Utility of Intravenous Ketamine as an Alternative, Effective Depression Treatment for Hospitalized Patients Unable to Receive Electroconvulsive Therapy Due to Medical Risks

Objective: To evaluate the effects of low-dose fentanyl combined with a reduced dose of propofol on seizure duration and hemodynamic response during electroconvulsive therapy (ECT). Materials and Methods: Twenty-two patients with the American Society of Anesthesiologist Physical Status II to III undergoing ECT were enrolled in the present study. One hundred and five bilateral ECT sessions randomized to receive thiopental 2 mg/kg, propofol 1 mg/kg, and fentanyl 0.3 mcg/kg, followed by propofol 0.5 mg/kg. Succinylcholine 0.5 mg/kg was used for muscle paralysis. Seizure duration, awakening time and hemodynamic changes were compared between groups. Results: One hundred and five bilateral ECT treatments were randomized into thiopental group (n=35), propofol group (n=35), and fentanyl plus propofol group (n=35). The thiopental and fentanyl plus propofol groups had longer EEG and motor seizure durations than the propofol group, but the differences were not statistically significant. There was no difference in stimulus intensity across groups. However, fentanyl plus propofol group had statistically significant prolonged awakening time compare with thiopental group [mean difference 2.71, (95% CI 0.37 to 5.06, p=0.019)] and propofol group (mean difference 2.77, 95% CI 0.42 to 5.12, p=0.016). Only systolic blood pressure in propofol group was significantly lower than thiopental group [mean difference –10.4, (95% CI –19.4 to –1.38, p=0.018)]. There were no significant differences in diastolic blood pressure (df=2, F=2.546, p=0.083), heart rate (df=2, F=0.596, p=0.553), or oxygen saturation across group (df=2, F=2.914, p=0.059). Conclusion: Using a combination of low-dose fentanyl and low-dose propofol during ECT could be beneficial. Further investigation is needed to establish the optimal dose of propofol and fentanyl. Keywords: Electroconvulsive therapy; Fentanyl, Hemodynamic response; Propofol; Thiopental; Seizure duration

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The Efficacy of Electroconvulsive Therapy in the Treatment of Schizophrenia

The British Journal of Psychiatry ◽

10.1192/bjp.151.2.152 ◽

1987 ◽

Vol 151 (2) ◽

pp. 152-155 ◽

Cited By ~ 41

Author(s):

K. R. Abraham ◽

P. Kulhara

Keyword(s):

Electroconvulsive Therapy ◽

Rating Scale ◽

Double Blind Trial ◽

Double Blind ◽

Blind Trial ◽

Brief Psychiatric Rating Scale ◽

Psychiatric Rating ◽

Psychiatric Rating Scale ◽

To Receive

The efficacy of ECT was investigated in a double-blind trial. Twenty-two patients with schizophrenia received trifluoperazine and were randomly allocated to receive eight real or eight simulated ECTs. In the first eight weeks, the group receiving real ECTs showed significantly more improvement as measured on the Brief Psychiatric Rating Scale. However, the groups showed no significant differences from the twelfth week onwards. The superiority of real ECT was not confirmed at the end of six months.

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Recovery after ECT: comparison of propofol, etomidate and thiopental

Brazilian Journal of Psychiatry ◽

10.1590/s1516-44462008005000010 ◽

2008 ◽

Vol 30 (2) ◽

pp. 149-151 ◽

Cited By ~ 10

Author(s):

Moacyr A Rosa ◽

Marina O Rosa ◽

Iara M T Belegarde ◽

Celso R Bueno ◽

Felipe Fregni

Keyword(s):

Electroconvulsive Therapy ◽

Electric Charge ◽

Seizure Threshold ◽

Recovery Profile ◽

Different Types ◽

The Mean ◽

Hypnotic Drugs ◽

To Receive ◽

Mean Time ◽

Therapy Treatment

OBJECTIVES: To compare post anesthetic time for patient recovery after electroconvulsive therapy, as measured by the post anesthetic Recovery Score of Aldrete and Kroulik, using three different types of hypnotic drugs (propofol, etomidate and thiopental). METHOD: Thirty patients were randomized to receive one of the three drugs (n = 10 in each group), during a course of electroconvulsive therapy treatment. Patients and raters were blinded to which drug was received. Main treatment characteristics were recorded (as total electric charge received seizure threshold, number of treatments, and the mean time for recovery) along the whole treatment. RESULTS: Thiopental and propofol were associated with a significance increase in charge needed to induce a seizure (p < 0.0001) when compared to etomidate, as well as a significant decrease of time for recovery (p = 0.042). CONCLUSIONS: These findings suggest that, although there seems to be no difference in the clinical outcome across these three drugs, propofol offers the best recovery profile. However, it makes a higher mean electric charge necessary.

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Adaptive randomised controlled non-inferiority multicentre trial (the Ketodex Trial) on intranasal dexmedetomidine plus ketamine for procedural sedation in children: study protocol

BMJ Open ◽

10.1136/bmjopen-2020-041319 ◽

2020 ◽

Vol 10 (12) ◽

pp. e041319

Author(s):

Naveen Poonai ◽

Kamary Coriolano ◽

Terry Klassen ◽

Anna Heath ◽

Maryna Yaskina ◽

...

Keyword(s):

Sample Size ◽

Error Rate ◽

Closed Reduction ◽

Primary Outcome ◽

Average Length ◽

Procedural Sedation ◽

Type I ◽

Size Estimation ◽

To Receive ◽

Intravenous Ketamine

IntroductionUp to 40% of orthopaedic injuries in children require a closed reduction, almost always necessitating procedural sedation. Intravenous ketamine is the most commonly used sedative agent. However, intravenous insertion is painful and can be technically difficult in children. We hypothesise that a combination of intranasal dexmedetomidine plus intranasal ketamine (Ketodex) will be non-inferior to intravenous ketamine for effective sedation in children undergoing a closed reduction.Methods and analysisThis is a six-centre, four-arm, adaptive, randomised, blinded, controlled, non-inferiority trial. We will include children 4–17 years with a simple upper limb fracture or dislocation that requires sedation for a closed reduction. Participants will be randomised to receive either intranasal Ketodex (one of three dexmedetomidine and ketamine combinations) or intravenous ketamine. The primary outcome is adequate sedation as measured using the Paediatric Sedation State Scale. Secondary outcomes include length of stay, time to wakening and adverse effects. The results of both per protocol and intention-to-treat analyses will be reported for the primary outcome. All inferential analyses will be undertaken using a response-adaptive Bayesian design. Logistic regression will be used to model the dose–response relationship for the combinations of intranasal Ketodex. Using the Average Length Criterion for Bayesian sample size estimation, a survey-informed non-inferiority margin of 17.8% and priors from historical data, a sample size of 410 participants will be required. Simulations estimate a type II error rate of 0.08 and a type I error rate of 0.047.Ethics and disseminationEthics approval was obtained from Clinical Trials Ontario for London Health Sciences Centre and McMaster Research Ethics Board. Other sites have yet to receive approval from their institutions. Informed consent will be obtained from guardians of all participants in addition to assent from participants. Study data will be submitted for publication regardless of results.Trial registration numberNCT0419525.

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Effect of a Fermented Milk CombiningLactobacillus AcidophilusCL1285 andLactobacillus Caseiin the Prevention of Antibiotic-Associated Diarrhea: A Randomized, Double-Blind, Placebo-Controlled Trial

Canadian Journal of Gastroenterology ◽

10.1155/2007/720205 ◽

2007 ◽

Vol 21 (11) ◽

pp. 732-736 ◽

Cited By ~ 98

Author(s):

Mélanie Beausoleil ◽

Nadia Fortier ◽

Stéphanie Guénette ◽

Amélie L’Ecuyer ◽

Michel Savoie ◽

...

Keyword(s):

Placebo Group ◽

Controlled Trial ◽

Randomized Study ◽

Fermented Milk ◽

Daily Basis ◽

Hospitalized Patients ◽

Double Blind ◽

Antibiotic Associated Diarrhea ◽

Potential Measure ◽

To Receive

BACKGROUND: Antibiotic-associated diarrhea is an important problem in hospitalized patients. The use of probiotics is gaining interest in the scientific community as a potential measure to prevent this complication. The main objective of the present study was to assess the efficacy and safety of a fermented milk combiningLactobacillus acidophilusandLactobacillus caseithat is widely available in Canada, in the prevention of antibiotic-associated diarrhea.METHODS: In this double-blind, randomized study, hospitalized patients were randomly assigned to receive either a lactobacilli-fermented milk or a placebo on a daily basis.RESULTS: Among 89 randomized patients, antibiotic-associated diarrhea occurred in seven of 44 patients (15.9%) in the lactobacilli group and in 16 of 45 patients (35.6%) in the placebo group (OR 0.34, 95% CI 0.125 to 0.944; P=0.05). The median hospitalization duration was eight days in the lactobacilli group, compared with 10 days in the placebo group (P=0.09). Overall, the lactobacilli-fermented milk was well tolerated.CONCLUSION: The daily administration of a lactobacilli-fermented milk was safe and effective in the prevention of antibiotic-associated diarrhea in hospitalized patients.

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Electroconvulsive Therapy and Cognitive Improvement in a Very Elderly Depressed Patient

The British Journal of Psychiatry ◽

10.1192/bjp.150.2.255 ◽

1987 ◽

Vol 150 (2) ◽

pp. 255-257 ◽

Cited By ~ 6

Author(s):

Brian O'Shea ◽

Thomas Lynch ◽

Jane Falvey ◽

Gerald O'Mahoney

Keyword(s):

Depressed Patient ◽

Electroconvulsive Therapy ◽

Paranoid Schizophrenia ◽

Advanced Age ◽

Computer Search ◽

Very Elderly ◽

Convulsive Therapy ◽

Cognitive Improvement ◽

Electro Convulsive Therapy ◽

To Receive

A computer search of the literature revealed that the oldest documented patient to receive electro convulsive therapy (ECT) was a 94-year-old woman (Bernstein, 1972) who was diagnosed as having ‘anorexniearvosa’, but the history was suggestive of paranoid schizophrenia. She received a course of five ECTs and became much less paranoid, ate well, and put on weight. Her daughter lamented the fact that ECT had been deemed to be contra indicated 15years earlier on the grounds of advanced age.

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Convalescence plasma treatment of COVID-19: results from a prematurely terminated randomized controlled open-label study in Southern Sweden

BMC Research Notes ◽

10.1186/s13104-021-05847-7 ◽

2021 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

Karin Holm ◽

Maria N. Lundgren ◽

Jens Kjeldsen-Kragh ◽

Oskar Ljungquist ◽

Blenda Böttiger ◽

...

Keyword(s):

Plasma Treatment ◽

Viral Infections ◽

Standard Of Care ◽

Hospitalized Patients ◽

Care Group ◽

Open Label ◽

Randomized Controlled ◽

Oxygen Treatment ◽

Randomized Controlled Studies ◽

To Receive

Abstract Objective Convalescent plasma has been tried as therapy for various viral infections. Early observational studies of convalescent plasma treatment for hospitalized COVID-19 patients were promising, but randomized controlled studies were lacking at the time. The objective of this study was to investigate if convalescent plasma is beneficial to hospitalized patients with COVID-19. Results Hospitalized patients with confirmed COVID-19 and an oxygen saturation below 94% were randomized 1:1 to receive convalescent plasma in addition to standard of care or standard of care only. The primary outcome was number of days of oxygen treatment to keep saturation above 93% within 28 days from inclusion. The study was prematurely terminated when thirty-one of 100 intended patients had been included. The median time of oxygen treatment among survivors was 11 days (IQR 6–15) for the convalescent plasma group and 7 days (IQR 5–9) for the standard of care group (p = 0.4, median difference -4). Two patients in the convalescent plasma group and three patients in the standard of care group died (p = 0.64, OR 0.49, 95% CI 0.08–2.79). Thus no significant differences were observed between the groups. Trial registration ClinicalTrials NCT04600440, retrospectively registered Oct 23, 2020.

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Are Veterans Getting Their Preferred Depression Treatment? A National Observational Study in the Veterans Health Administration

Journal of General Internal Medicine ◽

10.1007/s11606-021-07136-2 ◽

2021 ◽

Author(s):

Lucinda B. Leung ◽

Hannah N. Ziobrowski ◽

Victor Puac-Polanco ◽

Robert M. Bossarte ◽

Corey Bryant ◽

...

Keyword(s):

Treatment Adherence ◽

Patient Preferences ◽

Veterans Health Administration ◽

Self Report ◽

Treatment Preferences ◽

Depression Treatment ◽

Veterans Health ◽

Health Administration ◽

Treatment Type ◽

To Receive

Abstract Background Physician responsiveness to patient preferences for depression treatment may improve treatment adherence and clinical outcomes. Objective To examine associations of patient treatment preferences with types of depression treatment received and treatment adherence among Veterans initiating depression treatment. Design Patient self-report surveys at treatment initiation linked to medical records. Setting Veterans Health Administration (VA) clinics nationally, 2018–2020. Participants A total of 2582 patients (76.7% male, mean age 48.7 years, 62.3% Non-Hispanic White) Main Measures Patient self-reported preferences for medication and psychotherapy on 0–10 self-anchoring visual analog scales (0=“completely unwilling”; 10=“completely willing”). Treatment receipt and adherence (refilling medications; attending 3+ psychotherapy sessions) over 3 months. Logistic regression models controlled for socio-demographics and geographic variables. Key Results More patients reported strong preferences (10/10) for psychotherapy than medication (51.2% versus 36.7%, McNemar χ21=175.3, p<0.001). A total of 32.1% of patients who preferred (7–10/10) medication and 21.8% who preferred psychotherapy did not receive these treatments. Patients who strongly preferred medication were substantially more likely to receive medication than those who had strong negative preferences (odds ratios [OR]=17.5; 95% confidence interval [CI]=12.5–24.5). Compared with patients who had strong negative psychotherapy preferences, those with strong psychotherapy preferences were about twice as likely to receive psychotherapy (OR=1.9; 95% CI=1.0–3.5). Patients who strongly preferred psychotherapy were more likely to adhere to psychotherapy than those with strong negative preferences (OR=3.3; 95% CI=1.4–7.4). Treatment preferences were not associated with medication or combined treatment adherence. Patients in primary care settings had lower odds of receiving (but not adhering to) psychotherapy than patients in specialty mental health settings. Depression severity was not associated with treatment receipt or adherence. Conclusions Mismatches between treatment preferences and treatment type received were common and associated with worse treatment adherence for psychotherapy. Future research could examine ways to decrease mismatch between patient preferences and treatments received and potential effects on patient outcomes.

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COVID-19 and antibacterial therapy in the inpatient settings: to whom, when, why?

Russian Pulmonology ◽

10.18093/0869-0189-2021-31-6-701-709 ◽

2021 ◽

Vol 31 (6) ◽

pp. 701-709

Author(s):

Nina A. Karoli ◽

Alena V. Aparkina ◽

Elena V. Grigoryeva ◽

Nadezhda A. Magdeeva ◽

Natalia M. Nikitina ◽

...

Keyword(s):

Bacterial Infection ◽

Elective Surgery ◽

Unintended Consequences ◽

Hospitalized Patients ◽

Fourth Generation ◽

Treatment Regimens ◽

Inpatient Settings ◽

Group 2 ◽

To Receive ◽

Group 1

Although antibiotics (ABs) are ineffective against COVID-19, they are often prescribed to patients with the new coronavirus infection. Many of these prescriptions are uncalled for.The aim of the work is to assess the frequency of prescribing antibiotics to hospitalized patients with confirmed COVID-19, identify the most commonly prescribed ABs, and determine the significance of various biomarkers for the diagnosis of bacterial infection.Methods. A retrospective analysis of 190 inpatient cases with confirmed COVID-19 was carried out. The records of COVID-19 patients who were admitted to the intensive care unit were excluded from the analysis. Two groups were formed: 30 patients (group 1) with COVID-19, emergency or elective surgery, and exacerbation of chronic infectious diseases, and 160 patients (group 2) with manifestations of COVID-19 only.Results. ABs were prescribed to 189 patients upon admission to the hospital. The most frequently prescribed ABs included macrolides (63.5%), respiratory fluoroquinolones (49.7%), and third or fourth-generation cephalosporins (57.1%). ABs were administered starting from the first day of admission and until the discharge. The patients in group 2 were more often prescribed respiratory fluoroquinolones and, less often, III - IV generation cephalosporins. Moreover, macrolides were used in the treatment regimens of both groups. Longer administration of respiratory fluoroquinolones to patients in group 2 than patients in group 1 (p < 0,05) was noted. Group 2 also tended to receive longer therapy with macrolides. On admission, the patients with signs of bacterial infection had more significant leukocytosis with a neutrophilic shift, a more common increase in ESR of more than 20 mm/h and an increase in the level of procalcitonin > 0,5 ng/ml.Conclusion. ABs were administered to the overwhelming majority of hospitalized patients in the absence of clear therapeutic indications. The ABs are likely to have a minimal benefit as empirical treatment of COVID-19 and are associated with unintended consequences, including adverse effects and increased antibiotic resistance. According to our data, the most informative markers of a secondary bacterial infection in patients with COVID-19 are leukocytosis with a neutrophilic shift, an increase in ESR of more than 20 mm/h, and a procalcitonin level of more than 0,5 ng/ml.

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