Patient

Anesthesia for youngsters is a tricky calculation

baby having surgery
Short, one-time bouts of anesthesia probably don’t cause lasting harm to children’s brains, several studies suggest. But scientists have a lot to learn about anesthetics’ lasting effects, particularly in the youngest patients.

If your young child is facing ear tubes, an MRI or even extensive dental work, you’ve probably got a lot of concerns. One of them may be about whether the drugs used to render your child briefly unconscious can permanently harm his brain. Here’s the frustrating answer: No one knows.

“It’s a tough conundrum for parents of kids who need procedures,” says pediatric anesthesiologist Mary Ellen McCann, a pediatric anesthesiologist at Boston Children’s Hospital. “Everything has risks and benefits,” but in this case, the decision to go ahead with surgery is made more difficult by an incomplete understanding of anesthesia’s risks for babies and young children. Some studies suggest that single, short exposures to anesthesia aren’t dangerous. Still, scientists and doctors say that we desperately need more data before we really understand what anesthesia does to developing brains.

It helps to know this nonanswer comes with a lot of baggage, a sign that a lot of very smart and committed people are trying to answer the question. In December, the FDA issued a drug safety communication about anesthetics that sounded alarming, beginning with a warning that “repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in children younger than 3 years or in pregnant women during their third trimester may affect the development of children’s brains.” FDA recommended more conversations between parents and doctors, in the hopes of delaying surgeries that can safely wait, and the amount of anesthesia exposure in this potentially vulnerable population.

The trouble with that statement, though, is that it raises concerns without answering them, says pediatric anesthesiologist Dean Andropoulos of Texas Children’s Hospital in Houston. And that concern might lead to worse outcomes for their youngest patients. “Until reassuring new information from well-designed clinical trials is available, we are concerned that the FDA…

This How Talk Therapy Changes Our Brains for the Better

Talk therapy is often considered the soft option when it comes to mental health treatment. Yet millions of patients and numerous studies testify to its long-term effectiveness, and now researchers say one type of talk therapy can produce visible changes in patients’ brains. They published their research in the journal Translational Psychiatry.

One of the best-known and most successful techniques is called Cognitive Behavioral Therapy, or CBT. People in CBT learn skills that allow them to challenge and disrupt unpleasant and negative thoughts, feelings, and behaviors. CBT is especially useful for people experiencing psychosis, a state of mind in which it becomes hard—if not impossible—to tell what’s real and what’s not. CBT for psychosis (CBTp) gives patients the tools to reframe their troubling thoughts and help calm themselves down.

For the study, researchers recruited 22 people who were already on medication to help with…

Behind-the-Scenes With Paramedics

Paramedics, who are among the most highly-skilled of Emergency Medical Services (or EMS) professionals, are in many ways like real-life superheroes, tending to people in their time of greatest need. While most of us hope to never see a paramedic on our doorstep, their appearance in times of distress can be critical to patient survival and recovery. Mental_floss spoke with several of these professionals about what it’s like to be a medical first responder.

1. THEY ARE NOT JUST “AMBULANCE DRIVERS.”

Paramedics are skilled medical professionals who have undergone many hours of rigorous training—far more than your average emergency medical technician (EMT). “A lot of people call us ambulance drivers,” says Nick, a critical care paramedic in New York. “It aggravates us because driving is such a small part of the job. Emergency medicine is what we’re doing.” Medical tasks paramedics regularly carry out include administering medication, starting IVs, intubating unconscious patients to help them breathe, intraosseous (bone) injections, reading electrocardiograms (EKGs), needle chest decompression (sticking a needle into the ribs to fix a collapsed lung), and differentiating between different types of heart attacks.

2. THEIR JOB IS NOT ALL BLOOD, BRUISES, AND BROKEN BONES.

Contrary to the popular image of emergency medical workers, some paramedics handle a relatively small number of traumatic injury calls. In New York and other big cities, the emergency medical system can be large enough to be split into specific specialties. Consequently, explains Thomas Rivalis, a New York paramedic who runs emergency management consulting firm Sagex LLC, city EMTs are often sent to scenes of trauma, while paramedics respond to medical calls (think heart attacks, strokes, and seizures). “If you are in a car accident, the person pulling you out of the car is most likely an EMT,” he says. “If you see someone clutch their chest and fall over, and you call 9-1-1, that is most likely going to be a paramedic.”

But in smaller suburban and rural systems, where resources are scarcer, it is more common for duties to overlap and paramedics to handle all types of calls.

3. THEY MIGHT ALSO HAVE TO PUT OUT FIRES—LITERALLY.

Emergency medical systems vary greatly by location, resulting in significant differences in the work paramedics carry out. Bruce Goldthwaite, a shift captain and paramedic in Franklin, New Hampshire, works in a dual role system where paramedics not only respond to all types of calls, but where all emergency medical workers work as firefighters as well. Bruce explains that on a typical day, he “could go on an ambulance call, to a building fire, on a technical rescue … On an odd day you could be on all of those trucks in a single shift.”

There are other common differences. Rural and suburban EMTs, unlike their urban counterparts, are frequently volunteers, drawing a paycheck if they choose to move on and become paramedics. And it’s typical for small-town EMS workers to wait for calls in a station house outfitted with beds and a lounge, unlike New York medics, who spend their time between calls waiting on an assigned corner in an ambulance.

4. THEY FIND WAYS TO FILL THEIR DOWN TIME.

While the job of an EMS worker is all about action, it also involves a fair amount of time sitting in an ambulance (or a station, depending on where you work) waiting for disaster to strike. Every paramedic has their preferred way of filling the time. “HBO Go is a thing,” Thomas says. “You’ve got guys who will binge-watch a whole series of Game of Thrones. Some people read. Then you’ve got the super tech who wants to bring in cardiac textbooks.” Since paramedics are subject to regular recertification, they sometimes use their downtime for studying. Thomas adds, however, that “bringing any type of napping accoutrement (read: pillows, blankets) is frowned upon.”

5. TRAFFIC IS THEIR BIGGEST HAZARD.

While driving may not constitute the most significant part of a paramedic’s job, it is one of the most dangerous. Nick has been in over 10 collisions in the course of his EMS career. “Far and away the driving is the most dangerous aspect,” he says. “When you’re driving with sirens and going through red lights and trying to move aggressively through traffic, it’s inherently dangerous.”

Compounding the issue is the fact that the patient compartment of most ambulances, unlike the cab, is essentially an aluminum box…