No Detectable Developmental Issues in Children Exposed to Anesthesia and Surgery

MedicalResearch.com Interview with:
"Anesthesia" by Liran Szeiman is licensed under CC BY-NC-ND 4.0James D. O’Leary, MD

Department of Anesthesia and Pain Medicine,
Child Health Evaluative Sciences
The Hospital for Sick Children
Department of Anesthesia, University of Toronto
Toronto, Ontario, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is substantial evidence from laboratory studies that the developing brain is susceptible to injury from general anesthetic drugs, which culminated in the US Food Drug Administration issuing a safety communication in 2017 stating that the use of general anaesthetic drugs “for lengthy periods of time or over multiple surgeries or procedures may negatively affect brain development in children younger than 3 years”. Considering the substantial number of children who require general anesthesia every year (almost 3 million in the US annually) even small differences in child development outcomes after surgical procedures that require general anesthesia may have significant public health implications.

Undertaking studies of anesthesia-related neurotoxicity in humans is difficult as adverse child development is a function of the complex interaction between many risk and protective factors. By examining differences between biological siblings in Ontario, Canada, this study seeks to mitigate differences in risk from biological vulnerability and environmental factors, to provide a more accurate estimate of the adverse effects of anesthesia and surgery on child development.

In the current study, young children who had surgical procedures that require general anesthesia were not found to be at increased risk of adverse child development outcomes compared to their biological siblings who did not have surgery. These findings further support that exposure to anesthesia and surgery in early childhood is not associated with detectable adverse child development outcomes. Continue reading

Ketamine vs Opioids for Acute Pain in the Emergency Department

MedicalResearch.com Interview with:

Evan Schwarz, MD FACEP, FACMT Associate Professor of Emergency Medicine Medical Toxicology Fellowship Director Section Chief Medical Toxicology Advisory Dean in the Office of Student Affairs Division of Emergency Medicine Washington University School of Medicine

Dr. Schwarz

Evan Schwarz, MD FACEP, FACMT
Associate Professor of Emergency Medicine
Medical Toxicology Fellowship Director
Section Chief Medical Toxicology
Advisory Dean in the Office of Student Affairs
Division of Emergency Medicine
Washington University School of Medicine 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Ketamine is being increasingly used in the emergency department (ED) for a variety of conditions, including as an analgesic. While its usage continues to increase, there are limited studies evaluating ketamine as an analgesic in the emergency department.

Most of the studies evaluating ketamine utilized it as an adjunct to an opioid, however, multiple recommendations on blogs and other websites recommend ketamine as a single agent. The purpose of the meta-analysis was to compare the analgesic effect of ketamine compared to an opioid in adult patients presenting with acute pain to the ED.

In this study, we found that ketamine was non-inferior to opioids. We also found that the number of severe adverse events to be similar between both groups.

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Does Nail Polish Really Affect Pulse Oxygen Reading?

MedicalResearch.com Interview with:
Dr James Purcell
University College Cork and
South Infirmary Victoria University Hospital
Cork, Ireland

MedicalResearch.com: What is the background for this study?

Response: Nail varnish and acrylic nails are common accessories and as such are commonly encountered by an array of healthcare professionals in various scenarios when SpO2 readings may be part of patient care.. Colloquially there was a wide variety of approaches and beliefs as to whether or not these treatments impacted on SpO2 readings. This is due to the fact that the Digital Pulse oximetry relies on the passing of a wavelength of light through a pulsatile nailbed to a sensor on the opposite side of the finger tip in order to read SpO2 levels. Any potential interference to this process by polish of certain hues, or acrylic was therefor believed to impact on the resultant readings

As such it was decided to analyse the actual level of knowledge and variety of approaches to the issue by means of a multisite study involving Consultants, NCHDs, and nursing staff in areas where this issue may arise. A second, experimental part of the study was set up using healthy volunteers and venous congestion and hypoxia modelling. Nail varnish of differing hues and acrylic nails were applied and results of SpO2 readout in healthy and pathological models with and without nail treatments applies were analysed.

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General Anesthesia vs Conscious Sedation for Endovascular Therapy of Stroke

MedicalResearch.com Interview with:

Dr. Claus Z. Simonsen, MD, PhD Department of Neurology Aarhus University Hospital

Dr. Simonsen

Dr. Claus Z. Simonsen, MD, PhD
Department of Neurology
Aarhus University Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Retrospective studies find worse outcome when performing (Endovascular Therapy) EVT under General Anesthesia (GA).

The main finding is that infarct growth in the Conscious Sedation (CS) and GA are not different. And that patients who had EVT under GA had a better outcome after 90 days. This is probably explained by better reperfusion rates under GA which was another part of the study that was surprising. Our neurointerventionalist are comfortable performing EVT under CS, but our study indicates that maybe it is easier to achieve reperfusion it the patient is anesthesized.

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Virtual Cartoon Technology Can Ease Pediatric Anxiety in OR Before Anesthesia

MedicalResearch.com Interview with:
Dr. Sunghee Han
Professor
Seoul National Unversity College of Medicine
Seoul National University Hospital
Department of Anesthesia and Pain Medicin

What is the background for this new technology and study? What are the main findings?

Response: The time from patient arrival in the operating theatre to induction of general anesthesia is one of the most stressful moments for children undergoing surgery. Various strategies such as ‘pre-operative guided operating room tour’ or ‘therapeutic play intervention’ have been developed in order to reduce children’s pre-operative anxiety. Although these existing simulation-based approaches may be effective, they have not been widely used in real clinical settings with limited budget and resources such as manpower and space.

Virtual Reality(VR), a relatively new technology in the field of healthcare, can allow the user to experience an immersive environment. In this study, using VR technology, we provided the children with a realistic trip to the operating theatre accompanied by ‘My best friend’ Pororo. “Pororo, The Little Penguin” is a very famous cartoon character in Korea and Asia. Most children in Korea watch Pororo in TV, play with Pororo toys since early yeas and perceive Pororo as a ‘close friend’. In the VR content used in this study, Pororo acts as a patient and is subjected to anesthesia and surgery himself. Pororo kindly brings his friend(the viewer; paediatric patient) to the theatre and shows all that is going on in there.

Intervention with the VR content was able to reduce the level of anxiety in paediatric patients and promote collaborative behavior and acceptance of the invasive procedures, especially general anesthesia. Parental satisfaction level was also relatively higher in the VR group.

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Combination Opioids and Benzodiazepines Raises Risk of Overdose

MedicalResearch.com Interview with:

Eric C Sun MD PhD, assistant professor Department of Anesthesiology Perioperative and Pain Medicine Stanford University School of Medicine Stanford, CA

Dr. Eric Sun

Eric C Sun MD PhD, assistant professor
Department of Anesthesiology
Perioperative and Pain Medicine
Stanford University School of Medicine
Stanford, CA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There have been large increases in opioid-related adverse events over the past decade. The goal of our study was to examine the extent to which these increases may have been driven by combined use of opioids and benzodiazepines, a combination that is known to be potentially risky. Overall, we found that the combined use of opioids and benzodiazepines nearly doubled (80% increase) between 2001 and 2013, and that opioid users who also used benzodiazepines were at a higher risk of an opioid-related adverse event. Indeed, our results suggest eliminating the combined use of opioids and benzodiazepines could have reduced the population risk of an opioid-related adverse event by 15%.

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Liposomal Bupivacaine Infiltration Reduced Costs and Opioid Use in TKA Surgery

MedicalResearch.com Interview with:
Bryan Sakamoto MD, PhD
Department of Anesthesia
Richard L. Roudebush, Veterans Affairs Medical Center
Department of Anesthesia
Indiana University School of Medicine
Indianapolis, Indiana

MedicalResearch.com: What is the background for this study?

Response: Liposomal bupivacaine is a novel extended-duration anesthetic that has recently become a popular option in total knee arthroplasty (TKA) for post-operative pain management. Although liposomal bupivacaine is widely used, it is unknown if the benefits justify the cost in the veteran population at our institution. The main purpose of this medication use study was to evaluate the cost verses benefit of using this agent in our veteran patient population.

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Persistent Postpartum Pain Linked To Higher Risk of Depression

MedicalResearch.com Interview with:
MS WEI DU, First author
Third Year Medical Student
DUKE-NUS Medical School and
DR BAN LEONG SNG, Senior Author
Senior Consultant Department of Women’s Anesthesia KK
Women’s and Children’s Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

MS WEI DU: We performed a cohort study involving 200 healthy women who received epidural pain relief during the deliveries of their firstborns to investigate the relationship between persistent childbirth pain, psychological and pain vulnerability with postnatal depression. Postnatal depression was evaluated using the Edinburgh Postnatal Depression Score (EPDS).

Patients with persistent pain (>4 weeks postpartum) had significantly higher EPDS scores as compared to patients whose pain resolved by 4 weeks by a difference of 2.44 mean score, and compared to patients who never had pain postpartum by a difference of 4.07 mean score. Other significant factors that were associated with higher EDPS score included higher levels of stress, greater pain vulnerability during the intrapartum period and higher anxiety level at 6 to 8 weeks postpartum.

DR BAN LEONG SNG: Patients with persistent pain (>4 weeks postpartum) had significantly higher EPDS scores as compared to patients whose pain resolved by 4 weeks by a difference of 2.44 mean score, and compared to patients who never had pain postpartum by a difference of 4.07 mean score. Other significant factors that were associated with higher EDPS score included higher levels of stress, greater pain vulnerability during the intrapartum period and higher anxiety level at 6 to 8 weeks postpartum.

MedicalResearch.com: What should readers take away from your report?

MS WEI DU: We concluded that greater pain vulnerability and stress during intrapartum period, and presence of persistent pain or higher anxiety during postpartum period are positively associated with higher scores on postnatal depression tests.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

DR BAN LEONG SNG: The research findings support the need to address pain comprehensively to lessen the risk of developing postnatal depression. We are currently conducting a larger study to evaluate the impact of pain and postnatal depression in pregnant women.

MedicalResearch.com: Is there anything else you would like to add?

DR BAN LEONG SNG: Postnatal evaluation and management of childbirth pain and postnatal depression is important in our care of mothers and their newborns.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

World Congress of Anaesthesiologists abstract discussing:

Persistent childbirth pain increases risk of postnatal depression

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

New Drug Class May Prevent Learning Deficits In Infants Exposed To Repeated Anesthesia

MedicalResearch.com Interview with:

Guang Yang, Ph.D. Assistant Professor NYU Langone School of Medicine Alexandria Center for Life Sciences New York, NY 10016

Dr. Guang Yang

Guang Yang, Ph.D.
Assistant Professor
NYU Langone School of Medicine
Alexandria Center for Life Sciences
New York, NY 10016

MedicalResearch.com: What is the background for this study? How common is the problem of long-lasting behavioral deficits after repeated anesthesia exposure in neonates?

Response: Each year, in the United States alone, more than 1 million children under 4 years of age undergo surgical procedures that require anesthesia. Many lines of evidence from animal studies have shown that prolonged or repeated exposure to general anesthesia during critical stages of brain development leads to long-lasting behavioral deficits later in life. The results from human studies are less clear, although some studies suggest a higher incidence of learning disabilities and attention-deficit and hyperactivity disorders in children repeatedly exposed to procedures requiring general anesthesia. To date, there has been no effective treatment to mitigate the potential neurotoxic effects of general anesthesia.

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Limited Anesthesia in Young Children Not Link To Later Cognitive Impairment

MedicalResearch.com Interview with:

Lena S. Sun, MD E. M. Papper Professor of Pediatric Anesthesiology Professor of Anesthesiology and Pediatrics Executive Vice Chairman, Department of Anesthesiology Chief, Division of Pediatric Anesthesiology Columbia University Medical Center New York, New York 10032

Dr. Lena S. Sun

Lena S. Sun, MD
E. M. Papper Professor of Pediatric Anesthesiology
Professor of Anesthesiology and Pediatrics
Executive Vice Chairman, Department of Anesthesiology
Chief, Division of Pediatric Anesthesiology
Columbia University Medical Center
New York, New York 10032

MedicalResearch.com: What is the background for this study?

Dr. Sun: The background for the study is as follow: There is robust evidence in both rodent and non-human primate studies that exposure of the developing brain leads to impairment in cognitive function and behavior later in life. The evidence from human studies derives mostly from retrospective studies and the results have been mixed. Some have demonstrated anesthesia in early childhood was associated with impaired neurocognitive function, while others have found no such association. Our study is the first to specifically designed to address the question of effects of general anesthesia exposure on cognitive function, comparing exposure with no exposure.

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Listening To Music Reduces Anxiety During Awake Eye Surgery

MedicalResearch.com Interview with:
Dr Gilles Guerrier
Cochin University Hospital
Paris, France

MedicalResearch.com: What is the background for this study?

Dr. Guerrier: Awake eye surgery is particularly stressful for patients. Music has long been known to reduce anxiety, minimise the need for sedatives, and make patients feel more at ease. The purpose of this pilot study was to evaluate the effect of music on anxiety in outpatients undergoing elective eye surgery under topical (local) anaesthesia. The music played was specifically composed to ease anxiety following strict criteria, including instrumental pieces only using a decreasing tempo and a progressive decrease in the number of instruments playing. Each patient was able to choose from a panel of 16 recorded music styles according to their own preferences, and listened through high quality headphones. There were various styles available, including jazz, flamenco, Cuban, classical and piano. The music was provided by MUSIC CARE, a Paris-based company that produces music aimed at preventing and managing pain, anxiety and depression.

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Opioid-Free Approach To Breast Cancer Surgery Explored

MedicalResearch.com Interview with:
Dr. Sarah Saxena
Université Libre de Bruxelles

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Saxena: Opioids are well known analgesics, but like every drug, they do not come without side-effects. Recently, certain studies have been published about an opioid-free approach in bariatric patients. An opioid free approach is possible combining ketamine, lidocaine and clonidine.

We studied this type of approach in breast cancer patients and looked at several factors such as patient comfort pain quality after an opioid free approach vs after an opioid approach. The study showed patients requiring less analgesics after an opioid free approach.

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Study of Cognitive Functioning after Surgery Has Reassuring Findings

MedicalResearch.com Interview with:

Unni Dokkedal, M.P.H. Unit of Epidemiology, Biostatistics, and Biodemography University of Southern Denmark

Unni Dokkedal

Unni Dokkedal, M.P.H.
Unit of Epidemiology, Biostatistics, and Biodemography
University of Southern Denmark

MedicalResearch: What is the background for this study? 

Response: Early (seven days) postoperative cognitive impairment is common in adult surgical patients of all ages, but elderly patients are at higher risk for this complication. Previous studies have shown that these impairments are detectable up to three months after surgery in patients older than 60 years. Furthermore, the condition may persist for longer than six months in some patients with potential long-term implications of the surgery leading to impaired quality of life and increased mortality risk. We wanted to investigate the contribution of surgery, anesthesia, preexisting conditions and other factors on the postoperative cognitive functioning of elderly patients.

MedicalResearch:  What are the main findings?

Response: For a sample of 4,299 middle-aged twins younger than 70 years and 4,204 elderly twins over 70 years, all of whom were residents of Denmark, medical records were reviewed from 1977 and until the accomplishment of cognitive tests in the period from 1995 to 2001. Results from five cognitive tests were compared in twins exposed to surgery, classified as major, minor, hip and knee replacement, or other, with those of a reference group without surgery. A statistically significant lower composite cognitive score was found in twins with at least one major surgery compared with the reference group (mean difference, −0.27; 95% CI, −0.48 to −0.06), which is a negligible effect size. None of the other groups differed from the reference group except the knee and hip replacement group that tended to have higher cognitive scores (mean difference, 0.35; 95% CI, −0.18 to 0.87).To consider genetic and shared environmental confounding and to take preoperative cognition into account, intrapair analyses were performed in same-sexed pairs in whom one had a history of major surgery and the other no surgery. No difference was found in the intra-pair analysis. The results suggest that preoperative cognitive functioning and underlying diseases were more important for cognitive functioning in mid- and late life than surgery and anesthesia.
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ER Trial of Inhaling Isopropyl Alcohol From Pads Reduced Nausea

Michael D. April, MD, DPhil Department of Emergency Medicine San Antonio Uniformed Services Health Education Consortium San Antonio, TX

Dr. April

MedicalResearch.com Interview with:
Michael D. April, MD, DPhil
Department of Emergency Medicine
San Antonio Uniformed Services Health Education Consortium
San Antonio, TX 

Medical Research: What is the background for this study? What are the main findings?

Dr. April: Anesthesia research studies have found that nasal inhalation of isopropyl
alcohol has efficacy in treating nausea among post-operative patients. We
sought to study this agent among Emergency Department patients with nausea or
vomiting. We found that patients randomized to inhale isopropyl alcohol had
improved self-reported nausea scores compared to patients randomized to inhale
saline (placebo).

MedicalEditor’s note:  Do Not Do This Without Medical Supervision!

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Soothing Words Do More Than Pills To Decrease Patient Anxiety

Dr Emmanuel Boselli, MD, PhD Anesthesiology and Intensive Care University Claude Bernard Lyon I University of Lyon Lyon, France

Dr. Boselli

MedicalResearch.com Interview with:
Dr Emmanuel Boselli, MD, PhD
Anesthesiology and Intensive Care
University Claude Bernard Lyon I
University of Lyon
Lyon, France

Medical Research: What is the background for this study? What are the main findings?

Dr. Boselli: We hypothesized that the use of conversational hypnosis in patients undergoing regional anesthesia procedures for ambulatory upper limb surgery might provide better comfort than the use of oral premedication during the regional anesthesia procedure. We assessed the subjective effect of conversational hypnosis on a patient self-reported comfort scale ranging from 0 (no comfort) to 10 (maximal comfort), and the objective effect was assessed using the Analgesia/Nociception Index (ANI), a 0-100 index derived from heart rate variability reflecting the relative parasympathetic tone. In our study of 100 patients undergoing hand surgery in two different centers, 50 had conversational hypnosis while being given regional anesthesia (Saint-Grégoire hospital), and 50 were given of oral hydroxyzine 30 minutes to an hour before the regional anesthesia procedure (Lyon hospital). Patients having hypnosis measured an average ANI of 51 before and 78 after hypnosis, whereas those who had premedication averaged 63 before and 70 after. The average comfort scale of those who had received hypnosis was 6.7 before and 9.3 after, while patients who had medication averaged 7.8 before and 8.3 after. The main finding of this study is that conversational hypnosis induced greater increase in comfort scales and ANI values than oral premedication.

Medical Research: What is conversational hypnosis? What does it consist of?

Dr. Boselli: Conversational hypnosis consists of matching the patient’s behavioral communication patterns, reflective listening, avoiding any negative suggestion (e.g. “Keep calm and quiet” instead of “Please don’t move!”) and focalizing the patient’s attention on something else than the regional anesthesia procedure, such as the ultrasound machine screen.

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Medicaid Patients, Minorities Less Likely To Receive Regional Anesthesia

Jashvant Poeran MD PhD Assistant Professor Dept. of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York, NY

Dr. Jashvant Poeran

MedicalResearch.com Interview with:
Jashvant Poeran MD PhD
Assistant Professor
Dept. of Population Health Science & Policy
Icahn School of Medicine at Mount Sinai
New York, NY

Medical Research: What is the background for this study?

Dr. Poeran: Neuraxial anesthesia and peripheral nerve blocks  are two techniques for regional anesthesia for hip and knee replacements. Compared to general anesthesia, these two regional anesthesia techniques are increasingly seen as ‘higher quality care’ as a growing number of studies show that patients have better outcomes after surgery when regional anesthesia is used. However, less is known about the factors that influence the process of anesthetic care. This is important information because the choice for regional anesthesia might affect outcomes after hip and knee replacement surgery. We therefore used a large national database of health claims of hip and knee replacement procedures to study if specific patient subgroups were less likely to receive regional anesthesia.

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Music Therapy Reduced Anxiety During Ambulatory Breast Cancer Surgery

Jaclyn Bradley Palmer, MM, MT-BC University Hospitals Of Cleveland Cleveland, OHMedicalResearch.com Interview with:
Jaclyn Bradley Palmer, MM, MT-BC
University Hospitals Of Cleveland
Cleveland, OH

 Medical Research: What is the background for this study? What are the main findings?

Response: Patients awaiting breast cancer surgery may be understandably anxious. While pharmacologic intervention may reduce anxiety, higher doses of preoperative drugs can depress circulation and respiration, making alternative measures a particular interest. Music therapy is the clinical use of music interventions to accomplish individualized goals within a therapeutic relationship by a board-certified music therapist. While music in surgery has been researched under the label of “music therapy”, many of the studied investigations illicit recorded music provided by non-music therapy staff, making it truly “music medicine” practices instead. In this investigation, the effect of both live and recorded music therapy on anxiety, anesthesia requirements, recovery time and patient satisfaction were studied perioperatively. Breast cancer surgery patients were engaged in a brief music therapy session which consisted of one live or recorded preferred song choice, followed by discussion and processing of emotions. Compared to usual care, both live and recorded music therapy groups experienced significantly greater reductions in anxiety (p<.001) with point reductions of 27.5 (42.5%) and 26.7 (41.2%), respectively. During surgery, both music groups listened to music-therapist selected recorded, instrumental harp music, chosen for it’s evidence-based therapeutic value of smooth lines, consistent volumes and stable melodies. In measuring the amount of interoperative drug (propofol) needed to reach moderate sedation, the intraoperative music was not found to have an effect in this trial. Patient satisfaction was universally high in all three study groups. Those who received live music preoperatively were discharged an average of 12.5 minutes sooner than those who received recorded music preoperatively, although neither music group was dischanged significantly sooner than the control group. Subjective reactions to the music interventions relayed that music therapy in surgery was an enjoyable addition.

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Anesthesia Drug and Deep Sleep Use Same Neural Circuits In Brain

Nick Franks FSB, FRCA, FMedSci, FRS Professor of Biophysics and Anaesthetics, Professor William Wisden, Chair in Molecular NeuroscienceMedicalResearch.com Interview
Professor Nick Franks 

Professor of Biophysics and Anaesthetics

Professor William Wisden,
Chair in Molecular Neuroscience
Department of Life sciences
Wolfson Laboratories, Imperial College, South Kensington London

Medical Research: What is the background for this study? What are the main findings?

Profs. Franks and Wisden: We were interested in finding out how a particular type of sedative drug, dexmedetomidine, works in the brain. This drug is increasingly used during intensive care for sedation of patients, but unlike other powerful sedatives, it induces a state whereby the patient can be temporarily woken up. This is a highly useful property because it means patients can be both sedated and responsive during procedures. The drugged sedative state induced by dexmedetomidine struck us as being highly similar to the deep sleep that we all need to have if we have been extensively sleep deprived. If people and animals are kept awake for extended periods of time, they have to sleep. Most people know this from common experience – catching up on lost sleep. But how and why we need to sleep after sleep deprivation is not known. We found that dexmedetomidine-induced sedation and this recovery sleep used the same brain circuits, in a tiny area at the base of the brain called the preoptic hypothalamus. To do this we used a new genetic technique in mice that allowed us to mark or “tag” which neurons in the mouse’s brain were active during sedation or recovery sleep after sleep deprivation. The beauty of this technique is that we could then specifically reactivate these same neurons several days later with a special molecule that only binds to the tagged neurons. This reactivation caused the mice to go into a deep sleep. We concluded that the sedative drug dexmedetomidine copies or hijacks the mechanism used by the brain to respond to sleep deprivation and trigger deep sleep.

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More Attention To Cognitive Effects of Anesthesia May Be Needed

MedicalResearch.com Interview with:
Jan G. Jakobsson
Institution for Clinical Science
Karolinska Institutet, Danderyds Hospital
Stockholm, Sweden

Medical Research: What are the main findings of the study?

Dr. Jakobsson:  We found that anaesthesiologists and nurse anaesthetists were concerned about the risk for neurocognitive side effects, but there routines and practice for preoperative identification of patients at risk, intraoperative management to minimise risk and assessment and management of patients showing signs and/or symptoms of neurocognitive side effects after anaesthesia was rarely at place.
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