Browsing by Subject "Cholinesterase Inhibitors"
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Item Changes in Brain Functional Connectivity Following Donepezil Treatment in Alzheimer's Disease(2006-05-16) Zaidel, Liam; Allen, GregThis study used resting state functional connectivity magnetic resonance imaging (fcMRI) to explore changes in brain connectivity and their behavior correlates in nine regions of interest (ROIs) in eleven patients with mild Alzheimer's disease (AD) following treatment with the cholinesterase inhibitor, donepezil. The ROIs were selected on the basis of their association with cholinergic neurotransmission, AD neuropathology, and neurocognitive deficits in AD. These ROIs included the medial septal nuclei, left and right hippocampi, left Broca's area and its right hemisphere homologue, left and right dorsolateral prefrontal cortices, and left and right primary visual cortices. Changes in connectivity were also related to changes in performance on neurocognitive tests of verbal fluency and episodic memory. Among the ROIs, the effects of the drug were selective. Only the connection between left and right DLPFC increased significantly after treatment. However, ten of the eighteen connections measured showed significant relationships between connectivity and behavior. The significant correlations centered around left hippocampus, left Broca's area, and dorsolateral prefrontal cortex bilaterally. Connections originating in the left hippocampus showed mostly inverse relationships with behavior. Predictions of selective increases in connectivity in networks associated with the neurochemical, the neuropathological, and neurocognitive profiles of AD were generally not supported. A separate, whole-brain, exploratory, analysis measured changes in connectivity throughout the brain with each of the nine regions of interest (ROIs). There were increases in connectivity among bilateral frontal areas in language circuits, including the left IFG, left superior temporal gyrus, and left supramarginal gyrus, and in the sensory-motor integrative network. Further connections were noted between the left inferior frontal gyrus and caudate nucleus. The data suggest that the drug had selective effects on executive networks of attention.Item OPIDN: organophosphate-induced delayed neurotoxicity(1996-10-10) Haley, Robert W.Item Organic phosphate ester poisoning (anti cholinesterase intoxication)(1960-03-09) Combes, Mollie A.Item Sugammadex versus Neostigmine for Reversal of Rocuronium-Induced Neuromuscular Blockade: A Study of Thoracic Surgical Patients(2019-01-22) Jan, Kathryn; Pak, Taylor; Smith, Katelynn; Somasundaram, Alwin; Moon, Tiffany SunBACKGROUND: Sugammadex is a novel agent for the reversal of neuromuscular paralysis. Neostigmine is more commonly used for reversal but is associated with side effects including bronchospasm, nausea/vomiting, hypotension, and bradycardia. While there has been anecdotal evidence that patients treated with sugammadex have better subjective measures of recovery compared to those treated with neostigmine, few studies have systematically evaluated this, especially in patients whose pre-existing pulmonary disease predisposes them to postoperative adverse respiratory events. The simultaneous evaluation of clinical outcomes, economic implications, and postoperative recovery quality could give evidence to support usage of a neuromuscular reversal agent with less side effects. HYPOTHESIS: In thoracic surgical patients, reversal with sugammadex as compared to neostigmine will result in less hypoxic episodes in the post-anesthesia care unit (PACU), improved postoperative recovery quality, and lower costs secondary to the faster reversal to extubation, reversal out of operating room (OR), and shorter PACU stay. METHODS: 100 adult patients undergoing thoracic surgery with general endotracheal anesthesia are enrolled into this double-blind study to evaluate three domains: physiological factors, nociceptive factors, and emotional factors. After obtaining baseline parameters, patients are randomized to one of two groups: one receiving 50mcg/kg, maximum 5mg of neostigmine mixed with 8mcg/kg, maximum of 1mg glycopyrrolate; the other receiving 2 mg/kg of sugammadex. Upon patient's PACU arrival, degree of neuromuscular function is assessed utilizing the TOF Watch accelerometer device, and parameters, including vitals, postoperative quality recovery scale (PQRS) assessment, adverse events, and drugs given, from the time the patient arrived in the PACU until discharge are observed and recorded. PRELIMINARY RESULTS: While approximately 81 patients have been enrolled so far, statistical analysis is pending more data collection; however, there appears to be two distinct groups, one of which has a significantly shorter reversal time as well as a shorter duration in the PACU than the other. It is predicted that those who receive sugammadex will experience better outcomes related to these factors. CONCLUSION: If there is a significant improvement as a result of sugammadex usage, a revision of current protocol for neuromuscular blockade reversal in thoracic surgical patients is recommended to improve patient outcomes and lower costs.