Were You Wondering...

Children’s Anesthesia Options

My son was recently at the dentist and we were told that he has 8 cavities. My husband and I take average care of his and his sister’s teeth. His sister is 6 and has no cavities. Luckily, we only have to have 2 filled: in his molars. This led me to wonder what types of anesthesia are available to children having procedures or surgery. Our dentist suggested 3 different options: sedate my son with Lorazepam (Ativan) so that he is relaxed, but awake, go with no sedation at all, and use the gum numbing cream, then the freezing needle; which is what most adults experience, or to completely put him under general anesthesia. Another suggestion was to use nitrous oxide which yields the “I can feel the pain, but I don’t care” feeling. I had to have nitrous when receiving my epidural before my cesarean section, and it didn’t make me feel too altered. You should be aware,  that patients have a restricted food and fluid intake prior to any sedation. This is because there is a risk that the patient will lose control over airway management, and are at risk for aspiration; basically, many drugs that sedate you, also make you nauseous. If you lose control of your airway, and happen to vomit, the vomit may go into your lungs and drown you, or severely damage you. Over the age of 3, your little ones will have to fast for 8 or more hours prior to their procedure. My dentist seemed to feel that it was important that my son not have a traumatic experience at the dentist and thought it was appropriate to use some sort of sedation, and I agreed, but my husband felt that any sedation was too risky and my son would be fine going the normal, adult route. So, what are all of the different options for anesthesia for children and what are the inherent risks involved?

The area of children’s surgical pain management is filled with some controversy as most drug companies are extremely hesitant (with good reason) to test safe dosages for children. As a result, anesthesiologists make up their own formulas from years of experience. Many children undergoing surgery are undermedicated, but there is obviously a fine line between undermedication/proper/overmedication. Physicians fear respiratory depression as a side effect of anesthetics; which is a risk for adult as well. Thus, there is a significant gap in the marketplace for analgesic/anesthetic medications for children and babies.

Firstly, I would like to point out that I am in no way a medical professional and you should always consult with your doctor or medical professional about any medications. I am coming from a place of a mom who is looking at the different options available for her son and sharing the information that I found to be useful in my quest for an answer.

Lorazepam (Ativan and other brand names) is a benzodiazepine that is a strong anti anxiety medication and sedative used in some surgeries. It is not recommended for use over a long term hospital visit due to both its addictive nature and the benzyl alcohol solution that it is carried in has at times been toxic to some patients. According to Wikipedia, this drug is not recommended for patients under 16 years of age, but there is always debate in the medical community. I have not yet talked to our family doctor, but since I have taken Ativan on and off for many years to control anxiety, I feel like I have a relationship with this medication, making me more comfortable with the possibility of using it on my son under doctors orders with the proper dose. One website that I found stated that the minimum pediatric dose for this drug is .02mg/kilogram and the maximum was .6mg/kilogram. Also stated, was the increased half life of the drug in pediatric patients. Half life is the amount of time for half of the drug to leave your system. It has an increased risk of excitation, agitation and hallucinations in patients under 8 years old.

Propofol is given intravenously to induce sedation. Two common side effects (these occur with many anesthesia drugs) include respiratory depression resulting in airway management issues during surgery and hypotension (low blood pressure). One very problematic side note is that this drug can be very painful to receive and some anesthetic prep may be needed to get this drug into the body, such as lidocane. Propofol may be prepared with soy bean oil and purified egg phospholipid so watch out for allergies. One source says that Propofol may be contraindicated for any pediatric sedation. This drug is administered in two phases; each with differing half lives: phase one is 2 to 4 minutes and phase two is 30 to 64 mintues. Total clearance from the system may take up to 12 hours.

Midazolam is another benziodiazpeine used in dental surgeries. It is short acting, making it a possible choice for dental procedures. This is the drug that is offered to inmates on death row to calm them before being put to death! Midazolam can be given orally, intranasally, sublingually, or rectally. One study showed that children who received the nasal spray version experienced irritation and pain after administration. Although widely used, this drug has not officially been approved for pediatric use.

Nitrous Oxide/Oxygen is, according the American Acadamy of Pediatric Dentistry, may be the safest sedative used in pediatric dentistry. As its name implies, it is a mixture of nitrous oxide and oxygen that is given via a mask worn on the child’s face. If you little one isn’t accustomed to the mask, it may be a bit frightening for them, but you could prep them ahead of time by buying a medical mask from the local pharmacy, or ask your doctor/dentist to give you one in order to give your child practice. While wearing the mask, your child will smell a gentle aroma and feel relaxed, but awake. Normal breathing clears the drug from their system relatively quickly after the removal of the mask.

Oralet is a new drug on the market specifically designed for children, It contains the narcotic fentanyl which induces sleep and provides pain relief. It was introduced in 1993 and watched very closely for overprescription by the FDA. It comes in a raspberry flavored hard candy on the end of a stick or in lozenge form.

Whatever route you decide to go: completely asleep, drowsy and relaxed or totally alert will depend upon the personality of your child. My eldest is a really nervous kid and I would probably opt for drowsy or even asleep for her. Some the the medications to induce drowsiness don’t work as well on very anxious kids. Adequate preparation and talking about what will happen may alleviate your child’s fear of the procedure. I used to buy a lot of Berenstain Bears books because they go through many experiences that happen in a family and help to answer questions; from going to the dentist, to the first day of school, to consumerism, moving and babysitters, these books pretty much cover them all. Preachy at times, but effective in getting the concept across.

Good luck and remember to talk to your doctor about anything you are considering. There may be new products available that I haven’t listed here.

Posted in Anatomy, Biology, Health |

Recovering Alcoholics Could Fall Off the Wagon in Familiar Drinking Settings.

Researchers have proven in animal studies what we intuitively know to be true. People who are recovering from alcohol addiction may be tempted to drink again when in surroundings that they associate with pleasurable drinking experiences. Possible triggers can include sight, smell, sound, familiar surroundings or people. It seems logical to think that if a reformed drinker goes to a place where, in the past, they went just to drink, they are going to experience strong cravings.

Chaudhri and colleagues from Ernest Gallo Clinic and Research Center introduced rats to an environment with distinctive smells, sounds and visuals, then exposed them to a tone before pouring alcohol in their drinking dish. Rats became accustomed to the alcohol whenever they heard the tone. These same rats were then placed in a completely new environment where the tone was played. At first, they visited their drinking dish to look for the alcohol, but without the presence of the distinctive environment, they quickly learned not to expect alcohol after the tone was played. These same rats were then placed into the original distinctive environment and upon hearing the tone, immediately returned to their drinking dish in anticipation of alcohol. This affect can be reduced if the same cues are introduced a number of times under different circumstances presenting treatment centers with a possible cognitive behavioral model of treating alcoholism involving repeated mental exposures to environments that trigger drinking.

The upshot is that if you want to continue to socially attend spots where you previously drank alcohol, do different activities that don’t involve drinking. This could prove difficult in a bar!

See the full press release at Eureka Alert.

Posted in Anatomy, Beverages, Breaking Health News, Health |

Higher Alcohol Consumption May Be Related to Increased Allergic Rhinitis.

In an article published in the July edition of Clinical and Experimental Allergy shows the results of a Danish study involving over 5000 women between the ages of 20 and 29 who were not currently suffering from Allergic Rhinitis (AR), an upper respiratory disease also known as Hay Fever. The participants filled out a lifestyle questionairre including questions relating to alcohol consumption. After 7 to 9 years these same women were questioned about whether they suffered from AR and what their alcohol consumption had been like during the past years. The results were quite astonishing: for every additional drink consumed per week, participants have a 3% higher chance of developing AR. At 14 or more drinks per week, women had a 78% chance of developing AR.

The study was limited to women only; who may experience a more pronounced effect than men because alcohol exerts a stronger effect on women’s immune systems.

A full copy of the press release can be found at Eureka Alert.

Posted in Uncategorized |

New Hope For Cystic Fibrosis Patients.

Dr. Richard Rozmahel with the Lawson Research Group in London, Ontario has discovered the gene responsible for the production of excess mucus in the lungs and intestines of mice. A similar gene exists in humans. The gene mCLCA3 is responsible for clearing away mucus that normally builds up in patients who suffer from Cystic Fibrosis; one of the most common diseases in the U.S. to cause premature death. Mucus is unable to be cleared from the lungs and builds up in layers, clogging passageways for breathing. This prevents the individual from breathing effectively during times of activity. In addition, the mucus build up causes damage to the lung tissue from inflammation. The lungs become irreversibly damaged. Another major complication is the invasion of bacteria into the mucus layer. People with CF rarely live beyond their 30’s and many require lung translplants.

The discovery of mCLCA3 may pave the road for scientists to invent a treatment that effectively manages the abnormal levels of this gene; allowing the mucus to be cleared and resulting in a better and longer quality of life for sufferers.

A full copy of this press release can be found at Eureka Alert.

Posted in Anatomy, Breaking Health News, Health |

Exposure to Air Pollution Can Increase Blood Pressure.

Researchers at Ohio State University found that exposure to the four most common air pollutants in busy cities, ozone, particulate matter, nitrogen dioxide and sulfur dioxide, contributed to increased blood pressure in rats predisposed to high blood pressure. Two groups of hypertensive rats were examined in the study. One group was exposed to environmental pollutants over a 10 week period and one group was not. At week 9, Angiotensin II, the hormone responsible for increasing blood pressure in humans was introduced into each chamber (the chamber with rats who had and hadn’t been exposed to the pollutants). The rats who had been breathing polluted air showed a marked increase in blood pressure while the rats breathing relatively clean air showed no increase. The level of pollutants used was equivalent to that experienced by a New York City commuter.

This study was funded by the National Institute of Health and researched by scientists from the EPA, Ohio State University, the New York University School of Medicine, the University of Michigan and the Institute of Statistical Science. Given the EPA’s involvement, new guidelines for maximum emmissions may be introduced, letting us all breathe a little easier.

The full press release can be found at the Ohio State University website.

Posted in Anatomy, Health |

Germinated Brown Rice May Help Prevent Nerve Damage in Diabetes Patients.

Researchers at the Medical College of Georgia have isolated the specific compound in germinated brown rice that could reduce nerve damage in patients with diabetes. In 2007, these same researchers had found a then, unidentified lipid in pre soaked (germinated) brown rice that was more beneficial to diabetes patients than unsoaked brown rice or white rice. The germination of the brown rice was activated by soaking it in water overnight before cooking it.

The lipid responsible is called acylated steryl glucosides (ASG) and it helps the body maintain more normal levels of blood sugar. ASG’s do this by increasing the levels of enzymes that have been decreased by diabetes such as ATPase and HTase. ATPase is responsible for helping to maintain nerve signal transmission. Nerve damage is a huge problem in diabetic patients that can lead to blindness and limb amputation. HTase breaks down homocysteine, a chemical made by the liver that can kill cells and cause vascular damage.

Now that that ASG has been identified as the beneficial component, scientists are beginning to work on a supplement with this specific compound that can be taken in pill form.

The study was funded by Fancl Hatsuga Genmai Co., Ltd, a subsidiary of the Fancl Group out of Japan. Their primary business is cosmetics and nutritional supplements. I am always skeptical about funding for research that will financially benefit the funder; however, with dwindling government support for scientific research, private industry funds a lot of research that may not otherwise be done.

For the full press release, visit the Medical College of Georgia Website.

Posted in Anatomy, Food, Health |

Surgeons Are Able to Remove Your Gallbladder Without an External Incision.

Doctor’s at New York’s Presbyterian Hospital have been participating in an ongoing clinical trial to remove a woman’s gallbladder without entering the body cavity through her abdomen. The clinical trial is only for women at this time because the procedure is performed though a small incision in the back of the uterus using an endoscope. After the gallbladder has been detached, the incision is sutured. The results are promising; less pain, reduced healing time and no visible scars.

Natural Orifice surgery has been employed since the 1980’s, but mainly in the gastrointestinal tract. This new procedure is called NOTES (Natural Orifice Translumenal Endoscopic Surgery). Gallbladder removal surgery; called a cholecystectomy, is a commonly performed surgery to end the pain associated with gallstones. Any external incision is at risk for infection from opportunistic bacteria such as MRSA, a growing concern in hospitals as many strains are resitant to multiple types of antibiotics; so the NOTES procedure will reduce the number of infections and time of hospital stays. Good for your health and your pocketbook. Currently 90% of cholecystectomies are performed laproscopically with a small incision into the abdomen; a vast improvement over the 10 inch incision needed before laproscopic surgery was common.

New York-Presbyterian Hospital also offers this type of surgery for appendectomies, abominal explorations and biopsies. Unfortuneately, for men, these surgeries are only available through the uterus, but doctors are working on ways to go through the anal cavity or mouth; sounds unpleasant, but less unpleasant than a big cut into your abdomen!

For more information, patients may call (212) 305-9506.

An full copy of this press release can be found at Eureka Alert.

Posted in Anatomy, Health |

Ritalin May Decrease Seniors’ Risk of Falls

An interesting study out of Tel Aviv has found that the drug used to treat ADHD, methylphenidate (the generic name for Ritalin) decreases the risk of falls in seniors. Some (the study doesn’t site the source of this statistic) estimate that approximately 50% of seniors die within a year of breaking a hip. This is because they move around less, both from pain and a fear of falling. Immobility creates all sorts of problems like poor venous return, which can lead to blood clots and bed sores that can become infected.

In a double blind design, after assessing a risk for falls in a group of seniors, half were given methylphenidate and half were given a placebo. Prof. Jeffrey M. Hausdorff, a researcher at Sackler School of Medicine at Tel Aviv University found that seniors on methylphenidate moved with more ease than seniors given the placebo because the drug improves the cognitive ability that naturally occurs with aging. It was once thought that walking was an automatic, simple motor task, but we now understand that there is a significant cognitive component as well. Methylphenidate has been found to decrease the risk of falls in Parkinson’s patients, although further study in this area is needed.

Barring any advances in drug technology, seniors who remain active, both physically and mentally have higher cognitive functioning and better physical fitness, leading to a decreased risk of falls.

The original press release can be found at American Friends Tel Aviv University.

Posted in Anatomy, Health |

Scientists Have Uncovered A Possible Cure for MRSA

MRSA, or methicillin resistant staphylococcus aureus is a bacteria that causes skin infections. It is the scourge of many hospitals and retirement homes because it can be spread by touch contact and is incredibly difficult to treat. As its name implies, it is resistant to methicillin, but many different strains are resistant to all classes of antibiotics:

Aminoglycosides are used to fight infections caused by gram-negative bacteria including e-coli, pseuodomonas.

Carbapenems are broad spectrum antibiotics for gram positive and gram negative bacteria.

Cephalasporins have 5 different sub classes.

Macrolides are used to treat strep, syphillis and respiratory infections.

Penicillins treat a wide range of infections.

Polypeptides treat eye, ear or bladder infections.

Quinolones are used to treat pneumonia, diarrhea and urinary tract infections.

Sulphonamides are used for urinary tract infections

Tetracycline is used to treat acne, syphilis, and chlamydial infections.

Cerexa antibiotics are a new class that are currently in clinical trials. They have shown promise in overcoming the resistance of the MRSA bacteria. They have come through their first two clinical trials with rave reviews. Cerexa  Inc. is a subsidiary of Forest Laboratories. You can visit the Cerexa website to learn more about ceftaroline acetate, they drug under investigation.

A full copy of this press release can be found at Eureka Alert.

Posted in Anatomy, Biology, Health |

Further Inroads Made Into Slowing the Progression of Alzheimer’s Disease.

Researchers from the Boston University School of Medicine (BUSM) found that patients who concurrently suffered from Alzheimer’s Disease and who were taking Angiotensin Receptor Blockers (ARB’s) had a 35-40% lower chance of developing the disease than patients who weren’t taking ARB’s. A description of Angiotensin and its link to high blood pressure can be found below. This data was found when researching records from the Decision Support System Database of the U.S. Department of Health System Veterans Affairs, who have records on over 5 million people. Specifically, they examined people who were comparable in health status in two groups: those who were taking ARB’s and those who were not. The study doesn’t mention whether these patients had a familial history of Alzheimer’s Disease. The also looked at patients who were already suffering from the disease and found these people had a 45% less chance of developing delirium, being admitted to nursing homes or dying prematurely.

This research does look promising, but I would be interested to know if there is a link between high blood pressure and a lower incidence of Alzheimer’s Disease. Also, I wonder what effect (if any) taking ARB’s would have on people who didn’t have high blood pressure or who suffered from low blood pressure; would these people be at risk for dying from oxygen starvation?

What is angiotensin? It is a protein that causes a number affects in the body in a complicated physiological cascade reaction. It is the precurser to angiotensin I-IV. Without getting too technical; angiotensin causes your blood vessels to constrict; leaving a narrower channel for blood flow - think about a river getting forced into a narrow channel and the resulting velocity change. Blood vessel constriction leads to an increase in blood pressure; that can lead to vessel damage and heart problems. Angiotensin also stimulates the secretion of Aldosterone from the adrenal cortex (adrenal glands are the little blobs that sit on top of your kidneys). Aldosterone causes your kidneys to conserve salt. Wherever salt stays, water will follow. The more water you have in your blood, the higher your blood pressure. Angiotensin also causes you to be really thirsty, resulting in an increase in water in your body leading to an increase in blood pressure. Angiotensin receptor blockers work by blocking the action of angiotensin.

The image included is a section of the cerebral cortex in your brain with plaque formation starting to occur.

The full version of this press release can be found at Eureka Alert.

Posted in Anatomy, Health |