Effects of S-ketamine as an anesthetic adjuvant to propofol on treatment response to electroconvulsive therapy in treatment-resistant depression: a randomized pilot study.

OBJECTIVE: Ketamine in electroconvulsive therapy (ECT) anesthesia has been reported to be associated with better seizure quality and longer duration compared with methohexital anesthesia. Furthermore, ketamine may enhance the efficacy of ECT while having rapid independent antidepressant properties itself. However, data on the effects of ketamine with ECT are inconsistent, and there are no reports of S-ketamine. The aim of the present pilot study was to explore the effects of S-ketamine as an adjuvant to propofol on the efficacy, seizure duration, and quality of electroencephalography in patients with treatment-resistant depression. METHODS: Thirty-two patients with a recurrent severe or psychotic major depressive disorder with treatment resistance to antidepressants were included in the study. For induction of anesthesia, the patients were randomized into 2 study groups. The S-ketamine group first received S-ketamine (0.4 mg/kg) as a bolus and then propofol. The treatment-as-usual group first received saline and then propofol. RESULTS: A statistically significant and clinically relevant reduction in the depression symptom scores was found in both study groups during ECT. There was no difference in the magnitude or speed of response between the study groups, nor was there any difference in the numbers of ECT treatments, seizure thresholds, seizure durations, and the electrical doses either. The patients recovered from anesthesia equally, but the degree of posttreatment disorientation and restlessness was more marked in the S-ketamine group. CONCLUSIONS: In conclusion, a subanesthetic adjuvant dose of S-ketamine with propofol may not increase the effects of ECT in patients with treatment-resistant depression. However, S-ketamine was associated with increased posttreatment disorientation and restlessness.

Novel electrode configuration for highly linear impedance pneumography.

Impedance pneumography (IP) is a non-invasive respiration measurement technique. Emerging applications of IP in respiratory medicine use the measured signal to monitor pulmonary flow and volume parameters related to airway obstruction during tidal breathing (TB). This requires a high impedance change (ΔZ)-to-lung volume change (ΔV) linearity. Four potential electrode configurations were tested on 10 healthy subjects. Only the novel configuration where the electrodes were placed in both the thorax and the arms yielded a highly linear ΔZ/ΔV in all subjects. The presented electrode configuration may expand the clinical use of IP from the conventional tidal volume estimation to flow measurement.

Randomized study comparing postoperative pain between coblation and bipolar scissor tonsillectomy.

Coblation tonsillectomy has shown promising results with respect to postoperative pain when compared with other techniques. Our study was designed to compare this technique with bipolar scissor tonsillectomy. Forty adult patients with a history of chronic or recurrent tonsillitis referred for standard tonsillectomy were recruited and randomized into two groups. Twenty were operated with Coblator and 20 with bipolar scissors. Exclusion criteria were a history of quinsy, bleeding disorder, or any major health problems. All participants completed the study. Postoperative pain, return to normal diet, and estimated need for sick leave were utilized as parameters. Data on operative time, difficulty of tissue removal, and hemostasis were also analyzed. Operative time was longer (P < 0.001) and tissue removal as well as hemostasis control were more difficult (P = 0.005, P = 0.013) with Coblator than with bipolar scissors. Participants in Coblator group assessed higher pain scores 1 and 3 h postoperatively (P = 0.044, P = 0.036). From the time of extubation, patients had access to an opioid (fentanyl) via a self-controlled analgesia device. The number of doses of analgesics needed during the hospital stay was significantly higher in the Coblator group (P = 0.020). During the 14-day follow-up, no significant differences were found in pain scores, return to solid food or subjective working ability between the groups. Considering the overall outcome of the patients the results did not favor coblation technique over bipolar scissors.