右美托咪定辅助用药对全麻苏醒期躁动的影响

目的:观察右美托咪定辅助用药对全麻苏醒期躁动的影响。方法:选择全麻患者60例,按入院时间随机分成右美托咪定辅助用药组(A组)和单纯全麻组(B组)。右美托咪定辅助用药组(A组)15min内静脉给予右美托咪定1μg/kg的负荷量,之后以0.2μg.kg-1.h-1的速度连续输注,手术结束前20min停止输注。记录全麻期间各时间点血流动力学变化及苏醒期躁动发生情况。结果:A组在麻醉诱导前心率下降明显,拔管前、后血流动力学平稳,苏醒期躁动明显减少(P<0.05)。结论:右美托咪定辅助用药能减少全麻苏醒期躁动。     

Effect of process variables on physicomechanical properties of the agglomerates obtained by spherical crystallization technique

This study deals with the spherical crystallization process by the spherical agglomeration mechanism to obtain agglomerates with improved physicomechanical properties. The effect of temperature and speed of agitation on the micromeritic, mechanical and dissolution behavior of the agglomerates were investigated in order to make the link between the variables and properties of the agglomerates. Primary properties of the agglomerates were also evaluated by powder X-ray diffraction (XRPD) and differential scanning calorimetry (DSC). The mean particle size, flowability, bulk density and drug release of the agglomerates were found to be affected by either of the two variables, but there is no significant influence found on the compactibility properties. Hence, both variables must be fixed to obtained dense and well-shaped agglomerates adequate for direct tableting. XRPD and DSC results showed that during the agglomeration process, carbamazepine Form III changed to Form I.     

地佐辛超前镇痛对胸腔镜食管癌根治术患者术后躁动的效果观察

目的 探讨地佐辛超前镇痛对胸腔镜食管癌手术患者术后躁动的疗效.方法 选择60例ASA Ⅰ、Ⅱ级择期行胸腔镜食管癌根治术患者,随机分为观察组(30例)和对照组(30例),观察组于麻醉诱导前10 min静脉注射地佐辛0.1 mg/kg,对照组常规诱导,观察两组患者术毕躁动情况,记录拔管即刻及15、30、45 min后的VAS评分及苏醒时间、拔管时间和拔管时血流动力学变化.结果 观察组患者术后躁动发生率[10％ (3/30)]明显低于对照组[60％ (19/30)],差异有统计学意义(P＜0.01);观察组拔管即刻及15、30、45 min的VAS评分[(1.3±1.2)、(2.4±1.7)、(2.7±1.3)、(2.8±1.2)分]明显低于对照组[(3.4±1.5)、(4.7±1.8)、(5.0±1.6)、(4.8±1.7)分],差异有统计学意义(F组内=18.6、P＜0.05,F组间=20.4、P＜0.05,F交互=20.0、P＜0.05;两组不同时间段比较,P均＜0.01).结论 地佐辛超前镇痛可以明显降低胸腔镜食管癌根治术患者术后躁动的发生率,能有效减轻术后疼痛.     

Impact of postnatal blockade of N-methyl-D-aspartate receptors on rat behavior: a search for a new developmental model of schizophrenia

The malfunction of glutamatergic neurotransmission in the neonatal or postnatal periods may be a risk factor for the appearance of neuroanatomical, neurochemical or functional changes that are characteristic of schizophrenia. Thus, the present study was undertaken to investigate whether blockade of N-methyl-d-aspartate (NMDA) receptors in the postnatal period influences rat behavior in tests characterizing schizophrenia-like deficits such as psychomotor agitation, impairments of sensorimotor gating, working memory, and intensity of social interactions. (E)-2-amino-4-methyl-5-phosphono-3-pentenoic acid (CGP 40116), a competitive antagonist of NMDA receptors, was given postnatally (1.25 mg/kg on days 1, 3, 6, 9; 2.5 mg/kg on days 12, 15, 18; and finally 5 mg/kg on day 21, all injections s.c.), and rats were tested at 60 days old. We found that blockade of NMDA receptors in the postnatal period led to an enhancement of exploration, mimicking psychomotor agitation, impairments in sensorimotor gating as measured by a prepulse-evoked inhibition of acoustic startle response, and an impaired working memory, as measured by an increase in the latency to achieve accurate rate of response in the delayed alternation task. Decreases in non-aggressive social interactions and increases in aggressive interactions were also observed. In addition to cognitive deficits typical of schizophrenia, rats treated postnatally with NMDA receptor antagonists also showed higher level of fear exhibited in the elevated plus maze. Thus, the blockade of NMDA receptors in the postnatal period may model deficits that are characteristic of schizophrenia.     

Are Oral Medications Effective in the Management of Acute Agitation?

Background

Current expert guidelines recommend treating agitation with oral medications instead of intramuscular medications if possible. Oral medications are sometimes believed to be inappropriate for the emergency department (ED) as they require patient cooperation and may have a slower onset of action. This review examined published literature for the efficacy of oral agents in agitation.Clinical question: Are oral medications effective at managing acute agitation?

Methods

Structured review of PubMed of articles in which the first timepoints of evaluation were < 24 hours (i.e., the typical timecourse in the ED).

Results

11 articles included for final analysis.

Conclusions/Clinical Bottom Line

Treatment with oral medications is as effective as intramuscular medications in rapidly reducing psychotic agitation in the ED. Their use is thought to pose less risk to both patient and ED staff and is less coercive. There is little to no evidence about the use of oral medications for ED patients with extreme agitation.     

腹部手术患者全麻苏醒期躁动相关因素分析

目的对腹部手术全麻苏醒期躁动的相关因素进行分析,筛选出独立危险因素。方法观察腹部手术术后患者意识恢复情况,记录患者性别、年龄、体重、疾病类别、术前睡眠时间、麻醉时间、吸入麻醉用量、吸入麻醉停用时间、术中输液量、输血量、失血量、尿量。用Logistic回归分析研究影响全麻苏醒期躁动的相关因素。结果共有142例患者纳入分析,全麻苏醒期躁动发生率17.61%。年龄（B=-0.059,P=0.007,OR=0.943,95%CI of OR：0.902～0.986）和术前睡眠时间（B=-0.786,P=0.000,OR=0.455,95%CI of OR：0.317～0.655）对全麻苏醒期躁动具有显著影响。结论年龄和术前睡眠时间是影响腹部手术患者全麻苏醒期躁动的独立危险因素。     

Rapid acute treatment of agitation in patients with bipolar I disorder: a multicenter, randomized, placebo-controlled clinical trial with inhaled loxapine

Kwentus J, Riesenberg RA, Marandi M, Manning RA, Allen MH, Fishman RS, Spyker DA, Kehne JH, Cassella JV. Rapid acute treatment of agitation in patients with bipolar I disorder: a multicenter, randomized, placebo‐controlled clinical trial with inhaled loxapine. Bipolar Disord 2012: 14: 31–40. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S. Objective: The present study evaluated inhaled loxapine for the acute treatment of agitation in patients with bipolar I disorder. Methods: A Phase 3, randomized, double blind, placebo‐controlled, parallel group inpatient study was performed at 17 psychiatric research facilities. Agitated patients (N = 314) with bipolar I disorder (manic or mixed episodes) were randomized (1:1:1) to inhaled loxapine 5 mg or 10 mg, or inhaled placebo using the Staccato^® system. Following baseline assessments, patients received Dose 1 and were evaluated for 24 hours. If required, up to two additional doses of study drug and/or lorazepam rescue medication were given. The primary efficacy endpoint was change from baseline in the Positive and Negative Syndrome Scale‐Excited Component (PANSS‐EC) score two hours after Dose 1. The key secondary endpoint was the Clinical Global Impression‐Improvement score at two hours after Dose 1. Additional endpoints included the changes from baseline in the PANSS‐EC from 10 min through 24 hours after Dose 1. Safety was assessed by adverse events, vital signs, physical examinations, and laboratory tests. Results: For the primary and key secondary endpoints, both doses of inhaled loxapine significantly reduced agitation compared with placebo. Reduced agitation, as reflected in PANSS‐EC score, was evident 10 min after Dose 1 with both doses. Inhaled loxapine was well tolerated, and the most common adverse events were known effects of loxapine or minor oral effects common with inhaled medications (dysgeusia was reported in 17% of patients receiving active drug versus 6% receiving placebo). Conclusions: Inhaled loxapine provided a rapid, non‐injection, well‐tolerated acute treatment for agitation in patients with bipolar I disorder.     

Experiences of nursing home staff using the targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms (TIME) – a qualitative study

Background/Aims: Neuropsychiatric symptoms (NPS) in dementia pose great challenges for residents and staff in nursing homes. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a randomized controlled trial demonstrated reductions in NPS. We explored the participating staff's experiences with the model and how it meets the challenges when dealing with the complexity of NPS.

Methods: Three to six months after the end of the intervention, we interviewed 32 of the caregivers, leaders, and physicians participating in the trial, in five focus groups. We used thematic content analysis.

Results: The analysis yielded two main themes: (1) a systematic reflection method enhanced learning at work; (2) the structure of the approach helped staff to cope with NPS in residents with dementia.

Conclusion: TIME shifts the way of learning for the staff from a traditional to a more innovative and reflection-based learning through a process of learning how to learn at work. The staff's experienced increased coping in their approach to complex problems. Our results emphasise the importance of a structured and biopsychosocial approach to NPS in clinical practice. Future research should explore models for integrating situated learning in daily routines in nursing homes.