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Nappi F, Bellomo F, Avtaar Singh SS. Worsening Thrombotic Complication of Atherosclerotic Plaques Due to Neutrophils Extracellular Traps: A Systematic Review. Biomedicines 2023; 11:biomedicines11010113. [PMID: 36672621 PMCID: PMC9855935 DOI: 10.3390/biomedicines11010113] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023] Open
Abstract
Neutrophil extracellular traps (NETs) recently emerged as a newly recognized contributor to venous and arterial thrombosis. These strands of DNA, extruded by activated or dying neutrophils, decorated with various protein mediators, become solid-state reactors that can localize at the critical interface of blood with the intimal surface of diseased arteries alongside propagating and amplifying the regional injury. NETs thus furnish a previously unsuspected link between inflammation, innate immunity, thrombosis, oxidative stress, and cardiovascular diseases. In response to disease-relevant stimuli, neutrophils undergo a specialized series of reactions that culminate in NET formation. DNA derived from either nuclei or mitochondria can contribute to NET formation. The DNA liberated from neutrophils forms a reticular mesh that resembles morphologically a net, rendering the acronym NETs particularly appropriate. The DNA backbone of NETs not only presents intrinsic neutrophil proteins (e.g., MPO (myeloperoxidase) and various proteinases) but can congregate other proteins found in blood (e.g., tissue factor procoagulant). This systematic review discusses the current hypothesis of neutrophil biology, focusing on the triggers and mechanisms of NET formation. Furthermore, the contribution of NETs to atherosclerosis and thrombosis is extensively addressed. Again, the use of NET markers in clinical trials was considered. Ultimately, given the vast body of the published literature, we aim to integrate the experimental evidence with the growing body of clinical information relating to NET critically.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord of Saint-Denis, 93200 Saint-Denis, France
- Correspondence: ; Tel.: +33-(14)-9334104; Fax: +33-149334119
| | - Francesca Bellomo
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
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Shimamoto Y, Sanuki M, Kurita S, Ueki M, Kuwahara Y. Two-handed facemask technique effectively causes hyperventilation in electroconvulsive therapy: an observational study. BMC Anesthesiol 2022; 22:376. [PMID: 36471246 PMCID: PMC9720916 DOI: 10.1186/s12871-022-01928-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) remains the mainstay treatment option for patients with psychiatric diseases, such as severe depression. Although various anesthetic techniques provide adequate therapeutic seizures, hyperventilation is a useful adjunct to augment seizure duration and improve seizure quality. We investigated how to efficiently use a facemask to accomplish protocolized hyperventilation and evaluate its effect on ECT seizure. METHODS We studied 60 patients aged ≥18 years who underwent ECT. The patients were divided into two groups according to the technique of facemask ventilation used: the one-handed (n = 30) and two-handed (n = 30) groups. Following anesthesia induction under preoxygenation conditions, hyperventilation induced hypocapnia in the one-handed facemask group with manual bag ventilation was compared to that in the two-handed facemask group with assisted pressure-controlled ventilation. Ictal and peri-ictal electroencephalogram parameters and cardiovascular responses were monitored and compared between the one-handed and two-handed groups. RESULTS The two-handed technique demonstrated better electroencephalogram regularity and minimized cardiovascular stress compared to the one-handed technique. These conclusions come from the fact that the one-handed technique induced a substantial volume of leaks around the facemask (201.7 ± 98.6 mL/breath), whereas minimal leaks (25.8 ± 44.6 mL/breath) with stabler and higher ventilation rate led to greater inhaled minute ventilation in the two-handed group (the one-handed group, 9.52 ± 3.94 L/min; the two-handed group, 11.95 ± 2.29 L/min; p < 0.005). At the end of ECT treatment, all parameters of blood pressure and heart rate increased significantly in both groups equally, with lower SpO2 and more ST-segment depression on the electrocardiogram in the one-handed group. Comparing baseline values before anesthesia, ECT treatment significantly depressed ST-segment in both groups, while the degree of depression in ST-segment increased significantly in the one-handed group compared to that in the two-handed group. CONCLUSIONS End-tidal carbon dioxide monitoring for hyperventilation can reliably ensure hypocapnia only in the two-handed group. In ECT, the two-handed technique assisted by pressure-controlled ventilation is an effective and practical method for hyperventilation to induce adequate therapeutic seizures. While, the two-handed group with sufficient preoxygenation did not cause more cardiovascular stress than the one-handed group. TRIAL REGISTRATION UMIN Clinical Trials Registry 000046544, Date of registration 05/01/2022.
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Affiliation(s)
- Yoko Shimamoto
- grid.440118.80000 0004 0569 3483Department of Anesthesiology, NHO Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, Japan
| | - Michiyoshi Sanuki
- grid.440118.80000 0004 0569 3483Department of Anesthesiology, NHO Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, Japan
| | - Shigeaki Kurita
- grid.440118.80000 0004 0569 3483Department of Anesthesiology, NHO Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, Japan
| | - Masaya Ueki
- grid.440118.80000 0004 0569 3483Department of Anesthesiology, NHO Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, Japan
| | - Yoshie Kuwahara
- grid.440118.80000 0004 0569 3483Department of Anesthesiology, NHO Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, Japan
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Salinas FV. Contemporary Anesthetic Evaluation and Management for Electroconvulsive Therapy. Adv Anesth 2022; 40:201-221. [PMID: 36333048 DOI: 10.1016/j.aan.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Electroconvulsive therapy (ECT) is a medical treatment most often used in patients with severe major depression that has not responded to other treatments. ECT is also indicated for patients with other severe psychiatric conditions, including bipolar disorder, schizophrenia, schizoaffective disorders, catatonia, and neuroleptic malignant syndrome. Contemporary "modified ECT" involves inducing general anesthesia with neuromuscular blockade before inducing the therapeutic seizure. The goal of this review is to combine an evidence-based update with the experience of the author's institution to provide a practical approach to anesthetic care for the patient undergoing ECT.
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Affiliation(s)
- Francis V Salinas
- Swedish Medical Center, Seattle and Issaquah, Washington, USA; Medical Director of Anesthesia Services and Interventional Platform-Swedish Issaquah Hospital, Issaquah, Washington, USA.
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Factors Predicting Ictal Quality in Bilateral Electroconvulsive Therapy Sessions. Brain Sci 2021; 11:brainsci11060781. [PMID: 34204783 PMCID: PMC8231613 DOI: 10.3390/brainsci11060781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
In electroconvulsive therapy (ECT), ictal characteristics predict treatment response and can be modified by changes in seizure threshold and in the ECT technique. We aimed to study the impact of ECT procedure-related variables that interact during each session and might influence the seizure results. Two hundred and fifty sessions of bilateral ECT in forty-seven subjects were included. Seizure results were evaluated by two different scales of combined ictal EEG parameters (seizure quality index (SQI) and seizure adequacy markers sum (SAMS) scores) and postictal suppression rating. Repeated measurement regression analyses were performed to identify predictors of each session’s three outcome variables. Univariate models identified age, physical status, hyperventilation, basal oxygen saturation, days between sessions, benzodiazepines, lithium, and tricyclic antidepressants as predictors of seizure quality. Days elapsed between sessions, higher oxygen saturation and protocolized hyperventilation application were significant predictors of better seizure quality in both scales used in multivariate models. Additionally, lower ASA classification influenced SQI scores as well as benzodiazepine use and lithium daily doses were predictors of SAMS scores. Higher muscle relaxant doses and lower applied stimulus intensities significantly influenced the postictal suppression rating. The study found several modifiable procedural factors that impacted the obtained seizure characteristics; they could be adjusted to optimize ECT session results.
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de Arriba-Arnau A, Dalmau Llitjos A, Soria V, Menchón JM, Urretavizcaya M. Effective Adaptation of Ventilation Maneuvers in Electroconvulsive Therapy Sessions During the Coronavirus Disease 2019 Pandemic. J ECT 2021; 37:76. [PMID: 34029303 PMCID: PMC8168704 DOI: 10.1097/yct.0000000000000748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/02/2020] [Indexed: 12/05/2022]
Abstract
Supplemental digital content is available in the text.
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Affiliation(s)
- Aida de Arriba-Arnau
- From the Department of Psychiatry, Bellvitge University Hospital–ICS, Neurosciences Group—Psychiatry and Mental Health, Bellvitge Biomedical Research Institute, Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid
| | - Antònia Dalmau Llitjos
- Department of Anesthesiology, Reanimation and Pain Clinic, Bellvitge University Hospital–ICS
| | - Virginia Soria
- From the Department of Psychiatry, Bellvitge University Hospital–ICS, Neurosciences Group—Psychiatry and Mental Health, Bellvitge Biomedical Research Institute, Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - José Manuel Menchón
- From the Department of Psychiatry, Bellvitge University Hospital–ICS, Neurosciences Group—Psychiatry and Mental Health, Bellvitge Biomedical Research Institute, Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Mikel Urretavizcaya
- From the Department of Psychiatry, Bellvitge University Hospital–ICS, Neurosciences Group—Psychiatry and Mental Health, Bellvitge Biomedical Research Institute, Barcelona
- Centro de Investigación Biomédica en Red de Salud Mental, Carlos III Health Institute, Madrid
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
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de Arriba-Arnau A, Dalmau Llitjos A, Soria V, Labad J, Menchón JM, Urretavizcaya M. Ventilation Adjustment in ECT During COVID-19: Voluntary Hyperventilation is an Effective Strategy. Neuropsychiatr Dis Treat 2021; 17:1563-1569. [PMID: 34045858 PMCID: PMC8144845 DOI: 10.2147/ndt.s303877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/21/2021] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Airway management is a key objective in adapted electroconvulsive therapy (ECT) protocols during the COVID-19 pandemic to prevent infection. The objective of this study was to describe the effectiveness of a modified ventilation procedure designed to reduce aerosol-generating bag-mask ventilation (BMV) and isolate possible droplets while maintaining adequate respiratory gas values in ECT sessions. MATERIALS AND METHODS This prospective study analyzed the results of the modified protocol applied over a month. Adaptations entailed preoxygenation and extension of the voluntary hyperventilation (VHV) time for two minutes before anesthesia induction, asking patients to hyperventilate with oxygen therapy via nasal cannula and while wearing a face mask. Thereafter, vigorous hyperventilation was avoided, and patients were only assisted with tightly sealed BMV until emergence from anesthesia, isolating the ventilation by using a single-use plastic device. Oxygen saturation (SpO2) and transcutaneous partial pressure of carbon dioxide (TcPCO2) were recorded throughout the session. RESULTS The study included 74 sessions of bilateral ECT with the modified ventilation protocol in 15 subjects. After VHV, the mean SpO2 increase was 2.12±2.14%, and the mean TcPCO2 decrease was 4.05±2.98 mmHg. TcPCO2 values at the moment of stimulus administration were 2.22±3.07 mmHg below pre-ECT values. The mean EEG seizure was 38.70±17.03 s, and postictal suppression was 68.31± 34.58% and 2.13±0.75 on a 0-3 scale. Brief desaturation (SpO2 <90) of 4-5 seconds duration was observed in 4 sessions. CONCLUSION This modified ventilation protocol was effective during COVID-19, and it did not elicit significant side effects. In addition to avoiding vigorous BMV, it induced moderate hypocapnia, which has been tied to seizure optimization and less hypercapnia during the apnea period.
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Affiliation(s)
- Aida de Arriba-Arnau
- Department of Psychiatry, Bellvitge University Hospital-ICS, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health. L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Barcelona, Spain
| | - Antònia Dalmau Llitjos
- Department of Anesthesiology, Reanimation and Pain Clinic, Bellvitge University Hospital-ICS, Universitat de Barcelona (UB), Barcelona, Spain
| | - Virginia Soria
- Department of Psychiatry, Bellvitge University Hospital-ICS, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health. L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), Barcelona, Spain
| | - Javier Labad
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Barcelona, Spain
- Department of Mental Health, Consorci Sanitari del Maresme, Mataró, Spain
- Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Barcelona, Spain
| | - José Manuel Menchón
- Department of Psychiatry, Bellvitge University Hospital-ICS, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health. L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), Barcelona, Spain
| | - Mikel Urretavizcaya
- Department of Psychiatry, Bellvitge University Hospital-ICS, Bellvitge Biomedical Research Institute (IDIBELL), Neurosciences Group - Psychiatry and Mental Health. L’Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universitat de Barcelona (UB), Barcelona, Spain
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Tedeschi EA, Patusco LM, Zahler S, Martini M, Chiavaro da Fonseca R, Magalhães PVS. Factors Associated With Seizure Adequacy Along the Course of Electroconvulsive Therapy. J ECT 2021; 37:46-50. [PMID: 32881781 DOI: 10.1097/yct.0000000000000716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Eliciting a generalized seizure is essential to electroconvulsive therapy (ECT), but there is still a need to understand how patient and session variables interact to generate a seizure of adequate quality. Here, we investigate factors associated with motor seizure length as a measure of quality in a large database of patients who underwent ECT. METHODS This is a retrospective cohort including data from all adult inpatients who underwent ECT at a university hospital in Brazil from 2009 to 2015. We used linear mixed models to investigate the effects of patient, session, and medication on seizure length. RESULTS Session information was available for 387 patients, a total of 3544 sessions and 4167 individual stimulations. Multiple stimulations were necessary in 12.4% of sessions. Median seizure length was 30 seconds. Seizure length was directly correlated with stimulus dosage and inversely correlated with the session number, patient age, prescription of anticonvulsants in the day before and β-blockers during the session, and the thiopental dose. Use of benzodiazepines was not associated with a shorter seizure duration, irrespective of dose. CONCLUSIONS We demonstrate here how motor seizure length evolves during a course of ECT. With a large number of sessions, we are able to integrate a host of factors in a prediction model. Seizure quality was influenced by a number of the studied factors, many of which are potentially modifiable and could be assessed before initiating and handled during treatment.
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Affiliation(s)
- Eduardo Antonio Tedeschi
- From the Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Clínica, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
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Abstract
Electroconvulsive therapy (ECT) is an important component in the treatment of depression and schizophrenia in Germany. For this intervention patients undergo short-term general anesthesia and muscle relaxation. Before anesthesia can be carried out patients are subject to a comprehensive examination. For general anesthesia all established hypnotics can be used, but differences with respect to the success of the ECT have been described. Short-acting or reversible relaxants should be preferentially used. The risks of general anesthesia during ECT are estimated to be low but a transient hemodynamic instability of patients can occur. Treatment can be performed as an inpatient but also as an outpatient procedure.
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Affiliation(s)
- T Ninke
- Klinik für Anaesthesiologie, Klinikum der Universität München, LMU München, München, Deutschland.
| | - S Bayerl
- Klinik für Anaesthesiologie, Klinikum der Universität München, LMU München, München, Deutschland
| | - P Groene
- Klinik für Anaesthesiologie, Klinikum der Universität München, LMU München, München, Deutschland
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Luccarelli J, Fernandez-Robles C, Fernandez-Robles C, Horvath RJ, Berg S, McCoy TH, Seiner SJ, Henry ME. Modified Anesthesia Protocol for Electroconvulsive Therapy Permits Reduction in Aerosol-Generating Bag-Mask Ventilation during the COVID-19 Pandemic. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:314-319. [PMID: 32554959 PMCID: PMC7483857 DOI: 10.1159/000509113] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Electroconvulsive therapy (ECT) is a critical procedure in psychiatric treatment, but as typically delivered involves the use of bag-mask ventilation (BMV), which during the COVID-19 pandemic exposes patients and treatment staff to potentially infectious aerosols. OBJECTIVE To demonstrate the utility of a modified anesthesia protocol for ECT utilizing preoxygenation by facemask and withholding the use of BMV for only those patients who desaturate during the apneic period. METHODS This chart review study analyzes patients who were treated with ECT using both the traditional and modified anesthesia protocols. RESULTS A total of 106 patients were analyzed, of whom 51 (48.1%) required BMV using the new protocol. Of clinical factors, only patient BMI was significantly associated with the requirement for BMV. Mean seizure duration reduced from 52.0 ± 22.4 to 46.6 ± 17.1 s, but seizure duration was adequate in all cases. No acute physical, respiratory, or psychiatric complications occurred during treatment. CONCLUSIONS A modified anesthesia protocol reduces the use of BMV by more than 50%, while retaining adequate seizure duration.
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Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA,
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA,
| | | | | | - Ryan J Horvath
- Department of Anesthesia Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sheri Berg
- Department of Anesthesia Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas H McCoy
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephen J Seiner
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts, USA
| | - Michael E Henry
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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The effects of hyperventilation on seizure length and cerebral oxygenation during electroconvulsive therapy. North Clin Istanb 2020; 7:246-254. [PMID: 32478296 PMCID: PMC7251261 DOI: 10.14744/nci.2019.70893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 12/12/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Previous studies have reported that hyperventilation prolongs seizure length. However, there is no clear consensus in clinical guidelines on how to perform hyperventilation during Electroconvulsive Therapy (ECT). The present study aims to investigate the effects of hyperventilation on seizure length and cerebral oxygenation. METHODS Forty patients aged 18-65 and classified as ASA I-II, who would have their first ECT course were included in the study. Ethics committee approval was obtained and all patients' consent was taken. The consecutive patients were randomized into two groups as follows: group H (20 patients; target etCO2: 25-30 mmHg) and group N (20 patients; target etCO2 35-40 mmHg). All patients were ventilated with a facial mask for two minutes and later were ventilated by a laryngeal mask (LMA) for one minute. Vital signs, peripheric oxygen saturation (SpO2), and regional oxygen saturation (rSO2) were measured before general anesthesia induction, on the 3rd minute of ventilation with an LMA (LMA3), on the 1st minute postictal (PI1), on the 5th (PI5), and 10th (PI10) minutes. The motor seizure duration, Richmond sedation-agitation scale, and the time needed to reach Aldrete Score 9 were also recorded. RESULTS There was a significant difference between the groups when they were compared concerning seizure length and recovery time. However, when we compared the rSO2 values that were measured at different times in group H, the difference between the measurements was statistically significant. When rSO2 values in group H were compared in doubles, there were significant differences between measurements between the basal and LMA3, basal and PI1, and the basal and PI5. When Richmond agitation scores in both groups are compared, there were no significant differences between the groups. CONCLUSION This study found that seizure length was longer, and the recovery time was shorter in group H. There was a contribution of hyperventilation on cerebral oxygenation that was measured on the same person at different times, but cerebral oxygenation was not statistically different from patients that were normoventilated. More studies are required to form a consensus regarding how hyperventilation applies to ECT.
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Döring Y, Libby P, Soehnlein O. Neutrophil Extracellular Traps Participate in Cardiovascular Diseases: Recent Experimental and Clinical Insights. Circ Res 2020; 126:1228-1241. [PMID: 32324499 PMCID: PMC7185047 DOI: 10.1161/circresaha.120.315931] [Citation(s) in RCA: 179] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neutrophil extracellular traps (NETs) have recently emerged as a newly recognized contributor to venous and arterial thrombosis. These strands of DNA extruded by activated or dying neutrophils, decorated with various protein mediators, become solid-state reactors that can localize at the critical interface of blood with the intimal surface of diseased arteries and propagate and amplify the regional injury. NETs thus furnish a previously unsuspected link between inflammation, innate immunity, thrombosis, oxidative stress, and cardiovascular diseases. In response to disease-relevant stimuli, neutrophils undergo a specialized series of reactions that culminate in NET formation. DNA derived from either nuclei or mitochondria can contribute to NET formation. The DNA liberated from neutrophils forms a reticular mesh that resembles morphologically a net, rendering the acronym NETs particularly appropriate. The DNA backbone of NETs not only presents intrinsic neutrophil proteins (eg, MPO [myeloperoxidase] and various proteinases) but can gather other proteins found in blood (eg, tissue factor procoagulant). This review presents current concepts of neutrophil biology, the triggers to and mechanisms of NET formation, and the contribution of NETs to atherosclerosis and to thrombosis. We consider the use of markers of NETs in clinical studies. We aim here to integrate critically the experimental literature with the growing body of clinical information regarding NETs.
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Affiliation(s)
- Yvonne Döring
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, Bern, Switzerland
- Institute of Cardiovascular Prevention, Department of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Oliver Soehnlein
- Institute of Cardiovascular Prevention, Department of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Physiology and Pharmacology (FyFA), Karolinska Institute, Stockholm, Sweden
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