Efficacy of addition of the anti-inflammatory, IV glutathione to standard ketamine IV therapy in major depressive disorder.

Ketamine, a N-methyl-D-aspartate (NMDA) antagonist, is used for treatment-resistant depression (TRD). Recent studies have shown that there are increased levels of pro-inflammatory cytokines in individuals with major depressive disorder (MDD) and those with higher levels of oxidative stress markers have a decreased or null response to conventional antidepressants. Glutathione (GSH) as an antioxidant adjuvant to ketamine has not been well studied. This double-blind study with 30 patients divided into 2 groups of 15 each, aimed to determine if GSH, added to standard ketamine infusion (GSH+K), rendered better outcomes in MDD patients versus patients receiving ketamine infusions with a normal saline placebo (K+NS). There were significant drops in BDI-II scores from day 1 to day 14, PHQ- scores from day 1 to day 14 and PHQ-9 scores day 14 to day 28, suggesting the overall treatment was effective. There were no statistically significant differences between the groups over time. However, a sustained improvement in depressive symptoms was observed for 14 days post-infusion in both groups.

Certified Registered Nurse Anesthetists' occupational exposure to inhalational anesthetic agents: a survey of anesthetic gas safety.

BACKGROUND: Anesthetic gases have been known to cause damage when inhaled over long periods of time. Modern safety measures have been put in place to reduce the risk to anesthesia providers, however there is continued lack of information on providers experiencing short term effects (lethargy, fatigue, headache, slowed cognitive ability, nausea, and mucosal irritation) thereby leading to long-term sequalae (sister chromatid exchanges, micronuclei, chromosomal aberrations, and comet assays). METHOD: A thirteen item, multiple choice survey was sent to 3,000 anesthesia providers, of which 463 completed the survey. A Chi-square test of independence was used to determine the association between gas exposure and participant self-reported symptoms. A Spearman's Correlation test was also utilized to interpret this data since both frequency of smelling gas and frequency of symptoms were ordinal variables for which Spearman's rho correlation was the appropriate measure of association. RESULTS: The major findings were that as the frequency of smelling anesthetic gas increased, so too did the frequency of self-reported headaches and fatigue. Spearman's rho = .148 and .092. P value = .002 and .049, respectively. CONCLUSION: There have been many efforts to decrease the risk of exposure of anesthesia providers to anesthetic gases. While there is a decrease in reported exposures, indications of possible long-term effects remain a concern in anesthesia providers. Potential implications of exposure could lead to chromosomal aberrations, sister chromatid exchanges, comet assays, spontaneous abortions, and genotoxic effects.

Chronic Opioid Use After Surgery: An Exploratory Study Examining Rural Certified Registered Nurse Anesthetist Strategies to Mitigate Chronic Opioid Use and Their View of Their Role in the Opioid Crisis.

Certified registered nurse anesthetists (CRNAs) provide most of the anesthesia care in the rural United States. Rural regions of the US also have the highest opioid prescribing rates and opioid-related hospital admissions and deaths. Although CRNAs are the primary anesthesia providers in these regions, little research examines the strategies CRNAs may use to mitigate the development of chronic opioid use after surgery. The purpose of this study was to assess the views of rural CRNAs regarding their role in mitigating chronic opioid use after surgery and to determine what, if any, preventative strategies they may use. A survey was developed and distributed to CRNAs practicing in rural areas of the US with the highest opioid prescribing rates. Of the 160 CRNAs who responded, 73% agreed that they could influence whether their patient developed chronic opioid use after surgery. Those who agreed were more likely to be involved in policy development to decrease opioid use. The survey also found that CRNAs with a doctoral degree, compared with those with master's level preparation, were more likely to report that they could influence whether their patient developed chronic opioid use after surgery.