Feride Karacaer

Effect of Ketamine, Thiopental and Ketamine-Thiopental Combination during Electroconvulsive Therapy for Depression.

OBJECTIVE We aimed to evaluate the effect of anaesthesia with thiopental (4 mg kg(-1)), ketamine (1 mg kg(-1)) and ketamine-thiopental (1 mg kg(-1) and 4 mg kg(-1), respectively) combination during electroconvulsive therapy (ECT) on the Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HAM-A) and haemodynamic variables in patients with resistant major depression. METHODS Patients with HDRS scores above 17 were included. The patients were randomly divided into three groups according to the anaesthesia used. Group 1 was given thiopental (4 mg kg(-1)), Group 2 was given ketamine (1 mg kg(-1)) and Group 3 was given ketamine (1 mg kg(-1)) and thiopental (4 mg kg(-1)). Succinylcholine (1 mg kg(-1)) was administered in all patients for muscle relaxation. HDRS and HAM-A scores were evaluated before ECT, after 3, 6. ECT and after the final ECT. Systolic and diastolic blood pressures, heart rates and oxygen saturations were recorded before and after anaesthesia induction and after the ECT procedure. Seizure duration was recorded. RESULTS Fifty-eight patients were included in the study. Thirty (52%) patients were male and 28 (48%) were female. The mean age was 42.7±15.8 years in Group 1, 44.8±11 years in Group 2 and 38.6±6.8 years in Group 3. In all groups, HDRS scores were reduced compared with the baseline values. There was no statistical significant difference between the groups regarding HDRS scores. HAM-A scores were higher in Group 2 and Group 3. Systolic and diastolic blood pressures and heart rate values were lower in Group 1 and the difference was statistically significant. CONCLUSION In this study, anaesthesia induced with thiopental, ketamine and thiopental-ketamine combination was observed to not result in a difference in ECT for patients with treatment-resistant depression. Ketamine at a dose of 1 mg kg(-1) given just before ECT did not enhance the antidepressant effect of ECT; however, anxiety scores were increased with ketamine application.

The function of probiotics on the treatment of ventilator-associated pneumonia (VAP): facts and gaps

Abstract Probiotics have been used for centuries in making fermented dairy products. The health benefits related to probiotics consumption are well recognized and they are generally regarded as safe (GRAS). Their therapeutic effects are due to the production of a variety of antimicrobial compounds, such as short‐chain fatty acids, organic acids (such as lactic, acetic, formic, propionic and butyric acids), ethanol, hydrogen peroxide and bacteriocins. Ventilator‐associated pneumonia (VAP) is a nosocomial infection associated with high mortality in intensive care units. VAP can result from endotracheal intubation and mechanical ventilation. These interventions increase the risk of infection as patients lose the natural barrier between the oropharynx and the trachea, which in turn facilitates the entry of pathogens through the aspiration of oropharyngeal secretions containing bacteria into the lung. In order to prevent this, probiotics have been used extensively against VAP. This review is an update containing information extracted from recent studies on the use of probiotics to treat VAP. In addition, probiotic safety, the therapeutic properties of probiotics, the probiotic strains used and the action of the probiotics mechanism are reviewed. Furthermore, the therapeutic effects of probiotic treatment procedures for VAP are compared to those of antibiotics. Finally, the influences of bacteriocin on the growth of human pathogens, and the side‐effects and limitations of using probiotics for the treatment of VAP are addressed.

Amyloidosis and difficult airway: a case report -

Öz Amyloidosis is a disease which can affect any tissue in the body with extracellular deposition of low molecular weight protein fibrils. Amyloid deposition can appear in many organs and tissues. Amyloidosis of tongue occurs most commonly in systemic form as rubbery macroglossia due to extra-deposition of amyloid within the suprahyoid muscle. Anesthesiologist can experience the negative consequences of amyloidosis in many conditions. Difficult airway due to amyloid deposition in tongue is an unexpected condition. We aimed to report a case that had respiratory distress with extremely big tongue due to amyloidosis. We performed a fiberoptic intubation for emergent tracheostomy without any complication. Amiloidozis, düşük molekül ağırlıklı amiloid moleküllerinin ekstrasellüler birikimi ile karakterize bir hastalıktır. Amiloid birikimi kalp, karaciğer, böbrek, cilt, barsak, otonom sinir sistemi, dil ve karpal tünelde görülebilir. Dilde amiloidozis, amiloidin suprahyoid kaslarda ekstrasellüler depozisyonuna bağlı makroglossi çoğunlukla amiloidin sistemik formuna bağlı görülmektedir.Anestezistler amiloidozisle pek çok farklı durumda karşılaşabilirler. Dilde amiloid birikimine bağlı zor hava yolu beklenmedik bir durumdur. Fiberoptik bronkoskopi ile acil trakeostomi açılmasını sağladık ve herhangi bir komplikasyon gözlenmedi. Burada amiloidozise bağlı aşırı büyük dilden kaynaklanan solunum sıkıntısını sunulması amaçlanmıştır.