Duration of general anaesthetic exposure in early childhood and long-term language and cognitive ability.

BACKGROUND: The anaesthetic dose causing neurotoxicity in animals has been evaluated, but the relationship between duration of volatile anaesthetic (VA) exposure and neurodevelopment in children remains unclear. METHODS: Data were obtained from the Western Australian Pregnancy Cohort (Raine) Study, with language (Clinical Evaluation of Language Fundamentals: Receptive [CELF-R] and Expressive [CELF-E] and Total [CELF-T]) and cognition (Coloured Progressive Matrices [CPM]) assessed at age 10 yr. Medical records were reviewed, and children divided into quartiles based on total VA exposure duration before age three yr. The association between test score and exposure duration quartile was evaluated using linear regression, adjusting for patient characteristics and comorbidity. RESULTS: Of 1622 children with available test scores, 148 had documented VA exposure and were split into the following quartiles: ≤25, >25 to ≤35, >35 to ≤60 and >60 min. Compared with unexposed children, CELF-T scores for children in the first and second quartiles did not differ, but those in the third and fourth quartiles had significantly lower scores ([3 rd quartile - Unexposed] -5.3; 95% confidence interval [CI], (-10.2 - -0.4), [4 th quartile - Unexposed] -6.2; 95% CI, (-11.6 - -0.9). CELF-E showed similar findings, but significant differences were not found in CELF-R or CPM for any quartile. CONCLUSIONS: Children with VA exposures ≤35 min did not differ from unexposed children, but those with exposures >35 min had lower total and expressive language scores. It remains unclear if this is a dose-response relationship, or if children requiring longer exposures for longer surgeries have other clinical reasons for lower scores.

Malaria in an urban emergency department: epidemiology and diagnostic features of 25 cases.

This article presents a retrospective study of 25 patients diagnosed with malaria in an urban emergency department (ED) between June 1986 and June 1989. The mean annual case rate of malaria in this study group was more than three times the national rate. This may be ascribed to the notable ethnic diversity of the population. A history of travel to an area endemic for malaria was eventually elicited from all patients. The most common chief complaint was fever (56%) followed by abdominal pain (12%). Temperatures were elevated in 70% of the patients, with a mean temperature of 102.9 degrees F (39 degrees C). Gender was found to play a role in delaying diagnosis, with women accounting for 83% of a group of patients requiring multiple ED visits before diagnosis. The authors conclude that malaria must be considered when diagnosing patients in ethnically diverse populations. Gender may be associated with a delay in diagnosis. A careful travel history and a peripheral smear are aids in rapid diagnosis.