ISSN:0952-7907    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The present review focuses on some aspects of stroke management and covers important clinical studies and studies in basic research published during the past year. It is subdivided in three sections. First, we focus on ischaemic stroke and discuss some new insights into the genetics of ischaemic stroke, intensive stroke care including cerebral thrombolysis, and neuroprotective treatment. Secondly, new insights into the risk factors and outcome of primary and iatrogenic intracerebral haemorrhage are discussed. Finally, we review in the section on subarachnoid haemorrhage literature on the further development of endovascular treatment of cerebral aneurysms, and research into the causes of vasospasms and secondary cerebral ischaemia.

ISSN:0952-7907    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

During the past few decades, management of acute traumatic brain injury has advanced substantially on several fronts. Implementation of rapid transport systems and the advent of trauma centres, together with advances in emergency medicine, critical care medicine and trauma neurosurgery, have improved outcome following head injury. Technological advances made during the past years in the field of invasive neuromonitoring that provide real-time information on brain oxygenation may further improve outcome by enabling individualized therapies for intracranial hypertension. Furthermore, these recent technological advances will provide insights into the pathophysiological processes that are active in traumatic brain injury and a better understanding of the biochemical effects of specific therapeutic regimens.

ISSN:0952-7907    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Anaesthetic care of neurosurgical patients increasingly involves management issues that apply not only to ‘asleep patients’, but also to ‘awake and waking-up patients’ during and after intracranial operations. On one hand, awake brain surgery poses unique anaesthetic challenges for the provision of awake brain mapping, which requires that a part of the procedure is performed under conscious patient sedation. Recent case reports suggest that local infiltration anaesthesia combined with sedative regimens using short-acting drugs and improved monitoring devices have assumed increasing importance. These techniques may optimize rapid adjustments of the narcotic depth, providing analgesia and patient immobility yet permitting a swift return to cooperative patient alertness for functional brain tests. Regional anaesthesia and peripheral nerve blocks were used to prevent uncontrolled movements in special cases of intractable seizures. However, few of these strategies have been evaluated in controlled trials. Awake craniotomy for tumour removal is performed as early discharge surgery. Meticulous consideration of postoperative patient safety is therefore strongly advised. On the other hand, waking-up patients or the emergence from general anaesthesia after brain surgery is still an area with considerable variation in clinical practice. Developments indicate that fast-acting anaesthetic agents and prophylactic strategies to prevent postoperative complications minimize the adverse effects of anaesthesia on the recovery process. Recent data do not advocate a delay in extubating patients when neurological impairment is the only reason for prolonged intubation. An appropriate choice of sedatives and analgesics during mechanical ventilation of neurosurgical patients allows for a narrower range of wake-up time, and weaning protocols incorporating respiratory and neurological measures may improve outcome. In conclusion, despite a lack of key evidence to request ‘fast-tracking pathways’ for neurosurgical patients, innovative approaches to accelerate recovery after brain surgery are needed.

ISSN:0952-7907    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The term ‘neuroprotection’ is used to refer to any prophylactic measure that is initiated during the peri-ischaemic period in order to improve neuronal survival. Cell death after ischaemia has an immediate, necrotic and a delayed, apoptotic origin. The major biochemical mechanisms that are involved in this process include transmembrane ionic fluxes and intracellular calcium increase, excitotoxicity, free radical formation, peroxynitrite production, release of inflammatory mediators, mitochondrial dysfunction, cytochrome c release, and activation of caspases and transcription factors. Strategies of neuroprotection essentially impact on those biochemical pathways. The label ‘neuroprotectant’ requires that the therapy has basic properties that are consistent with potential mechanisms of neuroprotection, and that conclusive results are available from animal studies that can be converted into clinical benefit. The present review focuses on neuroprotective effects of anaesthetics and is based on the most recently published reports.

ISSN:0952-7907    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:0952-7907    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Pre-emptive analgesia studies have provided mixed results, some showing benefit and others no benefit, whereas others have shown small differences that are probably not clinically useful. There is no consensus yet about whether pre-emptive analgesia is a clinically useful tool. This review examines the mechanisms of pre-emptive analgesia before surveying the recent literature. A new definition of pre-emptive analgesia is proposed that accommodates the need for a broader definition. Recently published trials confirm that confusion exists about what pre-emptive analgesia is, how to distinguish it from simple analgesia, and how to design trials that truly assess pre-emptive analgesia, defined as analgesia that is capable of modifying the central excitatory responses.

ISSN:0952-7907    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

In recent years, tricyclic antidepressant drugs have experienced a resurgence in their use as valuable pharmacological tools in the treatment of pain. Along with the evolution in our understanding of their analgesic mechanisms of action, there have been concurrent breakthroughs regarding their indications for use and modes of administration. This review focuses on recent advances in our understanding of how antidepressant drugs exert their antinociceptive effects, and new developments regarding their clinical application.

ISSN:0952-7907    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Alpha2agonists have been in clinical use for decades, primarily in the treatment of hypertension. In recent years, alpha2agonists have found wider application, particularly in the fields of anesthesia and pain management. It has been noted that these agents can enhance analgesia provided by traditional analgesics, such as opiates, and may result in opiate-sparing effects. This has important implications for the management of acute postoperative pain and chronic pain states, including disorders involving spasticity or myofascial pain, neuropathic pain, and chronic daily headaches. The clinical utility of these agents is ever expanding, as they are gaining broader use in neuraxial analgesia, and new applications are continuously under investigation. The alpha2agonists that are currently employed in anesthesia and pain management include clonidine, tizanidine, and dexmedetomidine. Moxonidine and radolmidine, which are not currently in clinical use in humans, may offer favorable side-effect profiles when compared with traditional alpha2agonists, and may thereby allow for more widespread pain management applications.

ISSN:0952-7907    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

This short review focuses on the most recent findings in the rapidly expanding field of kinin research. Through a series of recent publications, the crucial relevance of this group of peptides as mediators of inflammatory pain is becoming increasingly evident. On the strength of this idea, kinins have been implicated as algogen peptides produced in response to noxious stimuli. The importance of kinins has been elucidated by different pharmacological and molecular approaches. Special attention has been given to studies with selective kinin antagonists, as well as to the use of receptor gene deletion technology. The gathering of results has demonstrated that both B1and B2receptors seem to exert a meaningful role during nociceptive responses, the B1receptor being most relevant in the chronic stages of inflammatory pain. It is hoped that new effective and useful therapeutic agents, mainly B1kinin selective receptor antagonists, might soon be available.

ISSN:0952-7907    

出版商:OVID    

年代:2001

数据来源: OVID