1
|
Miyamoto K, Saeki A, Oshita S, Kobata M, Takami R, Miyamoto D, Okutani H, Ueki R, Kariya N, Hirose M. Age-related changes in intraoperative mean values of nociceptive response in patients undergoing non-cardiac surgery under general anesthesia: A retrospective cohort study. J Clin Monit Comput 2024; 38:581-589. [PMID: 38280112 DOI: 10.1007/s10877-023-01125-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/29/2023] [Indexed: 01/29/2024]
Abstract
Intraoperative nociception is affected by preoperative factors, surgical invasiveness, and anesthesia. Although age-related changes in nociception in conscious humans have been well examined, those in intraoperative nociception in unconscious patients under general anesthesia are unknown. To clarify associations between age and intraoperative nociception under general anesthesia, we performed a retrospective cohort study in consecutive patients of all ages undergoing non-cardiac surgery under general anesthesia from January 2019 to July 2023. The intraoperative nociception value in each surgery was assessed by the averaged value of nociceptive response (mean NR) index during surgery. Patient characteristics, including age, sex, body mass index (BMI), emergent surgery, preoperative serum C-reactive protein (CRP) level, and comorbidities were also collected. After excluding patients with missing data of CRP and mean NR index, 22,061 patients were enrolled, and were divided into low, intermediate, and high surgical risk groups. Multivariable regression analysis showed a significant association between age and mean NR index in all three surgical procedure risk groups. The preoperative variables of CRP levels, BMI, emergent surgery, atrial fibrillation, renal failure, and long-term steroid use also showed significant associations with mean NR index in all three groups. Sensitivity analysis showed that intraoperative mean NR index was higher in younger children than that in both older children and younger adults, and it gradually increased again in older adults to the same level as in younger children. In conclusion, there is likely an association between age and intraoperative mean NR index in patients under general anesthesia.
Collapse
Affiliation(s)
- Kazunori Miyamoto
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Atsuto Saeki
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Sachiko Oshita
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Mayu Kobata
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Rie Takami
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Daimu Miyamoto
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Hiroai Okutani
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Ryusuke Ueki
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Nobutaka Kariya
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan
| | - Munetaka Hirose
- Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, 1-1 Mukogawa-cho, Nishinomiya, 663-8501, Hyogo, Japan.
| |
Collapse
|
2
|
Tsai TJ, Lin CM, Cheang IN, Hsu YJ, Wei CH, Chin TW, Wu CY, Chang WY, Fu YW. Comparing Outcomes of Single-Incision Laparoscopic Herniorrhaphy in Newborns and Infants. Diagnostics (Basel) 2023; 13:diagnostics13030529. [PMID: 36766634 PMCID: PMC9914195 DOI: 10.3390/diagnostics13030529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND As surgical techniques progress, laparoscopic herniorrhaphy is now performed more often in premature babies. The aim of this study was to analyze the outcomes of newborns and infants who underwent single-incision laparoscopic herniorrhaphy (SILH) at our center. METHODS We retrospectively reviewed patients younger than 12 months old who received SILH at our department from 2016 to 2020. SILH involved a 5 mm 30-degree scope and 3 mm instruments with a 3-0 Silk purse-string intracorporeal suture for closure of the internal ring. At the time of surgery, Group 1 newborns, whose corrected age was 2 months and below, were compared to the Group 2 infants, whose age was above 2 months. We assessed the patients' characteristics, anesthesia, surgical data, and complications. RESULTS A total of 197 patients were included (114 newborns in Group 1 and 83 infants in Group 2). The mean age and body weight in Group 1 were 1.2 months and 3.8 kg, respectively, whereas in Group 2, they were 3.2 months and 6.7 kg, respectively. There were no significant differences in operative time (Group 1 = 34.1 min vs. Group 2 = 32.3 min, p = 0.26), anesthetic time (Group 1 = 80.0 min vs. Group 2 = 76.3 min, p = 0.07), length of hospitalization (Group 1 = 2.3 days vs. Group 2 = 2.4 days, p = 0.88), postoperative complications including omphalitis (Group 1 = 5.3% vs. Group 2 = 1.2%, p = 0.13), wound infection (Group 1 = 0.9% vs. Group 2 = 1.2%, p = 0.81), and hydrocele (Group 1 = 0.35% vs. Group 2 = 8.4%, p = 0.14). No recurrence, testicular ascent or atrophy, or mortality was observed in either group during the 2-year follow-up period. CONCLUSIONS Single-incision laparoscopic herniorrhaphy is a safe and effective operation for inguinal hernia repair in infants, even those with prematurity, lower body weight at the time of surgery, or cardiac and/or pulmonary comorbidities. Comparable results revealed no significant differences in perioperative complications despite younger ages and lower body weights.
Collapse
Affiliation(s)
- Tsung-Jung Tsai
- Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Ching-Min Lin
- Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - I Nok Cheang
- Division of Pediatric Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Yao-Jen Hsu
- Division of Pediatric Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Chin-Hun Wei
- Division of Pediatric Surgery, Department of Surgery, Shuang Ho Hospital, New Taipei City 235, Taiwan
| | - Tai-Wai Chin
- Division of Pediatric Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Chin-Yen Wu
- Department of Nursing, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Wen-Yuan Chang
- Department of Nursing, Changhua Christian Hospital, Changhua 500, Taiwan
| | - Yu-Wei Fu
- Division of Pediatric Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan
- Correspondence: ; Tel.: +886-4723-8595
| |
Collapse
|
3
|
El-Shahawy O, Labib K, Stevens E, Kahn LG, Anwar W, Oncken C, Loney T, Sherman SE, Mead-Morse EL. Exclusive and Dual Cigarette and Hookah Smoking Is Associated with Adverse Perinatal Outcomes among Pregnant Women in Cairo, Egypt. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412974. [PMID: 34948585 PMCID: PMC8701206 DOI: 10.3390/ijerph182412974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022]
Abstract
This study assessed the prevalence of prenatal smoking, factors associated with prenatal smoking, and its association with birth outcomes in a sample of pregnant women in Egypt. Pregnant women were recruited during their last trimester from antenatal clinics in Cairo from June 2015 to May 2016. Participants completed an interviewer-administered survey that assessed tobacco use and attitudes, and exhaled carbon monoxide (CO) was measured. Gestational age at delivery and offspring birth weight were collected via a postnatal phone interview. Two hundred pregnant women ages 16–37 years participated. More than a quarter (29.0%) of women reported smoking (cigarettes, hookah, or both) during their current pregnancy, and hookah was more popular than cigarettes. Most women who smoked prior to their current pregnancy either maintained their current smoking habits (46.6%) or switched from dual to hookah-only smoking (46.6%). Current smokers during pregnancy had a higher mean (±SD) exhaled CO level (2.97 ± 1.45 vs. 0.25 ± 0.60 ppm, p < 0.001) and had babies with a lower mean birth weight (2583 ± 300 vs. 2991 ± 478 g, p < 0.001) than non-smokers. Smokers during pregnancy had greater odds of premature birth and/or low birth weight babies compared to non-smokers. Dual cigarette-hookah smokers had the highest risk. Additional focused programs are required to prevent women of childbearing age from initiating tobacco use and empower women to stop tobacco use during the preconception and gestational periods.
Collapse
Affiliation(s)
- Omar El-Shahawy
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA; (E.S.); (S.E.S.)
- School of Global Public Health, New York University, New York, NY 10013, USA
- Correspondence: or ; Tel.: +1-646-501-3587
| | - Kareem Labib
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo 11517, Egypt;
| | - Elizabeth Stevens
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA; (E.S.); (S.E.S.)
| | - Linda G. Kahn
- Departments of Pediatrics and Population Health, New York University School of Medicine, New York, NY 10016, USA;
| | - Wagida Anwar
- Department of Community and Environmental Medicine, Faculty of Medicine, Ain Shams University, Cairo 11517, Egypt;
| | - Cheryl Oncken
- Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA; (C.O.); (E.L.M.-M.)
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Heath Sciences, Dubai P.O. Box 505055, United Arab Emirates;
| | - Scott E. Sherman
- Department of Population Health, New York University School of Medicine, New York, NY 10016, USA; (E.S.); (S.E.S.)
| | - Erin L. Mead-Morse
- Department of Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA; (C.O.); (E.L.M.-M.)
| |
Collapse
|
4
|
Comparison of Recurrence and Complication Rates Following Laparoscopic Inguinal Hernia Repair among Preterm versus Full-Term Newborns: A Systematic Review and Meta-Analysis. CHILDREN-BASEL 2021; 8:children8100853. [PMID: 34682118 PMCID: PMC8534929 DOI: 10.3390/children8100853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 01/20/2023]
Abstract
Background: Laparoscopic inguinal hernia repair (LHR) in children has been widely performed in the last decades, although it is still not sufficiently researched in preterm infants. This systematic review and meta-analysis compared the recurrence and complication rates following laparoscopic hernia repair among preterm (PT) versus full-term (FT) newborns. Methods: Scientific databases (PubMed, EMBASE, Scopus, and Web of Science databases) were systematically searched for relevant articles. The following terms were used: (laparoscopic hernia repair) AND (preterm). The inclusion criteria were all preterm newborns with a unilateral or bilateral inguinal hernia who underwent LHR. The main outcomes were the incidence of recurrence of hernia and the proportion of children developing postoperative complications in comparison with FT newborns following LHR. Results: The present meta-analysis included four comparative studies. Three studies had a retrospective study design while one was a prospective study. A total of 1702 children were included (PT n = 523, FT n = 1179). The incidence of hernia recurrence showed no significant difference between the PT versus FT groups (RR = 2.58, 95% CI 0.89–7.47, p = 0.08). A significantly higher incidence of complications was observed in the PT group compared to the FT group (RR = 4.05, 95% CI 2.11–7.77, p < 0.0001). The PT group of newborns accounted for 81% and 72% of the major and minor complications. The major complications were either non-surgical (i.e., severe respiratory distress requiring reintubation with prolonged ventilation (or high-frequency ventilation), seizures, bradycardia), or surgical (i.e., hydroceles requiring operative intervention and umbilical port-site hernia). Conclusions: LHR in PT infants is associated with similar recurrence rates as in FT infants. However, the incidence of complications is significantly higher in PT versus FT infants.
Collapse
|
5
|
Liu G, Zhang W, Zhou J, Sun B, Jiang B, Wang H. Laparoscopic versus open herniorrhaphy for children with inguinal hernia: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e21557. [PMID: 32872005 PMCID: PMC7437831 DOI: 10.1097/md.0000000000021557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to compare the effectiveness between laparoscopic herniorrhaphy (LH) and open herniorrhaphy (OH) in children with inguinal hernia. METHODS PubMed, EmBase, and the Cochrane library were searched to select trials from their inception till April 2019. The summary of relative risks (RRs) and weighted mean differences (WMDs) with corresponding 95% confidence intervals (CIs) were employed to evaluate the treatment effectiveness between LH and OH. RESULTS Six randomized controlled trials (RCTs) including a total of 594 children were selected. No significant differences were observed between LH and OH regarding the risk of postoperative complications. However, LH significantly reduced the risk of major postoperative complications when compared with OH. Moreover, LH showed association with a shorter operative time in bilateral inguinal hernia when compared with OH, whereas no significant difference between groups for unilateral inguinal hernia. Finally, children who received LH showed association with longer time to discharge than those who received OH, whereas no significant difference was observed between the groups for time to resume full activity. CONCLUSIONS These findings suggested that children who received LH had protection against major postoperative complications than those who received OH. Moreover, children who received LH had shorter operative time, and longer time to discharge.
Collapse
|
6
|
Esposito C, Gargiulo F, Farina A, Del Conte F, Cortese G, Servillo G, Escolino M. Laparoscopic Treatment of Inguinal Ovarian Hernia in Female Infants and Children: Standardizing the Technique. J Laparoendosc Adv Surg Tech A 2019; 29:568-572. [PMID: 30676267 DOI: 10.1089/lap.2018.0630] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Sliding indirect inguinal hernias containing ovary are not uncommon in girls. We reported our experience with laparoscopic treatment of inguinal ovarian hernias in female infants and children with the aim to standardize the surgical technique. METHODS The medical records of all girls who underwent laparoscopic inguinal hernia repair in our unit over the past 5 years were retrospectively reviewed. Only patients with an ovary found intraoperatively in the hernia sac were included in the study. All patients younger than 1 year received preoperatively a bowel preparation with simethicone and enemas. RESULTS A total of 289 girls (median age 3.2 ± 0.5 years) underwent laparoscopic inguinal hernia repair during the study period. Thirty-seven patients (12.8%) had an ovarian hernia and were included in the study. Of these 37 girls, 9 (28.1%) were younger than 1 month, 20 (62.5%) ranged in age from 2 months to 1 year, and 3 (9.4%) were from 1 to 7 years. The average operative time was 23.7 minutes (range 18-43 minutes). No necrotic ovary was found intraoperatively, and all the procedures were accomplished laparoscopically. Neither intraoperative nor postoperative complications were reported. A patency of the contralateral canal of Nuck was found in 16 of the 37 patients (43.2%) and repaired during the same procedure. The average length of hospitalization was 21.8 hours (range 18-36 hours). No hernia recurrence or ovarian atrophy was recorded at a mean follow-up of 36 months (range 1-60 months). CONCLUSIONS On the basis of our experience, laparoscopy should be considered the gold standard for the treatment of inguinal ovarian hernias in girls. Key points for standardization of the technique are as follows: bowel preparation in children younger than 1 year, use of 5-mm umbilical balloon trocar, correct positioning of 3-mm working screw trocars, section of the abnormal attachment of ovarian suspensory ligament, section of the periorificial peritoneum, and use of nonresorbable sutures.
Collapse
Affiliation(s)
- Ciro Esposito
- 1 Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Francesca Gargiulo
- 1 Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Alessandra Farina
- 1 Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Fulvia Del Conte
- 1 Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Cortese
- 2 Department of Anesthesiology, Federico II University of Naples, Naples, Italy
| | - Giuseppe Servillo
- 2 Department of Anesthesiology, Federico II University of Naples, Naples, Italy
| | - Maria Escolino
- 1 Pediatric Surgery Unit, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| |
Collapse
|
7
|
Laparoscopic repair of inguinal hernia in infants: Comparison with open hernia repair. J Pediatr Surg 2018; 53:2008-2012. [PMID: 29477445 DOI: 10.1016/j.jpedsurg.2018.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/27/2018] [Accepted: 01/29/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to evaluate the usefulness of laparoscopic repair of inguinal hernia (LR) in infants in comparison with open hernia repair (OR). METHODS We retrospectively analyzed the clinical data of 465 infants treated for inguinal hernia from January 2006 to December 2015. Among them, 124 underwent LR and 341 underwent OR. RESULTS In the OR group, 16.1% (55/341) primarily underwent bilateral inguinal hernia repair and 13.6% (42/308) subsequently developed metachronous contralateral inguinal hernia during follow-up. In the LR group, 75.8% (94/124) underwent primary bilateral inguinal hernia repair and only 1.6% (2/123) developed metachronous contralateral inguinal hernia. The mean operation times of unilateral inguinal hernia repair showed no statistical differences between LR and OR. However, the mean operation times of bilateral inguinal hernia repair were shorter in LR (39.8±10.4 vs. 51.1±14.4min, p<0.001). Postoperative recurrence and wound infection showed no statistical differences between the groups, but postoperative scrotal swelling was more common in OR (0.0% vs. 4.0%, p=0.006). CONCLUSION LR in infants showed a lower incidence of metachronous hernia, shorter operation times, and better postoperative course than OR. LR could be considered the primary operation method in infants with inguinal hernia. LEVELS OF EVIDENCE Prognosis Study, Retrospective Study, Level III.
Collapse
|
8
|
Raveenthiran V, Agarwal P. Choice of Repairing Inguinal Hernia in Children: Open Versus Laparoscopy. Indian J Pediatr 2017; 84:555-563. [PMID: 28550349 DOI: 10.1007/s12098-017-2354-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/12/2017] [Indexed: 11/24/2022]
Abstract
Inguinal hernia is a common disorder of childhood that requires surgical repair at diagnosis. Traditionally, it is operated upon by open inguinal incision. However, with the introduction of laparoscopic repair in 1990, opinion of scientific community is divided concerning the best method of pediatric herniotomy. Educated parents, who long to have the choicest of the best, often gather information from internet and prefer to discuss their concerns with primary care physicians. This descriptive review is intended to provide practicing pediatricians with updated evidence-based information which will enable them to counsel parents regarding the choice of hernia repair. Based on careful analysis of current literature, unacceptable standards are defined in this paper and rationalized recommendations are proposed. Laparoscopy appears to be beneficial in bilateral hernia of girls, giant hernia, recurrence following failed open repair and in hernia associated with undescended testis or ambiguous genitalia. On the other hand, open herniotomy appears to be advantageous in male inguinal hernia, unilateral female hernia, premature newborns, failed laparoscopic repair and in hernia associated with serious co-morbidity.
Collapse
Affiliation(s)
- Venkatachalam Raveenthiran
- Department of Pediatric Surgery, Sri Ramasamy Memorial (SRM) Medical College, Kattankulathur, Chennai, Tamil Nadu, India.
| | - Prakash Agarwal
- Department of Pediatric Surgery, Sri Ramachandra Medical College, Porur, Chennai, Tamil Nadu, India
| |
Collapse
|
9
|
Twenty-year experience with laparoscopic inguinal hernia repair in infants and children: considerations and results on 1833 hernia repairs. Surg Endosc 2016; 31:1461-1468. [DOI: 10.1007/s00464-016-5139-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
|