RESUMO
Preclinical and clinical data suggest the possibility of neurotoxicity following exposure of young children to general anesthetics with subsequent behavioral disturbances. The aim of the study was to determine the overall effect of repeated general anesthesia on behavior and emotions of young children aged 1½-5 years old, compared to healthy children. Thirty-five children underwent repeated anesthesia and surgery were matched with the same number of healthy children who attended vaccination clinic, as a control group. Both groups were administered the child behavior checklist [CBCL] 1½-5 years and Diagnostic and Statistical Manual of Mental Disorders [DSM] oriented scale. Behavior data were collected through a semi-structured questionnaire. The CBCL score revealed that children with repeated anesthesia were at risk to become anxious or depressed [relative risk [RR]; 95% confidence interval [CI] = 11 [1.5-80.7]], to have sleep [RR; 95% CI = 4.5 [1.1-19.4]], and attention problems [RR; 95% CI = 8 [1.1-60.6]]. There was no difference in the risk between the two groups regarding emotionally reactive, somatic complaints, withdrawn problems, aggressive behavior, internalizing or externalizing problems. On DSM scale, children with repeated anesthesia were at risk to develop anxiety problems [RR; 95% CI = 3.7 [1.1-12.0]], and attention deficit/hyperactivity problems [RR; 95% CI = 3 [1.1-8.4]]. There was no difference in the risk between the two groups regarding affective, pervasive developmental and oppositional defiant problems. Young children who undergone repeated surgical procedures under general anesthesia were at risk for subsequent behavioral and emotional disturbances. Proper perioperative pain management, social support, and avoidance of unpleasant surgical experiences could minimize these untoward consequences
RESUMO
To evaluate the psychiatric morbidity [anxiety and depression] in women underwent an abdominal and vaginal hysterectomy of a benign indication. This is a prospective observational study which was done in the Obstetric and Gynecology and Neuropsychiatry Departments, Sohag University Hospital. One hundred and two women were scheduled for undergoing hysterectomy after fulfilling the inclusion criteria. All women underwent a thorough history taking, clinical examination and complete psychiatric history. General health questionnaire [GHQ-28] was used to assess women with psychiatric co-morbidity before and after the operation. All women with psychiatric co-morbidity were re-evaluated by Beck depression inventory [BDI] and Hamilton anxiety scale [HAMA] before and after hysterectomy. On screening for psychiatric co-morbidity using the GHQ-28 for the 96 women who completed the follow up protocol of the study 35 [36.46%] scored >/= 4 [Group I] with psychiatric co-morbidity, and 61 [63.54%] scored <4 [Group II] without psychiatric co-morbidity. GHQ-28 was reapplied to all women in group II [post-operatively] where 48 [78.69%] scored >/= 4 [group IIa] and 13 [21.31%] scored <4 [group IIb. Severe anxiety and depressive symptomes were the most common presentation after the operation and represented 8 [40%] and 8 [53.3%], of patients of group I, respectively. In patient, of group II [without psychiatric morbidity] after hysterectomy, depressive and anxiety symptoms was the most common presentation in nulliparous women and was found in 7 [63.64%] and 3 [27.27%], respectively. However, the least depressive and anxiety symptoms was observed in women with parity >/= 5 and was found in 12 [38.7%] and 9 [29.03%], respectively. It is not worthy that the majority of women free from psychiatric co-morbidity was observed in women with parity >/= 5 and represented 10 [32.5%] of patients. It was clear that there was a definite significant relation between hysterectomized women and psychiatric morbidity of a depressive and anxiety nature. So we recommend that before hysterectomy in benign conditions, gynecologists should exhaust great effort of using the available recent less invasive modalities of treatment as first option