Antidepressant effects of ketamine and ECT: A pilot comparison.

BACKGROUND: To compare the antidepressant effects and cognitive adverse effects of intravenous ketamine infusion and Electro-convulsive therapy (ECT) in persons with severe depressive episodes. METHODS: This assessor-blinded randomized control trial included 25 patients (either sex; 18-65 years) meeting ICD-10 criteria for severe depression (bipolar or unipolar). Patients received either ECT (n = 13) or intravenous infusions of ketamine hydrochloride (0.5 mg/kg over 45 min; n = 12) for six alternate day sessions over a period of two weeks. Severity of depression was assessed at baseline and on every alternate day of intervention using the Hamilton Depression Rating Scale (HDRS) and self-reported Beck Depression Inventory (BDI). RESULTS: Baseline socio-demographic and clinical variables including HDRS (ECT: 25.15±6.58; Ketamine: 23.33±4.05, p = 0.418) and BDI (ECT: 37.07±6.58; Ketamine: 33.33±9.29; p = 0.254) were comparable. Repeated-measures analysis of variance revealed that ECT patients showed significantly greater reduction in HDRS (group*time interaction effect; F = 4.79; p<0.001) and BDI scores (group*time interaction effect; F = 3.83; p<0.01). ECT patients had higher response rate than ketamine patients [HDRS: ECT- 13/13(100%) vs ketamine- 8/12 (66.70%); p = 0.04]. This was true for remission as well [ECT- 12/13(92.30%) vs ketamine- 6/12(50%), p = 0.030; both HDRS and BDI]. Performance on Digit Symbol Substitution Test (as part of the Battery for ECT-Related Cognitive Deficits scale) significantly improved in ketamine patients (p = 0.02) while that in ECT patients worsened non significantly (p = 0.30). LIMITATIONS: Relatively small sample size; higher proportion of dropouts in the Ketamine arm. CONCLUSION: This study favoured ECT over ketamine for a better efficacy over six treatment sessions in severe depression. The results need to be replicated in larger studies. TRIAL REGISTRATION: CTRI/2019/09/021184.

Perioperative Factors Affecting Neurologic Outcome in Infants Undergoing Surgery for Intracranial Lesion: A Retrospective Study.

BACKGROUND: The short-term neurologic outcome of infants undergoing brain tumor surgery depends on various perioperative factors. This study was undertaken to analyze the effects of perioperative variables on the postoperative neurologic outcome in infants undergoing brain tumor surgery. METHODS: We retrospectively reviewed the chart of infants undergoing craniotomy for brain tumor removal from 2000 to 2017. The data related to preoperative variables, intraoperative management details, and postoperative factors were collected and analyzed. The primary outcome measure was occurrence of new postoperative neurologic deficit (POND) and the secondary outcome measure was length of hospital stay (LOHS). RESULTS: Complete data were available for 40 infants undergoing craniotomy for excision of intracranial tumor. New-onset POND was found in 14 infants (35%). Based on logistic regression analysis, POND was associated with use of mannitol and massive blood transfusion (MBT) trended toward significance. Based on linear regression analysis, the risk factor associated with prolonged LOHS was reintubation and POND trended toward significance. CONCLUSIONS: In this study, factors associated with new POND were mannitol use and to a certain extent MBT. The variables associated with prolonged LOHS were reintubation and to a certain extent POND. The anesthetic technique, location of tumor, tumor histology, and extent of tumor resection did not influence the occurrence of new POND or prolonged LOHS in infantile intracranial tumor surgery. Further prospective studies with larger samples are required for confirmation of these findings and identification of new perioperative risk factors.

An unusual cause of high peak airway pressure: Interpretation of displayed alarms.

Airway pressure monitoring is critical in modern day anesthesia ventilators to detect and warn high or low pressure conditions in the breathing system. We report a scenario leading to unexpectedly very high peak inspiratory pressure in the intraoperative period and describe the mechanism for high priority alarm activation. We also discuss the role of a blocked bacterial filter in causing sustained display of increased airway pressure. This scenario is a very good example for understanding the unique safety feature present in the Dräger ventilators and the attending anesthesiologist must have an adequate knowledge of the functioning and safety feature of the ventilators they are using to interpret the alarms in the perioperative to prevent unnecessary anxiety and intervention.

Anesthetic management of patients with Joubert syndrome: a retrospective analysis of a single-institutional case series.

OBJECTIVE: To analyze the anesthetic techniques used for sedation during magnetic resonance imaging (MRI) study of patients with Joubert syndrome (JS) and assess the safety and efficacy of these anesthetic regimens in these children. BACKGROUND: Joubert syndrome is a rare neurological disorder with significant anesthetic implications. This study describes the anesthetic management of children with JS undergoing MRI study with different anesthetic agents and implications of various anesthetic techniques in these patients. MATERIALS AND METHODS: The records of ten patients with JS undergoing MRI study with different anesthetic techniques were retrospectively reviewed over the last 5 years. RESULTS: The patients were aged between 6 months and 21 years. The most commonly used sedation technique involved use of alpha-2 agonists, and this technique had least complications such as apnea and patient movement during imaging. None of the patients had postanesthetic respiratory problems, although one patient receiving propofol had apnea and desaturation on induction requiring airway intervention. CONCLUSION: Alpha-2 agonist based anesthetic technique appears to be most suitable for sedation during MRI study in patients with JS with respect to adverse events and outcome.