The outcome of patients with severe head injuries treated with amantadine sulphate.

OBJECTIVE: To compare our pilot therapeutic results of patients with severe head injury treated either with standard therapy alone or with standard therapy plus amantadine sulphate. DESIGN: Retrospective pilot study. SETTING: Intensive Care Unit (ICU), University Hospital. PATIENTS: All patients with severe head injury (GCS < 8) admitted to the ICU between January 1, 1999 and December 31, 2001. The patients were divided into two groups based on the fact, whether they did or did not receive amantadine sulphate included in standard therapy. Group 1 consisted of 41 patients of average age 42.12 +/- 16.8 years, of them 35 were males and 6 females. Group 2 included 33 patients of average age 43.91 +/- 18.45 years consisting of the 30 males and 3 females. INTERVENTION: Both groups were treated with the standard therapy of severe head injury accepted in our institution. In addition, group 1 patients received amantadine sulphate in a dose of 200 mg i.v. twice daily for 3 days, starting on day 3 of hospitalisation. The reason for amantadin sulphate administration was persistent comatos condition. MEASUREMENTS AND RESULTS: Glasgow Coma Scale in patients on admission (after resuscitation) and on discharge from the ICU and mortality rate were compared. In the group 1 the average income GCS was 4.47 +/- 2.26 and the average outcome GCS was 9.76 +/- 3.95. In the group 2 the average income GCS was 4.70 +/- 2.14 and the average outcome GCS was 5.73 +/- 3.57. In the amantadine sulphate group two patients out of 33 died (6.06%). There were 17 deaths (51.51%) out of 33 patients in the second control group. CONCLUSION: In the group of patients with severe brain injuries treated with standard therapy plus amantadine sulphate the outcome GCS was higher and the case fatality rate lower than in the group treated with standard therapy alone.

[Memory, awareness and learning in general anesthesia]. / Pamät, uvedomovaná bdelost a ucenie v celkovej anestézii.

Enough information concerning memory and other cognitive functions in total anesthesia is available in the literature. Some basic theories about neuronal mechanisms of memory and consciousness are known. An attempt trying to bridge the gap between psychological and biologic levels is the usage of anesthetics in pharmacologic tests enabling the study of their influence on awareness and memory in humans. With the help of this approach it is possible to inquire into the psychological mechanisms and to demonstrate the influence of anesthetics on them. 44 patients were included in the study, operated on in inhalation anesthesia. The effects of anesthesia on awareness, consciousness, learning and memory in our study sample were following: 1. No episode of awareness was observed during the study; 2. There was an improvement of the memory quotient (MQ) following total inhalation anesthesia (p < 0.05); 3. The pain threshold significantly decreased after anesthesia (p < 0.001); 4. There exists a learning mechanism in total anesthesia more efficient in the group of patients auditively learning pain related words (p < 0.05) comparing to the control group of patients auditively learning pain nonrelated words; 5. Statistical analysis of the number of remembered pain related words and pain nonrelated words revealed significantly higher number of words in the first group of pain related words (p < 0.001). (Tab. 3, fig. 6, Ref. 22.)

[Nociception and mental functions after combined neuroleptanalgesia]. / Nocicepcia a niektoré psychické funkcie po kombinovanej neuroleptanalgéze.

In a group of 25 patients divided at random into subgroups anaesthetized by neuroleptoanalgesia or ataralgesia resp. on account of arthroscopy, the authors assessed the state of mental functions--perception, memory before, and after operation, emotional make-up, affectivity, cognitive functions and some personality parameters. By means of an algometer and the cuff of a manometer they assessed the threshold of pressure and ischemic pressure pain. They found that in no instance intraoperative experience appeared, the threshold of nociceptive pressure perception was considerably reduced after operation in both groups. The threshold of ischemic pressure pain was significantly reduced only in the group with Hb greater than 150 and Le greater than 8.0, anaesthetized by neuroleptanalgesia. A significant increase of the depressivity (5%) was recorded in the group with combined neuroleptoanalgesia. Dysphoria and emotional indifference increased (5%) in the group with neuroleptanalgesia. Within 2-4 hours after termination of anaesthesia significant consolidation of long-term memory occurred, whereby short-term memory did not display any changes in either group i.e. regardless of the type of anaesthesia. Attention was significantly improved after both types of anaesthesia, but more markedly after neuroleptanalgesia. In the group with combined neuroleptanalgesia sensory and neurasthenic complaints improved (5%). The degree of experienced fear and anxiety in conjunction with the operation as well other psychic parameters before operation were equal in both groups and the groups were thus equivalent. In relation to the plasma cortisol level (degree of preoperative stress) there was a close correlation between the emotional lability on the one hand and maladaptation on the other. The degree of preoperative stress created a close correlation between fear and maladaptation on the one hand and frightening experience on the other.