Transcranial Doppler (TCD) is widely used to investigate the effects of anesthetic drugs on cerebral blood flow. Its repeatability and non-invasivity makes it an ideal, first choice method. Anesthesia providers are required to be conscious of the cerebral hemodynamic effects of drugs given in their practice, especially in neurosurgery and in subjects with impaired brain functions. The purpose of this review is to present the basic concepts of the TCD technique and the effects on cerebral hemodynamics of the most popular anesthetic drugs evaluated using TCD ultrasonography.

Purpose Various studies have examined the role of executive functions in autism, but there is a lack of research in the current literature on cognitive flexibility in autism spectrum disorders (ASD). The purpose of this study is to investigate whether cognitive flexibility deficits could be related to facial emotion recognition deficits in ASD. Design/methodology/approach In total, 20 children with ASD and 20 typically developing children, matched for intelligence quotient and gender, were examined both in facial emotion recognition tasks and in cognitive flexibility tasks through the dimensional change card sorting task. Findings Despite cognitive flexibility not being a core deficit in ASD, impaired cognitive flexibility is evident in the present research. Results show that cognitive flexibility is related to facial emotion recognition and support the hypothesis of an executive specific deficit in children with autism. Research limitations/implications One of the limit is the use of just one cognitive test to measure cognitive flexibility and facial recognition. This could be important to be taken into account in the new research. By increasing the number of common variables assessing cognitive flexibility, this will allow for a better comparison between studies to characterize impairment in cognitive flexibility in ASD. Practical implications Investigating impairment in cognitive flexibility may help to plan training intervention based on the induction of flexibility. Social implications If the authors implement cognitive flexibility people with ASD can have also an effect on their social behavior and overcome the typical and repetitive behaviors that are the hallmark of ASD. Originality/value The originality is to relate cognitive flexibility deficits to facial emotion.

The aim of this study was to investigate the effects of tramadol on the Bispectral Index (BIS) during total intravenous propofol-remifentanil anaesthesia. Forty-four adult ASA Physical status I-II patients, scheduled for elective general surgical procedures were included in a prospective observational randomized study. Doses for anaesthetics and opioids were adjusted to keep the BIS value at 50±5. After 20 minutes of stable anaesthesia, the subjects were randomly allocated to receive intravenous saline (control group) or tramadol 1.5 mg/kg (tramadol group). BIS values, mean arterial pressure, and heart rate were recorded every five minutes for 20 minutes. Mean BIS values after tramadol administration were not significantly different from those following saline, throughout the observation period (P>0.05). There were no patients in whom BIS values were more than 60 or who presented explicit recall of events under anaesthesia. There were no significant changes in mean arterial pressure, SpO 2 , or heart rate (P>0.05).The results indicate that the administration of tramadol during stable total intravenous anaesthesia with propofolremifentanil does not affect BIS values. The clinical relevance is that tramadol can be safely administered pre-and intraoperatively as pre-emptive or preventive analgesia without modification of the depth of anaesthesia.

Twin birth may represent a challenging event often associated with prematurity. We previously reported on developmental trajectories in preterm children categorized by gestational age. Based on the same study population, in this study we investigated the influence of gemellarity on the neurodevelopment of 73 twins (26.4%) and 207 singletons (73.6%), categorized into three groups according to their gestational age. The age of the achievement of developmental milestones between the three groups and the influence of preperinatal events on neurodevelopment were analyzed. An early neurodevelopmental advantage was detected in preterm twins born between 32 and 33 weeks. Environmental and nurturing factors may explain these findings.