RESUMO
BACKGROUND: The aim of this retrospective study was to compare the clinical performance of the modified Marsh model for propofol between underweight and normal-weight patients with Crohn's disease. METHODS: The medical records of 50 patients who underwent elective surgery for Crohn's disease were reviewed retrospectively. Propofol and remifentanil were administered using target effect-site concentration (Ce)-controlled infusion with the modified Marsh and Minto models. Target Ce values of propofol were adjusted within a range of 2.5–3 µg/ml to maintain a bispectral index (BIS) value of less than 60 during anesthesia maintenance. Dosages of anesthetic agents administered during surgery were compared between underweight and normal-weight patients. The infusion profiles of patients were applied as inputs to calculate the Ce values in the Schnider model. RESULTS: The total midazolam and remifentanil dosages required for underweight patients were higher than those required for normal-weight patients to maintain BIS values at less than 60 within a target propofol Ce range of 2.5–3 µg/ml. Simulation results suggested that the Schnider model may be an appropriate pharmacokinetic model for target-controlled infusion in underweight patients, as the clearance was consistently higher in the Schnider model than the modified Marsh model, particularly in underweight patients. CONCLUSIONS: The modified Marsh model might cause inadvertent propofol underdosing in underweight patients. Future studies are necessary to compare the predictive performance of the modified Marsh and Schnider pharmacokinetic models in underweight patients.
Assuntos
Humanos , Anestesia , Anestésicos , Doença de Crohn , Prontuários Médicos , Midazolam , Farmacocinética , Propofol , Estudos Retrospectivos , Magreza , Áreas AlagadasRESUMO
BACKGROUND: Apathy is one of the most frequent behavioral symptoms in Alzheimer's disease (AD) and interferes with activities of daily living. The purpose of this study was to evaluate the differences of cerebral blood flow between AD without apathy and with apathy. METHODS: Nineteen AD patients without apathy (AD-NA group) and 15 AD patients with apathy (AD-A group) were evaluated. Cerebral perfusion was measured by (99m)Tc-ECD single photon emission computed tomography (SPECT). The images of the AD-A and AD-NA groups were statistically analysed by means of statistical parametric mapping (SPM) 99. RESULTS: Compared with AD-NA group, the AD-A group had significantly lower perfusion in the left inferior frontal regions (left orbital gyrus, Broadmann area 47 and left median frontal gyrus, Broadmann area 11) (uncorrected p<0.01). CONCLUSIONS: These results suggest apathy may be related with disturbances in projections of frontal subcortical circuits, even though apathy is primarily related with dysfunction of the cingulate gyrus.
Assuntos
Humanos , Atividades Cotidianas , Doença de Alzheimer , Apatia , Sintomas Comportamentais , Giro do Cíngulo , Órbita , Perfusão , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
Paroxysmal sensorimotor phenomena of the spinal cord have been associated with contrast material injection, transverse myelitis, spinal cord injury and multiple sclerosis. We report a 48-year-old woman with recurrent tonic spasms, which occurred 1 month after acute cervical cord myelopathy. A tingling sensation beginning in the left leg was followed by painful tonic spasm and abnormal sensation of the upper and lower right limbs except the face. Consciousness, scalp EEG was normal and SPECT showed hot uptake in the cervical cord during spasms.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Estado de Consciência , Eletroencefalografia , Extremidades , Perna (Membro) , Esclerose Múltipla , Mielite Transversa , Couro Cabeludo , Sensação , Espasmo , Medula Espinal , Doenças da Medula Espinal , Traumatismos da Medula Espinal , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
Paroxysmal sensorimotor phenomena of the spinal cord have been associated with contrast material injection, transverse myelitis, spinal cord injury and multiple sclerosis. We report a 48-year-old woman with recurrent tonic spasms, which occurred 1 month after acute cervical cord myelopathy. A tingling sensation beginning in the left leg was followed by painful tonic spasm and abnormal sensation of the upper and lower right limbs except the face. Consciousness, scalp EEG was normal and SPECT showed hot uptake in the cervical cord during spasms.