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Anesthesia and analgesia · Apr 2020
Meta AnalysisPositive End-Expiratory Pressure During Anesthesia for Prevention of Postoperative Pulmonary Complications: A Meta-analysis With Trial Sequential Analysis of Randomized Controlled Trials.
It is still uncertain whether intraoperative PEEP actually reduces postoperative respiratory complications.
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Atelectasis during general anaesthesia increases with age up to 50 years and BMI up to 30 kg/m2, but appears curiously limited beyond this.
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Anesthesia and analgesia · Jun 2020
Randomized Controlled Trial Multicenter StudyQuality of Recovery After Breast Surgery: A Multicenter Randomized Clinical Trial Comparing Pectoral Nerves Interfascial Plane (Pectoral Nerves II) Block With Surgical Infiltration.
For non-mastectomy breast surgery the PECS II block is no better than surgical local infiltration.
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Curr Opin Anaesthesiol · Aug 2018
ReviewEmerging evidence for antidepressant actions of anesthetic agents.
What's the story here?
Growing evidence points to significant anti-depressant effects of several anesthetic agents, including ketamine, nitrous oxide, propofol and isoflurane. These may provide avenues for use as novel antidepressants or lead to development of new agents, supplanting other therapies such as ECT.
Why is this important?
Major depression and its consequences contributes to significant disease burden worldwide. Depression prevalence is increasing globally, with one third suffering treatment-resistant depression, unresponsive to modern antidepressant drugs.
Ketamine appears to produce both a fast antidepressant and antisuicidal effect, persisting for up to 1 week. The effect appears dose-responsive in the 0.1 to 0.75 mg/kg range.
Isoflurane when administered to achieve burst suppression (1.5-2 MAC) may have antidepressant effects in 75% of those treated, and achieved full remission in 50% in one 2013 study, comparable to ECT but with fewer cognitive side effects.
N2O use in one small pilot study resulted in depression improvement, likely through similar mechanisms as ketamine. Similarly, propofol-induced burst suppression has also shown an antidepressant effect similar in magnitude to isoflurane.
Bottom line: Several anesthetic agents appear to offer significant antidepressant benefits, which may lead to more mainstream use and supplant ECT. Anesthesiologists will be need to be aware of these effects as they become involved in their provision.
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