Effect of Obesity on the Recovery Profile After General Anesthesia in Children: A Prospective Cohort Study

Background: Obesity has become a serious problem not only in adult patients but also in pediatric patients. Aim: To evaluate whether obesity affects the recovery profile after general anesthesia in children. Participants: 40 children (aged 2–12 years) who underwent surgery under general anesthesia and had an American Society of Anesthesiologists (ASA) physical I and II. Methods: This prospective cohort study was conducted over a period of 3 months (January- April, 2021). The patients were divided into two groups according to body mass index (BMI): Group I comprised obese children (BMI ?95th for age percentile) (n=20) and Group II comprised children with a normal BMI (25– 75th for-age percentile) (n=20). Anesthesia induction and maintenance were performed as per standard guidelines in both the groups. Outcome: The recovery profile was evaluated with the following parameters: time to spontaneous ventilation, laryngeal mask airway removal time, time to open eyes, and postanesthesia care unit discharge time. Results: When the recovery profiles were compared, no significant differences were found between the groups. Time to spontaneous ventilation [mean difference (95% CI); 0.66 (0.09- 1.42); P=0.085], laryngeal mask airway removal time [MD (95% CI); 1.12 (0.06–2.22); P=0.057), time to open eyes [MD (95% CI) 0.66 (0.40–1.74); P=0.217], and post-anesthesia care unit discharge time [MD (95% CI) 3.60 (0.59-7.25); P=0.054] were higher in Group II; however, these differences lacked both statistical and clinical significance. Conclusion: The results suggest that obesity has no effect on the recovery profile after general anesthesia in children in our setting.

The effect of bispectral index monitoring on cognitive performance following sedation for outpatient colonoscopy: a randomized controlled trial

ABSTRACT BACKGROUND: Bispectral index (BIS) monitoring can positively affect cognitive performance through decreasing the use of sedative agents. We aimed to evaluate the effect of BIS monitoring on early cognitive performance among patients undergoing sedation for colonoscopy. DESIGN AND SETTING: Randomized, controlled trial in a university hospital. METHODS: 100 patients were randomized into two groups. In the monitored group (n = 50), the depth of anesthesia was monitored using the BIS, and BIS scores were maintained between 60 and 80. In the usual care group (n = 50), BIS monitoring was not performed. To determine the patients' baseline cognitive performance levels, the mini-mental state examination (MMSE), Trieger dot test (TDT) and clock drawing test (CDT) were used. The patients' post-procedure cognitive performance levels were determined when they were classified as ready for discharge. RESULTS: The total volume (mg) of propofol used [median (range) IQR] in the sedation procedure was lower in the monitored group [100 (50-200) 100-140] than in the usual care group [150 (75-200) 100-200] (P < 0.001). The discharge scores [mean (SD)] using MMSE and CDT were higher in the monitored group [26 (3) and 3 (1), respectively] than in the usual care group [23 (3) and 2 (1), respectively] (P = 0.002 and P = 0.002, respectively). The discharge scores using TDT [mean (SD)] were lower in the monitored group [11 (7)] than in the usual care group [15 (11)] (P = 0.033). CONCLUSION: BIS monitoring among sedated patients was associated with lower propofol use and smaller decline in cognitive performance. CLINICAL TRIAL REGISTRATION: This trial was registered in the Australian New Zealand Clinical Trial Registry (ACTRN12617000134325).

Comparison of Muscle Mass between Obesity Classes by Different Formulas in Diabetes Mellitus

Objective: Sarcopenia is a risk for type 2 diabetes mellitus (DM) patients, however, to diagnose sarcopenia is difficult in these patients since they are generally obese. There is more than one method used to diagnose sarcopenia. The present study aimed to compare different formulas that evaluate muscle mass among age and BMI groups in overweight and obese DM patients. Methods: The study included DM over the age of 18 years with BMI ≥ 25 kg/ m2. In all patients, body weight, total appendicular muscle mass (ASM), total muscle mass, and total fat mass were measured by bioimpedance method. Thereafter, skeletal muscle index was calculated dividing ASM by height (kg/ m2); appendicular muscle mass percentage (%) was calculated dividing ASM by body weight; total muscle mass index (kg/m2) was calculated dividing total muscle mass by body height (kg/m2); and total muscle percentage (%) was calculated dividing total muscle mass by body weight. Results: Of the 486 DM patients enrolled in the study, the mean age was 54.47 ± 8.82 years, and the mean BMI was 38.58 ± 6.25 kg/m2. Skeletal muscle index was 8.16 ± 0.95 kg/m2 in overweight, 9.23 ± 1.04 kg/m2 in class-1 obese, 9.95 ± 1.05 kg/m2 in class-2 obese, and 11.59 ± 1.58 kg/m2 in class-3 obese (p<0.001). Total muscle percentage was 66.18 ± 6.63% in overweight, 58.89 ± 5.77% in class-1 obese, 54.35 ± 4.51% in class-2 obese, and 51.19 ± 3.92% in class-3 obese (p<0.001). Conclusions: Total muscle percentage may be useful in assessing muscle mass in obese subjects like DM patients.

Female sexual dysfunction in the late postpartum period among women with previous gestational diabetes mellitus

Objective: To compare the status of female sexual dysfunction [FSD] between women with a history of previous gestational diabetes mellitus [GDM] and those with follow-up of a healthy pregnancy, using the female sexual function index [FSFI] questionnaire

Study Design: Cross-sectional study

Place and Duration of Study: Department of Obstetrics and Gynecology, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey, from September to December 2015

Methodology: Healthy sexually active adult parous females were included. Participants were asked to complete the validated Turkish versions of the FSFI and Hospital Anxiety and Depression Scale [HADS] questionnaires. Student's t-test was used for two-group comparisons of normally distributed variables and quantitative data. Mann-Whitney U-test was used for two-group comparisons of non-normally distributed variables. Pearson's chi-squared test, the Fisher-Freeman-Halton test, Fisher's exact test, and Yates' continuity correction test were used for comparison of qualitative data

Results: The mean FSFI scores of the 179 participants was 23.50 +/- 3.94. FSFI scores and scores of desire, arousal, lubrication, orgasm, satisfaction, and pain were not statistically significantly different [p>0.05], according to a history of GDM and types of FSD [none, mild, severe]. HADS scores and anxiety and depression types did not statistically significantly differ according to the history of GDM [p>0.05]

Conclusion: An association could not be found in FSFI scores between participants with both the history of previous GDM and with healthy pregnancy; subclinical sexual dysfunction may be observed in the late postpartum period among women with a history of previous GDM. This may adversely affect their sexual health