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A New Way to Prevent Awareness Under Anesthesia

Healthline News

Slow brain waves reveal precisely when a patient loses awareness while under anesthesia, and could prevent the small percentage of cases in which patients are "awake" during surgery.

Being aware of what's happening during surgery and even feeling the pain seems like an unthinkable nightmare. Isn't that what anesthesia is for?

But it does happen in up to one percent of surgeries involving high-risk patients, according to research published in 2011, and affects between 20,000 and 40,000 patients annually in the U.S. alone. Now, scientists from the University of Oxford in the U.K. believe they've found a way to put an end to this disturbing statistic.

Using EEG brain monitoring and MRI imaging scans, the researchers discovered that people lost awareness when low-frequency electrical waves, also called “slow waves,” enveloped the brain. When the waves reached a plateau, sensory signals no longer reached the thalamocortical regions, which are the parts of the brain linked to conscious awareness.

“Awareness in anesthesia is a 'never event'—it isn't good enough for it to be rare,” Roisin Ní Mhuircheartaigh, one of the researchers, told Healthline. “Our goal is to allow anesthesiologists to look at a patient's brain activity and know with confidence that [he or she] is safely asleep.”

The researchers have applied for a patent on their findings and are looking into developing better monitoring equipment for patients under anesthesia. They are the second group of scientists this year to do so. Earlier this year, researchers from the Massachusetts Institute of Technology and Boston University published their findings on slow waves and unconsciousness.

“They looked at EEG, too, but have focused on the relationship between slow waves and alpha activity,” Catherine Warnaby, another Oxford researcher, told Healthline. “A key difference is that we have looked at slow wave saturation and have the FMRI evidence to support that this state represents a state of perception loss.” Changing the Standards for Anesthesia

Warnaby stressed that anesthesia is very safe, but little is known about how it works in the brain. In patients with severe health problems, too much anesthesia can adversely affect their heart or lungs. Elderly patients may experience severe confusion after an operation if given too much anesthesia.

“We think that this has great potential to become an individualized marker for delivering anesthesia during surgery,” Warnaby said. “If we can prove further that this saturation relates to the point where people lose awareness of the outside world, it may change the way that anesthetics are delivered worldwide. Anesthesiologists would be able to give anesthetics to achieve this saturation level and know that they were giving each individual just the right amount of the drug.”

Learn About the Risks and Benefits of Anesthesia During Delivery »

The research could also help resolve other riddles of the brain, Warnaby added. "Our findings could have implications for all sorts of altered states and disorders of consciousness, such as locked-in syndrome or persistent vegetative state."

In both the Oxford and U.S. research, scientists experimented with the common anesthetic, propofol.

There are EEG monitors available to assess the depth of anesthesia, although there isn't much evidence that these methods are better than traditional monitoring at reducing awareness during surgery, Warnaby said.

The next step is to perform further experiments to recreate a surgical setting. Researchers will look at how other drugs used during surgery—such as painkillers—affect slow waves during anesthesia.

“Depending on the operation, anesthesiologists have to give drugs that block muscle function, 'paralyzing drugs,'” Mhuircheartaigh said. “If inadequate anesthetic drugs are given while the patient can't move to let us know they're awake, awareness can occur.”

Like Warnaby, Mhuircheartaigh stressed the rarity of these cases, especially in healthy people. “However, rare isn't good enough,” she told Healthline. “We hope that by looking at this key process in the brain we can be sure that the patient can't perceive any surgery.”

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Products seized from Toronto sex shops may pose health risks

Toronto police are searching for the driver after an early-morning crash.

It appears a white vehicle slammed into a bus shelter on Davenport Road at Caledonia Park Road, just west of Lansdowne Avenue, around 3:30 a.m. on Monday. The driver then ran away.

The bus shelter was heavily damaged.

No one else was hurt.

Health Canada is warning that some products seized from two Toronto sex shops may pose serious health risks.

Health Canada says it seized a variety of items from the two stores.

They include poppers and products promoted for sexual enhancement.

Health Canada say the items contain ingredients that could pose a danger to users.

The agency says those who have used the product should consult a doctor if they’ve had any health problems.

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New hope for men wanting to enlarge their manhood: Silicone penis implant adds two inches to girth AND length - and lasts for life

The size of a man’s penis plays a huge role in his self esteem.

Having a small member can proliferate feelings of being less masculine or appealing to the opposite sex.

And so, men blighted by a smaller manhood may abstain from sexual encounters – or shy away from the locker rooms at the gym.

These feelings of inadequacy can lead to depression, problems with intimacy and potentially even suicidal thoughts.

However, a Beverly Hills urologist, Dr James Elist, has developed a revolutionary penile enhancement procedure that offers new hope to men with small penises.

A silicone implant is inserted into the penis during the $13,000 (£9,000) procedure – instantly increasing the length and girth by approximately two inches.

Dr Elist told Daily Mail Online that patients have the option of choosing between three implant sizes for the procedure: Large, extra large and double extra large.

The surgeon explained: ‘Nobody wants to have a small or medium one.’

Dr Elist has been working as an urologist for more than 35 years.

He has always had an interest in men’s sexual dysfunction – and even garnered notoriety as the first doctor to link cigarette smoking with impotence.

‘If men see the sign on cigarettes that say smoking can cause impotency, they can blame it on me,’ he said.

For decades, the doctor was one of many who performed an operation on men with erectile dysfunction, in which a prosthesis was inserted into the arteries of the penis.

The procedure was designed to allow blood to properly flow through the arteries, so that a man could achieve an erection.

Dr Elist explained: ‘I noticed after insertion of the implant, between a year or two, most men were complaining that the size of their penis shrunk.

‘They did have an erection, but the girth and length of the penis decreased.’

In 2002, the doctor discovered a solution for the ‘shrinking’ problem.

At the time, there were many penile enhancement treatments available – but none were effective.

Fat injections were previously used to increase the girth, but Dr Elist told Daily Mail Online that fat is absorbed after five or six months.

He said: ‘It gives the patients total deformity, because it was forming lumps and bumps under the penis.’

Furthermore, foreign tissue transplants and even gel fillers – which are commonly used on the face to decrease wrinkles – proved to be ineffective as well.

That’s why Dr Elist came up with the idea of implanting a soft silicone sheath under the penis.

‘This is similar to breast implants – but a breast implant is a bag filled with silicone gel or in some cases saline,’ the urologist explained.

‘My implant is different; it’s not filled with anything.

‘The material is very soft silicone with the shape of the penis – which covers the penis for 270 degrees around and the whole length of the penis.’

The doctor patented his invention in 2002 – and began performing operations to insert the implants in 2004.

Since then, he has tinkered with the design, shape, techniques and even the surgery procedure.

Dr Elist said: ‘Now at this point in time, we have the perfect product: Something that I’m really very happy and even proud to present to the community.’

The implant is inserted through a small incision of an inch to an inch-and-a-half in the groin.

During the short procedure, the patient is under local anesthesia, unable to feel anything that is happening.

The doctor inserts the implant through the skin of the groin, until it gets under the skin of the penis.

Immediately after the procedure, a man’s penis will have expanded between 1.5 and 2.5 inches, Dr Elist said.

He said: ‘For most of the patients after surgery, the length of the penis and the girth of the penis are very similar.’

However, whether the doctor inserts a large, extra large or double extra large implant is partially up to the patient – but also dependent upon the man’s skin.

‘Some patients, unfortunately, are born with tight skin – or when they had the circumcision, a lot of skin was removed, so they don’t have enough skin,’ Dr Elist said.

‘So for them we start with large.’

But for patients with ‘good skin’ the doctor generally begins with an extra large implant.

The implant is designed to last for the man’s entire life.

However, the doctor noted, 10 to 15 per cent of the doctor’s patients opt to ‘upgrade’ after the procedure.

In those instances, the doctor uses the double extra large implant.

Recovery from the procedure doesn’t take too long, he said.

The men are able to go back to their daily activities and routine the following day.

However, it is vital that men abstain from sexual activities – including masturbation and oral sex – for four to six weeks afterwards.

Dr Elist said: ‘That is very important, unfortunately, some of our patients did not follow the instructions and we had some problems.

‘The skin is thin at that point, so it can get infected and you’d have to remove it.’

The surgeon has become renowned around the world for his work in penile enhancement.

Patients fly from all over to seek his help – even as far away as Moscow and Brazil.

Currently, he performs two of the implantation procedures each day.

Dr Elist told Daily Mail Online that the vast majority of his patients see a huge improvement in their self confidence after undergoing the operation.

‘We did a study of 400 of our patients retrospectively, and we noticed that the self-confidence of patients has increased significantly,’ he said.

Those whose confidence levels were previously at one or two out of 10, spiked up to nine or 10 out of 10 after the implant, the doctor added.

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