[APPLICATION OF DEXMEDETOMIDIN FOR SEDATION OF PATIENTS IN ALCOHOL WITHDRAWAL STATE IN THE ICU].

The efficacy and safety of sedation on 44 patients in alcohol withdrawal state (AWS) for use of intravenous dexmedetomidine infusion. Dexmedetomidine increased the duration of target sedation level to 20%, decreased the duration of excessive/insufficient sedation to 10%, it was associated with AWS symptoms regression, better communication with the patient, reduced consumption of benzodiazepines (BZD) from 40 to 30 mg per day and antypsihotics for control AWS symptoms. The common complications of dexmedetomidine infusion were bradycardia and hypotension. Dexmedetomidine could be an alternative drug for sedation patients with mild or moderate AWS and applied in addition to BZD and antipsyhotics in patients with severe AWS.

Microsurgical tissue transfers for head and neck reconstruction in patients with alcohol-induced mental disorder.

BACKGROUND: Free tissue transfer in patients with organic mental disorder has always been known to be risky. Herein, the outcomes of free tissue transfers for head and neck reconstruction in those with alcohol-induced mental disorder were analyzed. MATERIALS AND METHODS: We retrospectively reviewed and analyzed data from the past 10 years of 1,364 patients who had undergone microsurgical tissue transfers after head and neck cancer ablation. Among them, 54 patients had been diagnosed with alcohol-induced mental disorders post-operatively. Age ranged from 33 to 71 years. Alcohol-drinking history averaged 17.5 years. Reconstructive procedures included 25 forearm flaps, 13 anterolateral thigh (ALT) flaps, 10 fibula osteocutaneous flaps, and 6 double flaps (fibula+ALT). The outcomes and complications were analyzed. RESULTS: Onset periods ranged from the first to fourth days post-operatively. Duration of alcohol withdrawal or delirium tremens was 3-10 days. All patients gradually stabilized after immediate psychiatric consultation and intensive medical treatment. The flap survival rate in patients with alcohol withdrawal was significantly decreased in comparison with patients not suffering alcohol withdrawal (83% versus 96.4%, P < 0.001). During this critical post-operative period, 28 (52%) patients with alcohol withdrawal syndrome experienced complications; 26 (48%) suffered flap-related complications, and 19 (35.2%) required additional surgery. The analytical parameters revealed that secondary operative procedures and duration of hospitalization differed significantly between the complication and non-complication groups (P < 0.001). CONCLUSION: Higher rates of complications and level of critical care were needed in patients with alcohol-induced mental disorder after head and neck microsurgical reconstructions. Treatment requires a multidisciplinary approach, rapid diagnosis, and intensive medical care.

Intracerebral grafting impedes hippocampal cell loss during withdrawal after long-term alcohol consumption in rats.

We previously found that, in the hippocampal formation as well as other central nervous system regions, withdrawal from alcohol following long periods of ingestion did not impede the ethanol-induced degenerative changes, including cell loss: on the contrary, neuronal degeneration was found to be increased in withdrawn rats. By grafting withdrawn rats either with immature hippocampal blocks or with suspensions of cultured astrocytes, we hoped to arrest the process of cell loss or even reverse it, because it is known that grafted material might display trophic and eventually protective effects in conditions of brain damage. The dentate granule and hippocampal CA3 pyramidal cells were counted both in the grafted hemisphere and in the contralateral one. Grafts of astrocyte suspensions did not interfere with the ongoing process of cell death in withdrawn rats. Conversely, grafts of hippocampal tissue impeded the degeneration observed in the granule and pyramidal cells of the grafted hemisphere, although in the contralateral one the cell loss persisted. We therefore conclude that the protective effect displayed by solid grafts might be a local process dependent on the release of diffusible trophic agents. We cannot explain the absence of any effect displayed by astroglial grafts, inasmuch as in different experimental situations such an effect was described.