Current drug targets
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to review current knowledge concerning the use of magnesium in anesthesiology, the role of hypomagnesemia and hypermagnesemia in perioperative period, analyzing the cardiologic problems related to blood serum concentration changes of magnesium that can interesting in primis the anaesthesist in perioperative period. ⋯ Magnesium has many known indications. In peioperative period blood serum concentration changes of magnesium are frequent so anesthesiologists need to know the role of this important cation.
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Current drug targets · Aug 2009
ReviewGabapentin and pregabalin for the acute post-operative pain management. A systematic-narrative review of the recent clinical evidences.
Gabapentin and pregabalin inhibit Ca(2+) currents via high-voltage-activated channels containing the alpha2delta-1 subunit, reducing neurotransmitter release and attenuating the postsynaptic excitability. They are antiepileptic drugs successfully used also for the chronic pain treatment. A large number of clinical trials indicate that gabapentin and pregabalin could be effective as postoperative analgesics. This systematic-narrative review aims to analyse the most recent evidences regarding the effect of gabapentinoids on postoperative pain treatment. ⋯ Gabapentin and pregabalin reduce pain and opioid consumption after surgery in confront with placebo, but comparisons with other standard post-operative regimens are not sufficient. Gabapentin and pregabalin seem not to have any influence on the prevention of PONV.
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To outline recent findings concerning the efficacy of immunonutrients in patients undergoing surgery. ⋯ Immunonutrition is effective in improving outcome in a wide range of patients, particularly in malnourished individuals. However, further research using larger, better-designed trials is needed to assess whether immune function is benefited, with an improved clinical outcome in vulnerable patients.
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In the current era, more complex cardiac surgical procedures are being performed on elderly patients with variety of co-morbid conditions, which increases the demand to further improve the outcome of cardiac surgery. The role of insulin therapy in improving cardiac surgical outcomes has long been studied. However, the more recent evidence suggests that the entire potential of the insulin therapy has not yet been fully disclosed. The aim of this paper is to review different aspects of insulin therapy including different protocols used, timing of therapy and the objective glycemic target levels with its effect on improving cardiac surgical outcomes.
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Current drug targets · Jan 2009
ReviewPathophysiology of sepsis in the elderly: clinical impact and therapeutic considerations.
The aging world population will increase the incidence and mortality of severe sepsis. The aim of the present article is to review the pathophysiological differences in sepsis and its clinical impact on the elderly. The impact of immunosenescence on innate and acquired immunity is associated with relative immunologic depression that may favor the spreading of inflammation. ⋯ The initial clinical picture of sepsis in the elderly may be ambiguous but the specific pathopysiological changes of aging increase the risk of a sudden deterioration to severe sepsis with the development of a serious cardiovascular dysfunction. The reduced stress tolerance characteristic of aged tissues explains the high incidence of multi-organ failure in such patients. The specific pathophysiological and clinical picture of sepsis underlies the increased mortality in such patients and prompts research on therapeutic strategies with particular benefits to elderly septic patients.