Incidence and risk factors for postoperative lingual neuropraxia following airway instrumentation: A retrospective matched case-control study.

BACKGROUND: Lingual nerve injury or neuropraxia is a rare but potentially serious perioperative complication following airway instrumentation during general anesthesia. This study explored the the incidence and perioperative risk factors for lingual nerve injury in patients receiving laryngeal mask (LMA) or endotracheal (ETGA) general anesthesia in a single center experience. METHODS AND RESULTS: All surgical patients in our hospital who received LMA or ETGA from 2009 to 2013 were included, and potential perioperative risk factors were compared. Matched controls were randomly selected (in 1:5 ratio) from the same database in non-case patients. A total of 36 patients in the records had reported experiencing tongue numbness after anesthesia in this study. Compared with the non-case surgical population (n = 54314), patients with tongue numbness were significantly younger (52.2±19.5 vs 42.0±14.5; P = 0.002) and reported lower ASA physical statuses (2.3±0.7 vs 1.6±0.6; P<0.001). Patient gender, anesthesia technique used, and airway device type (LMA or ETGA) did not differ significantly across the two groups. A significantly higher proportion of patients underwent operations of the head-and-neck region (38.9 vs 15.6%; P = 0.002) developed tongue numbness after anesthesia. Multivariate logistic regression analysis indicated that head-and-neck operations remained the most significant independent risk factor for postoperative lingual nerve injury (AOR 7.63; 95% CI 2.03-28.70). CONCLUSION: The overall incidence rate of postoperative lingual neuropraxy was 0.066% in patients receiving general anesthesia with airway device in place. Young and generally healthy patients receiving head-and-neck operation are at higher risk in developing postoperative lingual neuropraxy. Attention should be particularly exercised to reduce the pressure of endotracheal tube or laryngeal mask on the tongue during head-and-neck operation to avert the occurrence of postoperative lingual neuropraxy.

Exendin-4, a glucagon-like peptide-1 analogue accelerates healing of chronic gastric ulcer in diabetic rats.

BACKGROUND: Diabetes mellitus is an independent risk factor for impaired healing of peptic ulcers, and there are currently no supplementary therapeutics other than the standard antipeptic medicine to improve the ulcer healing in diabetes. This study examined the potential pleiotropic effect of a glucagon-like peptide (Glp)-1 analogue exendin (Ex)-4 on the regeneration of gastric ulcer in streptozotocin-induced diabetic rats. METHODS AND RESULTS: Chronic ulcer was created in rat stomach by submucosal injection of acetic acid and peri-ulcer tissues were analyzed 7 days after operation. Ulcer wound healing was impaired in diabetic rats with suppressed tissue expression of eNOS and enhanced levels of pro-inflammatory reactions. Treatment with intraperitoneal injection of Ex4 (0.5 µg/kg/d) significantly reduced the area of gastric ulcer without changing blood glucose level. Ex-4 restored the expression of pro-angiogenic factors, and attenuated the generation of regional inflammation and superoxide anions. The improvement of ulcer healing was associated with increased expression of MMP-2 and formation of granulation tissue in the peri-ulcer area. CONCLUSION: Administration of Ex4 may induce pro-angiogenic, anti-inflammatory and anti-oxidative reactions in the peri-ulcer tissue of diabetic rats that eventually enhances tissue granulation and closure of ulcerative wounds. Our results support the potential clinical application of Glp-1 analogues as supplementary hypoglycemic agents in the antipeptic ulcer medication in diabetes.

Incidence and characteristic analysis of in-hospital falls after anesthesia.

BACKGROUND: In-hospital falls may result in serious clinical adverse consequences, but the effects of anesthesia in the occurrence of postoperative falls are still undetermined. Anesthesia may theoretically cause postoperative falls due to the residual pharmacologic and neuromuscular blocking effects of anesthetics. We retrospectively reviewed events of in-hospital falls occurred after anesthesia management to identify the incidence and risk factors of postanesthesia falls. METHODS: We reviewed the postanesthesia visit of patients received anesthesia in the Hualien Buddhist Tzu Chi General Hospital from January 2009 to December 2013. Falls happened within 24 h after anesthesia were recorded. The Poisson regression model was used for simultaneous analysis of the association between incidence proportion of postanesthesia falls and the potential risk factors. RESULTS: A total of 60,796 inpatients received anesthesia management over the past 5 years, and ten patients fell within 24 h after anesthesia. All cases happened in the general wards. Falls occurred more often at the bedside, presence of caregivers, and during the daytime. Patients underwent regional anesthesia, and old age significantly increased the risk of postanesthesia falls, while differences in gender and ASA physical status did not affect the occurrence of postanesthesia falls. CONCLUSIONS: The overall incidence proportion of postanesthesia falls is 1.6 cases per 10,000 patients (95 % CI 0.006 to 0.026 %) over a 24-h observation period. Falls are more commonly happened during the less expected periods after operation and are increased in the elderly and patients received regional anesthesia. This study highlights that more comprehensive clinical practice guidelines for postoperative care should be exercised to prevent the in-hospital falls.