纳美芬不同给药时机对全麻下腹腔镜全子宫切除术后苏醒期躁动的影响

目的 观察纳美芬不同给药时机对全麻下腹腔镜全子宫切除术后苏醒期间躁动的影响.方法 选择90例按美国麻醉医师协会（American Society of Anesthesiologists ASA）1～2级需要在全麻下行腹腔镜全子宫切除术的患者,随机分为三组,每组30例,分别在麻醉停药前5min（A组）,麻醉停药时（B组）和麻醉停药后5min（C组）静脉注入纳美芬0.25μg/kg.三组麻醉诱导及麻醉维持方法均相同.分别纪录麻醉维持时间、呼吸恢复时间、拔气管导管时间、拔管10min后的呼吸次数、拔管时镇静-躁动（RASS）评分及拔管后10min视觉模拟评分（VAS）.结果 三组患者麻醉维持时间差异均无显著性（P＞0.05）.A组与B组之间呼吸恢复时间、拔管时间和拔管后10min呼吸次数（次/分）差异均无显著性（P＞0.05）,A组和B组与C组之间呼吸恢复时间、拔管时间和拔管后10min呼吸次数（次/分）差异均有显著性（P＜0.05）,A组和B组比C组促进呼吸恢复的效果更明显;B组和C组与A组之间镇静—躁动评分和疼痛程度评分均差异有显著性（P＜0.05）,B组和C组比A组预防躁动和减轻术后10min疼痛效果更好.结论 全麻麻醉停药时静脉注入小剂量纳美芬,能够有效减少腹腔镜全子宫切除术后全麻苏醒期躁动的发生,并能促进呼吸的恢复.     

奥卡西平与通窍活血汤治疗瘀血内阻型血管性痴呆患者激越行为的疗效比较

目的观察奥卡西平与通窍活血汤治疗瘀血内阻型血管性痴呆患者激越行为的疗效。方法将70例伴有激越行为的瘀血内阻型血管性痴呆患者随机分为西药组和中药组,每组35例,分别应用奥卡西平和通窍活血汤治疗。治疗前及治疗2、4、8周末分别采用简易智能状态检查量表（MMSE）、痴呆行为量表（BEHAVE-AD）、日常生活能力量表（ADL）等进行疗效评定,并记录不良反应。结果两组均完成研究,无脱落病例。治疗2周西药组显著进步率高于中药组（P〈0.05）,西药组BEHAVE-AD量表总分及攻击行为因子分低于中药组（P〈0.05）;治疗8周后中药组显著进步率高于西药组（P〈0.05）,中药组BEHAVE-AD量表总分及攻击行为因子分低于西药组（P〈0.05,P〈0.01）;中药组MMSE量表总分高于西药组（P〈0.05）,而ADL量表总分低于西药组（P〈0.05）;治疗期间,中药组＂过度镇静＂及＂认知功能进行性下降＂发生率均低于西药组（P〈0.05）。结论奥卡西平治疗瘀血内阻型血管性痴呆患者激越行为起效快,急性期疗效优于通窍活血汤;而通窍活血汤治疗起效较慢,但疗效相对稳定持久,且有利于改善患者的认知功能,副反应相对较轻。     

地佐辛和曲马多预防小儿全麻苏醒期躁动的临床观察

目的比较地佐辛和曲马多用于预防小儿全凭静脉下行扁桃体联合腺样体切除术后苏醒期躁动的有效性和安全性。方法选择60例在全麻下行双侧扁桃体联合腺样体切除术的患儿随机分为曲马多组、地佐辛组、对照组三组,每组20例。地佐辛组在气管插管后静脉注射生理盐水2 mL,在一侧标本切下后（大约手术结束前10～20 min）静注地佐辛0.1 mg/kg;曲马多组在气管插管后静脉注射曲马多2 mg/kg,一侧标本切下后静注生理盐水2 mL;对照组在两个时间点均注射生理盐水2 mL,观察三组患儿苏醒期的血流动力学变化、躁动评分、疼痛评分以及所有患儿的不良反应。结果拔管时和清醒时对照组患儿的MAP和HR高于曲马多组和地佐辛组,与麻醉前和停药时比较差异有统计学意义（P〈0.05）;对照组的躁动评分和疼痛评分均高于曲马多组和地佐辛组,比较差异有统计学意义（P〈0.05）,地佐辛组与曲马多组比较差异无统计学意义;曲马多组中有8例出现恶心呕吐,地佐辛组和对照组有2例和3例出现呕吐,曲马多组与地佐辛组、对照组比较差异有统计学意义（P〈0.05）;三组患儿均无呼吸抑制。结论地佐辛和曲马多均可有效预防小儿全麻苏醒期躁动,维持苏醒期血流动力学稳定,但应用地佐辛恶心呕吐的发生率更低、更安全。     

外耳再造手术全麻苏醒期躁动回顾性分析

【目的】比较外耳再造手术中4种麻醉方法对全麻苏醒期躁动（emergence agitation,EA）发生率的影响。【方法】2002年6月-2013年8月,外耳再造手术860例,分别采用吸入异氟醚53例（Ⅰ组）,吸入七氟醚88例（Ⅱ组）,吸入七氟醚与静脉复合麻醉152例（Ⅲ组）,全凭静脉麻醉567例（Ⅳ组）。所有患者麻醉诱导均采用丙泊酚2．5mg／kg,维库溴铵0．1mg／kg,芬太尼2μg／kg。I组术中维持吸入1％～2％异氟醚;Ⅱ组术中维持吸入3％～5％七氟醚;Ⅲ组静脉泵注内泊酚50～70μg·（kg·min）^-1,瑞芬太尼0．2μg·（kg·min）^-1,吸入1％～3％七氟醚,以上3组皆每间隔40min静注维库溴铵0．05mg／kg维持肌松。Ⅳ组采用无使用肌松药物,全凭静脉麻醉维持,静脉泵注丙泊酚45～50μg·（kg·min）^-1,瑞芬太尼03～0．5μg·（kg·min）^-1。苏醒期观察各组EA发生例数,统计EA持续时间。【结果】Ⅳ组EA发生率最低,持续时间最短,与其余3组比较有非常显著差异。【结论】无使用肌松药物麻醉维持,丙泊酚一瑞芬太尼全凭静脉麻醉,EA发生率低,持续时间短,适用于外耳再造手术的麻醉。     

Ethnicity Is an Inherent Criterion for Assessment of Individualized Music for Persons With Alzheimer’s Disease

A growing number of ethnically diverse persons are diagnosed with Alzheimer’s disease and related disorders (ADRD). Cognitive impairment is a key antecedent to agitation in persons with ADRD. There is increased recognition for the identification and testing of non-pharmacological interventions for the management of agitation in ethnically diverse populations. The evidence-based guideline of individualized music, currently in its 5th edition (Gerdner, 2013a), is one such intervention. This guideline has been tested in eight countries. In keeping with the holistic approach to this intervention, this article focuses on the importance of incorporating the role of ethnicity in the assessment of individualized music. This is underscored with a previously unpublished case example of a Mexican American man.     

A Model of Consequences of Need-Driven, Dementia-Compromised Behavior

PURPOSE: To extend the original need-driven, dementia-compromised behavior (NDB) model by explaining the consequences of behavioral symptoms for the person with dementia. ORGANIZING CONSTRUCT AND METHODS: Literature is reviewed and the consequences of expressing needs through need-driven, dementia-compromised behaviors are posited. The consequences of need-driven, dementia-compromised behavior (C-NDB) theory is proposed as a framework to improve understanding of the person with dementia and the consequences of behavioral symptoms and unmet needs. FINDINGS: Instead of normative verbal communication, people with significant dementia commonly communicate need via non-normative behaviors, making it difficult for caregivers to know that the person has a need and the extent of such need. Not meeting needs of people with dementia affects the person with dementia, care factors, and contextual factors. Cascading effects occur in which not meeting the original need results in new needs and behavioral symptoms. CONCLUSIONS: This framework indicates the consequences of expressing need behaviorally rather than verbally and shows that caregiver actions might moderate the events that lead to many needs being unresolved. Suggestions are made regarding future research questions deduced from the model.     

The relationship between cognitive function and agitation in senior day care participants

The relationship between cognitive impairment and functional status with agitation was assessed in 200 participants of senior day care programs. Results revealed better than 85% agreement in measures of cognitive impairment (BCRS, MMSE, physician assessment of dementia). Regression analyses showed that physically non-aggressive and verbally aggressive behaviors were related to level of cognitive impairment (BCRS, MMSE). These results showed that physically non-aggressive behaviors were manifested at earlier stages of dementia than physically aggressive behaviors, which were not manifested until late stages of dementia. Verbally non-aggressive behaviors increased with severity of dementia up to moderate-severe levels of impairment and then diminished. In contrast, verbally aggressive behaviors tended to be manifested fairly consistently across levels of dementia with a small increase at the severest levels. Findings are discussed in relation to previous findings for nursing home residents.     

The efficacy of mirtazapine in agitated patients with Alzheimer’s disease: A 12-week open-label pilot study

Agitation is one of the most devastating behavioral symptoms in demented patients but there is little evidence about effective and safe pharmacotherapy. We aimed to determine the effectiveness and safety of mirtazapine in treatment of agitated patients with Alzheimer’s disease (AD). The consecutive patients with AD who have significant agitation were assigned to a 12-week open-label, prospective study. Patients received mirtazapine 15–30 mg/day. The changes in Cohen-Mansfield Agitation Inventory-Short form (CMAI-SF) scores were primary outcome measurement. The change in Clinical Global Impression-Severity scale (CGI-S) scores and tolerability-safety profile were the secondary efficacy variables. Thirteen of 16 (81.25%) patients completed the study. There was a significant reduction in CMAI-SF and CGI-S between the pre- and post-treatment with mirtzapaine (p < 0.001). The mean baseline score was 26.54 ( ± 5.4) and mean reduction was 10.6 ( ± 7.5) in CMAI-SF. There was no significant side effect and cognitive deterioration. The results of this open-label pilot study suggest that mirtazapine may be an effective choice for treatment of agitated patients with AD.     

Recovery profile of patients undergoing nasal surgical procedures: a comparison between sevoflurane and propofol

Objectives  To compare the recovery profile of sevoflurane and propofol in nasal surgical procedures. Design  A prospective, double blind, randomized study Setting  King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, a tertiary care teaching hospital, attached with King Saud University, Riyadh Saudi Arabia. Patients  60 ASA I–II patients age between 18–35 years, and weighing 50-80 kg, scheduled for nasal surgical procedures. Methods  Patients were assigned randomly to one of the two groups, the Sevoflurane Group-S (n = 30) & the Propofol Group-P (n = 30). Anesthetic induction was carried out using propofol 2.0mg/kg.in both the groups. Cis-atracurium 0.15mg/kg was given for intubation. Airway was protected with a throat pack around the endo-tracheal tube. Fentanyl 1microgram/kg was given as bolus followed by infusion at a rate of 1 microgram/kg/ hour. Anesthesia was maintained with sevoflurane 2% in Group-S, and propofol infusion at a rate of 200 microgram/kg/min. in Group-P. 50% oxygen in nitrous oxide was given in both the groups. At the end of surgery, patients were extubated after reversal of the neuromuscular block. Immediate recovery was assessed by recording the time to breathe spontaneously, time to extubation, and time of spontaneous eyes movements from the time of giving reversal. Ketoprofen 1.5mg/kg intramuscularly was given to all patients before transfer to (PACU). In PACU, sedation score was assessed for 45 min. Intermediate recovery was assessed by TDT and DSST at 15, 30 and 45 min. Time taken to state name and father’s name was recorded. Results  Patients in Group-S breathed significantly earlier than those in Group-P. Group-P showed significantly better performance with TDT at 45 min and with DSST at 30 and 45 min. Conclusions  We conclude that both sevoflurane and propofol provide early and comparable post anesthesia recovery for patients undergoing nasal surgical procedures.     

Video-analytic study of manual kinesics and its lateralization in the course of treatment of depressive syndromes.

Video-taped interviews of 47, predominantly endogenous depressive in-patients, recorded on days 0 and 21 of pharmacotherapy were analysed with respect to frequency, duration and side-preference of defined hand movements. The data were related to clinical improvement or deterioration as assessed by judgement of the syndromal aspects: retardation and agitation. 1. Above all, improvement is marked by a decrease of Continuous body-focused movements (C) and an increase of Object-focused movements (O) of the speech primacy type (OS)-deterioration by an increase of C and decrease of OS. 2. The degree of retardation corresponds to O, the degree of agitation, above all to C. 3. O show no side-preference with a higher degree of retardation or agitation respectively, but a marked right perference with a lower degree of retardation or agitation, Discrete body touching (D) shows a left preference only, with a higher degree of retardation. A comparison of sidedness of O between interviews 1 and 2 shows no lateralization trend, either in the improvement or the deterioration group. In contrast, D changed from left weightiness to symmetry, coinciding with improvement but not with deterioration, With reference to the latter findings we discuss the possibility of a particular mode of cerebral lateralization predisposing to endogenous depression.