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Ladha KS, Lee J, Mattina GF, Pazmino-Canizares J, Wijeysundera DN, Gholamali Nezhad F, Philip K, Tassone VK, Adamsahib F, Bhat V. Sustained Mood Improvement with Laughing Gas Exposure (SMILE): Study protocol for a randomized placebo-controlled pilot trial of nitrous oxide for treatment-resistant depression. PLoS One 2024; 19:e0297330. [PMID: 38241247 PMCID: PMC10798444 DOI: 10.1371/journal.pone.0297330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/12/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Nitrous oxide has shown potentially as an efficacious intervention for treatment-resistant depression, yet there remains insufficient evidence pertaining to repeated administration of nitrous oxide over time and active placebo-controlled studies with optimal blinding. Thus, we aim to examine the feasibility and preliminary efficacy of a six-week follow up study examining the effects of a 4 week course of weekly administered nitrous oxide as compared to the active placebo, midazolam. METHODS In this randomized, active placebo-controlled, pilot trial, 40 participants with treatment-resistant depression will receive either inhaled nitrous oxide (1 hour at 50% concentration) plus intravenous saline (100mL) or inhaled oxygen (1 hour at 50% concentration) plus intravenous midazolam (0.02 mg/kg in 100mL, up to 2mg) once per week, for 4 consecutive weeks. Participants will be followed up for 6 weeks starting from the first treatment visit. Primary feasibility outcomes include recruitment rate, withdrawal rate, adherence, missing data, and adverse events. The primary exploratory clinical outcome is change in Montgomery-Åsberg Depression Rating Scale (MADRS) score at day 42 of the study. Other exploratory clinical outcomes include remission (defined as MADRS score <10), response (defined as ≥ 50% reduction in MADRS score), and adverse side effects. DISCUSSION This pilot study will provide valuable information regarding the feasibility and preliminary efficacy of repeated nitrous oxide administration over time for treatment-resistant depression. If feasible, this study will inform the design of a future definitive trial of nitrous oxide as an efficacious and fast-acting treatment for treatment-resistant depression. TRIAL REGISTRATION ClinicalTrials.gov NCT04957368. Registered on July 12, 2021.
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Affiliation(s)
- Karim S. Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Jiwon Lee
- Department of Anesthesia, St. Michael’s Hospital, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Duminda N. Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, St. Michael’s Hospital, Toronto, Ontario, Canada
| | | | - Kaylyssa Philip
- Department of Anesthesia, St. Michael’s Hospital, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa K. Tassone
- Interventional Psychiatry Program, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Fathima Adamsahib
- Interventional Psychiatry Program, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, St. Michael’s Hospital, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Neuroscience Research Program, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Muñoz-Leyva F, Perlas A, Chin KJ, Soheili M, Li Q, Huszti E, Chan V. A hood shield reduces postdoffing contamination during simulated COVID-19 airway management: an exploratory, simulation-based randomized study. Can J Anaesth 2023; 70:869-877. [PMID: 37020172 PMCID: PMC10075501 DOI: 10.1007/s12630-023-02400-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 04/07/2023] Open
Abstract
PURPOSE SARS-CoV-2 poses a significant occupational health threat to health care workers performing aerosol-generating medical procedures, with a threefold increased risk of a positive test and predicted infection compared with the general population. Nevertheless, the personal protective equipment (PPE) configuration that provides better protection with lower contamination rates is still unknown. METHODS We enrolled 40 practitioners with airway management training (anesthesiologists, anesthesia assistants/nurses) in an exploratory, simulation-based randomized study. We evaluated the performance of a novel, locally designed hood (n = 20) in terms of protection from surrogate contamination using an ultraviolet (UV) marker during a standardized urgent intubation procedure and a simulated episode of coughing in a high-fidelity simulation setting compared with standard PPE (n = 20). The primary outcome was the presence of residual UV fluorescent contamination on any base clothing or exposed skin of the upper body after doffing PPE assessed by a blinded evaluator. RESULTS The proportion of participants with residual contamination on any base clothing or exposed skin of the upper body after doffing was less than half in the hood PPE group compared with the standard PPE group (8/20 [40%] vs 18/20 [90%], respectively; P = 0.002). CONCLUSIONS Compared with standard PPE, enhanced PPE with a locally designed prototype hood was associated with reduced contamination of the upper torso and fewer body areas being exposed to droplets after a simulated aerosol-generating scenario without designed airflow. STUDY REGISTRATION ClinicalTrials.gov (NCT04373096); registered 4 May 2020.
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Affiliation(s)
- Felipe Muñoz-Leyva
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst St., Mc Laughlin Pavilion, 2-405, Toronto, ON, M5T 2S8, Canada
- Hospital Universitario Mayor, Méderi, Bogotá, Colombia
- Faculty of Medicine, Universidad del Rosario, Bogotá, Colombia
| | - Anahi Perlas
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst St., Mc Laughlin Pavilion, 2-405, Toronto, ON, M5T 2S8, Canada.
| | - Ki Jinn Chin
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst St., Mc Laughlin Pavilion, 2-405, Toronto, ON, M5T 2S8, Canada
| | - Mehdi Soheili
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst St., Mc Laughlin Pavilion, 2-405, Toronto, ON, M5T 2S8, Canada
| | - Qixuan Li
- Biostatistics Research Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Vincent Chan
- Department of Anesthesiology and Pain Medicine, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst St., Mc Laughlin Pavilion, 2-405, Toronto, ON, M5T 2S8, Canada
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van den Bosch OFC, Fiset ME, Downey K, Maxwell C, Carvalho JCA. Anesthetic management of patients with class 3 obesity undergoing elective Cesarean delivery: a single-centre historical cohort study. Can J Anaesth 2023; 70:202-210. [PMID: 36447090 PMCID: PMC9957904 DOI: 10.1007/s12630-022-02365-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The preferred neuraxial anesthetic technique for patients with class 3 obesity undergoing elective Cesarean delivery is still under debate. We aimed to describe the anesthetic technique used in our tertiary institution across body mass index (BMI) groups and different surgical incisions. METHOD In this historical cohort study, we reviewed medical records of patients with a BMI ≥ 40 kg·m-2 undergoing elective Cesarean delivery between July 2014 and December 2020. We collected data on patient characteristics, anesthetic and surgical technique, and procedural times. For data analysis, we stratified patients by BMI into three different groups: 40.0-49.9 kg·m-2, 50.0-59.9 kg·m-2, and ≥ 60.0 kg·m-2. RESULTS We included 396 deliveries, distributed as follows: 258 with a BMI 40.0-49.9 kg·m-2, 112 with a BMI 50.0-59.9 kg·m-2, and 26 with a BMI ≥ 60.0 kg·m-2. For patients with a BMI 40.0-49.9 kg·m-2, the anesthetic technique of first choice was predominantly spinal anesthesia (71%), whereas for those with a BMI ≥ 60.0 kg·m-2, spinal anesthesia was never used as the anesthetic of first choice. With regard to the surgical incision, spinal anesthesia was almost exclusively used for patients undergoing Pfannenstiel incision and was rarely used for a higher supra- or infraumbilical transverse or midline incision. The overall incidence of general anesthesia was low (7/396, 1.8%). Anesthetic time, surgical time, and operating room time increased almost twofold in patients with a BMI ≥ 60.0 kg·m-2 compared with those with a BMI of 40.0-49.9 kg·m-2. CONCLUSION Neuraxial anesthesia was successfully used in approximately 98% of patients with class 3 obesity undergoing elective Cesarean delivery. The choice of regional anesthesia technique varied with increasing BMI and with the planned surgical incision. Procedural times increased with increasing BMI. This information should prove useful for comparing anesthetic choices and outcomes in this challenging population.
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Affiliation(s)
- Oscar F C van den Bosch
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, 600 University Ave, Room 7-400, Toronto, ON, M5G 1X5, Canada.
| | - Marie-Eve Fiset
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, 600 University Ave, Room 7-400, Toronto, ON, M5G 1X5, Canada
| | - Kristi Downey
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, 600 University Ave, Room 7-400, Toronto, ON, M5G 1X5, Canada
| | - Cynthia Maxwell
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Jose C A Carvalho
- Department of Anesthesiology and Pain Medicine, Mount Sinai Hospital, University of Toronto, 600 University Ave, Room 7-400, Toronto, ON, M5G 1X5, Canada
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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