We report a case of a 41-year-old male with postinjury neuropathic pain comorbid with major depression in which electroconvulsive therapy (ECT) was effective in relieving both neuropathic pain and major depression. A total of 12 sessions of bilateral ECT were performed using a Thymatron® (Somatics LLC; Lake Bluff, IL). After ECT, the patient was subsequently maintained on paroxetine, eszopiclone (2 mg/day), and alprazolam. There was no relapse for at least one year after the last ECT. This case indicates that ECT might be an alternative treatment for major depression associated with chronic neuropathic pain after traumatic injury.
Posters 469 maternal renal function. We therefore wanted to evaluate until when maternal creatinaemia still affects neonatal creatinaemia in ELBW infants.
Methods:Retrospective data analysis of maternal (within 24 h of delivery) creatinaemia (mg/dl) and neonatal creatinaemia in the first 8 postnatal days in ELBW infants (< 1 000 g). Postnatal data were compared with maternal creatinaemia (paired Wilcoxon, correlation, Bland-Altman).
Results:In an dataset of 155 neonates (weight = 810, 330-1000 g, age = 27, 23-33 weeks), 80 neonates were linked with maternal creatinaemia (median 0.8, range 0.41-1.6) at delivery. Median postnatal creatinaemia was not significantly different from maternal observations on day 1 (0.78) and displayed a progressive, significant (Wilxocon) increase up to day 3 (1.085) with subsequent significant decrease from day 4 (1.075) until day 8 (0.81). Correlations between maternal and neonatal creatinaemia became weaker (r = 0.72, 0.37, 0.21) with increasing age and were no longer significant after day 3. Bland-Altman fit was perfect (mean 0.02, SD 0.19) on day 1, with a subsequent weakening on day 2 and 3 (mean -0.23, SD 0.39, -0.28, SD 0.53).
Conclusions:Maternal creatinaemia is the most relevant covariate of neonatal creatinaemia in the first 3 days of life. In these first postnatal days, creatinaemia does not yet reflect neonatal renal function and therefore, cannot yet be used to assess glomerular filtration rate.
A 38-year-old woman with cardiac failure was scheduled for an urgent appendectomy. She was classified as NYHA class IV and her cardiac ejection fraction was 14% . Antiplatelet drug and anticoagulant had been administered just before surgery. She received a transversus abdominis plane block with 30 ml of 0.75% ropivacaine and was given fentanyl intravenously. Hemodymamic status was stable during the surgery and no analgesic agent was needed. An ultrasound-guided transversus abdominis plane block with a small dose of intravenous fentanyl is suggested to be useful for anesthetic management in patients with severe cardiac failure.
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