Propofol misuse in medical professions: a scoping review.

Purpose: We aimed to describe the current literature concerning propofol misuse in medical professionals, specifically relating to the individual demographics of those misusing propofol and the outcomes of propofol misuse.

Methods: We conducted a retrospective scoping review of the literature using a modified PRISMA approach. We used MEDLINE, EMBASE, and PsycINFO databases to identify relevant studies based on search terms.

Extreme variability in succinylcholine dose for muscle relaxation in electroconvulsive therapy.

Objectives: To determine what dose of succinylcholine falls outside the range of 2 SD above or below the mean optimal dose of 0.9 mg/kg used for electroconvulsive therapy (ECT).

Methods: In this retrospective chart review, for all patients who received ECT at our institution within the 5-year study period, the initial dose of succinylcholine in milligrams per kilogram was compared with subsequent doses after adjustments were made for individual patient responses.

The opioid epidemic and the current prevalence of substance use disorder in anesthesiologists.

Purpose Of Review: There has been a substantial increase in prescription and illicit opioid abuse in the general population observed over the last two decades. Initially fueled by an influx of prescription opioid medications, the opioid epidemic now includes increasingly potent heroin and illicit fentanyl. Younger anesthesiologists, those currently in training or recent graduates, have come of age in a society where opioid abuse is much more prevalent.

Individualized Anesthetic Management for Patients Undergoing Electroconvulsive Therapy: A Review of Current Practice.

Electroconvulsive therapy (ECT) remains an indispensable treatment for severe psychiatric illness. It is practiced extensively in the United States and around the world, yet there is little guidance for anesthesiologists involved with this common practice. Communication between the anesthesiologist and the proceduralist is particularly important for ECT, because the choice of anesthetic and management of physiologic sequelae of the therapeutic seizure can directly impact both the efficacy and safety of the treatment.

The impaired anesthesiologist: what you should know about substance abuse.

Purpose: Despite our considerable experience with the problem of addiction in our specialty, most anesthesia care providers don't know how to identify or help an impaired colleague. The purpose of this article to provide sufficient information on substance use disorder (SUD) to aid in its identification amongst colleagues and to assist in its management.

Principal Findings: Depending on the region, 10-15% of the general population is prone to developing a SUD and will abuse drugs or alcohol at some point in their life.

Preventable drug waste among anesthesia providers: opportunities for efficiency.

Background: Health care service bundling experiments at the state and regional levels have showed reduced costs by providing a single lump-sum reimbursement for anesthesia services, surgery, and postoperative care. Potential for cost savings related to the provision of anesthesia care has the potential to significantly impact sustainability. This study defines and quantifies routine and preventable anesthetic drug waste and the patient, procedure, and anesthesia provider characteristics associated with increased waste.

Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: A systematic review of the case literature.

Background/objectives: Nitrous oxide (N2 O) is known to have abuse potential, although debate regarding the toxic effects of such abuse continues. Our objective was to review the case literature and present the neurologic, psychiatric and medical consequences of N2 O abuse.

Methods: A systematic literature review was completed for case reports using keywords "nitrous oxide" with "abuse/abusing" or "misuse/misusing" or "overuse/overusing" or "addiction.

General Anesthesia in a Patient With Urticaria Pigmentosa Referred for Electroconvulsive Therapy.

Urticaria pigmentosa is a rare disorder characterized by an abnormal systemic proliferation of mast cells. In this condition, various triggers can induce either cutaneous histamine release, resulting in rash, or generalized histamine release, resulting in symptomatic hypotension, syncope, or in its severest form, an anaphylactoid reaction resistant to most resuscitative measures. Many anesthetic agents and adjuncts are known potential triggers, and patients who require surgery or procedures under anesthesia must be managed carefully.

The Safe Use of Electroconvulsive Therapy in a Patient With a Repaired Arteriovenous Malformation: Images Showing Surgical Clips.

We present images showing surgical clips from a remotely repaired cerebral arteriovenous malformation in a patient treated safely with electroconvulsive therapy.

Hemifacial Erythema in Right Unilateral Electroconvulsive Therapy.

We present a case of transient right hemifacial rash after right unilateral electroconvulsive therapy. This phenomenon may have similarities with the cranial dysautonomia, Harlequin syndrome.

Case report: transient left bundle branch block associated with ECT.

We present the first reported case of transient left bundle branch block (LBBB) occurring during electroconvulsive therapy (ECT). LBBB is an important clinical finding, as it is associated with a significant increase in mortality. Physicians providing ECT should be aware of the significance of new-onset LBBB; it may occur during treatment.

Safe resumption of maintenance electroconvulsive therapy 12 days after surgical repair of hip fracture.

Hip fractures are a common injury affecting older individuals, especially women with osteoporosis. When patients who are at risk for hip fractures or who have had such a fracture that was recently repaired require electroconvulsive therapy, care must be taken to ensure complete muscle relaxation. Adequate muscle relaxation can be achieved using a dose of succinylcholine of approximately 1 mg/kg in most patients, but for patients who are at risk for complications resulting from inadequate muscle relaxation, the dose of succinylcholine may need to be increased by 40% to 50% to ensure complete relaxation.

Stuck on You: Chewing Gum Adherent to the Oral Airway in Electroconvulsive Therapy (ECT).

We present a case in which a piece of chewing gum was discovered adhering to the oral airway when it was removed after an ECT procedure. We suggest that careful examination of the patient's mouth for foreign objects be a standard part of the pre-ECT protocol.