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BMJ Open May 2024Late-life treatment-resistant depression (LL-TRD) is common and increases risk for accelerated ageing and cognitive decline. Impaired sleep is common in LL-TRD and is a...
INTRODUCTION
Late-life treatment-resistant depression (LL-TRD) is common and increases risk for accelerated ageing and cognitive decline. Impaired sleep is common in LL-TRD and is a risk factor for cognitive decline. Slow wave sleep (SWS) has been implicated in key processes including synaptic plasticity and memory. A deficiency in SWS may be a core component of depression pathophysiology. The anaesthetic propofol can induce electroencephalographic (EEG) slow waves that resemble SWS. Propofol may enhance SWS and oral antidepressant therapy, but relationships are unclear. We hypothesise that propofol infusions will enhance SWS and improve depression in older adults with LL-TRD. This hypothesis has been supported by a recent small case series.
METHODS AND ANALYSIS
SWIPED (Slow Wave Induction by Propofol to Eliminate Depression) phase I is an ongoing open-label, single-arm trial that assesses the safety and feasibility of using propofol to enhance SWS in older adults with LL-TRD. The study is enrolling 15 English-speaking adults over age 60 with LL-TRD. Participants will receive two propofol infusions 2-6 days apart. Propofol infusions are individually titrated to maximise the expression of EEG slow waves. Preinfusion and postinfusion sleep architecture are evaluated through at-home overnight EEG recordings acquired using a wireless headband equipped with dry electrodes. Sleep EEG recordings are scored manually. Key EEG measures include sleep slow wave activity, SWS duration and delta sleep ratio. Longitudinal changes in depression, suicidality and anhedonia are assessed. Assessments are performed prior to the first infusion and up to 10 weeks after the second infusion. Cognitive ability is assessed at enrolment and approximately 3 weeks after the second infusion.
ETHICS AND DISSEMINATION
The study was approved by the Washington University Human Research Protection Office. Recruitment began in November 2022. Dissemination plans include presentations at scientific conferences, peer-reviewed publications and mass media. Positive results will lead to a larger phase II randomised placebo-controlled trial.
TRIAL REGISTRATION NUMBER
NCT04680910.
Topics: Humans; Propofol; Cognitive Dysfunction; Aged; Sleep, Slow-Wave; Electroencephalography; Male; Anesthetics, Intravenous; Depressive Disorder, Treatment-Resistant; Female; Middle Aged; Clinical Trials, Phase I as Topic
PubMed: 38816055
DOI: 10.1136/bmjopen-2024-087516 -
The Turkish Journal of Pediatrics May 2024Cardiovascular system involvement is quite common and the leading cause of morbidity and mortality in patients with Williams syndrome (WS), most of whom need surgery....
BACKGROUND
Cardiovascular system involvement is quite common and the leading cause of morbidity and mortality in patients with Williams syndrome (WS), most of whom need surgery. The present study aimed to provide a detailed evaluation of the features of surgical procedures and outcomes of patients with WS given as single-center experience, and additionally to make a detailed review from Türkiye.
MATERIALS AND METHODS
Thirty-five children with WS diagnosed between the years 1992 and 2021 were evaluated retrospectively including cardiovascular data, surgical treatment features, and outcomes. A total of six articles from Türkiye were evaluated.
RESULTS
A total of 35 patients with Williams Syndrome (24 male) with a median age of cardiologic diagnosis of 6 months (range, 2 days-6 years) were evaluated. The cardiac defects of the patients with WS were found as supravalvular aortic stenosis (SVAS) (n=30, 85%) and peripheral pulmonary stenosis (PPS) (n=21, 65%). Additional cardiac anomalies were seen in 71% patients. The rate of SVAS and PPS surgery in all patients with WS was 77.1%. The median surgical age of the patients was 2.5 years (range, 7 months-15.5 years). No patients died due to surgery. But one patient died because of ventricular tachycardia due to anesthesia at the beginning of angiography. A total of 138 (63% male) patients with WS were evaluated from the articles published in Türkiye. Of 138 patients, 64.4% had SVAS, 52.1% had PPS, and 39.8% had additional cardiac anomaly. The median follow-up period ranged from 17 months to 18 years, and six (4.3%) patients died in the early postoperative period.
CONCLUSION
Cardiovascular system involvement is extremely common and is the leading cause of morbidity and mortality in patients with WS, often requiring surgical intervention. As seen in our study including 35 patients with WS and in publications from Türkiye, SVAS in patients with WS generally requires surgery, especially in the first year of life. PPS, on the other hand, requires surgery less frequently than SVAS, and pulmonary stenosis appears to decrease over time.
Topics: Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Follow-Up Studies; Heart Defects, Congenital; Retrospective Studies; Turkey; Williams Syndrome; Adolescent
PubMed: 38814298
DOI: 10.24953/turkjpediatr.2024.4591 -
Ear, Nose, & Throat Journal May 2024Pyriform fossa (PF) branchial apparatus anomalies (PFBAA) are rare congenital third or fourth branchial apparatus anomalies (TBAA or FBAA). This article summarizes our...
Pyriform fossa (PF) branchial apparatus anomalies (PFBAA) are rare congenital third or fourth branchial apparatus anomalies (TBAA or FBAA). This article summarizes our paradigm in managing this condition by combining endoscopic procedures and open neck surgery. A retrospective review was undertaken concerning PFBAA cases treated at our tertiary medical institution between July 2020 and November 2023. Data were collected from case records. Three sequential steps were implemented: (1) direct laryngoscopy to identify internal orifice (IO), with injection of methylene blue into it; (2) open neck surgery to resect all inflammatory tissues, focusing on the ligation of the sinus tract out of PF; and (3) plasma coblation of IO mucosa. In total, 7 cases (4 men and 3 women) were included (28-67 years old, median age 53). Presenting symptoms were various, with 6 lesions on the left and 1 on the right side. Preoperative (PO) fiberoptic laryngoscopy identified IO in 6 patients, while PO barium esophageal study identified outflow from PF in 4 patients. A preliminary diagnosis of PFBAA could be established in all cases (2 TBAA and 5 FBAA cases). Direct laryngoscopy after general anesthesia identified IO in all cases (2 on the base of PF and 5 on the apex of PF). All the surgical procedures were successful, with uneventful recovery in all the patients. No postoperative complications were observed. All the patients resumed oral fluid intake after confirmation of no pharyngeal fistula by barium esophageal study on the seventh postoperative day. The duration of follow-up was between 6 and 40 months (with a median duration of 27 months). No recurrence was observed. Open neck surgery, assisted by endoscopic dyeing of sinus tracts and plasma coblation of IO mucosa, is a suitable treatment for PFBAA in adults. This paradigm is effective and safe for senior surgeons.
PubMed: 38813945
DOI: 10.1177/01455613241253924 -
Journal of Veterinary Internal Medicine May 2024Syndecan-1 (SDC1) is an established marker of endothelial glycocalyx shedding. Most research on SDC1 has focused on plasma or serum concentrations, and little is known...
BACKGROUND
Syndecan-1 (SDC1) is an established marker of endothelial glycocalyx shedding. Most research on SDC1 has focused on plasma or serum concentrations, and little is known about urine concentrations.
OBJECTIVES
Measure urinary SDC1 concentrations in dogs undergoing anesthesia with either sevoflurane or isoflurane and assess the effects of anesthesia duration and IV crystalloids on urinary SDC1 concentrations.
ANIMALS
Thirty-one client-owned dogs undergoing anesthesia for magnetic resonance imaging (MRI) with or without surgery for suspected intervertebral disk disease (IVDD) were used.
METHODS
Dogs with suspected IVDD were randomized to undergo anesthesia with either sevoflurane or isoflurane. Urine was collected before and immediately after anesthesia for the analysis of SDC1. Urinary creatinine concentrations also were measured, and the ratio of urinary SDC1 to urinary creatinine (USCR) was used to account for dilution.
RESULTS
Median (range) USCR was significantly higher after anesthesia compared with baseline for all groups combined (P < .05). No significant difference was found between the groups for age, sex, weight, and type of anesthesia. Multiple regression analysis of the effect of the independent variables inhalant type, age, weight, sex, anesthesia time, surgery, and quantity of IV fluids on the dependent variable SDC1 found that only the quantity of IV fluids significantly predicted a change (P < .001).
CONCLUSIONS AND CLINICAL IMPORTANCE
The total volume of lactated Ringer's solution administered to anesthetized dogs may affect USCR. Further investigations are warranted to evaluate the relationship between IV fluids and SDC1.
PubMed: 38813802
DOI: 10.1111/jvim.17121 -
CPT: Pharmacometrics & Systems... May 2024Cardiopulmonary bypass (CPB) can alter pharmacokinetic (PK) parameters and the drug may adsorb to the CPB device, altering exposure. Cefazolin is a beta-lactam...
Cardiopulmonary bypass (CPB) can alter pharmacokinetic (PK) parameters and the drug may adsorb to the CPB device, altering exposure. Cefazolin is a beta-lactam antibiotic used for antimicrobial prophylaxis during cardiac surgery supported by CPB. Adsorption of cefazolin could result in therapeutic failure. An ex vivo study was undertaken using CPB devices primed and then dosed with cefazolin and samples were obtained over 1 hour of recirculation. Twelve experimental runs were conducted using different CPB device sizes (neonate, infant, child, and adult), device coatings (Xcoating™, Rheoparin®, PH.I.S.I.O), and priming solutions. The time course of saturable binding, using B (binding capacity), K (dissociation constant), and T2 (half-time of dissociation), described cefazolin adsorption. B estimates for the device sizes were neonate 40.0 mg (95% CI 24.3, 67.4), infant 48.6 mg (95% CI 5.97, 80.2), child 77.8 mg (95% CI 54.9, 103), and adult 196 mg (95% CI 191, 199). The Xcoating™ K estimate was 139 mg/L (95% CI 27.0, 283) and the T2 estimate was 98.4 min (95% CI 66.8, 129). The Rheoparin® and PH.I.S.I.O coatings had similar binding parameters with K and T2 estimates of 0.169 mg/L (95% CI 0.01, 1.99) and 4.94 min (95% CI 0.17, 59.4). The B was small (< 10%) relative to a typical total patient dose during cardiac surgery supported by CPB. A dose adjustment for cefazolin based solely on drug adsorption is not required. This framework could be extended to other PK studies involving CPB.
PubMed: 38813588
DOI: 10.1002/psp4.13180 -
Frontiers in Public Health 2024Anesthesia providers face numerous occupational hazards, including exposure to anesthesia gases, which can lead to fatigue. These professionals face challenges such as...
BACKGROUND
Anesthesia providers face numerous occupational hazards, including exposure to anesthesia gases, which can lead to fatigue. These professionals face challenges such as night shifts, OR stress, limited mobility and sunlight access, high workload, inadequate rest breaks. Health-related sociodemographic variables, such as smoking, sleep patterns, and obesity. Our research aims to explore various risk factors associated with fatigue among operating theatre workers including sleep quality.
METHODS
A cross-sectional study was conducted on 227 of operating room healthcare professionals from five tertiary hospitals in Saudi Arabia, for a period of 6 months, between January 1, 2023 to June 1, 2023. The study used a five-point Likert scale sheet and the FSS "fatigue severity scale" to analyze and measure fatigue and sleep quality. The questionnaire included all socio-demographic variables, work conditions, and fatigue severity scale items.
RESULTS
The major findings revealed a significant correlation between fatigue severity scores and exposure to anesthesia gases. Socio-demographic variables such as smoking have showed major relevance to fatigue in the sample size, as (76.6%) of the participants that answered as regular smokers have showed result of positive correlation to fatigue and with a significant of (0.034). Out of the total sample, 76.1% were exposed to anesthesia gases once daily, showing a positive association with fatigue severity scores. Work-related factors like job experience and position also had a lower association with fatigue severity. (0.031) Univariate logistic regression (0.035).
CONCLUSION
The study found that the work-related conditions like workload on Anesthesia technicians and technologists over 44 h per week and gas exposure is directly linked to fatigue severity and sleep quality so is the socio-demographic considerations. With poor sleep quality in younger staff which is documented in the study result a large-scale prospective analysis to understand the factors affecting OR staff's sleep quality and fatigue severity and what can be done to regulate working hours and break time and incorporate naps in to enhance patient safety and well-being for anesthesia providers in Saudi Arabia.
Topics: Humans; Cross-Sectional Studies; Fatigue; Saudi Arabia; Operating Rooms; Male; Adult; Female; Surveys and Questionnaires; Sleep Quality; Middle Aged; Occupational Exposure; Risk Factors; Health Personnel
PubMed: 38813423
DOI: 10.3389/fpubh.2024.1392950 -
Anesthesiology Research and Practice 2024Anesthesia providers categorize patients utilizing the American Society of Anesthesiologists Physical Status (ASA-PS) classification originally created by the ASA in...
Improvement in Accuracy and Concordance of American Society of Anesthesiologist's Physical Status (ASA-PS) Scoring Assignment over a 11 Year Time Period Using Patient BMI as a Comorbidity Finding.
BACKGROUND
Anesthesia providers categorize patients utilizing the American Society of Anesthesiologists Physical Status (ASA-PS) classification originally created by the ASA in 1941. There is published variability and discordance among providers when assigning patient ASA scores in part due to the subjectivity of scoring utilizing patient medical conditions, but variability is also found using objective findings like BMI. To date, there are few studies evaluating the accuracy of anesthesia providers' ASA assignment based on objective body mass index (BMI) alone. The aim of this retrospective chart review is to determine improvement in accuracy of anesthesia providers to correctly assign patient ASA scores, based on BMI criteria added to the ASA-PS in October of 2014, utilizing a multifaceted strategy including creation of an active finance committee in the fall of 2015, multiple e-mail communications about the updated definitions and recommendations for ASA-PS scoring in the fall of 2015 and spring of 2016, a department grand rounds presentation in February 2016, placement of laminated copies of the ASA definitions and recommendations in the anesthesia chartrooms, and the development of a tool embedded into our EMR providing a recommendation of ASA-PS based on patient comorbidity findings.
METHODS
After attaining IRB approval, all eligible patients over the age of 18 who had surgical procedures under general anesthesia at Mayo Clinic in Rochester, MN, between January 1, 2010, and December 31, 2020, were retrospectively analyzed. A segmented logistic regression model was used to estimate the trends (per-year change in odds) of ASA under classification according to severity of obesity during 3 epochs: preimplementation (2010-2014), implementation (2015), and postimplementation (2016-2020).
RESULTS
A total of 16,467 patients of the 200,423 (8.2%) patients with obesity (class 1, 2, and 3) were underscored based on BMI alone. Accuracy of ASA-PS classification, as it pertains to BMI alone, was found to show meaningful improvement year-to-year following the updated ASA-PS guidelines with examples released in October of 2014 ( < 0.001). Most of the improvement occurred in 2015-2017 with relatively little between-year variability in the rate of underscoring from 2017-2020.
CONCLUSION
Despite updated ASA-PS published guidelines, providers may still be unaware of the updated guidelines and inclusion of examples used within the ASA-PS classification system. Accuracy of scoring did improve annually following the release of the updated guidelines with examples as well as department-wide educational activities on the topic. Additional education and awareness should be offered to those responsible for preanesthesia evaluation and assignment of ASA-PS in patients to improve accuracy as it pertains to BMI.
PubMed: 38813264
DOI: 10.1155/2024/6989174 -
Heliyon May 2024The erector spinae plane block (ESPB) was proposed as a part of the postoperative multimodal analgesic regimen to improve pain management after posterior spinal surgery....
BACKGROUND
The erector spinae plane block (ESPB) was proposed as a part of the postoperative multimodal analgesic regimen to improve pain management after posterior spinal surgery. However, ESPB might cause more surgical incisional wound exudate and poor wound healing, which might be improved after topical lyophilized thrombin application.
MATERIALS AND METHODS
We performed a retrospective study on patients who received posterior spinal surgery between January 2018 and December 2021. These patients were assigned into three groups: group A (general anesthesia), group B (general anesthesia with ESPB), and group C (general anesthesia with ESPB and topical 1000-unit thrombin application). Postoperative outcomes, including times of dressing changes, duration of suture removal, and incisional wound healing, were compared among these groups.
RESULTS
Our study included 89 patients, with 48, 20, and 21 patients in groups A, B, and C, respectively. Baseline demographics, height, weight, comorbidities, and operation duration were comparable among the three groups. Group B required statistically significantly more dressing changes and had a prolonged duration of suture removal than group A (9.4 ± 4.7 versus 6.5 ± 2.0 times, 16.2 ± 3.7 versus 14.2 ± 1.4 days, respectively), which could be statistically significantly improved after the thrombin application in group C. Group B also had more frequent poor wound healing (25.0 %), which could also be improved after the thrombin application (0.0 %).
CONCLUSIONS
ESPB could cause more dressing changes and poor surgical wound healing after posterior spinal surgery, which could be improved by topical lyophilized thrombin powder application.
PubMed: 38813190
DOI: 10.1016/j.heliyon.2024.e31335 -
Turkish Journal of Medical Sciences 2023A significant cause of mortality and morbidity in the neonatal era is hypoxic-ischemic encephalopathy (HIE). This study examined the histopathological analysis and...
BACKGROUND/AIM
A significant cause of mortality and morbidity in the neonatal era is hypoxic-ischemic encephalopathy (HIE). This study examined the histopathological analysis and neuroprotective impact of syringin (SYR) in an experimental HIE rat model.
MATERIAL AND METHODS
On the 7th postnatal day, 24 Wistar albino rats were evaluated in 3 groups using the HIE model under gas anesthesia. In the experiment, Group A received 10 mg/kg SYR plus dimethyl sulfoxide (DMSO), Group B received DMSO only, and Group C served as a sham group. Immunohistochemical techniques were used to assess apoptotic cell measurement and proinflammatory cytokines (TNF-α and IL-1β primary antibodies).
RESULTS
Rats suffering from hypoxic-ischemic brain damage had their apoptosis assessed. The SYR and sham groups had statistically fewer cells undergoing apoptosis (p < 0.001). There was no difference between the groups in terms of IL-1β and TNF-α during immunohistochemical staining. Neuronal degeneration was significantly lower in the histological evaluation of the hippocampus in the SYR group (p = 0.01). A statistically significant difference (p = 0.01) was observed between the SYR and the control groups regarding pericellular and perivascular edema.
CONCLUSION
SYR reduced apoptosis, perivascular and pericellular edema, and neuronal degeneration in rat cerebral tissue. These results raise the possibility that SYR may have a neuroprotective effect on the harm brought on by HIE. This is the first investigation of SYR's function within the HIE paradigm.
Topics: Animals; Neuroprotective Agents; Hypoxia-Ischemia, Brain; Rats; Rats, Wistar; Disease Models, Animal; Animals, Newborn; Phenylpropionates; Glucosides; Apoptosis; Interleukin-1beta
PubMed: 38813032
DOI: 10.55730/1300-0144.5697 -
Turkish Journal of Medical Sciences 2023The aim of this study was to adapt the "Quality of Recovery-15 Scale", developed to measure the postoperative recovery quality of individuals, into Turkish by carrying...
BACKGROUND/AIM
The aim of this study was to adapt the "Quality of Recovery-15 Scale", developed to measure the postoperative recovery quality of individuals, into Turkish by carrying out validity and reliability studies.
MATERIALS AND METHODS
This methodological study was conducted with a total of 150 patients who underwent surgery under general anesthesia between November 2021 and January 2022 in a training and research hospital in the Black Sea region. Data was collected from the patients through the face-to-face interview method before the operation, on the 24th and the 48th hour postoperatively. First, the linguistic validity of the scale and then the validity and reliability analyses were carried out. Construct validity, confirmatory factor, and reliability analyses were then performed.
RESULTS
The Cronbach's alpha coefficient of the scale was 0.851. The Kaiser-Meyer-Olkin test for goodness of fit of the one-dimensional 14-item scale was 0.853 and Bartlett's test was significant. The goodness of fit values of the scale were found to be RMSEA = 0.149, CFI = 0.769, and GFI = 0.745, and they were considered acceptable levels. The eighth item was removed from the scale, which had originally consisted of 15 items, because the item correlation coefficient of this item was <0.200.
CONCLUSION
The "Quality of Recovery Scale" was found to be a reliable and valid scale that can be used to measure the quality of recovery after surgery in Turkish society.
Topics: Humans; Reproducibility of Results; Female; Male; Turkey; Adult; Middle Aged; Psychometrics; Surveys and Questionnaires; Young Adult; Aged; Postoperative Period
PubMed: 38813011
DOI: 10.55730/1300-0144.5680