Articles: cognition-disorders.
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Anaesth Intensive Care · Aug 1978
Intravenous ketamine anaesthesia for major abdominal surgery--an assessment of a technique and the influence of ataractic drugs on the psychomimetic effects of ketamine.
Eighty-two patients presenting for major abdominal surgery were divided into five groups, and received intravenous ketamine, muscle relaxation and controlled ventilation with oxygen-enriched air. For maintenance of anaesthesia patients were given a single intravenous dose of either droperidol 5 mg, diazepam 5 mg, promethazine 25 mg, flunitrazepam 0.5 mg or lorazepam 2 mg, followed by incremental doses of ketamine. Flunitrazepam and lorazepam were the adjuvants associated with the lowest incidence of dreaming and emergence phenomena; postanaesthetic sequelae occurred most frequently with both ketamine/diazepam and ketamine/droperidol anaesthesia. However, the differences between the five groups failed to reach statistical significance.
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Confusional states in the elderly are not uncommon and demand a high level of diagnostic and therapeutic skills in the physician. An immediate requirement is to provide protection and care while the cause is being elucidated. ⋯ Confusion may be due to disorder in various body systems with effects on the brain, or to a primary brain disorder. Careful evaluation of general health and also of cognitive, affective and social factors is necessary to clarify diagnosis and management.
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Illustrated by clinical reports, this study attempts to demonstrate the practical and didactic interest of various somatopsychological correlations in geriatrics. The confusional state in the elderly has no specific etiopathogenesis. ⋯ Any change is considered by the elderly patient as dangerous and worrying. Our perfectly justified fear of inaction and passivity together with a desire for rapid efficacy, should not lead us to forget that in geriatrics more than in any other branch of medicine, a prudent attitude in therapeutics is most likely to be successful.