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Medscape
5 days ago
- Health
- Medscape
Adverse Events in Airway Procedures in Kids: Key Risks
TOPLINE: Adverse events occurred in 2% of children who underwent procedures for airway management under general anesthesia, with higher rates in neonates and infants. Risk factors included younger age, the presence of anatomic difficulties, and undergoing anesthesia outside operating rooms. METHODOLOGY: Researchers conducted a prospective observational study at 10 tertiary care hospitals in Japan from June 2022 to January 2024, focusing on the incidence of adverse events during airway management in children under general anesthesia. A total of 16,695 children (mean age, 6.3 years; 41.4% girls; 1.8% neonates and 11.7% infants) received advanced airway management at least once under general anesthesia, with or without regional anesthesia, including tracheal intubation or the placement of a supraglottic airway device. Data on patient comorbidities, types of surgeries, training levels of anesthesia providers, and practices for airway management were collected. The primary outcome was the occurrence of adverse events related to airway management procedures during general anesthesia; the secondary outcome was desaturation, defined as a drop in oxygen saturation of at least 10%. Occurrences of any adverse events, including at least one hemodynamic and airway-related complication, and respiratory adverse events were recorded, and risk factors for adverse events and desaturation were identified. TAKEAWAY: Any adverse events occurred in 2% of cases of airway management, and desaturation was noted in 2.3% of cases. The incidence of any adverse events was 5.8% in neonates and 3.3% in infants, higher than that in preschool and school-going children and adolescents. Increasing age was linked to reduced odds of any adverse events (adjusted odds ratio [aOR], 0.92; P < .001). Insertion of a supraglottic airway device and the use of muscle relaxants at first attempt were also linked to reduced odds of any adverse events. Factors associated with increased odds of any adverse events included undergoing anesthesia in CT, MRI, or radiation therapy rooms (aOR, 5.7; P = .006); having airway sensitivity (aOR, 1.46; P = .010); and having one (aOR, 1.74; P = .042) or at least two (aOR, 2.82; P = .017) anatomic difficulties. The odds of desaturation decreased with increasing age (aOR, 0.78; P < .001) but were higher when anesthesia was provided in catheter labs and CT, MRI, or radiology therapy rooms than when provided in operating rooms. Airway management by nonspecialist anesthesiologists and trainees also was linked to higher odds of desaturation than when the intervention was performed by pediatric anesthetists. IN PRACTICE: 'Our study, focusing specifically on airway management, showed that approximately 21% of neonates and 7% of infants experienced desaturation, which was higher than that in other age groups,' the researchers reported. 'Neonates' unique physiological and anatomical characteristics can explain this hypoxic progression tendency…The higher desaturation incidence in neonates in our study highlights the necessity for shorter tracheal intubation time and higher first-attempt success rates in neonates,' they added. SOURCE: This study was led by Taiki Kojima, MD, MPH, of the Department of Anesthesiology at Aichi Children's Health and Medical Center in Obu, Japan. It was published online on July 07, 2025, in Anesthesiology. LIMITATIONS: The reliance on self-reported data from anesthesiologists may have introduced reporting bias and inaccuracies. Selection bias could have occurred due to missing cases, and unmeasured confounders may have affected the results. The exact incidence of adverse events by device type remained unclear due to multiple attempts with different devices. DISCLOSURES: The J-PEDIA study was funded by grants from the Ministry of Education in Japan. This study received Grants-in-Aid for Scientific Research from the Ministry of Education in Japan. No additional conflicts of interest were disclosed by the authors. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
13-06-2025
- Health
- Medscape
Add-On Simvastatin Shows No Benefit in Depression
In a trial of patients with major depressive disorder (MDD) and obesity, adding simvastatin to escitalopram treatment led to no significant reduction in depressive symptoms compared with placebo; however, the combination effectively reduced levels of low-density lipoprotein (LDL) cholesterol and C-reactive protein (CRP). METHODOLOGY: This confirmatory, double-blind, placebo-controlled trial included 160 adults (mean age, 39 years; 79% women) with MDD and comorbid obesity from nine tertiary care centres in Germany. Participants were randomly assigned to receive either simvastatin (40 mg/d; n = 81) or placebo (n = 79) as add-on to escitalopram (10 mg for the first 2 weeks, then increased to 20 mg until the end of the study) for 12 weeks. The primary outcome was the change in Montgomery-Åsberg Depression Rating Scale (MADRS) scores from baseline to week 12. The key secondary outcome was the change in self-reported Beck Depression Inventory II (BDI-II) scores. TAKEAWAY: Compared with the use of add-on placebo, the use of add-on simvastatin led to no significant change in MADRS scores ( P = .71) and BDI-II scores ( P = .70). = .71) and BDI-II scores ( = .70). Moreover, compared with the use of add-on placebo, the use of add-on simvastatin led to a significant reduction in levels of LDL cholesterol ( P < .001), total cholesterol ( P < .001), and CRP ( P = .003). < .001), total cholesterol ( < .001), and CRP ( = .003). Add-on simvastatin did not affect any mental health-related secondary endpoint, despite improving the cardiovascular risk profile. Four severe adverse events were reported, with no significant differences observed between the groups. IN PRACTICE: "Even though simvastatin did not exert additional antidepressive effects in our study, it had the expected and well-known effects on lipids and inflammatory activity. Given that both MDD and obesity are associated with increased cardiovascular risk and higher mortality, statins should be prescribed in this comorbid group of patients following the guidelines for statin use in primary prevention," the authors wrote. SOURCE: This study was led by Christian Otte, MD, Charité — Universitätsmedizin Berlin, Berlin, Germany. It was published online on June 04 in JAMA Psychiatry . LIMITATIONS: This study was conducted in tertiary care centres in a high-income country, with patients showing moderate symptom severity and a high response rate, which limited its generalisability. Additionally, participants with an established indication for statin treatment and those with a history of suicide attempt were not included. DISCLOSURES: This study was supported by a grant from the German Ministry of Education and Research and sponsored by Charité — Universitätsmedizin Berlin. Several authors reported receiving grants and personal fees from various sources, outside the submitted work. Details are provided in the original article.
Medscape
23-05-2025
- Health
- Medscape
Ultrasound Achieves 95% Accuracy for Testicular Torsion
A systematic review and meta-analysis found that ultrasound had a high diagnostic accuracy for testicular torsion, with colour Doppler sonography achieved a sensitivity of 95.3% and a specificity of 98.3% in its detection. METHODOLOGY: Researchers conducted a systematic review and meta-analysis of 63 studies that included men presenting to secondary or tertiary care with suspected testicular torsion and who subsequently underwent diagnostic assessment with ultrasound. The analysis included colour Doppler sonography as the primary index test, with surgical scrotal exploration or clinical follow-up as reference standards. Of the studies included, 54 (85.7%) assessed colour Doppler sonography, and the others examined spectral Doppler sonography, contrast-enhanced ultrasound, or alternative ultrasound technologies. TAKEAWAY: Across 42 studies involving 4422 participants, colour Doppler sonography demonstrated high diagnostic accuracy, with a sensitivity of 95.3% (95% CI, 91.4-97.5) and a specificity of 98.3% (95% CI, 96.2-99.3) in detecting testicular torsion. The positive predictive value was 96.1% (95% CI, 91.4-98.4) and the negative predictive value was 97.9% (95% CI, 96.2-98.9), based on 1358 cases of testicular torsion. The analysis revealed that younger patient age, non-radiologist user status, and the implementation of point-of-care ultrasound did not have a significant effect on diagnostic accuracy. IN PRACTICE: "There is evidence to suggest that ultrasound is highly sensitive and specific for TT [testicular torsion] detection. The ideal patient pathway for suspected TT should integrate timely access to ultrasound alongside clinical assessment, with careful patient counselling," the authors wrote. SOURCE: This study was led by Cameron E. Alexander, Luton and Dunstable University Hospital, Luton, England. It was published online on May 13, 2025, in European Urology Focus . LIMITATIONS: Insufficient data reporting prevented the assessment of the effect of several predefined factors on diagnostic accuracy. Although the accuracy has improved over time with modern technology, previous studies demonstrated that junior radiologists were more likely to yield false negative results in a multicentre European study. DISCLOSURES: This study did not receive any specific funding. One author reported receiving infrastructure support from the National Institute for Health and Care Research Imperial Biomedical Research Centre and Imperial College Experimental Cancer Medicine Centre, research funding from the Urology Foundation, consultation fees from Janssen and Varian, and funding to attend scientific conferences from Janssen and Sonablate Corp.
