scholarly journals The impact of inhalation anesthetics on early postoperative cognitive function and recovery characteristics in Down syndrome patients: a randomized, double – blind study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emmanouil Gkliatis ◽  
Alexandros Makris ◽  
Chryssoula Staikou
Keyword(s):  
Down Syndrome ◽  
Intellectual Disability ◽  
Cognitive Function ◽  
Blind Study ◽  
Double Blind Study ◽  
Double Blind ◽  
Dental Surgery ◽  
Eye Opening ◽  
The Impact ◽  
Discharge Criteria

Abstract Background Down syndrome (DS) is associated with intellectual disability. DS patients may be unable to cooperate and often require general anesthesia even for minor surgeries. Rapid recovery significantly contributes to fast-tracking. This prospective randomized, double - blind study investigates the impact of desflurane and sevoflurane on recovery and early postoperative cognitive function of these patients. Methods Forty-four patients undergoing dental surgery, were randomized to receive desflurane (DES-group) or sevoflurane (SEVO-group) for anesthesia maintenance. The primary outcome was postoperative cognitive function (Prudhoe Cognitive Function Test, PCFT) at 90 min and 4 h postoperatively. Secondary outcome measures were the time between volatile discontinuation and spontaneous breath, eye opening, extubation, orientation and response to commands, time to achieve an Aldrete score ≥ 9 in the Post-anesthesia Care Unit and time to fulfill discharge criteria (Post Anesthetic Discharge Scoring System, PADSS). Results At 90 min, PCFT scores significantly decreased from baseline in both groups. Nevertheless, at 4 h, in DES-group there was no significant change from baseline (p = 0.163), while in SEVO-group the decrease remained significant (p < 0.001). Desflurane was also found superior regarding recovery characteristics, such as time to eye opening (p = 0.021), spatial orientation (p = 0.004), response to commands (p = 0.004). Discharge criteria were met earlier in DES-group (p = 0.018 for Aldrete score / p < 0.001 for PADSS). Conclusions Desflurane was found superior to sevoflurane in terms of faster recovery and better preserved postoperative cognitive function in DS patients undergoing dental surgery. We suggest that desflurane, as part of a multimodal anesthetic approach, could be a useful agent to enhance early discharge from hospital of ambulatory patients with intellectual disability. Trial registration Registered with ClinicalTrials.gov (NCT02971254, principal investigator: E.G; November 2016).

The Impact of Alvimopan on Return of Bowel Function After Major Spine Surgery – A Prospective, Randomized, Double-Blind Study

Neurosurgery ◽  
2019 ◽  
Vol 85 (2) ◽  
pp. E233-E239
Author(s):  
Lauren K Dunn ◽  
Robert H Thiele ◽  
Michelle C Lin ◽  
Edward C Nemergut ◽  
Marcel E Durieux ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Bowel Movement ◽  
Bowel Function ◽  
Blind Study ◽  
Double Blind Study ◽  
Opioid Use ◽  
Double Blind ◽  
Pain Scores ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND Pain management following major spine surgery requires high doses of opioids and is associated with a risk of opioid-induced constipation. Peripheral mu-receptor antagonists decrease the gastrointestinal complications of perioperative systemic opioid administration without antagonizing the analgesic benefits of these drugs. OBJECTIVE To investigate the impact of alvimopan in opioid-naive patients undergoing major spine surgery. METHODS Patients undergoing >3 levels of thoracic and/or lumbar spine surgery were enrolled in this prospective, randomized, double-blind study to receive either alvimopan or placebo prior to and following surgery. Opioid consumption; pain scores; and time of first oral intake, flatus, and bowel movement were recorded. RESULTS A total of 24 patients were assigned to the active group and 25 were assigned to the placebo group. There was no significant difference in demographics between the groups. Postoperatively, the alvimopan group reported earlier time to first solid intake [median (range): alvimopan: 15 h (3-25) vs placebo: 17 h (3-46), P < .001], passing of flatus [median (range): alvimopan: 22 h (7-63) vs placebo: 28 h (10-58), P < .001], and first bowel movement [median (range): alvimopan: 50 h (22-80) vs placebo: 64 h (40-114), P < .001]. The alvimopan group had higher pain scores (maximum, minimum, and median); however, there was no significant difference between the groups with postoperative opioid use. CONCLUSION This study shows that the perioperative use of alvimopan significantly reduced the time to return of bowel function with no increase in postoperative opioid use despite a slight increase in pain scores.

scholarly journals Impact of Compliance on Elastic Compression Stockings Efficacy to Prevent Post-Thrombotic Syndrome: A Prespecified Analysis of the Celest Double-Blind Study

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 2127-2127
Author(s):  
Jean philippe Galanaud ◽  
Genty Celine ◽  
Alexa Comte ◽  
Carole Rolland ◽  
Francois Verriere ◽  
...  
Keyword(s):  
Independent Predictor ◽  
Blind Study ◽  
Double Blind Study ◽  
Multivariable Model ◽  
Compression Stockings ◽  
Open Label ◽  
Double Blind ◽  
Tree Algorithm ◽  
The Impact

Abstract Introduction: Elastic compression stockings (ECS) are commonly used for the prevention of post-thrombotic syndrome (PTS) after deep venous thrombosis (DVT). However, their efficacy is controversial. While two open-label studies reported a 50% risk reduction of PTS in the ECS vs. no-ECS groups, a large double-blind study didn't find any benefit of ECS vs. placebo-ECS to prevent PTS. These opposite results could be explained either by a placebo effect in the open-label studies or to a lack of compliance to study ECS in the double-blind study. Additional data on the impact of compliance on ECS efficacy, obtained in a double-blind way, are therefore needed. Methods: We analyzed data from the French, CELEST, multicentre double-blind trial comparing 25mmHg ECS vs. 35mmHg ECS to prevent PTS at 2 years after a first symptomatic ipsilateral proximal DVT (NCT01578122). All CELEST patients who had complete data for primary outcome (i.e. PTS, defined as a Villalta score ≥5 on the DVT affected leg at the one- or 2-year follow up visit) were included. The objectives of this predefined analysis were to: i) compare the incidences of PTS at 2 years according to compliance to ECS (irrespective of allocated treatment group) during the first 3 months of treatment and during the 2-year follow-up; ii) assess independent predictors of PTS using a stepwise multivariable model including all of the following variables (baseline patients' and DVT characteristics, anticoagulant treatment and compliance to ECS) if they achieved a p value of 0.2 or less in univariate analysis as well as ECS strength allocation group; iii) build an induction tree algorithm to measure the impact in terms of incidence of PTS of each of the independent predictor of PTS. Compliance to ECS was defined as reasonable and optimal if the patient had worn the study ECS more than 50% and more than 80% of the time respectively and had a modified GIRERD score of 0-2. Results: 249 patients were eligible for this analysis. Mean baseline age was 57 years, 70% (n=174) were men, 20% (n=50) were obese, 21% (n=52) had previous VTE event, 7% (n=18) had a baseline Villalta score ≥5 and the most proximal extent of DVT was the iliac vein in 15% (n=37) of cases. In 80% (n=179) of cases patients were treated with anticoagulation for more than 6 months after DVT and a direct oral anticoagulant (DOAC) was used in 69% (n=164) of cases. 32 % (n=80) of patients developed PTS at 2 years. When patients wore study ECS&gt;80% of the time (i.e optimal compliance), incidence of PTS over 2 years was 26.1% (n=31). Incidence of PTS was 25.0% (n=10) and 40.5% (n=34) in those patients who wore ECS 50-80% and &lt;50% of the time, p=0.06. When comparing patients who never wore study ECS (compliance&lt;50% during the whole study follow-up) to those who were reasonably compliant during the whole study follow-up, incidence of PTS was respectively 46.4% (n=13) vs. 25.3% (n=38), p=0.02. Results of the univariate and multivariate analyses are presented in Table 1 and induction tree algorithm is provided in Figure 1. Conclusions: In our double bling study assessing 25mmHg vs. 35mmHg ECS to prevent PTS, compliance to ECS was a significant independent predictor of PTS in our multivariable model. Impact of ECS use became apparent when patient used ECS at least 50% of the time without any strong benefit beyond. Wearing study ECS&gt;50% of the time was associated with 2-fold decreased risk of developing PTS, which is consistent with the results from previous 'positive' open-label studies. It suggests that use of ECS influences the risk of developing PTS. Our induction tree algorithm evidences that being compliant with ECS seems particularly beneficial in - non-obese - patients with extensive DVT. Figure 1 Figure 1. Disclosures Verriere: Laboratoires Innothera: Current Employment.

Improvement of Cognitive Function in Schizophrenic Patients Receiving Clozapine or Zotepine: Results from a Double-Blind Study

1997 ◽  
Vol 30 (02) ◽  
pp. 35-42 ◽  
Author(s):  
A. Meyer-Lindenberg ◽  
H. Gruppe ◽  
Ulrike Bauer ◽  
Stefanie Lis ◽  
S. Krieger ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Blind Study ◽  
Double Blind Study ◽  
Double Blind ◽  
Schizophrenic Patients

A randomized-controlled, double-blind study of the impact of selenium supplementation on thyroid autoimmunity and inflammation with focus on the GPx1 genotypes

2015 ◽  
Vol 38 (10) ◽  
pp. 1065-1074 ◽  
Author(s):  
C. R. de Farias ◽  
B. R. Cardoso ◽  
G. M. B. de Oliveira ◽  
I. C. de Mello Guazzelli ◽  
R. M. Catarino ◽  
...  
Keyword(s):  
Thyroid Autoimmunity ◽  
Selenium Supplementation ◽  
Blind Study ◽  
Double Blind Study ◽  
Double Blind ◽  
Randomized Controlled ◽  
The Impact

Efficacy of flupirtine on cognitive function in patients with CJD: A double-blind study

Neurology ◽  
2004 ◽  
Vol 62 (5) ◽  
pp. 714-718 ◽  
Author(s):  
M. Otto ◽  
L. Cepek ◽  
P. Ratzka ◽  
S. Doehlinger ◽  
I. Boekhoff ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Blind Study ◽  
Double Blind Study ◽  
Double Blind

AURAPTENE IN THE PEELS OF CITRUS KAWACHIENSIS (KAWACHIBANKAN) CONTRIBUTES TO THE PRESERVATION OF COGNITIVE FUNCTION: A RANDOMIZED, PLACEBO-CONTROLLED, DOUBLE-BLIND STUDY IN HEALTHY VOLUNTEERS

2017 ◽  
pp. 1-5
Author(s):  
M. Igase ◽  
Y. Okada ◽  
M. Ochi ◽  
K. Igase ◽  
H. Ochi ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Cognitive Decline ◽  
Test Score ◽  
Recall Test ◽  
Blind Study ◽  
Percentage Change ◽  
Double Blind Study ◽  
Double Blind ◽  
Immediate Recall ◽  
Significant Difference

OBJECTIVES: Dementia, which is characterized by a progressive decline in cognitive function, is a major concern in aging societies. Although a number of treatments have been approved, an effective therapy to prevent the disorder is lacking. A supplement that improves cognitive function would benefit patients. The aim of this study was to assess whether auraptene, a citrus coumarin, has a protective effect on cognitive decline. DESIGN: A randomized, placebo-controlled, double-blind study SETTING: Outpatient medical check-up program for cognitive disorders PARTICIPANTS: 84 adult volunteers (they are cognitively normal) met inclusion and exclusion criteria to participate. INTERVENTION: 42 participants received auraptene enriched (containing 6.0 mg/day of auraptene) test juice, and another participants received placebo juice. MEASUREMENTS: 1) Mild Cognitive Impairment (MCI) Screen using the 10-word immediate recall test. 2) The Mini-Mental State Examination (MMSE). Cognitive assessment ware carried out baseline and at 24 weeks. RESULTS: Auraptene enriched test juice did not improve cognitive function after 24 weeks compared with baseline data. However, there was a significant difference in the percentage change in cognitive function between the test and placebo orange juice groups (6.3 ± 18.9 vs. −2.4 ± 14.8, P < 0.05). Multiple regression analysis demonstrated a significant independent relationship between the percentage change in the 10-word immediate recall test score and test juice consumption including baseline 10-word immediate recall test score in all subjects. CONCLUSION: This is the first study to assess the effectiveness of auraptene in the prevention of cognitive decline. Our results suggest that auraptene is a safe supplement for the prevention of cognitive decline.

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