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      Postoperative complications of pediatric dental general anesthesia procedure provided in Jeddah hospitals, Saudi Arabia

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      1 , , 2 , 3 , 1
      BMC Oral Health
      BioMed Central

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          Abstract

          Background

          Review of post-operative morbidity reports for pediatric dental care under general anesthesia (GA) show great variations. Until now, no morbidity data has been available to estimate the safety of pediatric patients under GA for dental rehabilitation in Saudi Arabia. The purposes of this study were to (1) investigate post-operative complications associated with dental care under GA and (2) correlate morbidity reports with patient's characteristics, dental procedures, and hospital protocol.

          Methods

          Study sample included 90 children attending GA for dental treatment at major governmental hospitals in Jeddah. Data were collected from every patient on three occasions, intra-operatively at the operating room, and post-operatively via phone calls in the first and third days after operation.

          Results

          Results showed that 99% of the children had one or more complaints in the first day in contrast to only 33% in the third day. Inability to eat (86%), sleepiness (71%), and pain (48%) were the most common complaints in the first day, followed by bleeding (40%), drowsiness (39%), sore throat (34%), vomiting (26%), psychological changes (24%), fever (21%), cough (12%), and nausea (8%). A great significant complaints reduction was reported by the third post-operative day. Age, gender, admission type of the patients and GA duration were the factors that showed a significant relationship with post-operative complaints.

          Conclusion

          Post-operative morbidity was common, but mostly of mild severity and limited to the first day. Hospital staff efforts should be directed to control commonly reported postoperative complaints.

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          Most cited references26

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          Behavioural changes in children following day-case surgery: a 4-week follow-up of 551 children.

          The purpose of this prospective multicentre survey was to evaluate the occurrence and the type of changes in children's behaviour during the first 4 weeks following the day of surgery, and to assess the significance of some patient-related factors on the incidence. Pre- and postoperative questionnaires were completed by the parents of 551 children aged 4 months to 13.4 years in five hospitals incorporating nine operative units in Northern Finland. The overall incidence of problematical behavioural changes was 47% and that of beneficial changes 17%. Problematical changes were most common in the 1.0 to 2.9 year olds and the incidence decreased significantly from 46% on the day of the operation to 9% 4 weeks later (p < 0.0001). Predictors by multiple logistic regression analysis were age, mild pain at home following surgery, severe pain and a previous bad experience of health care which had adversely affected the attitude of the child towards doctors or nurses. Hospital influenced playing was a significant factor 3 and 4 weeks after the operation. By the 4th week, beneficial and problematical changes were equally common (9%). Gender, previous operations and experience of repeated paracenteses (for treatment of middle ear infection) did not have a significant effect on the incidence. Pain on the day of the operation predicted the occurrence of behavioural problems up to the 4th week, 2-4 weeks longer than the duration of pain itself. The results emphasise the importance of effective prevention of postoperative pain as well as the importance of avoiding unpleasant experiences in all contacts children have with health care. Playing could perhaps be used to help children cope with a short hospital experience.
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            Human cardiorespiratory and cerebrovascular function during severe passive hyperthermia: effects of mild hypohydration.

            The influence of severe passive heat stress and hypohydration (Hypo) on cardiorespiratory and cerebrovascular function is not known. We hypothesized that 1) heating-induced hypocapnia and peripheral redistribution of cardiac output (Q) would compromise blood flow velocity in the middle cerebral artery (MCAv) and cerebral oxygenation; 2) Hypo would exacerbate the hyperthermic-induced hypocapnia, further decreasing MCAv; and 3) heating would reduce MCAv-CO2 reactivity, thereby altering ventilation. Ten men, resting supine in a water-perfused suit, underwent progressive hyperthermia [0.5 degrees C increments in core (esophageal) temperature (TC) to +2 degrees C] while euhydrated (Euh) or Hypo by 1.5% body mass (attained previous evening). Time-control (i.e., non-heat stressed) data were obtained on six of these subjects. Cerebral oxygenation (near-infrared spectroscopy), MCAv, end-tidal carbon dioxide (PetCO2) and arterial blood pressure, Q (flow model), and brachial and carotid blood flows (CCA) were measured continuously each 0.5 degrees C change in TC. At each level, hypercapnia was achieved through 3-min administrations of 5% CO2, and hypocapnia was achieved with controlled hyperventilation. At baseline in Hypo, heart rate, MCAv and CCA were elevated (P<0.05 vs. Euh). MCAv-CO2 reactivity was unchanged in both groups at all TC levels. Independent of hydration, hyperthermic-induced hyperventilation caused a severe drop in PetCO2 (-8+/-1 mmHg/ degrees C), which was related to lower MCAv (-15+/-3%/ degrees C; R2=0.98; P<0.001). Elevations in Q were related to increases in brachial blood flow (R2=0.65; P<0.01) and reductions in MCAv (R2=0.70; P<0.01), reflecting peripheral distribution of Q. Cerebral oxygenation was maintained, presumably via enhanced O2-extraction or regional differences in cerebral perfusion.
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              Prevalence and molecular epidemiology of noroviruses in hospitalized children with acute gastroenteritis in Rio de Janeiro, Brazil, 2004.

              The role of noroviruses (NoV) as a cause of gastroenteritis outbreaks is well documented; however, the importance of NoV infections in hospitalized children is not well established. The aim of this study was to determine the prevalence and the genetic diversity of NoV in hospitalized children. Three-hundred eighteen fecal samples were collected from January to December 2004, from children with acute gastroenteritis in 3 public hospitals in Rio de Janeiro, Brazil. The prevalence and genetic diversity of NoV was carried out by using genome amplification and sequencing of polymerase and capsid genes. NoV infections were detected in 65 (20%) of the samples, of which 11 (4%) were mixed infections with rotavirus. Infants up to 1-year-old were the most affected and a peak of virus detection was observed in autumn and spring seasons. Dehydration and diarrhea were the inclusion criterion; coughing (51%), vomiting (33%), and fever (22%) were the main clinical manifestations. Phylogenetic analysis showed that Genogroup II and GII/4 were prevalent. Two potential recombinant strains based in the different clustering pattern were observed. This study demonstrated the importance of NoV infections causing severe acute gastroenteritis in hospitalized children in Rio de Janeiro, Brazil. Molecular epidemiology surveillance determining the circulation pattern of different genotypes and recombinant strains is helpful for designing prevention strategies of NoV transmission in children. Studies concerning the prevalence and the molecular epidemiology of gastroenteric viruses in hospitalized children are particularly important to evaluate the impact of the rotavirus vaccine in Brazil.
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                Author and article information

                Journal
                BMC Oral Health
                BMC Oral Health
                BioMed Central
                1472-6831
                2009
                19 February 2009
                : 9
                : 6
                Affiliations
                [1 ]Department of Preventive Dental Sciences, Pediatric Dentistry Division, Faculty of Dentistry, Jeddah, Saudi Arabia
                [2 ]National Guard Hospital, Jeddah, Saudi Arabia
                [3 ]Department of Anesthesia and Critical Care, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
                Article
                1472-6831-9-6
                10.1186/1472-6831-9-6
                2667174
                19228406
                afa8af50-d5fa-406d-819a-6aa83e9ee55c
                Copyright © 2009 Farsi et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 July 2008
                : 19 February 2009
                Categories
                Research Article

                Dentistry
                Dentistry

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