Eur Rev Med Pharmaco
-
Eur Rev Med Pharmaco · Feb 2013
Effect of heparin on neuroprotection against spinal cord ischemia and reperfusion in rats.
Paraplegia due to ischemia/reperfusion (I/R) injury of the spinal cord is a devastating and undesired complication of thoraco-abdominal aortic surgery. Unidentified clots cause a variety of thromboembolic events and deteriorate the severity of ischemia. We investigated the effect of the degree of anticoagulation on spinal cord I/R injury and whether heparin is protective against I/R injury beside its anticoagulant properties. ⋯ Protection of spinal cord from I/R injury requires a multimodal management. We should not miss out the importance of adequate anticoagulation in thoraco-abdominal surgical procedures. Furthermore, the recently discovered anti-inflammatory property of glycosaminoglycans, including heparin, deserves to be investigated.
-
Eur Rev Med Pharmaco · Feb 2013
Randomized Controlled TrialCost analysis and safety comparison of Cisatracurium and Atracurium in patients undergoing general anesthesia.
Non-depolarizing neuromuscular blocking agents (NMB) differ in pharmacokinetic and pharmacodynamic parameters. An anesthesiologist according to these similarities and differences is able to choose the least costly one if the same safety profile and same clinical benefit achieved with the different alternatives. ⋯ According to our study it seems that atracurium and cisatracurium had similar safety profile and atracurium had a cost benefit relative to cisatracurium in initial loading doses. In patients with instability in hemodynamic parameters the cisatracurium was the appropriate choice.
-
Eur Rev Med Pharmaco · Feb 2013
ReviewPsychiatric emergencies (part III): psychiatric symptoms resulting from organic diseases.
An exhaustive review on the organic illnesses presenting with psychiatric manifestations, properly defined pseudopsychiatric emergencies, is presented. A systematic classification of the numerous organic causes of psychiatric disorders, based on authors' experience and literature revision, is carefully analysed, and their suitable diagnostic management in emergency setting is proposed. ⋯ The role of immune system in influencing the central nervous system, explaining the model of "sickness behaviour" in inflammatory disease, is also described, according to recent reports of "psychoneuroimmunology". Moreover, the immune-mediated mechanism explaining how neoplasm can influence brain function in the "paraneoplastic syndromes" is shown. In order to facilitate the teaching method, organic illnesses presenting with acute psychic manifestations or mimicking specific psychiatric disorders are subdivided into three groups: (1) Endocrine and metabolic disorders and deficiency states; (2) Internal diseases; (3) Neurologic disorders.
-
Eur Rev Med Pharmaco · Feb 2013
ReviewPsychiatric emergencies (part I): psychiatric disorders causing organic symptoms.
Psychiatric emergencies are conditions that mostly destabilize the already frenetic activity of the Emergency Department. Sometimes the emergency is clearly referable to primitive psychiatric illness. Other times, psychiatric and organic symptoms can independently coexist (comorbidity), or develop together in different conditions of substance abuse, including alcohol and prescription drugs. ⋯ A brief review of major psychiatric disorder and related behaviour abnormalities, vegetative symptoms and cognitive impairment, according to DMS IV-TR classification, are described. Finally, the reactive psychic symptoms and behavioral responses to acute or chronic organic disease, so called "somatopsychic disorders", commonly occurring in elderly and pediatric patients, are presented. The specific conditions of post-operative and intensive care unit patients, and cancer and HIV positive population are emphasized.
-
Eur Rev Med Pharmaco · Feb 2013
ReviewCurrent practice and recent advances in pediatric pain management.
Differently from the adult patients, in pediatric age it is more difficult to assess and treat efficaciously the pain and often this symptom is undertreated or not treated. In children, selection of appropriate pain assessment tools should consider age, cognitive level and the presence of eventual disability, type of pain and the situation in which it is occurring. Improved understanding of developmental neurobiology and paediatric analgesic drugs pharmacokinetics should facilitate a better management of childhood pain. ⋯ A multimodal analgesic regimen provides better pain control and functional outcome in children. Cooperation and communication between the anaesthesiologist, surgeon, and paediatrician are essential for successful anaesthesia and pain management.