Current drug targets
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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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Dexmedetomidine is a potent and highly selective alpha(2)-adrenoreceptor agonist currently utilized for continuous infusion for sedation/analgesia in the intensive care unit (ICU). Dexmedetomidine offers remarkable pharmacological properties including sedation, anxiolysis, and analgesia with the unique characteristic to cause no respiratory depression. In addition it posses sympatholytic and antinociceptive effects that allow hemodynamic stability during surgical stimulation. ⋯ In the last years it has emerged as an affective therapeutic drug in a wide range of anesthetic management, promising large benefits in the perioperative use. In particular this review focuses on dexmedetomidine utilization in premedication, general surgery, neurosurgery, cardiac surgery, bariatric surgery, and for procedural sedation and awake fiberoptic intubation. In all these fields dexmedetomidine has demonstrated to be an efficacious and safe adjuvant to other sedative and anesthetic medications.
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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.