Subclinical epileptiform activity in the Alzheimer continuum: association with disease, cognition and detection method.

Background: Epileptic seizures are an established comorbidity of Alzheimer's disease (AD). Subclinical epileptiform activity (SEA) as detected by 24-h electroencephalography (EEG) or magneto-encephalography (MEG) has been reported in temporal regions of clinically diagnosed AD patients. Although epileptic activity in AD probably arises in the mesial temporal lobe, electrical activity within this region might not propagate to EEG scalp electrodes and could remain undetected by standard EEG.

Impact of fatigue on anaesthesia providers: a scoping review.

Background: Recently, fatigue has received more attention as a workplace hazard. This scoping review focuses on fatigue in anaesthesia providers. We explore the prevalence of fatigue in anaesthesia providers, and we examine how fatigue impacts their performance.

Etomidate and other non-barbiturates.

It is today generally accepted that anesthetics act by binding directly to sensitive target proteins. For certain intravenous anesthetics, such as propofol, barbiturates, and etomidate, the major target for anesthetic effect has been identified as the gamma-aminobutyric acid type A (GABA(A)) receptor, with particular subunits playing a crucial role. Etomidate, an intravenous imidazole general anesthetic, is thought to produce anesthesia by modulating or activating ionotropic Cl(-)-permeable GABA(A) receptors.

Propofol.

The hypnotic agent propofol has pharmacokinetic characteristics that allow for rapid onset and offset of drug effect and fast elimination from the body. Elderly patients show a greater sensitivity to the hypnotic effect of propofol. The drug is extensively metabolized in the liver through the cytochrome P450 system and glucuronidation, with potential for drug interaction.

The role of COX-2 inhibitors in pain modulation.

NSAIDs are the analgesics that are most commonly used world-wide. In the past few years, there have been significant advances in explaining the mechanism of action and clinical efficacy of the drugs belonging to this pharmacological family. Recent data relating to the role of cyclo-oxygenase (COX)-2 in the development of neuronal hyperexcitability and pain hypersensitivity have opened new perspectives in our understanding of the therapeutic effects of these drugs in several painful conditions.

Pharmacology of systemic analgesics.

Systemic administration of analgesic drugs is still the most widely used method for providing pain relief in acute painful situations. Opioids may be selected on the basis of their physicochemical characteristics and their diffusion index to the brain. But in clinical practice, their very steep concentration-analgesic effect relationship remains a critical aspect of opioid therapy.

Nonsteroidal anti-inflammatory drugs and paracetamol in children.

The cyclooxygenase enzymes produce large amounts of prostaglandins in presence of tissue injury and inflammation. Prostaglandins exert their influence on nerve membrane excitability both at the peripheral site and at the spinal dorsal horn. Their key role in peripheral tissue inflammation and central sensitization warrants their incorporation in pain management strategies for children.

Pharmaco-economic evaluation of a disposable patient-controlled analgesia device and intramuscular analgesia in surgical patients.

The present study contrasted the pharmaco-economics and analgesic efficacy of intramuscular (i.m.) opioid treatment with a parenteral disposable patient-controlled analgesia (PCA) system in two groups of 20 female patients (ASA I-II, aged 35-69 years) scheduled for abdominal hysterectomy.

Comparison of remifentanil and propofol infusions for sedation during regional anesthesia.

Background And Objectives: Patients treated with regional anesthesia often require concomitant medication for comfort and sedation. Propofol is widely used for this purpose. Remifentanil, a new ultra-short-acting opioid, exhibits at low doses distinct sedative properties that may be useful for supplementation of regional anesthesia.

Preoperative ketorolac administration has no preemptive analgesic effect for minor orthopaedic surgery.

The utility of preoperative ketorolac administration to reduce the intensity and duration of postoperative pain was compared with placebo in a randomized double-blind design of 60 ASA 1-2 patients scheduled for minor orthopaedic surgery. No opioids nor local anaesthetic blocks were used during surgery. The patients received either 30 mg ketorolac IV before surgery followed by a placebo injection after surgery or the reverse.

Side effects of NSAIDs and dosing recommendations for ketorolac.

We reviewed the pathogenesis of the most important side effects of non-steroidal antiinflammatory drugs (NSAIDs). Short-term treatments for postoperative pain are not generally associated with gastric damage. Pharmacoepidemiological studies have shown that for ketorolac the risk of gastrointestinal bleeding was only important in older patients and when doses > 90 mg/day were used.

Timing of perioperative non-steroidal anti-inflammatory drug treatment.

The time of non-steroidal antiinflammatory drug (NSAID) administration may be clinically important because their onset of effect may be delayed by 30-60 minutes while their opioid sparing effect is not apparent until 4 hours after administration. These findings can be explained by the pharmacokinetic behavior of these agents. Numerous studies addressing the short-term benefit of preemptive administration of NSAIDs gave inconclusive results, in part due to the study design.

Postoperative pain treatment after cholecystectomy with epidural sufentanil at lumbar or thoracic level.

The difference in analgesic activity following lumbar (group I) or thoracic (group II) epidural administration of 50 micrograms sufentanil was studied after cholecystectomy. Fifteen patients in each group were evaluated for pain relief using a linear analog scale (LAS), heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), peak expiratory flow (PEF), forced vital capacity (FVC), forced expiratory volume (FEV1) and arterial CO2 tension (PaCO2). In five additional patients in each group 75 micrograms sufentanil was injected for determination of serum levels.

Prostaglandin synthetase inhibitor treatment and the regulatory role of prostaglandins on organ perfusion.

Prostaglandin synthetase inhibitors (PGIs) are increasingly used in anesthetic practice and postoperative care. The influence of these agents on the hemodynamics and organ perfusion control remains largely unknown. This review attempts to assess the role of endogenous prostaglandins on the regulation of the microcirculation in different organs and to identify disease states in which PGIs may have deleterious effects.