Yearly Archives: 2023

What was the cause of hearing loss after anesthesia in these 4 cases?

rHGH Space / / Medical

The focus of anesthesia is not limited to the vital signs on the monitor. There are many hidden risks……
At present, common anesthesia methods in clinic include general anesthesia, spinal anesthesia and nerve block anesthesia, and each anesthesia scheme is associated with different risks.
Some common post-anesthesia complications are well known to anesthesiologists. However, some complications remain unknown due to unclear theory and extremely rare incidence, including post-anesthesia hearing loss.
The formation of hearing is a complex mechanism composed of multiple structures, which can be divided into the outer ear, the middle ear and the inner ear according to its anatomical characteristics.
The outer ear comprises the auricle and the outer auditory canal; The middle ear consists of tympanum, eustachian tube, tympanic sinus, and mastoid process. The inner ear, also known as labyrinthine, is located in the temporal bone petrogeny and is divided into bony labyrinthine and membranous labyrinthine. When any one of these links is damaged, it may lead to hearing impairment.
Through literature review, it is found that there have been cases of hearing loss after anesthesia no matter what kind of anesthesia program in the past. Relatively speaking, there are more reports of hearing loss after spinal anesthesia. The following examples are given.
Case 1: Intraspinal anesthesia
The mother, 28 years old, 165cm, 90kg, was admitted to hospital in emergency due to “pregnancy complicated with giant baby and premature rupture of membranes”. The puerpera underwent caesarean section in the lower uterine segment under combined lumbo-epidural anesthesia. The vital signs of the mother were stable during the operation. The operation lasted for 1 hour. After the operation, the epidural catheter was pulled out, and the patient returned to the ward to be in supine position with the removal of the pillow.
Headache and tinnitus appeared 12 hours after the operation, and tinnitus was more severe on the left side. 10 days later, the maternal headache was relieved, and the left ear hearing was basically restored.
▌ Analysis of the Causes:
Changes in cerebrospinal fluid pressure are rapidly transmitted to the outer inner ear lymphatic through the open cochlear aqueduct. The relative balance between endolymphatic pressure and exolymphatic pressure maintains the normal structure of the inner ear. This balance can cause semicircular canal dysfunction and hearing impairment.
The drop in cerebrospinal fluid pressure caused by perforating the dura leads to a rapid drop in exolymph pressure and a slower response in the endolymphatic system. The pressure regulation of endolymph is mainly through changing the formation of the endolymph in the vasculature and the absorption of the endolymph sac.
Therefore, a sharp drop in cerebrospinal fluid pressure makes the endolymphatic pressure significantly greater than the epolymphatic pressure, resulting in deformation of the vestibular membrane and basement membrane, rupture of the hair cells and thus hearing loss.
Another possible reason is that when the abdomen is pressed during cesarean section, some amniotic fluid may enter the systemic circulation and reach the branch of the inner ear artery through the basilar artery. Because the branch of the inner ear artery has no collateral blood supply, when it is embolized, it is easy to cause ischemia and thus lead to hearing damage.
In this case, the prognosis is generally poor, with partial recovery of hearing but not complete recovery. In this case, there were no clinical manifestations of embolism during and after the operation of obstetrics and gynecology, and hearing was completely recovered after 10 days without sequelae, so this possibility can be ruled out.
Case 2: Nerve block anesthesia
A 48-year-old female patient was admitted to the hospital for “right hand trauma for 2 hours.” The patient underwent open reduction and internal fixation for a right radial fracture under brachial plexus block. The puncture point was located near the omohyoid muscle through the intermuscular sulci approach. After accurate positioning, the patient was repeatedly drawn back without blood and cerebrospinal fluid and slowly pushed into 5ml mixture of 1% lidocaine and 0.25% ropivacaine mesylate. The patient was asked if he had vertigo and tinnitus, but no abnormalities were reported, and slowly pushed into 25ml local anesthetic.
Eight minutes later, the patient developed right nasal congestion, drooping eyelids, redness, no tinnitus, dizziness, nausea, vomiting and other symptoms.
The patient’s vital signs were stable and there was no obvious discomfort. The operation time was 1 hour. One hour after surgery, the patient felt hearing loss on the right side, and a hearing test was conducted. According to the average hearing threshold of speech frequency (500-4000 Hz), there was a 60dB loss on the right side of the patient’s hearing threshold, and the left side was normal. The right side of the patient recovered 8 hours after surgery, without obvious sequelae.
▌ Analysis of the Causes:
It may be due to local sympathetic nerve block that causes vasodilation of eustachian tube and middle ear, resulting in blocked sound conduction from the middle ear to the inner ear, indirectly affecting the spiral apparatus of cochlea and leading to ipsilateral hearing loss.
The patient also presented with typical Horner syndrome, but it does not indicate that Horner syndrome is related to hearing impairment. Horner’s syndrome is mainly caused by blocking the cervical sympathetic ganglia, which are separate from the superior cervical ganglia that supply the eyes and ears.
In addition, local anesthetic poisoning can cause tinnitus and affect hearing, but this patient did not show symptoms of tinnitus or local anesthetic poisoning.
Case 3: General Anesthesia (Non-Extracorporeal Circulation)
A 72-year-old male patient underwent a L2-L5 laminectomy under general anesthesia for “severe lumbar spinal stenosis.” Prior medical history did not include ear disease, and preoperative medication was not ototoxic. General anesthesia drugs used during surgery include midazolam, fentanyl, propofol, vecuronium bromide, and nitrous oxide.
Cefazolin sodium was used for anti-infection during the operation. Postoperatively, the patient complained of ear plugs and bilateral hearing loss, but had no other signs or symptoms of ear dysfunction.
▌ Analysis of the Causes:
The mechanism of hearing impairment after general anesthesia is still unclear, but it may be related to the changes of middle ear pressure, the pathological changes of auditory organ blood vessels, the changes of cerebrospinal fluid pressure, embolism and the use of ototoxic drugs. Excessive or sudden changes in middle ear pressure can perforate the eardrum, resulting in significant hearing loss.
During nitrous oxide anesthesia, middle ear pressure fluctuations can occur, and the tympanic membrane shifts inward or outward or even perforates during nitrous oxide uptake and elimination, disrupting the reconstruction of middle ear conduction structure.
The amplitude of pressure fluctuation in the tympanic membrane is related to the inhalation concentration of nitrous oxide and the rate at which it changes. Too high or too fast inhalation concentration of nitrous oxide may lead to hearing impairment resulting from perforation of the tympanic membrane.
Case 4: General Anesthesia (Extracorporeal Circulation)
A 71-year-old male patient underwent coronary artery bypass grafting (CABG) under extracorporeal circulation. In the first few hours after surgery, patients have low cardiac output and need adrenaline and dopamine to maintain stable circulation. Immediately after awakening, the patient experienced swelling in the left ear, tinnitus, and hearing loss, but no dizziness.
Audiometry at 6 weeks and 4 months postoperatively revealed a low frequency sensory hearing loss of 65dB. Middle ear pressure is normal, and CT scans of the middle and inner ears are normal.
▌ Analysis of the Causes:
So combined with this information, can you deduce what caused the patient’s hearing loss in case four?

AI to prevent sudden death? Ai can detect heart disease with 99.6 percent accuracy

rHGH Space / / Health

Artificial intelligence software that can determine if a patient is suffering from a heart attack is being trialled at Scottish hospitals in an effort to cut accident and emergency response times.

A heart attack can be hard to spot because its symptoms – including chest pain, dizziness and shortness of breath – are linked to many other conditions. Doctors often miss other vital signs. The British Heart Foundation (BHF) claims that if misdiagnosed and untreated, patients have a “70% increased risk of death after 30 days”.

Meanwhile, the AI system being tested can “rule out heart attacks in more than twice as many patients, with 99.6 percent accuracy,” the nonprofit suggests.

“Chest pain is one of the most common reasons why people turn up at A&E,” commented Sir Nilesh Samani, medical director of the BHF. “Every day, doctors around the world face the challenge of separating patients in pain due to a heart attack from patients in pain due to less serious medical conditions.”

The charity helped fund the development of the CoDE-ACS (Collaboration for the Diagnosis and Assessment of Acute Coronary Syndromes) tool to diagnose heart attacks. The system is powered by machine learning algorithms that predict how likely a patient is to have a heart attack.

CoDE-ACS analyzes a patient’s age, gender, medical history, examines electrocardiogram data, and uses a blood test to look for troponin, a protein that appears when heart muscle is damaged, to calculate a perfect score of 100. A higher score means a higher chance of heart attack. The researchers believe the algorithm could figure out whether some people who end up in A&E because of their symptoms actually have heart disease, allowing doctors to more quickly identify those at higher risk.

“For patients who develop acute chest pain as a result of a heart attack, early diagnosis and treatment can save lives,” explains Nicholas Mills, professor of cardiology at the Centre for Cardiovascular Sciences at the University of Edinburgh, who led the study published in Nature.

“Unfortunately, many conditions can cause these common symptoms, and diagnosis is not always straightforward. Leveraging data and AI to support clinical decision making has tremendous potential to improve patient care and increase efficiency in our busy emergency departments.”

The BHF said the technology was being trialled again in Scotland to see if it could improve care in accident and emergency departments. “The CoDE-ACS clinical decision support system, if adopted in practice, can reduce time spent in the emergency room, prevent unnecessary hospitalizations in patients who are less likely to have a myocardial infarction and at low risk of cardiogenic death, and improve the identification and treatment of those who have a myocardial infarction. Myocardial infarction rather than myocardial injury is beneficial for both patients and healthcare providers, “the study concluded.

Can Asthma be Controlled?

rHGH Space / / Medical

Asthma is a common chronic respiratory disease. According to statistics, more than 300 million people in the world suffer from asthma, which has a great impact on human health.

Although asthma is a chronic disease, with proper treatment and lifestyle management, patients can effectively control their condition and lead a normal life.

What is the nature of asthma

When we breathe, air enters our lungs through our nose or mouth. But, for asthmatics, this process can become very difficult.

Asthma is a chronic inflammatory disease of the airways that causes the airways to contract, causing sufferers to feel out of breath. Asthma attacks are usually accompanied by coughing, wheezing, chest tightness and other symptoms. These symptoms may last for minutes or hours, and may become more pronounced at night or in the morning. Some people may only occasionally experience mild asthma symptoms, while others may need urgent medical attention.
How do you recognize an asthma attack

During an asthma attack, patients usually experience the following symptoms: shortness of breath, wheezing, chest tightness, and coughing. It’s important to recognize an asthma attack because taking immediate action can prevent it from getting worse. You may be experiencing an asthma attack if you experience the following symptoms: shortness of breath, wheezing, chest tightness, coughing, especially at night or early in the morning. If these symptoms persist for a long time, you should seek medical attention immediately.
Treatment method

Asthma treatment is usually divided into asthma control and acute attack treatment. Asthma control is mainly through the prevention and reduction of asthma attacks to achieve long-term treatment. Common asthma control drugs include inhaled corticosteroids, long-acting beta-2 agonists, and slow-release theophylline. Acute attack treatment is an emergency treatment mainly taken during an asthma attack, including inhalation of short-acting beta-2 agonists, systemic hormones and short-acting theophylline.

Life matters needing attention

People with asthma need to pay attention to the following aspects in their daily life:

(1) Avoid allergens: Allergens are one of the main causes of asthma attacks, asthma patients should avoid exposure to allergens as much as possible. Common allergens include pollen, dust, mites, pet dander, allergenic foods, etc.

(2) Avoid second-hand smoke: Harmful substances in second-hand smoke can irritate the respiratory tract and cause asthma attacks. Asthma patients should avoid inhaling second-hand smoke.

(3) Keep indoor air clean: Asthmatics should keep indoor air clean and change their air filters regularly. In addition, indoor humidity should be controlled properly to avoid too dry or humid air.

(4) Regular work and rest: asthmatic patients should keep regular work and rest time to avoid excessive fatigue or mental strain.

(5) pay attention to diet: asthmatic patients should avoid eating irritating food, such as spicy food, alcohol, etc. In the meantime, people with asthma should eat more fresh vegetables and fruits and increase their intake of vitamins C and E.

In addition, the daily use of the department cure high voltage potential therapy instrument for auxiliary treatment. High potential therapy can regulate immune function bidirectional, can desensitize, so it can relieve bronchospasm, but also can play a preventive role.

From the perspective of breast cancer patients to discuss the psychological problems of patients.

rHGH Space / / Anti Cancer

Breast cancer is one of the common malignant tumors in women. For patients, it is not only a physical disease, but also brings psychological troubles. Patients may face many psychological problems during treatment, recovery and tumor recurrence, which not only affect the quality of life of patients, but also may affect the effectiveness of treatment. Today Xiaoyu takes you from the perspective of a patient and tells you that treating cancer not only requires medical support, but also psychological support is very important.

In the process of facing cancer, patients often experience a variety of mood swings and psychological pressure, so how to deal with psychological problems has become an aspect of treatment that needs to be paid attention to. We can explore some coping strategies to help patients relieve negative emotions and better face the challenges of the treatment process:

One, accept your feelings

From the moment of diagnosis of “breast cancer”, patients may feel anxiety, fear, anger and other negative emotions. Research results show that breast cancer patients and their spouses are at high risk of anxiety and depression during diagnosis and treatment.

Postoperative rehabilitation period, if the patient is shrouded in negative mental emotions for a long time, it may cause the decline of immune function, hormone level disorders, for the recovery of the disease is very unfavorable.

When facing cancer, patients not only have to suffer from psychological pain, but also suffer from physical distress. In the process of breast cancer treatment will bring certain physiological side effects, in addition to the majority of patients will be complicated by postoperative pain, breast reduction, etc., a study of Cancer Research UK found that a common side effect of breast cancer patients may occur during the treatment is “hand-foot syndrome”. Symptoms include severe pain, erythema and peeling of the skin on the palms and soles of the feet.

This side effect occurs in about 10-30% of patients, and some patients experience severe symptoms and even need to suspend or discontinue treatment. And these physical problems can exacerbate the impact on a patient’s mental state.

The person should accept these feelings and try to find their own way to relieve them. Consider seeking counseling or a support group.

  1. Keep a positive attitude

Although cancer is a difficult disease to accept, maintaining a positive attitude helps patients better cope with the difficulties and challenges they encounter during treatment. A 2019 study published in Cancer Medicine showed that optimism was associated with better survival and a lower risk of death among breast cancer patients.

In addition, a study published in the Journal of Psychosocial Oncology suggests that a positive attitude can promote recovery by stimulating patients to adopt healthy behaviors and follow doctors’ orders. So you can try to participate in some relaxing activities, such as meditation, yoga and other activities, as well as hearing and reading about positive energy content to relax the body and mind, but also reduce anxiety and depression and other emotional troubles.

  1. Seek social support

Cancer treatment is often a long process, so it’s important to find someone who can support you. Of course, close family members and friends often provide the most immediate and warm social support. Close connections with family and friends can provide comfort, support and affection during the illness. Sufferers can ask family and friends to help them deal with life problems, listen to their emotions and provide moral support.

In addition, patients can join recovery groups online or offline, and communicating with others who have experienced or are experiencing similar illnesses can provide valuable help and psychological support, especially those who have recovered.

In addition to choosing social support, patients can also use professional counseling and therapy to help themselves face emotional and psychological problems and strengthen their social support.

  1. Pay more attention to your own needs

Treating cancer can take up a lot of the patient’s time and energy, but remember to be open and listen to your own needs, protect yourself, maybe recognize what’s important to you, and try to get help to reduce your physical and mental load so you can cope better with the whole process.

In addition, while it can be helpful to have a basic understanding of cancer, worrying too much can exacerbate negative feelings. Therefore, patients need timely access to knowledge and understanding of the situation to alleviate unnecessary doubts.

Malaysia has seen a sharp increase in cancer cases in recent years

rHGH Space / / Anti Cancer

The number of cancer cases in Malaysia in 2022 more than doubled from 393,000 in 2019 to 874,000 in 2022, the National Cancer Society of Malaysia said on Monday.

In addition to genetic factors, lifestyle is also a major factor in the increase in cancer cases, said National Cancer Institute director Banu. In particular, she noted that people’s inability to go out and exercise during the COVID-19 pandemic and their less healthy diet may have contributed to the increase in cancer cases over the past three years.

The official also pointed out that cancer cases in Malaysia are currently as young as two months old and as old as 90 years old. Breast and colon cancers are the country’s biggest cancer killers. She called on the government and social organizations to work together to enhance cancer awareness.

How to use hgh correctly

rHGH Space / / HGH

Human Growth Hormone (HGH) is a hormone produced by the pituitary gland that plays a vital role in growth and development in children and adolescents1. It also helps regulate body composition, body fluids, muscle and bone growth, sugar and fat metabolism, and possibly heart function1.

If you are considering using HGH for medical purposes, it is important to consult with a doctor first1. If you are using HGH for bodybuilding or athletic performance enhancement purposes, it is important to use it correctly and safely23. Here are some tips on how to use HGH correctly:

Always use sterile needles before injection.
Disinfect the injection site and pinch your skin with the fingertips of your non-dominant hand.
Use your dominant hand to quickly stick the whole needle into the pinched fold of skin.
If your HGH required reconstitution, then replace the needle with a smaller one, suitable for subcutaneous injections2.
Inject HGH subcutaneously (under the skin) rather than intramuscularly (into the muscle).
Use a 2UI syringe for injecting HGH.
Inject HGH at night before bed as this is when your body naturally produces it.
Remember that HGH should only be used under medical supervision and only for approved medical purposes1. Using HGH without medical supervision can lead to serious health problems

 
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