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Sample records for mac sedation clinical

  1. Sedation in clinical oncology.

    PubMed

    González Barón, Manuel; Gómez Raposo, César; Pinto Marín, Alvaro

    2005-08-01

    The clinical status of terminal cancer patients is very complex and is affected by several severe symptoms, of extended duration, changing with time and of multifactorial origin. When there are no reasonable cancer treatments specifically able to modify the natural history of the disease, symptom control acquires priority and favours the possible better adaptation to the general inexorable deterioration related to the neoplasic progression. Despite the important advances in Palliative Medicine, symptoms are frequently observed that are intolerable for the patient and which do not respond to usual palliative measures. This situation, characterised by rapid deterioration of the patient, very often heralds, implicitly or explicitly, approaching death. The intolerable nature and being refractory to treatment indicates to the health-care team, on many occasions, the need for sedation of the patient. The requirement for sedation of the cancer patient is a situation that does not allow for an attitude of doubt regarding maintenance of the patient in unnecessary suffering for more than a reasonable time. Given the undoubted clinical difficulty in its indication, it is important to have explored at an earlier stage all usual treatments possible and the grade of response, commensurate with the patient's values and desires. Sedation consists of the deliberate administration of drugs in minimum doses and combinations required not only to reduce the consciousness of the patients but also to achieve adequate alleviation of one or more refractory symptoms, and with the prior consent given by the patient explicitly, or implicitly or delegated. Sedation is accepted as ethically warranted when considering the imperative of palliation and its administration and, whenever contemplated, the arguments that justify them are clear recorded in the clinical history. It is not an easy decision for the physician since, traditionally, the training has been "for the fight to save life

  2. Practical oral sedation in dentistry. Part II--Clinical application of various oral sedatives and discussion.

    PubMed

    Lu, Dominic P; Lu, Winston I

    2006-09-01

    This article presents a practical approach for safe oral sedation in the dental practice. When used properly, oral sedation can provide comfort and a calming treatment environment for patients whose fear inhibits them from securing needed dental care. In Part I, the authors provided information on medico-legal aspects of sedation, patient treatment recommendations, counseling, evaluation, monitoring, documentation, and proper discharge procedures. In this part, the reliable sedatives that have undergone years of clinical trials and have good records of safety and predictable results are presented. For each sedative, the description, formulation and dosage, onset, duration of sedation, and side effects are discussed. PMID:17052039

  3. Sedative drug interactions of clinical importance.

    PubMed

    Cushman, P

    1986-01-01

    In an age of widespread availability of psychoactive drugs, use of multiple sedatives is very common. Why such multiple drug use prevails is poorly understood. Sequential drug use may leave sequential problems. Concomitant use of several drugs can produce a host of interactions. Increasingly, the metabolic basis of sedative interactions are becoming known. Cross-tolerance between sedatives permit substitution of one for another and reduced sedation when combined. Metabolic interactions at the hepatic oxidation enzyme level may greatly affect drug disposal rates. Recognition of polysubstance abuse can assist in management. Treatment ranges from urgent life support to abrupt or slow withdrawal, to substitution long-term treatment usually requiring specialized care, with abstinence the preferred goal. However, polysubstance abusers seem to have low probabilities of achieving lasting abstinence. PMID:2871595

  4. Intranasal Midazolam Sedation in a Pediatric Emergency Dental Clinic.

    PubMed

    Peerbhay, Fathima; Elsheikhomer, Ahmed Mahgoub

    2016-01-01

    The purpose of this study was to compare the effectiveness and recovery times of 0.3 and 0.5 mg/kg intranasal midazolam (INM) administered with a mucosal atomizer device (MAD) in a pediatric emergency dental hospital clinic. One hundred eighteen children aged from 4 to 6 years were randomly administered either 0.3 or 0.5 mg/kg INM via an MAD in a triple-blinded randomized controlled trial. Sedation was achieved to some degree in 100% of the sample. The pulse rate and oxygen saturation were within the normal range in 99% of the patients. A burning sensation was reported in 9% of children. The recovery time of the 0.5 mg/kg group was statistically longer than that of the 0.3 mg/kg group (16.5 vs 18.8 minutes) but the difference was not clinically significant. The findings of this study show that 0.3 or 0.5 mg/kg doses of INM resulted in safe and effective sedation. The 0.5 mg/kg dose was more effective than the 0.3 mg/kg dose in reducing anxiety. PMID:27585415

  5. 75 FR 73104 - Clinical Development Programs for Sedation Products; Request for Assistance

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-29

    ... analyses for the purpose of further understanding the physiology of sedation and clinical trial design...) sedation, as well as associated clinical trial design issues. FDA believes that a public meeting would help... emphasize the rationale for various approaches to key clinical trial design issues involving...

  6. Challenges in paediatric procedural sedation: political, economic, and clinical aspects.

    PubMed

    Mason, K P

    2014-12-01

    Paediatric sedation has expanded in volume and demand over the past decade. In parallel with the increasing demand for and delivery of sedation by multi-specialty providers, conflicting political agendas have surfaced. With a limited selection of sedatives and few new sedatives to market over the past decade, some providers utilize agents that formerly were considered exclusive for administration by anaesthesiologists. This review highlights the important contributions to paediatric sedation over the past century. Considerations include the barriers and politics that impede progress and also future advances and contributions that may lie ahead. PMID:25498582

  7. Efficacy Outcome Measures for Procedural Sedation Clinical Trials in Adults: An ACTTION Systematic Review.

    PubMed

    Williams, Mark R; McKeown, Andrew; Dexter, Franklin; Miner, James R; Sessler, Daniel I; Vargo, John; Turk, Dennis C; Dworkin, Robert H

    2016-01-01

    Successful procedural sedation represents a spectrum of patient- and clinician-related goals. The absence of a gold-standard measure of the efficacy of procedural sedation has led to a variety of outcomes being used in clinical trials, with the consequent lack of consistency among measures, making comparisons among trials and meta-analyses challenging. We evaluated which existing measures have undergone psychometric analysis in a procedural sedation setting and whether the validity of any of these measures support their use across the range of procedures for which sedation is indicated. Numerous measures were found to have been used in clinical research on procedural sedation across a wide range of procedures. However, reliability and validity have been evaluated for only a limited number of sedation scales, observer-rated pain/discomfort scales, and satisfaction measures in only a few categories of procedures. Typically, studies only examined 1 or 2 aspects of scale validity. The results are likely unique to the specific clinical settings they were tested in. Certain scales, for example, those requiring motor stimulation, are unsuitable to evaluate sedation for procedures where movement is prohibited (e.g., magnetic resonance imaging scans). Further work is required to evaluate existing measures for procedures for which they were not developed. Depending on the outcomes of these efforts, it might ultimately be necessary to consider measures of sedation efficacy to be procedure specific. PMID:26678470

  8. Early sedation and clinical outcomes of mechanically ventilated patients: a prospective multicenter cohort study

    PubMed Central

    2014-01-01

    Introduction Sedation overuse is frequent and possibly associated with poor outcomes in the intensive care unit (ICU) patients. However, the association of early oversedation with clinical outcomes has not been thoroughly evaluated. The aim of this study was to assess the association of early sedation strategies with outcomes of critically ill adult patients under mechanical ventilation (MV). Methods A secondary analysis of a multicenter prospective cohort conducted in 45 Brazilian ICUs, including adult patients requiring ventilatory support and sedation in the first 48 hours of ICU admissions, was performed. Sedation depth was evaluated after 48 hours of MV. Multivariate analysis was used to identify variables associated with hospital mortality. Results A total of 322 patients were evaluated. Overall, ICU and hospital mortality rates were 30.4% and 38.8%, respectively. Deep sedation was observed in 113 patients (35.1%). Longer duration of ventilatory support was observed (7 (4 to 10) versus 5 (3 to 9) days, P = 0.041) and more tracheostomies were performed in the deep sedation group (38.9% versus 22%, P = 0.001) despite similar PaO2/FiO2 ratios and acute respiratory distress syndrome (ARDS) severity. In a multivariate analysis, age (Odds Ratio (OR) 1.02; 95% confidence interval (CI) 1.00 to 1.03), Charlson Comorbidity Index >2 (OR 2.06; 95% CI, 1.44 to 2.94), Simplified Acute Physiology Score 3 (SAPS 3) score (OR 1.02; CI 95%, 1.00 to 1.04), severe ARDS (OR 1.44; CI 95%, 1.09 to 1.91) and deep sedation (OR 2.36; CI 95%, 1.31 to 4.25) were independently associated with increased hospital mortality. Conclusions Early deep sedation is associated with adverse outcomes and constitutes an independent predictor of hospital mortality in mechanically ventilated patients. PMID:25047960

  9. 76 FR 68197 - Clinical Development Programs for Sedation Products; Public Workshop; Request for Comments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-03

    ... advance. SUPPLEMENTARY INFORMATION: I. Introduction In the Federal Register of November 29, 2010 (75 FR... this workshop to further understand the physiology of sedation and clinical trial design issues related... products? 3. What is the most appropriate primary efficacy endpoint to assess in a clinical trial of...

  10. Clinical testing of propofol geriatic dose for sedation designed via in silico trial.

    PubMed

    Gallardo-Hernandez, Ana Gabriela; Hernandez-Perez, Ana Luisa; Ordoñez-Espinosa, German; Sanchez-Lopez, Antonio; Revilla-Monsalve, Cristina; Islas-Andrade, Sergio

    2016-08-01

    The geriatric population shows significant physiological changes due to aging and the multiple co-morbidities that they often present. Conventionally the propofol sedation dose for patients older than 65 years is 80% of the adult dose. We performed an in silico trial for elderly population and the results showed that the necessary simulated dose of propofol was lower than the conventional dose; therefore, a clinical trial was implemented to test three different propofol doses, two of them lower than the conventional dose, during a pacemaker implantation. The clinical trial showed that there was no clinical difference between the effects of the doses. A BIS monitor was used to measure the level of sedation, which proved to be adequate and well maintained by all patients. All the patients maintained an acceptable level of sedation, measured by a BIS monitor. Since propofol has some dose-dependent secondary effects, the use of lower doses, especially the ones designed for this age group, helps to avoid them. PMID:27282224

  11. Rectal Thiopental versus Intramuscular Ketamine in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial

    PubMed Central

    Azizkhani, Reza; Esmailian, Mehrdad; shojaei, Azadeh; Golshani, Keihan

    2015-01-01

    Introduction: Physicians frequently deal with procedures which require sedation of pediatric patients. Laceration repair is one of them. No study has been performed regarding the comparison between induction of sedation with sodium thiopental and ketamine in laceration repair. Therefore, the present study was aimed to comparison of induced sedation by rectal sodium thiopental and muscular injection of hydrochloride ketamine in pediatric patients need laceration repair. Methods: The presented study is a single-blinded clinical trial performed through 2013 to 2014 in Ayatollah Kashani and Alzahra Hospitals, Isfahan, Iran. Patients from 3 months to 14 years, needed sedation for laceration repair, were entered. Patients were sequentially evaluated and randomly categorized in two groups of hydrochloride ketamine with dose of 2-4 milligram per kilogram and sodium thiopental with dose of 25 milligram per kilogram. Demographic data and vital signs before drug administration and after induction of sedation, Ramsey score, time to onset of action, and sedation recovery time were evaluated. Chi-squared, Mann-Whitney, and Non-parametric analysis of covariance tests were used. P<0.05 was considered as a significant level. Results: In this study 60 pediatric patients were entered. 30 patients with mean age of 42.8±18.82 months were received sodium thiopental and the rest with mean age of 30.08±16.88 months given ketamine. Mann-Whitney test was showed that time to onset of action in sodium thiopental group (28.23±5.18 minutes) was significantly higher than ketamine (7.77±4.13 minutes), (p<0.001). The sedation recovery time in ketamine group (29.83±7.70) was higher than sodium thiopental. Depth of sedation had no significant difference between two groups based on Ramsey score (p=0.87). No significant difference was seen between two groups in the respiratory rate (df=1, 58; F=0.002; P=0.96) and heart rate (df=1, 58; F=0.98; P=0.33). However, arterial oxygen saturation level (df

  12. Clinical Decision Support and Closed-Loop Control for Cardiopulmonary Management and Intensive Care Unit Sedation Using Expert Systems

    PubMed Central

    Gholami, Behnood; Bailey, James M.; Haddad, Wassim M.; Tannenbaum, Allen R.

    2013-01-01

    Patients in the intensive care unit (ICU) who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. The need for sedation arises both from patient anxiety due to the loss of personal control and the unfamiliar and intrusive environment of the ICU, and also due to pain or other variants of noxious stimuli. While physicians select the agent(s) used for sedation and cardiovascular function, the actual administration of these agents is the responsibility of the nursing staff. If clinical decision support systems and closed-loop control systems could be developed for critical care monitoring and lifesaving interventions as well as the administration of sedation and cardiopulmonary management, the ICU nurse could be released from the intense monitoring of sedation, allowing her/him to focus on other critical tasks. One particularly attractive strategy is to utilize the knowledge and experience of skilled clinicians, capturing explicitly the rules expert clinicians use to decide on how to titrate drug doses depending on the level of sedation. In this paper, we extend the deterministic rule-based expert system for cardiopulmonary management and ICU sedation framework presented in [1] to a stochastic setting by using probability theory to quantify uncertainty and hence deal with more realistic clinical situations. PMID:23620646

  13. Clinical Decision Support and Closed-Loop Control for Cardiopulmonary Management and Intensive Care Unit Sedation Using Expert Systems.

    PubMed

    Gholami, Behnood; Bailey, James M; Haddad, Wassim M; Tannenbaum, Allen R

    2012-03-01

    Patients in the intensive care unit (ICU) who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. The need for sedation arises both from patient anxiety due to the loss of personal control and the unfamiliar and intrusive environment of the ICU, and also due to pain or other variants of noxious stimuli. While physicians select the agent(s) used for sedation and cardiovascular function, the actual administration of these agents is the responsibility of the nursing staff. If clinical decision support systems and closed-loop control systems could be developed for critical care monitoring and lifesaving interventions as well as the administration of sedation and cardiopulmonary management, the ICU nurse could be released from the intense monitoring of sedation, allowing her/him to focus on other critical tasks. One particularly attractive strategy is to utilize the knowledge and experience of skilled clinicians, capturing explicitly the rules expert clinicians use to decide on how to titrate drug doses depending on the level of sedation. In this paper, we extend the deterministic rule-based expert system for cardiopulmonary management and ICU sedation framework presented in [1] to a stochastic setting by using probability theory to quantify uncertainty and hence deal with more realistic clinical situations. PMID:23620646

  14. Clinical and ethical challenges of palliative sedation therapy. The need for clear guidance and professional competencies.

    PubMed

    Schildmann, J; Schildmann, E

    2013-11-01

    Palliative sedation therapy (PST) has become a frequent practice in end-of-life care and advocated in the literature as a less problematic alternative to practices of physician-assisted dying, such as ending patients' lives on request or assisted suicide . However, in clinical practice, patients, healthcare professionals and other parties involved in decisions about PST are facing numerous clinical and ethical challenges. This perspective aims to analyse important challenges associated with professional decision-making about PST and to explore the recommendations of guidelines, which have been published in recent years. PMID:24165423

  15. Clinical evaluation of medetomidine, a novel sedative and analgesic drug for dogs and cats.

    PubMed

    Vähä-Vahe, T

    1989-01-01

    Medetomidine, a potent alpha 2-adrenoceptor agonist, was investigated in open, multicenter clinical trials with patients of various canine and feline breeds (1736 dogs and 678 cats). The purpose of the study was to find an optimal dose of medetomidine for sedation and analgesia in clinical practice and to study how well the intended procedure could be performed under the influence of the drug. The mean dose (i.m.) of medetomidine used for examinations, clinical procedures and minor surgical interventions was 40 micrograms/kg, and for radiography 30 micrograms/kg. In cats the dose was 80-110 micrograms/kg. On the doses chosen, almost all animals were recumbent and 72% of the dogs and 85% of the cats were in a slight anaesthetic stage, unable to rise. The evaluation of the overall suitability of medetomidine (% of cases) in different indications was "very satisfactory" or "satisfactory" in 95% of dogs and 81-96% of cats. Side effects reported were limited almost exclusively to vomiting and muscle jerking in dogs (12% and 0.5% of the cases) and to vomiting in cats (65%). Medetomidine seems to suffice for pharmacological restraint of dogs and cats. The concomitant use of medetomidine (80-100 micrograms/kg) and ketamine (7 mg/kg) in cats (n = 295) provided a good anaesthesia (20-40 min). The recovery was smooth. The present study shows that medetomidine provides an effective level of sedation and analgesia for clinical use. PMID:2698057

  16. Validation of Chinese version of the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR) in patients with schizophrenia spectrum disorders.

    PubMed

    Lan, Tsuo-Hung; Wu, Bo-Jian; Chen, Hsing-Kang; Liao, Hsun-Yi; Lee, Shin-Min; Sun, Hsiao-Ju

    2013-12-15

    There is a lack of validated instruments assessing the decision-making capacity to consent to clinical research of patients with schizophrenia spectrum disorders who speak Chinese. This study aimed to determine the validity and reliability of the Chinese version of MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR). The MacCAT-CR using a hypothetical study, the Positive and Negative Syndrome Scale (PANSS), the Mini-Mental State Examination (MMSE) assessed 139 patients with schizophrenia or schizoaffective disorder. The Cronbach's alpha coefficient was 0.74. The intra-class coefficients for understanding, appreciation, and reasoning scores ranged from 0.53 to 0.81. Regarding validity, the understanding, appreciation and reasoning scores were negatively correlated with the PANSS (r ranged from -0.27 to -0.33), and the negative subscale score (r ranged from -0.31 to -0.37) as well as positively correlated with the MMSE (r ranged from 0.26 to 0.43). All pvalues were less than 0.01. The factor analysis explained 57.6 % of the total variance; specifically, Components 1 and 2 contributed 44.5% and 13.1 % of the variance respectively. These findings indicate that the Chinese version of the MacCAT-CR is a reliable and valid instrument to assess the decision-making capacity to consent to clinical research of patients with schizophrenia spectrum disorders. PMID:23928212

  17. Clinical analysis of moderate-to-deep-sedation by nonmedical sedation practitioners in 597 patients undergoing gastrointestinal endoscopy: a retrospective study

    PubMed Central

    Vaessen, Hermanus; Bruens, Elisabeth; Knape, Johannes

    2016-01-01

    Background and study aim: The purpose of this study was to evaluate whether moderate-to-deep sedation with propofol and alfentanil can be administered safely by nonmedical sedation practitioners, and the outcomes of this practice in the Netherlands. We retrospectively analyzed the occurrence of sedation-related complications in patients undergoing gastrointestinal endoscopic procedures. Patients and methods: In this study, 597 adult patients consecutively underwent upper gastrointestinal endoscopic procedures. The health status of the patients was screened according to a standardized protocol, and the patients were sedated by trained nonmedical sedation practitioners. Their vital signs were continuously monitored and recorded. All patients received oxygen, and the depth of sedation was continuously assessed and recorded. Mild and severe complications were recorded and analyzed. Results: All patients recovered uneventfully, and no mortality occurred. Overall, of the 597 sedated patients, 85 had mild and 4 had severe complications. Hypoxemia and upper airway obstruction, which were easily managed by trained nonmedical sedation practitioners, were the most common events. Hypotension was rare. No signs or symptoms suggestive of aspiration were reported. Conclusion: Moderate-to-deep sedation has been and continues to be a risky medical procedure. Serious complications of propofol/opioid-based sedation, especially respiratory and cardiovascular adverse events, may occur. These complications need to be recognized rapidly and appropriately managed. Our study shows that well-trained nonmedical sedation practitioners can be entrusted to take responsibility for the safe administration of moderate-to-deep sedation. PMID:27227116

  18. A Continuous Quality Improvement Approach to Improving Clinical Practice in the Areas of Sedation, Analgesia, and Neuromuscular Blockade.

    ERIC Educational Resources Information Center

    Arbour, Richard

    2003-01-01

    A continuous improvement approach to upgrading nurses' administration of sedatives and analgesics included (1) data collection from charts, shift reports, rounds, and bedside examinations; (2) identification of clinical issues and needs; and (3) design of interventions using on teaching moments, competency-based modules, and instruction during…

  19. Protocolized Sedation versus Usual Care in Pediatric Patients Mechanically Ventilated for Acute Respiratory Failure: A Randomized Clinical Trial

    PubMed Central

    Curley, Martha A.Q.; Wypij, David; Watson, R. Scott; Grant, Mary Jo C.; Asaro, Lisa A.; Cheifetz, Ira M.; Dodson, Brenda; Franck, Linda S.; Gedeit, Rainer G.; Angus, Derek C.; Matthay, Michael A.

    2016-01-01

    Importance Protocolized sedation improves clinical outcomes in critically-ill adults, but its effect in children is unknown. Objective To determine whether critically-ill children managed with a nurse-implemented, goal-directed sedation protocol (RESTORE) would experience fewer days of mechanical ventilation than patients receiving usual care. Design, Setting, and Participants Cluster-randomized trial conducted in 31 U.S. Pediatric Intensive Care Units (PICUs). Children (n=2449; mean age 4.7 years, range 2 weeks to 17 years) mechanically ventilated for acute respiratory failure were enrolled 2009–2013 and followed until 72 hours after opioids were discontinued, 28 days, or hospital discharge. Interventions Intervention PICUs (17 sites, n=1225 patients) managed sedation using a protocol that included targeted sedation, arousal assessments, extubation readiness testing, sedation adjustment every 8 hours, and sedation weaning. Control PICUs (14 sites, n=1224 patients) managed sedation per usual care without a protocol. Main Outcome and Measures The primary outcome was duration of mechanical ventilation. Secondary outcomes included time to recovery from acute respiratory failure, duration of weaning from mechanical ventilation, neurological testing, PICU and hospital lengths of stay, in-hospital mortality, sedation-related adverse events, sedative exposure including measures of wakefulness, pain, and agitation, and occurrence of iatrogenic withdrawal. Results Duration of mechanical ventilation was not statistically significantly different between the two groups (median; interquartile range: intervention: 6.5 days; 4.1–11.2 vs. control: 6.5; 3.7–12.1). Sedation-related adverse events including inadequate pain and sedation management, clinically significant iatrogenic withdrawal, and unplanned endotracheal tube/invasive line removal were not statistically significantly different between the two groups. Intervention patients experienced more post-extubation stridor

  20. Benzodiazepines: Sedation and Agitation.

    PubMed

    Gallagher, Catherine

    2016-01-01

    Dental anxiety is common and frequently poses a barrier to necessary dental treatment. The increasing availability of conscious sedation in dental practice has made treatment much more accessible for anxious patients. At present, benzodiazepines are the most commonly used drugs in sedation practice and provide a pleasant experience for most, but not all, patients. An understanding of the mechanism of action of benzodiazepines should inform our practice and deepen our understanding of why and how sedation may fail. CPD/CLINICAL RELEVANCE: As an increasing number of dentists provide sedation for their patients an update on benzodiazepines is timely. PMID:27024905

  1. The relationship between the Bispectral Index (BIS) and the Observer Alertness of Sedation Scale (OASS) scores during propofol sedation with and without ketamine: a randomized, double blinded, placebo controlled clinical trial.

    PubMed

    De Oliveira, Gildasio S; Kendall, Mark C; Marcus, R-Jay; McCarthy, Robert J

    2016-08-01

    Prior studies have examined the static effect of intravenous ketamine on the BIS Index for sedation but it remains unknown if the BIS Index is a reliable method to track sedation levels in the presence of ketamine. The major objective of the current investigation was to compare the BIS Vista Index ability to track varying depths of sedation as determined by OASS scores in a standardized anesthetic regimen with and without ketamine. The study was a randomized, double blinded clinical trial. Patients undergoing breast surgery under sedation with propofol were randomized to receive ketamine (1.5 μg kg min(-1)) or saline. Infusion data was used to estimate propofol plasma concentrations (Cp). The main outcome of interest was the correlation between the BIS Vista Index with the OASS score. Twenty subjects were recruited and fifteen completed the study. Four hundred fifty-five paired data points were included in the analysis. Model performance (Nagelkerke R(2)) of the multinomial logistic regression model was 0.57 with the c-statistic of 0.87 (95 % CI 0.82-0.91). Compared to awake the odds ratio for BIS values predicting moderate sedation in the saline/propofol group 1.19 (95 % CI 1.12-1.25) but only 1.06 (95 % CI 1.02-1.1) in the ketamine/propofol group (P = 0.001). There was no difference in the odds for BIS values to predict deep sedation between groups (P = 0.14). The BIS monitor can be used to monitor sedation level even when ketamine is used with propofol as part of the sedation regimen. However, ketamine reduces the value of the BIS in predicting moderate sedation levels. PMID:26219614

  2. [Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam].

    PubMed

    Neves, Jose Francisco Nunes Pereira das; Araújo, Mariana Moraes Pereira das Neves; Araújo, Fernando de Paiva; Ferreira, Clarice Martins; Duarte, Fabiana Baeta Neves; Pace, Fabio Heleno; Ornellas, Laura Cotta; Baron, Todd H; Ferreira, Lincoln Eduardo Villela Vieira de Castro

    2016-01-01

    Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic five minutes before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction. PMID:25818341

  3. Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam.

    PubMed

    das Neves, Jose Francisco Nunes Pereira; das Neves Araújo, Mariana Moraes Pereira; de Paiva Araújo, Fernando; Ferreira, Clarice Martins; Duarte, Fabiana Baeta Neves; Pace, Fabio Heleno; Ornellas, Laura Cotta; Baron, Todd H; Ferreira, Lincoln Eduardo Villela Vieira de Castro

    2016-01-01

    Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction. PMID:27108817

  4. Evaluation of sedation and clinical effects of midazolam with ketamine or dexmedetomidine in pet rabbits.

    PubMed

    Bellini, L; Banzato, T; Contiero, B; Zotti, A

    2014-10-18

    The effects of two sedation protocols combining midazolam with ketamine (ketamine group) or dexmedetomidine (dexmedetomidine group) were studied in dwarf companion rabbits undergoing abdominal ultrasound scan. The onset of sedation was faster in the ketamine group; a few rabbits in the dexmedetomidine group required additional doses to lose the righting reflex, although sedation time was not different between groups. A semi-quantitative scale was used to score sedation quality, which was higher in rabbits that received dexmedetomidine rather than ketamine. Pulse rate was lower in the dexmedetomidine group (206 vs 240 bpm), although Doppler blood pressure was higher than in the ketamine group (109 vs 89 mm Hg). Respiratory rate decreased in relation to the baseline values with both protocols but arterial haemoglobin saturation with oxygen was maintained similar to the pre-sedation values throughout the entire procedure, regardless of protocol used and without oxygen supplementation. Both protocols allowed performance of ultrasound scanning, although dexmedetomidine may be preferred if a deep sedation level is required. PMID:24989038

  5. Endoscopically Assisted Water Perfusion Esophageal Manometry with Minimal Sedation: Technique, Indications and Implication on the Clinical Management

    PubMed Central

    Brun, Rita; Staller, Kyle; Viner, Sofia; Kuo, Braden

    2015-01-01

    Goals To demonstrate feasibility and clinical utility of endoscopically-assisted manometry (EAM). Background Esophageal manometry performed without sedation is the standard for assessment of esophageal motility. However, some patients can not tolerate the procedure with intranasal intubation. We have accumulated experience performing EAM with minimal sedation on patients that can not tolerate standard esophageal manometry. Study We report our single center experience of EAM in adult patients. Patient records were analyzed retrospectively. Procedure protocol: Upper endoscopy is performed with minimal sedation to place a guide wire, over which a water perfusion manometry catheter is introduced and standard manometry protocol performed. Results From 2007-2009, 51 patients underwent EAM, 41 (80.4%) for failed transnasal esophageal manometry and 10 (19.6%) for Zencker diverticulum, achalasia, or neurologic disease. Five patients could not tolerate the procedure despite sedation. No early or late complications were recorded and 100% of the completed procedures were diagnostic: 15 (32.6%) patients had a normal study, 13 (28.3%) were diagnosed with achalasia, 12 (26.1%) patients had low LES pressure, 10 (21.7%) patients demonstrated Ineffective Esophageal Motility, 3 (6.5%) patients had hypertensive LES, and one (2.2%) patient had Nutcracker esophagus. Completed procedures resulted in treatment for achalasia (33.3%), medication changes (33.3%), completion of pre-operative assessment for antireflux surgery (27.7%), or no impact clinical management (11.1%). EAM had a direct clinical impact on 89% of patients. Conclusions EAM is a safe, reliable, and feasible technique providing objective diagnostic information that directly impacted clinical management in many problematic patients where the standard procedure failed. PMID:21602703

  6. Sedation in gastrointestinal endoscopy: a prospective study comparing nonanesthesiologist-administered propofol and monitored anesthesia care

    PubMed Central

    de Paulo, Gustavo Andrade; Martins, Fernanda P.B.; Macedo, Erika P.; Gonçalves, Manoel Ernesto P.; Mourão, Carlos Alberto; Ferrari, Angelo P.

    2015-01-01

    Introduction: Adequate sedation is one of the cornerstones of good quality gastrointestinal endoscopy (GIE). Propofol sedation has increased significantly but there has been much debate over whether it can be administered by endoscopists. The aim of this prospective trial was to compare nonanesthesiologist-administered propofol (NAAP) and monitored anesthesia care (MAC). Methods: A total of 2000 outpatients undergoing GIE at Hospital Albert Einstein (São Paulo, Brazil), a tertiary-care private hospital, were divided into two matched groups: NAAP (n = 1000) and MAC (n = 1000). In NAAP, propofol doses were determined by the endoscopist. A second physician stayed in the room during the entire procedure, according to local regulations. In MAC, the anesthesiologist administered propofol. Results: In total, 1427 patients (71.3 %) were ASA (American Society of Anesthesiologists) class I and 573 were ASA class II. In NAAP, patients received more propofol + fentanyl (61.1 % vs. 50.5 %; P < 0.05) and there were fewer cases of deep sedation (44.7 % vs. 66.1 %; P < 0.05). Hypoxemia rates were similar (12.8 % for NAAP and 11.2 % for MAC; P = 0.3) but these reverted more rapidly in MAC (4.22 seconds vs. 7.26 seconds; P < 0.05). Agitation was more frequent in MAC (14.0 % vs. 5.6 %; P < 0.05). No later complications were observed. Patient satisfaction was very high and similar in both groups. Conclusion: In this setting, NAAP was as safe and effective as MAC for healthy patients undergoing GIE. Clinical trial ref. no.: U1111-1134-4430 PMID:26134777

  7. Monitoring and delivery of sedation.

    PubMed

    Sheahan, C G; Mathews, D M

    2014-12-01

    Sedation for medical procedures is provided in a variety of clinical settings by medical personnel with differing levels of education and training. Although generally a safe practice, there is a degree of morbidity and mortality associated with sedation practice. Monitoring standards continue to be refined by professional societies with the goal of improving care. The depth of sedation should be monitored with clinical criteria. Processed electroencephalographic monitors currently do not contribute significantly to sedation care. Monitoring ventilation using pulse oximetry should be abandoned for more direct methods, such as capnography-transcutaneous carbon dioxide, respiratory acoustical and thoracic impedance monitoring could also play a role. Propofol has become widely utilized for sedation, although there are concerns about its margin of safety and synergistic interactions with other agents. Dexmedetomidine and propofol/ketamine also have utility. Patient-controlled sedation pumps and target-controlled infusion devices have been developed to improve patient care and satisfaction. A computer-assisted propofol sedation device to be used by non-anaesthesiologists has been approved in the USA by the Food and Drug Administration. More computer-assisted sedation delivery devices are likely to be developed, but their clinical utility is unclear. PMID:25498581

  8. Comparison of sedation effectiveness of remifentanil-dexmedetomidine and remifentanil-midazolam combinations and their effects on postoperative cognitive functions in cystoscopies: A randomized clinical trial

    PubMed Central

    Arpaci, Ayse Hande; Bozkırlı, Fusun

    2013-01-01

    Background: The aim of the study is to compare the effects of remifentanil/dexmedetomidine and remifentanil/midazolam combinations in monitored anesthesia care (MAC) during cystoscopies. Materials and Methods: Forty patients who received remifentanil infusion of 0.05 μg kg-1 min-1 for cytoscopy procedure were randomized into two groups: Either dexmedetomidine 1 mg kg-1 (Group D) or midazolam 0.2 mg kg-1 h-1 (Group M) was administered intravenously for the first 10 min. Subsequently, anesthesia was maintained by using the bispectral index as a continuous infusion of dexmedetomidine (0.2-0.7 μg kg-1 h-1) or midazolam (0.05-0.15 μg kg-1 h-1). Heart rate, mean arterial pressure, mini-mental state examination findings, levels of sedation andanalgesia, and the patient's and surgeon's satisfaction were recorded. Results: Successful sedation and analgesia were achieved in all the patients. We were able to reach the target sedation level faster in Group D (P<0.0001). In Group D, the cognitive functions were less affected than in Group M (P<0.0001). Patient's and surgeon's satisfaction were significantly higher in Group D. Conclusion: The targeted sedation levels were achieved in a shorter period with dexmedetomidine-remifentanil compared to midazolam-remifentanil. The dexmedetomidine-remifentanil combination was observed to affect the cognitive functions less than midazolam-remifentanil did with shorter recovery times. Besides, patient's and surgeon's satisfaction rates were superior with dexmedetomidine-remifentanil. It was concluded that dexmedetomidine-remifentanil may be a combination of choice for monitored anesthesia care applications in outpatient surgical procedures of short duration. PMID:23914211

  9. Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines

    PubMed Central

    2010-01-01

    Background Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs. The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase. Methods A framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA). Results The applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows. Conclusions The framework is an

  10. Post-sedation events in children sedated for dental care.

    PubMed

    Ritwik, Priyanshi; Cao, Linda T; Curran, Ronald; Musselman, Robert J

    2013-01-01

    Moderate oral sedation is used in pediatric dentistry for safe delivery of dental care to children. However, there is a paucity of data on the effects of pediatric dental sedations after discharge of children from the dental office. The purpose of this study was to evaluate and compare the incidence of adverse events occurring with meperidine and hydroxyzine versus midazolam alone 8 and 24 hours after sedation in pediatric dental patients. In this prospective study, a convenience sample of 46 healthy children presenting to a private pediatric dental practice for dental treatment needs was selected. A telephone survey of the parents of children sedated with either meperidine and hydroxyzine or midazolam alone was conducted 8 and 24 hours after the administration of sedation medications. Data analysis included descriptive statistics, frequency and proportion analysis, and Fisher exact test. Forty children were sedated with meperidine and hydroxyzine, and 6 who were sedated with midazolam. In both groups, 50% of the children slept in the car on the way home. Three children in the meperidine and hydroxyzine group vomited in the car. A significantly larger proportion of children in the meperidine and hydroxyzine group experienced prolonged sleep at home (P = .015). More children in the midazolam group exhibited irritability in the first 8 hours (P = .07). There were no statistical differences between the 2 groups with respect to incidence of pain, fever, vomiting, sleeping in the car, snoring, and difficulty in waking up. The lingering effects of orally administered sedation medications can lead to prolonged sleep, irritability, and vomiting in children after they have been discharged from the dental clinic. Most of these events occurred within the first 8 hours, but in some children the effects were seen up to 24 hours later. PMID:23763560

  11. Sedation in gastrointestinal endoscopy: Current issues

    PubMed Central

    Triantafillidis, John K; Merikas, Emmanuel; Nikolakis, Dimitrios; Papalois, Apostolos E

    2013-01-01

    Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate (conscious) sedation. Moderate sedation, using midazolam and an opioid, is the standard method of sedation, although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation. Moreover, the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and, consequently, its low risk of inducing hepatic encephalopathy. In the future, propofol could become the preferred sedation agent, especially for routine colonoscopy. Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam. Among opioids, pethidine and fentanyl are the most popular. A number of other substances have been tested in several clinical trials with promising results. Among them, newer opioids, such as remifentanil, enable a faster recovery. The controversy regarding the administration of sedation by an endoscopist or an experienced nurse, as well as the optimal staffing of endoscopy units, continues to be a matter of discussion. Safe sedation in special clinical circumstances, such as in the cases of obese, pregnant, and elderly individuals, as well as patients with chronic lung, renal or liver disease, requires modification of the dose of the drugs used for sedation. In the great majority of patients, sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide. In this review, an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature. PMID:23382625

  12. Endoscopic Sedation: Medicolegal Considerations.

    PubMed

    Kralios, Andreas A; Feld, Kayla A; Feld, Andrew D

    2016-07-01

    Goals of endoscopic sedation are to provide patients with a successful procedure, and ensure that they remain safe and are relieved from anxiety and discomfort; agents should provide efficient, appropriate sedation and allow patients to recover rapidly. Sedation is usually safe and effective; however, complications may ensue. This paper outlines some medicolegal aspects of endoscopic sedation, including informed consent, possible withdrawal of consent during the procedure, standard of care for monitoring sedation, use of anesthesia personnel to deliver sedation, and new agents and devices. PMID:27372770

  13. [Monitoring Required for Monitored Anesthesia Care (MAC) and Specific MAC Methodologies].

    PubMed

    Suzuki, Toshiyasu

    2015-03-01

    Many physicians responsible for monitored anesthesia care (MAC) are not anesthesiologists and are not acquainted with treatment in response to sudden changes in patient condition. In particular, rapid response and early detection are essential for respiratory depression. Physicians engaged in MAC require pharmacological knowledge regarding sedative and analgesic medications, need to be able to accurately evaluate physiological responses to sedative and anesthetic levels, and need to be acquainted with emergency procedures such as basic life support (BLS) and advanced cardiovascular life support (ACLS). Patient management focusing on both ventilation and oxygenation, through the use of capnography and continuous respiratory monitoring, in addition to oxygenation monitoring using a pulse oximeter, and measuring ECGs and blood pressure in the management of sedated patients, is also important. PMID:26121782

  14. Intensive care sedation: the past, present and the future

    PubMed Central

    2013-01-01

    Despite the universal prescription of sedative drugs in the intensive care unit (ICU), current practice is not guided by high-level evidence. Landmark sedation trials have made significant contributions to our understanding of the problems associated with ICU sedation and have promoted changes to current practice. We identified challenges and limitations of clinical trials which reduced the generalizability and the universal adoption of key interventions. We present an international perspective regarding current sedation practice and a blueprint for future research, which seeks to avoid known limitations and generate much-needed high-level evidence to better guide clinicians' management and therapeutic choices of sedative agents. PMID:23758942

  15. Intensive care sedation: the past, present and the future.

    PubMed

    Shehabi, Yahya; Bellomo, Rinaldo; Mehta, Sangeeta; Riker, Richard; Takala, Jukka

    2013-01-01

    Despite the universal prescription of sedative drugs in the intensive care unit (ICU), current practice is not guided by high-level evidence. Landmark sedation trials have made significant contributions to our understanding of the problems associated with ICU sedation and have promoted changes to current practice. We identified challenges and limitations of clinical trials which reduced the generalizability and the universal adoption of key interventions. We present an international perspective regarding current sedation practice and a blueprint for future research, which seeks to avoid known limitations and generate much-needed high-level evidence to better guide clinicians' management and therapeutic choices of sedative agents. PMID:23758942

  16. Monitoring sedation in the critically ill child.

    PubMed

    Lamas, A; López-Herce, Jesús

    2010-05-01

    Sedation is an essential part of the management of the critically ill child, and its monitoring must be individualised and continuous in order to adjust drug doses according to the clinical state. There is no ideal method for evaluating sedation in the critically ill child. Haemodynamic variables have not been found to be useful. Clinical scales are useful when sedation is moderate, but are limited by their subjective nature, the use of stimuli, and the impossibility of evaluating profoundly sedated patients or those receiving neuromuscular blocking drugs; in addition, many of these scales have not been evaluated in children. The COMFORT scale is the most appropriate, as it was designed and validated for critically ill children requiring mechanical ventilation. Electroencephalography-derived methods permit continuous monitoring, provide an early indication of changes in the level of sedation, and facilitate a rapid adjustment of medication. However, these methods were designed and validated for patients under anaesthesia and their results cannot be fully extrapolated to the critically ill patient; in addition, some of them have not been validated in small children and there is still little experience in critically ill children. The main indications for the use of these methods are in patients with deep sedation and/or neuromuscular blockade. The bispectral index is the most widely used method at the present time. Analysis and comparison of the efficacy of the different methods for evaluating sedation in the critically ill child is required. PMID:20175774

  17. Intravenous ketamine, propofol and propofol-ketamine combination used for pediatric dental sedation: A randomized clinical study

    PubMed Central

    Canpolat, Dilek Gunay; Yildirim, Mustafa Denizhan; Aksu, Recep; Kutuk, Nukhet; Alkan, Alper; Cantekin, Kenan

    2016-01-01

    Background and Objective: Dental treatments cannot bealways performed under local anesthesia inpediatric non-cooperative patients. For this purpose, differentanesthetic techniques have been applied to increase patient comport to dental treatments. Methods: Sixty children classified as ASA I-II, between aged 3 to 9, who were scheduled to undergo tooth extraction, were enrolled for this randomized study. Group K received 1 mg/kg ketamine, Group P received 1 mg/kg propofol, and Group KP received 0.5 mg/kg propofol plus 0.5 mg/kg ketamine intravenously for anesthesia induction. Results: Recovery time was significantly lower in Group P than Group KP. No significant differences were found between groups regarding HR, before and after the induction, at tenth minute. Fifth minute’s HR was higher in Group K than Group KP. Mean arterial pressure (MAP) values were similar at baseline, before and after the induction, and at tenth minute, whereas significantly lower values were found in Group P and Group KP than in Group K at fifth minute. Conclusions: Although ketamine, propofol and ketamine-propofol combination are effective for sedation in tooth extraction in pediatric patients, propofol may be an excellent alternative, with the shortest recovery, no nausea and vomiting, and reasonable surgical satisfaction. PMID:27375714

  18. EFFECT OF SEDATION ON PAIN PERCEPTION

    PubMed Central

    Frölich, Michael A.; Zhang, Kui; Ness, Timothy

    2013-01-01

    Background Sedation or anesthesia is used to facilitate many cases of an estimated 45 million diagnostic and therapeutic medical procedures in the United States. Preclinical studies have called attention to the possibility that sedative hypnotic drugs can increase pain perception but it remains unclear whether this observation holds true in humans and whether pain-modulating effects are agent specific or characteristic of intravenous sedation in general. Methods To study this important clinical question, we recruited 86 healthy volunteers and randomly assigned them to receive one of three sedative drugs; midazolam, propofol or dexmedetomidine. We asked participants to rate their pain in response to four experimental pain tasks (cold, heat, ischemic or electrical pain) before and during moderate sedation. Results Midazolam increased cold, heat and electrical pain perception significantly (10-point pain rating scale change = 0.82 ± 0.29, mean ± SEM). Propofol reduced ischemic pain and dexmedetomidine reduced both cold and ischemic pain significantly (−1.58 ± 0.28, mean ± SEM). We observed a gender-by-race interaction for dexmedetomidine. In addition to these drug specific effects, we observed gender effects on pain perception; females rated identical experimental pain stimuli higher than males. We also noted racedrug interaction effects for dexmedetomidine with higher doses of drug needed to sedate Caucasians when compared to African-Americans. Conclusions The results of our study call attention to the fact that intravenous sedatives may increase pain perception. The effect of sedation on pain perception is agent and pain type specific. Knowledge of these effects provides a rational basis for analgesia and sedation to facilitate medical procedures. PMID:23314164

  19. Sedation in the intensive care setting

    PubMed Central

    Hughes, Christopher G; McGrane, Stuart; Pandharipande, Pratik P

    2012-01-01

    Critically ill patients are routinely provided analgesia and sedation to prevent pain and anxiety, permit invasive procedures, reduce stress and oxygen consumption, and improve synchrony with mechanical ventilation. Regional preferences, patient history, institutional bias, and individual patient and practitioner variability, however, create a wide discrepancy in the approach to sedation of critically ill patients. Untreated pain and agitation increase the sympathetic stress response, potentially leading to negative acute and long-term consequences. Oversedation, however, occurs commonly and is associated with worse clinical outcomes, including longer time on mechanical ventilation, prolonged stay in the intensive care unit, and increased brain dysfunction (delirium and coma). Modifying sedation delivery by incorporating analgesia and sedation protocols, targeted arousal goals, daily interruption of sedation, linked spontaneous awakening and breathing trials, and early mobilization of patients have all been associated with improvements in patient outcomes and should be incorporated into the clinical management of critically ill patients. To improve outcomes, including time on mechanical ventilation and development of acute brain dysfunction, conventional sedation paradigms should be altered by providing necessary analgesia, incorporating propofol or dexmedetomidine to reach arousal targets, and reducing benzodiazepine exposure. PMID:23204873

  20. Registered nurse-administered sedation for gastrointestinal endoscopic procedure

    PubMed Central

    Amornyotin, Somchai

    2015-01-01

    The rising use of nonanesthesiologist-administered sedation for gastrointestinal endoscopy has clinical significances. Most endoscopic patients require some forms of sedation and/or anesthesia. The goals of this sedation are to guard the patient’s safety, minimize physical discomfort, to control behavior and to diminish psychological responses. Generally, moderate sedation for these procedures has been offered by the non-anesthesiologist by using benzodiazepines and/or opioids. Anesthesiologists and non-anesthesiologist personnel will need to work together for these challenges and for safety of the patients. The sedation training courses including clinical skills and knowledge are necessary for the registered nurses to facilitate the patient safety and the successful procedure. However, appropriate patient selection and preparation, adequate monitoring and regular training will ensure that the use of nurse-administered sedation is a feasible and safe technique for gastrointestinal endoscopic procedures. PMID:26191341

  1. Mycobacterium Avium Complex (MAC)

    MedlinePlus

    ... MAC? The symptoms of MAC can include high fevers, chills, diarrhea , weight loss, stomach aches, fatigue, and anemia ( ... anemia. Many drug interactions. Rifampin (Rifampicin, Rifadin, Rimactane): fever, chills, muscle or bone pain; can turn urine, sweat, ...

  2. Hypnotics and Sedatives

    NASA Astrophysics Data System (ADS)

    Kabra, Pokar M.; Koo, Howard Y.; Marton, Laurence J.

    In recent years, most large hospitals have observed a marked increase in the admission of patients suffering from drug overdose. Overdose of narcotic drugs, such as the opiates, represent less of a problem on a day-to-day basis than do overdoses of prescribed drugs, such as sedatives and hypnotics. Clinical signs and symptoms for a narcotic drug overdose are very distinct, and in the majority of cases can be easily recognized by the attending physicians without the help of a toxicology laboratory. Loomis (1) reported that the majority of fatal poisonings owed to one, or a combination, of four agents: barbiturates, carbon monoxide, ethyl alcohol, and salicylates. Berry (2) estimated that 5-5'-disubstituted barbiturates were the second commonest cause of fatal poisoning in England, and that the frequency of their use was increasing. Other nonbarbiturate hypnotics involved in coma-producing incidents include glutethimide (Doriden®), methyprylon (Noludar®), and meprobamate (3, 4). In the last five years, diazepam (Valium®) has become one of the leading misused drugs (5).

  3. Dental treatment of a patient with central sleep apnea and phobic anxiety under sedation: report of a case and clinical considerations.

    PubMed

    Kılınç, Yeliz; Işık, Berrin

    2012-11-01

    Central sleep apnea (CSA) results from a reduction in lack of output from the central respiratory generator in the brainstem, manifesting as apneas and hypopneas without discernible efforts. CSA can lead to hypercarbia, arrhythmias, pulmonary hypertension, and heart failure. Indeed, the patient may develop a disturbed breathing during sedation procedures. We report a patient who was diagnosed with CSA and had been on continuous positive airway pressure (CPAP) therapy for 5 years. He was referred for multiple tooth extractions under sedation owing to severe gag reflex and phobic anxiety disorder. The treatment was completed uneventfully under N(2)O and sevoflurane inhalation accompanied by midazolam and ketamine induction. The role of sedative, analgesic, and anesthetic agents as a precipitating factor for CSA is of particular concern. The combined administration of midazolam, ketamine, sevoflurane, and N(2)O/O(2) is a useful and safe option for patients requiring sedation. PMID:23083486

  4. Pediatric Sedation: A Global Challenge

    PubMed Central

    Gozal, David; Mason, Keira P.

    2010-01-01

    Pediatric sedation is a challenge which spans all continents and has grown to encompass specialties outside of anesthesia, radiology and emergency medicine. All sedatives are not universally available and local and national regulations often limit the sedation practice to specific agents and those with specific credentials. Some specialties have established certification and credentials for sedation delivery whereas most have not. Some of the relevant sedation guidelines and recommendations of specialty organizations worldwide will be explored. The challenge facing sedation care providers moving forward in the 21st century will be to determine how to apply the local, regional and national guidelines to the individual sedation practices. A greater challenge, perhaps impossible, will be to determine whether the sedation community can come together worldwide to develop standards, guidelines and recommendations for safe sedation practice. PMID:20981309

  5. Clustering of capnogram features to track state transitions during procedural sedation.

    PubMed

    Mieloszyk, Rebecca J; Guo, Margaret G; Verghese, George C; Andolfatto, Gary; Heldt, Thomas; Krauss, Baruch S

    2015-08-01

    Procedural sedation has allowed many painful interventions to be conducted outside the operating room. During such procedures, it is important to maintain an appropriate level of sedation to minimize the risk of respiratory depression if patients are over-sedated and added pain or anxiety if under-sedated. However, there is currently no objective way to measure the patient's evolving level of sedation during a procedure. We investigated the use of capnography-derived features as an objective measure of sedation level. Time-based capnograms were recorded from 30 patients during sedation for cardioversion. Through causal k-means clustering of selected features, we sequentially assigned each exhalation to one of three distinct clusters, or states. Transitions between these states correlated to events during sedation (drug administration, procedure start and end, and clinical interventions). Similar clustering of capnogram recordings from 26 healthy, non-sedated subjects did not reveal distinctly separated states. PMID:26736604

  6. Safe Sedation and Hypnosis using Dexmedetomidine for Minimally Invasive Spine Surgery in a Prone Position.

    PubMed

    Kim, Kyung Hoon

    2014-10-01

    Dexmedetomidine, an imidazoline compound, is a highly selective α2-adrenoceptor agonist with sympatholytic, sedative, amnestic, and analgesic properties. In order to minimize the patients' pain and anxiety during minimally invasive spine surgery (MISS) when compared to conventional surgery under general anesthesia, an adequate conscious sedation (CS) or monitored anesthetic care (MAC) should be provided. Commonly used intravenous sedatives and hypnotics, such as midazolam and propofol, are not suitable for operations in a prone position due to undesired respiratory depression. Dexmedetomidine converges on an endogenous non-rapid eye movement (NREM) sleep-promoting pathway to exert its sedative effects. The great merit of dexmedetomidine for CS or MAC is the ability of the operator to recognize nerve damage during percutaneous endoscopic lumbar discectomy, a representative MISS. However, there are 2 shortcomings for dexmedetomidine in MISS: hypotension/bradycardia and delayed emergence. Its hypotension/bradycardiac effects can be prevented by ketamine intraoperatively. Using atipamezole (an α2-adrenoceptor antagonist) might allow doctors to control the rate of recovery from procedural sedation in the future. MAC, with other analgesics such as ketorolac and opioids, creates ideal conditions for MISS. In conclusion, dexmedetomidine provides a favorable surgical condition in patients receiving MISS in a prone position due to its unique properties of conscious sedation followed by unconscious hypnosis with analgesia. However, no respiratory depression occurs based on the dexmedetomidine-related endogenous sleep pathways involves the inhibition of the locus coeruleus in the pons, which facilitates VLPO firing in the anterior hypothalamus. PMID:25317279

  7. Strategies to optimize analgesia and sedation.

    PubMed

    Schweickert, William D; Kress, John P

    2008-01-01

    Achieving adequate but not excessive sedation in critically ill, mechanically ventilated patients is a complex process. Analgesics and sedatives employed in this context are extremely potent, and drug requirements and metabolism are unpredictable. Clinicians must have heightened awareness of the potential for enduring effects and are encouraged to employ strategies that maximize benefit while minimizing risk. Successful sedation protocols have three basic components: frequent assessments for pain, anxiety, and agitation using a reproducible scale; combination therapy coupling opioids and sedatives; and, most importantly, careful communication between team members, with a particular recognition that the bedside nurse must be empowered to pair assessments with drug manipulation. In recent years, two broad categories of sedation protocols have achieved clinical success in terms of decreasing duration of mechanical ventilation and intensive care unit length of stay by minimizing drug accumulation. Patient-targeted sedation protocols (the first category) rely on structured assessments to guide a careful schema of titrated drug escalation and withdrawal. Variation exists in the assessment tool utilized, but the optimal goal in all strategies is a patient who is awake and can be readily examined. Alternatively, daily interruption of continuous sedative infusions (the second category) may be employed to focus care providers on the goal of achieving a period of awakening in the earliest phases of critical illness possible. Newer literature has focused on the safety of this strategy and its comparison with intermittent drug administration. Ongoing investigations are evaluating the broad applicability of these types of protocols, and currently one may only speculate on whether one strategy is superior to another. PMID:18495057

  8. Optimizing sedation in patients with acute brain injury.

    PubMed

    Oddo, Mauro; Crippa, Ilaria Alice; Mehta, Sangeeta; Menon, David; Payen, Jean-Francois; Taccone, Fabio Silvio; Citerio, Giuseppe

    2016-01-01

    Daily interruption of sedative therapy and limitation of deep sedation have been shown in several randomized trials to reduce the duration of mechanical ventilation and hospital length of stay, and to improve the outcome of critically ill patients. However, patients with severe acute brain injury (ABI; including subjects with coma after traumatic brain injury, ischaemic/haemorrhagic stroke, cardiac arrest, status epilepticus) were excluded from these studies. Therefore, whether the new paradigm of minimal sedation can be translated to the neuro-ICU (NICU) is unclear. In patients with ABI, sedation has 'general' indications (control of anxiety, pain, discomfort, agitation, facilitation of mechanical ventilation) and 'neuro-specific' indications (reduction of cerebral metabolic demand, improved brain tolerance to ischaemia). Sedation also is an essential therapeutic component of intracranial pressure therapy, targeted temperature management and seizure control. Given the lack of large trials which have evaluated clinically relevant endpoints, sedative selection depends on the effect of each agent on cerebral and systemic haemodynamics. Titration and withdrawal of sedation in the NICU setting has to be balanced between the risk that interrupting sedation might exacerbate brain injury (e.g. intracranial pressure elevation) and the potential benefits of enhanced neurological function and reduced complications. In this review, we provide a concise summary of cerebral physiologic effects of sedatives and analgesics, the advantages/disadvantages of each agent, the comparative effects of standard sedatives (propofol and midazolam) and the emerging role of alternative drugs (ketamine). We suggest a pragmatic approach for the use of sedation-analgesia in the NICU, focusing on some practical aspects, including optimal titration and management of sedation withdrawal according to ABI severity. PMID:27145814

  9. Effects of bispectral index monitoring as an adjunct to nurse-administered propofol combined sedation during colonoscopy: a randomized clinical trial

    PubMed Central

    Heo, Jun; Jung, Min Kyu; Lee, Hyun Seok; Cho, Chang Min; Jeon, Seong Woo; Kim, Sung Kook; Jeon, Young Hoon

    2016-01-01

    Background/Aims: The efficacy of bispectral index (BIS) monitoring during colonoscopic sedation is debated. We aimed to determine whether BIS monitoring was useful for propofol dose titration, and to evaluate differences in sedative administration between expert and inexperienced medical personnel during colonoscopy procedures that required moderate sedation. Methods: Between February 2012 and August 2013, 280 consecutive patients scheduled to undergo a screening colonoscopy participated in this study and were randomly allocated to the expert or inexperienced endoscopist group. Each group was further divided into either a BIS or a modified Observer’s Assessment of Alertness/Sedation Scale (MOAA/S) subgroup. Trained nurses administered combined propofol sedation and monitored sedation using either the BIS or MOAA/S scale. Results: The mean BIS value throughout the procedure was 74.3 ± 6.7 for all 141 patients in the BIS group. The mean total propofol dose administered in the BIS group was higher than that in the MOAA/S group, independently of the endoscopists’ experience level (36.9 ± 29.6 and 11.3 ± 20.7, respectively; p < 0.001). The total dose of propofol administered was not significantly different between the inexperienced endoscopist group and the expert endoscopist group, both with and without the use of BIS (p = 0.430 and p = 0.640, respectively). Conclusions: Compared with monitoring using the MOAA/S score alone, BIS monitoring was not effective for titrating the dose of propofol during colonoscopy, irrespective of colonoscopist experience. PMID:26932401

  10. [Echocardiographic reference ranges of sedated cats].

    PubMed

    Dümmel, C; Neu, H; Hüttig, A; Failing, K

    1996-04-01

    The aim of this study was to get echocardiographic values of sedated healthy cats of the race European short hair for further reference. After the preliminary examinations checking on the state of health (anamnesis, general and special clinical examinations, ECG, X-ray of thorax and preparation of selected laboratory parameters), 74 sedated animals and additionally 33 cats without sedation were echocardiographically measured. For sedatives we used ketamine hydrochloride and xylazine in order to minimize defending movements of the animals and to reduce the heart rate, which facilitated the echocardiographical measurements. The covariance analysis of the measured values showed a statistically significant dependence on the weight. This did not hold for the two calculated values of the fractional shortening (FS) and the quotient of left atrium and aorta (LA/Ao), where the weight-dependence of each component was compensated by the calculation of the quotient. All stated weight-dependent reference values refer to an average bodyweight of 4.0 kg. A dependence on the age did not show in the covariance analysis. Due to the sedation, the diameter of the left atrium (LA) and the diameter of the left ventricular lumen in the diastole (LVDd) as well as the fractional shortening decreased significantly. PMID:8650689

  11. Prescription Sedative Misuse and Abuse

    PubMed Central

    Weaver, Michael F.

    2015-01-01

    Sedatives are widely prescribed for anxiety or insomnia and include benzodiazepines, selective benzodiazepine receptor subtype agonists (z-drugs), and barbiturates. These sedatives are controlled substances due to their potential for misuse and abuse. Misuse is often self-medication (chemical coping) of psychological symptoms in ways unauthorized by the prescriber, usually as dose escalation leading to requests for early refills. Sedatives are abused for euphoric effects, which may have dangerous consequences. Some sedative overdoses can be treated with flumazenil, a reversal agent, along with supportive care. Sedative withdrawal syndrome is treated by tapering the sedative and may require hospitalization. Long-term treatment of sedative addiction requires counseling, often with the help of an addiction-treatment professional. PMID:26339207

  12. Introduction to MAC CRM training

    NASA Technical Reports Server (NTRS)

    Brown, Donald D.

    1987-01-01

    The author introduces the Military Airlift Command (MAC) and its mission. A brief history of Cockpit Resource Management (CRM) as it relates to MAC is given. He also states why MAC is currently interested in CRM.

  13. Continuous monitoring of depth of sedation by EEG spectral analysis in patients requiring mechanical ventilation.

    PubMed

    Spencer, E M; Green, J L; Willatts, S M

    1994-11-01

    Twenty-three patients undergoing intensive therapy had continuous EEG recording in an attempt to assess depth of sedation using spectral analysis. Median power frequency (MPF) and spectral edge frequency (SEF) were calculated and correlated with the clinical sedation score and blood concentration of sedative drug. Fifteen patients received isoflurane and eight midazolam. There was no correlation between MPF or SEF and sedation score or blood concentration of drug. These results suggest that no simple measure of the EEG is likely to correlate with depth of sedation in critically ill patients. PMID:7826794

  14. Pain and anxiety management for pediatric dental procedures using various combinations of sedative drugs: A review.

    PubMed

    Gazal, Giath; Fareed, Wamiq Musheer; Zafar, Muhammad Sohail; Al-Samadani, Khalid H

    2016-07-01

    For fearful and uncooperative children behavioral management techniques are used. In order to control the pain and anxiety in pedodontic patients, pharmacologic sedation, anesthesia and analgesia are commonly used. Midazolam is commonly used as an oral sedation agent in children; it has several features such as safety of use, quick onset and certain degree of amnesia that makes it a desirable sedation agent in children. This review paper discusses various aspects of oral midazolam, ketamine and their combinations in conscious sedation including, advantages of oral route of sedation, pharmacokinetics, range of oral doses, and antagonists for clinical dental treatment procedures. PMID:27330369

  15. Back to basics: procedural sedation.

    PubMed

    Spruce, Lisa

    2015-03-01

    Patients undergoing surgery frequently receive procedural sedation from RNs in the perioperative setting. With appropriate training, perioperative RNs can administer procedural sedation safely and effectively, helping to eliminate the pain and anxiety often experienced by patients. Facility sedation protocols should provide guidance on training requirements, the RN's role, the credentialing process, the medications the RN may use, and when anesthesia personnel should be consulted. Creating these protocols is guided by state scope of practice laws, Centers for Medicare & Medicaid Services Interpretive Guidelines, and accreditation requirements. Training, physician guidance, and appropriate protocols give the necessary support for perioperative nurses to provide safe and effective procedural sedation. PMID:25707727

  16. Sedation in Japanese dental schools.

    PubMed Central

    Morse, Zac; Sano, Kimito; Fujii, Kazuyuki; Kanri, Tomio

    2004-01-01

    There is very little information about the practice of sedation in Japan. Despite the remarkable advances in dentistry, fear and anxiety continue to be significant deterrents for seeking dental services. Most dental procedures can fortunately be undertaken with the aid of sedation. A comprehensive survey of all the dental schools in Japan was carried out to determine what sedation practices were used in Japan. All 29 dental schools in Japan possessed a dedicated department of anesthesiology at the time of this survey. The survey attempted to determine the specific sedation methods (techniques, routes of administration, and agents used in sedation) as well as practices (monitoring, fasting, location, education, and fees involved in sedation). The results indicate that there was a broad range in sedation practices. The Japanese Dental Society of Anesthesiology may wish to examine the findings of this study and may wish to formulate guidelines appropriate for the practice of sedation in Japan. Others may also wish to compare their own practices with those of Japan. PMID:15497299

  17. Pediatric intensive care sedation: survey of fellowship training programs.

    PubMed

    Marx, C M; Rosenberg, D I; Ambuel, B; Hamlett, K W; Blumer, J L

    1993-02-01

    Children hospitalized in a pediatric intensive care unit are frequently distressed. The purpose of this study was to identify the patterns of use of sedative agents in pediatric critical care patients. A questionnaire survey was mailed to 45 directors of Pediatric Critical Care Fellowship Training Programs listed in Critical Care Medicine, January 1989. The response rate was 75.6% (34 questionnaires). The most commonly identified goals of sedation were reduced patient discomfort or distress and fewer unplanned extubations. The agents most frequently employed for this purpose were opioids (morphine or fentanyl), chloral hydrate, or benzodiazepines. Although conventional doses are used, opioids and benzodiazepines are often given hourly or by continuous infusion. Satisfaction with the efficacy and safety of commonly used opioids was greater (most common response "very satisfied") than for the benzodiazepines ("somewhat satisfied"). The physician's or nurse's clinical impression was reported to be the "most important" criterion for deciding when a patient required a dose of sedative; objective criteria were selected as less important. The majority of patients (65.7%) in the surveyed units were ideally "sedated to the point of no distress with as-needed medication." The majority of respondents (76.4%) identified efficacy as the major problem with sedation. Drug withdrawal was considered to be the major problem with sedative use by only a minority of respondents (6.9%). Although withdrawal is seen in 61.8% of units, it is generally treated when recognized, rather than prevented by routine tapering of sedation. Optimal sedation of pediatric intensive care unit patients is considered problematic, despite the use of frequent doses of many sedatives. Systematic investigation of pharmacodynamic response to these agents in the pediatric critical care population is indicated. PMID:8424013

  18. Therapeutics and Sedation in Dentistry

    PubMed Central

    Young, Earle R.

    1988-01-01

    Sedation can help to overcome the fear that prevents many Canadians from accepting dental treatment. This article discusses the indications and contraindications for oral, intramuscular, and inhalation sedation as used by the general dental practitioner for both adult and child patients, with a note on the growing number of specialist dental anesthetists who provide intravenous out-patient sedation. Local anesthesia is discussed with reference to allergic reactions, malignant hyperthermia, and the use of epinephrine as a vasoconstrictor in patients with cardiovascular diseases. PMID:21253202

  19. Recent results from MAC

    SciTech Connect

    MAC Collaboration

    1982-05-01

    Some preliminary results from the MAC detector at PEP are presented. These include measurements of the angular distribution of ..gamma gamma.., ..mu mu.. and tau tau final states, a determination of the tau lifetime, a measurement of R, and a presentation of the inclusive muon p/sub perpendicular/ distribution for hadronic events.

  20. Conscious sedation for surgical procedures

    MedlinePlus

    Anesthesia - conscious ... have, what medicines you are taking, and what anesthesia or sedation you have had before. You may ... M. Intravenous anesthetics. In: Miller RD, ed. Miller's Anesthesia . 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap ...

  1. Conscious sedation for surgical procedures

    MedlinePlus

    Sherwood ER, Williams CG, Prough DS. Anesthesiology principles, pain management, and conscious sedation. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery . 19th ed. Philadelphia, PA: Elsevier Saunders; ...

  2. Shared decision making after MacIntyre.

    PubMed

    Tilburt, Jon

    2011-04-01

    This paper explores the practical consequences that Enlightenment ideals had on morality as it applies to clinical practice, using Alisdair MacIntyre's conceptualization and critique of the Enlightenment as its reference point. Taking the perspective of a practicing clinician, I critically examine the historical origins of ideas that made shared decision making (SDM) a necessary and ideal model of clinician-patient relationship. I then build on MacIntyre's critique of Enlightenment thought and examine its implications for conceptions of shared decision-making that use an Enlightenment justification, as well as examining contemporary threats to SDM that the Enlightenment made possible. I conclude by offering an alternative framing of SDM that fits with the clinician's duty to act on behalf of and along with patients but that avoids the tenuous Enlightenment assumptions that MacIntyre's work so vocally critiques. PMID:21378085

  3. ABCDEs of ICU: Choice of sedative.

    PubMed

    Maraboto, Eddie

    2013-01-01

    When the clinical picture of a patient in the intensive care unit necessitates placement of an artificial airway supported by mechanical ventilation, a regimen of sedation and analgesia is initiated with the goal of providing anxiolysis and pain control to facilitate ventilation and therapeutic and diagnostic intervention. However, some of the most commonly used sedative agents, such as benzodiazepines, may have profound long-term effects on patients' health, including neuropsychological functioning. With more patients now surviving intensive care, more patients are suffering from these negative health consequences. A review of recent research on the subject suggests that more novel, non-benzodiazepine agents such as dexmedetomidine, fluorinated ether gases, and remifentanil function effectively as sedative agents in intubated patients in the intensive care unit, and are less likely to lead to delirium, agitation, aggression, psychosis, and other complications; in addition, use of these alternatives is associated with shorter times to awakening, extubation, and ICU discharge, as well as shorter overall length of stay and decreased cost of care. PMID:23470700

  4. [Sedation and analgesia during gastrointestinal endoscopy].

    PubMed

    Müllner, Katalin; Tulassay, Zsolt

    2011-03-13

    Sedative and analgesic premedication is frequently used during gastrointestinal endoscopy. Sedation improves patient's compliance, helping the examinations and their safe completion, but it lengthens the procedures, increases the costs, and complications can occur. Sedative drugs are applied during upper and lower gastrointestinal endoscopy, and also at ERCP. The review summarizes the different forms of sedation, drugs, future techniques and possibilities of improvements. Moreover, sedation practice in Hungary is also described. PMID:21362603

  5. Evaluation of BBL CHROMagar O157 versus Sorbitol-MacConkey Medium for Routine Detection of Escherichia coli O157 in a Centralized Regional Clinical Microbiology Laboratory▿

    PubMed Central

    Church, D. L.; Emshey, D.; Semeniuk, H.; Lloyd, T.; Pitout, J. D.

    2007-01-01

    The performance of BBL CHROMagar O157 (CHROM) versus that of sorbitol-MacConkey (SMAC) media for detection of Escherichia coli O157 was determined for a 3-month period. Results for 27/3,116 (0.9%) stool cultures were positive. CHROM had a higher sensitivity (96.30%) and negative predictive value (100%) and a better diagnostic efficiency than SMAC. Labor and material costs decreased when CHROM was used. PMID:17634298

  6. Results from MAC

    SciTech Connect

    Chadwick, G.B.

    1983-05-01

    The MAC detector has been exposed at PEP to 40 pb/sup -1/ luminosity of e/sup +/e/sup -/ collisions. The detector is described and recent results of a continuing analysis of hadronic cross section, lepton pair charge asymmetry, Bhabha process, two photon final state and radiative ..mu.. pairs are given. New results on flavor tagging of hadronic events with an inclusive ..mu.., and some searches for new particles are presented.

  7. Sedation for critically ill or injured adults in the intensive care unit: a shifting paradigm.

    PubMed

    Roberts, Derek J; Haroon, Babar; Hall, Richard I

    2012-10-01

    As most critically ill or injured patients will require some degree of sedation, the goal of this paper was to comprehensively review the literature associated with use of sedative agents in the intensive care unit (ICU). The first and selected latter portions of this article present a narrative overview of the shifting paradigm in ICU sedation practices, indications for uninterrupted or prolonged ICU sedation, and the pharmacology of sedative agents. In the second portion, we conducted a structured, although not entirely systematic, review of the available evidence associated with use of alternative sedative agents in critically ill or injured adults. Data sources for this review were derived by searching OVID MEDLINE and PubMed from their first available date until May 2012 for relevant randomized controlled trials (RCTs), systematic reviews and/or meta-analyses and economic evaluations. Advances in the technology of mechanical ventilation have permitted clinicians to limit the use of sedation among the critically ill through daily sedative interruptions or other means. These practices have been reported to result in improved mortality, a decreased length of ICU and hospital stay and a lower risk of drug-associated delirium. However, in some cases, prolonged or uninterrupted sedation may still be indicated, such as when patients develop intracranial hypertension following traumatic brain injury. The pharmacokinetics of sedative agents have clinical importance and may be altered by critical illness or injury, co-morbid conditions and/or drug-drug interactions. Although use of validated sedation scales to monitor depth of sedation is likely to reduce adverse events, they have no utility for patients receiving neuromuscular receptor blocking agents. Depth of sedation monitoring devices such as the Bispectral Index (BIS©) also have limitations. Among existing RCTs, no sedative agent has been reported to improve the risk of mortality among the critically ill or

  8. Tolerance to daytime sedative effects of H1 antihistamines.

    PubMed

    Richardson, Gary S; Roehrs, Timothy A; Rosenthal, Leon; Koshorek, Gail; Roth, Thomas

    2002-10-01

    Sedation is the principal side effect of first generation H1 antihistamines, and recent studies have suggested that this side effect should limit the clinical application of these drugs. The sedative effect also underlies the use of these first-generation drugs as nonprescriptive remedies for insomnia. In both cases, the potential for tolerance to the sedative effect of these drugs is an important issue for which there are few objective data. In the study reported here, 15 healthy men age 18 to 50 years received either diphenhydramine 50 mg or placebo twice a day for 4 days in a randomized, double-blind, crossover trial design. Dependent measures included objective and subjective assessments of sleepiness and computer-based tests of psychomotor performance. Both objective and subjective measures of sleepiness showed significantly higher levels on day 1 for diphenhydramine compared to placebo. By day 4, however, levels of sleepiness on diphenhydramine were indistinguishable from placebo. Similarly, diphenhydramine produced significant impairment of performance that was completely reversed by day 4. These data provide the first objective confirmation that tolerance develops to the sedative effect of a prototypical first-generation H1 antihistamine, diphenhydramine. On this dosing regimen, tolerance was complete by the end of 3 days of administration. While other antihistamines and dosing regimens may differ, these results suggest that tolerance to the sedation produced by these drugs develops with remarkable rapidity. PMID:12352276

  9. Computer-Assisted and Patient-Controlled Sedation Platforms.

    PubMed

    Pambianco, Daniel; Niklewski, Paul

    2016-07-01

    As the number and complexity of endoscopic procedures increase, the role of sedation has been integral in patient and physician satisfaction. This article discusses the advances of computer-assisted and patient-controlled platforms. These computer-assisted and patient-controlled platforms use different anesthetics and analgesics, all with the intent of achieving improved consistency in the level of sedation, appropriate to the needs of patients, while also improving patient safety. These systems have been around for decades; however, few are approved for use in the United States, and several still require further study before broad clinical application. PMID:27372778

  10. 'Early terminal sedation' is a distinct entity.

    PubMed

    Cellarius, Victor

    2011-01-01

    There has been much discussion regarding the acceptable use of sedation for palliation. A particularly contentious practice concerns deep, continuous sedation given to patients who are not imminently dying and given without provision of hydration or nutrition, with the end result that death is hastened. This has been called 'early terminal sedation'. Early terminal sedation is a practice composed of two legally and ethically accepted treatment options. Under certain conditions, patients have the right to reject hydration and nutrition, even if these are life-sustaining. Patients are also entitled to sedation as palliation for intolerable, intractable suffering. Though early terminal sedation is thought to be rare at present, the changing nature of palliative medicine suggests its use will increase. Arguments regarding early terminal sedation have failed to recognize early terminal sedation as a distinct legal and ethical entity. It can be seen as both the simple sum of treatment refusal and sedation for palliation, analogous to terminal sedation. It can also be seen as an indivisible palliative treatment, more analogous to assisted suicide or euthanasia. But ultimately, it is wholly analogous neither to terminal sedation given when death is imminent, nor to assisted suicide or euthanasia. This paper contends that early terminal sedation should be considered as a distinct entity. Such a reconception promises to provide a way forward in the debate, practice and policy regarding this contentious area of palliative medicine. PMID:19659853

  11. Terminal sedation: ethical implications in different situations.

    PubMed

    Hallenbeck, J L

    2000-01-01

    Terminal sedation (TS) is a recently coined term that may apply to a variety of practices with differing ethical implications. Two hypothetical cases are presented and contrasted. The first presents the more common scenario in which sedation is used for severe distress in a patient very close to death, who has stopped eating and drinking. The second case is more problematic: a nonterminally ill spinal cord injury patient requests sedation because of psychic distress. Sedation is supported in the former, but not the latter case. Suggested principles guiding the ethical use of sedation are: (1) While respect for autonomy is important, we are not obliged under all circumstances to provide sedation. (2) Physician intent matters. In providing sedation the physician's primary intent should be to alleviate suffering. (3) Reasonable inferences of intent can be made from physician actions, providing safeguards to ensure proper care. Sedatives should be titrated to observable signs of distress. (4) Proximity to death is a more useful concept than terminality in weighing benefits and burdens of sedation. (5) The nature of physician action should depend upon the nature of the suffering. Not all suffering is appropriately treated with sedation. (6) In patients close to death who have already stopped eating and drinking, sedation cannot be said to hasten death through dehydration or starvation. (7) Where TS is otherwise appropriate and where dehydration may in fact hasten death, ethical concerns may be addressed through informed consent. If hydration is refused, TS cannot be considered synonymous with euthanasia. PMID:15859672

  12. Dexmedetomidine: a novel sedative-analgesic agent

    PubMed Central

    2001-01-01

    Since the first report of clonidine, an α2-adrenoceptor agonist, the indications for this class of drugs have continued to expand. In December 1999, dexmedetomidine was approved as the most recent agent in this group and was introduced into clinical practice as a short-term sedative (<24 hours). α2-Adrenoceptor agonists have several beneficial actions during the perioperative period. They decrease sympathetic tone, with attenuation of the neuroendocrine and hemodynamic responses to anesthesia and surgery; reduce anesthetic and opioid requirements; and cause sedation and analgesia. They allow psychomotoric function to be preserved while letting the patient rest comfortably. With this combination of effects, α2-adrenoceptor agonists may offer benefits in the prophylaxis and adjuvant treatment of perioperative myocardial ischemia. Furthermore, their role in pain management and regional anesthesia is expanding. Side effects consist of mild to moderate cardiovascular depression, with slight decreases in blood pressure and heart rate. The development of new, more selective α2-adrenoceptor agonists with improved side effect profiles may provide a new concept for the administration of perioperative anesthesia and analgesia. This review aims to give background information to improve understanding of the properties and applications of the novel α2-adrenoceptor agonist, dexmedetomidine. PMID:16369581

  13. Non-Parenteral Medications for Procedural Sedation in Children- A Narrative: Review Article.

    PubMed

    Fallah, Razieh; Ferdosian, Farzad; Shajari, Ahmad

    2015-01-01

    Procedural sedation may be needed in many diagnostic and therapeutic procedures in children. To make pediatric procedural sedation as safe as possible, protocols should be developed by institutions. Response to sedation in children is highly variable, while some become deeply sedated after minimal doses, others may need much higher doses. Child developmental status, clinical circumstances and condition of patient should be considered and then pharmacologic and non-pharmacologic interventions for sedation be selected. Drug of choice and administration route depend on the condition of the child, type of procedure, and predicted pain degree. The drugs might be administered parenteral (intravenous or intramuscular) or non parenteral including oral, rectal, sublingual, aerosolized buccal and intranasal. The use of intravenous medication such propofol, ketamine, dexmedetomidine, or etomidate may be restricted in use by pediatric anesthesiologist or pediatric critical care specialists or pediatric emergency medicine specialists. In this review article we discuss on non-parenteral medications that can be used by non- anesthesiologist. PMID:26401146

  14. Dexmedetomidine versus midazolam for sedation during endoscopy: A meta-analysis

    PubMed Central

    ZHANG, FAN; SUN, HAO-RUI; ZHENG, ZE-BING; LIAO, REN; LIU, JIN

    2016-01-01

    Patients undergoing endoscopy frequently require sedation, which commonly includes the administration of midazolam or dexmedetomidine. Previous meta-analyses have mainly focused on comparing the effects of these two drugs in intensive care unit patients. In the present study, randomized controlled trials (RCTs) that compared the sedative and clinical effectiveness of these two drugs in patients undergoing endoscopy were searched in a number of databases. The meta-analysis showed that dexmedetomidine demonstrated a significantly lower rate of respiratory depression and adverse events compared with those presented upon midazolam administration. A significant difference was also observed in the sedation potency of the sedatives. The current controlled data suggest that dexmedetomidine may be an alternative to midazolam in the sedation for endoscopy. However, more high-quality and well-designed studies are required to further evaluate this conclusion. PMID:27284342

  15. Non-Parenteral Medications for Procedural Sedation in Children- A Narrative: Review Article

    PubMed Central

    FALLAH, Razieh; FERDOSIAN, Farzad; SHAJARI, Ahmad

    2015-01-01

    Procedural sedation may be needed in many diagnostic and therapeutic procedures in children. To make pediatric procedural sedation as safe as possible, protocols should be developed by institutions. Response to sedation in children is highly variable, while some become deeply sedated after minimal doses, others may need much higher doses. Child developmental status, clinical circumstances and condition of patient should be considered and then pharmacologic and non-pharmacologic interventions for sedation be selected. Drug of choice and administration route depend on the condition of the child, type of procedure, and predicted pain degree. The drugs might be administered parenteral (intravenous or intramuscular) or non parenteral including oral, rectal, sublingual, aerosolized buccal and intranasal. The use of intravenous medication such propofol, ketamine, dexmedetomidine, or etomidate may be restricted in use by pediatric anesthesiologist or pediatric critical care specialists or pediatric emergency medicine specialists. In this review article we discuss on non-parenteral medications that can be used by non- anesthesiologist. PMID:26401146

  16. Sedative and Analgesic Effects of Entonox Gas Compared with Midazolam and Fentanyl in Synchronized Cardioversion.

    PubMed

    Masoumi, Kambiz; Forouzan, Arash; Saghari, Sina; Feli, Maryam; Sattari, Ali Reza; Asgari Darian, Ali

    2015-01-01

    The purpose of this study was to determine if the Entonox gas could cause adequate analgesic and sedative effects in patients who need cardioversion. In this randomized not blinded clinical trial, the sedative and analgesic effects of midazolam and fentanyl were compared with Entonox. Eligible patients who need synchronized cardioversion because of dysrhythmia were randomly divided into two groups. The first group received intravenous midazolam and fentanyl; the second group received Entonox through a blower-dependent mask. Onset and end of sedation, sedation level, and pain score were recorded. There were nonsignificant differences between the two groups (22 patients in each group) regarding age, gender, weight, sedation level, and frequency and level of shock. The pain score recorded in the first group was 5.05 ± 1.32, and 3.9 ± 0.7 in the second group (P = 0.002). Furthermore, sedation duration and time to full recovery consciousness were shorter in the second group (P < 0.001). In the first group, seven patients needed additional doses to induce and maintain sedation. In addition, as a result of apnoea, four patients required airway support. None of them occurred in the second group. Entonox is a suitable medication in rapid cardioversion, as it has minimal side effects and adequate analgesic and sedative effects. PMID:26576298

  17. Effects of sedation on echocardiographic variables of left atrial and left ventricular function in healthy cats.

    PubMed

    Ward, Jessica L; Schober, Karsten E; Fuentes, Virginia Luis; Bonagura, John D

    2012-10-01

    Although sedation is frequently used to facilitate patient compliance in feline echocardiography, the effects of sedative drugs on echocardiographic variables have been poorly documented. This study investigated the effects of two sedation protocols on echocardiographic indices in healthy cats, with special emphasis on the assessment of left atrial size and function, as well as left ventricular diastolic performance. Seven cats underwent echocardiography (transthoracic two-dimensional, spectral Doppler, color flow Doppler and tissue Doppler imaging) before and after sedation with both acepromazine (0.1 mg/kg IM) and butorphanol (0.25 mg/kg IM), or acepromazine (0.1 mg/kg IM), butorphanol (0.25 mg/kg IM) and ketamine (1.5 mg/kg IV). Heart rate increased significantly following acepromazine/butorphanol/ketamine (mean±SD of increase, 40±26 beats/min) and non-invasive systolic blood pressure decreased significantly following acepromazine/butorphanol (mean±SD of decrease, 12±19 mmHg). The majority of echocardiographic variables were not significantly different after sedation compared with baseline values. Both sedation protocols resulted in mildly decreased left ventricular end-diastolic dimension and mildly increased left ventricular end-diastolic wall thickness. This study therefore failed to demonstrate clinically meaningful effects of these sedation protocols on echocardiographic measurements, suggesting that sedation with acepromazine, butorphanol and/or ketamine can be used to facilitate echocardiography in healthy cats. PMID:22577049

  18. EISCAT observations during MAC/SINE and MAC/Epsilon

    NASA Technical Reports Server (NTRS)

    Roettger, J.; Hoppe, U.-P.; Hall, C.

    1989-01-01

    The EISCAT incoherent scatter radar facility in Tromsoe, Norway was operated during the MAC/SINE campaign for 78 hours in the period 10 June to 17 July 1987, and during the MAC/Epsilon campaign for 90 hours in the period 15 October to 5 November 1987. The VHF (224 MHz) radar operations during MAC/SINE yielded most interesting observations of strong coherent echoes from the mesopause region. Characteristic data of these polar mesospheric summer echoes are presented. The UHF (933 MHz) radar operations during MAC/Epsilon were done with 18 deg off zenith beam and allows the deduction of meridonal and horizontal wind components as well as radial velocity spectra in addition to the usual electron density profiles in the D and lower E regions. Some results from the VHF and UHF radars indicating the presence of gravity waves are examined.

  19. DETERMINATION OF A SEDATIVE PROTOCOL FOR USE IN CALIFORNIA SEA LIONS (ZALOPHUS CALIFORNIANUS) WITH NEUROLOGIC ABNORMALITIES UNDERGOING ELECTROENCEPHALOGRAPHIC EXAMINATION

    PubMed Central

    Dennison, Sophie; Haulena, Martin; Williams, D. Colette; Dawson, John; Yandell, Brian S.; Gulland, Frances M. D.

    2010-01-01

    Sedation in sea lions exhibiting abnormal neurologic signs may require modification of established sedation protocols because of the likely interaction between effects of the sedative and physiologic changes in diseased animals. The effects of two sedative combinations, 0.07 mg/kg medetomidine and 0.07 mg/kg medetomidine plus 0.2 mg/kg butorphanol, were compared between California sea lions (Zalophus californianus) with signs of neurologic dysfunction (n = 33) and without neurologic signs (n = 8). Sedation depth was scored on a scale of 0 (no effect) to 4 (profound sedation) assessed by response to auditory, tactile, and visual stimuli at the time of perceived maximal sedative effect. In the medetomidine-alone group, sea lions with neurologic signs attained a median sedation score of 4 compared to a median sedation score of 1 in the clinically normal sea lions. Sea lions with and without neurologic signs given medetomidine–butorphanol attained a median sedation score of 4. No statistically significant difference in time to induction and respiratory rate was found between the two sedation protocols in all sea lions. In the sea lions with neurologic signs, the recovery time from medetomidine–butorphanol sedation was prolonged (P < 0.01) and minimum recorded heart rates, although remaining within normal physiologic limits, were lower (P = 0.02) when compared to the sea lions administered medetomidine alone. Muscle jerks were observed in many animals given medetomidine–butorphanol and were detrimental to the diagnostic quality of the electroencephalogram (EEG) recording. Medetomidine alone at a dose rate of 0.07 mg/kg thus provides adequate and safe sedation in sea lions with neurologic signs undergoing EEG evaluation. PMID:19110694

  20. Sedation With Propofol Has No Effect on Capsule Endoscopy Completion Rates

    PubMed Central

    Gan, Huo-Ye; Weng, Yi-Jie; Qiao, Wei-Guang; Chen, Zhen-Yu; Xu, Zhi-Min; Bai, Yang; Gong, Wei; Wan, Tian-Mo; Pan, De-Shou; Shi, Yong-Sheng; Qiu, Ai-Jun; Zhi, Fa-Chao

    2015-01-01

    Abstract Patients who need both capsule endoscopy (CE) and colonoscopy often undergo both examinations on the same day to avoid repeated bowel preparation and fasting. Sedation can relieve pain and is commonly used for colonoscopies but may influence the CE completion rate. To determine whether sedation with propofol influences the completion rate and small-bowel transit time (SBTT) of CE. From July 2014 to December 2014, patients (18–65 years old) who needed both CE and colonoscopy were assessed consecutively for enrollment in our study. Colonoscopies were performed with or without sedation based on patient preferences on the day of capsule ingestion. The completion rate, SBTT, and diagnostic yield of CEs were recorded. Patients’ satisfaction and pain scores were also recorded. Sedation with propofol had no significant effect on CE completion rates (83.3% sedation group vs 81.8% nonsedation group, P = 0.86) but was associated with increased SBTT (403.6 ± 160.3 sedation group vs 334.5 ± 134.4 nonsedation group, P = 0.006). The diagnostic yields in the sedation and nonsedation groups were 69.4% and 65.9%, respectively (P = 0.74). The median satisfaction scores were 8.6 in the sedation group and 3.5 in the nonsedation group (P < 0.001). Median pain scores were 1.4 in the sedation group and 6.7 in the nonsedation group (P < 0.001). Sedation with propofol increased SBTT but had no effect on CE completion rates, suggesting that CE and colonoscopy with propofol can be performed on the same day (clinical trial registration number: ChiCTR-ONRC-14004866). PMID:26166122

  1. Sedative effects of intramuscular alfaxalone administered to cats.

    PubMed

    Tamura, Jun; Ishizuka, Tomohito; Fukui, Sho; Oyama, Norihiko; Kawase, Kodai; Itami, Takaharu; Miyoshi, Kenjiro; Sano, Tadashi; Pasloske, Kirby; Yamashita, Kazuto

    2015-08-01

    The sedative effects of intramuscular (IM) alfaxalone in 2-hydroxypropyl-beta-cyclodextrin (alfaxalone-HPCD) were evaluated in cats. The cats were treated with alfaxalone-HPCD in five occasions with a minimum 14-day interval between treatments: an IM injection of 1.0 mg/kg (IM1), 2.5 mg/kg (IM2.5), 5 mg/kg (IM5) or 10 mg/kg (IM10), or an intravenous injection of 5 mg/kg (IV5). The sedative effects were evaluated subjectively using a composite measurement scoring system (a maximum score of 16). Cardio-respiratory variables were measured non-invasively. The median sedation scores peaked at 10 min (score 9), 15 min (score 14), 10 min (score 16), 10 to 20 min (score 16) and 2 to 5 min (score 16) after the IM1, IM2.5, IM5, IM10 and IV5 treatments, respectively. The IM5 treatment produced longer lasting sedation, compared to the IV5 treatment. Durations of maintenance of lateral recumbency after the IM10 treatment (115 ± 22 min) were longer than those after the IM2.5 (40 ± 15 min), IM5 (76 ± 21 min) and IV5 treatments (50 ± 5 min). Cardio-respiratory variables remained within clinically acceptable ranges, except for each one cat that showed hypotension (<60 mmHg) after the IM10 and IV5 treatments. Tremors, ataxia and opisthotonus-like posture were observed during the early recovery period after the IM2.5, IM5, IM10 and IV5 treatments. In conclusion, IM alfaxalone-HPCD produced dose-dependent and clinically relevant sedative effect at 2.5 to 10 mg/kg in healthy cats. Hypotension may occur at higher IM doses of alfaxalone-HPCD. PMID:25786416

  2. Sedative effects of intramuscular alfaxalone administered to cats

    PubMed Central

    TAMURA, Jun; ISHIZUKA, Tomohito; FUKUI, Sho; OYAMA, Norihiko; KAWASE, Kodai; ITAMI, Takaharu; MIYOSHI, Kenjiro; SANO, Tadashi; PASLOSKE, Kirby; YAMASHITA, Kazuto

    2015-01-01

    The sedative effects of intramuscular (IM) alfaxalone in 2-hydroxypropyl-beta-cyclodextrin (alfaxalone-HPCD) were evaluated in cats. The cats were treated with alfaxalone-HPCD in five occasions with a minimum 14-day interval between treatments: an IM injection of 1.0 mg/kg (IM1), 2.5 mg/kg (IM2.5), 5 mg/kg (IM5) or 10 mg/kg (IM10), or an intravenous injection of 5 mg/kg (IV5). The sedative effects were evaluated subjectively using a composite measurement scoring system (a maximum score of 16). Cardio-respiratory variables were measured non-invasively. The median sedation scores peaked at 10 min (score 9), 15 min (score 14), 10 min (score 16), 10 to 20 min (score 16) and 2 to 5 min (score 16) after the IM1, IM2.5, IM5, IM10 and IV5 treatments, respectively. The IM5 treatment produced longer lasting sedation, compared to the IV5 treatment. Durations of maintenance of lateral recumbency after the IM10 treatment (115 ± 22 min) were longer than those after the IM2.5 (40 ± 15 min), IM5 (76 ± 21 min) and IV5 treatments (50 ± 5 min). Cardio-respiratory variables remained within clinically acceptable ranges, except for each one cat that showed hypotension (<60 mmHg) after the IM10 and IV5 treatments. Tremors, ataxia and opisthotonus-like posture were observed during the early recovery period after the IM2.5, IM5, IM10 and IV5 treatments. In conclusion, IM alfaxalone-HPCD produced dose-dependent and clinically relevant sedative effect at 2.5 to 10 mg/kg in healthy cats. Hypotension may occur at higher IM doses of alfaxalone-HPCD. PMID:25786416

  3. Safe sedation for the non-anaesthetist.

    PubMed

    Yusuff, Hakeem; Prakash, Amit; Webb, Stephen

    2016-04-01

    Sedation has become an essential part of many invasive medical procedures. However, over the years, there have been concerns about the safety of sedation techniques. Various combinations of drug-based and non-drug-based approaches are used for procedural sedation depending on patient factors and the anticipated discomfort associated with each procedure. The common denominator for successful practice for a sedationist is knowledge, adequate training and a mechanism for revalidation. PMID:27037386

  4. Fiverr MacGyver

    NASA Astrophysics Data System (ADS)

    Hut, Rolf; van de Giesen, Nick; Larson, Martha

    2014-05-01

    Crowdsourcing has become popular over the past years, also for scientific endeavors. There are many Citizen Science projects and crowdfunding platforms, such as Kickstarter, that are make helpful contributions to moving environmental science forward. An interesting underused source of useful crowd-derived contributions to research is the website Fiverr.com. On this platform, thousands of people, acting as small-scale freelance contractors, offer their skills in the form of services. The platform offers a chance for people to take a hobby, skill, or pastime and make it something more by reaching out to a wider audience and by receiving a payment in return for services. As is typical of other crowdsourcing platforms, the tasks are small and usually self contained. As the name Fiverr suggests, offers start at US5 to provide a particular service. Services offered range from graphic design, to messages sung or spoken with various styles or accents, to complete apps for Android or iPhone. Skill providers on the platform can accept a range of variation of definition in the tasks, some can be described in general terms, for others it is more appropriate to provide examples. Fiverr provides a central location for those offering skills and those needing services to find each other, it makes it possible to communicate and exchange files, to make payments, and it provides support for resolving disputes. In all cases, it is important to keep expectations aligned with the nature of the platform: quality can and will vary. Ultimately, the critical contribution of Fiverr is not to replace professional services or otherwise save money, but rather to provide access to a large group of people with specialized skills who are able to make a contribution on short notice. In the context of this session, it can be considered a pool of people with MacGyver skills lying in wait of a MacGyyer task to attack. There are many ways in which Fiverr tasks, which are called 'gigs', can be useful in

  5. Experience with conscious sedation for oocyte retrieval in Nigeria.

    PubMed

    Fiebai, P O; Ogunmokun, A A; Ajayi, R A

    2008-04-01

    Conscious sedation is the most common method of pain relief used during ultrasound-directed transvaginal follicle aspiration (UDFA) for in-vitro fertilisation/embryo transfer (IVF/ETI). It is associated with minimal risks and facilitates early discharge following UDFA. The aim of this study was to assess clients' pain experience, acceptance of conscious sedation and correlates of pain during oocyte retrieval for in vitro fertilisation (IVF) at The Bridge Clinic, Port Harcourt. It was a cross-sectional survey conducted between May 1 and October 31 2004. Pain was assessed using a 100 mm visual analog scale (VAS). Clients' pain experience and correlates were evaluated using Pearson's correlation and the student's t-test. The mean pain score was low and the duration of the procedure did not significantly affect the severity of pain felt by the client. Most (69.0%) clients would prefer the same sedation and analgesia for any subsequent procedure. Conscious sedation and analgesia are one of several methods used to relieve pain during oocyte retrieval in IVF procedures. The information in this study is of value when considering the management of pain in patients undergoing oocyte retrieval procedures. PMID:20695152

  6. Sedation in neurological intensive care unit

    PubMed Central

    Paul, Birinder S.; Paul, Gunchan

    2013-01-01

    Analgesia and sedation has been widely used in intensive care units where iatrogenic discomfort often complicates patient management. In neurological patients maximal comfort without diminishing patient responsiveness is desirable. In these patients successful management of sedation and analgesia incorporates a patient based approach that includes detection and management of predisposing and causative factors, including delirium, monitoring using sedation scales, proper medication selection, emphasis on analgesia based drugs and incorporation of protocols or algorithms. So, to optimize care clinician should be familiar with the pharmacokinetic and pharmacodynamic variables that can affect the safety and efficacy of analgesics and sedatives. PMID:23956563

  7. Preprocedural Assessment for Sedation in Gastrointestinal Endoscopy.

    PubMed

    Tetzlaff, John E; Maurer, Walter G

    2016-07-01

    The role of the anesthesia service in sedation for gastrointestinal endoscopy (GIE) has been steadily increasing. The goals of preprocedural assessment are determined by the specific details of the procedure, the issues related to the illness that requires the endoscopy, comorbidities, the goals for sedation, and the risk of complications from the sedation and the endoscopic procedure. Rather than consider these issues as separate entities, they should be considered as part of a continuum of preparation for GIE. This is told from the perspective of an anesthesiologist who regularly participates in the full range of sedation for GIE. PMID:27372768

  8. Paediatric procedural sedation within the emergency department.

    PubMed

    Krieser, David; Kochar, Amit

    2016-02-01

    Procedural sedation and analgesia in children requires the use of non-pharmacological and pharmacological approaches to facilitate the management of painful procedures. The development of skills in such techniques has mirrored the development of paediatric emergency medicine as a subspecialty. Governance, education and credentialing must facilitate safe sedation practice, using a structured approach, as sedating children in the busy environment of an emergency department is not without risk. Emergency clinicians, patients and caregivers all have a role to play in developing a safe, effective sedation plan. PMID:27062624

  9. Pediatric dental sedation: challenges and opportunities

    PubMed Central

    Nelson, Travis M; Xu, Zheng

    2015-01-01

    High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of

  10. Dexmedetomidine sedation for transesophageal echocardiography during percutaneous atrial septal defect closure in adult.

    PubMed

    Jung, Jae Wook; Cheol Go, Gwang; Jeon, Sang Yoon; Bang, Sira; Lee, Ki Hwa; Kim, Yong Han; Kim, Dong-Kie

    2013-11-01

    Atrial septal defect (ASD) is second common congenital heart disease that often leads to adult period. Intracardiac or transesophageal echocardiography (TEE) is essential for percutaneous closure of ASD using Amplatzer septal occluder. Dexmedetomidine (DEX), which is a highly selective α2-agonist, has sedative and analgesic properties without respiratory depression in the clinical dose range. We report percutaneous closure of ASD with TEE under DEX sedation. PMID:24550975

  11. [Pain, delirium and sedation in intensive unit care].

    PubMed

    Mazul-Sunko, Branka; Brozović, Gordana; Goranović, Tatjana

    2012-03-01

    Delirium is a complication of intensive care treatment associated with permanent cognitive decline and increased mortality after hospital discharge. In several studies, postoperative pain was found as a possible precipitating factor. Aggressive pain treatment is part of current multicompartment protocols for delirium prevention after hip fracture. Protocol based sedation, pain and delirium management in intensive care units have been shown to have clinical and economic advantages. PMID:23088085

  12. Determination of a sedative protocol for use in California sea lions (Zalophus californianus) with neurologic abnormalities undergoing electroencephalographic examination.

    PubMed

    Dennison, Sophie; Haulena, Martin; Williams, D Colette; Dawson, John; Yandell, Brian S; Gulland, Frances M D

    2008-12-01

    Sedation in sea lions exhibiting abnormal neurologic signs may require modification of established sedatior protocols because of the likely interaction between effects of the sedative and physiologic changes in diseased animals The effects of two sedative combinations, 0.07 mg/kg medetomidine and 0.07 mg/kg medetomidine plus 0.2 mg/kg butorphanol, were compared between California sea lions (Zalophus californianus) with signs of neurologic dysfunctior (n=33) and without neurologic signs (n=8). Sedation depth was scored on a scale of 0 (no effect) to 4 (profound sedation) assessed by response to auditory, tactile, and visual stimuli at the time of perceived maximal sedative effect In the medetomidine-alone group, sea lions with neurologic signs attained a median sedation score of 4 compared to a median sedation score of 1 in the clinically normal sea lions. Sea lions with and without neurologic signs giver medetomidine-butorphanol attained a median sedation score of 4. No statistically significant difference in time to induction and respiratory rate was found between the two sedation protocols in all sea lions. In the sea lions with neurologic signs, the recovery time from medetomidine-butorphanol sedation was prolonged (P < 0.01) and minimum recorded heart rates, although remaining within normal physiologic limits, were lower (P = 0.02) when compared to the sea lions administered medetomidine alone. Muscle jerks were observed in many animals given medetomidine-butorphanol and were detrimental to the diagnostic quality of the electroencephalogram (EEG) recording. Medetomidine alone at a dose rate of 0.07 mg/kg thus provides adequate and safe sedation in sea lions with neurologic signs undergoing EEG evaluation. PMID:19110694

  13. Atypical antipsychotics: sedation versus efficacy.

    PubMed

    Kane, John M; Sharif, Zafar A

    2008-01-01

    Many patients with schizophrenia or bipolar disorder experience disturbances in their sleep-wake cycle, which may be a result of the disorder itself, of pharmacotherapy, or of a comorbid sleep disorder. These sleep disruptions can seriously impair patients' functioning as well as their quality of life. Therefore, accurate assessment of sleep problems is essential to appropriately treat patients and promote symptomatic remission. Sedating antipsychotics may ameliorate sleep disturbances, as well as agitation or other behavioral emergencies; however, these agents may also sedate patients to the point of dissatisfaction with the medication and/or impaired functioning, which may, in turn, increase treatment noncompliance and nonadherence. Using short-term adjunctive medications, such as benzo-diazepines or hypnotic agents, with a nonsedating antipsychotic to alleviate sleep disturbances is a reasonable treatment option for patients with schizophrenia or bipolar disorder. Overall, the pharma-cokinetics and pharmacodynamics of atypical antipsychotics are important factors to consider in the risk-benefit analysis, as are dosing strategies and individual patient factors, and clinicians must decide which agents are most appropriate for which patients. PMID:18484805

  14. Safe sedation in modern cardiological practice.

    PubMed

    Furniss, Stephen S; Sneyd, J Robert

    2015-10-01

    Safe sedation is fundamental to many modern cardiological procedures, and following the publication of the report on safe sedation by the Academy of Medical Royal Colleges, this report discusses sedation specifically in cardiological practice. The major areas within cardiology that use sedation are cardioversion, catheter ablation particularly of atrial fibrillation, transoesophageal echocardiography, implantable device (cardiovascular implantable electronic device) procedures and other procedures such as transcatheter aortic valve replacement. There is increasing demand for cardiological sedation but there is wide geographical variation in its use and there are also growing data to support non-anaesthetists giving sedation. The use of benzodiazepines, particularly for short procedures, is common, but even here good record-keeping and audit together with an understanding of the continuum of sedation and having appropriately trained staff and the necessary facilities are vital. Nurse administration of propofol may be appropriate for some procedures in cardiology that require at least moderate sedation. Appropriate training is essential and the use of capnography and target controlled infusion pumps for propofol administration is recommended. PMID:26085525

  15. Pharmacodynamic Considerations for Moderate and Deep Sedation

    PubMed Central

    Becker, Daniel E.

    2012-01-01

    Moderate and deep sedation can be provided using various classes of drugs, each having unique mechanisms of action. While drugs within a given classification share similar mechanisms and effects, certain classes demonstrate superior efficacy but added concern regarding safety. This continuing education article will highlight essential principles of pharmacodynamics and apply these to drugs commonly used to produce moderate and deep sedation. PMID:22428972

  16. The Multidimensional Audioconferencing Classification System (MACS).

    ERIC Educational Resources Information Center

    Cookson, Peter S.; Chang, Yu-bi

    1995-01-01

    Describes the development of the Multidimensional Audioconferencing Classification System (MACS), an instrument for the tabulation, analysis, and interpretation of audioconferencing instructional interactions. MACS draws on three theoretical and empirical streams: (1) systematic small group interaction analysis; (2) systematic classroom…

  17. The effect of interruption to propofol sedation on auditory event-related potentials and electroencephalogram in intensive care patients

    PubMed Central

    Yppärilä, Heidi; Nunes, Silvia; Korhonen, Ilkka; Partanen, Juhani; Ruokonen, Esko

    2004-01-01

    Introduction In this observational pilot study we evaluated the electroencephalogram (EEG) and auditory event-related potentials (ERPs) before and after discontinuation of propofol sedation in neurologically intact intensive care patients. Methods Nineteen intensive care unit patients received a propofol infusion in accordance with a sedation protocol. The EEG signal and the ERPs were measured at the frontal region (Fz) and central region (Cz), both during propofol sedation and after cessation of infusion when the sedative effects had subsided. The EEG signal was subjected to power spectral estimation, and the total root mean squared power and spectral edge frequency 95% were computed. For ERPs, we used an oddball paradigm to obtain the N100 and the mismatch negativity components. Results Despite considerable individual variability, the root mean squared power at Cz and Fz (P = 0.004 and P = 0.005, respectively) and the amplitude of the N100 component in response to the standard stimulus at Fz (P = 0.022) increased significantly after interruption to sedation. The amplitude of the N100 component (at Cz and Fz) was the only parameter that differed between sedation levels during propofol sedation (deep versus moderate versus light sedation: P = 0.016 and P = 0.008 for Cz and Fz, respectively). None of the computed parameters correlated with duration of propofol infusion. Conclusion Our findings suggest that use of ERPs, especially the N100 potential, may help to differentiate between levels of sedation. Thus, they may represent a useful complement to clinical sedation scales in the monitoring of sedation status over time in a heterogeneous group of neurologically intact intensive care patients. PMID:15566595

  18. Sedation in pediatric imaging using intranasal midazolam.

    PubMed

    Harcke, H T; Grissom, L E; Meister, M A

    1995-01-01

    Intranasal midazolam offers an attractive alternative for use as a sedative agent for medical imaging studies in children. Its convenient administration and rapid onset are significant advantages over intravenous and oral agents. Because of its short duration, it is effective only for short procedures and as an adjunct to other sedative agents. When younger children present with such requirements, a dose of 0.2 mg/kg has been safe and effective in our experience. We advocate its use with adherence to guidelines for sedation published by the American Academy of Pediatrics. PMID:7567258

  19. Oral Sedation: A Primer on Anxiolysis for the Adult Patient

    PubMed Central

    Donaldson, Mark; Gizzarelli, Gino; Chanpong, Brian

    2007-01-01

    The use of sedatives has established efficacy and safety for managing anxiety regarding dental treatment. This article will provide essential information regarding the pharmacology and therapeutic principles that govern the appropriate use of orally administered sedatives to provide mild sedation (anxiolysis). Dosages and protocols are intended for this purpose, not for providing moderate or deeper sedation levels. PMID:17900211

  20. Sedation Monitoring and Management during Percutaneous Endoscopic Lumbar Discectomy

    PubMed Central

    Oksar, Menekse; Gumus, Tulin; Kanbak, Orhan

    2016-01-01

    Percutaneous endoscopic laser discectomy (PELD) is a painful intervention that requires deep sedation and analgesia. However, sedation should be light at some point because cooperation by the patient during the procedure is required for successful surgical treatment. Light sedation poses a problem for endotracheal intubation, while patients placed in the prone position during percutaneous endoscopic discectomy pose a problem for airway management. Therefore, under these conditions, sedation should be not deeper than required. Here we report the sedation management of three cases that underwent PELD, with a focus on deep and safe sedation that was monitored using bispectral index score and observer's assessment of alertness/sedation score. PMID:27298743

  1. Sedation Monitoring and Management during Percutaneous Endoscopic Lumbar Discectomy.

    PubMed

    Oksar, Menekse; Gumus, Tulin; Kanbak, Orhan

    2016-01-01

    Percutaneous endoscopic laser discectomy (PELD) is a painful intervention that requires deep sedation and analgesia. However, sedation should be light at some point because cooperation by the patient during the procedure is required for successful surgical treatment. Light sedation poses a problem for endotracheal intubation, while patients placed in the prone position during percutaneous endoscopic discectomy pose a problem for airway management. Therefore, under these conditions, sedation should be not deeper than required. Here we report the sedation management of three cases that underwent PELD, with a focus on deep and safe sedation that was monitored using bispectral index score and observer's assessment of alertness/sedation score. PMID:27298743

  2. Guideline Implementation: Moderate Sedation/Analgesia.

    PubMed

    Fencl, Jennifer L

    2016-05-01

    Moderate sedation/analgesia is practiced in a variety of settings and delivered by a variety of health care providers, with a goal of reducing the patient's anxiety and discomfort during diagnostic and therapeutic procedures. The updated AORN "Guideline for care of the patient receiving moderate sedation/analgesia" provides guidance on RN administration of moderate sedation/analgesia within the scope of nursing practice as defined by the state boards of nursing. The guideline addresses patient selection and assessment, staffing for the procedure, patient monitoring, medication administration, and criteria for postoperative discharge. This article focuses on key points of the guideline to promote safe care throughout the perioperative continuum for a patient receiving moderate sedation/analgesia. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures. PMID:27129752

  3. Sedation in the intensive care unit.

    PubMed

    McGrane, S; Pandharipande, P P

    2012-03-01

    Analgesics and sedatives are commonly prescribed in the ICU environment for patient comfort, however, recent studies have shown that these medications can themselves lead to adverse patient outcomes. Interventions that facilitate a total dose reduction in analgesic and sedative medications e.g. the use of nurse controlled protocol guided sedation, the combination of spontaneous awakening and breathing trials, and the use of short acting medications, are associated with improved outcomes such as decreased time of mechanical ventilation and ICU length of stay. This purpose of this review is to provide an overview of the pharmacology of commonly prescribed analgesics and sedatives, and to discuss the evidence regarding best prescribing practices of these medications, to facilitate early liberation from mechanical ventilation and to promote animation in critically ill patients. PMID:22240616

  4. Controlled Sedation with Alphaxalone-Alphadolone

    PubMed Central

    Ramsay, M. A. E.; Savege, T. M.; Simpson, B. R. J.; Goodwin, R.

    1974-01-01

    Alphaxalone-alphadolone (Althesin), diluted and administered as a controlled infusion, was used as a sedative for 30 patients in an intensive therapy unit. This technique allowed rapid and accurate control of the level of sedation. It had three particularly useful applications: it provided “light sleep,” allowed rapid variation in the level of sedation, and enabled repeated assessment of the central nervous system. Sedation was satisfactory for 86% of the total time, and no serious complications were attributed to the use of the drug. Furthermore, though alphaxalone-alphadolone was given for periods up to 20 days there was no evidence of tachyphylaxis or delay in recovery time. PMID:4835444

  5. Remimazolam: The future of its sedative potential.

    PubMed

    Goudra, Basavana Gouda; Singh, Preet Mohinder

    2014-07-01

    Remimazolam (CNS 7056) is a new drug innovation in anesthesia. It combines the properties of two unique drugs already established in anesthesia - Midazolam and remifentanil. It acts on GABA receptors like midazolam and has organ-independent metabolism like remifentanil. It is likely to be the sedative of the future, as preliminary phase II trials have shown minimal residual effects on prolonged infusions. It has potential to be used as a sedative in ICU and as a novel agent for procedural sedation. Unlike most rapidly acting intravenous sedatives available presently, the propensity to cause apnea is very low. Availability of a specific antagonist (flumazenil) adds to its safety even in cases of overdose. The present review discusses remimazolam's potential as a new drug in anesthesia along with the presently available literary evidence. PMID:25191193

  6. Procedural sedation and analgesia in pediatric patients

    PubMed Central

    Mahajan, Charu; Dash, Hari Hara

    2014-01-01

    A spectrum of conditions requires sedation and analgesia in pediatric population. Ineffective treatment of pain may result in physiological and behavioral responses that can adversely affect the developing nociceptive system. The recognition of pain in children can be facilitated by different pain scales. This article reviews the procedural sedation and analgesia (PSA) practices in children along with pharmacology of the drugs used for this purpose. PMID:24891893

  7. Sedation Challenges: Obesity and Sleep Apnea.

    PubMed

    Jirapinyo, Pichamol; Thompson, Christopher C

    2016-07-01

    This article reviews the data for diagnostic and uncomplicated therapeutic upper endoscopy, which show it is safe and effective to perform the procedure under moderate sedation with a combination of benzodiazepine and opioids. For more complex procedures or for superobese patients anesthesia support is recommended. Performing endoscopy in this population should alert providers to plan carefully and individualize sedation plans because there is no objective way to quantify this risk pre-endoscopically. PMID:27372775

  8. Arousal from sedation in lower abdominal surgeries under spinal anesthesia: Comparison between dexmedetomidine and clonidine

    PubMed Central

    Kaur, Sarvjeet; Gupta, Kewal Krishan; Singh, Amanjot; Sunita; Baghla, Naresh

    2016-01-01

    Background and Aim: Dexmedetomidine and clonidine are commonly used drugs for sedation during regional anesthesia. However, data regarding arousal time from sedation with these drugs is sparse. Hence, we designed a study to compare arousal time from sedation with dexmedetomidine and clonidine during spinal anesthesia. We also tried to find out the correlation between clinical and objective method used for assessing the depth of sedation. Materials and Methods: In this study, 120 patients were randomly assigned in two groups to receive either dexmedetomidine (Group DE, n = 60) or Clonidine (Group CL, n = 60). Group DE received 1 μg/kg of dexmedetomidine followed by infusion at 0.5 μg/kg/h while Group CL received 1 μg/kg of clonidine followed by infusion at 1 μg/kg/h and titration until targeted Ramsay sedation scale (RSS) score of 3–5 was achieved and maintained. RSS and bispectral (BIS) were monitored until arousal of the patients. The time to achieve RSS of 2 and BIS of 90 during recovery, the correlation between BIS and RSS score in both the study groups and duration of postoperative analgesia were noted. Statistical Analysis Used: Chi-square tests for nonparametric data and Student's t-test for parametric data were used. Correlation between RSS and BIS was calculated with spearman correlation method. Results: Arousal time from sedation and time to reach BIS score 90 was lower for Group DE as compared to Group CL (P = 0.001). Dexmedetomidine also increased the time to first postoperative analgesic request when compared with clonidine (198.23 ± 33.15 min vs. 150.65 ± 28.55 min, P = 0.01). Conclusions: Intravenous dexmedetomidine infusion has shorter arousal time from sedation than clonidine during spinal anesthesia. A strong correlation exists between BIS and RSS during recovery from sedation. PMID:26957699

  9. Current methods of sedation in dental patients - a systematic review of the literature

    PubMed Central

    Silvestre-Rangil, Javier; Cutando-Soriano, Antonio; López-Jiménez, Julián

    2016-01-01

    Objetive The main objective of this systematic literature review is to identify the safest and most effective sedative drugs so as to ensure successful sedation with as few complications as possible. Study Design A systematic literature review of the PubMed MEDLINE database was carried out using the key words “conscious sedation,” “drugs,” and “dentistry.” A total of 1,827 scientific articles were found, and these were narrowed down to 473 articles after applying inclusion and exclusion criteria. These 473 studies were then individually assessed for their suitability for inclusion in this literature review. Results A total of 21 studies were selected due to their rigorous study design and conduciveness to further, more exhaustive analysis. The selected studies included a total of 1,0003 patients classified as ASA I or II. Midazolam was the drug most frequently used for successful sedation in dental surgical procedures. Ketamine also proved very useful when administered intranasally, although some side effects were observed when delivered via other routes of administration. Both propofol and nitrous oxide (N2O) are also effective sedative drugs. Conclusions Midazolam is the drug most commonly used to induce moderate sedation in dental surgical procedures, and it is also very safe. Other sedative drugs like ketamine, dexmedetomidine and propofol have also been proven safe and effective; however, further comparative clinical studies are needed to better demonstrate which of these are the safest and most effective. Key words:Conscious sedation, drugs, dentistry. PMID:27475684

  10. Trends in Continuous Deep Sedation until Death between 2007 and 2013: A Repeated Nationwide Survey

    PubMed Central

    Cohen, Joachim; Rietjens, Judith

    2016-01-01

    Background Continuous deep sedation until death is a highly debated medical practice, particularly regarding its potential to hasten death and its proper use in end-of-life care. A thorough analysis of important trends in this practice is needed to identify potentially problematic developments. This study aims to examine trends in the prevalence and practice characteristics of continuous deep sedation until death in Flanders, Belgium between 2007 and 2013, and to study variation on physicians’ degree of palliative training. Methods Population-based death certificate study in 2007 and 2013 in Flanders, Belgium. Reporting physicians received questionnaires about medical practices preceding the patient’s death. Patient characteristics, clinical characteristics (drugs used, duration, artificial nutrition/hydration, intention and consent), and palliative care training of attending physician were recorded. We posed the following question regarding continuous deep sedation: ‘Was the patient continuously and deeply sedated or kept in a coma until death by the use of one or more drugs’. Results After the initial rise of continuous deep sedation to 14.5% in 2007 (95%CI 13.1%-15.9%), its use decreased to 12.0% in 2013 (95%CI 10.9%-13.2%). Compared with 2007, in 2013 opioids were less often used as sole drug and the decision to use continuous deep sedation was more often preceded by patient request. Compared to non-experts, palliative care experts more often used benzodiazepines and less often opioids, withheld artificial nutrition/hydration more often and performed sedation more often after a request from or with the consent of the patient or family. Conclusion Worldwide, this study is the first to show a decrease in the prevalence of continuous deep sedation. Despite positive changes in performance and decision-making towards more compliance with due care requirements, there is still room for improvement in the use of recommended drugs and in the involvement of

  11. Dexmedetomidine-Induced Sedation Does Not Mimic the Neurobehavioral Phenotypes of Sleep in Sprague Dawley Rat

    PubMed Central

    Garrity, Abigail G.; Botta, Simhadri; Lazar, Stephanie B.; Swor, Erin; Vanini, Giancarlo; Baghdoyan, Helen A.; Lydic, Ralph

    2015-01-01

    Study Objectives: Dexmedetomidine is used clinically to induce states of sedation that have been described as homologous to nonrapid eye movement (NREM) sleep. A better understanding of the similarities and differences between NREM sleep and dexmedetomidine-induced sedation is essential for efforts to clarify the relationship between these two states. This study tested the hypothesis that dexmedetomidine-induced sedation is homologous to sleep. Design: This study used between-groups and within-groups designs. Setting: University of Michigan. Participants: Adult male Sprague Dawley rats (n = 40). Interventions: Independent variables were administration of dexmedetomidine and saline or Ringer's solution (control). Dependent variables included time spent in states of wakefulness, sleep, and sedation, electroencephalographic (EEG) power, adenosine levels in the substantia innominata (SI), and activation of pCREB and c-Fos in sleep related forebrain regions. Measurements and Results: Dexmedetomidine significantly decreased time spent in wakefulness (-49%), increased duration of sedation (1995%), increased EEG delta power (546%), and eliminated the rapid eye movement (REM) phase of sleep for 16 h. Sedation was followed by a rebound increase in NREM and REM sleep. Systemically administered dexmedetomidine significantly decreased (-39%) SI adenosine levels. Dialysis delivery of dexmedetomidine into SI did not decrease adenosine levels. Systemic delivery of dexmedetomidine did not alter c-Fos or pCREB expression in the horizontal diagonal band, or ventrolateral, median, and medial preoptic areas of the hypothalamus. Conclusions: Dexmedetomidine significantly altered normal sleep phenotypes, and the dexmedetomidine-induced state did not compensate for sleep need. Thus, in the Sprague Dawley rat, dexmedetomidine-induced sedation is characterized by behavioral, electrographic, and immunohistochemical phenotypes that are distinctly different from similar measures obtained

  12. Comfort and patient-centred care without excessive sedation: the eCASH concept.

    PubMed

    Vincent, Jean-Louis; Shehabi, Yahya; Walsh, Timothy S; Pandharipande, Pratik P; Ball, Jonathan A; Spronk, Peter; Longrois, Dan; Strøm, Thomas; Conti, Giorgio; Funk, Georg-Christian; Badenes, Rafael; Mantz, Jean; Spies, Claudia; Takala, Jukka

    2016-06-01

    We propose an integrated and adaptable approach to improve patient care and clinical outcomes through analgesia and light sedation, initiated early during an episode of critical illness and as a priority of care. This strategy, which may be regarded as an evolution of the Pain, Agitation and Delirium guidelines, is conveyed in the mnemonic eCASH-early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as the default presumption for intensive care unit (ICU) patients in the absence of recognised medical requirements for deeper sedation. Effective pain relief is the first priority for implementation of eCASH: we advocate flexible multimodal analgesia designed to minimise use of opioids. Sedation is secondary to pain relief and where possible should be based on agents that can be titrated to a prespecified target level that is subject to regular review and adjustment; routine use of benzodiazepines should be minimised. From the outset, the objective of sedation strategy is to eliminate the use of sedatives at the earliest medically justifiable opportunity. Effective analgesia and minimal sedation contribute to the larger aims of eCASH by facilitating promotion of sleep, early mobilization strategies and improved communication of patients with staff and relatives, all of which may be expected to assist rehabilitation and avoid isolation, confusion and possible long-term psychological complications of an ICU stay. eCASH represents a new paradigm for patient-centred care in the ICU. Some organizational challenges to the implementation of eCASH are identified. PMID:27075762

  13. Monitoring sedation levels by EEG spectral analysis.

    PubMed Central

    Griffiths, M. J.; Preece, A. W.; Green, J. L.

    1991-01-01

    Real-time electroencephalographic power spectra were obtained for a group of 37 volunteers undergoing sedation with enflurane at different concentrations in air. In part one, 17 subjects were given 0.5%, 0.75%, and 1.0% for 4 min at each level, and recovery after 5 min was assessed by the Trieger method. There was considerable variation in subject response to the different doses, but adequate sedation was indicated by the presence of a strong alpha rhythm (9-11 Hz) and suppression of frequencies below 5 Hz. Overdose was indicated by an initial shift in the alpha frequency to a lower value (6-7 Hz) followed by the appearance of delta waves (0.5-4 Hz) and loss of alpha waves. In part two, 20 volunteers inhaled enflurane at 0.5% for 10 min to allow adequate absorption, followed by a 10-min recovery period. Equal numbers showed sedation or a failure to respond to enflurane at this concentration. In the responders, sedation was accompanied by a marked shift in the ratio of the power in two frequency bands: 1-4 Hz and 8-12 Hz. Progress of the frequency band power ratio followed closely the state of the subject into sedation, overdose, and recovery. This measure was further improved by the use of multivariate analysis, which showed good discrimination of the alert, sedated, and overdosed states of the subject. PMID:1842161

  14. Safety of Conscious Sedation In Interventional Radiology

    SciTech Connect

    Arepally, Aravind; Oechsle, Denise; Kirkwood, Sharon; Savader, Scott J.

    2001-05-15

    Purpose: To identify rates of adverse events associated with the use of conscious sedation in interventional radiology.Methods: In a 5-month period, prospective data were collected on patients undergoing conscious sedation for interventional radiology procedures (n = 594). Adverse events were categorized as respiratory, sedative, or major adverse events. Respiratory adverse events were those that required oral airway placement, ambu bag, or jaw thrust. Sedation adverse events were unresponsiveness, oxygen saturation less than 90%, use of flumazenil/naloxone, or agitation. Major adverse events were hypotension, intubation, CPR, or cardiac arrest. The frequency of adverse events for the five most common radiology procedures were determined.Results: The five most common procedures (total n = 541) were biliary tube placement/exchange (n = 182), tunneled catheter placement (n 135), diagnostic arteriography (n = 125), vascular interventions (n = 52), and other catheter insertions (n = 46). Rates for respiratory, sedation, and major adverse events were 4.7%, 4.2%, and 2.0%, respectively. The most frequent major adverse event was hypotension (2.0%). Biliary procedures had the highest rate of total adverse events (p < .05) and respiratory adverse events (p < .05).Conclusion: The frequency of adverse events is low with the use of conscious sedation during interventional procedures. The highest rates occurred during biliary interventions.

  15. DETECTION,QUANTIFICATION AND CHARACTERIZATION OF MYCOBACTERIUM AVIUM COMPLEX (MAC) ORGANISMS IN DRINKING WATER.

    EPA Science Inventory

    Bacteria belonging to the Mycobacterium avium complex (MAC), including Mycobacterium avium and M. intracellulare, are clinically relevant and cause a myriad of opportunistic infections. Children, the elderly, and persons with previous lung conditions or immune system dysfunction...

  16. Sedative, hematologic and hemostatic effects of dexmedetomidine-butorphanol alone or in combination with ketamine in cats.

    PubMed

    Volpato, Julieta; Mattoso, Cláudio Roberto Scabelo; Beier, Suzane Lilian; Coelho, Mirelly Medeiros; Tocheto, Ronise; Kirsten, Cristine Elizabeth; Yonezawa, Letícia Andreza; Saito, Mere Erika

    2015-06-01

    Acute stress induced by physical restraint can interfere with the validity of laboratory findings. Sedation could minimize such stress. However, it is not known whether sedation can affect hematologic and hemostatic parameters in cats. The purpose of this study was to evaluate hematologic and hemostatic parameters in domestic cats subjected to physical restraint in addition to one of two sedation protocols. In total, 50 cats were subjected to physical restraint and were then randomly divided into two groups of 25 animals, receiving dexmedetomidine (5 µg/kg) and butorphanol (0.3 mg/kg; DB group) or dexmedetomidine (5 µg/kg), butorphanol (0.3 mg/kg) and ketamine (3 mg/kg; DBK group). The cats were assessed for acute stress, sedation level, onset of sedation and duration of sedation. Blood samples were collected after handling and after sedation. The complete blood count (CBC), platelet count, buccal mucosal bleeding time (BMBT), whole-blood clotting time, prothrombin time (PT), activated partial thromboplastin time (aPTT) and thrombin time (TT) were determined for each sample, before and after chemical restraint. No statistically significant differences were found in the hematologic parameters. Certain hemostatic parameters (PT, aPTT and TT) were higher in the DB group (P <0.05). The onset of sedation was similar in the two groups, and the duration of sedation was longer in the DBK group. Both sedation protocols were effective for short-duration chemical restraint for blood collection from the studied cats, and no clinically relevant effects on hematologic or hemostatic parameters were detected. PMID:25216730

  17. Laparoscopic Salpingo-oophorectomy in Conscious Sedation

    PubMed Central

    Bramante, Silvia; Conti, Fiorella; Rizzi, Maria; Frattari, Antonella; Spina, Tullio

    2015-01-01

    Introduction: Conscious sedation has traditionally been used for laparoscopic tubal ligation. General anesthesia with endotracheal intubation may be associated with side effects, such as nausea, vomiting, cough, and dizziness, whereas sedation offers the advantage of having the patient awake and breathing spontaneously. Until now, only diagnostic laparoscopy and minor surgical procedures have been performed in patients under conscious sedation. Case Description: Our report describes 5 cases of laparoscopic salpingo-oophorectomy successfully performed with the aid of conventional-diameter multifunctional instruments in patients under local anesthesia. Totally intravenous sedation was provided by the continuous infusion of propofol and remifentanil, administered through a workstation that uses pharmacokinetic–pharmacodynamic models to titrate each drug, as well as monitoring tools for levels of conscious sedation and local anesthesia. We have labelled our current procedure with the acronym OLICS (Operative Laparoscopy in Conscious Sedation). Four of the patients had mono- or bilateral ovarian cysts and 1 patient, with the BRCA1 gene mutation and a family history of ovarian cancer, had normal ovaries. Insufflation time ranged from 19 to 25 minutes. All patients maintained spontaneous breathing throughout the surgical procedure, and no episodes of hypotension or bradycardia occurred. Optimal pain control was obtained in all cases. During the hospital stay, the patients did not need further analgesic drugs. All the women reported high or very high satisfaction and were discharged within 18 hours of the procedure. Discussion and Conclusion: Salpingo-oophorectomy in conscious sedation is safe and feasible and avoids the complications of general anesthesia. It can be offered to well-motivated patients without a history of pelvic surgery and low to normal body mass index. PMID:26175550

  18. Procedural sedation: A review of sedative agents, monitoring, and management of complications

    PubMed Central

    Tobias, Joseph D.; Leder, Marc

    2011-01-01

    Given the continued increase in the complexity of invasive and noninvasive procedures, healthcare practitioners are faced with a larger number of patients requiring procedural sedation. Effective sedation and analgesia during procedures not only provides relief of suffering, but also frequently facilitates the successful and timely completion of the procedure. However, any of the agents used for sedation and/or analgesia may result in adverse effects. These adverse effects most often affect upper airway patency, ventilatory function or the cardiovascular system. This manuscript reviews the pharmacology of the most commonly used agents for sedation and outlines their primary effects on respiratory and cardiovascular function. Suggested guidelines for the avoidance of adverse effects through appropriate pre-sedation evaluation, early identification of changes in respiratory and cardiovascular function, and their treatment are outlined. PMID:22144928

  19. Serotonin syndrome precipitated by fentanyl during procedural sedation.

    PubMed

    Kirschner, Ron; Donovan, J Ward

    2010-05-01

    Fentanyl is frequently used for analgesia during emergency procedures. We present the cases of 2 patients who developed agitation and delirium after intravenous fentanyl administration. These patients were chronically taking selective serotonin reuptake inhibitors (SSRIs). Both developed neuromuscular examinations consistent with serotonin syndrome, a diagnosis that must be established on the basis of clinical criteria. Although they required aggressive supportive care, including mechanical ventilation, both patients made a full recovery. Use of fentanyl for procedural sedation may precipitate serotonin syndrome in patients taking SSRIs or other serotonergic drugs. PMID:18757161

  20. Retrospective comparison of sedated and non-sedated colonoscopy in an outpatient practice.

    PubMed

    Al-Zubaidi, Ali Mothanna; Al-Shadadi, Abdelfattah Abdelqader; Alghamdy, Hassan Uthman; Alzobady, Abdu Hassan; Al-Qureshi, Laeeque Ahmed; Al-Bakri, Ibraheem Mohammed

    2016-03-01

    Although sedation and analgesia for patients undergoing colonoscopy are the standard practice in western countries, non-sedated colonoscopy is still in practice in Europe and the Far East. This variation in sedation practice relies on the different cultural attitudes of both patients and endoscopists across these countries. Data from the literature consistently report that, in non-sedated patients, the use of alternative techniques, such as water irrigation or carbon dioxide insufflation, can allow a high-quality and well-tolerated examination. We retrospectively reviewed prospectively collected performance improvement in endoscopy unit at King Khalid Hospital, Najran, Saudi Arabia. The tolerance of colonoscopy without sedation in terms of patient's ability to return to routine work and drive if necessary on the same day of procedure was evaluated. A total of 538 patients who underwent a colonoscopy at King Khalid Hospital endoscopy unit (Najran, Kingdom of Saudi Arabia) were reviewed from September 2011 to November 2013. All of the procedures were performed by two expert endoscopists, assisted by well-trained nursing staff. Insertion of the colonoscope was aided by insufflations of air, and in a few instances, by water through the colonoscope to minimize air insufflations. IV sedatives were administered upon the judgment of the physician when patient was unable to tolerate the procedure. Of 538 patients who underwent a colonoscopy, 79 patients required sedation. Forty-seven during the procedure and 32 requested pre-procedure sedation, most of them below 20 years of age. Thirty-two who requested pre-procedure sedation were excluded from our statistics. Of the remaining 506 cases, 47 (9.3 %) required sedation during procedure while 459 (90.7 %) tolerated the procedure without sedation. This shortened the hospital stay time, improved the ability to return to work much earlier, and undertake daily activities such as driving. It is also cost effective. The approach of

  1. The influence of immigrant background on the choice of sedation method in paediatric dentistry.

    PubMed

    Dahlander, Andreas; Jansson, Leif; Carlstedt, Kerstin; Grindefjord, Margaret

    2015-01-01

    The effects of immigration on the demographics of the Swedish population have changed the situation for many dental care providers, placing increased demand on cultural competence. The aim of this investigation was to study the choice of sedation method among children with immigrant background, referred to paediatric dentistry specialists, because of behaviour management problems or dental fear in combination with treatment needs. The material consisted of dental records from children referred to two clinics for paediatric dentistry: 117 records from children with an immigrant background and 106 from children with a non-immigrant background. Information about choice of sedation method (conventional treatment, conscious sedation with midazolam, nitrous oxide, or general anaesthesia) and dental status was collected from the records. The number of missed appointments (defaults) was also registered. Binary logistic regression analyses were used to calculate the influence of potential predictors on choice of sedation method. The mean age of the patients in the immigrant group was 4.9 yrs, making them significantly younger than the patients in the non-immigrant group (mean 5.7 yrs). In the immigrant group, 26% of the patients defaulted from treatments, while the corresponding frequency was significantly lower for the reference group (7%). The numbers of primary teeth with caries and permanent teeth with caries were positively and significantly correlated with the choice of treatment under general anaesthesia. Conscious sedation was used significantly more often in younger children and in the non-immigrant group, while nitrous oxide was preferred in the older children. In conclusion, conscious sedation was more frequently used in the non-immigrant group. The choice of sedation was influenced by caries frequency and the age of the child. PMID:26529840

  2. The design of a multicentre Canadian surveillance study of sedation safety in the paediatric emergency department

    PubMed Central

    Bhatt, Maala; Roback, Mark G; Joubert, Gary; Farion, Ken J; Ali, Samina; Beno, Suzanne; McTimoney, C Michelle; Dixon, Andrew; Dubrovsky, Alexander Sasha; Barrowman, Nick; Johnson, David W

    2015-01-01

    Introduction Procedural sedation and analgesia have become standard practice in paediatric emergency departments worldwide. Although generally regarded as safe, serious adverse events such as bradycardia, asystole, pulmonary aspiration, permanent neurological injury and death have been reported, but their incidence is unknown due to the infrequency of their occurrence and lack of surveillance of sedation safety. To improve our understanding of the safety, comparative effectiveness and variation in care in paediatric procedural sedation, we are establishing a multicentre patient registry with the goal of conducting regular and ongoing surveillance for adverse events in procedural sedation. Methods This multicentre, prospective cohort study is enrolling patients under 18 years of age from six paediatric emergency departments across Canada. Data collection is fully integrated into clinical care and is performed electronically in real time by the healthcare professionals caring for the patient. The primary outcome is the proportion of patients who experience a serious adverse event as a result of their sedation. Secondary outcomes include the proportion of patients who experience an adverse event that could lead to a serious adverse event, proportion of patients who receive a significant intervention in response to an adverse event, proportion of patients who experience a successful sedation, and proportion of patients who experience a paradoxical reaction to sedation. There is no predetermined end date for data collection. Ethics and dissemination Ethics approval has been obtained from participating sites. Results will be disseminated using a multifaceted knowledge translation strategy by presenting at international conferences, publication in peer-reviewed journals, and through established networks. PMID:26024999

  3. Variation in the Use of Procedural Sedation for Incision and Drainage of Skin and Soft Tissue Infection in Pediatric Emergency Departments

    PubMed Central

    Uspal, Neil G.; Klein, Eileen J.; Tieder, Joel S.; Oron, Assaf P.; Simon, Tamara D.

    2015-01-01

    Objectives Little is known about procedural sedation use for anxiety and pain associated with skin and soft tissue infections (SSTIs) requiring incision and drainage (I&D). Our objectives were therefore (1) to characterize the use of procedural sedation use for SSTI I&D procedures in pediatric emergency departments (EDs), (2) to compare the frequency of procedural sedation for I&D across hospitals, and (3) to determine factors associated with use of procedural sedation for I&D. Methods We performed a retrospective cohort study of pediatric EDs contributing to the Pediatric Health Information Systems database in 2010. Cases were identified by primary International Classification of Diseases, 9th revision, Clinical Modification procedure codes for I&D. We used descriptive statistics to describe procedural sedation use across hospitals and logistic generalized linear mixed models to identify factors associated with use of procedural sedation. Results There were 6322 I&D procedures, and procedural sedation was used in 24% of cases. Hospital-level use of procedural sedation varied widely, with a range of 2% to 94% (median 17%). Procedural sedation use was positively associated with sensitive body site, female gender, and employer-based insurance, and negatively associated with African American race and increasing age. Estimates of hospital-level use of procedural sedation for a referent case eliminating demographic differences exhibit similar variability with a range of 5% to 97% (median 34%). Conclusions Use of procedural sedation for SSTI I&D varies widely across pediatric EDs, and the majority of variation is independent of demographic differences. Additional work is needed to understand decision-making and to standardize delivery of procedural sedation in children requiring I&D. PMID:25832973

  4. Rationale, design and methodology of a trial evaluating three strategies designed to improve sedation quality in intensive care units (DESIST study)

    PubMed Central

    Walsh, Timothy S; Kydonaki, Kalliopi; Antonelli, Jean; Stephen, Jacqueline; Lee, Robert J; Everingham, Kirsty; Hanley, Janet; Uutelo, Kimmo; Peltola, Petra; Weir, Christopher J

    2016-01-01

    Objectives To describe the rationale, design and methodology for a trial of three novel interventions developed to improve sedation-analgesia quality in adult intensive care units (ICUs). Participants and Setting 8 clusters, each a Scottish ICU. All mechanically ventilated sedated patients were potentially eligible for inclusion in data analysis. Design Cluster randomised design in 8 ICUs, with ICUs randomised after 45 weeks baseline data collection to implement one of four intervention combinations: a web-based educational programme (2 ICUs); education plus regular sedation quality feedback using process control charts (2 ICUs); education plus a novel sedation monitoring technology (2 ICUs); or all three interventions. ICUs measured sedation-analgesia quality, relevant drug use and clinical outcomes, during a 45-week preintervention and 45-week postintervention period separated by an 8-week implementation period. The intended sample size was >100 patients per site per study period. Main Outcome measures The primary outcome was the proportion of 12 h care periods with optimum sedation-analgesia, defined as the absence of agitation, unnecessary deep sedation, poor relaxation and poor ventilator synchronisation. Secondary outcomes were proportions of care periods with each of these four components of optimum sedation and rates of sedation-related adverse events. Sedative and analgesic drug use, and ICU and hospital outcomes were also measured. Analytic approach Multilevel generalised linear regression mixed models will explore the effects of each intervention taking clustering into account, and adjusting for age, gender and APACHE II score. Sedation-analgesia quality outcomes will be explored at ICU level and individual patient level. A process evaluation using mixed methods including quantitative description of intervention implementation, focus groups and direct observation will provide explanatory information regarding any effects observed. Conclusions The

  5. Sedation-related complications in gastrointestinal endoscopy.

    PubMed

    Vargo, John J

    2015-01-01

    Defining the risk of procedural sedation for gastrointestinal endoscopic procedures remains a vexing challenge. The definitions as to what constitutes a cardiopulmonary unplanned event are beginning to take focus but the existing literature is an amalgam of various definitions and subjective outcomes, providing a challenge to patient, practitioner, and researcher. Gastrointestinal endoscopy when undertaken by trained personnel after the appropriate preprocedural evaluation and in the right setting is a safe experience. However, significant challenges exist in further quantifying the sedation risks to patients, optimizing physiologic monitoring, and sublimating the pharmacoeconomic and regulatory embroglios that limit the scope of practice and the quality of services delivered to patients. PMID:25442964

  6. Sedation in Critically Ill Children with Respiratory Failure

    PubMed Central

    Vet, Nienke J.; Kleiber, Niina; Ista, Erwin; de Hoog, Matthijs; de Wildt, Saskia N.

    2016-01-01

    This article discusses the rationale of sedation in respiratory failure, sedation goals, how to assess the need for sedation as well as effectiveness of interventions in critically ill children, with validated observational sedation scales. The drugs and non-pharmacological approaches used for optimal sedation in ventilated children are reviewed, and specifically the rationale for drug selection, including short- and long-term efficacy and safety aspects of the selected drugs. The specific pharmacokinetic and pharmacodynamic aspects of sedative drugs in the critically ill child and consequences for dosing are presented. Furthermore, we discuss different sedation strategies and their adverse events, such as iatrogenic withdrawal syndrome and delirium. These principles can guide clinicians in the choice of sedative drugs in pediatric respiratory failure. PMID:27606309

  7. The combined effects of midazolam and propofol sedation on muscle power.

    PubMed

    Tomita, S; Matsuura, N; Ichinohe, T

    2013-05-01

    We performed a randomised, crossover study to investigate the effects of intravenous sedation on grip strength and bite force. Twenty male volunteers received a bolus intravenous injection of midazolam (0.02 mg.kg(-1)) together with a 30-min propofol infusion designed to achieve an effect-site concentration of 1.0 μg.ml(-1). Observed variables included bispectral index, observer's assessment of alertness/sedation, correct answer rate of Stroop colour-word test, grip strength and bite force. Grip strength decreased from a median (IQR [range]) of 483 (443-517 [380-586]) N to 358 (280-405 [108-580]) N (p < 0.001) during sedation and recovered following flumazenil administration, while bite force increased from 818 (593-1026 [405-1406]) N to 1377 (1243-1585 [836-2357]) N (p < 0.001) during sedation. Although bite force gradually returned to baseline following flumazenil administration, it remained increased throughout the experimental period. We conclude that bite force increased during intravenous sedation and that this may have clinical implications. PMID:23521655

  8. Perceptions and practices regarding delirium, sedation and analgesia in critically ill patients: a narrative review

    PubMed Central

    Shinotsuka, Cassia Righy; Salluh, Jorge Ibrain Figueira

    2013-01-01

    A significant number of landmark studies have been published in the last decade that increase the current knowledge on sedation for critically ill patients. Therefore, many practices that were considered standard of care are now outdated. Oversedation has been shown to be hazardous, and light sedation and no-sedation protocols are associated with better patient outcomes. Delirium is increasingly recognized as a major form of acute brain dysfunction that is associated with higher mortality, longer duration of mechanical ventilation and longer lengths of stay in the intensive care unit and hospital. Despite all the available evidence, translating research into bedside care is a daunting task. International surveys have shown that practices such as sedation interruption and titration are performed only in the minority of cases. Implementing best practices is a major challenge that must also be addressed in the new guidelines. In this review, we summarize the findings of sedation and delirium research over the last years. We also discuss the gap between evidence and clinical practice and highlight ways to implement best practices at the bedside. PMID:23917981

  9. Medetomidine sedation in dogs and cats: a review of its pharmacology, antagonism and dose.

    PubMed

    Cullen, L K

    1996-09-01

    Medetomidine is a relatively new sedative analgesic in dogs and cats but some precautions are required when using it. It is a potent alpha 2-adrenoceptor agonist and stimulates receptors centrally to produce dose-dependent sedation and analgesia and receptors centrally and peripherally to cause marked bradycardia and decrease the cardiac output. While hypotension occurs frequently, higher doses of the sedative can raise the blood pressure due to an affect on peripheral receptors. Slowing of the respiratory rate is a frequent effect of medetomidine with some dogs showing signs of cyanosis. Other actions that follow medetomidine use are slowing of gastrointestinal motility, hypothermia, changes to endocrine function and, occasionally, vomiting and muscle twitching. The clinical use of medetomidine in dogs and cats is discussed. Recommended dose rates are presented along with precautions that should be taken when it is used alone for sedation, as an anaesthetic premedicant or in combination with ketamine, propofol or opioids. Hypoxaemia occurs frequently in dogs given medetomidine and propofol. The actions of medetomidine can be rapidly reversed with the specific alpha 2-adrenoceptor antagonist, atipamezole, which is an advantage because undesirable and sedative actions of medetomidine can be terminated. PMID:8885463

  10. Sedation at the end of life: a hospice's decision-making practices in the UK.

    PubMed

    Dean, Antonia; Miller, Barbara; Woodwork, Catherine

    2014-10-01

    The administration of sedative drugs at the end of life raises both clinical and ethical challenges. This article details the evolution of sedation decision-making practices at a 14-bedded UK hospice over the course of 5 years through an initial review and two follow-up audits. Key areas, such as documented consideration of hydration status and discussion with family members, have been improved following the implementation of a checklist of decision-making prompts, demonstrating how practice can be improved and sustained over time. PMID:25350213

  11. Emergence delirium in a child given oral midazolam for conscious sedation.

    PubMed

    Doyle, W L; Perrin, L

    1994-12-01

    We report a case of emergence delirium in a 26-month-old girl after she received oral midazolam to achieve conscious sedation. This patient's clinical course is discussed. To our knowledge this is the first reported case of emergence delirium related to use of oral midazolam. PMID:7978604

  12. Intrathecal Veratridine Administration Increases MAC in Rats

    PubMed Central

    Zhang, Yi; Sharma, Manohar; Eger, Edmond I; Laster, Michael J.; Hemmings, Hugh C.; Harris, R. Adron

    2008-01-01

    Background Results from several studies point to sodium channels as potential mediators of the immobility produced by inhaled anesthetics. We hypothesized that the intrathecal administration of veratridine, a drug that enhances the activity or effect of sodium channels, should increase MAC. Methods We measured the change in isoflurane MAC caused by intrathecal infusion of various concentrations of veratridine into the lumbothoracic subarachnoid space of rats. We compared these result to those obtained from intracerebroventricular infusion. Results As predicted, intrathecal infusion of veratridine increased MAC. The greatest infused concentration (25 μM) also produced neuronal injury in the hind limbs of two rats and decreased the peak effect on MAC. A concentration of 1.6 μM produced the greatest (21%) increase in MAC. Intraventricular infusion of 1.6 and 6.4 μM veratridine did not alter MAC. Rats given 25 μM died. Conclusion Intrathecal administration of veratradine increases MAC of isoflurane, a finding consistent with a role for sodium channels as potential mediators of the immobility produced by inhaled anesthetics. Implications Intrathecal administration of veratridine can increase MAC, presumably by an effect on sodium channels. PMID:18713899

  13. George MacDonald's Estimate of Childhood

    ERIC Educational Resources Information Center

    Pridmore, John

    2007-01-01

    The nineteenth-century fantasy writer George MacDonald believed that "it is better to be a child in a green field than a knight of many orders." In this paper, I shall explore the bearing of this high estimate of childhood on spiritual education. MacDonald explores the spirituality of the child in his essay "A Sketch of Individual Development" and…

  14. MacIntyre, Rival Traditions and Education

    ERIC Educational Resources Information Center

    Stolz, Steven A.

    2016-01-01

    This paper critically discusses MacIntyre's thesis that education is essentially a contested concept. In order to contextualise my discussion, I discuss both whether rival educational traditions of education found in MacIntyre's work--which I refer to as instrumental and non-instrumental justifications of education--can be rationally resolved…

  15. Closed-loop control for cardiopulmonary management and intensive care unit sedation using digital imaging

    NASA Astrophysics Data System (ADS)

    Gholami, Behnood

    assessed by expert and non-expert human examiners. Next, we consider facial expression recognition using an unsupervised learning framework. We show that different facial expressions reside on distinct subspaces if the manifold is unfolded. In particular, semi-definite embedding is used to reduce the dimensionality and unfold the manifold of facial images. Next, generalized principal component analysis is used to fit a series of subspaces to the data points and associate each data point to a subspace. Data points that belong to the same subspace are shown to belong to the same facial expression. In clinical intensive care unit practice sedative/analgesic agents are titrated to achieve a specific level of sedation. The level of sedation is currently based on clinical scoring systems. Examples include the motor activity assessment scale (MAAS), the Richmond agitation-sedation scale (RASS), and the modified Ramsay sedation scale (MRSS). In general, the goal of the clinician is to find the drug dose that maintains the patient at a sedation score corresponding to a moderately sedated state. In this research, we use pharmacokinetic and pharmacodynamic modeling to find an optimal drug dosing control policy to drive the patient to a desired MRSS score. Atrial fibrillation, a cardiac arrhythmia characterized by unsynchronized electrical activity in the atrial chambers of the heart, is a rapidly growing problem in modern societies. One treatment, referred to as catheter ablation, targets specific parts of the left atrium for radio frequency ablation using an intracardiac catheter. As a first step towards the general solution to the computer-assisted segmentation of the left atrial wall, we use shape learning and shape-based image segmentation to identify the endocardial wall of the left atrium in the delayed-enhancement magnetic resonance images. (Abstract shortened by UMI.)

  16. Chinese medicines with sedative-hypnotic effects and their active components.

    PubMed

    Shi, Man-Man; Piao, Jin-Hua; Xu, Xi-Lin; Zhu, Liang; Yang, Li; Lin, Fu-Lan; Chen, Jian; Jiang, Jian-Guo

    2016-10-01

    The main pharmacological effects of sedative agents are sedation, hypnosis, antianxiety, and antidepression. Traditional Chinese medicine (TCM) has a long history of clinical experience in treating insomnia. This review focuses mainly on the role of active ingredients from TCM in the treatment of insomnia. Single herbs and their active ingredients from TCM with hypnotic effects are summarized through reviewing the relevant literature published in the past 20 y. The active ingredients are divided into alkaloids, terpenoids, and volatile oils, flavonoids, lignanoids and coumarins, saponins, and others. Current studies on TCM in treating insomnia are described from the aspects of active ingredients, sources, experimental models and methods, results, and mechanisms. In addition, Chinese compound prescriptions developed from a variety of single herbs with sedative-hypnotic effects are introduced. The acting pathways of TCM are covered from the perspectives of regulating central neurotransmitters, influencing sleep-related cytokines, and improving the structure of the central nervous system. PMID:26866454

  17. Palliative Sedation and What Constitutes Active Dying: A Case of Severe Progressive Dystonia and Intractable Pain.

    PubMed

    Strand, Jacob J; Feely, Molly A; Kramer, Neha M; Moeschler, Susan M; Swetz, Keith M

    2016-05-01

    We present the case of a 34-year-old woman with Klippel-Feil syndrome who developed progressive generalized dystonia of unclear etiology, resulting in intractable pain despite aggressive medical and surgical interventions. Ultimately, palliative sedation was required to relieve suffering. Herein, we describe ethical considerations including defining sedation, determining prognosis in the setting of an undefined neurodegenerative condition, and use of treatments that concurrently might prolong or alter end-of-life trajectory. We highlight pertinent literature and how it may be applied in challenging and unique clinical situations. Finally, we discuss the need for expert multidisciplinary involvement when implementing palliative sedation and illustrate that procedures and rules need to be interpreted to deliver optimal patient-centered plan of care. PMID:25487783

  18. Sedation/anaesthesia in paediatric radiology

    PubMed Central

    Arlachov, Y; Ganatra, R H

    2012-01-01

    Objectives In this article we will give a comprehensive literature review on sedation/general anaesthesia (S/GA) and discuss the international variations in practice and options available for S/GA for imaging children. Methods The key articles were obtained primarily from PubMed, MEDLINE, ERIC, NHS Evidence and The Cochrane Library. Results Recently, paediatric radiology has seen a surge of diagnostic and therapeutic procedures, some of which require children to be still and compliant for up to 1 h. It is difficult and sometimes even impossible to obtain quick and high-quality images without employing sedating techniques in certain children. As with any medical procedure, S/GA in radiological practice is not without risks and can have potentially disastrous consequences if mismanaged. In order to reduce any complications and practice safety in radiological units, it is imperative to carry out pre-sedation assessments of children, obtain parental/guardian consent, monitor them closely before, during and after the procedure and have adequate equipment, a safe environment and a well-trained personnel. Conclusion Although the S/GA techniques, sedative drugs and personnel involved vary from country to country, the ultimate goal of S/GA in radiology remains the same; namely, to provide safety and comfort for the patients. Advances in knowledge Imaging children under general anaesthesia is becoming routine and preferred by operators because it ensures patient conformity and provides a more controlled environment. PMID:22898157

  19. Factors Influencing Challenging Colonoscopies During Anesthesiologist-Assisted Deep Sedation

    PubMed Central

    Fabrizio, Cardin; Nadia, Minicuci; Alessandra, Andreotti; Elisa, Granziera; Carmelo, Militello

    2016-01-01

    Background/Aim: Increased demand for colon cancer screening procedures can significantly impact on routine colonoscopy management at dedicated facilities, prompting a review of the factors that can negatively affect workflow. Although potential adverse effects and impact on costs of deep sedation have been documented elsewhere, this study focuses on variables that can influence performance of colonoscopy in deep sedation and interfere with normal procedure scheduling in settings where the presence of an anesthesiologist is mandatory. Patients and Methods: We performed a cross-sectional study of the activities of a colonoscopy screening unit, applying Bayesian Network (BN) analysis, designed to assess interdependencies among variables that can affect a process in complex, multidimensional systems. The study was performed at a teaching hospital where endoscopists and anesthesiologists of varying work experience operate on a rota basis. During a six-month period, we analyzed 1485 consecutive colonoscopies performed under deep propofol sedation, administered by an anesthesiologist via hand-controlled syringe. The BN was constructed with the variables: Gender, age, ASA status, bowel preparation, baseline blood pressure, endoscopist's experience, anesthesiologist's experience, presence of polypectomy, and the target node, “challenging procedure.” This previously undefined category refers to any events disrupting the scheduled rota. Result and Conclusion: Two distinct networks were identified. One deals mainly with relationships among the variables, patients’ demographic and clinical characteristics (procedures with polypectomy, ASA and baseline blood pressure). The other explains relationships among the variables, “challenging procedure,” bowel preparation, and endoscopist's experience. The factors associated with the anesthesiologist's activity do not influence challenging colonoscopies. PMID:26831609

  20. Proposed Guideline Revisions for Dental Sedation and General Anesthesia: Why Target the Safest Level of Sedation?

    PubMed

    Dionne, Raymond A

    2016-09-01

    Recently proposed revisions to the American Dental Association's Guidelines for the Use of Sedation and General Anesthesia by Dentists, aimed at improving safety in dental offices, differentiate between levels of sedation based on drug-induced changes in physiologic and behavioral states. However, the author of this op-ed is concerned the proposed revisions may have far-reaching and unintended consequences. PMID:27608198

  1. Spider sedation induced by defensive chemicals of milliped prey.

    PubMed

    Carrel, J E; Eisner, T

    1984-02-01

    Wolf spiders (Lycosa spp.) show delayed induced sedation (total immobilization) of prolonged duration (in the order of days) after attacks upon millipeds (Glomeris marginata). The sedation is specifically attributable to glomerin and homoglomerin, two previously characterized quinazolinones present in the defensive secretion of Glomeris. Median sedative doses for the quinazolinones are in the range of 1-7 mug per spider, a fraction of the total (60-90 mug) present in the secretion of medium to full-grown millipeds. A sedative effect upon an invertebrate predator has not previously been demonstrated for an animal defense. Quinazolinones include the synthetic drug methaqualone (Quaalude), a potent human sedative. PMID:16593414

  2. Evaluation of the Efficacy and Safety of Short-Course Deep Sedation Therapy for the Treatment of Intracerebral Hemorrhage After Surgery: A Non-Randomized Control Study.

    PubMed

    Hou, Dapeng; Liu, Beibei; Zhang, Juan; Wang, Qiushi; Zheng, Wei

    2016-01-01

    BACKGROUND While mild and moderate sedation have been widely used to reduce sudden agitation in intracerebral hemorrhage (ICH) patients after surgery, agitation is still a frequent problem, which may cause postoperative blood pressure fluctuation. The present study aimed to evaluate the efficacy and safety of short-course deep sedation for the treatment of ICH after surgery. MATERIAL AND METHODS A total of 41 ICH patients who received surgery, including traditional craniotomy hematoma removal and decompressive craniectomy, were including in this non-randomized control study. Patients in the deep sedation group received continuous postoperative sedation with a target course for ≤12 hours and reached SAS scores of 1~2. Patients in the traditional sedition group received continuous light sedation and reached SAS scores of 3~4. Additional therapeutic interventions included antihypertensive treatment, mechanical ventilation, tracheotomy, and re-operation. RESULTS Patients in the deep sedation group had deeper sedation degree, and lower systolic blood pressure (SBP) and diastolic blood pressure (DBP). Residual hematoma after surgery in patients in the deep sedation group were smaller on the second, seventh, and fourteenth day after surgery (p=0.023, 0.003, 0.004, respectively). The 3-month mortality and quality of life of patients in the deep sedation group were lower and better than that of patients in the traditional sedation group, respectively (p=0.044, p<0.01). No significant difference in the incidence of ventilator-associated pneumonia (VAP) and ICU days were observed between the two groups. CONCLUSIONS Short-course deep sedation therapy in ICH patients after surgery is efficient in controlling postoperative blood pressure, reducing re-bleeding, and improving clinical prognosis. PMID:27466863

  3. Evaluation of the Efficacy and Safety of Short-Course Deep Sedation Therapy for the Treatment of Intracerebral Hemorrhage After Surgery: A Non-Randomized Control Study

    PubMed Central

    Hou, Dapeng; Liu, Beibei; Zhang, Juan; Wang, Qiushi; Zheng, Wei

    2016-01-01

    Background While mild and moderate sedation have been widely used to reduce sudden agitation in intracerebral hemorrhage (ICH) patients after surgery, agitation is still a frequent problem, which may cause postoperative blood pressure fluctuation. The present study aimed to evaluate the efficacy and safety of short-course deep sedation for the treatment of ICH after surgery. Material/Methods A total of 41 ICH patients who received surgery, including traditional craniotomy hematoma removal and decompressive craniectomy, were including in this non-randomized control study. Patients in the deep sedation group received continuous postoperative sedation with a target course for ≤12 hours and reached SAS scores of 1~2. Patients in the traditional sedition group received continuous light sedation and reached SAS scores of 3~4. Additional therapeutic interventions included antihypertensive treatment, mechanical ventilation, tracheotomy, and re-operation. Results Patients in the deep sedation group had deeper sedation degree, and lower systolic blood pressure (SBP) and diastolic blood pressure (DBP). Residual hematoma after surgery in patients in the deep sedation group were smaller on the second, seventh, and fourteenth day after surgery (p=0.023, 0.003, 0.004, respectively). The 3-month mortality and quality of life of patients in the deep sedation group were lower and better than that of patients in the traditional sedation group, respectively (p=0.044, p<0.01). No significant difference in the incidence of ventilator-associated pneumonia (VAP) and ICU days were observed between the two groups. Conclusions Short-course deep sedation therapy in ICH patients after surgery is efficient in controlling postoperative blood pressure, reducing re-bleeding, and improving clinical prognosis. PMID:27466863

  4. Bromoderma mimicking pyoderma gangrenosum caused by commercial sedatives.

    PubMed

    Oda, Fumiko; Tohyama, Mikiko; Murakami, Akiko; Kanno, Kazuhisa; Sonobe, Naomi; Sayama, Koji

    2016-05-01

    Bromoderma is a rare skin disorder caused by bromide intake. It presents as single or multiple papillomatous nodules or plaques, and ulcers studded with small pustules on the face or limbs. The clinical features of bromoderma are similar to those of pyoderma gangrenosum. A 41-year-old Japanese woman was diagnosed with pyoderma gangrenosum 11 years prior to presentation. Pyoderma had repeatedly appeared over her entire body despite treatment. She also frequently complained of syncopal episodes. She was admitted to our hospital after loss of consciousness and an episode of generalized convulsion. Laboratory tests revealed a negative serum anion gap and hyperchloremia. Her serum bromide level was significantly elevated, suggesting bromide intoxication. The patient had a 10-year history of high serum bromide levels. After the intake of bromide-containing sedatives was stopped, there was no recurrence of pyoderma in the absence of treatment. In conclusion, this case was diagnosed as bromoderma with commercial sedative-induced bromide intoxication. Although the US Food and Drug Administration have banned the use of bromides, over-the-counter (OTC) treatments containing bromides are still used in Japan and other countries. Long-term use of OTC medicines containing bromvalerylurea may result in the development of bromoderma. If unclarified neurological or psychiatric symptoms are associated with pyoderma, we propose measurement of the patient's serum chloride concentration. Determination of hyperchloremia is helpful for the diagnosis of chronic intoxication with bromides. PMID:26507105

  5. Fast arithmetic in MacLISP

    NASA Technical Reports Server (NTRS)

    Steele, G. L., Jr.

    1977-01-01

    MacLISP provides a compiler which produces numerical code competitive in speed with some FORTRAN implementations and yet compatible with the rest of the MacLISP system. All numerical programs can be run under the MacLISP interpreter. Additional declarations to the compiler specify type information which allows the generation of optimized numerical code which generally does not require the garbage collection of temporary numerical results. Array accesses are almost as fast as in FORTRAN, and permit the use of dynamically allocated arrays of varying dimensions. The implementation decisions regarding user interface, data representations, and interfacing conventions are discussed which allow the generation of fast numerical LISP code.

  6. Sedation with etomidate-fentanyl versus propofol-fentanyl in colonoscopies: A prospective randomized study

    PubMed Central

    Banihashem, Nadia; Alijanpour, Ebrahim; Basirat, Majid; Shokri Shirvany, Javad; Kashifard, Mehrdad; Taheri, Hasan; Savadkohi, Shahriyar; Hosseini, Vahid; Solimanian, Seyed Sedigheh

    2015-01-01

    Background: The combination of propofol-fentanyl for sedation during colonoscopy is characterized by high prevalence of side effects. Etomidate-fentanyl provides fewer hemodynamic and respiratory complications. The aim of our study was to compare the safety and efficacy of propofol-fentanyl and etomidate-fentanyl for conscious sedation in elective colonoscopy. Methods: This double-blind clinical trial was conducted on 90 patients aged between 18- 55 years old who were candidates for elective colonoscopy. Patients were randomized to receive sedation with fentanyl plus propofol or etomidate. Two minutes after injecting 1 micro/kg of fentanyl, the patients received 0.5mg/kg propofol by infusion (25 µ/kg/min) or 0.1 mg/kg etmoidate (15 µ/kg/min). Pulse rate, mean arterial blood pressure, respiratory rate, and saturation of peripheral oxygen (SPO2) were monitored. In addition, the patient and colonoscopist satisfaction, the recovery time, sedation and pain score in both groups were assessed. Results: Sedation score in propofol group was higher. Pain score as well as the physician and patient satisfaction showed no significant difference between the two study groups. Hemodynamic changes and arterial saturation were the same in both groups. The duration of recovery was 1.27±0.82 minutes in the etomidate group; versus 2.57±2.46 minutes in the propofol group (P=0.001). Recovery time in the etmoid group was 2.68±3.14 minutes and in the propofol group was 5.53±4.67 minutes (p=0.001). Conclusion: The combination of fentanyl and etomidate provides an acceptable alternative to sedation with fentanyl and propofol with the advantage of significantly faster recovery time, in the outpatient setting. PMID:26221491

  7. Bispectral index score and observer's assessment of awareness/sedation score may manifest divergence during onset of sedation: Study with midazolam and propofol

    PubMed Central

    Bagchi, Dipanjan; Mandal, Mohan Chandra; Das, Sabyasachi; Basu, Sekhar Ranjan; Sarkar, Susanta; Das, Jyotirmoy

    2013-01-01

    Background: Correlation between the clinical and electroencephalogram-based monitoring has been documented sporadically during the onset of sedation. Propofol and midazolam have been studied individually using the observer's assessment of awareness/sedation (OAA/S) score and Bispectral index score (BIS). The present study was designed to compare the time to onset of sedation for propofol and midazolam using both BIS and OAA/S scores, and to find out any correlation. Methods: A total of 46 patients (18-60 years, either sex, American Society of Anesthesiologists (ASA) I/II) posted for infraumbilical surgeries under spinal anaesthesia were randomly allocated to receive either injection propofol 1 mg/kg bolus followed by infusion 3 mg/kg/h (Group P, n=23) or injection midazolam 0.05 mg/kg bolus followed by infusion 0.06 mg/kg/h (Group M, n=23). Spinal anaesthesia was given with 2.5 ml to 3.0 ml of 0.5% bupivacaine heavy. When sensory block reached T6 level, sedation was initiated. The time to reach BIS score 70 and time to achieve OAA/S score 3 from the start of study drug were noted. OAA/S score at BIS score 70 was noted. Data from 43 patients were analyzed using SPSS 12 for Windows. Results: Time to reach BIS score 70 using propofol was significantly lower than using the midazolam (P<0.05). Time to achieve OAA/S score 3 using propofol was comparable with midazolam (P=0.358). Conclusion: A divergence exists between the time to reach BIS score 70 and time to achieve OAA/S score 3 using midazolam, compared with propofol, during the onset of sedation. PMID:24163448

  8. Use of sedation analgesia for pediatric dentistry.

    PubMed

    Sharma, R K; Pinto, R R; Mirchandani, N N

    1992-03-01

    26 healthy children between the ages of 36 and 60 months (mean 35 months) who satisfied the selection criteria during a screening visit participated in this double blind study. The subjects were assigned randomly to receive either 75 mg/kg Triclofos elixir (Regimen I-21 children) or 50 mg/1kg Trichlofos elixir combined with 1 mg/kg promethazine elixir (Regimen II-22 children). All medications were given orally 45 minutes before treatment. During operative procedures all subjects received nitrous oxide/oxygen at a concentration of 35%. All the patients were restrained in a papoose board (Indigenous). The subjects were monitored for vital signs and evaluated for sedation and sleep, movement, crying and overall behaviour before, during and after the operative procedure. Regimen II was found to be superior to Regimen I with regard to behaviour management of difficult young children. However extremely apprehensive children were not good subjects for this sedation technique. PMID:1308247

  9. Dexmedetomidine for Sedation during Withdrawal of Support

    PubMed Central

    O’Hara, Chris; Tamburro, Robert F; Ceneviva, Gary D

    2015-01-01

    Agents used to control end-of-life suffering are associated with troublesome side effects. The use of dexmedetomidine for sedation during withdrawal of support in pediatrics is not yet described. An adolescent female with progressive and irreversible pulmonary deterioration was admitted. Despite weeks of therapy, she did not tolerate weaning of supplemental oxygen or continuous bilevel positive airway pressure. Given her condition and the perception that she was suffering, the family requested withdrawal of support. Despite opioids and benzodiazepines, she appeared to be uncomfortable after support was withdrawn. Ketamine was initiated. Relief from ketamine was brief, and its use was associated with a “wide-eyed” look that was distressing to the family. Ketamine was discontinued and a dexmedetomidine infusion was initiated. The patient’s level of comfort improved greatly. The child died peacefully 24 hours after initiating dexmedetomidine from her underlying disease rather than the effects of the sedative. PMID:26339188

  10. Airway Assessment for Office Sedation/Anesthesia.

    PubMed

    Rosenberg, Morton B; Phero, James C

    2015-01-01

    Whenever a patient is about to receive sedation or general anesthesia, no matter what the technique, the preoperative assessment of the airway is one of the most important steps in ensuring patient safety and positive outcomes. This article, Part III in the series on airway management, is directed at the ambulatory office practice and focuses on predicting the success of advanced airway rescue techniques. PMID:26061578

  11. Systematic review and meta-analysis of patient-controlled sedation versus intravenous sedation for colonoscopy

    PubMed Central

    Lu, Yi; Hao, Li-Xiao; Chen, Lu; Jin, Zheng; Gong, Biao

    2015-01-01

    Background: Patient-controlled sedation (PCS) has been suggested as an alternative method for sedative colonoscopy. However, as any new techniques, PCS introduction as a potential alternative to traditional intravenous sedation (IVS) has brought about challenges. To evaluate the advantages and disadvantages between PCS and IVS more comprehensively, we conducted a systematic review and meta-analysis of the published literature. Methods: Several databases were searched from inception to 1 April, 2015, for trials comparing PCS with IVS for colonoscopy. The outcomes of interest included time for cecal intubation, rate of complete colonoscopy, dose of sedative drugs used, pain scores, recovery time, complications. Inconsistency was quantified using I 2 statistics. Results: In all, 12 trials were finally selected (1091 patients, with 545 in the PCS group, and 546 in the IVS group). The total propofol used, time for cecal intubation, rate of complete colonoscopy and pain score had no statistical difference between the two groups. However, PCS showed a reduction in the recovery time, incidence of oxygen desaturation and hypotension. The rates of other complications and patients’ willingness to repeat the same sedation had no statistical difference between the two groups. Conclusion: PCS is as feasible and effective as traditional IVS for colonoscopy, and there is a tendency that PCS shows its superiority in recovery time, incidence for oxygen saturation and hypotension. PMID:26884890

  12. MACS as a tool for international inspections

    SciTech Connect

    Curtiss, J.A.; Indusi, J.P.

    1995-08-01

    The MACS/ACRS (Managed Access by Controlled Sensing/Access by Controlled Remote Sensing) system is a collection of communication devices, video capability, and distance-measuring equipment which can effectively substitute for the physical presence of a challenge inspector within a facility. The MACS design allows growth of the prototype, developed in response to the Chemical Weapons Convention (CWC), into a versatile device for inspection of sensitive nuclear facilities under other international arrangements, for example the proposed Fissile Material Cutoff Convention. A MACS/ACRS-type system in a standard, international-recognized configuration could resolve sensitive information and safety concerns through providing a means of achieving the goals of an inspection while excluding the inspector. We believe the technology used to develop MACS for the Defense Nuclear Agency, followed by ACRS for the Department of Energy, is universally adaptable for minimally-intrusive managed-access international inspections of sensitive sites.

  13. User's manual for MacPASCO

    NASA Technical Reports Server (NTRS)

    Lucas, S. H.; Davis, R. C.

    1992-01-01

    A user's manual is presented for MacPASCO, which is an interactive, graphic, preprocessor for panel design. MacPASCO creates input for PASCO, an existing computer code for structural analysis and sizing of longitudinally stiffened composite panels. MacPASCO provides a graphical user interface which simplifies the specification of panel geometry and reduces user input errors. The user draws the initial structural geometry and reduces user input errors. The user draws the initial structural geometry on the computer screen, then uses a combination of graphic and text inputs to: refine the structural geometry; specify information required for analysis such as panel load and boundary conditions; and define design variables and constraints for minimum mass optimization. Only the use of MacPASCO is described, since the use of PASCO has been documented elsewhere.

  14. A Conversation with Patricia MacLachlan.

    ERIC Educational Resources Information Center

    Austin, Patricia

    1996-01-01

    Contains an interview with Patricia MacLachlan, former teacher and author of the award-winning novel "Sarah, Plain and Tall" about her views on the latest trends in teaching reading and writing to children. (TB)

  15. Cleanup MAC and MBA code ATP

    SciTech Connect

    Russell, V.K.

    1994-10-17

    The K Basins Materials Accounting (MAC) and Material Balance (MBA) database system had some minor code cleanup performed to its code. This ATP describes how the code was to be tested to verify its correctness.

  16. AeroMACS system characterization and demonstrations

    NASA Astrophysics Data System (ADS)

    Kerczewski, R. J.; Apaza, R. D.; Dimond, R. P.

    This The Aeronautical Mobile Airport Communications System (AeroMACS) is being developed to provide a new broadband wireless communications capability for safety critical communications in the airport surface domain, providing connectivity to aircraft and other ground vehicles as well as connections between other critical airport fixed assets. AeroMACS development has progressed from requirements definition through technology definition, prototype deployment and testing, and now into national and international standards development. The first prototype AeroMACS system has been deployed at the Cleveland Hopkins International Airport (CLE) and the adjacent NASA Glenn Research Center (GRC). During the past three years, extensive technical testing has taken place to characterize the performance of the AeroMACS prototype and provide technical support for the standards development process. The testing has characterized AeroMACS link and network performance over a variety of conditions for both fixed and mobile data transmission and has included basic system performance testing and fixed and mobile applications testing. This paper provides a summary of the AeroMACS performance testing and the status of standardization activities that the testing supports.

  17. AeroMACS System Characterization and Demonstrations

    NASA Technical Reports Server (NTRS)

    Kerczewski, Robert J.; Apaza, Rafael D.; Dimond, Robert P.

    2013-01-01

    This The Aeronautical Mobile Airport Communications System (AeroMACS) is being developed to provide a new broadband wireless communications capability for safety critical communications in the airport surface domain, providing connectivity to aircraft and other ground vehicles as well as connections between other critical airport fixed assets. AeroMACS development has progressed from requirements definition through technology definition, prototype deployment and testing, and now into national and international standards development. The first prototype AeroMACS system has been deployed at the Cleveland Hopkins International Airport (CLE) and the adjacent NASA Glenn Research Center (GRC). During the past 3 years, extensive technical testing has taken place to characterize the performance of the AeroMACS prototype and provide technical support for the standards development process. The testing has characterized AeroMACS link and network performance over a variety of conditions for both fixed and mobile data transmission and has included basic system performance testing and fixed and mobile applications testing. This paper provides a summary of the AeroMACS performance testing and the status of standardization activities that the testing supports.

  18. AeroMACS System Characterization and Demonstrations

    NASA Technical Reports Server (NTRS)

    Kerczewski, Robert J.; Apaza, Rafael D.; Dimond, Robert P.

    2013-01-01

    The Aeronautical Mobile Airport Communications System (AeroMACS) is being developed to provide a new broadband wireless communications capability for safety critical communications in the airport surface domain, providing connectivity to aircraft and other ground vehicles as well as connections between other critical airport fixed assets. AeroMACS development has progressed from requirements definition through technology definition, prototype deployment and testing, and now into national and international standards development. The first prototype AeroMACS system has been deployed at the Cleveland Hopkins International Airport (CLE) and the adjacent NASA Glenn Research Center (GRC). During the past three years, extensive technical testing has taken place to characterize the performance of the AeroMACS prototype and provide technical support for the standards development process. The testing has characterized AeroMACS link and network performance over a variety of conditions for both fixed and mobile data transmission and has included basic system performance testing and fixed and mobile applications testing. This paper provides a summary of the AeroMACS performance testing and the status of standardization activities that the testing supports.

  19. The effect of body position, sedation, and thoracic bandaging on functional residual capacity in healthy deep-chested dogs

    PubMed Central

    Rozanski, Elizabeth A.; Bedenice, Daniela; Lofgren, Jennifer; Abrams, Julie; Bach, Jonathan; Hoffman, Andrew M.

    2010-01-01

    The objective of this study was to determine the effect of body position, chest wrap, and sedation on functional residual capacity (FRC) in 6 healthy dogs. Functional residual capacity was determined by helium dilution (re-breathing) whilst in different clinically relevant conditions. These conditions included the standing (sternal) and lateral positions in unsedated dogs and then again both standing and lateral following chest bandaging, and sedation with acepromazine, IV and butorphanol, IV. The mean FRC at each measurement point was determined, as was the change in FRC (delta FRC) from one measurement point to another. Analysis of variance (ANOVA) with repeated measures with Fisher’s LSD post hoc test was used to evaluate the effect of interventions. The differences in delta FRC were evaluated using a t-test or Wilcoxon rank-sum test. P < 0.05 was considered significant. The mean FRC at baseline, defined as standing, unsedated and unwrapped, was 75.3 ± 23.8 mL/kg. Body position or sedation had the most profound effect on FRC with right lateral recumbency lowering FRC by a median of 20.4 mL/kg and sedation lowering FRC by a median of 19.8 mL/kg. Common clinical procedures and positioning result in lowered FRC in healthy deep-chested dogs. In critically ill or injured dogs, the iatrogenic loss of FRC through chest bandaging, sedation, or body position may be clinically relevant. PMID:20357956

  20. Postinjection Delirium/Sedation Syndrome with Olanzapine Depot Injection

    PubMed Central

    Sarangula, Sadhvi Mythili; Mythri, Starlin Vijay; Sanjay, Y.; Reddy, M. S.

    2016-01-01

    After 1 year of introduction of olanzapine long-acting injectable (LAI) in India, many psychiatrists believe that it is a very affordable, well-tolerated, and effective second generation long-acting antipsychotic depot compared to not well tolerated but cheap first generation antipsychotic depots and to other second generation depots which are costly. However, reports of its possible adverse events in clinical settings are not yet published. We report what probably might be the first case of postinjection delirium/sedation syndrome (PDSS) in India. Although the occurrence is uncommon, incorrect understanding of this event may hinder the future use of the potentially useful olanzapine LAI. We review the available literature on the proposed diagnostic guidelines, mechanism of this event, precautions, and management of PDSS. PMID:27570354

  1. Dexmedetomidine sedation with and without midazolam for third molar surgery.

    PubMed

    Smiley, Megann K; Prior, Simon R

    2014-01-01

    Twenty-four patients were randomly divided into 2 groups. Intraoperatively, one group received a continuous intravenous infusion of dexmedetomidine alone, whereas the other received a continuous dexmedetomidine infusion plus a small dose of midazolam. Early measurements of patient anxiety and psychomotor performance were lower in patients who had received midazolam. This difference was not seen later in the appointment. An amnesic effect was observed in those patients who received midazolam. This effect, however, did not translate into increased patient satisfaction in the group receiving midazolam. Our findings suggest a prolonged discharge time for patients who had been given midazolam that may be clinically significant. Overall, dexmedetomidine showed an unpredictable sedative response and may be less practical than more common alternatives for oral surgery procedures. PMID:24697819

  2. Postinjection Delirium/Sedation Syndrome with Olanzapine Depot Injection.

    PubMed

    Sarangula, Sadhvi Mythili; Mythri, Starlin Vijay; Sanjay, Y; Reddy, M S

    2016-01-01

    After 1 year of introduction of olanzapine long-acting injectable (LAI) in India, many psychiatrists believe that it is a very affordable, well-tolerated, and effective second generation long-acting antipsychotic depot compared to not well tolerated but cheap first generation antipsychotic depots and to other second generation depots which are costly. However, reports of its possible adverse events in clinical settings are not yet published. We report what probably might be the first case of postinjection delirium/sedation syndrome (PDSS) in India. Although the occurrence is uncommon, incorrect understanding of this event may hinder the future use of the potentially useful olanzapine LAI. We review the available literature on the proposed diagnostic guidelines, mechanism of this event, precautions, and management of PDSS. PMID:27570354

  3. Sedative effects of dexmedetomidine, dexmedetomidine-pethidine and dexmedetomidine-butorphanol in cats.

    PubMed

    Nagore, L; Soler, C; Gil, L; Serra, I; Soler, G; Redondo, J I

    2013-06-01

    The purpose of this study was to assess the clinical effects of dexmedetomidine, both alone and combined with pethidine or butorphanol, in cats. A prospective randomized blind study was performed. Thirty cats were randomly assigned to three groups of 10 animals: D: dexmedetomidine (20 μg/kg IM); DP: dexmedetomidine (10 μg/kg IM) and pethidine (2.5 mg/kg IM); DB: dexmedetomidine (10 μg/kg IM) and butorphanol (0.4 mg/kg IM). Quality of sedation, analgesia, muscle relaxation and the possibility of performing some clinical procedures were compared using a multifactorial scale. Sedation, analgesia and muscle relaxation increased progressively over time and did not differ in the three protocols. The three protocols facilitated the completion of several clinical procedures. The clinical variables studied showed a similar behaviour in the three protocols and remained close to the baseline, except for a drop in heart rate in protocol D. In conclusion, dexmedetomidine, either alone or combined with pethidine or butorphanol, offers suitable sedation, analgesia and relaxation to perform various clinical procedures in cats. PMID:22607033

  4. Relieving suffering at the end of life: practitioners' perspectives on palliative sedation from three European countries.

    PubMed

    Seymour, Jane E; Janssens, Rien; Broeckaert, Bert

    2007-04-01

    This paper reports findings from visits to palliative care settings and research units in the UK, Belgium and the Netherlands. The aim was to learn about clinicians' (both nurses and doctors) and academic researchers' understandings and experiences of palliative sedation for managing suffering at the end of life, and their views regarding its clinical, ethical and social implications. The project was linked to two larger studies of technologies used in palliative care. Eleven doctors, 14 nurses and 10 researchers took part in informal interviews. Relevant reports and papers from the academic, clinical and popular press were also collected from the three countries. The study took place in a context in which attention has been drawn towards palliative sedation by the legalisation of euthanasia in the Netherlands and Belgium, and by the re-examination of the legal position on assisted dying in the UK. In this context, palliative sedation has been posited by some as an alternative path of action. We report respondents' views under four headings: understanding and responding to suffering; the relationship between palliative sedation and euthanasia; palliative sedation and artificial hydration; and risks and uncertainties in the clinician-patient/family relationship. We conclude that the three countries can learn from one another about the difficult issues involved in giving compassionate care to those who are suffering immediately before death. Future research should be directed at enabling dialogue between countries: this has already been shown to open the door to the development of improved palliative care and to enhance respect for the different values and histories in each. PMID:17250941

  5. Efficacy and safety of oral triclofos as sedative for children undergoing sleep electroencephalogram: An observational study

    PubMed Central

    Jain, Puneet; Sharma, Suvasini; Sharma, Ankita; Goel, Shaiphali; Jose, Anjali; Aneja, Satinder

    2016-01-01

    Objectives: Triclofos may be a better sedative in view of better palatability and less gastric irritation as compared to chloral hydrate. This study aimed to assess the efficacy of triclofos (a commonly used sedative in India) as a sedative for sleep electroencephalogram (EEG) study in children. Methods: This prospective observational study was carried out in a tertiary care pediatric center. Consecutive children aged 6 months to 5 years referred for sleep EEG evaluation were recruited. Their clinical details were noted in a proforma after an informed consent. After a trial for natural sleep, oral triclofos was administered. Sleep parameters and adverse effects were noted. Results: One-hundred and sixty children were then enrolled. EEG was successfully recorded in 149 (93.1%) children. Median latency of sleep onset was 30 min and median duration of sleep was 90 min. The adverse effects in the following 24 h were mild and included dizziness, irritability, and vomiting. Conclusions: Oral triclofos was found to be an effective sedative for EEG in children with minimal adverse effects.

  6. GREEN-MAC-LCCP: a tool for assessing the life cycle climate performance of MAC systems.

    PubMed

    Papasavva, Stella; Hill, William R; Andersen, Stephen O

    2010-10-01

    In 2008, 95% of the vehicle fleet in the developed countries and 80% of fleet in the developing countries were equipped with mobile air conditioning systems (MACs). Greenhouse gases (GHGs) are emitted due to refrigerant leakage (direct emissions) and due to the energy consumed by MACs operation (indirect emissions). In response to reducing the global warming impact of MACs, policy makers and the industry are investigating alternative refrigerant systems that use low global warming potential (GWP) refrigerants. The GREEN-MAC-LCCP model assesses the direct and indirect CO(2) equivalent emissions related to MACs usage, as well as those associated with the production, use and disposal of alternative refrigerants and MACs components. This model provides a platform for simple data input and provides an output summary as well as details that can be analyzed in a custom fashion by the user. It provides engineers and policy makers a state-of-the-art tool, based on sound engineering data and methods, in order to facilitate the process of evaluating alternate refrigerants with low lifecycle global warming impact as well as providing the total impact of any MACs on the environment. It has been recognized as the standard of the MACs industry. PMID:20812721

  7. The use of bispectral analysis to monitor outpatient sedation.

    PubMed Central

    Sandler, N. A.

    2000-01-01

    The bispectral (BIS) index has been used to interpret partial EEG recordings to predict the level of sedation and loss of consciousness in patients undergoing general anesthesia. The author has evaluated BIS technology in determining the level of sedation in patients undergoing outpatient deep sedation. These experiences are outlined in this review article. Initially, the correlation of the BIS index with traditional subjective patient evaluation using the Observer's Assessment of Alertness and Sedation (OAA/S) scale was performed in 25 subjects. In a second study, the recovery profile of 39 patients where the BIS was used to monitor sedation was compared with a control group where the monitor was not used. A strong positive relationship between the BIS and OAA/S readings was found in the initial subjects. From the recovery study, it appears that use of the BIS monitor may help titrate the level of sedation so that less drugs are used to maintain the desired level of sedation. A trend to earlier return of motor function in BIS-monitored patients was also demonstrated. BIS technology offers an objective, ordinal means of assessing the depth of sedation. This can be invaluable in comparing studies of techniques. The BIS index provides additional information to standard monitoring techniques that helps guide the administration of sedative-hypnotic agents. The trend to earlier return of motor function in BIS-monitored patients warrants further investigation. Images Figure 1 Figure 2 Figure 3 PMID:11432160

  8. Obstructive Sleep Apnea and Modifications in Sedation: An Update.

    PubMed

    Weatherspoon, Deborah; Sullivan, Debra; Weatherspoon, Christopher A

    2016-06-01

    One factor that may contribute to an increased risk for airway compromise is obstructive sleep apnea (OSA). Sedation in this population carries an increased risk for hypopnea. Critical care nurses must decide on the amount and type of sedation to administer at the point of care. It is important for them to understand OSA and the routinely prescribed sedatives that may affect this disorder. This article discusses the pathophysiology of OSA and traits that may help identify patients with undiagnosed OSA. The most commonly prescribed sedative pharmacologic agents and adjunctive airway support mechanisms are reviewed for use in this population. PMID:27215359

  9. Conscious Sedation for Upper Endoscopy in the Gastric Bypass Patient: Prevalence of Cardiopulmonary Adverse Events and Predictors of Sedation Requirement

    PubMed Central

    Jirapinyo, Pichamol; Abu Dayyeh, Barham K.

    2016-01-01

    Background Safety of conscious sedation for performing esophagoduodenoscopy (EGD) in obese and Roux-en-Y gastric bypass (RYGB) patients remains controversial. Additionally, it has been suggested that patients with higher body mass index (BMI) require higher sedation doses, imparting greater risk. Aim The aim of this study is to assess the prevalence of sedation-related adverse events and the independent predictors of sedation requirements in RYGB patients. Methods This study is a retrospective database review of RYGB patients who underwent EGD under conscious sedation. Database analysis was performed and linear regression applied to identify significant predictors of sedation requirement. Primary outcomes are sedation-related adverse events and predictors of sedation requirement. Results Data on 1,385 consecutive procedures (diagnostic 967; therapeutic 418) performed under conscious sedation were analyzed. Unplanned events were reported in 1.6 %, with 0.6 % being cardiopulmonary in nature and 0.7 % requiring early termination. Multivariable linear regression revealed procedural time was the only significant predictor of fentanyl (standardized β 0.34; P value < 0.001) and midazolam (standardized β 0.30; P value < 0.001) doses. Post-RYGB BMI was not significantly associated with the dose of fentanyl (standardized β 0.08; P value 0.29) or midazolam administered (standardized β 0.01; P value 0.88). Conclusions Upper endoscopy can be safely performed in RYGB patients under conscious sedation with a similar cardiopulmonary risk profile to that of standard EGD. The non-cardiopulmonary adverse events were procedure-specific and unrelated to sedation. Procedure length, and not absolute BMI, was the only predictor of sedation requirement in this patient population. PMID:24723069

  10. Non-Intravenous Sedatives and Analgesics for Procedural Sedation for Imaging Procedures in Pediatric Patients

    PubMed Central

    Thomas, Amber; Miller, Jamie L.; Couloures, Kevin

    2015-01-01

    OBJECTIVES: The purpose of this study was to describe the method of delivery, dosage regimens, and outcomes of sedatives administered by extravascular route for imaging procedures in children. METHODS: Medline, Embase, International Pharmaceutical Abstracts, and Cochrane Database of Systematic Reviews were searched using keywords “child”, “midazolam”, “ketamine”, dexmedetomidine”, “fentanyl”, “nitrous oxide”, and “imaging.” Articles evaluating the use of extravascular sedation in children for imaging procedures published in English between 1946 and March 2015 were included. Two authors independently screened each article for inclusion. Reports were excluded if they did not contain sufficient details on dosage regimens and outcomes. RESULTS: Twenty reports representing 1,412 patients ranging in age from 0.33 to 19 years of age were included for analysis. Due to discrepancies in doses and types of analyses, statistical analyses were not performed. Oral midazolam was the most common agent evaluated; other agents included intranasal (IN) ketamine, IN midazolam, IN fentanyl, IN and transmucosal dexmedetomidine, and N2O. Most agents were considered efficacious compared with placebo. CONCLUSIONS: Most agents showed efficacy for sedation during imaging when delivered through an extra-vascular route. Selection of agents should be based on onset time, duration, patient acceptability, recovery time, and adverse events. More robust studies are necessary to determine the optimal agent and route to utilize for imaging procedures when sedation is needed. PMID:26766932

  11. HFGMC Enhancement of MAC/GMC

    NASA Technical Reports Server (NTRS)

    Arnold, Steven M.; Aboudi, Jacob; Pindera, Marek-Jerzy; Bednarcyk, Brett A.

    2006-01-01

    Additional information about a mathematical model denoted the high-fidelity generalized method of cells (HFGMC) and implementation of the HFGMC within version 4.0 of the MAC/GMC software has become available. MAC/GMC (Micromechanics Analysis Code With Generalized Method of Cells) was a topic of several prior NASA Tech Briefs articles, version 4.0 having been described in "Comprehensive Micromechanics-Analysis Code - Version 4.0" (LEW-17495-1), NASA Tech Briefs, Vol. 29, No. 9 (September 2005), page 54. MAC/GMC predicts elastic and inelastic thermomechanical responses of composite materials. MAC/GMC utilizes the generalized method of cells (GMC) - a model of micromechanics that predicts macroscopic responses of a composite material as functions of the properties, sizes, shapes, and responses of its constituents (e.g., matrix and fibers). The accuracy of the GMC is limited by neglect of coupling between normal and shear stresses. The HFGMC was developed by combining elements of the GMC and a related model, denoted the higher-order theory for functionally graded materials (HOTFGM), that can account for this coupling. Hence, the HFGMC enables simulation of stress and strain with greater accuracy. Some alterations of the MAC/GMC data structure were necessitated by the greater computational complexity of the HFGMC.

  12. A study of MAC protocols for WBANs.

    PubMed

    Ullah, Sana; Shen, Bin; Islam, S M Riazul; Khan, Pervez; Saleem, Shahnaz; Kwak, Kyung Sup

    2010-01-01

    The seamless integration of low-power, miniaturised, invasive/non-invasive lightweight sensor nodes have contributed to the development of a proactive and unobtrusive Wireless Body Area Network (WBAN). A WBAN provides long-term health monitoring of a patient without any constraint on his/her normal dailylife activities. This monitoring requires the low-power operation of invasive/non-invasive sensor nodes. In other words, a power-efficient Medium Access Control (MAC) protocol is required to satisfy the stringent WBAN requirements, including low-power consumption. In this paper, we first outline the WBAN requirements that are important for the design of a low-power MAC protocol. Then we study low-power MAC protocols proposed/investigated for a WBAN with emphasis on their strengths and weaknesses. We also review different power-efficient mechanisms for a WBAN. In addition, useful suggestions are given to help the MAC designers to develop a low-power MAC protocol that will satisfy the stringent requirements. PMID:22315531

  13. Abdominoplasty with procedural sedation and analgesia.

    PubMed

    Rosenberg, M H; Palaia, D A; Bonanno, P C

    2001-05-01

    The ability to perform abdominal cosmetic surgery in the ambulatory setting provides a more comfortable environment for the patient, ease of scheduling for the physician, and decreased costs. Avoiding the use of general anesthesia allows for quicker recovery, shorter length of hospital stay, and decreased rate of postoperative complications. The authors report 106 consecutive abdominoplasties, including fascial plication when indicated, using local anesthesia, with procedural sedation and analgesia. All procedures were performed with an anesthesiologist providing intraoperative monitoring of the patients. Their protocol uses procedural sedation and analgesia, which results in a depressed level of consciousness, but allows the patient to maintain airway control independently and continuously. The results of this approach were measured in terms of procedure time, length of hospital stay, rate of complications, total recovery time, and the level of patient satisfaction. Between January 1996 and January 1999, 106 patients underwent abdominoplasty (performed by one of the authors) under local anesthesia with procedural sedation and analgesia. All patients had an American Society of Anesthesiologists status of 1 to 3, and underwent a full abdominoplasty, including fascial plication. In 26% of the patients, allied procedures were also performed, most commonly liposuction or augmentation mammaplasty. The mean age in this series was 45 years, and all patients were available for follow-up at least 1 year after surgery. The mean operative time was 135 minutes, recovery room time was 68 minutes, and all patients were ambulatory. There were no surgical complications, including flap loss or wound dehiscence, and no complications related to anesthesia (cardiac, deep vein thrombosis, fat emboli, pulmonary embolism, etc.). Because paralytic agents were not used, none of the patients required catheterization postoperatively. Patients were generally pleased with the results of

  14. Entropy and bispectral index for assessment of sedation, analgesia and the effects of unpleasant stimuli in critically ill patients: an observational study

    PubMed Central

    Haenggi, Matthias; Ypparila-Wolters, Heidi; Bieri, Christine; Steiner, Carola; Takala, Jukka; Korhonen, Ilkka; Jakob, Stephan M

    2008-01-01

    Introduction Sedative and analgesic drugs are frequently used in critically ill patients. Their overuse may prolong mechanical ventilation and length of stay in the intensive care unit. Guidelines recommend use of sedation protocols that include sedation scores and trials of sedation cessation to minimize drug use. We evaluated processed electroencephalography (response and state entropy and bispectral index) as an adjunct to monitoring effects of commonly used sedative and analgesic drugs and intratracheal suctioning. Methods Electrodes for monitoring bispectral index and entropy were placed on the foreheads of 44 critically ill patients requiring mechanical ventilation and who previously had no brain dysfunction. Sedation was targeted individually using the Ramsay Sedation Scale, recorded every 2 hours or more frequently. Use of and indications for sedative and analgesic drugs and intratracheal suctioning were recorded manually and using a camera. At the end of the study, processed electroencephalographical and haemodynamic variables collected before and after each drug application and tracheal suctioning were analyzed. Ramsay score was used for comparison with processed electroencephalography when assessed within 15 minutes of an intervention. Results The indications for boli of sedative drugs exhibited statistically significant, albeit clinically irrelevant, differences in terms of their association with processed electroencephalographical parameters. Electroencephalographical variables decreased significantly after bolus, but a specific pattern in electroencephalographical variables before drug administration was not identified. The same was true for opiate administration. At both 30 minutes and 2 minutes before intratracheal suctioning, there was no difference in electroencephalographical or clinical signs in patients who had or had not received drugs 10 minutes before suctioning. Among patients who received drugs, electroencephalographical parameters

  15. Single-dose intravenous gammaglobulin can stabilize neutrophil Mac-1 activation in sickle cell pain crisis

    PubMed Central

    Manwani, Deepa; Chen, Grace; Carullo, Veronica; Serban, Stelian; Olowokure, Olugbenga; Jang, Jungeun; Huggins, Matthew; Cohen, Hillel W.; Billett, Henny; Atweh, George F.; Frenette, Paul S.; Shi, Patricia A.

    2015-01-01

    Intravenous immunoglobulin (IVIG) decreases neutrophil adhesion to endothelium and red blood cell-neutrophil interactions in sickle cell mice undergoing vaso-occlusion. In this Phase I clinical trial of sickle cell anemia (SCA) patients admitted with pain crisis, we evaluated the status of adhesion molecules on neutrophils in control and IVIG-treated subjects pre- and post-infusion up to 800 mg/kg, the same dose used in murine studies. Mac-1 function significantly decreased from baseline in the low-dose IVIG (200–400 mg/kg) cohorts. IVIG-related adverse events may have occurred in the high-dose (600–800 mg/kg) cohorts. There were no significant increases in neutrophil and leukocyte counts, suggesting that IVIG may more selectively inhibit Mac-1 function as opposed to neutrophil adhesion. This study provides the first in-human validation of pre-clinical murine studies that IVIG can decrease Mac-1 function. PMID:25616042

  16. Preserved Modular Network Organization in the Sedated Rat Brain

    PubMed Central

    Bruns, Andreas; Künnecke, Basil; von Kienlin, Markus; Van der Linden, Annemie; Mueggler, Thomas; Verhoye, Marleen

    2014-01-01

    Translation of resting-state functional connectivity (FC) magnetic resonance imaging (rs-fMRI) applications from human to rodents has experienced growing interest, and bears a great potential in pre-clinical imaging as it enables assessing non-invasively the topological organization of complex FC networks (FCNs) in rodent models under normal and various pathophysiological conditions. However, to date, little is known about the organizational architecture of FCNs in rodents in a mentally healthy state, although an understanding of the same is of paramount importance before investigating networks under compromised states. In this study, we characterized the properties of resting-state FCN in an extensive number of Sprague-Dawley rats (n = 40) under medetomidine sedation by evaluating its modular organization and centrality of brain regions and tested for reproducibility. Fully-connected large-scale complex networks of positively and negatively weighted connections were constructed based on Pearson partial correlation analysis between the time courses of 36 brain regions encompassing almost the entire brain. Applying recently proposed complex network analysis measures, we show that the rat FCN exhibits a modular architecture, comprising six modules with a high between subject reproducibility. In addition, we identified network hubs with strong connections to diverse brain regions. Overall our results obtained under a straight medetomidine protocol show for the first time that the community structure of the rat brain is preserved under pharmacologically induced sedation with a network modularity contrasting from the one reported for deep anesthesia but closely resembles the organization described for the rat in conscious state. PMID:25181007

  17. Sedation and mechanical hypoalgesia after sublingual administration of detomidine hydrochloride gel to donkeys.

    PubMed

    Lizarraga, Ignacio; Castillo-Alcala, Fernanda; Varner, Kelley M; Robinson, Lauren S

    2016-07-01

    OBJECTIVE To compare sedative and mechanical hypoalgesic effects of sublingual administration of 2 doses of detomidine gel to donkeys. DESIGN Randomized blinded controlled trial. ANIMALS 6 healthy castrated male donkeys. PROCEDURES In a crossover study design, donkeys received each of the following sublingual treatments 1 week apart in a randomly assigned order: 1 mL of molasses (D0) or detomidine hydrochloride gel at 20 μg/kg (9 μg/lb; D20) or 40 μg/kg (18 μg/lb; D40). Sedation score (SS), head height above the ground (HHAG), and mechanical nociceptive threshold (MNT) were assessed before and for 180 minutes after treatment. Areas under the effect change-versus-time curves (AUCs) from 0 to 30, 30 to 60, 60 to 120, and 120 to 180 minutes after administration were computed for SS, HHAG, and MNT and compared among treatments. RESULTS D20 and D40 resulted in greater SS AUCs from 60 to 120 minutes and smaller HHAG AUCs from 30 through 180 minutes than did D0. The D40 resulted in smaller HHAG AUCs from 60 to 120 minutes than did D20. Compared with D0 values, MNT AUCs from 60 to 120 minutes were higher for D20, whereas MNT AUCs from 30 through 180 minutes were higher for D40. CONCLUSIONS AND CLINICAL RELEVANCE D20 and D40 induced sedation and mechanical hypoalgesia in donkeys by > 30 minutes after administration, but only sedation was dose dependent. Sublingual administration of detomidine gel at 40 μg/kg may be useful for sedation of standing donkeys prior to potentially painful minor procedures. PMID:27308886

  18. Eliminating the Heart from the Curcumin Molecule: Monocarbonyl Curcumin Mimics (MACs)

    PubMed Central

    Shetty, Dinesh; Kim, Yong Joon; Shim, Hyunsuk; Snyder, James P.

    2015-01-01

    Curcumin is a natural product with several thousand years of heritage. Its traditional Asian application to human ailments has been subjected in recent decades to worldwide pharmacological, biochemical and clinical investigations. Curcumin’s Achilles heel lies in its poor aqueous solubility and rapid degradation at pH ~ 7.4. Researchers have sought to unlock curcumin’s assets by chemical manipulation. One class of molecules under scrutiny are the monocarbonyl analogs of curcumin (MACs). A thousand plus such agents have been created and tested primarily against cancer and inflammation. The outcome is clear. In vitro, MACs furnish a 10–20 fold potency gain vs. curcumin for numerous cancer cell lines and cellular proteins. Similarly, MACs have successfully demonstrated better pharmacokinetic (PK) profiles in mice and greater tumor regression in cancer xenografts in vivo than curcumin. The compounds reveal limited toxicity as measured by murine weight gain and histopathological assessment. To our knowledge, MAC members have not yet been monitored in larger animals or humans. However, Phase 1 clinical trials are certainly on the horizon. The present review focuses on the large and evolving body of work in cancer and inflammation, but also covers MAC structural diversity and early discovery for treatment of bacteria, tuberculosis, Alzheimer’s disease and malaria. PMID:25547726

  19. Analgesia and sedation for children undergoing burn wound care.

    PubMed

    Bayat, Ahmad; Ramaiah, Ramesh; Bhananker, Sanjay M

    2010-11-01

    Standard care of burn wounds consists of cleaning and debridement (removing devitalized tissue), followed by daily dressing changes. Children with burns undergo multiple, painful and anxiety-provoking procedures during wound care and rehabilitation. The goal of procedural sedation is safe and efficacious management of pain and emotional distress, requiring a careful and systematic approach. Achieving the best results needs understanding of the mechanisms of pain and the physiologic changes in burn patients, frequent evaluation and assessment of pain and anxiety, and administration of suitable pharmacological and nonpharmacological therapies. Pharmacological therapies provide the backbone of analgesia and sedation for procedural pain management. Opioids provide excellent pain control, but they must be administered judiciously due to their side effects. Sedative drugs, such as benzodiazepines and propofol, provide excellent sedation, but they must not be used as a substitute for analgesic drugs. Ketamine is increasingly used for analgesia and sedation in children as a single agent or an adjuvant. Nonpharmacological therapies such as virtual reality, relaxation, cartoon viewing, music, massage and hypnosis are necessary components of procedural sedation and analgesia for children. These can be combined with pharmacological techniques and are used to limit the use of drugs (and hence side effects), as well as to improve patient participation and satisfaction. In this article, we review the pathophysiologic changes associated with major thermal injury in children, the options available for sedation and analgesia for wound care procedures in these children and our institutional guidelines for procedural sedation. PMID:20977331

  20. [Sedation and analgesia assessment tools in ICU patients].

    PubMed

    Thuong, M

    2008-01-01

    Sedative and analgesic treatment administered to critically ill patients need to be regularly assessed to ensure that predefinite goals are well achieved as the risk of complications of oversedation is minimized. In most of the cases, which are lightly sedation patients, the goal to reach is a calm, cooperative and painless patient, adapted to the ventilator. Recently, eight new bedside scoring systems to monitor sedation have been developed and mainly tested for reliability and validity. The choice of a sedation scale measuring level of consciousness, could be made between the Ramsay sedation scale, the Richmond Agitation Sedation scale (RASS) and the Adaptation to The Intensive Care Environment scale-ATICE. The Behavioral Pain Scale (BPS) is a behavioral pain scale. Two of them have been tested with strong evidence of their clinimetric properties: ATICE, RASS. The nurses'preference for a convenient tool could be defined by the level of reliability, the level of clarity, the variety of sedation and agitation states represented user friendliness and speed. In fine, the choice between a simple scale easy to use and a well-defined and complex scale has to be discussed and determined in each unit. Actually, randomized controlled studies are needed to assess the potential superiority of one scale compared with others scales, including evaluation of the reliability and the compliance to the scale. The usefulness of the BIS in ICU for patients lightly sedated is limited, mainly because of EMG artefact, when subjective scales are more appropriated in this situation. On the other hand, subjective scales are insensitive to detect oversedation in patients requiring deep sedation. The contribution of the BIS in deeply sedation patients, patients under neuromuscular blockade or barbiturates has to be proved. Pharmacoeconomics studies are lacking. PMID:18602791

  1. Bispectral index monitoring of sedation depth in pediatric dental patients.

    PubMed

    Haberland, Christel M; Baker, Suher; Liu, Haibei

    2011-01-01

    The bispectral index (BIS) monitor records electroencephalogram waveforms and provides an objective measure of the hypnotic effect of a sedative drug on brain activity. The aim of this pilot study was to use the BIS monitor to evaluate the depth of procedural sedation in pediatric dental patients and to assess if the BIS monitor readings correlate with a validated pediatric sedation scale, the University of Michigan Sedation Scale (UMSS), in determining the level of sedation in these patients. Thirty-five pediatric dental patients requiring sedation were studied prospectively. A baseline BIS reading was obtained and during the procedure an independent observer recorded the BIS every 5 minutes. The operator, who was blinded to the BIS results, determined the UMSS scale at the same 5-minute interval. The patients were monitored postoperatively for 1 hour. There was a significant but moderate correlation between BIS values and UMSS scores (Spearman's rank correlation r  =  -0.574, P < .0001). Percentage of agreement and kappa coefficient using all the observations were also calculated. The percentage of agreement was 37.8%, the kappa coefficient was 0.18 (P < .0001), and the weighted kappa coefficient 0.26 (P < .0001). A lack of correlation was noted between the deeper levels of UMSS sedation scores and BIS values. This study demonstrated a significant correlation between BIS values and the UMSS score in pediatric dental patients undergoing mild to moderate sedation. Based on our results, it appears that the BIS monitor may be useful during mild or moderate sedations to establish the level of sedation objectively without the need to stimulate the patient. PMID:21679042

  2. Bispectral Index Monitoring of Sedation Depth in Pediatric Dental Patients

    PubMed Central

    Haberland, Christel M.; Baker, Suher; Liu, Haibei

    2011-01-01

    The bispectral index (BIS) monitor records electroencephalogram waveforms and provides an objective measure of the hypnotic effect of a sedative drug on brain activity. The aim of this pilot study was to use the BIS monitor to evaluate the depth of procedural sedation in pediatric dental patients and to assess if the BIS monitor readings correlate with a validated pediatric sedation scale, the University of Michigan Sedation Scale (UMSS), in determining the level of sedation in these patients. Thirty-five pediatric dental patients requiring sedation were studied prospectively. A baseline BIS reading was obtained and during the procedure an independent observer recorded the BIS every 5 minutes. The operator, who was blinded to the BIS results, determined the UMSS scale at the same 5-minute interval. The patients were monitored postoperatively for 1 hour. There was a significant but moderate correlation between BIS values and UMSS scores (Spearman's rank correlation r  =  −0.574, P < .0001). Percentage of agreement and kappa coefficient using all the observations were also calculated. The percentage of agreement was 37.8%, the kappa coefficient was 0.18 (P < .0001), and the weighted kappa coefficient 0.26 (P < .0001). A lack of correlation was noted between the deeper levels of UMSS sedation scores and BIS values. This study demonstrated a significant correlation between BIS values and the UMSS score in pediatric dental patients undergoing mild to moderate sedation. Based on our results, it appears that the BIS monitor may be useful during mild or moderate sedations to establish the level of sedation objectively without the need to stimulate the patient. PMID:21679042

  3. Effects of hypnosis as an adjunct to intravenous sedation for third molar extraction: a randomized, blind, controlled study.

    PubMed

    Mackey, Edward F

    2010-01-01

    The effects of hypnosis/therapeutic suggestion in connection with intravenous sedation and surgery have been described in many clinical publications; however, few randomized, controlled, and blind studies have been performed in the outpatient area. This study aimed to evaluate the use of hypnosis/therapeutic suggestion as an adjunct to intravenous (IV) sedation in patients having 3rd molar removal in an outpatient setting. The patients were randomly assigned to a treatment (n = 46) or control (n = 54) group. The treatment group listened to a rapid conversational induction and therapeutic suggestions via headphones throughout the entire surgical procedure along with a standard sedation dose of intravenous anesthetic. The control group listened to only music without any hypnotic intervention. Intraoperative Propofol administration, patient postoperative pain ratings, and postoperative prescription pain reliever consumption were all significantly reduced in the treatment compared to the control group. Implications of these results are discussed. PMID:20183736

  4. Lifetime tests for MAC vertex chamber

    SciTech Connect

    Nelson, H.N.

    1986-07-01

    A vertex chamber for MAC was proposed to increase precision in the measurement of the B hadron and tau lepton lifetimes. Thin-walled aluminized mylar drift tubes were used for detector elements. A study of radiation hardness was conducted under the conditions of the proposed design using different gases and different operating conditions. (LEW)

  5. Results from the MAC Vertex chamber

    SciTech Connect

    Nelson, H.N.

    1987-05-01

    The design, construction, and performance characteristics of a high precision gaseous drift chamber made of thin walled proportional tubes are described. The device achieved an average spatial resolution of 45 ..mu..m in use for physics analysis with the MAC detector. The B-lifetime result obtained with this chamber is discussed.

  6. The MacArthur Fellows Look Back.

    ERIC Educational Resources Information Center

    Cox, June; Daniel, Neil

    1984-01-01

    The article describes replies to a questionnaire by recipients of the MacArthur Fellows Program, an award given to individuals with uncommon abilities across a wide spectrum of creative pursuits. Replies touch on school and family backgrounds, acceleration, importance of grades, recognition of achievement, extracurricular activities, and…

  7. An Interview with Peter MacDonald.

    ERIC Educational Resources Information Center

    American Indian Journal, 1979

    1979-01-01

    Peter MacDonald, Chairman of the Navajo Nation, the largest tribe in the United States speaks to such issues as energy development/management, oil companies, Navajo-Hopi relocation legislation, traditionalism, and the role of the Council of Energy Resource Tribes. (RTS)

  8. Managed Access by Controlled Sensing (MACS)

    SciTech Connect

    Curtiss, J.A.; Indusi, J.P.

    1994-08-01

    During chemical weapons challenge inspections, the CWC treaty allows ``alternate means`` of access to be proposed by the nation challenged. BNL`s Safeguards, Safety and Nonproliferation Division is funded by the Defense Nuclear Agency to develop a system to provide the challenge inspection team with a ``virtual presence`` within the facility while denying personal access. A general purpose configuration of a mobile station manned by site personnel and a base station manned by the challenge inspector, supported by a flexible communication system, will allow facility personnel to tailor the basic model to their site. Design of the MACS system is based on maximum use of commercial equipment that is available on the international market. Design requirements for the MACS system include methods of establishing geographical position, distance measuring equipment for use in verifying dimensions on floor plans, video and two-way audio links between the mobile unit and the base station, and portability and versatility of the equipment. The MACS platform will also support deployment of selected instrumentation which the site may offer to the challenge inspection team. This paper describes the design and construction of the prototype MACS system.

  9. Exposure histories of lunar meteorites - ALHA81005, MAC88104, MAC88105, and Y791197

    NASA Technical Reports Server (NTRS)

    Nishiizumi, K.; Arnold, J. R.; Klein, J.; Fink, D.; Middleton, R.; Kubik, P. W.; Sharma, P.; Elmore, D.; Reedy, R. C.

    1991-01-01

    The cosmogenic radionuclides Ca-41, Cl-36, Al-26, and Be-10 in the Allan Hills 81005, MacAlpine Hills 88104, MacAlpine Hills 88105, and Yamato 791197 meteorites were measured by accelerator mass spectrometry. Mn-53 in Allan Hills 81005 and Yamato 791197 was measured by neutron activation. These four lunar meteorites experienced similar histories. They were ejected from near the surface of the moon ranging in depth down to 400 g/sq cm and had very short transition times (less than 0.1 Ma) from the moon to the earth. A comparison of the cosmogenic nuclide concentrations in MacAlpine Hills 88104 and MacAlpine Hills 88105 clearly indicates that they are a pair from the same fall.

  10. MACS as a tool for international inspections

    SciTech Connect

    Curtiss, J.A.; Indusi, J.P.

    1995-06-01

    General acceptance of the challenge provision in the Chemical Weapons Convention has the potential for influence in other arms control areas. While most applications of the challenge inspection may be straightforward, there may be instances where access to the site by inspectors may be problematic. The MACS system described in this paper was developed to respond to these situations. Inspection and verification may be difficult when a host is unwilling,for valid reasons, to permit physical access to a site. We proposed a system of remote sensors which may be used to demonstrate compliance with Chemical Weapons Convention (CWC) challenge inspections even ff the inspector is physically excluded from a sensitive site. The system is based upon alternative-means-of-access provisions of the CWC. The Defense Nuclear Agency (DNA) funded design and construction of a system prototype, designated as MACS for Managed Access by Controlled Sensing. Features of the MACS design allow growth of the prototype into a versatile device for international monitoring of production facilities and other sites. MACS consists of instrumentation and communication equipment allowing site personnel to conduct a facility tour and perform acceptable measurements, while physically excluding the inspector from the facility. MACS consists of a base station used by the inspector, and a mobile unit used within the facility and manipulated by the facility staff. The base station and the mobile unit are @ed by a communication system, currently realized as a fiber optic cable. The mobile unit is equipped with television cameras and remote-reading distance-measuring equipment (DME) for use in verifying locations and dimensions. Global Positioning System receivers on the mobile unit provide both precise location and dead reckoning, suitable for tracking the mobile unit`s position while within a building when satellite signals are not available.

  11. Terahertz spectroscopic study of benzodiazepine sedative hypnotics

    NASA Astrophysics Data System (ADS)

    Deng, Fusheng; Shen, Jingling; Wang, Xianfeng

    2011-08-01

    Terahertz time domain spectroscopy (THz-TDS) is used to the pure active ingredient of three benzodiazepine sedative hypnotics with similar molecular structure. The absorption spectra of them are studied in the range of 0.2~2.6THz. Based on the experiment, the theoretical simulation results of diazepam, nitrazepam and clonazepam are got by the Gaussian03 package of DFT/B3LYP/6-31G* method in single-molecule models. The experimental results show that even if the molecular structure and medicine property of them are similar, the accurate identification of them can still be done with their characteristic absorption spectra. Theoretical simulation results are well consistent with the experimental results. It demonstrates that absorption peaks of them in THz range mainly come from intra-molecular forces and are less affected by the intermolecular interaction and crystal effects.ô

  12. A systematic review of capnography for sedation.

    PubMed

    Conway, A; Douglas, C; Sutherland, J R

    2016-04-01

    We included six trials with 2524 participants. Capnography reduced hypoxaemic episodes, relative risk (95% CI) 0.71 (0.56-0.91), p = 0.02, but the quality of evidence was poor due to high risks of performance bias and detection bias and substantial statistical heterogeneity. The reduction in hypoxaemic episodes was statistically homogeneous in the subgroup of three trials of 1823 adults sedated for colonoscopy, relative risk (95% CI) 0.59 (0.48-0.73), p < 0.001, although the risks of performance and detection biases were high. There was no evidence that capnography affected other outcomes, including assisted ventilation, relative risk (95% CI) 0.58 (0.26-1.27), p = 0.17. PMID:26792775

  13. Sedation and anesthesia of hatchling leatherback sea turtles (Dermochelys coriacea) for auditory evoked potential measurement in air and in water.

    PubMed

    Harms, Craig A; Piniak, Wendy E D; Eckert, Scott A; Stringer, Elizabeth M

    2014-03-01

    Sedation or anesthesia of hatchling leatherback sea turtles was employed to acquire auditory evoked potential (AEP) measurements in air and in water to assess their hearing sensitivity in relation to potential consequences from anthropogenic noise. To reduce artifacts in AEP collection caused by muscle movement, hatchlings were sedated with midazolam 2 or 3 mg/kg i.v. for in-air (n = 7) or in-water (n = 11) AEP measurements; hatchlings (n = 5) were anesthetized with ketamine 6 mg/kg and dexmedetomidine 30 microg/kg i.v. reversed with atipamezole 300 microg/kg, half i.m. and half i.v. for in-air AEP measurements. Midazolam-sedated turtles were also physically restrained with a light elastic wrap. For in-water AEP measurements, sedated turtles were brought to the surface every 45-60 sec, or whenever they showed intention signs for breathing, and not submerged again until they took a breath. Postprocedure temperature-corrected venous blood pH, pCO2, pO2, and HCO3- did not differ among groups, although for the midazolam-sedated in-water group, pCO2 trended lower, and in the ketamine-dexmedetomidine anesthetized group there was one turtle considered clinically acidotic (temperature-corrected pH = 7.117). Venous blood lactate was greater for hatchlings recently emerged from the nest than for turtles sedated with midazolam in air, with the other two groups falling intermediate between, but not differing significantly from the high and low lactate groups. Disruptive movements were less frequent with anesthesia than with sedation in the in-air group. Both sedation with midazolam and anesthesia with ketamine-dexmedetomidine were successful for allowing AEP measurements in hatchling leatherback sea turtles. Sedation allowed the turtle to protect its airway voluntarily while limiting flipper movement. Midazolam or ketamine-dexmedetomidine (and reversal with atipamezole) would be useful for other procedures requiring minor or major restraint in leatherback sea turtle hatchlings

  14. Making Connections--The MeneMAC Online Learning Community

    ERIC Educational Resources Information Center

    Sueoka, Lynne

    2005-01-01

    In 2001, the MeneMAC (Media Arts Communications, dubbed "MeneMAC" in honor of the school mascot, the menehune) Learning Center at Moanalua High School (MoHS), inaugurated its integrated media curriculum for its class of 27 entering freshmen. MeneMAC originated as a media learning center, offering students a chance to explore their interests and…

  15. 42 CFR 423.2120 - Filing briefs with the MAC.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Filing briefs with the MAC. 423.2120 Section 423..., and Judicial Review § 423.2120 Filing briefs with the MAC. Upon request, the MAC will give the enrollee requesting review a reasonable opportunity to file a brief or other written statement about...

  16. Optimizing Sedative Dose in Preterm Infants Undergoing Treatment for Respiratory Distress Syndrome

    PubMed Central

    Thall, Peter F.; Nguyen, Hoang Q.; Zohar, Sarah; Maton, Pierre

    2014-01-01

    The Intubation-Surfactant-Extubation (INSURE) procedure is used worldwide to treat pre-term newborn infants suffering from respiratory distress syndrome, which is caused by an insufficient amount of the chemical surfactant in the lungs. With INSURE, the infant is intubated, surfactant is administered via the tube to the trachea, and at completion the infant is extubated. This improves the infant’s ability to breathe and thus decreases the risk of long term neurological or motor disabilities. To perform the intubation safely, the newborn infant first must be sedated. Despite extensive experience with INSURE, there is no consensus on what sedative dose is best. This paper describes a Bayesian sequentially adaptive design for a multi-institution clinical trial to optimize the sedative dose given to pre-term infants undergoing the INSURE procedure. The design is based on three clinical outcomes, two efficacy and one adverse, using elicited numerical utilities of the eight possible elementary outcomes. A flexible Bayesian parametric trivariate dose-outcome model is assumed, with the prior derived from elicited mean outcome probabilities. Doses are chosen adaptively for successive cohorts of infants using posterior mean utilities, subject to safety and efficacy constraints. A computer simulation study of the design is presented. PMID:25368435

  17. Intraoperative Fluids and Fluid Management for Ambulatory Dental Sedation and General Anesthesia

    PubMed Central

    Saraghi, Mana

    2015-01-01

    Intravenous fluids are administered in virtually every parenteral sedation and general anesthetic. The purpose of this article is to review the physiology of body-water distribution and fluid dynamics at the vascular endothelium, evaluation of fluid status, calculation of fluid requirements, and the clinical rationale for the use of various crystalloid and colloid solutions. In the setting of elective dental outpatient procedures with minor blood loss, isotonic balanced crystalloid solutions are the fluids of choice. Colloids, on the other hand, have no use in outpatient sedation or general anesthesia for dental or minor oral surgery procedures but may have several desirable properties in long and invasive maxillofacial surgical procedures where advanced hemodynamic monitoring may assess the adequacy of intravascular volume. PMID:26650497

  18. Sedation levels during propofol administration for outpatient colonoscopies.

    PubMed

    Ramsay, Michael A E; Newman, Kate B; Jacobson, Robert M; Richardson, Charles T; Rogers, Lindsay; Brown, Bertrand J; Hein, H A Tillmann; De Vol, Edward B; Daoud, Yahya A

    2014-01-01

    The levels of sedation required for patients to comfortably undergo colonoscopy with propofol were examined. One hundred patients undergoing colonoscopy with propofol were enrolled. In addition to standard-of-care monitoring, sedation level was monitored with the Patient State Index (PSI) obtained from a brain function monitor, transcutaneous carbon dioxide (tcpCO2) was monitored with the TCM TOSCA monitor, and end-tidal carbon dioxide was monitored via nasal cannula. The Ramsay Sedation Score (RSS) was also assessed and recorded. After baseline data were obtained from the first 40 consecutive patients enrolled in the study, the remaining 60 patients were randomized into two groups. In one group the PSI value was blinded from the anesthesiologist and in the second group the PSI was visible and the impact of this information on the management of the sedation was analyzed. Overall 96% of patients reached levels of deep sedation and 89% reached levels of general anesthesia. When comparing the blinded to PSI versus unblinded groups, the blinded group had a significantly lower PSI and higher RSS and tcpCO2, indicating the blinded group was maintained at a deeper sedation level with more respiratory compromise than the unblinded group. Patients undergoing colonoscopy under propofol sedation delivered by a bolus technique are frequently taken to levels of general anesthesia and are at risk for respiratory depression, airway obstruction, and hemodynamic compromise. PMID:24381393

  19. The Patient State Index is well balanced for propofol sedation

    PubMed Central

    Lee, K H; Kim, Y H; Sung, Y J; Oh, M K

    2015-01-01

    Background The SEDLine™ monitor derived patient state index (PSI) is used to follow the depth of sedation. The demand for propofol sedation by anesthesiologists or non-anesthesiologists is increasing, and there are only a few studies addressing the relationship between PSI and propofol sedation. We aimed to investigate the ability of PSI index to identify the correct level of sedation of our patients during induction to anesthesia with target-controlled infusions of propofol. Methods Twenty patients were enrolled in this study. The target effect site concentration of propofol was set at 1.5 μg/ml followed by increments of 0.5 μg/ml every five minutes. The PSI values and Modified Observer’s Assessment of Alertness/Sedation (MOAA/S) scale were recorded every twenty-five seconds during the infusion of propofol. Patients were considered losing verbal responsiveness at MOAA/S scale ≤ 2. Also, blood pressure, heart rate, and oxygen saturation were recorded every five minutes. Results The PSI values corresponding to the sedation of various depths (MOAA/S scales) and alertness with verbal response were significantly different (p <0.001). We observed a good correlation of the PSI values to the decreasing MOAA/S scale (r =0.87667). Conclusions The PSI index is well correlated with MOAA/S scale and effectively distinguishes the level of sedation during propofol infusion. Hippokratia 2015; 19 (3): 235-238. PMID:27418783

  20. Oral transmucosal administration of dexmedetomidine for sedation in 4 dogs

    PubMed Central

    Cohen, Anne E.; Bennett, Sara L.

    2015-01-01

    Injectable dexmedetomidine (DM) is widely used for sedation, restraint, anxiolysis, and analgesia in veterinary medicine. Oral transmucosal dexmedetomidine (OTM DM) has been evaluated in horses, cats, and humans, but not in dogs. In this case series, OTM DM (mean dose of 32.6 μg/kg body weight) was given in the buccal pouch to 4 aggressive dogs in a hospital setting. Two of the dogs were subsequently euthanized, and in the other 2, sedation was reversed with atipamezole. Satisfactory sedation was achieved in all cases. PMID:26538668

  1. Conscious Intravenous Sedation in Dentistry: A Review of Current Therapy.

    PubMed

    Southerland, Janet H; Brown, Lawrence R

    2016-04-01

    Several sedation options are used to minimize pain, anxiety, and discomfort during oral surgery procedures. Minimizing or eliminating pain and anxiety for dental care is the primary goal for conscious sedation. Intravenous conscious sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate as well as cardiovascular function. Patients must retain their protective airway reflexes, and respond to and understand verbal communication. The drugs and techniques used must therefore carry a broad margin of safety. PMID:27040288

  2. Intranasal midazolam for rapid sedation of an agitated patient

    PubMed Central

    Shrestha, Gentle Sunder; Joshi, Pankaj; Bhattarai, Krishna; Chhetri, Santosh; Acharya, Subhash Prasad

    2015-01-01

    Rapidly, establishing a difficult intravenous access in a dangerously agitated patient is a real challenge. Intranasal midazolam has been shown to be effective and safe for rapidly sedating patients before anesthesia, for procedural sedation and for control of seizure. Here, we report a patient in intensive care unit who was on mechanical ventilation and on inotropic support for management of septic shock and who turned out extremely agitated after accidental catheter removal. Intravenous access was successfully established following sedation with intranasal midazolam, using ultrasound guidance. PMID:26195863

  3. Oral transmucosal administration of dexmedetomidine for sedation in 4 dogs.

    PubMed

    Cohen, Anne E; Bennett, Sara L

    2015-11-01

    Injectable dexmedetomidine (DM) is widely used for sedation, restraint, anxiolysis, and analgesia in veterinary medicine. Oral transmucosal dexmedetomidine (OTM DM) has been evaluated in horses, cats, and humans, but not in dogs. In this case series, OTM DM (mean dose of 32.6 μg/kg body weight) was given in the buccal pouch to 4 aggressive dogs in a hospital setting. Two of the dogs were subsequently euthanized, and in the other 2, sedation was reversed with atipamezole. Satisfactory sedation was achieved in all cases. PMID:26538668

  4. Training and Competency in Sedation Practice in Gastrointestinal Endoscopy.

    PubMed

    Da, Ben; Buxbaum, James

    2016-07-01

    The practice of endoscopic sedation requires a thorough understanding of preprocedural assessment, sedation pharmacology, intraprocedure monitoring, adverse event management, and postprocedural care. The training process has become increasingly standardized and entails knowledge and practice-based components. The use of propofol in particular requires a higher level of structured training owing to its narrow therapeutic window. Simulation has increased opportunities for practice-based training in a controlled environment. After completion of training, the endoscopist must demonstrate competence in theoretical understanding and technical ability to administer sedation. Although individual institutions have certification processes, there is a lack of validated, standardized methods to confirm competence. PMID:27372769

  5. Towards a standardised approach for evaluating guidelines and guidance documents on palliative sedation: study protocol

    PubMed Central

    2014-01-01

    Background Sedation in palliative care has received growing attention in recent years; and so have guidelines, position statements, and related literature that provide recommendations for its practice. Yet little is known collectively about the content, scope and methodological quality of these materials. According to research, there are large variations in palliative sedation practice, depending on the definition and methodology used. However, a standardised approach to comparing and contrasting related documents, across countries, associations and governmental bodies is lacking. This paper reports on a protocol designed to enable thorough and systematic comparison of guidelines and guidance documents on palliative sedation. Methods and design A multidisciplinary and international group of palliative care researchers, identified themes and clinical issues on palliative sedation based on expert consultations and evidence drawn from the EAPC (European Association of Palliative Care) framework for palliative sedation and AGREE II (Appraisal Guideline Research and Evaluation) instrument for guideline assessment. The most relevant themes were selected and built into a comprehensive checklist. This was tested on people working closely with practitioners and patients, for user-friendliness and comprehensibility, and modified where necessary. Next, a systematic search was conducted for guidelines in English, Dutch, Flemish, or Italian. The search was performed in multiple databases (PubMed, CancerLit, CNAHL, Cochrane Library, NHS Evidence and Google Scholar), and via other Internet resources. Hereafter, the final version of the checklist will be used to extract data from selected literature, and the same will be compiled, entered into SPSS, cleaned and analysed systematically for publication. Discussion We have together developed a comprehensive checklist in a scientifically rigorous manner to allow standardised and systematic comparison. The protocol is applicable to all

  6. Delirium, Sedation and Analgesia in the Intensive Care Unit: A Multinational, Two-Part Survey among Intensivists

    PubMed Central

    Radtke, Finn M.; Jones, Christina; Citerio, Giuseppe; Walder, Bernhard; Weiss, Bjoern; Wernecke, Klaus-Dieter; Spies, Claudia

    2014-01-01

    Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1) and 868 patients (part 2) were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%). In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524) and approved by the ethical committee. PMID:25398099

  7. MAC, material accounting database user guide

    SciTech Connect

    Russell, V.K.

    1994-09-22

    The K Basins Material Accounting (MAC) database system user guide describes the user features and functions, and the document is structured like the database menus. This document presents the MAC database system user instructions which explain how to record the movements and configuration of canisters and materials within the K Basins on the computer, the mechanics of handling encapsulation tracking, and administrative functions associated with the system. This document includes the user instructions, which also serve as the software requirements specification for the system implemented on the microcomputer. This includes suggested user keystrokes, examples of screens displayed by the system, and reports generated by the system. It shows how the system is organized, via menus and screens. It does not explain system design nor provide programmer instructions.

  8. Impact of sedating antihistamines on safety and productivity.

    PubMed

    Kay, G G; Quig, M E

    2001-01-01

    The use of sedating antihistamines by allergy sufferers remains common, and physicians continue to prescribe these older antihistamines with great frequency. Precautionary statements warning of possible drowsiness and the need for caution when driving or operating machinery, which are required for sedating antihistamines, don't appear to be having much impact. Sedating antihistamines are frequently found to be a causal factor in fatal traffic accidents and are the leading medication found on autopsy of pilots who have crashed their aircraft. Patients taking sedating antihistamines frequently don't feel sleepy, yet they have difficulty staying awake and their brain functioning is impaired. The impact on safety is found in the increased risk of traumatic work-related injuries, driving accidents, and aviation fatalities. The cognitive and psychomotor deficits translate into losses in worker productivity and student learning. PMID:11715216

  9. Paired lunar meteorites MAC88104 and MAC88105: A new FAN of lunar petrology

    SciTech Connect

    Neal, C.R. Univ. of Notre Dame, IN ); Taylor, L.A. ); Lui, Yungang; Schmitt, R.A. )

    1991-11-01

    New lunar meteorite MAC88104/5 represents an exciting new opportunity to study a potentially unsampled region of the Moon. The authors have analyzed six thin sections by electron microprobe and three bulk samples by Instrumental Neutron Activation (INA) in order to determine the chemical characteristics of this new lunar sample. Lunar meteorite MAC88104/5 is dominated by lithologies of the ferroan anorthosite (FAN) suite and contains abundant granulitized highland clasts, devitrified glass beads of impact origin, and two small clasts which appear to be of basaltic origin. One of these basaltic clasts (clast E in MAC88105,84) is probably mesostasis material, whereas the second larger clast (clast G) may be similar to the Very Low-Ti (VLT) or low-Ti/high-alumina mare basalts. Impact melt clasts MAC88105,69 and ,72 have major and trace element compositions similar to the bulk meteorite. There is little evidence of any LKFM (Low-K Fra Mauro or low-K KREEP) contribution to this meteorite, as MAC88104/5 and other brecciated lunar meteorites are Fe-rich and poor in the incompatible elements relative to Apollo 16 regolith and feldspathic breccias. While the exact site of origin for the lunar meteorites cannot be pinpointed, it is evident that they were divided from a relatively KREEP-free ferroan anorthosite terrain.

  10. Dexmedetomidine hydrochloride as a long-term sedative

    PubMed Central

    Kunisawa, Takayuki

    2011-01-01

    Dexmedetomidine undoubtedly is a useful sedative in the intensive care setting because it has a minimal effect on the respiratory system. Dexmedetomidine infusions lasting more than 24 hours have not been approved since the first approval was acquired in the US in 1999. However, in 2008, dexmedetomidine infusions for prolonged use were approved in Colombia and in the Dominican Republic, and the number of countries that have granted approval for prolonged use has been increasing every year. This review discusses the literature examining prolonged use of dexmedetomidine and confirms the efficacy and safety of dexmedetomidine when it is used for more than 24 hours. Dexmedetomidine was administered at varying doses (0.1–2.5 μg/kg/hour) and durations up to 30 days. Dexmedetomidine seems to be an alternative to benzodiazepines or propofol for achieving sedation in adults because the incidences of delirium and coma associated with dexmedetomidine are lower than the corresponding incidences associated with benzodiazepines and propofol, although dexmedetomidine administration can cause mild adverse effects such as bradycardia. Controlled comparative studies on the efficacy and safety of dexmedetomidine and other sedatives in pediatric patients have not been reported. However, dexmedetomidine seems to be effective in managing extubation, reducing the use of conventional sedatives, and as an alternative for inducing sedation in patients for whom traditional sedatives induce inadequate sedation. Prolonged dexmedetomidine infusion has not been reported to have any serious adverse effects. Dexmedetomidine appears to be an alternative long-term sedative, but further studies are needed to establish its efficacy and safety. PMID:21845052

  11. Buprenorphine/naloxone inhibition of remifentanil procedural sedation.

    PubMed

    Gilmore, Thomas; Saccheti, Al; Cortese, Teena

    2012-10-01

    Opioid analgesics are the mainstay of treatment of moderate and severe pain. Remifentanil is an ultrashort acting opioid analgesic used in emergency department (ED)procedural sedation, whereas buprenorphine/naloxone (Suboxone) is an opioid agonist-antagonist combination used in the treatment of addiction-prone individuals. We report here a case of buprenorphine/naloxone inhibition of remifentanil analgesia in a patient undergoing ED procedural sedation. PMID:22030204

  12. EFFECTS OF MILD TO MODERATE SEDATION ON SACCADIC EYE MOVEMENTS

    PubMed Central

    Busettini, C.; Frölich, M. A.

    2014-01-01

    Sedatives alter the metrics of saccadic eye movements. If these effects are nonspecific consequences of sedation, like drowsiness and loss of attention to the task, or differ between sedatives is still unresolved. A placebo-controlled multi-step infusion of one of three sedatives, propofol or midazolam, both GABA-A agonists, or dexmedetedomidine, an α2-adrenergic agonist, was adopted to compare the effects of these three drugs in exactly the same experimental conditions. 60 healthy human volunteers, randomly divided in 4 groups, participated in the study. Each infusion step, delivered by a computer-controlled infusion pump, lasted 20 min. During the last 10 min of each step, the subject executed a saccadic task. Target concentration was doubled at each step. This block was repeated until the subject was too sedated to continue or for a maximum of 6 blocks. Subjects were unaware which infusion they were receiving. A video eye tracker was used to record the movements of the right eye. Saccadic parameters were modeled as a function of block number, estimated sedative plasma concentration, and subjective evaluation of sedation. Propofol and midazolam had strong effects on the dynamics and latency of the saccades. Midazolam, and to a less extent, propofol, caused saccades to become increasingly hypometric. Dexmedetedomidine had less impact on saccadic metrics and presented no changes in saccadic gain. Suppression of the sympathetic system associated with dexmedetomidine has different effects on eye movements from the increased activity of the inhibitory GABA-A receptors by propofol and midazolam even when the subjects reported similar sedation level. PMID:25026096

  13. Effect of Age on the Digit Blood Flow Response to Sedative Concentrations of Nitrous Oxide

    PubMed Central

    Roth, Gerald I.; Matheny, James L.; Falace, Donald A.; O'Reilly, James E.; Norton, James C.

    1984-01-01

    Twenty healthy male subjects [11 young, x̄ = 25.4 ± 0.8 (SEM) years old; 9 elderly, x̄ = 64.5 ± 0.7 years] volunteered for a study designed to investigate the effect of age on several cardiovascular parameters to inhaled N2O-O2. The protocol was designed to mimic the administration of N2O-O2 for sedation in the dental office, although no dental treatment was performed. Clinical criteria were used to judge the appropriate sedative level for each subject; no attempt was made to establish doseresponse relationships. Digit blood flow was measured by strain-gauge plethysmography, and heart rate, arterial blood pressure, respiratory rate, and skin temperature were monitored and recorded. N2O and CO2 levels were monitored in end-tidal gas samples by gas chromatography; machine gauge readings were calibrated against known gas mixtures by the same technique. Under the conditions of this experiment both healthy young and healthy elderly subjects experienced a marked (200-300%) increase in digit blood flow during N2O inhalation, compared to that during air and 100% O2 inhalation. There was no significant difference in the degree of flow increase between young and elderly subjects. Also, there were no significant differences in the response of these healthy young and healthy elderly subjects to sedative concentrations of N2O with regard to heart rate, arterial blood pressure, respiratory rate, skin temperature, or mean end-tidal CO2 levels. The data indicate that N2O, in the concentrations routinely administered in the dental office for sedation, does not have a differential effect on the measured parameters in healthy elderly and healthy young males. PMID:6587798

  14. Prehospital Use of IM Ketamine for Sedation of Violent and Agitated Patients

    PubMed Central

    Scheppke, Kenneth A.; Braghiroli, Joao; Shalaby, Mostafa; Chait, Robert

    2014-01-01

    Introduction Violent and agitated patients pose a serious challenge for emergency medical services (EMS) personnel. Rapid control of these patients is paramount to successful prehospital evaluation and also for the safety of both the patient and crew. Sedation is often required for these patients, but the ideal choice of medication is not clear. The objective is to demonstrate that ketamine, given as a single intramuscular injection for violent and agitated patients, including those with suspected excited delirium syndrome (ExDS), is both safe and effective during the prehospital phase of care, and allows for the rapid sedation and control of this difficult patient population. Methods We reviewed paramedic run sheets from five different catchment areas in suburban Florida communities. We identified 52 patients as having been given intramuscular ketamine 4mg/kg IM, following a specific protocol devised by the EMS medical director of these jurisdictions, to treat agitated and violent patients, including a subset of which would be expected to suffer from ExDS. Twenty-six of 52 patients were also given parenteral midazolam after medical control was obtained to prevent emergence reactions associated with ketamine. Results Review of records demonstrated that almost all patients (50/52) were rapidly sedated and in all but three patients no negative side effects were noted during the prehospital care. All patients were subsequently transported to the hospital before ketamine effects wore off. Conclusion Ketamine may be safely and effectively used by trained paramedics following a specific protocol. The drug provides excellent efficacy and few clinically significant side effects in the prehospital phase of care, making it an attractive choice in those situations requiring rapid and safe sedation especially without intravenous access. PMID:25493111

  15. Rethinking Critical Care: Decreasing Sedation, Increasing Delirium Monitoring, and Increasing Patient Mobility

    PubMed Central

    Bassett, Rick; Adams, Kelly McCutcheon; Danesh, Valerie; Groat, Patricia M.; Haugen, Angie; Kiewel, Angi; Small, Cora; Van-Leuven, Mark; Venus, Sam; Ely, E. Wesley

    2016-01-01

    Background/Methods Sedation management, delirium monitoring, and mobility programs are key features of recent evidence-based critical care guidelines and care bundles, yet implementation in the intensive care unit (ICU) remains highly variable. The Institute for Healthcare Improvement’s Rethinking Critical Care (IHI-RCC) program was established to reduce harm of critically ill patients by decreasing sedation, increasing monitoring and management of delirium, and increasing patient mobility. It involved one live case study and five iterations of an in-person seminar over 33 months (March 2011 to November 2013) that emphasized interdisciplinary teamwork and culture change. IHI-RCC has involved over 650 participants from 215 organizations. This report describes a convenience sample of five participating organizations chosen in advance of knowing their clinical outcomes. Results Qualitative descriptions of the changes tested at each of the five case study sites are provided, demonstrating the necessary teamwork, improved processes, and increased reliability of daily work. These sites all worked to implement the Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU) within the context of a bundled interventional care plan; they then tracked length of stay in the ICU and duration of mechanical ventilation, which are reported. Discussion Changing critical care practices requires an interdisciplinary approach addressing cultural, psychological, and practical issues. The IHI-RCC program is based on testing changes on a small scale, building highly effective interdisciplinary rounds, frequent data feedback to the frontline, and use of in-person demonstrations. Key lessons are emerging about effectively caring for critically ill patients in light of data about the harm of over-sedation, unrecognized and unaddressed delirium, and immobility. PMID:25976892

  16. Echocardiographic reference values in healthy cats sedated with ketamine hydrochloride.

    PubMed

    Fox, P R; Bond, B R; Peterson, M E

    1985-07-01

    An M-mode echocardiographic examination was performed in a consistent manner in 30 clinically healthy cats under light ketamine hydrochloride sedation. There was a significant linear relationship between increasing body size and increasing cardiac dimensions for several echocardiographic values. Positive correlation existed between body weight and body surface area with aortic root, left ventricular caudal wall thickness (LVCW), interventricular septal thickness (IVS), IVS/LVCW, and mean velocity of circumferential fiber shortening (Vcf); there was a negative correlation between body weight and body surface area with left ventricular ejection time (LVET). Body surface area also correlated positively with percentage of ventricular minor axis dimensional change (% delta D). Positive correlations were recorded between left ventricular end-diastolic dimension (LVEDD) and left ventricular endsystolic dimension (LVESD), LVESD and LVET, LVCW and IVS, LVET (calculated by LVCW motion) and LVET (calculated by aortic valve motion), % delta D and Vcf, heart rate and Vcf, and Vcf (calculated using aortic valve motion to compute LVET) and Vcf (using LVCW motion to compute LVET). There were negative correlations between LVEDD and % delta D, LVEDD and Vcf, LVESD and Vcf, LVET and Vcf, LVET and heart rate, LVET and % delta D. Significant differences were recorded between means of echocardiographic reference values generated in this and other studies, except for LVESD. PMID:4026030

  17. Anxiety, Sedation, and Simulated Driving in Binge Drinkers

    PubMed Central

    Aston, Elizabeth R.; Shannon, Erin E.; Liguori, Anthony

    2014-01-01

    The current study evaluated the relationships among trait anxiety, subjective response to alcohol, and simulated driving following a simulated alcohol binge. Sixty drinkers with a binge history completed the State Trait Anxiety Inventory (STAI), the Alcohol Use Questionnaire, and subsequently completed a driving simulation. Participants were then administered 0.2 g/kg ethanol at 30 minute intervals (cumulative dose 0.8 g/kg). Following alcohol consumption, the Biphasic Alcohol Effects Scale (BAES) and visual analog scales of subjective impairment and driving confidence were administered, after which simulated driving was re-assessed. Due to the emphasis on simulated driving after drinking in the current study, subjective response to alcohol (i.e., self-reported sedation, stimulation, impairment, and confidence in driving ability) was assessed once following alcohol consumption, as this is the time when drinkers tend to make decisions regarding legal driving ability. Alcohol increased driving speed, speeding tickets, and collisions. Sedation following alcohol predicted increased subjective impairment and decreased driving confidence. Subjective impairment was not predicted by sensitivity to stimulation or trait anxiety. High trait anxiety predicted low driving confidence after drinking and this relationship was mediated by sedation. Increased speed after alcohol was predicted by sedation, but not by trait anxiety or stimulation. Anxiety, combined with the sedating effects of alcohol, may indicate when consumption should cease. However, once driving is initiated, sensitivity to sedation following alcohol consumption is positively related to simulated driving speed. PMID:24955664

  18. Fospropofol Disodium for Sedation in Elderly Patients Undergoing Flexible Bronchoscopy

    PubMed Central

    Silvestri, Gerard A.; Vincent, Brad D.; Wahidi, Momen M.

    2011-01-01

    Background Fospropofol disodium is a water-soluble prodrug of propofol. A subset analysis was undertaken of elderly patients (≥65 y) undergoing flexible bronchoscopy, who were part of a larger multicenter, randomized, double-blind study. Methods Patients received fentanyl citrate (50 mcg) followed by fospropofol at initial (4.88mg/kg) and supplemental (1.63mg/kg) doses. The primary end point was sedation success (3 consecutive Modified Observer's Assessment of Alertness/Sedation scores of ≤4 and procedure completion without alternative sedative or assisted ventilation). Treatment success, time to fully alert, patient and physician satisfaction, and safety/tolerability were also evaluated. Results In the elderly patients subset (n=61), sedation success was 92%, the mean time to fully alert was 8.0±10.9 min, and memory retention was 72% during recovery, and these were comparable with the younger patients subgroup (age, <65 y). Sedation-related adverse events occurred in 23% of the elderly and 18% of the younger patients (age, <65 y) group. Hypoxemia occurred in 26% of the elderly and 18% of the younger patients group, but no escalation of care was required. Conclusions Fospropofol provided safe and effective sedation, rapid time to fully alert, and high satisfaction in this elderly subset undergoing flexible bronchoscopy, which was comparable with outcomes in younger patients. PMID:21701693

  19. Cardiopulmonary Safety of Propofol Versus Midazolam/Meperidine Sedation for Colonoscopy: A Prospective, Randomized, Double-Blinded Study

    PubMed Central

    Gurbulak, Bunyamin; Uzman, Sinan; Kabul Gurbulak, Esin; Gul, Yasar Gokhan; Toptas, Mehmet; Baltali, Sevim; Anil Savas, Osman

    2014-01-01

    Background: Different levels of pharmacological sedation ranging from minimal to general anesthesia are often used to increase patient tolerance for a successful colonoscopy. However, sedation increases the risk of respiratory depression and cardiovascular complications during colonoscopy. Objectives: We aimed to compare the propofol and midazolam/meperidine sedation methods for colonoscopy procedures with respect to cardiopulmonary safety, procedure-related times, and patient satisfaction. Patients and Methods: This was a prospective, randomized, double-blinded study, in which 124 consecutive patients undergoing elective outpatient diagnostic colonoscopies were divided into propofol and midazolam/meperidine sedation groups (n: 62, m/f ratio: 26/36, mean age: 46 ± 15 for the propofol group; n: 62, m/f ratio: 28/34, mean age: 49 ± 15 for the midazolam/meperidine group) by computer-generated randomization. The frequency of cardiopulmonary events (hypotension, bradycardia, hypoxemia), procedure-related times (duration of colonoscopy, time to cecal intubation, time to ileal intubation, awakening time, and time to hospital discharge) and patients’ evaluation results (pain assessment, quality of sedation, and recollection of procedure) were compared between the groups. Results: There were no statistically significant differences between the two groups with respect to demographic and clinical characteristics of the patients, the frequency of hypotension, hypoxemia or bradycardia, cecal and ileal intubation times, and the duration of colonoscopy. The logistic regression analysis indicated that the development of cardiopulmonary events was not associated with the sedative agent used or the characteristics of the patients. The time required for the patient to be fully awake and the time to hospital discharge was significantly longer in the propofol group (11 ± 8 and 37 ± 11 minutes, respectively) than the midazolam/meperidine group (8 ± 6 and 29 ± 12 minutes

  20. Alpha-2 agonists for sedation of mechanically ventilated adults in intensive care units: a systematic review.

    PubMed Central

    Cruickshank, Moira; Henderson, Lorna; MacLennan, Graeme; Fraser, Cynthia; Campbell, Marion; Blackwood, Bronagh; Gordon, Anthony; Brazzelli, Miriam

    2016-01-01

    data extracted. Random-effects meta-analyses were used for data synthesis. RESULTS Eighteen RCTs (2489 adult patients) were included. One trial at unclear risk of bias compared dexmedetomidine with clonidine and found that target sedation was achieved in a higher number of patients treated with dexmedetomidine with lesser need for additional sedation. The remaining 17 trials compared dexmedetomidine with propofol or benzodiazepines (midazolam or lorazepam). Trials varied considerably with regard to clinical population, type of comparators, dose of sedative agents, outcome measures and length of follow-up. Overall, risk of bias was generally high or unclear. In particular, few trials blinded outcome assessors. Compared with propofol or benzodiazepines (midazolam or lorazepam), dexmedetomidine had no significant effects on mortality [risk ratio (RR) 1.03, 95% confidence interval (CI) 0.85 to 1.24, I (2) = 0%; p = 0.78]. Length of ICU stay (mean difference -1.26 days, 95% CI -1.96 to -0.55 days, I (2) = 31%; p = 0.0004) and time to extubation (mean difference -1.85 days, 95% CI -2.61 to -1.09 days, I (2) = 0%; p < 0.00001) were significantly shorter among patients who received dexmedetomidine. No difference in time to target sedation range was observed between sedative interventions (I (2) = 0%; p = 0.14). Dexmedetomidine was associated with a higher risk of bradycardia (RR 1.88, 95% CI 1.28 to 2.77, I (2) = 46%; p = 0.001). LIMITATIONS Trials varied considerably with regard to participants, type of comparators, dose of sedative agents, outcome measures and length of follow-up. Overall, risk of bias was generally high or unclear. In particular, few trials blinded assessors. CONCLUSIONS Evidence on the use of clonidine in ICUs is very limited. Dexmedetomidine may be effective in reducing ICU length of stay and time to extubation in critically ill ICU patients. Risk of bradycardia but not of overall mortality is higher among patients

  1. S6 Kinase Reflects and Regulates Ethanol-Induced Sedation

    PubMed Central

    Acevedo, Summer F.; Peru y Colón de Portugal, Raniero L.; Gonzalez, Dante A.; Rodan, Aylin R.

    2015-01-01

    Alcohol use disorders (AUDs) affect people at great individual and societal cost. Individuals at risk for AUDs are sensitive to alcohol's rewarding effects and/or resistant to its aversive and sedating effects. The molecular basis for these traits is poorly understood. Here, we show that p70 S6 kinase (S6k), acting downstream of the insulin receptor (InR) and the small GTPase Arf6, is a key mediator of ethanol-induced sedation in Drosophila. S6k signaling in the adult nervous system determines flies' sensitivity to sedation. Furthermore, S6k activity, measured via levels of phosphorylation (P-S6k), is a molecular marker for sedation and overall neuronal activity: P-S6k levels are decreased when neurons are silenced, as well as after acute ethanol sedation. Conversely, P-S6k levels rebound upon recovery from sedation and are increased when neuronal activity is enhanced. Reducing neural activity increases sensitivity to ethanol-induced sedation, whereas neuronal activation decreases ethanol sensitivity. These data suggest that ethanol has acute silencing effects on adult neuronal activity, which suppresses InR/Arf6/S6k signaling and results in behavioral sedation. In addition, we show that activity of InR/Arf6/S6k signaling determines flies' behavioral sensitivity to ethanol-induced sedation, highlighting this pathway in acute responses to ethanol. SIGNIFICANCE STATEMENT Genetic factors play a major role in the development of addiction. Identifying these genes and understanding their molecular mechanisms is a necessary first step in the development of targeted therapeutic intervention. Here, we show that signaling from the insulin receptor in Drosophila neurons determines flies' sensitivity to ethanol-induced sedation. We show that this signaling cascade includes the small GTPase Arf6 and S6 kinase (S6k). In addition, activity of S6k is regulated by acute ethanol exposure and by neuronal activity. S6k activity is therefore both an acute target of ethanol exposure and

  2. Cost-consequence analysis of remifentanil-based analgo-sedation vs. conventional analgesia and sedation for patients on mechanical ventilation in the Netherlands

    PubMed Central

    2010-01-01

    Introduction Hospitals are increasingly forced to consider the economics of technology use. We estimated the incremental cost-consequences of remifentanil-based analgo-sedation (RS) vs. conventional analgesia and sedation (CS) in patients requiring mechanical ventilation (MV) in the intensive care unit (ICU), using a modelling approach. Methods A Markov model was developed to describe patient flow in the ICU. The hourly probabilities to move from one state to another were derived from UltiSAFE, a Dutch clinical study involving ICU patients with an expected MV-time of two to three days requiring analgesia and sedation. Study medication was either: CS (morphine or fentanyl combined with propofol, midazolam or lorazepam) or: RS (remifentanil, combined with propofol when required). Study drug costs were derived from the trial, whereas all other ICU costs were estimated separately in a Dutch micro-costing study. All costs were measured from the hospital perspective (price level of 2006). Patients were followed in the model for 28 days. We also studied the sub-population where weaning had started within 72 hours. Results The average total 28-day costs were €15,626 with RS versus €17,100 with CS, meaning a difference in costs of €1474 (95% CI -2163, 5110). The average length-of-stay (LOS) in the ICU was 7.6 days in the RS group versus 8.5 days in the CS group (difference 1.0, 95% CI -0.7, 2.6), while the average MV time was 5.0 days for RS versus 6.0 days for CS. Similar differences were found in the subgroup analysis. Conclusions Compared to CS, RS significantly decreases the overall costs in the ICU. Trial Registration Clinicaltrials.gov NCT00158873. PMID:21040558

  3. [OPIOID-FREE ANESTHESIA, ANALGESIA AND SEDATION IN SURGERY OF HEAD AND NECK TUMOR].

    PubMed

    Balandin, V V; Gorobec, E S

    2015-01-01

    62 adult patients had highly traumatic cancer head and neck surgery under multimodal non-opioid general anesthesia consisted of dexmedetomidine, lidocane, nefopam and sevoflurane. 18 patients had been intubatedwith fiber optic bronchoscope because of II-IV grade trismus. 10 patients with laryngeal stenosis had been tracheotomizedfor intubation. All these 28 patients had been sedated with dexmedetomidine, lidocane and small doses (10-20 mg) ketamine additionally to local anesthesia. All these patients maintained consciousness and breathed spontaneously. Propofol and rocuronium preceded tracheal intubation. I.V. infusion of dexmedetomidine and lidocane proceeded additionally to sevoflurane (1-1.5MAC) .during the main surgery procedure course. All 62 cases went and finished uneventfully. Awakening and spontaneous breathing recovered just after the end of the surgery. During two first postoperative days all the patients had persistent i.v. analgesia with 1% lidocaine, nefopam and tenoxycam. On the day. 3 analgesia proceeded with nefopam and tenoxycam i.m. The quality of analgesia was good, with no complications. Only 3 patients had one promedol (trimeperidine) or tramadol iniection at the start-up of this new method of analgesia. PMID:27025133

  4. Comparative study between the effects of dexmedetomidine and propofol on cerebral oxygenation during sedation at pediatric cardiac catheterization

    PubMed Central

    Cetin, Murat; Birbicer, Handan; Hallioglu, Olgu; Orekeci, Gulhan

    2016-01-01

    Introduction: Nowadays, assessment of brain oxygen saturation, which is simply appliable and noninvasive method, can provide the anesthesia plans to be optimized according to the needs of the brain, which is the main target organ. Brain may be exposed to hypoxia due to supply-demand imbalance of oxygen not only in general anesthesia procedures but also in sedation practices. The aim of the study is to compare the effects of dexmedetomidine and propofol which are widely used agents for pediatric catheterization procedures on brain oxygen saturation using Fore-Sight. Material and Methods: A total of 44 patients undergoing diagnostic cardiac catheterization between 1 and 18 years old were included in the study. All patients, who were randomly divided into two groups, had ASA physical status I-II. In Group Propofol (Group P, n = 22), induction of sedation was made by midazolam (0.5 mg,iv) + propofol (1m/kg,iv), and in Group Dexmedetomidine (Group D, n = 22), induction of sedation was made by midazolam (0.5 mg,iv) +dexmedetomidine (1mcg/kg, iv). Throughout the sedation, cerebral tissue oxygen saturation (SctO2) was recorded by Fore-Sight in addition to routine monitoring. Results: There were no statistically significant differences between the groups in terms of demographic data, hemodynamic data and sedation scores. On other hand, statistically significant decreases in cerebral tissue oxygen saturation were detected especially at 5th and 10th minutes, in Group D, while cerebral oxygenation level did not decrease in Group P. Though, statistically significant difference was determined between two groups in terms of cerebral oxygen saturation, the obtained data was not interpreted as cerebral desaturation. Conclusion: As a conclusion, there was a statistically significant but clinically insignificant decrease in cerebral tissue oxygen saturation in dexmedetomidine group compared to propofol group. Although it does not seem to be important in hemodynamic stabilization, we

  5. Comparative evaluation of bispectral index system after sedation with midazolam and propofol combined with remifentanil versus ketamine in uncooperative during dental procedures

    PubMed Central

    Eshghi, Alireza; Mohammadpour, Mehrnaz; Kaviani, Nasser; Tahririan, Dana; Akhlaghi, Najmeh

    2016-01-01

    Background: Proper analgesic agents should be used in combination with sedative agents. Remifentanil is a synthetic narcotic/analgesic agent with a short duration effect and decreases the risk of apnea during recovery. Bispectral index system (BIS) is a new noninvasive technique for the evaluation of the depth of sedation. The aim of present clinical trial was to evaluate and compare the efficacy of intravenous sedation with propofol/midazolam/remifentanil (PMR) in comparison to propofol/midazolam/ketamine (PMK) for dental procedures in children 3-7 years of age. Materials and Methods: In this clinical trial, 32 healthy uncooperative children who were candidates for dental treatments under sedation were randomly divided into two groups. Intravenous sedation was induced with PMR in one group and with PMK in the other group. After injection and during procedure BIS index, heart rate and respiratory rate, blood pressure, and oxygen saturation was evaluated every 5 min. After the procedure, recovery time was measured. Data were analyzed with ANOVA, Friedman, Wilcoxon, and t-test. Results: The BIS value was significantly low in ketamin group (P = 0.003) but respiratory rates and heart rates were same in both groups with no statistical difference (P = 0.884, P = 0.775). The recovery time was significantly shorter in remifentanil group (P = 0.008 and P = 0.003). Conclusion: It can be concluded that intravenous sedation technique with PMR combination induces effective and safe sedation, with less pain and more forgetfulness and a shorter recovery time for children 3-7 years of age during dental procedures. PMID:26962308

  6. The incidence of sub-optimal sedation in the ICU: a systematic review

    PubMed Central

    2009-01-01

    Introduction Patients in intensive care units (ICUs) are generally sedated for prolonged periods. Over-sedation and under-sedation both have negative effects on patient safety and resource use. We conducted a systematic review of the literature in order to establish the incidence of sub-optimal sedation (both over- and under-sedation) in ICUs. Methods We searched Medline, Embase and CINAHL (Cumulative Index to Nursing and Allied Health Literature) online literature databases from 1988 to 15 May 2008 and hand-searched conferences. English-language studies set in the ICU, in sedated adult humans on mechanical ventilation, which reported the incidence of sub-optimal sedation, were included. All abstracts were reviewed twice by two independent reviewers, with all conflicts resolved by a third reviewer, to check that they met the review inclusion criteria. Full papers of all included studies were retrieved and were again reviewed twice against inclusion criteria. Data were doubly extracted. Study aims, design, population, comparisons made, and data on the incidence of sub-optimal, optimal, over-sedation or under-sedation were extracted. Results There was considerable variation between included studies in the definition of optimal sedation and in the scale or method used to assess sedation. Across all included studies, a substantial incidence of sub-optimal sedation was reported, with a greater tendency toward over-sedation. Conclusions Our review suggests that improvements in the consistent definition and measurement of sedation may improve the quality of care of patients within the ICU. PMID:20015357

  7. Propofol sedation versus no sedation in detection of pharyngeal and upper gastrointestinal superficial squamous cell carcinoma using endoscopic narrow band imaging: a multicenter prospective trial

    PubMed Central

    He, Yuqi; Zhao, Yuqing; Fu, Kuangi; Du, Yongqiang; Yu, Jin; Wang, Jianxun; Jin, Peng; Zhao, Xiaojun; Li, Na; Guo, Hua; Li, Jiandong; Zhao, Fayun; Sheng, Jianqiu

    2015-01-01

    Intravenous propofol can provide a superior quality of sedation compared to standard sedation for upper gastrointestinal endoscopy. However, the utility of propofol sedation for the endoscopic early detection of superficial pharyngeal and esophageal squamous cell carcinoma has not been investigated. In a multicenter, prospective trial, 255 patients with esophageal squamous cell carcinomas (ESCCs) were assigned to receive propofol sedation or no sedation according to their own willingness. The primary aim was to compare the detection rates of superficial cancer in the pharyngeal region and the esophagus between two groups. The secondary aim was to evaluate factors associated with technical adequacy. The detection rate was higher in the propofol sedation vs. no sedation group for H&N region (6.06% vs. 2.40%), but not significantly (P=0.22). However, the small lesion (less than 10 mm in diameter) detection rate was higher in sedation vs. no sedation group for H&N region (88.89% vs. 33.33%; P=0.048). The median time for pharyngeal observation in the sedation group was faster than in the no sedation group (20.6 s vs. 44.3 s; P<0.001). Ninety-five percent of H&N region evaluations were totally complete in sedation compared with sixty percent in the no sedation group (P<0.001). The overall p value indicated that only smoking habit was associated with incomplete pharyngeal observation (P<0.05), and it was more difficult to accomplish a complete pharyngeal observation in patients who smoked more than 10 packs per day. Intravenous propofol sedation compared to no intravenous sedation during conventional upper gastrointestinal endoscopy can facilitate a more complete pharyngeal examination and increase the detection rate of superficial H&N squamous cell carcinoma in high risk patients. PMID:26770478

  8. Propofol sedation versus no sedation in detection of pharyngeal and upper gastrointestinal superficial squamous cell carcinoma using endoscopic narrow band imaging: a multicenter prospective trial.

    PubMed

    He, Yuqi; Zhao, Yuqing; Fu, Kuangi; Du, Yongqiang; Yu, Jin; Wang, Jianxun; Jin, Peng; Zhao, Xiaojun; Li, Na; Guo, Hua; Li, Jiandong; Zhao, Fayun; Sheng, Jianqiu

    2015-01-01

    Intravenous propofol can provide a superior quality of sedation compared to standard sedation for upper gastrointestinal endoscopy. However, the utility of propofol sedation for the endoscopic early detection of superficial pharyngeal and esophageal squamous cell carcinoma has not been investigated. In a multicenter, prospective trial, 255 patients with esophageal squamous cell carcinomas (ESCCs) were assigned to receive propofol sedation or no sedation according to their own willingness. The primary aim was to compare the detection rates of superficial cancer in the pharyngeal region and the esophagus between two groups. The secondary aim was to evaluate factors associated with technical adequacy. The detection rate was higher in the propofol sedation vs. no sedation group for H&N region (6.06% vs. 2.40%), but not significantly (P=0.22). However, the small lesion (less than 10 mm in diameter) detection rate was higher in sedation vs. no sedation group for H&N region (88.89% vs. 33.33%; P=0.048). The median time for pharyngeal observation in the sedation group was faster than in the no sedation group (20.6 s vs. 44.3 s; P<0.001). Ninety-five percent of H&N region evaluations were totally complete in sedation compared with sixty percent in the no sedation group (P<0.001). The overall p value indicated that only smoking habit was associated with incomplete pharyngeal observation (P<0.05), and it was more difficult to accomplish a complete pharyngeal observation in patients who smoked more than 10 packs per day. Intravenous propofol sedation compared to no intravenous sedation during conventional upper gastrointestinal endoscopy can facilitate a more complete pharyngeal examination and increase the detection rate of superficial H&N squamous cell carcinoma in high risk patients. PMID:26770478

  9. Wireless Sensor Networks Energy-Efficient MAC Protocol

    NASA Astrophysics Data System (ADS)

    Lijuan, Du; Yuanpeng, Wang; WeiPeng, Jing

    This paper presents a new wireless sensor network energy-efficient MAC protocol, ES-MAC protocol, and shows the results of simulation experiments. During the transmission the nodes do not send ACK packages while use a small amount of new information packets, so they can reduce unnecessary energy loss and wasted time. The theoretical analysis and simulation results show that ES-MAC protocol reduces energy consumption while reducing network latency and improving network throughput.

  10. Introduction to MacDraft. High-Technology Training Module.

    ERIC Educational Resources Information Center

    Traxler, Gene

    This training module on MacDraft is part of a computer drafting skills unit on communications technology for grades 9-12. The objective is for each student to complete a drawing on the MacIntosh computer using the MacDraft software program. This drawing is to be dimensioned with a dual system and is to include a border and title block. This module…

  11. [Preliminary study of the lymphology unit at the hospital of La Ferté-Macé (Orne)].

    PubMed

    Orhan, J

    1989-01-01

    The presence of people with lymphedema taking the waters at the thermal spa at Bagnoles-de-l'Orne led to the creation of a Lymphology Unit at the Hôpital de La Ferté-Macé, situated 5 km from the spa. A course of treatment at a spa is a considerable aid in treating lymphedema because of its filtering, resolving, keratolytic and sedative action and because of hydraulic pressure therapy. The Lymphology Unit finishes off the result using intensive care consisting of postural drainage, manual massage of lymphatic drainage, bandages, pneumatic pressure therapy and physiotherapy followed by final immobilization. Moreover, it can also carry out an intensive basic treatment or booster treatment for a short stay without spa treatment. The author sets out the first encouraging results from combining the two techniques. PMID:2772046

  12. A Mobile Automated Characterization System (MACS) for indoor floor characterization

    SciTech Connect

    Richardson, B.S.; Haley, D.C.; Dudar, A.M.; Ward, C.R.

    1995-03-01

    The Savannah River Technology Center (SRTC) and Oak Ridge National Laboratory are developing an advanced Mobile Automated Characterization System (MACS) to characterize indoor contaminated floors. MACS is based upon Semi-Intelligent Mobile Observing Navigator (SIMON), an earlier floor characterization system developed at SRTC. MACS will feature enhanced navigation systems, operator interface, and an interface to simplify integration of additional sensors. The enhanced navigation system will provide the capability to survey large open areas much more accurately than is now possible with SIMON, which is better suited for hallways and corridors that provide the means for recalibrating position and heading. MACS operator interface is designed to facilitate MACS`s use as a tool for health physicists, thus eliminating the need for additional training in the robot`s control language. Initial implementation of MACS will use radiation detectors. Additional sensors, such as PCB sensors currently being developed, will be integrated on MACS in the future. Initial use of MACS will be focused toward obtaining comparative results with manual methods. Surveys will be conducted both manually and with MACS to compare relative costs and data quality. While clear cost benefits anticipated, data quality benefits should be even more significant.

  13. A case of Mac Tel 2 with an unusual sub macular vitelliform lesion

    PubMed Central

    Lekha, T.; Sarwate, Nikit; Sarwate, Renuka

    2015-01-01

    Method: Observational case report describing the clinical, FFA, OCT and mfERG findings in an elderly female patient with atypical features of macular telangiectasia (Mac Tel 2) Results: A 71-year-old lady was detected to have characteristic features of Mac Tel 2 in the left eye (LE) and a yellowish sub macular vitelliform like lesion in the right eye (RE). FFA showed ill defined hyper fluorescence in the RE and telangiectasia and parafoveal leakage typical of Mac Tel 2 in the LE. On OCT RE had hyper reflective clump of echoes subfoveally with an intact RPE and LE had foveal thinning with hypo reflective intraretinal cavities. mfERG responses were normal in the RE and reduced in the LE. During the course of 3 years LE showed natural progression while RE remained unchanged. Conclusion: Structural and functional evaluation of an unusual sub macular vitelliform lesion seen in association with Mac Tel 2 and its course over a period of 3 years is described. The differentiating features of this lesion from adult onset foveomacular vitelliform dystrophy (AFMD) are discussed.

  14. Dexmedetomidine and fentanyl combination for procedural sedation in a case of Duchenne muscular dystrophy

    PubMed Central

    Kulshrestha, Ashish; Bajwa, Sukhminder Jit Singh; Singh, Amarjit; Kapoor, Vinod

    2011-01-01

    Duchenne muscular dystrophy, an X-linked disorder characterized by progressive muscle weakness, is the most common muscular dystrophy among children leading to death before the end of third decade. Anesthesia in such patients pose a great challenge due to various complications associated with it. The dreaded metabolic and clinical complications occur due to various inhalational anesthetics and succinylcholine in this subset of patients. We are reporting a child with diagnosed Duchenne muscular dystrophy who underwent excision of dentigerous cyst in oral cavity under procedural sedation with combination of dexmedetomidine and fentanyl and thus administration of general anesthesia was avoided. PMID:25885395

  15. An Update on the Use of Sedative-Hypnotic Medications in Psychiatric Disorders.

    PubMed

    Creado, Shane; Plante, David T

    2016-09-01

    Sleep disturbance is a common clinical problem experienced by patients with a wide range of psychiatric disorders. Accumulating evidence has demonstrated that insomnia is a comorbid process that affects the course and treatment of a number of forms of mental illness. The efficacy and safety of sedative-hypnotic medications have largely been established in patients who do not have comorbid psychiatric disorders, underscoring the need for further research in this sphere. This review summarizes pertinent findings in the recent literature that have examined the role of hypnotic medication in the treatment of psychiatric illness, and highlights potential areas that may prove fruitful avenues of future research. PMID:27417512

  16. PROPRANOLOL AND D-CYCLOSERINE AS ADJUNCTIVE MEDICATIONS IN REDUCING DENTAL FEAR IN SEDATION PRACTICE

    PubMed Central

    Heaton, Lisa J.; McNeil, Daniel W.; Milgrom, Peter

    2010-01-01

    Extensive research and clinical experience have demonstrated the usefulness of sedation in helping fearful patients receive dental treatment, particularly when they have urgent treatment needs. In addition, the efficacy of behavioural programmes for managing dental fears is well established. While often these two approaches are seen as oppositional, our work in Seattle, Morgantown and at King’s College London Dental Institute demonstrates the complementarity of the two approaches. Using the example of two compounds, one very familiar, propranolol, and one that has recently become of interest, D-cycloserine, we wish to illustrate the manner in which these medications can be used to enhance behavioural approaches to managing dental anxiety. PMID:20151608

  17. Postoperative sedation and analgesia after pediatric liver transplantation.

    PubMed

    Fumagalli, R; Ingelmo, P; Sperti, L R

    2006-04-01

    The goal of sedation in the pediatric intensive care unit (PICU) is to produce a calm and comfortable child, free from pain and discomfort. Children receiving liver transplantation need analgesics to control pain from surgical incisions, drains, vascular access, or endotracheal suctioning. Sedatives are used to facilitate the delivery of nursing care, to prevent self-extubation, and to facilitate mechanical ventilation. Optimal sedation produces a state in which the patient is somnolent, responsive to the environment but untroubled by it, and with no excessive movements. A common problem in the PICU is the fluctuation in the delivery of sedatives and analgesics depending on the health care providers and on a breakdown in communication between physicians and nurses to define end points for pharmacological therapy. This variability more often leads to oversedation rather than undersedation. Oversedation delays extubation, promotes ventilator-associated pneumonia, and increases the risk of reintubation. The use of written sedation policies to guide practice at the bedside reduces the length of time for which patients require mechanical ventilation and the length of PICU stay. Protocols for drug administration practices increase patient safety during mechanical ventilation, promote nursing autonomy, and facilitate communication between nurses and physicians as well as between nurses. PMID:16647489

  18. Female Patients Require a Higher Propofol Infusion Rate for Sedation.

    PubMed

    Maeda, Shigeru; Tomoyasu, Yumiko; Higuchi, Hitoshi; Honda, Yuka; Ishii-Maruhama, Minako; Miyawaki, Takuya

    2016-01-01

    Sedation may minimize physiologic and behavioral stress responses. In our facility, the infusion rate of propofol is adjusted according to the bispectral index (BIS) in all cases of implant-related surgery; multivariate analysis of retrospective data enabled us to extract independent factors that affect the dose of propofol in sedation that are considered useful indicators for achieving adequate sedation. The study population comprised all patients undergoing implant-related surgery under intravenous sedation in Okayama University Hospital from April 2009 to March 2013. The infusion rate of propofol was adjusted to maintain the BIS value at 70-80. The outcome was the average infusion rate of propofol, and potential predictor variables were age, sex, body weight, treatment time, and amount of midazolam. Independent variables that affected the average infusion rate of propofol were extracted with multiple regression analysis. One hundred twenty-five subjects were enrolled. In the multiple regression analysis, female sex was shown to be significantly associated with a higher average infusion rate of propofol. Females may require a higher infusion rate of propofol than males to achieve adequate sedation while undergoing implant-related surgery. PMID:27269663

  19. Is opiate action in cough due to sedation?

    PubMed Central

    Dickinson, Rebecca S.; Morjaria, Jaymin B.; Wright, Caroline E.

    2014-01-01

    Objectives: Opiates have been used for cough suppression for centuries. It is unclear whether this antitussive action is due to their known sedative effects. We aimed to assess correlation between cough suppression and opiate usage. Methods: We performed a post hoc analysis of two published trials with three opioids. In study one, patients with chronic cough were treated with 4 weeks of modified release morphine sulphate (5 mg twice daily) or placebo in a double-blinded placebo-controlled fashion. Cough suppression was assessed subjectively by the Leicester Cough Questionnaire and objectively by citric acid aerosol (CAA) induced cough challenge. In study 2, normal volunteers were given single doses of placebo, codeine 30 mg or dextromethorphan 50 mg and cough suppression assessed using the CAA-induced cough challenge. Sedation was contemporaneously assessed by direct questioning. Results: There were 14 episodes of patient-reported sedation; 2 with modified release morphine sulphate, 9 with codeine and 3 with dextromethorphan. There was no correlation between change in the Leicester Cough Questionnaire or the CAA-induced cough challenge and reported sedation. Conclusion: This observational study suggests that sedation is unlikely to underlie the antitussive properties of these opioids. Eliciting the mechanism of these medications in cough may be a target for future tailored drug development. PMID:25177477

  20. [Pediatric patient sedation and analgesia for diagnostic medical procedures].

    PubMed

    Kadosaki, Mamoru

    2014-08-01

    There is an increasing demand for anesthesiologists to work outside the operating room in order to provide general anesthesia or monitored sedation for a variety of medical investigations or procedures in infants and children. The concept that treatment should be a pain- and stress-free experience is now well accepted, and this has placed additional responsibilities on anesthesiologists. We describe pediatric anesthesia and monitored sedation for diagnostic medical procedures. Children requiring a painful procedure and prolonged examination should be provided with optimal sedation and analgesia. The child should be monitored with standard ASA monitors. In the case of medical procedures such as gastrointestinal endoscopy, transesophageal echocardiography, and cardiac catheterization, general endotracheal anesthesia with neuromuscular block is recommended. Several short-acting anesthetic drugs, including sevoflurane, propofol, remifentanil, and rocuronium, have become available in Japan, and the safety and efficacy of pediatric general anesthesia for diagnostic medical procedures have improved. Infants who require a noninvasive and short examination may not be provided with anesthetics. The feed and wrap method is recommended. Satisfactory immobilization of the child during noninvasive medical procedures, including magnetic resonance imaging, may be achieved by intravenous sedation or general anesthesia. Monitored intravenous sedation using propofol is the most widely used for healthy children; general anesthesia with a laryngeal mask airway or endotracheal intubation and controlled ventilation is required for a critically ill child. PMID:25669029

  1. TreeMAC: Localized TDMA MAC protocol for real-time high-data-rate sensor networks

    USGS Publications Warehouse

    Song, W.-Z.; Huang, R.; Shirazi, B.; LaHusen, R.

    2009-01-01

    Earlier sensor network MAC protocols focus on energy conservation in low-duty cycle applications, while some recent applications involve real-time high-data-rate signals. This motivates us to design an innovative localized TDMA MAC protocol to achieve high throughput and low congestion in data collection sensor networks, besides energy conservation. TreeMAC divides a time cycle into frames and each frame into slots. A parent node determines the children's frame assignment based on their relative bandwidth demand, and each node calculates its own slot assignment based on its hop-count to the sink. This innovative 2-dimensional frame-slot assignment algorithm has the following nice theory properties. First, given any node, at any time slot, there is at most one active sender in its neighborhood (including itself). Second, the packet scheduling with TreeMAC is bufferless, which therefore minimizes the probability of network congestion. Third, the data throughput to the gateway is at least 1/3 of the optimum assuming reliable links. Our experiments on a 24-node testbed show that TreeMAC protocol significantly improves network throughput, fairness, and energy efficiency compared to TinyOS's default CSMA MAC protocol and a recent TDMA MAC protocol Funneling-MAC. Partial results of this paper were published in Song, Huang, Shirazi and Lahusen [W.-Z. Song, R. Huang, B. Shirazi, and R. Lahusen, TreeMAC: Localized TDMA MAC protocol for high-throughput and fairness in sensor networks, in: The 7th Annual IEEE International Conference on Pervasive Computing and Communications, PerCom, March 2009]. Our new contributions include analyses of the performance of TreeMAC from various aspects. We also present more implementation detail and evaluate TreeMAC from other aspects. ?? 2009 Elsevier B.V.

  2. Accounting for personhood in palliative sedation: the Ring Theory of Personhood.

    PubMed

    Radha Krishna, Lalit Kumar

    2014-06-01

    Application of sedation at the end of life has been fraught with ethical and clinical concerns, primarily focused on its potential to hasten death. However, in the face of clinical data that assuage most of these concerns, a new threat to this treatment of last resort has arisen. Concern now pivots on its effects on the personhood of the patient, underpinned by the manner in which personhood has been conceptualised. For many authors, it is consciousness that is seen to be the seat of personhood, thus its loss is seen to rob a patient of their moral and ethical worth, leaving them in a state that cannot ethically be differentiated from death. Here I proffer a clinically based alternative to this view, the Ring Theory of Personhood, which dispels these concerns about sedation at the end of life. The Ring Theory envisages personhood as a coadunation of three domains of concern: the innate, the individual and the relational elements of personhood. The innate element of personhood is held to be present among all humans by virtue of their links with the Divine and or their human characteristics. The individual elements of personhood pivot on the presence of consciousness-dependent features such as self-awareness, self-determination and personality traits. The relational component of personhood envisages an individual as being 'socially embedded' replete with social and familial ties. It is these three equally important inter-related domains that define personhood. PMID:24072720

  3. Effects of pretest stimulative and sedative music on grip strength.

    PubMed

    Karageorghis, C I; Drew, K M; Terry, P C

    1996-12-01

    The purpose of the present study was to investigate the effects of stimulative (energizing) and sedative (relaxing) music on grip strength. A 2 x 3 (gender x condition) repeated-measures analysis of variance and post hoc tests showed that participants (N = 50) evidenced higher grip strength after listening to stimulative music (M = 43.94 kg.force) than after sedative music or a white noise control condition. Sedative music yielded lower scores than white noise. Men evidenced higher grip strength than women, but there was no interaction between gender and music condition. It was concluded that a simple motoric task such as grip strength provides a sensitive measure of psychophysical responses to music. PMID:9017751

  4. Considerable Variability of Procedural Sedation and Analgesia Practices for Gastrointestinal Endoscopic Procedures in Europe

    PubMed Central

    Vaessen, Hermanus H. B.; Knape, Johannes T. A.

    2016-01-01

    Background/Aims: The use of moderate to deep sedation for gastrointestinal endoscopic procedures has increased in Europe considerably. Because this level of sedation is a risky medical procedure, a number of international guidelines have been developed. This survey aims to review if, and if so which, quality aspects have been included in new sedation practices when compared to traditional uncontrolled sedation practices. Methods: A questionnaire was sent to the National Associations of Nurse Anesthetists in Europe and the National Delegates of the European Section and Board of Anaesthesiology from January 2012 to August 2012. Results: Huge variation in practices for moderate to deep sedation were identified between and within European countries in terms of safety, type of practitioners, responsibilities, monitoring, informed consent, patient satisfaction, complication registration, and training requirements. Seventy-five percent of respondents were not familiar with international sedation guidelines. Safe sedation practices (mainly propofol-based moderate to deep sedation) are rapidly gaining popularity. Conclusions: The risky medical procedure of moderate to deep sedation has become common practice for gastrointestinal endoscopy. Safe sedation practices requiring adequate selection of patients, adequate monitoring, training of sedation practitioners, and adequate after-care, are gaining attention in a field that is in transition from uncontrolled sedation care to controlled sedation care. PMID:26855924

  5. Comparison of Oral and Intranasal Midazolam/Ketamine Sedation in 3-6-year-old Uncooperative Dental Patients

    PubMed Central

    Fallahinejad Ghajari, Masoud; Ansari, Ghassem; Soleymani, Ali Asghar; Shayeghi, Shahnaz; Fotuhi Ardakani, Faezeh

    2015-01-01

    Background and aims. There are several known sedative drugs, with midazolam and ketamine being the most commonly used drugs in children. The aim of this study was to compare the effect of intranasal and oral midazolam plus ketamine in children with high levels of dental anxiety. Materials and methods.A crossover double-blind clinical trial was conducted on 23 uncooperative children aged 3-6 (negative or definitely negative by Frankel scale), who required at least two similar dental treatment visits. Cases were randomly given ketamine (10 mg/kg) and midazolam (0.5 mg/kg) through oral or intranasal routes in each visit. The sedative efficacy of the agents was assessed by an overall success rate judged by two independent pediatric dentists based on Houpt’s scale for sedation. Data analysis was carried out using Wilcoxon test and paired t-test. Results. Intranasal administration was more effective in reduction of crying and movement during dental procedures compared to oral sedation (P<0.05). Overall behavior control was scored higher in nasal compared to oral routes at the time of LA injection and after 15 minutes (P<0.05). The difference was found to be statistically significant at the start and during treatment. However, the difference was no longer significant after 30 minutes, with the vital signs remaining within physiological limits. Recovery time was longer in the intranasal group (P<0.001) with a more sleepy face (P=0.004). Conclusion.. Intranasal midazolam/ketamine combination was more satisfactory and effective than the oral route when sedating uncooperative children. PMID:26236429

  6. Intranasal Dexmedetomidine as a Sedative Premedication for Patients Undergoing Suspension Laryngoscopy: A Randomized Double-Blind Study

    PubMed Central

    Lu, Chengxiang; Zhang, Li-Ming; Zhang, Yuehong; Ying, Yanlu; Li, Ling; Xu, Lixin; Ruan, Xiangcai

    2016-01-01

    Background Intranasal dexmedetomidine, a well-tolerated and convenient treatment option, has been shown to induce a favorable perioperative anxiolysis in children. We investigate intranasal dexmedetomidine as a sedative premedication for anesthesia recovery in an adult population. Methods A prospective randomized controlled trial; 81 adult patients scheduled for elective suspension laryngoscopy received intranasal dexmedetomidine (1 μg∙kg–1) or a placebo 45–60 min before anesthetic induction. Extubation time was used as the primary outcome measure. Secondary variables included the levels of sedation (Observer’s Assessment of Alertness/Sedation scale, OAA/S) and anxiety (4-point anxiety score), anesthetic and analgesic requirements, hemodynamic fluctuations, and anesthesia recovery as well as side effects. Results The levels of sedation and anxiety differed significantly between the two groups at anesthesia pre-induction (p < 0.001 and = 0.001, respectively). Repeated-measure general linear model determined no significant interaction effect between group and time on the targeted concentration of propofol (F = 1.635, p = 0.200), but a significant main effect of group existed (F = 6.880, p = 0.010). A moderate but significant decrease in the heart rate was recorded in the dexmedetomidine group at pre-induction. Episodes of tachycardia and hypertension after tracheal intubation and extubation were more frequent in the placebo group. Conclusions Intranasal dexmedetomidine as a sedative premedication induced a favorable perioperative anxiolysis without prolongation in anesthesia recovery; the hemodynamic effect was modest. Trial Registration ClinicalTrials.gov NCT 02108171 PMID:27196121

  7. Deep sedation in GreenLight laser prostatectomy

    PubMed Central

    Fligou, Fotini; Kallidonis, Panagiotis; Flaris, Nicolaos; Al-Aown, Abdulrahman; Kyriazis, Iason; Vasilas, Marinos; Panagopoulos, Vasilis; Perimenis, Petros; Liatsikos, Evangelos; Vrettos, Theofanis

    2016-01-01

    Introduction: Evaluation of ketamine and propofol combination for the performance of photoselective vaporization of prostate (PVP). Patients and Methods: Twenty-six patients undergoing PVP for benign prostatic hyperplasia were included in the study. Co-morbidities were present in 24 patients. Midazolam 2 mg intravenous was administered for the induction to anesthesia. Propofol (10 mg/ml) and ketamine (1 mg/ml) were administered with the use of two pumps. An initial bolus dose of 0.03 ml/kg of propofol and 5 mg of ketamine was administered intravenously. The anesthesia was maintained by continuous infusion of 0.01 ml/kg/min of propofol and 2 ml/min of ketamine. Fentanyl was administered when deemed necessary. The level of sedation, peri-operative parameters and side-effects were recorded. Results: The average periods from the induction of anesthesia and intraoperative infusion were 12.38 ± 5.84 min and 59.5 ± 22.15 min, respectively. Average propofol and total ketamine dose were 85.5 ± 10.62 μg/kg/min and 144.9 ± 45.62 mg, respectively. The average dose of fentanyl administered was 29.81 ± 27.40 μcg. An average period between the end of the infusion and the discharge to the urology clinic was 34.62 ± 22.89 min. Ten patients experienced nausea and five eventually vomited. Hallucinations were observed in five cases while visual disturbances in two patients. Conclusion: The combined use of ketamine and propofol for the performance of PVP proved to be an efficient method for anesthesia. The “deep sedation” provided by these drugs was not associated with significant side-effects. Moreover, the use of the above method is indicated in patients with significant co-morbidities that should undergo PVP. PMID:27141193

  8. Assessing the Stability and Safety of Procedure during Endoscopic Submucosal Dissection According to Sedation Methods: A Randomized Trial

    PubMed Central

    Lee, Sang Kil; Lee, Hyuk; Lee, Yong Chan; Park, Jun Chul; Yoo, Young Chul

    2015-01-01

    sedation. Trial Registration ClinicalTrials.gov NCT01806753 PMID:25803441

  9. A Randomized Clinical Trial Comparing the Standard Mcintosh Laryngoscope and the C-Mac D blade Video laryngoscope™ for Double Lumen Tube Insertion for One Lung Ventilation in Onco surgical Patients

    PubMed Central

    Shah, Shagun Bhatia; Bhargava, Ajay Kumar; Hariharan, Uma; Mittal, Amit Kumar; Goel, Nitesh; Choudhary, Manish

    2016-01-01

    Background and Aims: Several devices enabling double-lumen tube (DLT) placement for thoracic surgeries are available, but there are no studies for D-blade video laryngoscope-guided DLT insertion. We compared the CMac D-blade videolaryngoscope™ and the Macintosh laryngoscope for DLT endobronchial intubation using parameters of time and attempts required for intubation, glottic view, incidence of complications and haemodynamic changes. Methods: Prospective, parallel group, randomised controlled clinical trial where sixty American Society of Anesthesiologists I and II patients aged 18-80 years scheduled for thoracic surgeries entailing DLT placement were randomly allocated in two groups based on the laryngoscopic device used for endobronchial intubation. Data were subjected to statistical analysis SPSS (version 17), the paired and Student's t-test for equality of means. Nominal categorical data between the groups were compared using Chi-squared test or Fisher's exact test as appropriate. P ˂ 0.05 was considered statistically significant. Results: Time required for intubation was comparable (37.41 ± 18.80 s in Group-M and 32.27 ± 11.13 s in Group-D). Number of attempts and incidence of complications (trauma, DLT cuff rupture, oesophageal intubation) was greater in the Macintosh group, except malpositioning into the wrong bronchus (easily rectified fibre-optic bronchoscopically), which was greater with the D-blade. Greater haemodynamic changes were observed during Macintosh laryngoscopy. Conclusion: D-blade videolaryngoscope™ is a useful alternative to the standard Macintosh laryngoscope for routine DLT insertion. PMID:27212717

  10. Negative impact of sedation on esophagogastric junction evaluation during esophagogastroduodenoscopy

    PubMed Central

    Kim, Eun Soo; Lee, Ho Young; Lee, Yoo Jin; Min, Bo Ram; Choi, Jae Hyuk; Park, Kyung Sik; Cho, Kwang Bum; Jang, Byoung Kuk; Chung, Woo Jin; Hwang, Jae Seok

    2014-01-01

    AIM: To compare the esophagogastric junction (EGJ) areas observed in sedated and non-sedated patients during esophagogastroduodenoscopy (EGD). METHODS: Data were collected prospectively from consecutive patients who underwent EGD for various reasons. The patients were divided into three groups according to the sedation used: propofol, midazolam, and control (no sedation). The EGJ was observed during both insertion and withdrawal of the endoscope. The extent of the EGJ territory observed was classified as excellent, good, fair, or poor. In addition, the time the EGJ was observed was estimated. RESULTS: The study included 103 patients (50 males; mean age 58.44 ± 10.3 years). An excellent observation was achieved less often in the propofol and midazolam groups than in the controls (27.3%, 28.6% and 91.4%, respectively, P < 0.001). There was a significant difference in the time at which EGJ was observed among the groups (propofol 20.7 ± 11.7 s vs midazolam 16.3 ± 7.3 s vs control 11.6 ± 5.8 s, P < 0.001). Multivariate analysis showed that sedation use was the only independent risk factor for impaired EGJ evaluation (propofol, OR = 24.4, P < 0.001; midazolam, OR = 25.3, P < 0.001). Hiccoughing was more frequent in the midazolam group (propofol 9% vs midazolam 25.7% vs control 0%, P = 0.002), while hypoxia (SaO2 < 90%) tended to occur more often in the propofol group (propofol 6.1% vs midazolam 0% vs control 0%, P = 0.101). CONCLUSION: Sedation during EGD has a negative effect on evaluation of the EGJ. PMID:24833883