Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study

The aim of the present study is to compare the safety, efficacy and cost effectiveness of anesthetic regimens by compound, using etomidate and propofol in elderly patients undergoing gastroscopy. A total of 200 volunteers (65–79 years of age) scheduled for gastroscopy under anesthesia were randomly divided into the following groups: P, propofol (1.5–2.0 mg/kg); E, etomidate (0.15-0.2 mg/kg); P+E, propofol (0.75–1 mg/kg) followed by etomidate (0.075-0.1 mg/kg); and E+P, etomidate (0.075-0.01 mg/kg) followed by propofol (0.75–1 mg/kg). Vital signs and bispectral index were monitored at different time points. Complications, induction and examination time, anesthesia duration, and recovery and discharge time were recorded. At the end of the procedure, the satisfaction of patients, endoscopists and the anesthetist were evaluated. The recovery (6.1±1.2 h) and discharge times (24.8±2.8 h) in group E were significantly longer compared with groups P, P+E and E+P (P<0.05). The occurrence of injection pain in group P+E was significantly higher compared with the other three groups (P<0.05). In addition, the incidence of myoclonus and post-operative nausea and vomiting were significantly higher in group P+E compared with the other three groups (P<0.05). There was no statistical difference among the four groups with regards to the patients' immediate, post-procedure satisfaction (P>0.05). Furthermore, there was no difference in the satisfaction of anesthesia, as evaluated by the anesthetist and endoscopist, among the four groups (P>0.05). The present study demonstrates that anesthesia for gastroscopy in elderly patients can be safely and effectively accomplished using a drug regimen that combines propofol with etomidate. The combined use of propofol and etomidate has unique characteristics which improve hemodynamic stability, cause minimal respiratory depression and less side effects, provide rapid return to full activity and result in high levels of satisfaction

Evaluation of medication treatment for Alzheimer's disease on clinical evidence

<p><strong>Objective</strong> To formulate the best treatment plan for Alzheimer's disease patients by evaluating the therapeutic efficacy and side effect of various evidence-based programs. <strong>Methods</strong> Alzheimer's disease, donepezil, rivastigmine, galantamine, memantine, rosiglitazone, etc. were defined as retrieval words. PubMed, Cochrane Library, Wanfang Data and China National Knowledge Infrastructure (CNKI) databases were used with applying of manual searching. Systematic reviews, randomized controlled trials (RCT), controlled clinical trials and case-observation studies were collected and evaluated by Jadad Scale. <strong>Results</strong> After screening, 33 selected resources included 14 systematic reviews, 14 randomized controlled trials, 4 controlled clinical trials and 1 case-observation study. According to Jadad Scale, total 28 articles were evaluated to be high quality (12 with score 4, 10 score 5, 6 score 7), and 5 were low quality with score 3. It was summarized as follows: 1) Alzheimer's disease is a progressive neurodegenerative disease for which no cure exists. To date, only symptomatic treatments with cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and an N-methyl-D-aspartate (NMDA) receptor noncompetitive antagonist (memantine), are effective and well tolerated to counterbalance the neurotransmitter disturbance, but cannot limit or impact on disease progression. 2) Disease modifying drug is an potential agent, with persistent effect on slowing the progression of structural damage, and can be detected even after withdrawing the treatment. Many types of disease modifying drugs are undergoing clinical trials. <strong>Conclusions</strong> Using evidence-based medicine methods can provide best clinical evidence on Alzheimer's disease treatment.</p><p> </p><p>doi: 10.3969/j.issn.1672-6731.2014.03.009</p

Neurochemical characterization of pERK-expressing spinal neurons in histamine-induced itch

Date of Acceptance: 08/07/2015 Acknowledgements This work was supported by grants from the Ministry of Science and Technology of China (2012CB966904, 2011CB51005), National Natural Science Foundation of China (31271182, 81200692, 91232724, 81200933, 81101026), Shanghai Natural Science Foundation (12ZR1434300), Key Specialty Construction Project of Pudong Health Bureau of Shanghai (PWZz2013-17), Shenzhen Key Laboratory for Molecular Biology of Neural Development (ZDSY20120617112838879), Fundamental Research Funds for the Central Universities (1500219072) and Sino-UK Higher Education Research Partnership for PhD Studies.Peer reviewedPublisher PD