Novel immunotherapies are increasingly being used to treat malignant melanoma. The use of such agents has been associated with triggering autoimmunity. However, there has been a paucity in reports of limbic encephalitis associated with these immunotherapies. Pembrolizumab, a monoclonal antibody against programmed cell death antigen (PD-1), is currently being trialled in the UK to treat malignant melanoma. We report a unique case of antibody-negative limbic encephalitis presenting 1 year after starting pembrolizumab, in the context of malignant melanoma. The patient presented with progressive cognitive decline. MRI of the brain revealed signal change within the limbic structures. Cerebrospinal fluid studies confirmed evidence of inflammation with raised white cell count and protein. We were able to prevent further progression of symptoms by stopping pembrolizumab and treating the patient instead with steroids. We advocate considering autoimmune neuroinflammation as a differential for neurological disorders presenting in patients receiving PD-1 antagonist treatment and immunotherapy in general.

Background & objectives: Surgery–related anxiety can be observed due to several factors in patients undergoing surgery. With developing technology virtual reality (VR) glasses have begun to be used to reduce anxiety in the preoperative period. We aimed to investigate the effect of using VR glasses on operation anxiety and sedation requirement in patients during operation under spinal anesthesia.    Methodology: We enrolled 97 patients between 18–75 y of age, ASA class I–II, in this study. Participants were randomized into VR glasses group or the standard care group. The State-Trait Anxiety Inventory for Trait Anxiety (STAI–TA) and State-Trait Anxiety Inventory for State Anxiety (STAI–SA) scores preoperatively and anxiety score on VAS scale during surgery were obtained. Patients watched a movie via VR glasses (BOBO® VR Z4) after spinal anesthesia and the surgical operation was commenced thereafter. In the control group, the surgery was begun without any additional procedure. Results: Both groups were similar in terms of demographic and hemodynamic data. There was no statistically significant difference between groups in terms of preoperative anxiety levels, STAI–SA and STAI–TA scores. However, the VAS and relative risk (RR) values were significantly lower in the study group in all measurements (p < 0.05). Conclusion: We believe that the use of VR glasses decreases perioperative anxiety and sedation requirements in patients undergoing a surgical procedure under spinal anesthesia. Key words: Spinal Anesthesia; Virtual Reality; Anxiety; Sedation Citation: Turan AZ, Yilmaz M, Saracoglu T. The effect of virtual reality glasses on anxiety during surgery under spinal anesthesia: a randomized controlled study. Anaesth pain intensive care 2021;25(2):170-175. DOI: 10.35975/apic.v25i2.1469 Received: 31 January 2021, Reviewed: 22, 25 February 2021, Accepted: 27 February 2021

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Background: Visual impairment is a risk factor for psychiatric disorders in the affected children and adolescents, but there are only a limited number of studies concerning the mental health characteristics of visually impaired children and adolescents. Objective: The aim of this study was to determine levels of loneliness and anxiety in visually impaired children and adolescents, to analyze parenting style perceived by visually impaired children and adolescents, to compare those with typically controls. Methods: The study included 40 children and adolescents with visually impairment and 34 control group without visual impairment. Sociodemographic data form, the UCLA loneliness scale, and the State-Trait Anxiety Inventory for Children were used in both groups. The parenting Style Scale was used to determine perceived parental attitudes. Results: This study found more loneliness and trait anxiety levels in visually impaired children and adolescents compared to the control group. Authoritative parenting style was the most frequent type of parental attitude in the visually impaired group. In visual impairment group, loneliness level was higher in subgroups of authoritative and permissive-indulgent parenting style. However, level of trait anxiety was higher in authoritative parenting style subgroup compared to the control group. Discussion: The results of this study showed higher loneliness and anxiety levels in visually impaired children and adolescents. Further studies are needed to determine psychopathological risks in this population.

ObjectiveTo evaluate the effects of 2 different dose regimens of propofol (low dose: < 1 mg/kg, high dose: ≥ 1 mg/kg) on the duration of the seizures, the required energy for the seizures, and the seizure threshold over the course of electroconvulsive therapy (ECT).MethodsThe electronic medical records of 165 patients receiving 971 sessions of ECT were analyzed retrospectively. Patients were evaluated in two groups according to the according to propofol doses that they had received for ECT. Group LP (n = 91): patients who received low dose propofol (< 1 mg/kg). Group HP (n = 74): patients who received high dose propofol (≥1 mg/kg).ResultsThe required energy for seizures in Group HP were significantly higher than the Group LP in the 3rd, 4th, 5th, 6th, 7th, 8th, and 9th sessions (p < 0.05). The duration of seizures in the Group HP were significantly lower than the Group LP in the 1st, 2nd, 4th, 5th, 7th, and 8th sessions (p < 0.05). Higher electrical stimulus was needed to acquire a minimum length of seizure (> 25 sn) during the course of ECT in higher propofol doses. Although there was an increase in the seizure threshold over the course of ECT in both groups, this increase was found to be much more pronounced in the high-dose propofol group according to the low-dose propofol group. Longer duration of seizures was observed in the low-dose propofol group.ConclusionHigher doses of propofol in induction of anesthesia can lead to a more progressive rise in seizure threshold than lower doses of propofol.