BACKGROUND: The rapid emergence and recovery from general anesthesia provided by sevoflurane is associated with a frequent incidence of emergence agitation in children. In this study, we compared the emergence and recovery profiles of patients who received sevoflurane with or without intravenous ketorolac or/and fentanyl. METHODS: By using a prospective, double blinded design, 60 children of 3 to 10 year of age, scheduled for elective tonsillectomy and adenoidectomy, were anesthetized with sevoflurane (1-3 vol%) in a 50% N2O/O2 gas mixture. Patients were randomized to one of four groups (group 1: sevoflurane only, group 2: sevoflurane + ketorolac 0.5 mg/kg, group 3: sevoflurane + fentanyl 1microgram/kg, group 4: sevoflurane + ketorolac 0.5 mg/kg + fentanyl 1microgram/kg). A blinded observer evaluated each patient using an agitation scale, Faces scale and an Objective pain/discomfort scale. RESULTS: No significant differences were observed among the four groups regarding age, sex, weight or duration of anesthesia. Recovery and discharge times were not statistically different. The incidence of severe agitation and the scores of Faces scale in the post anesthesia care unit, were significantly lower in groups 2, 3 and 4 than in group 1 (P < 0.05). The incidence of severe pain in the post anesthesia care unit, was significantly lower in groups 3 and 4 than in group 1 (P < 0.05). CONCLUSIONS: We conclude that a dose of 0.5 mg/kg of ketorolac, 1microgram/kg of fentanyl or both were sufficient to prevent severe emergence agitation and pain in children undergoing tonsillectomy and adenoidectomy with sevoflurane anesthesia.
Adenoidectomy* ; Anesthesia* ; Anesthesia, General ; Child* ; Dihydroergotamine ; Fentanyl* ; Humans ; Incidence ; Ketorolac* ; Prospective Studies ; Tonsillectomy*

BACKGROUND AND PURPOSE: Nicergoline is an ergoline derivative that is used to treat cognitive deficits in cerebrovascular disease and various forms of dementia. Although therapeutic effects of nicergoline have been established, little is known about its effects on cerebral perfusion in Alzheimer's disease (AD). The aim of this study was to examine the role of nicergoline in regional cerebral blood flow (rCBF) of AD patients using technetium-99m hexa-methyl-propylene-amine-oxime single photon emission computed tomography (SPECT). METHODS: Sixteen patients with early AD underwent a comprehensive clinical assessment including cognitive testing and SPECT scans before and after nicergoline treatment. Nicergoline (30 mg twice daily) was administered for an average duration of 1.5 years. Clinical and cognitive functioning was assessed using the Mini-Mental State Examination, Clinical Dementia Rating (CDR), CDR-Sum of Boxes, Global Deterioration Scale, Barthel Activities of Daily Living Index, Instrumental Activities of Daily Living, and Geriatric Depression Scale. RESULTS: Nicergoline treatment induced changes in the severity of dementia, cognitive function, activities of daily living, and depressive symptoms, which were not statistically significant. During the follow-up, the patients showed significant increases in their relative rCBF in the superior frontal gyrus, precentral gyrus, and postcentral gyrus. CONCLUSIONS: Nicergoline treatment improves perfusion of the frontal and parietal regions in early AD patients. It is possible that the increased perfusion in the superior frontal gyrus may be related to the mechanisms that delay or prevent progressive deterioration of cognitive functions in AD.
Activities of Daily Living ; Alzheimer Disease* ; Cerebrovascular Circulation ; Cerebrovascular Disorders ; Cognition ; Cognition Disorders ; Dementia ; Depression ; Ergolines ; Follow-Up Studies ; Frontal Lobe ; Humans ; Nicergoline* ; Parietal Lobe ; Perfusion* ; Pilot Projects* ; Prefrontal Cortex ; Somatosensory Cortex ; Therapeutic Uses ; Tomography, Emission-Computed, Single-Photon

BACKGROUND AND PURPOSE: Although sleep disturbances are common and considered a major burden for patients with Alzheimer's disease (AD), the fundamental mechanisms underlying the development and maintenance of sleep disturbance in AD patients have yet to be elucidated. The aim of this study was to examine the correlation between regional cerebral blood flow (rCBF) and sleep disturbance in AD patients using technetium-99m hexamethylpropylene amine oxime single-photon emission computed tomography (SPECT). METHODS: A total of 140 AD patients were included in this cross-sectional study. Seventy patients were assigned to the AD with sleep loss (SL) group and the rest were assigned to the AD without SL group. SL was measured using the sleep subscale of the Neuropsychiatric Inventory. A whole-brain voxel-wise analysis of brain SPECT data was conducted to compare the rCBF between the two groups. RESULTS: The two groups did not differ in demographic characteristics, severity of dementia, general cognitive function, and neuropsychiatric symptoms, with the exception of sleep disturbances. The SPECT imaging analysis displayed decreased perfusion in the bilateral inferior frontal gyrus, bilateral temporal pole, and right precentral gyrus in the AD patients with SL group compared with the AD patients without SL group. It also revealed increased perfusion in the right precuneus, right occipital pole, and left middle occipital gyrus in the AD with SL group compared with the AD without SL group. CONCLUSIONS: The AD patients who experienced sleep disturbance had notably decreased perfusion in the frontal and temporal lobes and increased rCBF in the parietal and occipital regions. The findings of this study suggest that functional alterations in these brain areas may be the underlying neural correlates of sleep disturbance in AD patients.
Alzheimer Disease* ; Brain* ; Cerebrovascular Circulation ; Cognition ; Cross-Sectional Studies ; Dementia ; Frontal Lobe ; Humans ; Occipital Lobe ; Parietal Lobe ; Perfusion* ; Prefrontal Cortex ; Rabeprazole ; Temporal Lobe ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

BACKGROUND AND PURPOSE: Apathy is one of the most common neuropsychiatric symptoms in patients with Alzheimer's disease (AD). It may have adverse impacts on the progression of AD. However, its neurobiological underpinnings remain unclear. The objective of this study was to investigate differences in regional cerebral blood flow (rCBF) between AD patients with apathy and those without apathy. METHODS: Sixty-six apathetic AD patients and 66 AD patients without apathy completed Neuropsychiatric Inventory (NPI) and underwent technetium-99m hexamethylpropylene amine oxime single-photon emission computed tomography (SPECT) scans. Voxel-wise differences in rCBF between the 2 groups were examined. Association between rCBF and levels of apathy in the apathetic group was also assessed. RESULTS: AD patients with apathy showed lower rCBF in the bilateral orbitofrontal cortex, left putamen, left nucleus accumbens, left thalamus, and bilateral insula than those without (all p < 0.005). Mean perfusion across all significant clusters showed a negative linear correlation with NPI apathy score in AD patients with apathy (β = −0.25; p = 0.04). CONCLUSIONS: Hypoperfusion in the prefrontal, striatal, and insular areas may be neural correlates of apathy in AD patients.
Alzheimer Disease* ; Apathy* ; Brain* ; Cerebrovascular Circulation ; Humans ; Nucleus Accumbens ; Perfusion* ; Prefrontal Cortex ; Putamen ; Regional Blood Flow ; Thalamus ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon