk Behaviors Among Tuberculosis Patients and Their Household Contacts Compared to the General Population in the Yangon Region, Myanmar.

Purpose: We investigated the association of TB patients and their household contacts with diabetes mellitus (DM) and hypertension compared to the general population, and the mediating effects of risk behaviors including current smoking, alcohol drinking, and poor diet quality. Patients and Methods: A cross-sectional study on screening for DM, hypertension, and risk behaviors among newly diagnosed TB patients (n = 221) and their household contacts (n = 257) aged 25-74 years in Yangon in 2018. Health data of the general population (n = 755) were obtained from an NCD risk factor survey in Yangon. A directed acyclic graph is used to identify possible pathways of association between variables. Associations are presented as adjusted odds ratios (aOR). Results: Compared to the general population, both TB patients and their household contacts were associated with current smoking and drinking, and TB patients were more likely to be underweight. Without considering mediating effects, TB patients had higher odds of DM (aOR = 6.3, 95% CI: 3.8-10.6), but both TB patients and household contacts had lower odds of hypertension (aOR = 0.54; 95% CI: 0.33-0.87) and (aOR = 0.68; 95% CI: 0.47-0.98), respectively. The body mass index-mediated pathway reduced the odds of DM and hypertension among TB patients (aOR = 3.4; 95% CI: 2.2-5.3) and (aOR = 0.3; 95% CI: 0.2-0.5), respectively. Conclusion: The shared risk behaviors among TB patients and household contacts with high burden of DM in TB patients endorse screening of risk behaviors and strengthening the integration of NCD services among TB patients and household contacts in this dual-burden country.

Clinical characteristics, radiologic features, and histopathology of biopsied lacrimal gland tumors.

Herein, we described the clinicopathologic and radiologic features of biopsied lacrimal gland tumors. A retrospective case series of 79 patients treated between 2004 and 2021 was reviewed. The median age was 48.9 years (range 18.3-88.3 years), with 51.9% females. The histopathologic diagnoses were as follows: immunoglobulin G4-related disease (IgG4-RD) = 23, reactive lymphoid hyperplasia = 14, lymphoma = 14, nonspecific inflammation = 10, adenoid cystic carcinoma (ACC) = 9, and pleomorphic adenoma = 9. The proportion of histopathologic diagnoses did not differ significantly over the range of symptom durations (≤ 1 month, > 1-3 months, > 3 months). Patients with ACC had significantly shorter symptom duration and more frequent proptosis than those with pleomorphic adenoma (p = 0.040 and p = 0.009, respectively). Patients with IgG4-RD were older (median 54.3 years) than those with nonspecific inflammation (36.2 years; p = 0.046). Patients with ACC were more likely to present with diplopia than those with lymphoma (p < 0.001). The superior wedge sign increased the likelihood of ACC compared with that of non-epithelial non-malignant lacrimal gland tumors (relative risk ratio = 13.44, p = 0.002). The overall survival of patients with ACC and lymphoma did not differ significantly. Although these patients present with a short symptom duration, urgent orbital imaging, tissue biopsy, and prompt treatment should be performed in patients with lacrimal gland tumors.

Development and diagnostic accuracy of dyslexia early identification flowchart for pediatric practice.

This study developed and evaluated the Rapid Automatized naming, Phonological Awareness, and Letter Identification (RAPALI) flowchart for early dyslexia identification in pediatric settings. Using early literacy skills at kindergarten level from the Thai emergent literacy for predicting dyslexia longitudinal study, the RAPALI flowchart effectively identified dyslexia risk at grade 3 level, boasting an AUC of 0.71, a sensitivity of 95.5%, and a negative predictive value of 99.1%. RAPALI demonstrated acceptable specificity and positive predictive value. The user-friendly flowchart aids early identification, interventions, and preventive measures for dyslexia, benefiting affected children and their families. However, further validation and adaptation are needed.

Validation of the prognostic scoring system for in-hospital mortality prediction in cardiogenic shock patients requiring veno-arterial extracorporeal membrane oxygenation.

BACKGROUND: A few prognostic scoring systems have been developed for predicting mortality in patients with cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO), albeit with variations in performance. This study aimed to assess and compare various mortality prediction models in a cohort of patients receiving VA-ECMO following cardiogenic shock or arrest. METHODS: We retrospectively analyzed 77 patients with cardiogenic shock who were placed on VA-ECMO support between March 2014 and August 2021. The APACHE II, SAPS II, SAVE, Modified SAVE, ENCOURAGE, and ECMO-ACCEPTS scores were calculated for each patient to predict the in-hospital mortality. RESULTS: Fifty-six (72.7%) patients died. All prediction model scores, except the ECMO-ACCEPTS, differed significantly between non-survivors and survivors as follows: ENCOURAGE, 23 versus 16 (p < 0.001); SAVE, -6 versus -3 (p = 0.008); Modified SAVE, -5 versus 0 (p = 0.005); APACHE II, 32 versus 22 (p = 0.009); and SAPS II, 67 versus 49 (p = 0.002). The ENCOURAGE score demonstrated the best discriminatory ability with an area under the receiver-operating characteristic curve of 0.81 (95% confidence interval: 0.7-0.81). All prognostic scoring systems possessed limited calibration ability. However, the SAPS II, SAVE, and ENCOURAGE scores had lower Akaike and Bayesian information criteria values, which were consistent with the results of the Hosmer-Lemeshow C statistic test, indicating better performance than the other scores. CONCLUSIONS: The ENCOURAGE score can help predict in-hospital mortality in all subsets of VA-ECMO patients, even though it was originally designed to predict intensive care unit mortality in the post-acute myocardial infarction setting.

Appendiceal tumors in patients undergoing primary surgery for mucinous ovarian tumors in a tertiary hospital, in Southern Thailand.

OBJECTIVE: To evaluate the prevalence of appendiceal tumors in patients diagnosed with mucinous ovarian tumors and to determine factors associated with coexisting appendiceal tumors. MATERIALS AND METHODS: Retrospective review of all patients who were diagnosed with mucinous ovarian tumors and underwent an appendectomy during surgery between January 2002 and June 2017 was performed. Univariate and multivariate logistic regression analyses were used to identify risk factors for coexisting appendiceal tumors. RESULTS: A total of 303 patients with mucinous ovarian tumors who underwent appendectomy were identified, including 77 (25.4%) mucinous cystadenoma and 226 (74.6%) mucinous borderline tumor or carcinoma. Twenty-one (6.9%) had coexisting appendiceal tumors including 8 that were primary appendiceal mucinous adenocarcinomas, 6 low-grade appendiceal mucinous neoplasms, 6 secondary appendiceal metastasis from the ovary, and one hyperplastic polyp. None of mucinous cystadenoma had coexisting appendiceal tumors. Multivariate analysis revealed advanced age ≥50 years, previous rupture of ovarian tumors, abdominal extension of tumors, and grossly abnormal appendix were independent factors for coexisting appendiceal tumors. CONCLUSION: Prevalence of coexisting appendiceal tumors in mucinous ovarian tumors was not uncommon. The risk factors were grossly abnormal appendix, abdominal extension of tumor, previous rupture of ovarian tumors, and advanced age.

Health Inequalities of STEMI Care Before Implementation of a New Regional Network: A Prefecture-Level Analysis of Social Determinants of Healthcare in Yunnan, China.

BACKGROUND: As one of the most serious types of coronary heart disease, ST-elevation myocardial infarction (STEMI) faces huge challenges in the equal management and care of patients due to its life-threatening and time-critical condition. Health inequalities such as sex and age differences in STEMI care have been reported from developed countries. However, limited outcomes have been investigated and the major drivers of inequality are still unclear, especially in under-developed areas. This study aimed to explore the major drivers of health inequalities in STEMI care before implementation of a new regional network in the south-west of China. METHODS: Prefecture-level data of STEMI patients before the implementation of a regional network were analysed retrospectively. Drivers of inequality were identified from six social determinants of health, namely area of residence, ethnicity, sex, age, education and occupation. Outcomes of STEMI care included timely presentation, reperfusion therapy, timely reperfusion therapy, heart failure, inpatient mortality, length of hospital stay, hospital costs, and various intervals of ischaemic time. RESULTS: A total of 376 STEMI patients in the research area before implementation of the STEMI network were included. Compared with urban residents, rural patients were significantly less likely to have timely presentation (odds ratio [OR]=0.47, 95% CI: 0.28-0.80, P=.004) and timely reperfusion therapy (OR=0.32, 95% CI: 0.14-0.70, P=.005). Rural residents were less likely to present to hospital promptly than urban residents (HR=0.65, 95% CI=0.52-0.82, P<.001). In the first 3 hours of percutaneous coronary intervention (PCI) reperfusion delay and first 6 hours of total ischaemic time, rural patients had a significantly lower probability to receive prompt PCI (hazard ratio [HR]=0.40, 95% CI: 0.29-0.54, P<.001) and reperfusion therapy (HR=0.37, 95% CI: 0.25-0.56, P<.001) compared to urban patients. CONCLUSION: Rural residents were a major vulnerable group before implementation of the regional STEMI network. No obvious inequalities in ethnicity, sex, age, education or occupation existed in STEMI care in Chuxiong Prefecture of China.

Expected Years Of Life Lost Due To Alcohol Consumption In Thai Adults: A 16-Year Follow-Up Cohort Of National Health Examination Survey 2004-2019.

AIMS: Evidence of premature death attributable to alcohol, a modifiable risk factor, is crucial for guiding public health policy for alcohol control. The aim of this study was to estimate alcohol-related mortality and potential years of life lost (PYLL) in Thailand in 2004-2019. METHODS: We analysed data of the third National Health Examination Survey in 2004 linked to National Death Registry data of 2004-2019. Causes of death were based on International Classification of Diseases version 10. PYLL was calculated by cause of death, age group and sex. All analyses were weighted to take into account the probabilities for the multi-stage sampling of the 2004 Thai population aged ≥15 years. RESULTS: There were 10,704 deaths with a follow-up time of 507,771.7 person-years. The crude mortality rate of the initial sample was 868.6 per 100,000 population. The mortality rate attributable to alcohol was 18.6 per 100,000 population (30.7 per 100,000 population in males and 6.8 per 100,000 population in females). The top leading cause of alcohol-attributable deaths was unspecified liver diseases in both males and females (6.1 and 3.1 per 100,000 population, respectively). The total years of life lost (YLL) at baseline were 9.4 million years or 49.5 years per person on average, with significantly more years in males. Mortality rate and expected YLL were highest in ages of 30-44 years, followed by 15-29 years. CONCLUSION: Males were 4-fold more likely to die from all alcohol-attributable causes compared with females. Young adults had a greater loss of life years than older adults.

Does perioperative respiratory event increase length of hospital stay and hospital cost in pediatric ambulatory surgery?

OBJECTIVE: We examined the consequences of perioperative respiratory event (PRE) in terms of hospitalization and hospital cost in children who underwent ambulatory surgery. METHODS: This subgroup analysis of a prospective cohort study (ClinicalTrials.gov: NCT02036021) was conducted in children aged between 1 month and 14 years who underwent ambulatory surgery between November 2012 and December 2013. Exposure was the presence of PRE either intraoperatively or in the postanesthetic care unit or both. The primary outcome was length of stay after surgery. The secondary outcome was excess hospital cost excluding surgical cost. Financial information was also compared between PRE and non-PRE. Directed acyclic graphs were used to select the covariates to be included in the multivariate regression models. The predictors of length of stay and excess hospital cost between PRE and non-PRE children are presented as adjusted odds ratio (OR) and cost ratio (CR), respectively with 95% confidence interval (CI). RESULTS: Sixty-three PRE and 249 non-PRE patients were recruited. In the univariate analysis, PRE was associated with length of stay (p = 0.004), postoperative oxygen requirement (p <0.001), and increased hospital charge (p = 0.006). After adjustments for age, history of snoring, American Society of Anesthesiologists physical status, type of surgery and type of payment, preoperative planned admission had an effect modification with PRE (p <0.001). The occurrence of PRE in the preoperative unplanned admission was associated with 24-fold increased odds of prolonged hospital stay (p <0.001). PRE was associated with higher excess hospital cost (CR = 1.35, p = 0.001). The mean differences in contribution margin for total procedure (per patient) (PRE vs non-PRE) differed significantly (mean = 1,523; 95% CI: 387, 2,658 baht). CONCLUSION: PRE with unplanned admission was significantly associated with prolonged length of stay whereas PRE regardless of unplanned admission increased hospital cost by 35% in pediatric ambulatory surgery. TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT02036021.

Characteristics, Influencing Factors, Predictive Scoring System, and Outcomes of the Patients with Nephrotoxicity Associated with Administration of Intravenous Colistin.

Multidrug-resistant Gram-negative infection is a major global public health threat. Currently, colistin is considered the last-resort treatment despite its nephrotoxicity. The purpose of this study was to estimate the incidence, characteristics, and influencing factors and to develop a prediction model for colistin-associated nephrotoxicity. A retrospective study was conducted in the university hospital in the South of Thailand from December 2015 to June 2019. A total of 381 patients (median age (IQR) of 64 (51-62) years) were analyzed. Overall, 282 (74%) had nephrotoxicity according to the Kidney Disease: Improving Global Outcomes (KDIGO) classification. In-hospital, 30-day mortality rates and cost of hospital admission were significantly higher among those with nephrotoxicity. Age > 60 years, comorbidities, serum albumin less than 3.5 g/dL, and concomitant nephrotoxic use were significantly associated with colistin-associated nephrotoxicity with adjusted OR (95% CI) 2.01 (1.23-2.45), 1.85 (1.18-3.6), 1.68 (1.09-2.99), and 1.77 (1.10-2.97), respectively. The prediction model for high-risk colistin-associated nephrotoxicity was identified with good overall performance (specificity of 79.6% (95% CI 70.3-87.1) and positive predictive value of 92.1% (95% CI 88.0-95.1)). In conclusion, the incidence of colistin-associated nephrotoxicity was high and incurred significant morbidity, mortality, and economic burden. Our predictive scoring system is relatively simple and useful for optimizing colistin therapy.

Socioeconomic inequalities in alcohol use and some related consequences from a household perspective in Vietnam.

INTRODUCTION AND AIMS: Alcohol-related harm reduction may target individuals, their households or communities. This study investigates the prevalence of and socioeconomic inequalities in alcohol use and alcohol-related consequences (injury, accident, property loss and interpersonal violence) at the family-level. DESIGNS AND METHODS: A cross-sectional survey of 2394 households was conducted in eight provinces from six socioeconomic regions and two metropolitan cities in Vietnam. Family-level alcohol use and injury were computed from individual data, while other measures were on a household basis. Unstandardised and indirectly standardised concentration index was used to measure degree of expenditure-based inequality in alcohol use and its consequences. RESULTS: Over the previous 12 months, 88.5% and 46.2% of households had at least one current-drinker and one heavy episodic drinking person, and in 41.7% the heavy episodic drinking person was the breadwinner. About 5.3% of households suffered alcohol-related injury, accident or property loss; 11.4% reported alcohol-related interpersonal violence. Poor and near-poor households suffered the double-burdens of both having heavy episodic drinking person and alcohol-related harm. A modest socioeconomic gradient was observed with all types of drinker, more concentrated among higher living-standard households, especially in urban areas. However, there was a persistent high-level inequality disadvantaging lower living-standard families, especially in rural areas, in suffering all measured alcohol-related harms. DISCUSSION AND CONCLUSIONS: Alcohol use and alcohol-related consequences are highly prevalent in Vietnam. Lower socioeconomic households, especially in rural areas, are important target groups for alcohol-related harm prevention and reduction interventions. The concentration index appeared to be a useful measure of inequalities in alcohol-related harms.

Diagnostic scoring system for tuberculous meningitis among adult patients with non-suppurative and non-bacterial meningitis.

Tuberculous meningitis (TBM) is the most severe form of extra-pulmonary tuberculosis. The definite diagnosis of this disease is difficult and can result in delayed treatment. Conventional culture yields low sensitivity while high-sensitivity diagnostic techniques are costly and unpractical. Adenosine deaminase (ADA) is used to diagnose several settings of extra-pulmonary tuberculosis but it is limited in TBM especially among HIV-infected patients. We retrospectively reviewed the data of patients with non-suppurative meningitis and compared the patient data with TBM and other causes including carcinomatous, lymphomatous, lymphocytic and fungal meningitis. We found that HIV infection, diabetes mellitus, duration of symptoms <14 days, radiologic findings of hydrocephalus, and CSF ADA level >10 IU were associated with TBM. The scoring system based on these parameters and their coefficients in the final model achieved an area under the receiver operating characteristic curve of 0.95,625. The indices were HIV infection = 5, diabetes mellitus = 3, duration of symptoms <14 days = 5, hydrocephalus = 4, and ADA in CSF >10 IU = 5. Based on the assumed costs of the patients with false negative and false positive, an appropriate cut off value of 10 was selected and the sensitivity was 92% and specificity was 89%.

Bacterial Contamination of Anaesthetic and Vasopressor Drugs in the Operating Theatres: Ameliyathanelerde Anestetik ve Vazopressör Ilaçlarin Bakteriyel Kontaminasyonu.

OBJECTIVE: The aim of this study was to determine the incidence of bacterial and fungal contamination in anaesthetic and vasopressor drugs before and after use in operating theatres. METHODS: A cross-sectional study was conducted in the operating theatres of a university hospital. We collected 945 samples of three different drugs, namely, propofol, vecuronium and ephedrine, from 20 operating rooms and refrigerators where the unused drugs were stored. Each drug was divided into two groups, the pre-use group and the post-use group. The pre-use drugs were cultured before the patient received the drug. The post-use drugs were cultured after the patient had received the drug or after the drugs had been transferred to other syringes. The culture results were reported as either positive or negative. RESULTS: Out of the 945 drug samples, 26 (2.8%, 95% confidence interval=1.8%-4.0%) gave a positive culture. Of the 317 propofol samples, 20 (6.3%) were found to have bacterial contamination, 11 in the pre-use group and 9 in the post-use group. Of the 318 ephedrine samples, 6 (1.9%) were found to be positive on culture, one in the pre-use group and five in the post-use group. Vecuronium gave no positive cultures. All organisms were non-pathogenic, and no fungal contamination was found. CONCLUSION: The incidence of bacterial contamination in anaesthetic and vasopressor drugs was 2.8%. Anaesthetic teams must be aware of contamination issues in anaesthetic drugs that have been prepared for later use and, in order to reduce the risk of contamination, they must improve the methods of administering drugs to patients.

Excess costs and length of hospital stay attributable to perioperative respiratory events in children.

BACKGROUND: Knowledge of the excess hospital costs and prolonged length of stay attributable to perioperative respiratory event (PRE) in pediatric anesthesia is useful for hospital planning. In this study, we compared costs (excess hospital costs and indirect costs) and length of hospital stay between children who had PRE and did not have PRE for noncardiac surgery at a tertiary care hospital in southern Thailand. METHODS: A prospective matched cohort study was conducted in children aged <15 years who underwent general anesthesia between November 2012 and December 2013 at Songklanagarind Hospital. PRE children were matched with no PRE children (1:1) using a random selection procedure on outpatients/inpatients, type of surgery, surgical charge (baht), ASA physical status, age difference <9 years, and difference in time of surgery <6 months. Primary end points were excess hospital costs and number of days hospitalized after surgery. Number of days hospitalized after surgery, excess hospital costs and indirect costs regarding transportation, and income loss of parents between groups were compared using Wilcoxon signed rank test. Any hospital stay after surgery between groups was compared using McNemar χ test. A hurdle model was used to predict any hospital stay and number of days hospitalized after surgery. Multiple mixed-effects linear regression was used to identify predictors of adjusted excess hospital costs and indirect costs. RESULTS: A total 430 children were included (215 matched pairs). More PRE children required hospital stay after surgery (81% vs 72%, P = 0.004), and PRE children had a longer number of days hospitalized after surgery (median [interquartile ranges]: 1 [1-3.5] vs 1 [0-2]; P < 0.001) and incurred higher excess costs (P < 0.001) but not indirect costs (P = 0.23). In multivariate analysis, PRE was a significant predictor for hospital stay after surgery (odds ratio, 2.56; 95% confidence interval, 1.23-5.31), longer hospitalization (count ratio, 2.10 [1.31-3.35]), higher excess costs (cost ratio, 1.30 [1.12-1.53]), and indirect cost (cost ratio, 1.58 [1.20-2.08]) after adjusting for patient and anesthesia characteristics. Universal coverage (74%) was associated with 35% and 64% higher excess cost compared with the Comptroller General's Department (17%) and self-pay (7%), respectively (P = 0.003). CONCLUSIONS: The effects of PRE in pediatric anesthesia were hospital stay after surgery, 2 times longer hospitalization, 30% higher excess hospital costs, and 58% higher indirect cost among outpatients. Hospital policy to efficiently manage hospital beds and compensatory budget should be developed.

Risk over time and risk factors of intraoperative respiratory events: a historical cohort study of 14,153 children.

BACKGROUND: The variation in the rate of intraoperative respiratory events (IRE) over time under anesthesia and the influence of anesthesia-related factors have not yet been described. The objectives of this study were to describe the risk over time and the risk factors for IRE in children at a tertiary care hospital in southern Thailand. METHODS: The surveillance anesthetic database and chart review of IRE of 14,153 children who received surgery at Songklanagarind Hospital during January 2005 to December 2011 were used to obtain demographic, surgical and anesthesia-related data. Incidence density of IRE per person-time was determined by a Poisson modelling. Risk of IRE over time was displayed using Kaplan Meier survival and Nelson-Aalen curves. Multivariate Cox regression was employed to identify independent predictors for IRE. Adjusted hazard ratios (HR) and their 95% confidence intervals (CI) were obtained from the final Cox model. RESULTS: Overall, IRE occurred in 315 out of 14,153 children. The number (%) of desaturation, wheezing or bronchospasm, laryngospasm, reintubation and upper airway obstruction were 235 (54%), 101 (23%), 75 (17%), 21 (5%) and 4 (1%) out of 315 IRE, respectively. The incidence density per 100,000 person-minutes of IRE at the induction period (61.3) was higher than that in the maintenance (13.7) and emergence periods (16.5) (p < 0.001). The risk of desaturation, wheezing and laryngospasm was highest during the first 15, 20 and 30 minutes of anesthesia, respectively. After adjusting for age, history of respiratory disease and American Society of Anesthesiologist (ASA) classification, anesthesia-related risk factors for laryngospasm were assisted ventilation via facemask (HR: 18.1, 95% CI: 6.4-51.4) or laryngeal mask airway (HR: 12.5, 95% CI: 4.6-33.9) compared to controlled ventilation via endotracheal tube (p < 0.001), and desflurane (HR: 11.0, 95% CI: 5.1-23.9) compared to sevoflurane anesthesia (p < 0.001). CONCLUSIONS: IRE risk was highest in the induction and early maintenance period. Assisted ventilation via facemask or LMA and desflurane anesthesia were anesthesia-related risk factors for laryngospasm. Therefore, anesthesiologists should pay more attention during the induction and early maintenance period especially when certain airway devices incorporated with assisted ventilation or desflurane are used.

Comparison of intelligence, weight and height in children after general anesthesia with and without perioperative desaturation in non-cardiac surgery: a historical and concurrent follow-up study.

PURPOSE: To determine whether perioperative desaturation (PD) in preschool children undergoing non-cardiac surgery is associated with subsequent impairment of intelligence or subsequent change in age-specific weight and height percentile. METHOD: A historical-concurrent follow-up study was conducted in children aged ≤ 60 months who underwent general anesthesia (GA) for non-cardiac surgery between January 2008 and December 2011 at Songklanagarind Hospital. Children who developed PD (PD group) and children who did not develop perioperative respiratory events (no-PRE group) were matched on sex, age, year of having index GA, type of surgery and choice of anesthesia. The children's age-specific weight and height percentile and intelligence quotient (IQ) scores by Standford Binet-LM or Wechsler Intelligence Scale for Children, 3rd edition 12-60 months after GA were compared using Student's t- test and Wilcoxon's rank sum test. Multivariate linear regression models for standardized IQ and multivariate mixed effects linear regression models for the change of age-specific weight and height percentile from the time of index GA to the time of IQ test were performed to identify independent predictors. The coefficients and 95% confidence intervals (CI) were displayed and considered significant if the F test p-values were < 0.05. RESULTS: Of 103 subjects in each group (PD vs no-PRE), there were no statistically significant differences in IQ (94.7 vs 98.3, p = 0.13), standardized IQ (-0.1 vs 0.1, p = 0.14) or age-specific weight percentile (38th vs 63th, p = 0.06). However, age-specific height percentile in the PD group at the time of IQ test was significantly lower (38th vs 50th, p = 0.02). In the multivariate analysis, PD was not a significant predictor for standardized IQ (coefficient: -0.06, 95% CI: -0.3, 0.19, p = 0.57), change in age-specific weight percentile (coefficient: 4.66, 95% CI: -2.63, 11.95, p = 0.21) or change in age-specific height percentile (coefficient: -1.65, 95% CI: -9.74, 6.44, p = 0.69) from the time of index GA to the time of IQ test after adjusting for family and anesthesia characteristics. CONCLUSION: Our study could not demonstrate any serious effect of PD on subsequent intelligence or on the change in age-specific weight and height percentile of children after non-cardiac surgery.

Perioperative desaturation and risk factors in general anesthesia.

OBJECTIVE: Despite advances in anesthetic technique, the incidence of perioperative desaturation in general anesthesia has remained high. Knowledge on factors associated with intraoperative desaturation is relatively scanty. The purpose of the present study was to investigate the distribution of time dependent intraoperative desaturation and factors predicting perioperative desaturation. MATERIAL AND METHOD: A prospective observational analytic study was conducted. One thousand and ninety three patients schedule for elective surgery under general anesthesia (GA) were enrolled. Exclusion criteria were patients with preoperative arterial oxygen saturation (SpO2) < or = 95%, pregnant women, obvious difficult airway and those requiring mechanical ventilation postoperatively. Desaturation was defined as oxygen saturation < or = 95% for > or = 10 seconds. RESULTS: Among 1093 eligible cases, 30 cases (2.74%) developed intraoperative desaturation. The probability of desaturation during induction, maintenance, and emergence were 0.55% (6/1093), 2.01% (22/1093), and 0.18% (2/1093), respectively. Occurrences of desaturation at the recovery room (RR) were noted in 224 patients (20.49%). Younger, obese patients, snorers, and lower respiratory tract infection were significant high-risk groups of intraoperative desaturation. Elderly, obese patients, snorers, positive history of pulmonary disease, modified Aldrete's score < or = 8, and duration of GA > or = 180 minutes predicted desaturation at RR. CONCLUSION: Obesity and snorers were the high-risk groups of perioperative desaturation. Elderly patients are at lower risk of desaturation than children intraoperatively, but at a higher risk in the postoperative period Higher FiO2 should be given to high-risk patients during the intraoperative period. Desaturation can still occur at RR, even in patients who received oxygen. Pulse oximeter monitoring should be continued throughout RR care.