British journal of anaesthesia
-
Epilepsy is the most common serious neurological disorder, with a prevalence of 0.5-1% of the population. While the traditional antiepileptic drugs (AEDs) still play a significant role in treatment of seizures, there has been an influx of newer agents over the last 20 yr, which are now in common usage. ⋯ This review examines perioperative epilepsy management, the mode of action of AEDs and their interaction with anaesthetic agents, potential adverse effects of anaesthetic agents, and the acute management of seizures and refractory status epilepticus on the ICU. Relevant literature was identified by a Pubmed search of epilepsy and status epilepticus in conjunction with individual anaesthetic agents.
-
Intensive care delirium is a well-recognized complication in critically ill patients. Delirium is an independent risk factor for death in the intensive care unit (ICU), leading to oversedation, increased duration of mechanical ventilation, and increased length of stay. Although there has not been a direct causal relationship shown between sleep deprivation and delirium, many studies have demonstrated that critically ill patients have an altered sleep pattern, abnormal levels of melatonin, and loss of circadian rhythms. ⋯ However, there are only a few studies of melatonin in ICU patients and these use heterogeneous methodologies. Therefore, it is not possible at this stage to make any clear recommendations regarding the clinical use of melatonin in this setting. There is a need for well-designed randomized controlled trials examining the role of melatonin in ICU.