Propofol and sevoflurane are two of the most commonly used anaesthetics for paediatric surgery. Data from some clinical trials suggest that postoperative pain incidence is lower when propofol is used for maintenance of anaesthesia compared with sevoflurane, although this is not clear. This meta-analysis compared postoperative pain following maintenance of anaesthesia with propofol or sevoflurane in paediatric surgeries. PubMed Medline, Embase, Scopus, Web of Science and Cochrane Library were searched for randomised controlled trials (RCTs) that compared postoperative pain between sevoflurane and propofol anaesthesia in children. After quality assessment, a meta-analysis was carried out using bias-adjusted inverse heterogeneity methods, heterogeneity using I² and publication bias using Doi plots. In total, 13 RCTs with 1174 children were included. The overall synthesis suggested nearly two-fold higher odds of overall postoperative pain in the sevoflurane group compared with the propofol group (odds ratio [OR] 1.88, 95% confidence interval [CI] 1.12-3.15, I²=58.2%). Further, children in the sevoflurane group had higher odds of having higher pain scores (OR 3.18, 95% CI 1.83-5.53, I²=20.9%), and a 60% increase in the odds of requiring postoperative rescue analgesia compared with propofol (OR 1.60, 95% CI 0.89-2.88, I²=58.2%). Children maintained on inhalational sevoflurane had higher odds of postoperative pain compared with those maintained on propofol. The results also suggest that sevoflurane is associated with higher odds of needing postoperative rescue analgesia compared with propofol. The protocol for this systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO) with registration ID CRD42023445913.

Objective: This research investigated the association between childhood and adulthood tobacco smoking exposure with ulcerative colitis (UC) and Crohn’s disease (CD) in Qatar. Study Design and Setting: In this case-control study, CD and UC cases were matched to controls of the same age and sex. The associations between UC and CD and childhood passive smoking and adulthood active smoking were assessed using conditional multivariable logistic regression. Results: A total of 89 CD cases, median age of 37 years (IQR 29– 47), and 362 UC cases, median age of 35 years (IQR 28– 44), and equal numbers of controls were included. After multivariable logistic regression, CD was associated with higher odds of being a current smoker (OR 2.51, 95% CI 0.85– 7.37, p=0.095), with weak evidence against the null hypothesis. This association was more pronounced in women, where CD was associated with both adulthood current smoking (OR 42.71, 95% CI, 1.17– 1559.57, p=0.041), and childhood smoking exposure (OR 8.23, 95% CI, 1.36– 49.66, p=0.021). In males, no associations were observed between CD and the smoking exposures. No associations were observed between UC and both smoking variables. Conclusion: In Qatar, adulthood tobacco smoking appears to increase the odds of CD. Further, our findings suggest that both childhood and adulthood cigarette smoke exposure may possibly have a detrimental effect on the odds of CD in females but not in males, although further research is needed.

Objective: To compare non-epidural labor, standard epidural analgesia, and dural puncture epidural analgesia with respect to labor progression, obstetric outcomes, analgesia-related outcomes, and neonatal results. Methods: This single-center retrospective observational cohort study included 168 term singleton parturients: 58 without epidural analgesia, 56 with standard epidural analgesia, and 54 with dural puncture epidural analgesia. The primary outcome was the duration of the second stage of labor. Secondary outcomes included first-stage duration, mode of delivery, blood loss, transfusion, analgesia quality, maternal side effects, umbilical venous pH, biochemical acidosis, Apgar scores, neonatal intensive care unit admission, and neonatal resuscitation. Analyses included group comparisons, adjusted models, quantile regression, Firth penalized logistic regression, propensity-score inverse probability weighting, and a nulliparous sensitivity analysis. Results: Second-stage duration was comparable across groups (median 40.0, 45.0, and 48.5 min in the no-epidural, standard epidural, and dural puncture epidural groups, respectively; p = 0.118). Active pushing time was likewise comparable (8.0, 8.5, and 12.0 min, respectively; p = 0.292), and quantile regression, together with a nulliparous sensitivity analysis—in which the second stage was longest in the no-epidural group—did not indicate epidural-related labor prolongation. Compared with standard epidural analgesia, dural puncture epidural analgesia showed numerically lower pain scores and a numerically lower rescue bolus requirement (30/54 [55.6%] vs. 39/56 [69.6%]; p = 0.183), although neither difference reached statistical significance. Umbilical cord venous pH and biochemical acidosis (cord venous pH < 7.20) did not differ significantly among groups (p = 0.266 and p = 0.335, respectively). The only neonatal endpoint that differed between groups was a recorded fetal acidosis flag, which was more frequent in the epidural groups (0%, 7.1%, and 16.7%; p = 0.004) but was not corroborated by objective cord pH, Apgar scores, neonatal resuscitation, or a significant increase in neonatal intensive care unit admission (5.2%, 10.7%, and 16.7%; p = 0.145). Conclusions: Contemporary low-dose standard epidural and dural puncture epidural analgesia were not associated with clinically meaningful prolongation of labor, active pushing time, or major obstetric intervention. Dural puncture epidural analgesia showed a non-significant trend toward more favorable analgesic performance compared with standard epidural analgesia. Objective neonatal acid–base measures (cord venous pH and biochemical acidosis) did not differ significantly between groups; only a recorded fetal acidosis flag was more frequent in the epidural groups, without correlation to objective cord pH or to adverse clinical neonatal outcomes. These results support the obstetric and neonatal safety of contemporary low-dose epidural techniques; the isolated recorded acidosis signal warrants confirmation in prospective studies with standardized cord blood gas sampling.

Transfusion requirements as a surrogate marker of mortality and morbidity in adults with severe burns: A retrospective cohort study - Turkish Journal of Surgery

Perioperative airway events in pediatric patients with obesity undergoing bariatric surgery: A retrospective cohort - Turkish Journal of Surgery