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Sample records for agitation sedation scale

  1. Entropy correlates with Richmond Agitation Sedation Scale in mechanically ventilated critically ill patients.

    PubMed

    Sharma, Ankur; Singh, Preet Mohinder; Trikha, Anjan; Rewari, Vimi; Chandralekha

    2014-04-01

    Sedation is routinely used in intensive care units. However due to absence of objective scoring systems like Bispectral Index and entropy our ability to regulate the degree of sedation is limited. This deficiency is further highlighted by the fact that agitation scores used in intensive care units (ICU) have no role in paralyzed patients. The present study compares entropy as a sedation scoring modality with Richmond Agitation Sedation Scale (RASS) in mechanically ventilated, critically ill patients in an ICU. Twenty-seven, mechanically ventilated, critically ill patients of either sex, 16-65 years of age, were studied over a period of 24 h. They received a standard sedation regimen consisting of a bolus dose of propofol 0.5 mg/kg and fentanyl 1 lg/kg followed by infusions of propofol and fentanyl ranging from 1.5 to 5 mg/kg/h and 0.5 to 2.0 lg/kg/h, respectively. Clinically relevant values of RASS for optimal ICU sedation (between 0 and -3) in non-paralyzed patients were compared to corresponding entropy values, to find if any significant correlation exists between the two. These entropy measurements were obtained using the Datex-Ohmeda-M-EntropyTM module. This module is presently not approved by Food and Drug Administration (FDA) for monitoring sedation in ICU. A total of 527 readings were obtained. There was a statistically significant correlation between the state entropy (SE) and RASS [Spearman's rho/rs = 0.334, p\\0.0001]; response entropy (RE) and RASS [Spearman's rho/rs = 0.341, p\\0.0001]). For adequate sedation as judged by a RASS value of 0 to -3, the mean SE was 57.86 ± 16.50 and RE was 67.75 ± 15.65. The present study illustrates that entropy correlates with RASS (between scores 0 and -3) when assessing the level of sedation in mechanically ventilated critically ill patients.

  2. 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.

  3. High-Dose Ketamine Sedation of an Agitated Patient During Air Medical Transport.

    PubMed

    Reicher, David

    2016-01-01

    We report a case in which a high-dose ketamine infusion was used to sedate an agitated patient for air medical transport, avoiding the risks of general anesthesia and causing no exacerbation of psychiatric symptoms. PMID:27021674

  4. 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

  5. [Monitoring of sedation].

    PubMed

    Chamorro, C; Martínez-Melgar, J L; Barrientos, R

    2008-02-01

    Once analgesia is assured, sedation has special relevance in the critically ill ventilated patient's global treatment. Sedatives should be adjusted to individual needs, by administering minimal effective doses to achieve the AIM. This aim must be clearly identified, defined at the beginning of the treatment and revised on a regular basis, ideally at least once per shift. Sedation strategies should foresee the different needs throughout the day within dynamic sedation concept framework. Required sedation depth depends on the patient's psychological characteristics, foreseen evolution and patient tolerance to the support techniques used in treatment. Sedation monitoring permits identification and correction of under- or over-sedation, either of which could negatively influence critically ill patient evolution. The over-sedation concept must be applied to all situations where patients receive more sedation than required. This Spanish Society of Critical Care Medicine's Analgesia and Sedation Work Group recommends the Richmond Agitation Sedation Scale, due to its interrelationship with the Confusion Assessment Method Scale (CAM-ICU), for sedation monitoring in patients under light sedation while it recommends bispectral index sedation monitoring in patients under deep sedation. In the latter case, maintaining values under 40 on the bispectral index doesn't produce any benefits except in patients who require a maximum decrease in neuronal metabolism. To avoid recall phenomena, bispectral monitoring is highly advisable in patients treated with neuromuscular blockers.

  6. Scale-up of high shear granulation based on agitation power.

    PubMed

    Sato, Yoshinobu; Okamoto, Takumi; Watano, Satoru

    2005-12-01

    Scale-up of wet granulation in a vertical high shear mixer was conducted. Pharmaceutical excipient mixtures composed of lactose, cornstarch and micro-crystalline cellulose, and hydroxypropylecellulose as a binder were mixed together and then granulated with purified water under various operating conditions and vessel scales. Torque of agitator shaft was continuously measured and then agitation power per unit vessel volume was calculated. The agitation power per unit vessel volume showed a good correlation with physical properties of obtained granules, such as mass median diameter, strength and compressibility. This implied that the scale-up characteristics could be well analyzed by means of the agitation power per unit vessel volume. In addition, the effects of agitator tip speed and Froude number on the agitation power per unit vessel volume were investigated. The results showed that the agitation power per unit vessel volume was well characterized by the tip speed rather than the Froude number. This meant that the granule growth mainly progressed by the shear stress from the agitator blade. Dynamic characteristics of high shear granulation were also discussed here. PMID:16327186

  7. Perspectives on sedation assessment in critical care.

    PubMed

    Olson, Daiwai M; Thoyre, Suzanne M; Auyong, David B

    2007-01-01

    Multiple studies have been undertaken to show that neurofunction monitors can correlate to objective sedation assessments. Showing a correlation between these 2 patient assessments tools may not be the correct approach for validation of neurofunction monitors. Two different methods of assessing 2 different modes of the patient's response to sedation should not be expected to precisely correlate unless the desire is to replace one method with the other. We provide a brief summary of several sedation scales, physiologic measures and neurofunction monitoring tools, and correlations literature for bispectral index monitoring, and the Ramsay Scale and the Sedation Agitation Scale. Neurofunction monitors provide near continuous information about a different domain of the sedation response than intermittent observational assessments. Further research should focus on contributions from this technology to the improvement of patient outcomes when neurofunction monitoring is used as a complement, not a replacement, for observational methods of sedation assessment.

  8. Evaluating and monitoring analgesia and sedation in the intensive care unit

    PubMed Central

    Sessler, Curtis N; Jo Grap, Mary; Ramsay, Michael AE

    2008-01-01

    Management of analgesia and sedation in the intensive care unit requires evaluation and monitoring of key parameters in order to detect and quantify pain and agitation, and to quantify sedation. The routine use of subjective scales for pain, agitation, and sedation promotes more effective management, including patient-focused titration of medications to specific end-points. The need for frequent measurement reflects the dynamic nature of pain, agitation, and sedation, which change constantly in critically ill patients. Further, close monitoring promotes repeated evaluation of response to therapy, thus helping to avoid over-sedation and to eliminate pain and agitation. Pain assessment tools include self-report (often using a numeric pain scale) for communicative patients and pain scales that incorporate observed behaviors and physiologic measures for noncommunicative patients. Some of these tools have undergone validity testing but more work is needed. Sedation-agitation scales can be used to identify and quantify agitation, and to grade the depth of sedation. Some scales incorporate a step-wise assessment of response to increasingly noxious stimuli and a brief assessment of cognition to define levels of consciousness; these tools can often be quickly performed and easily recalled. Many of the sedation-agitation scales have been extensively tested for inter-rater reliability and validated against a variety of parameters. Objective measurement of indicators of consciousness and brain function, such as with processed electroencephalography signals, holds considerable promise, but has not achieved widespread implementation. Further clarification of the roles of these tools, particularly within the context of patient safety, is needed, as is further technology development to eliminate artifacts and investigation to demonstrate added value. PMID:18495053

  9. 75 FR 73104 - Clinical Development Programs for Sedation Products; Request for Assistance

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-29

    ... trials? Are subjective and objective assessments of memory, recall, anxiety, agitation, delirium, among... purposes and not to treat an anxiety disorder or agitation? Should there be different scales for assessing... affect anxiety in a procedural sedation setting that would have to be standardized (e.g., physician...

  10. Phase III (full scale) agitated mixing test plan

    SciTech Connect

    Ruff, D.T.

    1994-10-17

    Waste Receiving and Processing Facility Module 2A (WRAP 2A) is the proposed second module of the WRAP facility. This facility will provide the required treatment for contact Handled (CH) Low Level (LL) Mixed Waste (MW) to allow its permanent disposal. Solidification of a portion of this waste using a cement based grout has been selected in order to reduce the toxicity and mobility of the waste in the disposal site. Mixing of the waste with the cement paste and material handling constraints/requirements associated with the mixed material is, therefore, a key process in the overall treatment strategy. This test plan addresses Phase 3, Full Scale Testing. The objectives of these tests are to determine if there are scale-up issues associated with the mixing results obtained in Phase 1 and 2 mixing tests, verify the workability of mixtures resulting from previous formulation development efforts (Waste Immobilization Development [WID]), and provide a baseline for WRAP 2A mixing equipment design. To this end, the following objectives are of particular interest: determine geometric influence of mixing blade at full scale (i.e., size, type, and location: height/offset); determine if similar results in terms of mixing effectiveness and product quality are achievable at this scale; determine if vibration is as effective at this larger scale in fluidizing the mixture and aiding in cleaning the vessel; determine if baffles or sweeping blades are needed to aid in mixing at the larger size and for cleaning the vessel; and determine quality of the poured monolithic product and investigate exotherm and filling influences at this larger size.

  11. Measuring quality of sedation in adult mechanically ventilated critically ill patients. the Vancouver Interaction and Calmness Scale. Sedation Focus Group.

    PubMed

    de Lemos, J; Tweeddale, M; Chittock, D

    2000-09-01

    There are no reliable, valid, and responsive scales to measure the quality of sedation in adult critically ill patients. Our objective was to develop a summated rating scale with these properties and to define the minimal clinically important difference (MCID). We developed and tested the scale in an 18-bed medical-surgical intensive care unit (ICU) (12-bed acute and 6-bed subacute unit). Following identification of relevant domains and item derivation, 116 observations were made on 38 patients; psychometric properties and interrater reliability were assessed to allow item reduction. The final scale consisted of two five-item subscales quantifying calmness and interaction along a continuum from 5 to 30 points. Interrater reliability was 0.89 and 0.90; internal consistency was 0. 95 for both subscales. To test construct validity, MCID, and responsiveness 302 observations were made on 54 patients. Construct validity: calmness score vs. need for further intervention to make the patient calm (R = -0.82, P < 0.001); interaction score discriminated between acute vs. subacute units, mean scores 15.28 +/- 8.26 vs. 23.54 +/- 7.42, mean difference 8.27 (95% CI - 10.32 to -6.22); MCID - 2.2 and 2.5 for the calmness and interaction subscales; Guyatt's responsiveness statistics - 1.4 and 2.3. The Vancouver Interaction and Calmness Scale (VICS) is reliable, valid, and responsive.

  12. [Sultopride and agitation].

    PubMed

    Blondel, F

    1982-12-01

    Sultopride, presented in this paper, was tried in five patients with psychomotor agitation and aggressiveness but with a variable underlying structure, from severe neurosis (borderline?) to chronic decompensated psychosis. These manifestations had failed to respond to the other neuroleptics used. Results with sultopride were excellent. This drug deserves a good position among sedative agents with no significant effect on vigilance used in aggressiveness.

  13. The effect of impeller type on silica sol formation in laboratory scale agitated tank

    NASA Astrophysics Data System (ADS)

    Nurtono, Tantular; Suprana, Yayang Ade; Latif, Abdul; Dewa, Restu Mulya; Machmudah, Siti; Widiyastuti, Winardi, Sugeng

    2016-02-01

    The multiphase polymerization reaction of the silica sol formation produced from silicic acid and potassium hydroxide solutions in laboratory scale agitated tank was studied. The reactor is equipped with four segmental baffle and top entering impeller. The inside diameter of reactor is 9 cm, the baffle width is 0.9 cm, and the impeller position is 3 cm from tank bottom. The diameter of standard six blades Rushton and three blades marine propeller impellers are 5 cm. The silicic acid solution was made from 0.2 volume fraction of water glass (sodium silicate) solution in which the sodium ion was exchanged by hydrogen ion from cation resin. The reactor initially filled with 286 ml silicic acid solution was operated in semi batch mode and the temperature was kept constant in 60 °C. The 3 ml/minute of 1 M potassium hydroxide solution was added into stirred tank and the solution was stirred. The impeller rotational speed was varied from 100 until 700 rpm. This titration was stopped if the solution in stirred tank had reached the pH of 10-The morphology of the silica particles in the silica sol product was analyzed by Scanning Electron Microscope (SEM). The size of silica particles in silica sol was measured based on the SEM image. The silica particle obtained in this research was amorphous particle and the shape was roughly cylinder. The flow field generated by different impeller gave significant effect on particle size and shape. The smallest geometric mean of length and diameter of particle (4.92 µm and 2.42 µm, respectively) was generated in reactor with marine propeller at 600 rpm. The reactor with Rushton impeller produced particle which the geometric mean of length and diameter of particle was 4.85 µm and 2.36 µm, respectively, at 150 rpm.

  14. Nicotine withdrawal and agitation in ventilated critically ill patients

    PubMed Central

    2010-01-01

    Introduction Smoking is highly addictive, and nicotine abstinence is associated with withdrawal syndrome in hospitalized patients. In this study, we aimed to evaluate the impact of sudden nicotine abstinence on the development of agitation and delirium, and on morbidities and outcomes in critically ill patients who required respiratory support, either noninvasive ventilation or intubation, and mechanical ventilation. Methods We conducted a prospective, observational study in two intensive care units (ICUs). The 144 consecutive patients admitted to ICUs and requiring mechanical ventilation for >48 hours were included. Smoking status was assessed at ICU admission by using the Fagerström Test of Nicotine Dependence (FTND). Agitation, with the Sedation-Agitation Scale (SAS), and delirium, with the Intensive Care Delirium Screening Checklist (ICDSC), were tested twice daily during the ICU stay. Agitation and delirium were defined by SAS >4 and ICDSC >4, respectively. Nosocomial complications and outcomes were evaluated. Results Smokers (n = 44) were younger and more frequently male and were more likely to have a history of alcoholism and to have septic shock as the reason for ICU admission than were nonsmokers. The incidence of agitation, but not delirium, increased significantly in the smoker group (64% versus 32%; P = 0.0005). Nicotine abstinence was associated with higher incidences of self-removal of tubes and catheters, and with more interventions, including the need for supplemental sedatives, analgesics, neuroleptics, and physical restraints. Sedation-free days, ventilator-free days, length of stay, and mortality in ICUs did not differ between groups. Multivariate analysis identified active smoking (OR, 3.13; 95% CI, 1.45-6.74; P = 0.003) as an independent risk factor for agitation. Based on a subgroup of 56 patients, analysis of 28 pairs of patients (smokers and nonsmokers in a 1:1 ratio) matched for age, gender, and alcoholism status found similar results

  15. Effect of impeller type and agitation on the performance of pilot scale ASBR and AnSBBR applied to sanitary wastewater treatment.

    PubMed

    de Novaes, Luciano Farias; Saratt, Bruna Luckmann; Rodrigues, José Alberto Domingues; Ratusznei, Suzana Maria; de Moraes, Deovaldo; Ribeiro, Rogers; Zaiat, Marcelo; Foresti, Eugenio

    2010-08-01

    The objective of this work was to assess the effect of agitation rate and impeller type in two mechanically stirred sequencing batch reactors: one containing granulated biomass (denominated ASBR) and the other immobilized biomass on polyurethane foam (denominated AnSBBR). Each configuration, with total volume of 1 m(3), treated 0.65 m(3) sanitary wastewater at ambient temperature in 8-h cycles. Three impeller types were assessed for each reactor configuration: flat-blade turbine impeller, 45 degrees -inclined-blade turbine impeller and helix impeller, as well as two agitation rates: 40 and 80 rpm, resulting in a combination of six experimental conditions. In addition, the ASBR was also operated at 20 rpm with a flat-blade turbine impeller and the AnSBBR was operated with a draft tube and helix impeller at 80 and 120 rpm. To quantify how impeller type and agitation rate relate to substrate consumption rate, results obtained during monitoring at the end of the cycle, as well as the time profiles during a cycle were analyzed. Increasing agitation rate from 40 rpm to 80 rpm in the AnSBBR improved substrate consumption rate whereas in the ASBR this increase destabilized the system, likely due to granule rupture caused by the higher agitation. The AnSBBR showed highest solids and substrate removal, highest kinetic constant and highest alkalinity production when using a helix impeller, 80 rpm, and no draft tube. The best condition for the ASBR was achieved with a flat-blade turbine impeller at 20 rpm. The presence of the draft tube in the AnSBBR did not show significant improvement in reactor efficiency. Furthermore, power consumption studies in these pilot scale reactors showed that power transfer required to improve mass transfer might be technically and economically feasible. PMID:20363066

  16. Impact of Sedation on Cognitive Function in Mechanically Ventilated Patients.

    PubMed

    Porhomayon, Jahan; El-Solh, Ali A; Adlparvar, Ghazaleh; Jaoude, Philippe; Nader, Nader D

    2016-02-01

    The practice of sedation dosing strategy in mechanically ventilated patient has a profound effect on cognitive function. We conducted a comprehensive review of outcome of sedation on mental health function in critically ill patients on mechanical ventilation in the intensive care unit (ICU). We specifically evaluated current sedative dosing strategy and the development of delirium, post-traumatic stress disorders (PTSDs) and agitation. Based on this review, heavy dosing sedation strategy with benzodiazepines contributes to cognitive dysfunction. However, outcome for mental health dysfunction is mixed in regard to newer sedatives agents such as dexmedetomidine and propofol. Moreover, studies that examine the impact of sedatives for persistence of PTSD/delirium and its long-term cognitive and functional outcomes for post-ICU patients are frequently underpowered. Most studies suffer from low sample sizes and methodological variations. Therefore, larger randomized controlled trials are needed to properly assess the impact of sedation dosing strategy on cognitive function. PMID:26559680

  17. Sedation and Analgesia in Intensive Care: A Comparison of Fentanyl and Remifentanil

    PubMed Central

    Cevik, F.; Celik, M.; Clark, P. M.; Macit, C.

    2011-01-01

    Optimal sedation and analgesia are of key importance in intensive care. The aim of this study was to assess the quality of sedoanalgesia and outcome parameters in regimens containing midazolam and either fentanyl or remifentanil. A prospective, randomized, open-label, controlled trial was carried out in the ICU unit of a large teaching hospital in Istanbul over a 9-month period. Thirty-four patients were randomly allocated to receive either a remifentanil-midazolam regimen (R group, n = 17) or a fentanyl-midazolam regimen (F group, n = 17). A strong correlation between Riker Sedation-Agitation Scale (SAS) and Ramsey Scale (RS) measurements was observed. Comparatively, remifentanil provided significantly more potent and rapid analgesia based on Behavioral-Physiological Scale (BPS) measurements and a statistically nonsignificantly shorter time to discharge. On the other hand, remifentanil also caused a significantly sharper fall in heart rate within the first six hours of treatment. PMID:22110929

  18. Application of Clinical Practice Guidelines for Pain, Agitation, and Delirium.

    PubMed

    Krupp, Anna; Balas, Michele C

    2016-06-01

    Critically ill patients experience several severe, distressing, and often life-altering symptoms during their intensive care unit stay. A clinical practice guideline released by the American College of Critical Care Medicine provides a template for improving the care and outcomes of the critically ill through evidence-based pain, agitation, and delirium assessment, prevention, and management. Key strategies include the use of valid and reliable assessment tools, setting a desired sedation level target, a focus on light sedation, choosing appropriate sedative medications, the use of nonpharmacologic symptom management strategies, and engaging and empowering patients and their family to play an active role in their intensive care unit care.

  19. 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.)

  20. [Pain, agitation and delirium in acute respiratory failure].

    PubMed

    Funk, G-C

    2016-02-01

    Avoiding pain, agitation and delirium as well as avoiding unnecessary deep sedation is a powerful yet challenging strategy in critical care medicine. A number of interactions between cerebral function and respiratory function should be regarded in patients with respiratory failure and mechanical ventilation. A cooperative sedation strategy (i.e. patient is awake and free of pain and delirium) is feasible in many patients requiring invasive mechanical ventilation. Especially patients with mild acute respiratory distress syndrome (ARDS) seem to benefit from preserved spontaneous breathing. While completely disabling spontaneous ventilation with or without neuromuscular blockade is not a standard strategy in ARDS, it might be temporarily required in patients with severe ARDS, who have substantial dyssynchrony or persistent hypoxaemia. Since pain, agitation and delirium compromise respiratory function they should also be regarded during noninvasive ventilation and during ventilator weaning. Pharmacological sedation can have favourable effects in these situations, but should not be given routinely or uncritically. PMID:26817653

  1. Effect of Ketamine on Post-Tonsillectomy Sedation and Pain Relief

    PubMed Central

    Bameshki, Seyed Alireza; Salari, Mohammad Reza; Bakhshaee, Mahdi; Razavi, Majid

    2015-01-01

    Introduction: Tonsillectomy is the one of the most common types of surgery in children, and is often accompanied by post-operative pain and discomfort. Methods of pain control such as use of non-steroidal anti-inflammatory drugs (NSAIDs), narcotics, and local anesthetics have been used, but each have their own particular side effects. In this study we investigated the effect of ketamine on post-operative sedation and pain relief. Materials and Methods: A total of 50 children aged between 5 and 12 years who were candidates for tonsillectomy were divided into two groups. The study group received ketamine-midazolam (ketamine 1 mg/kg, midazolam 0.1 mg/kg) and the control group received midazolam (0.1 mg/kg) in the pre-operative period. The same methods of anesthesia induction and maintenance were used in all patients. Pain score was assessed using the Wong-Baker Faces Pain Rating scale and sedation was evaluated using the Riker Sedation-Agitation scale at the time of extubation as well as 5, 10, 15, and 30 minutes and 1, 2, and 6 hours after surgery. Results: The two groups were similar in terms of age, weight, gender and duration of surgery. Pain after 15 and 30 minutes and agitation after 10 and 15 minutes following extubation were lower in the study group (ketamine-midazolam). Mean consumption and time of first request for analgesia after surgery as well as incidence of post-operative vomiting were similar in the two groups. Conclusion: Adding ketamine to midazolam in pre-operative of tonsillectomy reduces agitation and post-operative pain in the first 30 minutes after surgery. PMID:26788487

  2. 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.

  3. Prophylactic Use of Oral Acetaminophen or IV Dexamethasone and Combination of them on Prevention Emergence Agitation in Pediatric after Adenotonsillectomy

    PubMed Central

    Sajedi, Parvin; Baghery, Kivan; Hagibabie, Ezzat; Mehr, Asieh Maghami

    2014-01-01

    Background: The present study was aimed to evaluate the efficacy of acetaminophen plus dexamethasone on post-operative emergence agitation in pediatric adenotonsillectomy. Methods: A total of 128 patients were randomized and assigned among four groups as: Intravenous (IV) dexamethasone, oral acetaminophen, IV dexamethasone plus oral acetaminophen, placebo. Group 1 received 0.2 mg/kg dexamethasone plus 0.25 mg/kg strawberry syrup 2 h before surgery. Group 2 received 20 mg/kg oral acetaminophen (0.25 ml/kg) with 0.05 ml/kg IV normal saline. Group 3 received 20 mg/kg acetaminophen and 0.2 mg/kg dexamethasone intravenously. Group 4 received 0.25 ml/kg strawberry syrup and 0.05 ml/kg normal saline. Agitation was measured according to Richmond agitation sedation score in the post anesthetic care unit (PACU) after admission, 10, 20 and 30 min after extubation. Pain score was measured with FACE scale. Nurse satisfaction was measured with verbal analog scale. If agitation scale was 3 ≥ or pain scale was 4 ≥ meperidine was prescribed. If symptoms did not control wit in 15 min midazolam was prescribed. Patients were discharged from PACU according Modified Alderet Score. Data were analyzed with ANOVA, Chi-square, and Kruskal-Wallis among four groups. P < 0.05 was considered statistically significant. Results: A total of 140 patients were recruited in the study, which 12 of them were excluded. Thus, 128 patients were randomized and assigned among four groups. The four treatment groups were generally matched at baseline data. Median of pain score in 0, 10, 20 and 30 min after extubation were different between each study group with the control group (<0.001, 0.003 respectively). Also median of agitation score in 0, 10, 20 and 30 min after extubation were different between each study group with the control group (<0.001). Incidence of pain and incidence of agitation after extubation were not statistically identical among groups (P < 0.001 and P = 0.002 respectively). Mean of

  4. Early sedation use in critically ill mechanically ventilated patients: when less is really more.

    PubMed

    Lee, Christie M; Mehta, Sangeeta

    2014-01-01

    Over the last 10 years, there has been an explosion of literature surrounding sedation management for critically ill patients. The clinical target has moved away from an unconscious and immobile patient toward a goal of light or no sedation and early mobility. The move away from terms such as 'sedation' toward more patient-centered and symptom-based control of pain, anxiety, and agitation makes the management of critically ill patients more individualized and dynamic. Over-sedation has been associated with negative ICU outcomes, including longer durations of mechanical ventilation and lengths of stay, but few studies have been able to associate deep sedation with increased mortality. PMID:25673278

  5. Sedation options for intubated intensive care unit patients.

    PubMed

    Lacoske, Jennifer

    2015-03-01

    A common requirement for intubated patients in the intensive care unit (ICU) is sedation and pain management to facilitate patient safety and timely, atraumatic healing. The Society of Critical Care Medicine guidelines for management of pain, sedation, and delirium in adult ICU patients provide assessment scales for pain, sedation, and delirium; medications for sedation and pain management, and protocols for weaning sedation, are discussed. Proficient assessment skills, pharmacologic knowledge of medications administered to provide sedation, and an understanding of the importance of nonpharmacologic interventions can help the registered nurse provide patient advocacy, safety, and improved outcomes.

  6. A protocol for the acute control of agitation in palliative care: a preliminary report.

    PubMed

    Gonçalves, Ferraz; Almeida, Ana; Teixeira, Sara; Pereira, Sara; Edra, Natércia

    2012-11-01

    Agitation is one of the most frequent causes for palliative sedation. It often requires urgent control to avoid negative consequences and even endangerment of all involved, including the patients themselves. A protocol for the control of episodes of agitation was developed, based on a previous experience. The protocol includes a combination of haloperidol and midazolam. The protocol was used 86 times in 27 patients. Each patient was sedated from 1 to 12 times, median 2 times. The median time from the beginning of sedation to the control of agitation was 15 minutes with a range from 1 minute (2 cases) to 3 hours and 5 minutes (only 1 case). In 71 cases (83%), only the first dose was needed. There were no significant complications. PMID:22363035

  7. Microbial nar-GFP cell sensors reveal oxygen limitations in highly agitated and aerated laboratory-scale fermentors

    PubMed Central

    Garcia, Jose R; Cha, Hyung J; Rao, Govind; Marten, Mark R; Bentley, William E

    2009-01-01

    Background Small-scale microbial fermentations are often assumed to be homogeneous, and oxygen limitation due to inadequate micromixing is often overlooked as a potential problem. To assess the relative degree of micromixing, and hence propensity for oxygen limitation, a new cellular oxygen sensor has been developed. The oxygen responsive E. coli nitrate reductase (nar) promoter was used to construct an oxygen reporter plasmid (pNar-GFPuv) which allows cell-based reporting of oxygen limitation. Because there are greater than 109 cells in a fermentor, one can outfit a vessel with more than 109 sensors. Our concept was tested in high density, lab-scale (5 L), fed-batch, E. coli fermentations operated with varied mixing efficiency – one verses four impellers. Results In both cases, bioreactors were maintained identically at greater than 80% dissolved oxygen (DO) during batch phase and at approximately 20% DO during fed-batch phase. Trends for glucose consumption, biomass and DO showed nearly identical behavior. However, fermentations with only one impeller showed significantly higher GFPuv expression than those with four, indicating a higher degree of fluid segregation sufficient for cellular oxygen deprivation. As the characteristic time for GFPuv expression (approx 90 min.) is much larger than that for mixing (approx 10 s), increased specific fluorescence represents an averaged effect of oxygen limitation over time and by natural extension, over space. Conclusion Thus, the pNar-GFPuv plasmid enabled bioreactor-wide oxygen sensing in that bacterial cells served as individual recirculating sensors integrating their responses over space and time. We envision cell-based oxygen sensors may find utility in a wide variety of bioprocessing applications. PMID:19146688

  8. 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

  9. 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.

  10. 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

  11. Ketamine for continuous sedation of mechanically ventilated patients

    PubMed Central

    Umunna, Ben-Paul; Tekwani, Karis; Barounis, Dave; Kettaneh, Nick; Kulstad, Erik

    2015-01-01

    Context: Long-term sedation with midazolam or propofol has been demonstrated to have serious adverse side effects, such as toxic accumulation or propofol infusion syndrome. Ketamine remains a viable alternative for continuous sedation as it is inexpensive and widely available, however, there are few analyses regarding its safety in this clinical setting. Objective: To review the data related to safety and efficacy of ketamine as a potential sedative agent in mechanically ventilated patients admitted to the intensive care unit (ICU). Materials and Methods: This was a single-center retrospective study from September 2011 to March 2012 of patients who required sedation for greater than 24 hours, in whom ketamine was selected as the primary sedative agent. All patients greater than 18 years of age, regardless of admitting diagnosis, were eligible for inclusion. Patients that received ketamine for continuous infusion but died prior to receiving it for 24 hours were not included. Results: Thirty patients received ketamine for continuous sedation. In four patients, ketamine was switched to another sedative agent due to possible adverse side effects. Of these, two patients had tachydysrhythmias, both with new onset atrial fibrillation and two patients had agitation believed to be caused by ketamine. The adverse event rate in our patient population was 13% (4/30). Conclusions: Among ICU patients receiving prolonged mechanical ventilation, the use of ketamine appeared to have a frequency of adverse events similar to more common sedative agents, like propofol and benzodiazepines. PMID:25709246

  12. Agitations and Animations

    ERIC Educational Resources Information Center

    Shann, Steve

    2010-01-01

    As educators, we write about how we teach and how our students learn, but often there are some things missing from these accounts. These "somethings" are the animations and agitations that attend most deep learning. These are not easy to describe, particularly because they are often only visible in passing moments. I argue that story-telling is…

  13. Dexmedetomidine Infusion to Control Agitation due to Anticholinergic Toxidromes in Adolescents, a Case Series

    PubMed Central

    Lin, Ada; Tobias, Joseph D.

    2015-01-01

    Dexmedetomidine is an α2-adrenergic agonist approved by the US Food and Drug Administration for the sedation of adults who are intubated on mechanical ventilation and in non-intubated adults who are undergoing surgical procedures. However, it has also recently become a commonly used sedative agent in varied clinical settings for the pediatric patient as well. We present the use of dexmedetomidine for sedation in a unique clinical scenario, the severely agitated and combative patient following the intentional misuse of anticholinergic drugs. Its applications in this situation are discussed, and previous reports in the literature are reviewed. PMID:26380573

  14. Instruments for monitoring intensive care unit sedation

    PubMed Central

    Carrasco, Genís

    2000-01-01

    Although many promising objective methods (measuring systems) are available, there are no truly validated instruments for monitoring intensive care unit (ICU) sedation. Auditory evoked potentials can be used only for research in patients with a deep level of sedation. Other measuring systems require further development and validation to be useful in the ICU. Continuing research will provide an objective system to improve the monitoring and controlling of this essential treatment for ICU patients. Subjective methods (scoring systems) that are based on clinical observation have proven their usefulness in guiding sedative therapy. The Glasgow Coma Score modified by Cook and Palma (GCSC) achieves good face validity and reliability, which assures its clinical utility for routine practice and research. Other scales, in particular the Ramsay Scale, can be recommended preferably for clinical use. An accurate use of available instruments can improve the sedative treatment that we deliver to our patients. PMID:11094504

  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. Agitation apparatus. [Patent application

    DOEpatents

    Beets, A.L.; Lewis, B.E. Jr.

    1982-03-12

    Agitation apparatus includes a tank with a cylindrical upper portion, a frustoconical intermediate portion, and a cylindrical lower portion, a lift tube extending from the upper portion of the tank to a point near an end cap attached to the lower portion of the tank, the lift tube being concentric with the lower portion of the tank to provide a flow passage there between, and a plurality of air supply conduits extending along the lift tube and spaced apart around its perimeter, these air supply conduits terminating adjacent the lower end of the lift tube. Air discharged from the lower ends of the air supply conduits causes liquid in the tank to flow upwardly through the lift tube and out of apertures in the upper portion thereof. Due to the unique properties of nuclear fuel dissolver solutions and the constraint placed on the amount of air that can be injected therein by conventional apparatus, there has been a need for a more effective means for agitating liquid in nuclear fuel digester tanks.

  17. Platelet preservation: agitation and containers.

    PubMed

    van der Meer, Pieter F; de Korte, Dirk

    2011-06-01

    For platelets to maintain their in vitro quality and in vivo effectiveness, they need to be stored at room temperature with gentle agitation in gas-permeable containers. The mode of agitation affects the quality of the platelets, and a gentle method of agitation, either a circular or a flat bed movement, provides the best results. Tumblers or elliptical agitators induce platelet activation and subsequent damage. As long as the platelets remain in suspension, the agitation speed is not important. Agitation of the platelet concentrates ensures that the platelets are continuously oxygenated, that sufficient oxygen can enter the storage container and that excess carbon dioxide can be expelled. During transportation of platelet concentrates, nowadays over long distances where they are held without controlled agitation, platelets may tolerate a certain period without agitation. However, evidence is accumulating that during the time without agitation, local hypoxia surrounding the platelets may induce irreversible harm to the platelets. Over the decades, more gas-permeable plastics have been used to manufacture platelet containers. The use of different plastics and their influence on the platelet quality both in vitro and in vivo is discussed. The improved gas-permeability has allowed the extension of platelet storage from 3 days in the early 1980s, to currently at least 7 days. In the light of new developments, particularly the introduction of pathogen reduction techniques, the use of platelet additive solutions and the availability of improved automated separators, further (renewed) research in this area is warranted.

  18. 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

  19. Flunitrazepam: psychomotor impairment, agitation and paradoxical reactions.

    PubMed

    Bramness, Jørgen G; Skurtveit, Svetlana; Mørland, Jørg

    2006-06-01

    Benzodiazepines are sedatives used for anxiolysis, hypnosis, muscle relaxation and the treatment of epilepsy. Paradoxical reactions including agitation, talkativeness, confusion, disinhibition, aggression, violent behavior and loss of impulse control may, however, occur in some subjects. It has been claimed that high doses of flunitrazepam may cause aggression on a more regular basis in all individuals. The present study makes use of a Norwegian forensic toxicological database containing analytical results from drivers suspected of driving under the influence and suspects of violent crime to analyze the relationship between behavior and blood flunitrazepam concentration. Four-hundred and fifteen cases of drivers suspected of driving under the influence and seven cases of suspects of violent crime were studied. These selected cases had flunitrazepam as the only drug in blood samples and had been evaluated by a clinical test for impairment (CTI) performed by a police physician at the time of blood sampling. The impaired drivers had higher blood flunitrazepam concentrations than the not impaired drivers. Multivariate analysis revealed that both blood flunitrazepam concentration and age of the suspected drivers had independent impact on impairment, indicating tolerance with age. Most of the effects measured were sedative effects of flunitrazepam and these effects were related to flunitrazepam level. Possible paradoxical reactions were observed in a subgroup of 23 individuals (6%), but these reactions did not relate to blood flunitrazepam concentration. The suspects of violent crime showed similar degree impairment and had not more paradoxical reactions than the suspected drugged drivers. The findings were in agreement with other research that claims paradoxical reactions should be viewed as a reaction in certain individuals, and does not support the notion that flunitrazepam in high concentration produces aggression in all individuals taking the drug.

  20. The effect of mild agitation on in vitro erythroid development.

    PubMed

    Boehm, Daniela; Murphy, William G; Al-Rubeai, Mohamed

    2010-08-31

    The cultivation of erythroid cells at large scale would have to be performed in suitable bioreactors which would most likely employ some mode of agitation to ensure optimal mass and gas transfer and prevent culture inhomogeneity. The effect of low agitation at 15-20 rpm on ex vivo erythropoiesis of PB CD34+ derived cultures was investigated and found to have significant impact on erythroid development. Agitated cultures showed a reduced lag phase and increased cell expansion during the early stages of culture. Additionally, agitation accelerated erythroid differentiation as seen by the loss of early development markers, acquisition of late erythroid markers and premature cell cycle arrest, although not yielding higher fractions of terminally differentiated cells in comparison to stationary culture. However, agitation at 20 rpm led to significantly increased loss of cell viability after day 15 in culture, an effect that could be reduced by decreasing the agitation rate to 15 rpm. On the one hand these results imply that agitation may improve cell yields and reduce expensive cytokine-dependent early culture stages but on the other hand it might introduce the risk of increased cell death in large scale culture.

  1. Mechanical Agitation For Aqueous Cleaning

    NASA Technical Reports Server (NTRS)

    Morgan, Gene E.; Hosking, Timothy J.

    1995-01-01

    Cleaning basket placed in aqueous cleaning solution mechanically agitated by air spring. Compressed air at oscillating pressure supplied to air spring to produce repeated vertical motion of cleaning basket.

  2. Downhole gaseous liquid flow agitator

    SciTech Connect

    Kamilos, N.; Kennedy, D.D.; Lederhos, L.J. Jr.

    1989-03-14

    An apparatus is described for agitating and mixing of a gaseous phase and a liquid phase comprising: a first tube having non-blocking internal threads within the first tube to agitate a liquid phase adhering thereto with a gaseous phase passing therethrough, whereby a uniform gaseous phase and liquid phase mixture is formed; and a second tube connected to an end of the first tube having non-blocking internal threads of opposite handedness.

  3. Prescription Sedative Misuse and Abuse.

    PubMed

    Weaver, Michael F

    2015-09-01

    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.

  4. 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

  5. Aeroelasticity-based fluid agitation for lab-on-chips.

    PubMed

    Xia, H M; Wang, Z P; Wang, W; Fan, W; Wijaya, A; Wang, Z F

    2013-04-21

    In this study, we report a robust agitation method for small-volume liquids. It utilizes an elastic diaphragm as the bottom of a liquid chamber, upon which an initial tension is also applied to enhance the aeroelasticity effects at small/micro scales. As a result, spontaneous vibration of the diaphragm can be induced by an external air flow, which further provides fluid agitations. The device structure is simple and can be easily fabricated at low cost. More importantly, the vibration amplitude is controllable and varies widely from several tens to several hundred micrometers depending on the applied air pressure. The resulting agitation is effective and applicable at high viscosities of up to 900 cSt. The influences of air pressure and liquid viscosity on the vibration frequency are discussed. Potential applications of this technique for solid particle agitation, focusing and fluid mixing are also demonstrated.

  6. Aeroelasticity-based fluid agitation for lab-on-chips.

    PubMed

    Xia, H M; Wang, Z P; Wang, W; Fan, W; Wijaya, A; Wang, Z F

    2013-04-21

    In this study, we report a robust agitation method for small-volume liquids. It utilizes an elastic diaphragm as the bottom of a liquid chamber, upon which an initial tension is also applied to enhance the aeroelasticity effects at small/micro scales. As a result, spontaneous vibration of the diaphragm can be induced by an external air flow, which further provides fluid agitations. The device structure is simple and can be easily fabricated at low cost. More importantly, the vibration amplitude is controllable and varies widely from several tens to several hundred micrometers depending on the applied air pressure. The resulting agitation is effective and applicable at high viscosities of up to 900 cSt. The influences of air pressure and liquid viscosity on the vibration frequency are discussed. Potential applications of this technique for solid particle agitation, focusing and fluid mixing are also demonstrated. PMID:23455690

  7. Managing Agitation Associated with Schizophrenia and Bipolar Disorder in the Emergency Setting

    PubMed Central

    Zeller, Scott L.; Citrome, Leslie

    2016-01-01

    Introduction Patient agitation represents a significant challenge in the emergency department (ED), a setting in which medical staff are working under pressure dealing with a diverse range of medical emergencies. The potential for escalation into aggressive behavior, putting patients, staff, and others at risk, makes it imperative to address agitated behavior rapidly and efficiently. Time constraints and limited access to specialist psychiatric support have in the past led to the strategy of “restrain and sedate,” which was believed to represent the optimal approach; however, it is increasingly recognized that more patient-centered approaches result in improved outcomes. The objective of this review is to raise awareness of best practices for the management of agitation in the ED and to consider the role of new pharmacologic interventions in this setting. Discussion The Best practices in Evaluation and Treatment of Agitation (BETA) guidelines address the complete management of agitation, including triage, diagnosis, interpersonal calming skills, and medicine choices. Since their publication in 2012, there have been further developments in pharmacologic approaches for dealing with agitation, including both new agents and new modes of delivery, which increase the options available for both patients and physicians. Newer modes of delivery that could be useful in rapidly managing agitation include inhaled, buccal/sublingual and intranasal formulations. To date, the only formulation administered via a non-intramuscular route with a specific indication for agitation associated with bipolar or schizophrenia is inhaled loxapine. Non-invasive formulations, although requiring cooperation from patients, have the potential to improve overall patient experience, thereby improving future cooperation between patients and healthcare providers. Conclusion Management of agitation in the ED should encompass a patient-centered approach, incorporating non-pharmacologic approaches

  8. 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

  9. Sedation of children for auditory brainstem response using ketamine-midazolam-atropine combination - a retrospective analysis.

    PubMed

    Bocskai, Tímea; Németh, Adrienne; Bogár, Lajos; Pytel, József

    2013-12-01

    Authors investigated sedation quality in children for auditory brainstem response testing. Two-hundred and seventy-six sedation procedures were retrospectively analyzed using recorded data focusing on efficacy of sedation and complications. Intramuscular ketamine-midazolam-atropine combination was administered on sedation preceded by narcotic suppository as pre-medication. On using the combination vital parameters remained within normal range, the complication rate was minimal. Pulse rate, arterial blood pressure and pulse oxymetry readings were stable, hypoventilation developed in 4, apnoea in none of the cases, post-sedation agitation occurred in 3 and nausea and/or vomiting in 2 cases. Repeated administration of narcotic agent was necessary in a single case only. Our practice is suitable for the sedation assisting hearing examinations in children. It has no influence on the auditory brainstem testing, the conditions necessary for the test can be met entirely with minimal side-effects. Our practice provides a more lasting sedation time in children during the examination hence there is no need for the repetition of the narcotics.

  10. Incidence of adverse events in paediatric procedural sedation in the emergency department: a systematic review and meta-analysis

    PubMed Central

    Bellolio, M Fernanda; Puls, Henrique A; Anderson, Jana L; Gilani, Waqas I; Murad, M Hassan; Barrionuevo, Patricia; Erwin, Patricia J; Wang, Zhen; Hess, Erik P

    2016-01-01

    Objective and design We conducted a systematic review and meta-analysis to evaluate the incidence of adverse events in the emergency department (ED) during procedural sedation in the paediatric population. Randomised controlled trials and observational studies from the past 10 years were included. We adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Setting ED. Participants Children. Interventions Procedural sedation. Outcomes Adverse events like vomiting, agitation, hypoxia and apnoea. Meta-analysis was performed with random-effects model and reported as incidence rates with 95% CIs. Results A total of 1177 studies were retrieved for screening and 258 were selected for full-text review. 41 studies reporting on 13 883 procedural sedations in 13 876 children (≤18 years) were included. The most common adverse events (all reported per 1000 sedations) were: vomiting 55.5 (CI 45.2 to 65.8), agitation 17.9 (CI 12.2 to 23.7), hypoxia 14.8 (CI 10.2 to 19.3) and apnoea 7.1 (CI 3.2 to 11.0). The need to intervene with either bag valve mask, oral airway or positive pressure ventilation occurred in 5.0 per 1000 sedations (CI 2.3 to 7.6). The incidences of severe respiratory events were: 34 cases of laryngospasm among 8687 sedations (2.9 per 1000 sedations, CI 1.1 to 4.7; absolute rate 3.9 per 1000 sedations), 4 intubations among 9136 sedations and 0 cases of aspiration among 3326 sedations. 33 of the 34 cases of laryngospasm occurred in patients who received ketamine. Conclusions Serious adverse respiratory events are very rare in paediatric procedural sedation in the ED. Emesis and agitation are the most frequent adverse events. Hypoxia, a late indicator of respiratory depression, occurs in 1.5% of sedations. Laryngospasm, though rare, happens most frequently with ketamine. The results of this study provide quantitative risk estimates to facilitate shared decision-making, risk communication, informed consent and

  11. 7 CFR 58.417 - Mechanical agitators.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 3 2014-01-01 2014-01-01 false Mechanical agitators. 58.417 Section 58.417 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards....417 Mechanical agitators. The mechanical agitators shall be of sanitary construction. The...

  12. 7 CFR 58.417 - Mechanical agitators.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 3 2012-01-01 2012-01-01 false Mechanical agitators. 58.417 Section 58.417 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards....417 Mechanical agitators. The mechanical agitators shall be of sanitary construction. The...

  13. 7 CFR 58.417 - Mechanical agitators.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 3 2011-01-01 2011-01-01 false Mechanical agitators. 58.417 Section 58.417 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards....417 Mechanical agitators. The mechanical agitators shall be of sanitary construction. The...

  14. 7 CFR 58.417 - Mechanical agitators.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 7 Agriculture 3 2013-01-01 2013-01-01 false Mechanical agitators. 58.417 Section 58.417 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards....417 Mechanical agitators. The mechanical agitators shall be of sanitary construction. The...

  15. 7 CFR 58.417 - Mechanical agitators.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 3 2010-01-01 2010-01-01 false Mechanical agitators. 58.417 Section 58.417 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards....417 Mechanical agitators. The mechanical agitators shall be of sanitary construction. The...

  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. [The use of a sedative neuroleptic agent, sultopride, in posttraumatic Korsakoff syndrome in a young adult].

    PubMed

    Cornier, P

    1983-05-19

    In a young woman with a post-traumatic Korsakoff syndrome exhibiting agitation and anxiety, sedative drugs were difficult to use as they either exacerbated confusion or generated ataxia. Administration of meprobamate with oral sultopride in a high dosage (2 g per day) was promptly followed by an improvement in the patient's condition. Doses were therefore rapidly tapered (over approximately a month and a half). Complete recovery, which is the well-known outcome, thus took place in favorable conditions, as anxiety and agitation no longer hindered the patient's relationships with others.

  18. The implementation of an analgesia-based sedation protocol reduced deep sedation and proved to be safe and feasible in patients on mechanical ventilation

    PubMed Central

    Bugedo, Guillermo; Tobar, Eduardo; Aguirre, Marcia; Gonzalez, Hugo; Godoy, Jorge; Lira, Maria Teresa; Lora, Pilar; Encalada, Eduardo; Hernandez, Antonio; Tomicic, Vinko; Castro, José; Jara, Juan; Andresen, Max; Ugarte, Héctor

    2013-01-01

    Introduction Deep sedation in critically ill patients is associated with a longer duration of mechanical ventilation and a prolonged length of stay in the intensive care unit. Several protocols have been used to improve these outcomes. We implement and evaluate an analgesia-based, goal-directed, nurse-driven sedation protocol used to treat critically ill patients who receive mechanical ventilation. Methods We performed a prospective, two-phase (before-after), non-randomized multicenter study that involved 13 intensive care units in Chile. After an observational phase (observational group, n=155), we designed, implemented and evaluated an analgesia-based, goal-directed, nurse-driven sedation protocol (intervention group, n=132) to treat patients who required mechanical ventilation for more than 48 hours. The primary outcome was to achieve ventilator-free days by day 28. Results The proportion of patients in deep sedation or in a coma decreased from 55.2% to 44.0% in the interventional group. Agitation did not change between the periods and remained approximately 7%. Ventilator-free days to day 28, length of stay in the intensive care unit and mortality were similar in both groups. At one year, post-traumatic stress disorder symptoms in survivors were similar in both groups. Conclusions We designed and implemented an analgesia-based, goal-directed, nurse-driven sedation protocol in Chile. Although there was no improvement in major outcomes, we observed that the present protocol was safe and feasible and that it resulted in decreased periods of deep sedation without increasing agitation. PMID:24213081

  19. Agitation

    MedlinePlus

    ... or acute mental status change in the older patient. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 28. Prager LM, Ivkovic A. Emergency psychiatry. In: Stern TA, Rosenbaum JF, Fava M, Wilens ...

  20. Mechanisms of cell damage in agitated microcarrier tissue culture reactors

    NASA Technical Reports Server (NTRS)

    Cherry, Robert S.; Papoutsakis, E. Terry

    1986-01-01

    Cells growing on microcarriers may be damaged by collisions of the microcarrier against another microcarrier or the reactor agitator. Bead-bead collisions are caused by small-scale turbulence, which can also cause high local shear stress on the cells. The cells are also exposed to 10-20 Hz cyclic shear stress by bead rotation.

  1. Management of pain, agitation, and delirium in critically ill patients.

    PubMed

    Pandharipande, Pratik P; Patel, Mayur B; Barr, Juliana

    2014-01-01

    Pain, agitation, and delirium (PAD) are common in critically ill patients. Consequently, analgesic and sedative medications are frequently administered to critically ill patients to treat PAD, to improve synchrony with mechanical ventilation, and to decrease the physiological stress response. However, prolonged, continuous deep sedation of intensive care unit (ICU) patients is associated with numerous adverse outcomes, including longer durations of mechanical ventilation, prolonged ICU stays, acute brain dysfunction, and an increased risk of death. The 2013 ICU PAD Guidelines were developed to provide a clear, evidence-based road map for clinicians to better manage PAD in critically ill patients. Significant knowledge gaps in these areas still remain, but if widely adopted, the PAD Guidelines can help bridge these gaps and will be transformative in terms of their impact on ICU care. Strong evidence indicates that linking PAD management strategies with ventilator weaning, early mobility, and sleep hygiene in ICU patients will result in significant synergistic benefits to patient care and reductions in costs. An interdisciplinary team-based approach, using proven process improvement strategies, and ICU patient and family activation and engagement, will help ensure successful implementation of the ICU PAD Care Bundle in ICUs. This paper highlights the major recommendations of the 2013 ICU PAD Guidelines. We hope this review will help ICU physicians and other health care providers advance the management of PAD in critically ill patients, and improve patients' clinical outcomes.

  2. Therapeutics and sedation in dentistry.

    PubMed

    Young, E R

    1988-06-01

    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

  3. A Controlled Agitation Process for Improving Quality of Canned Green Beans during Agitation Thermal Processing.

    PubMed

    Singh, Anika; Pratap Singh, Anubhav; Ramaswamy, Hosahalli S

    2016-06-01

    This work introduces the concept of a controlled agitation thermal process to reduce quality damage in liquid-particulate products during agitation thermal processing. Reciprocating agitation thermal processing (RA-TP) was used as the agitation thermal process. In order to reduce the impact of agitation, a new concept of "stopping agitations after sufficient development of cold-spot temperature" was proposed. Green beans were processed in No. 2 (307×409) cans filled with liquids of various consistency (0% to 2% CMC) at various frequencies (1 to 3 Hz) of RA-TP using a full-factorial design and heat penetration results were collected. Corresponding operator's process time to impart a 10-min process lethality (Fo ) and agitation time (AT) were calculated using heat penetration results. Accordingly, products were processed again by stopping agitations as per 3 agitation regimes, namely; full time agitation, equilibration time agitation, and partial time agitation. Processed products were photographed and tested for visual quality, color, texture, breakage of green beans, turbidity, and percentage of insoluble solids in can liquid. Results showed that stopping agitations after sufficient development of cold-spot temperatures is an effective way of reducing product damages caused by agitation (for example, breakage of beans and its leaching into liquid). Agitations till one-log temperature difference gave best color, texture and visual product quality for low-viscosity liquid-particulate mixture and extended agitations till equilibration time was best for high-viscosity products. Thus, it was shown that a controlled agitation thermal process is more effective in obtaining high product quality as compared to a regular agitation thermal process.

  4. A Controlled Agitation Process for Improving Quality of Canned Green Beans during Agitation Thermal Processing.

    PubMed

    Singh, Anika; Pratap Singh, Anubhav; Ramaswamy, Hosahalli S

    2016-06-01

    This work introduces the concept of a controlled agitation thermal process to reduce quality damage in liquid-particulate products during agitation thermal processing. Reciprocating agitation thermal processing (RA-TP) was used as the agitation thermal process. In order to reduce the impact of agitation, a new concept of "stopping agitations after sufficient development of cold-spot temperature" was proposed. Green beans were processed in No. 2 (307×409) cans filled with liquids of various consistency (0% to 2% CMC) at various frequencies (1 to 3 Hz) of RA-TP using a full-factorial design and heat penetration results were collected. Corresponding operator's process time to impart a 10-min process lethality (Fo ) and agitation time (AT) were calculated using heat penetration results. Accordingly, products were processed again by stopping agitations as per 3 agitation regimes, namely; full time agitation, equilibration time agitation, and partial time agitation. Processed products were photographed and tested for visual quality, color, texture, breakage of green beans, turbidity, and percentage of insoluble solids in can liquid. Results showed that stopping agitations after sufficient development of cold-spot temperatures is an effective way of reducing product damages caused by agitation (for example, breakage of beans and its leaching into liquid). Agitations till one-log temperature difference gave best color, texture and visual product quality for low-viscosity liquid-particulate mixture and extended agitations till equilibration time was best for high-viscosity products. Thus, it was shown that a controlled agitation thermal process is more effective in obtaining high product quality as compared to a regular agitation thermal process. PMID:27096606

  5. 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. ...

  6. Performing bone marrow biopsies with or without sedation: a comparison.

    PubMed

    Giannoutsos, I; Grech, H; Maboreke, T; Morgenstern, G

    2004-06-01

    Although intravenous sedation (ISED) in addition to a local anaesthetic (LA) is commonly used in the performance of a bone marrow aspirate and trephine (BMAT), it is not clear under what circumstances and in which way sedation may be most beneficial. In this study, information was gathered using a questionnaire, from 112 patients shortly after undergoing BMAT; the duration of the procedures and the length of the biopsy cores were measured and any complications noted. Most patients (68%) chose to receive LA only, and almost all (74/76) were happy with their decision. Patients who received sedation gave lower pain scores than patients receiving LA only (1 vs. 3) and were found to have lower levels of apprehension at the thought of having a repeat procedure. Patients having a repeat BMAT showed a slightly increased preference for having sedation compared with patients who were undergoing it for the first time. There is some concern that guidelines regarding the use of ISED for procedures other than BMAT are not always adhered to, and current practice may be best revealed by a large-scale audit of sedation practice for the performance of BMAT. Patients should be given the choice of having ISED if the appropriate resources are available, but in most cases the additional small risk of receiving sedation can be avoided.

  7. Intranasal sedatives in pediatric dentistry

    PubMed Central

    AlSarheed, Maha A.

    2016-01-01

    Objectives: To identify the intranasal (IN) sedatives used to achieve conscious sedation during dental procedures amongst children. Methods: A literature review was conducted by identifying relevant studies through searches on Medline. Search included IN of midazolam, ketamine, sufentanil, dexmedetomidine, clonidine, haloperidol and loranzepam. Studies included were conducted amongst individuals below 18 years, published in English, and were not restricted by year. Exclusion criteria were articles that did not focus on pediatric dentistry. Results: Twenty studies were included. The most commonly used sedatives were midazolam, followed by ketamine and sufentanil. Onset of action for IN midazolam was 5-15 minutes (min), however, IN ketamine was faster (mean 5.74 min), while both IN sufentanil (mean 20 min) and IN dexmedetomidine (mean 25 min) were slow in comparison. Midazolam was effective for modifying behavior in mild to moderately anxious children, however, for more invasive or prolonged procedures, stronger sedatives, such as IN ketamine, IN sufentanil were recommended. In addition, ketamine fared better in overall success rate (89%) when compared with IN midazolam (69%). Intranasal dexmedetomidine was only used as pre-medication amongst children. While its’ onset of action is longer when compared with IN midazolam, it produced deeper sedation at the time of separation from the parent and at the time of anesthesia induction. Conclusion: Intranasal midazolam, ketamine and sufentanil are effective and safe for conscious sedation, while intranasal midazolam, dexmedetomidine and sufentanil have proven to be effective premedications. PMID:27570849

  8. 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).

  9. 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

  10. 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.

  11. 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

  12. The effects of agitation and aeration on the production of gluconic acid by Aspergillus niger

    SciTech Connect

    Dronawat, S.N.; Svihla, C.K.; Hanley, T.R.

    1995-12-31

    The effects of agitation and aeration in the production of gluconic acid by Aspergillus niger from a glucose medium were investigated. Experiments were conducted at aeration rates of 5.0 and 10.0 L/min. Four different agitation speeds were investigated for each aeration rate. Gluconic acid concentration and biomass concentration were analyzed, and the rate of consumption of substrate by A. niger was noted. The main purpose of this work was to find the optimal conditions of agitation and aeration for the growth of A. niger and production of gluconic acid in submerged culture in a batch fermentor at a bench-top scale. The oxygen-transfer rates at different agitation and aeration rates were calculated. The gluconic acid concentration and rate of growth of A. niger increased with increase in the agitation and aeration rates.

  13. Agitated behavior in elderly nursing home residents with dementia in Japan.

    PubMed

    Schreiner, A S; Yamamoto, E; Shiotani, H

    2000-05-01

    This study is the first investigation of the frequency of agitated behaviors in elderly dementia patients in Japanese nursing homes using the Cohen-Mansfield Agitation Inventory (J. Cohen-Mansfield, 1991). Despite major differences between Japanese and American cultures, findings were highly consistent with those of previous U.S. studies. Physically aggressive behavior, although evidenced by only 10-20% of the sample, comprised the strongest factor. A separate factor for verbal agitation also emerged. The behaviors declined during the evening and night shifts. In both the Japanese and U.S. samples, wandering, general restlessness, verbal agitation such as repetitious questioning, cursing, and complaining occurred most frequently. Another 4-point scale was used to code the degree to which agitated behavior occurred during eating, dressing, bathing, and toileting for each resident. The majority of aggressive behavior occurred in relation to personal caregiving, especially in regard to bathing. Despite major cultural differences, Japanese findings paralleled previous U.S. results.

  14. Isoflurane compared with midazolam for sedation in the intensive care unit.

    PubMed Central

    Kong, K. L.; Willatts, S. M.; Prys-Roberts, C.

    1989-01-01

    OBJECTIVE--To compare isoflurane with midazolam for sedation of ventilated patients. DESIGN--Randomised control study. Setting--Intensive care unit in university teaching hospital. PATIENTS--Sixty patients aged 18-76 who required mechanical ventilation. INTERVENTIONS--Sedation with either 0.1-0.6% isoflurane in an air-oxygen mixture (30 patients) or a continuous intravenous infusion of midazolam 0.01-0.20 mg/kg/h (30 patients). Sedation was assessed initially and hourly thereafter on a six point scale. Incremental intravenous doses of morphine 0.05 mg/kg were given for analgesia as required. The trial sedative was stopped when the patient was judged ready for weaning from ventilatory support or at 24 hours (whichever was earlier). END POINT--Achievement of a predetermined level of sedation for as much of the time as possible. MAIN RESULTS--Isoflurane produced satisfactory sedation for a greater proportion of time (86%) than midazolam (64%), and patients sedated with isoflurane recovered more rapidly from sedation. CONCLUSION--Isoflurane is a promising alternative technique for sedation of ventilated patients in the intensive care unit. PMID:2500195

  15. Anxiety and Agitation in Mechanically Ventilated Patients

    PubMed Central

    Tate, Judith Ann; Dabbs, Annette Devito; Hoffman, Leslie; Milbrandt, Eric; Happ, Mary Beth

    2013-01-01

    During an ethnography conducted in an intensive care unit (ICU), we found that anxiety and agitation occurred frequently, and were important considerations in the care of 30 patients weaning from prolonged mechanical ventilation. We conducted a secondary analysis to (a) describe characteristics of anxiety and agitation experienced by mechanically ventilated patients; (b) explore how clinicians recognize and interpret anxiety and agitation and (c) describe strategies and interventions used to manage anxiety and agitation with mechanically ventilated patients. We constructed the Anxiety-Agitation in Mechanical Ventilation Model to illustrate the multidimensional features of symptom recognition and management. Patients’ ability to interact with the environment served as a basis for identification and management of anxiety or agitation. Clinicians’ attributions about anxiety or agitation and “knowing the patient” contributed to their assessment of patient responses. Clinicians chose strategies to overcome either the stimulus or patient’s appraisal of risk of the stimulus. This article contributes to the body of knowledge about symptom recognition and management in the ICU by providing a comprehensive model to guide future research and practice. PMID:21908706

  16. Managing agitated behaviour in older people.

    PubMed

    King, Camille

    2012-09-01

    Older people diagnosed with dementia can have complex needs, especially when they exhibit agitated behaviour. Patients with agitated behaviour challenge the delivery of health care. Often the behaviour is a symptom of unmet needs in this population (Dewing 2010). It is important for nurses to understand the underlying causes and apply evidence-based interventions in their nursing practice to promote health, safety and the highest quality of life possible. This article defines and classifies agitated behaviours, discusses implications for their management and then presents evidence-based interventions nurses can use. The interventions are categorised according to each of the five senses.

  17. 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

  18. [Sultopride in the treatment of agitation].

    PubMed

    Mohy, Y

    1983-04-28

    Sultopride was given to 5 patients with chronic psychosis and 5 with agitation or a psychiatric emergency. Initial dosages were from 3 to 6 vials/day in acute conditions and from 3 to 6 tablets/day in chronic diseases. Sultopride was effective in 70% of patients, with a 100% efficiency rate in acute conditions. Results on agitation were very satisfactory considering the severity of most of the conditions included in the study. On the whole, tolerance was very good.

  19. Monoamine oxidase and agitation in psychiatric patients.

    PubMed

    Nikolac Perkovic, Matea; Svob Strac, Dubravka; Nedic Erjavec, Gordana; Uzun, Suzana; Podobnik, Josip; Kozumplik, Oliver; Vlatkovic, Suzana; Pivac, Nela

    2016-08-01

    Subjects with schizophrenia or conduct disorder display a lifelong pattern of antisocial, aggressive and violent behavior and agitation. Monoamine oxidase (MAO) is an enzyme involved in the degradation of various monoamine neurotransmitters and neuromodulators and therefore has a role in various psychiatric and neurodegenerative disorders and pathological behaviors. Platelet MAO-B activity has been associated with psychopathy- and aggression-related personality traits, while variants of the MAOA and MAOB genes have been associated with diverse clinical phenotypes, including aggressiveness, antisocial problems and violent delinquency. The aim of the study was to evaluate the association of platelet MAO-B activity, MAOB rs1799836 polymorphism and MAOA uVNTR polymorphism with severe agitation in 363 subjects with schizophrenia and conduct disorder. The results demonstrated significant association of severe agitation and smoking, but not diagnosis or age, with platelet MAO-B activity. Higher platelet MAO-B activity was found in subjects with severe agitation compared to non-agitated subjects. Platelet MAO-B activity was not associated with MAOB rs1799836 polymorphism. These results suggested the association between increased platelet MAO-B activity and severe agitation. No significant association was found between severe agitation and MAOA uVNTR or MAOB rs1799836 polymorphism, revealing that these individual polymorphisms in MAO genes are not related to severe agitation in subjects with schizophrenia and conduct disorder. As our study included 363 homogenous Caucasian male subjects, our data showing this negative genetic association will be a useful addition to future meta-analyses. PMID:26851573

  20. [Helicopter transportation of a sedated, mechanically ventilated patient with cervical cord injury].

    PubMed

    Kato, Hideya; Nishiwaki, Yuko; Hosoi, Kunihiko; Shiomi, Naoto; Hirata, Masashi

    2013-09-01

    We report helicopter transportation of a sedated, mechanically ventilated patient with cervical cord injury. A 20-year-old male sustained traumatic injury to the cervical spinal cord during extracurricular activities in a college. On arrival at the hospital, a halo vest was placed on the patient and tracheostomy was performed. On the 38th hospital day, he was transported a distance of 520km by helicopter to a specialized hospital in Fukuoka for medical repatriation. Cabin space was narrow. Since power supply and carrying capacity were limited, battery-driven and portable medical devices were used. In consideration for patient's psychological stress, he was sedated with propofol. RSS (Ramsay sedation scale) scores were recorded to evaluate whether the patient was adequately sedated during helicopter transportation. Prior to transport, we rehearsed the sedation using bispectral index monitoring (BIS) in the hospital to further ensure the patient's safety during the transport. PMID:24063142

  1. Change in agitation in Alzheimer's disease in the placebo arm of a 9-week controlled trial

    PubMed Central

    Drye, Lea T.; Porsteinsson, Anton P.; Pollock, Bruce G.; Devanand, D.P.; Frangakis, Constantine; Ismail, Zahinoor; Marano, Christopher; Meinert, Curtis L.; Mintzer, Jacobo E.; Munro, Cynthia A.; Pelton, Gregory; Rabins, Peter V.; Schneider, Lon S.; Shade, David M.; Weintraub, Daniel; Newell, Jeffery; Yesavage, Jerome; Lyketsos, Constantine G.

    2015-01-01

    Background Placebo responses raise significant challenges for design of clinical trials. We report changes in agitation outcomes in the placebo arm of a recent trial of citalopram for agitation in Alzheimer's disease (AD). Methods In the Citalopram for Agitation in Alzheimer's Disease (Cit AD) study, all participants and caregivers received a psychosocial intervention and 92 were assigned to placebo for 9 weeks. Outcomes included Neurobehavioral Rating Scale agitation subscale (NBRS-A), modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change (CGIC), Cohen-Mansfield Agitation Inventory (CMAI), the Neuropsychiatric Inventory (NPI) Agitation/Aggression domain (NPI A/A) and Total (NPI-Total) and ADLs. Continuous outcomes were analyzed with mixed-effects modeling and dichotomous outcomes with logistic regression. Results Agitation outcomes improved over 9 weeks: NBRS-A mean (SD) decreased from 7.8 (3.0) at baseline to 5.4 (3.2), CMAI from 28.7 (6.7) to 26.7 (7.4), NPI A/A from 8.0 (2.4) to 4.9 (3.8), and NPI-Total from 37.3 (17.7) to 28.4 (22.1). The proportion of CGI-C agitation responders ranged from 21 to 29% and was significantly different from zero. MMSE improved from 14.4 (6.9) to 15.7 (7.2) and ADLs similarly improved. Most of the improvement was observed by 3 weeks and was sustained through 9 weeks. The major predictor of improvement in each agitation measure was a higher baseline score in that measure. Conclusions We observed significant placebo response which may be due to regression to the mean, response to a psychosocial intervention, natural course of symptoms, or nonspecific benefits of participation in a trial. PMID:26305876

  2. The agitative mixing and shearing of the CWM

    SciTech Connect

    Zhang Rongzeng; Sun Zongyue; Huangfu Jinghua

    1998-12-31

    Agitation has different operating purposes for different steps during the CWM preparation process. At present, the theoretical research of the agitation is still immature, especially for the non-Newtonian fluid. Based on the findings of agitation in other industries, the CWM agitative process is discussed in the paper.

  3. The ethical and clinical importance of measuring consciousness in continuously sedated patients.

    PubMed

    Raus, Kaspar; de Laat, Martine; Mortier, Eric; Sterckx, Sigrid

    2014-01-01

    Continuous sedation at the end of life is a practice that has attracted a great deal of attention. An increasing number of guidelines on the proposed correct performance of the practice have been drafted. All of the guidelines stress the importance of using sedation in proportion to the severity of the patient's symptoms, thus to reduce the patient's consciousness no more than is absolutely necessary. As different patients can have different experiences of suffering, the amount of suffering should, ideally, be assessed subjectively; that is, via communication with the patient. Continuously sedated patients are often unable to communicate, however, making subjective methods of pain assessment unusable. For these patients, the degree of consciousness is the sole available measure. It therefore seems important to adequately measure how deeply the patient is sedated, thereby allowing sedation to be increased when it is too light and decreased when it is too heavy. This is in accordance with the idea that reducing consciousness is not an ethically neutral act. Although consciousness measuring techniques are a hot topic in anesthesiology, almost no research exists on the use of such techniques in the context of continuous sedation at the end of life. This article aims to review existing techniques to measure consciousness and to evaluate their applicability, efficiency, and invasiveness for patients who are continuously sedated until death. Techniques commonly used to assess the depth of sedation in continuously sedated patients are basic clinical assessment and sedation scales, as they are often considered reliable and non-invasive. These techniques might not be very reliable, however, since it is known that some patients are nonresponsive and yet aware. Moreover, sedation scales require stimulation of the patient (for example prodding, shaking, or providing painful stimuli), and can thus be considered invasive of one's bodily integrity or dignity. Other techniques

  4. 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

  5. Microbial ecology in anaerobic digestion at agitated and non-agitated conditions.

    PubMed

    Tian, Zhuoli; Cabrol, Léa; Ruiz-Filippi, Gonzalo; Pullammanappallil, Pratap

    2014-01-01

    To investigate the distribution and dynamics of microbial community in anaerobic digestion at agitated and non-agitated condition, 454 pyrosequencing of 16s rRNA was conducted. It revealed the distinct community compositions between the two digesters and their progressive shifting over time. Methanogens and syntrophic bacteria were found much less abundant in the agitated digester, which was mainly attributed to the presence of bacterial genera Acetanaerobacterium and Ruminococcus with relatively high abundance. The characterization of the microbial community corroborated the digestion performance affected at the agitated condition, where lower methane yield and delayed methane production rate were observed. This was further verified by the accumulation of propionic acid in the agitated digester.

  6. Microbial Ecology in Anaerobic Digestion at Agitated and Non-Agitated Conditions

    PubMed Central

    Tian, Zhuoli; Cabrol, Léa; Ruiz-Filippi, Gonzalo; Pullammanappallil, Pratap

    2014-01-01

    To investigate the distribution and dynamics of microbial community in anaerobic digestion at agitated and non-agitated condition, 454 pyrosequencing of 16s rRNA was conducted. It revealed the distinct community compositions between the two digesters and their progressive shifting over time. Methanogens and syntrophic bacteria were found much less abundant in the agitated digester, which was mainly attributed to the presence of bacterial genera Acetanaerobacterium and Ruminococcus with relatively high abundance. The characterization of the microbial community corroborated the digestion performance affected at the agitated condition, where lower methane yield and delayed methane production rate were observed. This was further verified by the accumulation of propionic acid in the agitated digester. PMID:25313520

  7. Fuzzy logic control for intracranial pressure via continuous propofol sedation in a neurosurgical intensive care unit.

    PubMed

    Huang, Sheng-Jean; Shieh, Jiann-Shing; Fu, Mu; Kao, Ming-Chien

    2006-09-01

    The major goal of this paper is to provide automatically continuous propofol sedation for patients with severe head injury, unconsciousness, and mechanical ventilation in order to reduce the effect of agitation on intracranial pressure (ICP) using fuzzy logic control in a neurosurgical intensive care unit (NICU). Seventeen patients were divided into three groups in which control was provided with three different controllers. Experimental control periods were of 60min duration in all cases. Group A used a conventional rule-based controller (RBC), Group B a fuzzy logic controller (FLC), and Group C a self-organizing fuzzy logic controller (SOFLC). The performance of the controllers was analyzed by ICP pattern of sedation. The ICP pattern of errors was analyzed for mean and root mean square deviation (RMSD) for the entire duration of control (i.e., 1h). The results indicate that FLC can easily mimic the rule-base of human experts (i.e., neurosurgeons) to achieve stable sedation similar to the RBC group. Furthermore, the results also show that a SOFLC can provide more stable sedation of ICP pattern because it can modify the fuzzy rule-base to compensate for inter-patient variations.

  8. Sedation in gastrointestinal endoscopy: current issues.

    PubMed

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

    2013-01-28

    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.

  9. 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

  10. Sedation-related complications in gastrointestinal endoscopy.

    PubMed

    Amornyotin, Somchai

    2013-11-16

    Sedation practices for gastrointestinal endoscopic (GIE) procedures vary widely in different countries depending on health system regulations and local circumstances. The goal of procedural sedation is the safe and effective control of pain and anxiety, as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation-related complications in gastrointestinal endoscopy, once occurred, can lead to significant morbidity and occasional mortality in patients. The risk factors of these complications include the type, dose and mode of administration of sedative agents, as well as the patient's age and underlying medical diseases. Complications attributed to moderate and deep sedation levels are more often associated with cardiovascular and respiratory systems. However, sedation-related complications during GIE procedures are commonly transient and of a mild degree. The risk for these complications while providing any level of sedation is greatest when caring for patients already medically compromised. Significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support, as well as post-procedure management. Additionally, physicians must be prepared to manage these complications. This article will review sedation-related complications during moderate and deep sedation for GIE procedures and also address their appropriate management. PMID:24255744

  11. Coal storage hopper with vibrating screen agitator

    DOEpatents

    Daw, Charles S.; Lackey, Mack E.; Sy, Ronald L.

    1984-01-01

    The present invention is directed to a vibrating screen agitator in a coal storage hopper for assuring the uniform feed of coal having sufficient moisture content to effect agglomeration and bridging thereof in the coal hopper from the latter onto a conveyor mechanism. The vibrating screen agitator is provided by a plurality of transversely oriented and vertically spaced apart screens in the storage hopper with a plurality of vertically oriented rods attached to the screens. The rods are vibrated to effect the vibration of the screens and the breaking up of agglomerates in the coal which might impede the uniform flow of the coal from the hopper onto a conveyer.

  12. Citalopram for agitation in Alzheimer’s disease (CitAD): design and methods

    PubMed Central

    Drye, Lea T.; Ismail, Zahinoor; Porsteinsson, Anton P.; Rosenberg, Paul B.; Weintraub, Daniel; Marano, Christopher; Pelton, Gregory; Frangakis, Constantine; Rabins, Peter V.; Munro, Cynthia A.; Meinert, Curtis L.; Devanand, D.P.; Yesavage, Jerome; Mintzer, Jacobo E.; Schneider, Lon S.; Pollock, Bruce G.; Lyketsos, Constantine G.

    2012-01-01

    Background Agitation is one of the most common neuropsychiatric symptoms of Alzheimer’s disease (AD), and is associated with serious adverse consequences for patients and caregivers. Evidence-supported treatment options for agitation are limited. The citalopram for agitation in Alzheimer’s disease (CitAD) study was designed to evaluate the potential of citalopram to ameliorate these symptoms. Methods CitAD is a randomized, double-masked, placebo-controlled multicenter clinical trial with two parallel treatment groups assigned in a 1:1 ratio and randomization stratified by clinical center. The study has eight recruiting clinical centers, a chair’s office and a coordinating center located in university settings in the United States and Canada. 200 people having probable Alzheimer’s disease with clinically significant agitation and without major depression are being recruited. Patients are randomized to receive citalopram (target dose of 30 mg/day) or matching placebo. Caregivers of patients in both treatment groups receive a structured psychosocial therapy. Agitation will be compared between treatment groups using the NeuroBehavioral Rating Scale and the AD Cooperative Study- Clinical Global Impression of Change which are the primary outcomes. Functional performance, cognition, caregiver distress and rates of adverse and serious adverse events will also be measured. Conclusion The authors believe the design elements in CitAD are important features to be included in trials assessing the safety and efficacy of psychotropic medications for clinically significant agitation in Alzheimer’s disease. PMID:22301195

  13. A review of the practice of sedation with inhalational anaesthetics in the intensive care unit with the AnaConDa® device

    PubMed Central

    Misra, Satyajeet; Koshy, Thomas

    2012-01-01

    The intensive care unit (ICU) environment is often perceived to be hostile and frightening by patients due to unfamiliar surroundings coupled with presence of numerous personnel, monitors and other equipments as well as a loss of perception of time. Mechanical ventilation and multiple painful procedures that often need to be carried out in these critically ill patients add to their overall anxiety. Sedation is therefore required not only to allay the stress and anxiety, but also to allow for mechanical ventilation and other invasive therapeutic and diagnostic procedures to be performed. The conventional intravenous sedative agents used in ICUs suffer from problems of over sedation, tachyphylaxis, drug accumulation, organ specific elimination and often lead to patient agitation on withdrawal. All this tend to prolong the ventilatory as well as ICU and hospital discharge time, which increase the risk for infection and add to the overall increase in morbidity, mortality and hospital costs. In 2005, the anaesthetic conserving device (AnaConDa®) was marketed for ICU sedation with volatile anaesthetic agents. A number of trials have shown the effectiveness of using volatile anaesthetic agents for ICU sedation with the AnaConDa device. Compared with intravenous sedatives, use of volatile anaesthetic agents have resulted in shorter wake up and extubation time, lesser duration of mechanical ventilation and faster discharge from hospitals. This review shall focus on the benefits, technical pre-requisites and status of sedation with volatile anaesthetic agents in ICUs with the AnaConDa® device. PMID:23325934

  14. 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

  15. An Agitation Experiment with Multiple Aspects

    ERIC Educational Resources Information Center

    Spencer, Jordan L.

    2006-01-01

    This paper describes a multifaceted agitation and mixing experiment. The relatively inexpensive apparatus includes a variable-speed stirrer motor, two polycarbonate tanks, and an instrumented torque table. Students measure torque as a function of stirrer speed, and use conductive tracer data to estimate two parameters of a flow model. The effect…

  16. Preoperative anxiety and propofol requirement in conscious sedation for ovum retrieval.

    PubMed

    Hong, Jeong-Yeon; Kang, Inn Soo; Koong, Mi Kyoung; Yoon, Hee Jo; Jee, Young Suck; Park, Jeong Wook; Park, Mi Hyun

    2003-12-01

    The purpose of the present study was to evaluate the correlation among the trial number of in vitro fertilization (IVF), preoperative anxiety, and propofol requirement for conscious sedation. One hundred and twenty six Korean women undergoing oocyte retrieval were enrolled. The target-controlled infusion by the anesthesiologist was conducted with initial target propofol concentration of 2.5 microg/mL, which was manipulated until the sedation score 3 and desired clinical end point were achieved. A weak correlation was observed between visual analogue scale (VAS) anxiety and the dose of propofol required for the induction of conscious sedation (r=0.22, p=0.0192). A weak correlation was also found between VAS anxiety and the sedation time needed to reach the proper conscious sedation level for the procedure (r=0.181, p=0.0484). Multiple regression analysis showed that VAS anxiety, preoperative baseline prolactin level, and cortisol level had statistically significant effects on the propofol induction dose for target controlled conscious sedation. We concluded that the induction dose and time requirements for propofol in anesthesiologist-controlled conscious sedation be modified based on the preoperative anxiety level and the baseline blood concentration of stress hormone, cortisol and prolactin.

  17. Palliative sedation versus euthanasia: an ethical assessment.

    PubMed

    ten Have, Henk; Welie, Jos V M

    2014-01-01

    The aim of this article was to review the ethical debate concerning palliative sedation. Although recent guidelines articulate the differences between palliative sedation and euthanasia, the ethical controversies remain. The dominant view is that euthanasia and palliative sedation are morally distinct practices. However, ambiguous moral experiences and considerable practice variation call this view into question. When heterogeneous sedative practices are all labeled as palliative sedation, there is the risk that palliative sedation is expanded to include practices that are actually intended to bring about the patients' death. This troublesome expansion is fostered by an expansive use of the concept of intention such that this decisive ethical concept is no longer restricted to signify the aim in guiding the action. In this article, it is argued that intention should be used in a restricted way. The significance of intention is related to other ethical parameters to demarcate the practice of palliative sedation: terminality, refractory symptoms, proportionality, and separation from other end-of-life decisions. These additional parameters, although not without ethical and practical problems, together formulate a framework to ethically distinguish a more narrowly defined practice of palliative sedation from practices that are tantamount to euthanasia. Finally, the article raises the question as to what impact palliative sedation might have on the practice of palliative care itself. The increasing interest in palliative sedation may reemphasize characteristics of health care that initially encouraged the emergence of palliative care in the first place: the focus on therapy rather than care, the physical dimension rather than the whole person, the individual rather than the community, and the primacy of intervention rather than receptiveness and presence.

  18. Intravenous dexmedetomidine versus propofol for intraoperative moderate sedation during spinal anesthesia: A comparative study

    PubMed Central

    Shah, Pratibha Jain; Dubey, Kamta Prasad; Sahare, Kamal Kishore; Agrawal, Amit

    2016-01-01

    Background and Aims: There has been a paradigm shift of focus toward quality of spinal anesthesia with sedation being an integral aspect of this regional anesthesia technique. Thus, this study was designed to compare efficacy of intravenous dexmedetomidine and propofol for moderate sedation during spinal anesthesia. Material and Methods: A total of 120 patients of age group 18-60 years of American Society of Anesthesiologists grade I & II, posted for surgeries under spinal anesthesia were randomly divided in to three groups (n = 40 each); Group D received infusion of dexmedetomidine 1 μg/kg over 10 min followed by maintenance infusion of 0.5 μg/kg/h. Group P received infusion of propofol 6 mg/kg/h for 10 min followed by the infusion maintenance of 2.5 mg/kg/h. Group C (control group) received normal saline. Level of sedation (using observer's assessment of alertness/sedation score), pain intensity (by visual analogue scale), onset and recovery from sedation, hemodynamic changes, and overall patient's satisfaction were assessed. Results: The onset and recovery from sedation were significantly earlier with propofol (15.57 ± 1.89 min vs. 27.06 ± 2.26 min; P < 0.001) however intraoperative sedation (level 4), and overall patient's satisfaction was significantly better with dexmedetomidine group (p < 0.05). Duration of postoperative analgesia was significantly prolonged with dexmedetomidine (225.53 ± 5.61 min vs. 139.60 ± 3.03 min; P = 0.0013). Mean heart rate and blood pressure were significantly lower in the propofol group (P < 0.05). Conclusion: Dexmedetomidine with its stable cardio-respiratory profile, better sedation, overall patient's satisfaction, and analgesia could be a valuable adjunct for intraoperative sedation during spinal anesthesia. PMID:27275058

  19. Do Past Experiences Predict Agitation in Nursing Home Residents?

    ERIC Educational Resources Information Center

    Cohen-Mansfield, Jiska; Marx, Marcia S.

    1989-01-01

    Examined relationships between agitated behavior and past personality in 408 nursing home residents. Agitated and nonaggressive behaviors were correlated with past stressful events, and physically aggressive behavior was correlated with the lack thereof; no relationships were found between agitated behavior and history of a mental disorder or past…

  20. 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

  1. 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

  2. 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

  3. [Effect of agitation on hyaluronic acid produced by Streptococcus zooepidemicus by using computational fluid dynamics].

    PubMed

    Gu, Xiaohua; Duan, Xujie; Tan, Wensong; Zhang, Xu

    2009-11-01

    Agitation plays an important role in the hyaluronic acid (HA) fermentation process. However, views about the effect of agitation on HA production remain controversial. We investigated the effect of agitation on cell growth and HA synthesis during HA fermentation process by using Computational Fluid Dynamics (CFD) technology. The results showed that the biomass and HA yield changed a little with the increase of impeller speed, but the HA molecular weight firstly increased and then decreased. The results of phase agitation control strategy demonstrated that the influence of agitation on the HA molecular weight mainly exhibited at the stage of HA synthesis. Moreover, the CFD simulation results indicated that when impeller speed increased, the mixing time reduced while the shear rate increased significantly. The removal of anchor could moderate the contradiction between the mixing time and shear rate, and finally the HA molecular weight increased by 23.9%. The results of this work could provide guidelines for optimizing the HA fermentation, as well as the bioreactor design and scaling up. PMID:20222466

  4. Chem I Supplement: Some Biochemistry of Sedatives.

    ERIC Educational Resources Information Center

    Journal of Chemical Education, 1979

    1979-01-01

    Antianxiety agents are discussed in terms of their effects on the brain and central nervous system. Formulas for some substances, commonly prescribed as sedatives, are given. Includes a discussion on the toxicity and side effects of the drugs. (SA)

  5. Assessment of the effect of continuous sedation with mechanical ventilation on adrenal insufficiency in patients with traumatic brain injury.

    PubMed

    Li, Min; Zhang, Ying; Wu, Kang-Song; Hu, Ying-Hong

    2016-03-01

    The aim of this study was to assess the effect of continuous propofol sedation plus prolonged mechanical ventilation on adrenal insufficiency (AI) in patients with traumatic brain injury (TBI). Eighty-five adult patients diagnosed with moderate TBI (Glasgow Coma Scale (GCS) score 9-13) from October 2011 to October 2012 were included in this prospective study. The patients comprised three groups: no mechanical ventilation and sedation (n=27), mechanical ventilation alone (n=24) and mechanical ventilation plus sedation (n=34). The low-dose short Synacthen test was performed at 8:00 on the first, third, and fifth days after TBI. Logistic regression analysis was performed to identify factors affecting the use of mechanical ventilation and sedation, and the incidence of AI. On the fifth day after injury, the mean baseline cortisol and simulated cortisol levels were significantly lower in the mechanical ventilation plus sedation group compared with the other two groups. Multivariate regression analysis showed that the Acute Physiology and Chronic Health Evaluation (APACHE) score was independently associated with treatment with mechanical ventilation and sedation compared to mechanical ventilation alone. Furthermore, hypoxemia on admission and shock were associated with the development of AI. The findings showed that sedation is associated with an increased incidence of AI. Patients with TBI who are treated with continuous sedation should be monitored for AI carefully. PMID:26912007

  6. Pediatric oral conscious sedation: changes to come.

    PubMed

    Malamed, S F; Reggiardo, P

    1999-11-01

    Recent media attention has focused the public's attention on issues surrounding pediatric oral conscious sedation. Under a law passed in 1998 and taking affect on Jan. 1, 2000, California dentists will be subject to certification and procedural provisions designed to ensure the educational qualification of the provider and the standards under which the procedure is performed. This article discusses the history of concern and regulation regarding sedation of children in the dental office.

  7. Nonmedical use of sedatives in urban Bengaluru

    PubMed Central

    Nattala, Prasanthi; Murthy, Pratima; Thennarasu, K.; Cottler, Linda B.

    2014-01-01

    Background: Nonmedical sedative use is emerging as a serious problem in India. However, there is paucity of literature on the patterns of use in the population. Aim: The aim of the present analysis was to explore sedative use patterns in an urban metropolis. Materials and Methods: Data for the present analysis come from the parent study on nonmedical prescription drug use in Bengaluru, India. Participants (n = 717) were recruited using a mall-intercept approach, wherein they were intercepted in five randomly selected shopping malls, and administered an interview on their use of prescription drugs. Results: Past 12-month nonmedical sedative use was reported by 12%, benzodiazepines being the commonest. Reasons cited for nonmedical use included “sleeplessness, pain relief, stress.” A majority (73%) reported sedative use “in ways other than as prescribed,” compared to “use without prescription” (27%). All prescriptions were issued by general physicians in private hospitals. About 11% among those who used “in ways other than as prescribed,” and 100% of nonprescribed users, reported irregular use (skipping doses/stopping/restarting). Among those who used “in ways other than prescribed,” pharmacy stores were the source of obtaining the sedatives. Among “nonprescribed users,” family/friends were the main source. Three-percent reported using sedatives and alcohol together in the same use episode. In multivariate logistic regression analyses, nonmedical sedative use was significantly associated with graduation-level education or above (adjusted odds ratio [aOR]: 2.53, 95% confidence interval [CI]: 1.30-4.91), and married status (aOR: 2.32, 95% CI: 1.04-5.18). Conclusions: Findings underscore the need for considering various contextual factors in tailoring preventive interventions for reducing nonmedical sedative use. PMID:25316935

  8. 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

  9. Effect of Citalopram on Agitation in Alzheimer's Disease – The CitAD Randomized Controlled Trial

    PubMed Central

    Porsteinsson, Anton P.; Drye, Lea T.; Pollock, Bruce G.; Devanand, D.P.; Frangakis, Constantine; Ismail, Zahinoor; Marano, Christopher; Meinert, Curtis L.; Mintzer, Jacobo E.; Munro, Cynthia A.; Pelton, Gregory; Rabins, Peter V.; Rosenberg, Paul B.; Schneider, Lon S.; Shade, David M.; Weintraub, Daniel; Yesavage, Jerome; Lyketsos, Constantine G.

    2014-01-01

    Importance Agitation is common, persistent, and associated with adverse consequences for patients with Alzheimer's disease (AD). Pharmacological treatment options, including antipsychotics are not satisfactory. Objective The primary objective was to evaluate the efficacy of citalopram for agitation in patients with AD. Key secondary objectives examined effects of citalopram on function, caregiver distress, safety, cognitive safety, and tolerability. Design, Setting and Participants The Citalopram for Agitation in Alzheimer's Disease Study (CitAD) was a multicenter, randomized, placebo-controlled, double-blind, parallel group trial that enrolled 186 patients with probable AD and clinically significant agitation from eight academic centers in the US and Canada from August 2009 to January 2013. Interventions Participants (n=186) were randomized to receive a psychosocial intervention plus either citalopram (n=94) or placebo (n=92) for 9 weeks. Dose began at 10 mg/d with planned titration to 30 mg/d over 3 weeks based on response and tolerability. Main Outcomes and Measures Primary outcome measures were the Neurobehavioral Rating Scale, agitation subscale (NBRS-A) and the modified Alzheimer Disease Cooperative Study-Clinical Global Impression of Change (mADCS-CGIC) Other outcomes were the Cohen-Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory (NPI), activities of daily living (ADLs), caregiver distress, cognitive safety (MMSE), and adverse events. Results Participants on citalopram showed significant improvement compared to placebo on both primary outcome measures. NBRS-A estimated treatment difference at week 9 (citalopram minus placebo) was −0.93 [95% CI: −1.80 to −0.06], p = 0.036. mADCS-CGIC results showed 40% of citalopram participants having moderate or marked improvement from baseline compared to 26% on placebo, with estimated treatment effect (odds ratio of being at or better than a given CGIC category) of 2.13 [95% CI 1.23 to 3.69], p = 0

  10. Perceived Stress, Alexithymia, and Psychological Health as Predictors of Sedative Abuse

    PubMed Central

    Gilan, Nader Rajabi; Reshadat, Sohyla; Komasi, Saeid; Ghasemi, Seyed Ramin

    2015-01-01

    Background The harmful effects of sedative medications and substances in conjunction with limited research regarding predictive psychological constructs of drug abuse necessitate further investigation of associated factors. Therefore, the present study aimed to elucidate the roles of perceived stress, alexithymia, and psychological health as predictors of sedative abuse in medical students. Methods In this cross-sectional study, 548 students at Kermanshah University of Medical Sciences, Iran, were selected using stratified random sampling. The data were obtained using the Perceived Stress Scale, an alexithymia scale (Farsi version of the Toronto Alexithymia Scale-20), and a General Health Questionnaire to assess psychological health. Data were analyzed using discriminant analyses. Results The results demonstrated that the user and non-user of sedative substances groups had significantly different predictive variables (except for social function disorder) (P>0.05). Physical complaints, alexithymia, and perceived stress, which had standard coefficients of 0.80, 0.60, and -0.27, respectively, predicted sedative drug use. Conclusion The results of the present study indicate that perceived stress, alexithymia, physical complaints, anxiety, and depression are associated with sedative drug abuse. PMID:26435810

  11. [The dosage of sedative was reduced by patient-controlled sedation during epidural anesthesia].

    PubMed

    Tsunoda, K

    1995-01-01

    The dosage of sedatives required for sedation was studied in patients who underwent total abdominal histerectomy under epidural anesthesia using patient-controlled sedation (PCS) and in those with anesthesiologist-controlled sedation (ACS). Patients in experimental groups received 1.0 or 1.5 mg bolus dose of midazolam by their request until desirable sedation was obtained using a computer-controlled device. In control group, anesthesiologists gave 1.5 mg bolus dose of midazolam and repeated until enough sedation was obtained. The total amount of midazolam was 12.15 +/- 3.90 mg (mean +/- SD) in ACS group and showed significant differences from experimental groups (PCS-1.0 group: 7.43 +/- 1.81 mg, PCS-1.5 group: 6.30 +/- 2.81 mg). The level of sedation showed wider variation in PCS groups than in ACS groups. The results suggest that PCS is a technique which allows reduction of sedatives in patients who undergo operation under local anesthesia.

  12. 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

  13. Hydrodynamic effects on cells in agitated tissue culture reactors

    NASA Technical Reports Server (NTRS)

    Cherry, R. S.; Papoutsakis, E. T.

    1986-01-01

    The mechanisms by which hydrodynamic forces can affect cells grown on microcarrier beads in agitated cell culture reactors were investigated by analyzing the motion of microcarriers relative to the surrounding fluid, to each other, and to moving or stationary solid surfaces. It was found that harmful effects on cell cultures that have been previously attributed to shear can be better explained as the effects of turbulence (of a size scale comparable to the microcarriers or the spacing between them) or collisions. The primary mechanisms of cell damage involve direct interaction between microcarriers and turbulent eddies, collisions between microcarriers in turbulent flow, and collisions against the impeller or other solid surfaces. The implications of these analytical results for the design of tissue culture reactors are discussed.

  14. 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

  15. Spontaneous knotting of an agitated string.

    PubMed

    Raymer, Dorian M; Smith, Douglas E

    2007-10-16

    It is well known that a jostled string tends to become knotted; yet the factors governing the "spontaneous" formation of various knots are unclear. We performed experiments in which a string was tumbled inside a box and found that complex knots often form within seconds. We used mathematical knot theory to analyze the knots. Above a critical string length, the probability P of knotting at first increased sharply with length but then saturated below 100%. This behavior differs from that of mathematical self-avoiding random walks, where P has been proven to approach 100%. Finite agitation time and jamming of the string due to its stiffness result in lower probability, but P approaches 100% with long, flexible strings. We analyzed the knots by calculating their Jones polynomials via computer analysis of digital photos of the string. Remarkably, almost all were identified as prime knots: 120 different types, having minimum crossing numbers up to 11, were observed in 3,415 trials. All prime knots with up to seven crossings were observed. The relative probability of forming a knot decreased exponentially with minimum crossing number and Möbius energy, mathematical measures of knot complexity. Based on the observation that long, stiff strings tend to form a coiled structure when confined, we propose a simple model to describe the knot formation based on random "braid moves" of the string end. Our model can qualitatively account for the observed distribution of knots and dependence on agitation time and string length.

  16. [Increased risk of suicide in patients with agitated depression].

    PubMed

    Kenchadze, V G; Chkoniia, E D; Sikharulidze, G G

    2009-12-01

    In our study we aimed to verify the clinical features of agitated depression, which intensify suicidal trends leading to completed suicide. From 477 patients with agitated depression we selected 126, who presented high risk of suicide and studded them by using Mood Anxiety Inventory. On the bases of the structural-dynamic analyses we determine seven clinical variations of agitated-depression with prominent affective, cognitive, psychomotor, somato-algetic and behavioral symptoms. The most dangerous types with regards of suicidal behavior appeared to be senestopathic and algetic types and agitated depression with depersonalization and derealization. PMID:20090153

  17. Ketamine Sedation in Gastrointestinal Endoscopy in Children

    PubMed Central

    Eskander, Ayman E.; Baroudy, Nevine R. El; Refay, Amira S. El

    2016-01-01

    BACKGROUND: Moderate sedation for gastrointestinal endoscopy has traditionally been provided by the endoscopist. Controversy has ensued over safe and efficient sedation practice as endoscopy has increased in numbers and complexity. AIM: To evaluate the safety of ketamine sedation given by non-anesthesiologist during gastrointestinal endoscopy in children. METHODS: A prospective study of 100 paediatric patients with gastrointestinal symptoms who were a candidate for upper or lower gastrointestinal endoscopy in paediatric endoscopy unit at Abo El-Reesh Paediatric Hospital, Cairo University. All children were > 2 years old and weighed > 6 kg. The analysis was performed in terms of sedation-related complications. RESULTS: A total 100 paediatric patients including 53 males and 47 females with mean age of 5.04 years were involved in the study. All children were medicated with ketamine with a mean dose of 3.77mg/kg. No complications occurred in 87% of cases. Desaturation occurred in 13% of the cases and was reversible by supplemental nasal oxygen. Desaturation was more frequent during Upper GI Endoscopy and with the intramuscular route (p value=0.049). No apnea, bradycardia, arrest or emergence reactions were recorded. CONCLUSION: Ketamine sedation found to be safe for paediatric gastrointestinal endoscopy in Egyptian children without co-morbidities. Transient Hypoxia (13%) may occur but easily reversed by nasal oxygen therapy. PMID:27703561

  18. 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

  19. Efficacy of oral ketamine compared to midazolam for sedation of children undergoing laceration repair

    PubMed Central

    Rubinstein, Orit; Barkan, Shiri; Breitbart, Rachelle; Berkovitch, Sofia; Toledano, Michal; Weiser, Giora; Karadi, Natali; Nassi, Anat; Kozer, Eran

    2016-01-01

    Abstract Objective: To assess the efficacy of oral ketamine versus oral midazolam for sedation during laceration repair at a pediatric emergency department. Methods: Children between 1 and 10 years requiring laceration repair were randomly assigned to 2 groups, treated either with oral midazolam (0.7 mg/kg) or with oral ketamine (5 mg/kg). Main outcomes measured were level of pain during local anesthesia, as assessed by the parent on a 10-cm visual analog scale (VAS) and the number of children who required intravenous sedation. Secondary outcomes included VAS by physician, pain assessment by child, maximal sedation depth assessed by the University of Michigan Sedation Scale, time until University of Michigan Sedation Scale 2 or more, general satisfaction of a parent and treating physician, length of procedure, total sedation time, and the incidence of any adverse events. Results: Sixty-eight children were recruited of which 33 were girls. Average age was 5.08 ± 2.14 years. Thirty-seven children were treated with ketamine and 31 with midazolam. Parent-assessed VAS in ketamine treated patients was 5.07 ± 0.75 compared with 3.68 ± 0.7 in midazolam treated patients [mean difference = 1.39 95% confidence interval (CI) –0.47 to 3.26]. Twelve (32%) of the children treated with ketamine required the addition of IV sedation compared to only 2 children (6%) of the children treated with midazolam [odds ratio (adjusted for age and gender) 6.1, 95% CI: 1.2 to 30.5]. The rest of the measured variables were similar between the groups, with no statistical significance. Discussion: No difference in the level of pain was found between ketamine and midazolam treated patients. Compared with oral midazolam (0.7 mg/kg), oral ketamine (5 mg/kg) was associated with higher rates of sedation failure, and thus is not recommended as a single agent for oral sedation in children requiring laceration repair. PMID:27368000

  20. [Handicapped patients. General anesthesia or sedation?].

    PubMed

    Bettelli, G; Giulietti, M P; Bitelli, G; Iseppi, D; Caproni, G; Saetti, A; Sentimenti, F; Vernole, B

    1990-03-15

    The Authors consider the problems involved in dental treatment of the handicapped patients. Accuracy in diagnosis of the handicap factor, knowledge about its consequences on pathophysiological status and about chronically assumed drugs are the first step: in fact these patients may be affected by a wide variety of physiopathologic and mental diseases. Failure of cooperation requires general anesthesia or sedation techniques. General anesthesia can be dangerous (malignant hyperthermia in myopathies, difficult intubation in facial anomalies, pharmacological interactions); furthermore, its frequent application even in order to perform minimal treatment is often unsuitable. Sedation techniques offer a more convenient possibility, but must be practised by trained operators. Nitrous oxide alone rarely produces in fact a sufficient degree of sedation and is suitable only in patients affected by very slight mental insufficiency. In the other cases, association with various drugs (as benzodiazepines, barbiturates etc) is needed. In such a situation, the active and continuous presence of the anesthesiologist becomes mandatory. PMID:2144246

  1. Clinical recovery time from conscious sedation for dental outpatients.

    PubMed Central

    Takarada, Tohru; Kawahara, Michio; Irifune, Masahiro; Endo, Chie; Shimizu, Yoshitaka; Maeoka, Kiyoshi; Tanaka, Chikako; Katayama, Sotaro

    2002-01-01

    For dental outpatients undergoing conscious sedation, recovery from sedation must be sufficient to allow safe discharge home, and many researchers have defined "recovery time" as the time until the patient was permitted to return home after the end of dental treatment. But it is frequently observed that patients remain in the clinic after receiving permission to go home. The present study investigated "clinical recovery time," which is defined as the time until discharge from the clinic after a dental procedure. We analyzed data from 61 outpatients who had received dental treatment under conscious sedation at the Hiroshima University Dental Hospital between January 1998 and December 2000 (nitrous oxide-oxygen inhalation sedation [n = 35], intravenous sedation with midazolam [n = 10], intravenous sedation with propofol [n = 16]). We found that the median clinical recovery time was 40 minutes after nitrous oxide-oxygen sedation, 80 minutes after midazolam sedation, and 52 minutes after propofol sedation. The clinical recovery time was about twice as long as the recovery time described in previous studies. In a comparison of the sedation methods, clinical recovery time differed (P = .0008), being longer in the midazolam sedation group than in the nitrous oxide-oxygen sedation group (P = .018). These results suggest the need for changes in treatment planning for dental outpatients undergoing conscious sedation. PMID:12779113

  2. [Awakening of intensive care patients after prolonged continuous sedation].

    PubMed

    Acosta Mejuto, B; Delgado Hito, P; Mirabete Rodríguez, I; Sola Prado, A

    1998-01-01

    A study was made of the degree of orientation, cooperation, and anxiety of patients admitted to the Intensive Care Unit of the Hospital de la Santa Creu i Sant Pau (level III), at the conclusion of prolonged continuous sedation. Recovery time was evaluated, understood as the time required to achieve orientation in time, place, and person. The study was descriptive. An analysis was made of 37 patients who met inclusion criteria between July 1995 and March 1996. After discontinuing sedation, the Glasgow assessment was carried out (modified by Cook and Palma) every four hours until a score of > or = 14 was obtained. From then on, the degree of anxiety, using the Hamilton scale, and cooperation and orientation, using our own scales, were evaluated four times a day. The assessment concluded when the patient was oriented in time, space, and person. We recorded age, sex, disease, disease severity, previous admissions, type of sedation, need for additional bolus injections, and the state of anxiety as perceived by family members. Mean age of patients was 65.1 +/- 13.3 years; 81.1% were men. Respiratory disease was the most common pathology, mean SAPS was 10.7 +/- 2.6, and the most frequently administered drug was midazolam (81%). Patients required an average of 15 hours (164-0) to awaken and tended to taken longer to awake with midazolam. Once the were awake, the required 10 hours (48-0) hours before the were completely oriented. The degree of anxiety was mild and cooperation was regular during all measurements. No relation was found between variables. Our results suggest that a care plan designed to shorten temporal disorientation and promote cooperation would improve the quality of awakening.

  3. [Extracorporeal shockwave lithotripsy in sedation-analgesia].

    PubMed

    Berger, M; Brandstetter, A; Chowanetz, E; Gasser, G; Mossig, H; Schmidt, P

    1988-03-01

    The aim of the present study was to examine the effects of combined sedation and analgesia during extracorporeal shockwave lithotripsy using the Dornier lithotriptor HM III. We used a combination of a benzodiazepin derivatives with an opioid. We tested the dosage of drugs needed in relation to the length of treatment, the size of the stone and the overall energy output of the lithotriptor. In addition, continuous records were made of the patient's blood pressure and the oxygen saturation in the blood, with and without oxygen insufflation. Our results show that sedation combined with analgesia is a reasonable and useable alternative to general or regional anaesthesia for extracorporeal lithotripsy.

  4. Identifying characteristics of children requiring sedation for urodynamics.

    PubMed

    Sweeney, Heidi; Rzepski, Barbara; Hochman, Howard; Kim, Christina; Lerer, Trudy; Ferrer, Fernando

    2008-08-01

    The aim of this study was to identify characteristics of children requiring sedation for urodynamics. Findings suggest children between the ages of 3 and 7 are more likely to require sedation for urodynamics when compared to other age groups.

  5. Effect of Preferred Music on Agitation After Traumatic Brain Injury.

    PubMed

    Park, Soohyun; Williams, Reg Arthur; Lee, Donghyun

    2016-04-01

    Agitation is a common behavioral problem after traumatic brain injury (TBI), which threatens the safety of patients and caregivers and disrupts the rehabilitation process. This study aimed to evaluate the effects of a preferred music intervention on the reduction of agitation in TBI patients and to compare the effects of preferred music with those of classical "relaxation" music. A single group, within-subjects, randomized crossover trial design was formed, consisting of 14 agitated patients with cognitive impairment after severe TBI. Patients listened to preferred music and classical "relaxation" music, with a wash-out period in between. Patients listening to the preferred music reported a significantly greater reduction in agitation compared with the effect seen during the classical "relaxation" music intervention (p = .046). These findings provide preliminary evidence that the preferred music intervention may be effective as an environmental therapeutic approach for reducing agitation after TBI.

  6. A randomized, controlled cross-over trial of dermally-applied lavender (Lavandula angustifolia) oil as a treatment of agitated behaviour in dementia

    PubMed Central

    2013-01-01

    Background Lavender essential oil shows evidence of sedative properties in neurophysiological and animal studies but clinical trials of its effectiveness as a treatment of agitation in people with dementia have shown mixed results. Study methods have varied widely, however, making comparisons hazardous. To help remedy previous methodological shortcomings, we delivered high grade lavender oil in specified amounts to nursing home residents whose agitated behaviours were recorded objectively. Methods 64 nursing home residents with frequent physically agitated behaviours were entered into a randomized, single-blind cross-over trial of dermally-applied, neurophysiologically active, high purity 30% lavender oil versus an inactive control oil. A blinded observer counted the presence or absence of target behaviours and rated participants’ predominant affect during each minute for 30 minutes prior to exposure and for 60 minutes afterwards. Results Lavender oil did not prove superior to the control oil in reducing the frequency of physically agitated behaviours or in improving participants’ affect. Conclusions Studies of essential oils are constrained by their variable formulations and uncertain pharmacokinetics and so optimal dosing and delivery regimens remain speculative. Notwithstanding this, topically delivered, high strength, pure lavender oil had no discernible effect on affect and behaviour in a well-defined clinical sample. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN 12609000569202) PMID:24219098

  7. Quality of life following third molar removal under conscious sedation

    PubMed Central

    Sancho-Puchades, Manuel; Berini-Aytés, Leonardo; Gay-Escoda, Cosme

    2012-01-01

    Aim: The aim of this study was to assess quality of life (QoL) and degree of satisfaction among outpatients subjected to surgical extraction of all four third molars under conscious sedation. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after extraction. Study design: Fifty patients received a questionnaire assessing social isolation, working isolation, eating and speaking ability, diet modifications, sleep impairment, changes in physical appearance, discomfort at suture removal and overall satisfaction at days 4 and 7 after surgery. Pain was recorded by patients on a 100-mm pain visual analogue scale (VAS) every day after extraction until day 7. Results: Thirty-nine patients fulfilled correctly the questionnaire. Postoperative pain values suffered small fluctuations until day 5 (range: 23 to 33 mm in a 100-mm VAS), when dicreased significantly. A positive association was observed between difficult ranked surgeries and higher postoperative pain levels. The average number of days for which the patient stopped working was 4.9. Conclusion: The removal of all third molars in a single appointment causes an important deterioration of the patient’s QoL during the first postoperative week, especially due to local pain and eating discomfort. Key words:Third molar removal, quality of life, sedation. PMID:22926461

  8. 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.

  9. 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

  10. Dependence of mycelial morphology on impeller type and agitation intensity.

    PubMed

    Jüsten, P; Paul, G C; Nienow, A W; Thomas, C R

    1996-12-20

    The influence of the agitation conditions on the morphology of Penicillium chrysogenum (freely dispersed and aggregated forms) was examined using radial (Rushton turbines and paddles), axial (pitched blades, propeller, and Prochem Maxflow T), and counterflow impellers (Intermig). Culture broth was taken from a continuous fermentation at steady state and was agitated for 30 min in an ungassed vessel of 1.4-L working volume. The power inputs per unit volume of liquid in the tank, P/V(L), ranged from 0.6 to 6 kW/m(3). Image analysis was used to measure mycelial morphology. To characterize the intensity of the damage caused by different impellers, the mean total hyphal length (freely dispersed form) and the mean projected area (all dispersed types, i.e., also including aggregates) were used. [In this study, breakage of aggregates was taken into account quantitatively for the first time.]At 1.4-L scale and a given P/V(L), changes in the morphology depended significantly on the impeller geometry. However, the morphological data (obtained with different geometries and various P/V(L)) could be correlated on the basis of equal tip speed and two other, less simple, mixing parameters. One is based on the specific energy dissipation rate in the impeller region, which is simply related to P/V(L) and particular impeller geometrical parameters. The other which is developed in this study is based on a combination of the specific energy dissipation rate in the impeller swept volume and the frequency of mycelial circulation through that volume. For convenience, the function arising from this concept is called the "energy dissipation/circulation" function.To test the broader validity of these correlations, scale-up experiments were carried out in mixing tanks of 1.4, 20, and 180 L using a Rushton turbine and broth from a fed-batch fermentation. The energy dissipation/circulation function was a reasonable correlating parameter for hyphal damage over this range of scales, whereas tip

  11. 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.

  12. Assessment of pain and agitation in critically ill infants.

    PubMed

    Ramelet, A S

    1999-09-01

    Critically ill infants are subjected to many painful experiences that, if inadequately treated, can have severe physiological and psychological consequences. Optimal management of pain relies on the adequacy of nurses' assessment; this, however, is complicated by another common condition, agitation. A multidimensional assessment is therefore necessary to adequately identify pain and agitation. The aim of this descriptive study was to identify the cues that nurses caring for critically ill infants use to assess pain and agitation. A questionnaire, developed from the literature, was distributed to all registered nurses (85) working in the neonatal and paediatric intensive care units of an Australian teaching hospital. Questionnaires were completed by 41 nurses (a 57 per cent response rate). Results revealed that, except for diagnosis, there were no significant differences between the cues participants used to assess pain and those to assess agitation. Nurses used numerous cues from various sources: most importantly, their own judgement (99 per cent); the parents' judgement (90 per cent); the infant's environment; documentation (78 per cent), and the infant's cues (70 per cent). These findings demonstrate the relevance of the nurse's role in assessment of pain and agitation in critically ill infants. Nurses used cues specific to the critically ill rather than the less sick infant. Results of this study also show the difficulty of differentiating between pain and agitation. Further research on ways of distinguishing between the construct of pain and agitation needs to be undertaken.

  13. Nanocellulose Composite Materials Synthesizes with Ultrasonic Agitation

    NASA Astrophysics Data System (ADS)

    Kidd, Timothy; Folken, Andrew; Fritch, Byron; Bradley, Derek

    We have extended current techniques in forming nanocellulose composite solids, suspensions and aerogels to enhance the breakdown of cellulose into its molecular components. Using only mechanical processing which includes ball milling, using a simple mortar and pestle, and ultrasonic agitation, we are able to create very low concentration uniform nanocellulose suspensions in water, as well as incorporate other materials such as graphite, carbon nanotubes, and magnetic materials. Of interest is that no chemical processing is necessary, nor is the use of nanoparticles, necessary for composite formation. Using both graphite and carbon nanotubes, we are able to achieve conducting nanocellulose solids and aerogels. Standard magnetic powder can also be incorporated to create magnetic solids. The technique also allows for the creation of an extremely fine nanocellulose suspension in water. Using extremely low concentrations, less than 1% cellulose by mass, along with careful control over processing parameters, we are able to achieve highly dilute, yet homogenous nanocellulose suspensions. When air dried, these suspensions have similar hardness and strength properties to those created with more typical starting cellulose concentrations (2-10%). However, when freeze-dried, these dilute suspensions form aerogels with a new morphology with much higher surface area than those with higher starting concentrations. We are currently examining the effect of this higher surface area on the properties of nanocellulose aerogel composites and how it influences the impact of incorporating nanocellulose into other polymer materials.

  14. Agitated Honeybees Exhibit Pessimistic Cognitive Biases

    PubMed Central

    Bateson, Melissa; Desire, Suzanne; Gartside, Sarah E.; Wright, Geraldine A.

    2011-01-01

    Summary Whether animals experience human-like emotions is controversial and of immense societal concern [1–3]. Because animals cannot provide subjective reports of how they feel, emotional state can only be inferred using physiological, cognitive, and behavioral measures [4–8]. In humans, negative feelings are reliably correlated with pessimistic cognitive biases, defined as the increased expectation of bad outcomes [9–11]. Recently, mammals [12–16] and birds [17–20] with poor welfare have also been found to display pessimistic-like decision making, but cognitive biases have not thus far been explored in invertebrates. Here, we ask whether honeybees display a pessimistic cognitive bias when they are subjected to an anxiety-like state induced by vigorous shaking designed to simulate a predatory attack. We show for the first time that agitated bees are more likely to classify ambiguous stimuli as predicting punishment. Shaken bees also have lower levels of hemolymph dopamine, octopamine, and serotonin. In demonstrating state-dependent modulation of categorization in bees, and thereby a cognitive component of emotion, we show that the bees' response to a negatively valenced event has more in common with that of vertebrates than previously thought. This finding reinforces the use of cognitive bias as a measure of negative emotional states across species and suggests that honeybees could be regarded as exhibiting emotions. Video Abstract PMID:21636277

  15. Interprofessional Implementation of a Pain/Sedation Guideline on a Trauma Intensive Care Unit.

    PubMed

    Sacco, Tara L; LaRiccia, Brenton

    2016-01-01

    Trauma patients experience pain and agitation during their hospitalization. Many complications have been noted both in the absence of symptom management and the in presence of oversedation/narcotization. To combat noted untoward effects of pain and sedation management, an interprofessional team convened to develop a pain and sedation guideline for use in a trauma intensive care unit. Guideline development began with a comprehensive review of the literature. With the input of unit stakeholders, a nurse-driven analgosedation guideline was implemented for a 6-month trial. During this time, unit champions were integral to successful trial execution. Outcome measurement included patient and unit outcomes, nursing satisfaction, and a pre- and postimplementation patient comparison. Following implementation, unit length of stay decreased by 4.16% and there was a 17.81% decrease in average time on the ventilator following the initiation of weaning. Patient reports of nurse sensitivity and responsiveness to pain increased from 93.7 to 94.9. Nurses reported satisfaction with the practice change and improvements in care. In comparing pre- and postimplementation patient data, there was a significant decrease in mean analgesic treatment duration and an increase in the use of antipsychotics for delirium management. Following the trial period, this guideline was permanently adopted across the adult critical care service. The development of a nurse-driven analgosedation guideline was noted to be both feasible and successful. PMID:27163223

  16. Effects of individualized music on confused and agitated elderly patients.

    PubMed

    Gerdner, L A; Swanson, E A

    1993-10-01

    The Progressively Lowered Stress Threshold Model in conjunction with an identified theoretical basis provides a framework for the use of individualized music in individuals with Dementia of the Alzheimer's Type (DAT). The effects of individualized music is explored in five elderly patients who are confused and agitated and residing in a long-term care facility. The Modified Cohen-Mansfield Agitation Inventory is used to measure the outcome. The immediate and 1-hour residual effects suggest the potential of individualized music as an alternative approach to the management of agitation in confused elderly patients.

  17. Conscious sedation for dentistry: risk management and patient selection.

    PubMed

    Jackson, Douglass L; Johnson, Barton S

    2002-10-01

    There are many safe and effective medications available to the dental practitioner for producing conscious sedation. Given the many sedatives available, all possessing slightly different clinical characteristics and various degrees of risk, careful consideration needs to be given to the objectives of the sedation when deciding which pharmacologic agents to use. Before making plans to sedate dental patients, however, one needs to make sure that several "layers" of risk management are in place to ensure the sedation procedure is as safe as possible. Included in this risk management plan is a complete understanding of the regulations that define conscious sedation and the training that is required to deliver this state of depressed consciousness. Careful attention also needs to be given to selecting appropriate dental patients for sedation. A thorough understanding of the patient's physical and psychologic status is necessary when making decisions about sedation. Because most dental disease is not life threatening, dental treatment needs tend to be primarily elective in nature. Considering the training requirements for delivering inhalational or enteral conscious sedation with a single agent, it is prudent to limit this type of sedation to the patient population that is healthy (e.g., ASA I and II) and psychologically stable as a way of minimizing risk. The amount of additional risk one encounters when sedating more medically compromised patients (ASA III and greater) should suggest that deferring elective dental treatments until the health status improves is prudent. In situations in which an improvement in the patient's health status is not likely, referral to someone with more experience sedating medically compromised patients is strongly recommended. Equally important to the conscious sedation risk management plan is an assurance that the patient understands what is meant by conscious sedation and that their treatment expectations are realistic. Finally, even

  18. Dexmedetomidine combined with midazolam vs. dexmedetomidine alone for sedation during spinal anesthesia

    PubMed Central

    Yoon, Douk-Keun; Ban, Jong-Seouk; Lee, Sang-Gon; Lee, Ji-Hyang

    2016-01-01

    Background Dexmedetomidine is a useful sedative agent for spinal anesthesia. However, it has been reported that dexmedetomidine decreases heart rate in a dose-dependent manner. In the current study, we compared the administration of a bolus dose of midazolam and bolus loading of dexmedetomidine over 10 min with the goal of identifying an additional method of sedation. Methods Ninety patients classified as American Society of Anesthesiologists physical status I–II who were undergoing spinal anesthesia were divided into two groups. In the midazolam and dexmedetomidine combined group (group MD), 10 min after bolus loading of 0.05 mg/kg midazolam, 0.5 µg/kg/h dexmedetomidine was continuously infused. In the dexmedetomidine group (group D), 1 µg/kg dexmedetomidine was infused over 10 min, and then 0.5 µg/kg/h dexmedetomidine was continuously infused. Results At 10 min, the sedation depth of the two groups was almost equal. In both groups, the bispectral index was within the optimal score range of 55–80 and the Ramsay Sedation Scale score was within the optimal range of 3–5. Satisfaction with sedation for both patient and surgeon did not differ between the two groups. At 10 min, heart rate was significantly lower (P < 0.010) in group D and mean blood pressure was significantly lower (P < 0.010) in group MD. The prevalence of bradycardia, hypotension, and hypoxia did not differ statistically between the two groups (P = 0.714, P = 0.089, P = 0.495, respectively). Conclusions Midazolam bolus and dexmedetomidine continuous infusion (the regimen of group MD) may be an additional sedation method for patients who have severe bradycardia. PMID:27703624

  19. 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

  20. 91. VIEW OF PORTLAND FILTER VACUUM RECEIVER FROM NORTHWEST. AGITATORS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    91. VIEW OF PORTLAND FILTER VACUUM RECEIVER FROM NORTHWEST. AGITATORS No. 4 AND No. 5 VISIBLE IN BACKGROUND. - Bald Mountain Gold Mill, Nevada Gulch at head of False Bottom Creek, Lead, Lawrence County, SD

  1. 6. VIEW OF BRINING TANK Older, redwood model. Paddles agitated ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    6. VIEW OF BRINING TANK Older, redwood model. Paddles agitated the skins while they soaked in brine. The skins were then hung to dry. - Sealing Plant, St. George Island, Pribilof Islands, Saint George, Aleutians West Census Area, AK

  2. Hydrodynamic effects on cell growth in agitated microcarrier bioreactors

    NASA Technical Reports Server (NTRS)

    Cherry, Robert S.; Papoutsakis, E. Terry

    1988-01-01

    The net growth rate of bovine embryonic kidney cells in microcarrier bioreactor is the result of a variable death rate imposed on a cell culture trying to grow at a constant intrinsic growth rate. The death rate is a function of the agitation conditions in the system, and increases at higher agitation because of increasingly energetic interactions of the cell covered microcarriers with turbulent eddies in the fluid. At very low agitation rates bead-bead bridging becomes important; the large clumps formed by bridging can interact with larger eddies than single beads, leading to a higher death rate at low agitation. The growth and death rate were correlated with a dimensionless eddy number which compares eddy forces to the buoyant force on the bead.

  3. Improved heat treating through change in agitation and quenchant

    SciTech Connect

    Gritzmacher, W.R.; Walter, M.

    1996-12-31

    Recognized relationships of as-quenched hardness to quenchant agitation severity and quenchant type provide the heat treater with the ability to serve the customer. This paper provides examples of how the use of data bases helped the conversion from oil to polymer in a variable agitated impeller quench. Also discussed are the apparent improvements in quench capability and as quenched properties in the conversion to polymer.

  4. Period Tripling Causes Rotating Spirals in Agitated Wet Granular Layers

    NASA Astrophysics Data System (ADS)

    Huang, Kai; Rehberg, Ingo

    2011-07-01

    Pattern formation of a thin layer of vertically agitated wet granular matter is investigated experimentally. Rotating spirals with three arms, which correspond to the kinks between regions with different colliding phases, are the dominating pattern. This preferred number of arms corresponds to period tripling of the agitated granular layer, unlike predominantly subharmonic Faraday crispations in dry granular matter. The chirality of the spatiotemporal pattern corresponds to the rotation direction of the spirals.

  5. Dreaming and recall during sedation for colonoscopy.

    PubMed

    Stait, M L; Leslie, K; Bailey, R

    2008-09-01

    Dreaming is reported by one in five patients who are interviewed on emergence from general anaesthesia, but the incidence, predictors and consequences of dreaming during procedural sedation are not known. In this prospective observational study, 200 patients presenting for elective colonoscopy under intravenous sedation were interviewed on emergence to determine the incidences of dreaming and recall. Sedation technique was left to the discretion of the anaesthetist. The incidence of dreaming was 25.5%. Patients reporting dreaming were younger than those who did not report dreaming. Doses of midazolam and fentanyl were similar between dreamers and non-dreamers, however propofol doses were higher in patients who reported dreams than those who did not. Patients reported short, simple dreams about everyday life--no dream suggested near-miss recall of the procedure. Frank recall of the procedure was reported by 4% of the patients, which was consistent with propofol doses commensurate with light general anaesthesia. The only significant predictor of recall was lower propofol dose. Satisfaction with care was generally high, however dreamers were more satisfied with their care than non-dreamers.

  6. Internists' attitudes towards terminal sedation in end of life care

    PubMed Central

    Kaldjian, L; Jekel, J; Bernene, J; Rosenthal, G; Vaughan-Sarrazin, M; Duffy, T

    2004-01-01

    Objective: To describe the frequency of support for terminal sedation among internists, determine whether support for terminal sedation is accompanied by support for physician assisted suicide (PAS), and explore characteristics of internists who support terminal sedation but not assisted suicide. Design: A statewide, anonymous postal survey. Setting: Connecticut, USA. Participants: 677 Connecticut members of the American College of Physicians. Measurements: Attitudes toward terminal sedation and assisted suicide; experience providing primary care to terminally ill patients; demographic and religious characteristics. Results: 78% of respondents believed that if a terminally ill patient has intractable pain despite aggressive analgesia, it is ethically appropriate to provide terminal sedation (diminish consciousness to halt the experience of pain). Of those who favoured terminal sedation, 38% also agreed that PAS is ethically appropriate in some circumstances. Along a three point spectrum of aggressiveness in end of life care, the plurality of respondents (47%) were in the middle, agreeing with terminal sedation but not with PAS. Compared with respondents who were less aggressive or more aggressive, physicians in this middle group were more likely to report having more experience providing primary care to terminally ill patients (p = 0.02) and attending religious services more frequently (p<0.001). Conclusions: Support for terminal sedation was widespread in this population of physicians, and most who agreed with terminal sedation did not support PAS. Most internists who support aggressive palliation appear likely to draw an ethical line between terminal sedation and assisted suicide. PMID:15467087

  7. Nalmefene for elective reversal of procedural sedation in children.

    PubMed

    Chumpa, A; Kaplan, R L; Burns, M M; Shannon, M W

    2001-11-01

    Nalmefene is a newer, long-acting opioid antagonist. Its use in children for the elective reversal of emergency department procedures has not been investigated. The objective was to evaluate the safety of nalmefene in children. An open-label pediatric clinical trial was performed. The study was conducted at the emergency department of an urban, university-affiliated children's hospital and consisted of children aged 6 months to 12 years who required procedural sedation where an opioid agent was administered. Patients were excluded if there was altered mental status, history of head trauma, history of opioid allergy, or the anticipated need for opioid agents for pain relief after the procedure. At the completion of the procedure, nalmefene was administered in a dose of 0.25 microg/kg increments (max 10 microg) until sedation was resolved, or to a maximum of 1.0 microg/kg (max 40 microg). Serial ECGs, vital signs, and oxygen saturation were recorded. Sedation was assessed using the Clinical Global Impression Scale (CGIS) at baseline, 2, 4, 6, 8, and 10 minutes after the initial nalmefene dose. The observer's assessment of alertness and sedation (OAA/S) was measured at baseline, 10, 30, 60, 90, and 120 minutes after the first dose of nalmefene. Episodes of resedation were recorded. All patients received follow-up by telephone at 4 and 24 hours after the initial dose of nalmefene to identify any potential late adverse effects. Over the study interval 15 patients were enrolled. Mean age was 59.1 +/- 41.5 months. Procedures involved fracture reduction (n=8), laceration repair (n = 4), abscess drainage (n = 2), and arthrocentesis (n = 1). All patients received IV fentanyl and midazolam. The mean dosage of fentanyl and midazolam was 3.21 +/- 1.03 microg/kg and 0.07 +/- 0.03 mg/kg, respectively. The mean dose of nalmefene at the time of complete response (CGIS = 1 or 2) was 0.55 +/- 0.29 microg/kg. The median number of nalmefene doses was 2. All but one patient (93%) had a

  8. Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical-ventilatory support: a randomized clinical trial

    PubMed Central

    Chlan, Linda L.; Weinert, Craig R.; Heiderscheit, Annie; Tracy, Mary Fran; Skaar, Debra J.; Guttormson, Jill L.; Savik, Kay

    2013-01-01

    Context Alternatives to sedative medications are needed to reduce anxiety in mechanically ventilated patients. Music is an integrative therapy without adverse effects that may alleviate the anxiety associated with ventilatory support. Objective To test whether patient-directed, self-initiated music listening can reduce anxiety and sedative exposure during ventilatory support in critically ill patients as compared with 2 control conditions. Design, Setting, and Patients Randomized, controlled trial that enrolled 373 ICU patients from the Minneapolis-St. Paul area receiving acute mechanical-ventilatory support for respiratory failure between September 2006 and March 2011. Patients were Caucasian (86%), female (52%), with mean age 59 (SD 14), APACHE III 63 (SD 21.6), on protocol 5.7 (SD 6.4) days. Intervention Patients (1) self-initiated music listening (patient-directed music; PDM) with preferred selections tailored by a music therapist whenever desired while receiving ventilatory support, (2) self-initiated use of noise-abating headphones (HP), or (3) received usual ICU care (UC). Main Outcome Measures Daily assessments of anxiety (100-mm visual analog scale) and two aggregate measure of sedative exposure (sedation intensity and sedation frequency). Results Mixed-models analysis showed that PDM patients had decreased levels of anxiety compared with the UC group of −19.5 (p=.003). By the fifth study day anxiety was reduced by 36.5% in PDM patients. The interaction between treatment and time showed PDM significantly reduced both measures of sedative exposure. PDM reduced sedation intensity by −.18 (−.36, −.004) points per day and frequency by −.21 (−.37, −.05) points per day compared to UC (p = .05, .01 respectively). PDM reduced sedation frequency by −.18 (−.36, −.004) points per day compared to HP (p = .04). By the fifth study day, PDM patients received two fewer sedative doses (reduction of 38%) and had a reduction of 36% in sedation intensity

  9. Intention, procedure, outcome and personhood in palliative sedation and euthanasia.

    PubMed

    Materstvedt, Lars Johan

    2012-03-01

    Palliative sedation at the end of life has become an important last-resort treatment strategy for managing refractory symptoms as well as a topic of controversy within palliative care. Furthermore, palliative sedation is prominent in the public debate about the possible legalisation of voluntary assisted dying (physician-assisted suicide and euthanasia). This article attempts to demonstrate that palliative sedation is fundamentally different from euthanasia when it comes to intention, procedure, outcome and the status of the person. Nonetheless, palliative sedation in its most radical form of terminal deep sedation parallels euthanasia in one respect: both end the experience of suffering. However, only the latter intentionally ends life and also has this as its goal. There is the danger that deep sedation could bring death forward in time due to particular side effects of the treatment. Still that would, if it happens, not be intended, and accordingly is defensible in view of the doctrine of double effect.

  10. Midazolam for sedation in the paediatric intensive care unit.

    PubMed

    Rosen, D A; Rosen, K R

    1991-01-01

    This retrospective study examines data from 55 patients sedated in a paediatric intensive care unit (PICU) with midazolam. Midazolam sedation was initiated with a bolus of 0.25 mg.kg-1 followed by a continuous infusion of 0.4-4 micrograms.kg-1.min-1. Physiological and metabolic parameters, infusion rates, duration, and sedation scores were monitored. Midazolam infusions were effective in sedating all the children studied during all or part of their PICU admission. The median duration of sedation was 74 h with a range of 4 to 1272 h. Haemodynamics were unchanged. Of the patients 46% were effectively alimented by the enteral route, and enteral alimentation was successful in all patients in whom it was attempted. Unassisted ventilation occurred in 44% of the patients during infusion. Oxygen consumption was 28% lower than in the control. Disadvantages of midazolam infusion have included inability to sedate during extracorporeal membrane oxygenation and development of acute tolerance.

  11. Rapid sedation induced by fentanyl combined with propofol via an intrathecal chemotherapy injection for leukemia in children.

    PubMed

    Tian, X; Yang, Y-H; Wei, H-Y; Lao, J-Q; Wang, H-P; Tian, Y-Y

    2015-01-01

    This study explored the sedative and analgesic effects of fentanyl combined with propofol via an intrathecal chemotherapy injection for acute leukemia (acute lymphocytic leukemia or acute myelocytic leukemia) among children, to relieve pain and difficulty during intrathecal injection, improve treatment compliance, increase the success rate of single puncture, and reduce procedure failure, with the aim of developing a painless procedure for children with acute leukemia. Fifty person-times received fentanyl combined with propofol via an intrathecal chemotherapy injection among the hospitalized children with leukemia. The patients' cooperation with the procedure, response to the medication, dosages of fentanyl and propofol, reaction to the procedures, wake-up time, and changes in oxygen saturation (SpO2), heart rate (HR), respiration, and blood pressure (BP) before, during, and after the procedures were observed. The doctors who performed the procedures assessed the quality of sedation and analgesia. In the treatment group, the patients were quiet during the lumbar puncture and intrathecal injection, showing good sedation and analgesia. HR and respiration decreased slightly. There were no changes in SpO2 and BP. No obvious respiratory depression occurred with proper dosages. Only a few patients showed stertorous respiration, which stopped soon after the procedures. In the control group, the patients were agitated, crying, and not cooperative before and during the procedures, which made the procedures very difficult. During intrathecal injection, pain obviously reduced and the success rate of single lumbar puncture increased. It is safe and effective to apply fentanyl combined with propofol for sedation and analgesia. PMID:25966137

  12. Quality Assurance in the Endoscopy Suite: Sedation and Monitoring.

    PubMed

    Harris, Zachary P; Liu, Julia; Saltzman, John R

    2016-07-01

    Recent development and expansion of endoscopy units has necessitated similar progress in the quality assurance of procedure sedation and monitoring. The large number of endoscopic procedures performed annually underlies the need for standardized quality initiatives focused on mitigating patient risk before, during, and immediately after endoscopic sedation, as well as improving procedure outcomes and patient satisfaction. Specific standards are needed for newer sedation modalities, including propofol administration. This article reviews the current guidelines and literature concerning quality assurance and endoscopic procedure sedation. PMID:27372777

  13. Unlocking Chain Exchange in Highly Amphiphilic Block Polymer Micellar Systems: Influence of Agitation

    PubMed Central

    2015-01-01

    Chain exchange between block polymer micelles in highly selective solvents, such as water, is well-known to be arrested under quiescent conditions, yet this work demonstrates that simple agitation methods can induce rapid chain exchange in these solvents. Aqueous solutions containing either pure poly(butadiene-b-ethylene oxide) or pure poly(butadiene-b-ethylene oxide-d4) micelles were combined and then subjected to agitation by vortex mixing, concentric cylinder Couette flow, or nitrogen gas sparging. Subsequently, the extent of chain exchange between micelles was quantified using small angle neutron scattering. Rapid vortex mixing induced chain exchange within minutes, as evidenced by a monotonic decrease in scattered intensity, whereas Couette flow and sparging did not lead to measurable chain exchange over the examined time scale of hours. The linear kinetics with respect to agitation time suggested a surface-limited exchange process at the air–water interface. These findings demonstrate the strong influence of processing conditions on block polymer solution assemblies. PMID:25642383

  14. Helically agitated mixing in dry dilute acid pretreatment enhances the bioconversion of corn stover into ethanol

    PubMed Central

    2014-01-01

    Background Dry dilute acid pretreatment at extremely high solids loading of lignocellulose materials demonstrated promising advantages of no waste water generation, less sugar loss, and low steam consumption while maintaining high hydrolysis yield. However, the routine pretreatment reactor without mixing apparatus was found not suitable for dry pretreatment operation because of poor mixing and mass transfer. In this study, helically agitated mixing was introduced into the dry dilute acid pretreatment of corn stover and its effect on pretreatment efficiency, inhibitor generation, sugar production, and bioconversion efficiency through simultaneous saccharification and ethanol fermentation (SSF) were evaluated. Results The overall cellulose conversion taking account of cellulose loss in pretreatment was used to evaluate the efficiency of pretreatment. The two-phase computational fluid dynamics (CFD) model on dry pretreatment was established and applied to analyze the mixing mechanism. The results showed that the pretreatment efficiency was significantly improved and the inhibitor generation was reduced by the helically agitated mixing, compared to the dry pretreatment without mixing: the ethanol titer and yield from cellulose in the SSF reached 56.20 g/L and 69.43% at the 30% solids loading and 15 FPU/DM cellulase dosage, respectively, corresponding to a 26.5% increase in ethanol titer and 17.2% increase in ethanol yield at the same fermentation conditions. Conclusions The advantage of helically agitated mixing may provide a prototype of dry dilute acid pretreatment processing for future commercial-scale production of cellulosic ethanol. PMID:24387051

  15. 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

  16. Managing verbal agitation in people with dementia and delirium.

    PubMed

    Inkley, Francesca; Goldberg, Sarah

    2016-03-01

    Patients with dementia and delirium in acute hospitals can exhibit verbal agitation, but there is no research on rate of occurrence or how ward staff manage such behaviour. This service evaluation aimed to measure rate of occurrence of verbal agitation in confused older inpatients and understand the management strategies used by staff. An agitation inventory was completed daily by the nursing team for all verbally agitated patients on eight older person wards over two weeks. Six semi-structured interviews were conducted with staff and three hours of non-participant observations were undertaken. A mean 6% (13/223) of patients were verbally agitated each day. Management strategies included trial and error, distraction and engagement, reassurance, communication and familiarity. Staff did not adopt a systematic approach to care planning due to lack of training and support on the ward, as well as scarce resources in terms of staff, space and activities. Research is needed to develop and evaluate interventions that support staff to care for these patients.

  17. [Sedation with propofol and fentanyl in patients under intensive care].

    PubMed

    Beauvoir, C; Chardon, P; d'Athis, F; Mathieu-Daudé, J C; du Cailar, J

    1992-01-01

    This study investigated the efficacy of a constant rate infusion of propofol and fentanyl in thirty patients requiring artificial ventilation for more than 24 h. A loading dose, which differed according to the patient's age, was administered over a 30 min period: 2.5 mg.kg-1 for patients less than 50 (G1) (n = 9), 2 mg.kg-1 for patients between 50 and 60 years old (G2) (n = 9), and 1.5 mg.kg-1 for patients over 60 (G3) (n = 12). This was followed by an infusion of 3 mg.kg-1.h-1 in G1 and G2, and 2 mg.kg-1.h-1 in G3. A 1 microgram.kg-1.h-1 infusion of fentanyl was also given. The degree of sedation was assessed with the Ramsay scale before starting, after induction, and every four hours thereafter. When this proved to be insufficient, the dose of propofol was increased by 0.5 mg.kg-1.h-1 as well as that of fentanyl by 0.5 microgram.kg-1.h-1. Heart rate, mean arterial blood pressure, blood propofol, creatinine, transaminase and lipid levels, and urine output were measured before, during, and after the infusion. The blood propofol level increased during the infusion, being correlated to the doses given (r = 0.64, p less than 0.001). Sedation lasted 91.7 +/- 57.7 h. After stopping the infusion of propofol, mean recovery times were 7.5 +/- 5.9 min (G1), 11.4 +/- 11.4 min, and 14.4 +/- 13.5 min (G3) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Comparison of preanesthetic sedation in pediatric patients with oral and intranasal midazolam

    PubMed Central

    Deshmukh, Purvashree Vijay; Kulkarni, Sadhana Sudhir; Parchandekar, Mukund Kachru; Sikchi, Sneha Purshottam

    2016-01-01

    Background and Aims: Preoperative anxiety in children leading to postoperative negative changes and long-term behavioral problems needs better preanesthetic sedation. Across the world, midazolam is the most commonly used premedicant in pediatric patients. The fact that no single route has achieved universal acceptance for its administration suggests that each route has its own merits and demerits. This study compares oral midazolam syrup and intranasal midazolam spray as painless and needleless systems of drug administration for preanesthetic sedation in children. Material and Methods: With randomization, Group O (30 children): Received oral midazolam syrup 0.5 mg/kg and Group IN (30 children): Received intranasal midazolam spray 0.2 mg/kg. Every child was observed for acceptance of drug, response to drug administration, sedation scale, separation score, acceptance to mask, recovery score and side effects of drug. Data were analyzed using Student's t-test, standard error of the difference between two means and Chi-square test. Results: In Group O and IN, 15/30 children (50%) and 7/30 children (23%) accepted drug easily (P < 0.05); 4/22 children (18%) in Group O and 11/20 children (55%) in Group IN cried after drug administration (P < 0.05). In both the groups, sedation at 20 min after premedication (Group O [80%] 24/30 vs. Group IN [77%] 23/30), parental separation and acceptance to mask were comparable (P > 0.05); 12/30 children (40%) in Group IN showed transient nasal irritation. Conclusion: Oral midazolam and intranasal midazolam spray produce similar anxiolysis and sedation, but acceptance of drug and response to drug administration is better with oral route. PMID:27625485

  19. Baclofen for alcohol dependence: Relationships between baclofen and alcohol dosing and the occurrence of major sedation.

    PubMed

    Rolland, Benjamin; Labreuche, Julien; Duhamel, Alain; Deheul, Sylvie; Gautier, Sophie; Auffret, Marine; Pignon, Baptiste; Valin, Thomas; Bordet, Régis; Cottencin, Olivier

    2015-10-01

    High-dose baclofen, i.e., 300 mg/d or more, has recently emerged as a strategy for treating alcohol dependence. The impact that the co-exposure of large amounts of alcohol and baclofen has on sedation is unclear. In a prospective cohort of 253 subjects with alcohol dependence, we collected daily alcohol and baclofen doses across the first year of baclofen treatment and the monthly maximum subjective sedation experienced by each patient (0-10 visual analog scale). For each patient-month, we determined the average weekly alcohol consumption (AWAC; standard-drinks/week) and the maximum daily dose of baclofen (DDB; mg/d). The occurrence of an episode of major sedation (EMS) during a patient-month was defined as a sedation score ≥7. The relationship between the EMS occurrence and the concurrent AWAC and DDB was investigated using a generalized estimating equation model. In total, 1528 patient-months were compiled (70 with an EMS). Univariate analyses demonstrated that the rate of patient-month to EMS increased gradually with AWAC (p<0.001), from 0.9% for AWAC=0 to 9.4% for AWAC >35. There was also a significant gradual risk for EMS associated with DDB (<0.001). Multivariate analysis demonstrated a significant interaction between DDB and AWAC on EMS risk (p=0.047). Each 20mg/d increase in DDB was associated with an OR of EMS in AWAC >35 of 1.22 (95%CI, 1.08-1.38) versus 1.11 (95%CI, 0.96-1.29) in AWAC=1-35, and 0.95 (95%CI, 0.76-1.19) in AWAC=0. The level of sedation observed in patients using baclofen for alcohol dependence appears to directly depend on the immediate doses of both the baclofen and the alcohol.

  20. A retrospective comparison of dexmedetomidine versus midazolam for pediatric patients with congenital heart disease requiring postoperative sedation.

    PubMed

    Jiang, Li; Ding, Sheng; Yan, Hongtao; Li, Yunming; Zhang, Liping; Chen, Xue; Yin, Xiumei; Liu, Shunbi; Tang, Xiuying; Zhang, Jinbao

    2015-06-01

    We hypothesized that postoperative sedation with dexmedetomidine/fentanyl would be effective in infants and neonates with congenital heart disease and pulmonary arterial hypertension (PAH). Children who were <36 months of age, had congenital heart disease with PAH, and had been treated at our hospital between October 2011 and April 2013 (n = 187) were included in this retrospective study. Either dexmedetomidine/fentanyl (Group Dex) or midazolam/fentanyl (Group Mid) was used for postoperative sedation. The main outcome variables included delirium scores, supplemental sedative/analgesic drugs, ventilator use, and sedation time. Baseline demographics and clinical characteristics were similar between the two groups. The Pediatric Anesthesia Emergence Delirium scale (5.2 ± 5.3 vs. 7.1 ± 5.2 in the Dex and Mid groups, respectively; P = 0.016) and the incidence of delirium (18.2 vs. 32.0 % in the Dex and Mid groups, respectively; P = 0.039) were significantly lower in the Dex group than in the Mid group. Total sufentanil, midazolam, and propofol doses given during the operation did not differ between the two groups. Group Dex patients required significantly lower doses of adjunctive sedative/analgesic drugs than group Mid patients in the cardiac intensive care unit (CICU; midazolam, P = 0.007; morphine, P < 0.001). In conclusion, we found no differences between dexmedetomidine/fentanyl and midazolam/fentanyl in terms of the duration of sedation, mechanical ventilator use, and CICU stay in children with PAH. However, patients in the Dex group required a lower additional sedative/analgesic drugs and had a lower incidence of delirium than patients in the Mid group. PMID:25661272

  1. Sedation during weaning from mechanical ventilation.

    PubMed

    Suter, P M

    1994-01-01

    The transition from mechanical ventilation to spontaneous breathing in the intensive care unit is a two-stage process: weaning and extubation. Certain parameters require consideration before the commencement of weaning, namely respiratory function (both pulmonary gas exchange and respiratory muscle strength), cardiovascular status, stability of clinical condition, low metabolic demands, psychological factors and, possibly, patient collaboration. Appropriate sedation is crucial for successful weaning to keep the patient rested and to maintain the oxygen consumption and carbon dioxide production low. In this review, three types of patient are considered: patients having short-term ventilation after trauma or surgery, those having long-term ventilation for chronic pulmonary disease, and those with other associated severe organ dysfunction, such as heart failure. Strategies for weaning are outlined for each of these situations and the role of sedation is discussed. Making the transition from mechanical ventilation to unassisted spontaneous breathing can be a difficult process, particularly for those patients in the intensive care unit (ICU) requiring prolonged ventilatory assistance for severe respiratory failure secondary to: exacerbation of chronic obstructive airways disease (COAD) acute respiratory distress syndrome (ARDS) underlying diseases affecting cardiac function. This transition may be considered to comprise two separate stages, namely weaning and extubation. Weaning consists of preparation for spontaneous breathing supported and monitored by a mechanical ventilator and attendant monitoring of all the important vital parameters, while extubation marks the final switch to unsupported spontaneous breathing, which may be quite a big step for the patient. Important weaning parameters.

  2. Mass transfer from bubbles and drops in; mechanically agitated apparatuses

    SciTech Connect

    Barabash, V.A.; Belevitskaya, M.A.

    1995-07-01

    Mass transfer from bubbles and drops moving in a turbulent flow is analyzed on the basis of relationships for the flow of a liquid and turbulence damping in the vicinity of the interface being distorted and information on the behavior of the dispersed-phase elements in mechanically agitated apparatuses. Several relations for calculating linear and volumetric mass-transfer coefficients for agitated liquid-gas and liquid-liquid systems are obtained. The calculated results are compared with the experimental data available in the literature.

  3. Application of hydraulically assembled shaft coupling hubs to large agitators

    SciTech Connect

    Murray, W.E.; Anderson, T.D. ); Bethmann, H.K. )

    1991-01-01

    This paper describes the basis for and implementation of hydraulically assembled shaft coupling hubs for large tank-mounted agitators. This modification to the original design was intended to minimize maintenance personnel exposure to ionizing radiation and also provide for disassembly capability without damage to shafts or hubs. In addition to realizing these objectives, test confirmed that the modified couplings reduced agitator shaft end runouts approximately 65%, thereby reducing bearing loads and increasing service life, a significant enhancement for a nuclear facility. 5 refs.

  4. Application of hydraulically assembled shaft coupling hubs to large agitators

    SciTech Connect

    Murray, W.E.; Anderson, T.D.; Bethmann, H.K.

    1991-12-31

    This paper describes the basis for and implementation of hydraulically assembled shaft coupling hubs for large tank-mounted agitators. This modification to the original design was intended to minimize maintenance personnel exposure to ionizing radiation and also provide for disassembly capability without damage to shafts or hubs. In addition to realizing these objectives, test confirmed that the modified couplings reduced agitator shaft end runouts approximately 65%, thereby reducing bearing loads and increasing service life, a significant enhancement for a nuclear facility. 5 refs.

  5. Coal storage hopper with vibrating-screen agitator

    DOEpatents

    Daw, C.S.; Lackey, M.E.; Sy, R.L.

    1982-04-27

    The present invention is directed to a vibrating screen agitator in a coal storage hopper for assuring the uniform feed of coal having sufficient moisture content to effect agglomeration and bridging thereof in the coal hopper from the latter onto a conveyer mechanism. The vibrating scrren agitator is provided by a plurality of transversely oriented and vertically spaced apart screens in the storage hopper with a plurality of vertically oriented rods attached to the screens. The rods are vibrated to effect the vibration of the screens and the breaking up of agglomerates in the coal which might impede the uniform flow of the coal from the hopper onto a conveyer.

  6. Heavy use versus less heavy use of sedatives among non-medical sedative users: Characteristics and correlates.

    PubMed

    Nattala, Prasanthi; Leung, Kit Sang; Abdallah, Arbi Ben; Cottler, Linda B

    2011-01-01

    Non-medical use of sedatives is an ongoing problem. However, very little is known about the characteristics of individuals who use sedatives non-medically, or the motives behind such use. The present analysis, involving a sample of individuals reporting non-medical use of sedatives in the past 12 months (N=188), examined the relationship between socio-demographic variables, past-year use of other licit and illicit drugs, type of non-medical use (use in ways other than as prescribed, use when not prescribed, or both), motives, and past 12-month sedative use. Past 12-month sedative use was dichotomized as Heavy Use (>90 pills in past 12 months) and Less Heavy Use (≤90 pills), using a median split. Multivariate logistic regression analyses indicated that Heavy Use of sedatives was significantly associated with positive diagnoses for sedative use disorder and prescription opioid use disorder, a higher number of motives for sedative use, and reporting 'sedative use in ways other than as prescribed' and 'both forms of non-medical use, namely, other than as prescribed, and when not prescribed,' compared to non-prescribed use. Although in univariate analyses a positive diagnosis for past 12-month cocaine use disorder, and individual motives for sedative use such as 'to get high' and 'for pain relief', significantly predicted past 12-month Heavy Use, their effects diminished and became non-significant after adjusting for other covariates. Findings underscore the need for considering differential risk factors in tailoring preventive interventions for reducing non-medical sedative use. PMID:20934814

  7. Heavy Use versus Less Heavy Use of sedatives among non-medical sedative users: characteristics and correlates

    PubMed Central

    Nattala, Prasanthi; Leung, Kit Sang; Abdallah, Arbi Ben; Cottler, Linda B.

    2010-01-01

    Non-medical use of sedatives is an ongoing problem. However, very little is known about the characteristics of individuals who use sedatives non-medically, or the motives behind such use. The present analysis, involving a sample of individuals reporting non-medical use of sedatives in the past 12 months (N=188), examined the relationship between socio-demographic variables, past-year use of other licit and illicit drugs, type of non-medical use (use in ways other than as prescribed, use when not prescribed, or both), motives, and past 12-month sedative use. Past 12-month sedative use was dichotomized as Heavy Use (>90 pills in past 12 months) and Less Heavy Use (≤90 pills), using a median split. Multivariate logistic regression analyses indicated that Heavy Use of sedatives was significantly associated with a positive diagnosis for sedative use disorder and prescription opioid use disorder, a higher number of motives for sedative use, and reporting ‘sedative use in ways other than as prescribed’ and ‘both forms of non-medical use, namely, other than as prescribed, and when not prescribed,’ compared to non-prescribed use. Although in univariate analyses a positive diagnosis for past 12-month cocaine use disorder, and individual motives for sedative use such as ‘to get high’ and ‘for pain relief’, significantly predicted past 12-month Heavy Use, their effects diminished and became non-significant after adjusting for other covariates. Findings underscore the need for considering differential risk factors in tailoring preventive interventions for reducing non-medical sedative use. PMID:20934814

  8. Florida hospital cuts failed pediatric sedation rate 98%.

    PubMed

    2008-07-01

    * In a survey of Broward General Medical Center, The Joint Commission found fault with the administration of sedation for pediatric outpatient diagnostic procedures. * There is a great deal of variation among health care facilities on sedatives use and techniques and safety standards used. * Broward's initiative eliminated rescheduled exams and failed procedures by 98%.

  9. Survey of Anxiety in Ordinary Workers and Doctors Regarding Sedative Use during Endoscopic Examination in the Seoul Metropolitan Area

    PubMed Central

    Ra, Yoon-Suk; Kim, Chi-Hyo; Kim, Youn-Jin; Han, Jong-In

    2016-01-01

    Background/Aims Sedative use is common in endoscopic examinations. The anxiety regarding sedative use may be different between doctors and nonmedical individuals. Methods A questionnaire survey was conducted by a research company (DOOIT Survey), and responses were collected from 649 doctors and 1,738 individuals who perform typical jobs in nonmedical fields. In this study, these ordinary workers are considered to represent nonmedical individuals. Anxiety was measured using a 5-point Likert scale. Results The nonmedical individuals exhibited more anxiety regarding the sedative use than the doctors. Age <40 years (odds ratio [OR], 2.27; p<0.001), female sex (OR, 1.62; p=0.002), experience of an adverse event (OR, 1.79; p=0.049), and insufficient explanation (OR, 2.05; p<0.001) were the significant factors that increased the anxiety of the nonmedical individuals. The doctors who experienced a sedative-related adverse event reported increased anxiety compared with the doctors who did not report this experience (OR, 1.73; p=0.031). Conclusions Anxiety regarding sedative use during an endoscopic examination was significantly different between doctors and non-medical individuals. A younger age, female sex, an adverse event, and insufficient explanation affect the anxiety of nonmedical individuals. An adverse event also affects the anxiety of doctors. PMID:27563022

  10. Impact of Psychological Interventions on Reducing Anxiety, Fear and the Need for Sedation in Children Undergoing Magnetic Resonance Imaging

    PubMed Central

    Viggiano, Maria Pia; Giganti, Fiorenza; Rossi, Arianna; Di Feo, Daniele; Vagnoli, Laura; Calcagno, Giovanna; Defilippi, Claudio

    2015-01-01

    Children undergoing magnetic resonance imaging examination frequently experience anxiety and fear before and during the scanning. The aim of the present study was to assess: i) whether and to what extent psychological interventions might reduce anxiety and fear levels; ii) whether the intervention is related to a decrease in the need for sedation. The interventions consisted of three activities: a clown show, dog interaction and live music. The emotional status (anxiety and fear) of the children was evaluated before and after the activities through a rating scale questionnaire. The results showed that the activities had high effectiveness in reducing the level of anxiety and fear and decreased the need for sedation in the experimental group compared to the control group. This approach proved to be a positive patient experience, helping to alleviate children’s anxiety and fear, decreasing the need for sedation, and was cost-effective. PMID:25918624

  11. Impact of psychological interventions on reducing anxiety, fear and the need for sedation in children undergoing magnetic resonance imaging.

    PubMed

    Viggiano, Maria Pia; Giganti, Fiorenza; Rossi, Arianna; Di Feo, Daniele; Vagnoli, Laura; Calcagno, Giovanna; Defilippi, Claudio

    2015-02-24

    Children undergoing magnetic resonance imaging examination frequently experience anxiety and fear before and during the scanning. The aim of the present study was to assess: i) whether and to what extent psychological interventions might reduce anxiety and fear levels; ii) whether the intervention is related to a decrease in the need for sedation. The interventions consisted of three activities: a clown show, dog interaction and live music. The emotional status (anxiety and fear) of the children was evaluated before and after the activities through a rating scale questionnaire. The results showed that the activities had high effectiveness in reducing the level of anxiety and fear and decreased the need for sedation in the experimental group compared to the control group. This approach proved to be a positive patient experience, helping to alleviate children's anxiety and fear, decreasing the need for sedation, and was cost-effective. PMID:25918624

  12. Impact of psychological interventions on reducing anxiety, fear and the need for sedation in children undergoing magnetic resonance imaging.

    PubMed

    Viggiano, Maria Pia; Giganti, Fiorenza; Rossi, Arianna; Di Feo, Daniele; Vagnoli, Laura; Calcagno, Giovanna; Defilippi, Claudio

    2015-02-24

    Children undergoing magnetic resonance imaging examination frequently experience anxiety and fear before and during the scanning. The aim of the present study was to assess: i) whether and to what extent psychological interventions might reduce anxiety and fear levels; ii) whether the intervention is related to a decrease in the need for sedation. The interventions consisted of three activities: a clown show, dog interaction and live music. The emotional status (anxiety and fear) of the children was evaluated before and after the activities through a rating scale questionnaire. The results showed that the activities had high effectiveness in reducing the level of anxiety and fear and decreased the need for sedation in the experimental group compared to the control group. This approach proved to be a positive patient experience, helping to alleviate children's anxiety and fear, decreasing the need for sedation, and was cost-effective.

  13. Heat-transfer coefficients in agitated vessels. Sensible heat models

    SciTech Connect

    Kumpinsky, E.

    1995-12-01

    Transient models for sensible heat were developed to assess the thermal performance of agitated vessels with coils and jackets. Performance is quantified with the computation of heat-transfer coefficients by introducing vessel heating and cooling data into model equations. Of the two model categories studied, differential and macroscopic, the latter is preferred due to mathematical simplicity and lower sensitivity to experimental data variability.

  14. Management of agitation and aggression associated with Alzheimer disease.

    PubMed

    Ballard, Clive G; Gauthier, Serge; Cummings, Jeffrey L; Brodaty, Henry; Grossberg, George T; Robert, Philippe; Lyketsos, Constantine G

    2009-05-01

    Agitation and aggression are frequently occurring and distressing behavioral and psychological symptoms of dementia (BPSD). These symptoms are disturbing for individuals with Alzheimer disease, commonly confer risk to the patient and others, and present a major management challenge for clinicians. The most widely prescribed pharmacological treatments for these symptoms-atypical antipsychotics-have a modest but significant beneficial effect in the short-term treatment (over 6-12 weeks) of aggression but limited benefits in longer term therapy. Benefits are less well established for other symptoms of agitation. In addition, concerns are growing over the potential for serious adverse outcomes with these treatments, including stroke and death. A detailed consideration of other pharmacological and nonpharmacological approaches to agitation and aggression in patients with Alzheimer disease is, therefore, imperative. This article reviews the increasing evidence in support of psychological interventions or alternative therapies (such as aromatherapy) as a first-line management strategy for agitation, as well as the potential pharmacological alternatives to atypical antipsychotics-preliminary evidence for memantine, carbamazepine, and citalopram is encouraging.

  15. Patient-directed music therapy reduces anxiety and sedation exposure in mechanically-ventilated patients: a research critique.

    PubMed

    Gullick, Janice G; Kwan, Xiu Xian

    2015-05-01

    This research appraisal, guided by the CASP Randomised Controlled Trial Checklist, critiques a randomised, controlled trial of patient-directed music therapy compared to either noise-cancelling headphones or usual care. This study recruited 373 alert, mechanically-ventilated patients across five intensive care units in the United States. The Music Assessment Tool, administered by a music therapist, facilitated music selection by participants in the intervention group. Anxiety was measured using the VAS-A scale. Sedation exposure was measured by both sedation frequency and by sedation intensity using a daily sedation intensity score. Context for the data was supported by an environmental scan form recording unit activity and by written comments from nurses about the patient's responses to the protocol. Patient-directed music therapy allowed a significant reduction in sedation frequency compared to noise-cancelling headphones and usual care participants. Patient-directed music therapy led to significantly lower anxiety and sedation intensity compared to usual care, but not compared to noise-cancelling headphones. This is a robust study with clear aims and a detailed description of research methods and follow-up. While no participants were lost to follow-up, not all were included in the analysis: 37% did not have the minimum of two anxiety assessments for comparison and 23% were not included in sedation analysis. While some participants utilised the intervention or active control for many hours-per-day, half the music therapy participants listened for 12min or less per day and half of the noise-cancelling headphone participants did not appear to use them. While the results suggest that patient-directed music therapy and noise-cancelling headphones may be useful and cost-effective interventions that lead to an overall improvement in anxiety and sedation exposure, these may appeal to a subset of ICU patients. The self-directed use of music therapy and noise

  16. 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

  17. 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

  18. 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

  19. Emergency Neurological Life Support: Airway, Ventilation, and Sedation.

    PubMed

    Seder, David B; Jagoda, Andy; Riggs, Becky

    2015-12-01

    Airway management and ventilation are central to the resuscitation of the neurologically ill. These patients often have evolving processes that threaten the airway and adequate ventilation. Furthermore, intubation, ventilation, and sedative choices directly affect brain perfusion. Therefore, airway, ventilation, and sedation was chosen as an emergency neurological life support protocol. Topics include airway management, when and how to intubate with special attention to hemodynamics and preservation of cerebral blood flow, mechanical ventilation settings, and the use of sedative agents based on the patient's neurological status. PMID:26438457

  20. Effects of a simulation-based sedation training course on non-anesthesiologists' attitudes toward sedation and analgesia.

    PubMed

    Komasawa, Nobuyasu; Fujiwara, Shunsuke; Atagi, Kazuaki; Ueki, Ryusuke; Haba, Masanori; Ueshima, Hironobu; Kaminoh, Yoshiroh; Minami, Toshiaki

    2014-10-01

    The purpose of this study was to conduct a survey of emergency or complication during sedation and change of attitude toward sedation by simulation-based sedation training course (SEDTC) hosted by the Japanese Association of Medical Simulation. We used a questionnaire survey to non-anesthesiologists who participated in the 1st to 13th SEDTCs from 2011 to 2012. Survey contents included emergencies or complications during sedation and impressions of the Sedation and Analgesia guidelines for non-anesthesia doctors developed by the American Society of Anesthesiologists. Of 84 non-anesthesiologists, 81 have encountered patient respiratory suppression. More than 70% non-anesthesiologists have encountered patient respiratory arrest. All non-anesthesiologists have encountered patient cardiac suppression; 20-30% of non-anesthesiologists have encountered patient anaphylaxis, asthma attack, and cardiac arrest; and all non-anesthesiologists have encountered patient vomiting and about 80% aspiration. Non-anesthesiologists largely accepted the guidelines. SEDTC attendance improved significantly 13 points of 18 important suggestions. As non-anesthesiologists experience several complications during sedation, SEDTC may be useful for the improvement of their attitude toward the safety management of sedation. PMID:24442129

  1. Phonological studies of the new gas-induced agitated reactor using computational fluid dynamics.

    PubMed

    Yang, T C; Hsu, Y C; Wang, S F

    2001-06-01

    An ozone-induced agitated reactor has been found to be very effective in degrading industrial wastewater. However, the cost of the ozone generation as well as its short residence time in reactors has restricted its application in a commercial scale. An innovated gas-induced draft tube installed inside a conventional agitated reactor was proved to effectively retain the ozone in a reactor. The setup was demonstrated to significantly promote the ozone utilization rate up to 96% from the conventional rate of 60% above the onset speed. This work investigates the mixing mechanism of an innovated gas-induced reactor for the future scale-up design by using the technique of computational fluid dynamics. A three-dimensional flow model was proposed to compute the liquid-gas free surface as well as the flow patterns inside the reactor. The turbulent effects generated by two 45 degrees pitch-blade turbines were considered and the two phases mixing phenomena were also manipulated by the Eulerian-Eulerian techniques. The consistency of the free surface profiles and the fluid flow patterns proved a good agreement between computational results and the experimental observation. PMID:11482384

  2. 40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid service. (a) Pumps, valves, connectors, and agitators in heavy liquid...

  3. 40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid service. (a) Pumps, valves, connectors, and agitators in heavy liquid...

  4. 40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid service. (a) Pumps, valves, connectors, and agitators in heavy liquid...

  5. 40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid service. (a) Pumps, valves, connectors, and agitators in heavy liquid...

  6. Syndrome of agitated delirium and visual impairment: a manifestation of medial temporo-occipital infarction.

    PubMed

    Medina, J L; Chokroverty, S; Rubino, F A

    1977-09-01

    Three patients presented with sudden visual impairment followed by agitated delirium one to three days later. Examination revealed marked agitation, dementia, and loss of vision. Computerised axial tomography demonstrated temporo-occipital infarctions. All recovered from the agitated state in four days to two months, but their visual impairment and dementia persisted one to four years later.

  7. Sedation, an unpleasant, undesirable and potentially dangerous side-effect of many psychotropic drugs.

    PubMed

    Bourin, Michel; Briley, Mike

    2004-03-01

    Sedation is a property of many psychotropic drugs. It can be defined as a decrease in psychomotor and cognitive performance. Many of the earlier neuroleptic, anxiolytic, antidepressant and antihistamine drugs were extremely sedative and sedation came to be considered as an integral part of the activity of these compounds. Newer, far less sedative, examples of each of these classes have shown that sedation is not required for their efficacy. Sedation is now increasingly considered as an adverse effect which should be avoided rather than a desirable effect especially when treating disorders such as anxiety or depression. This article discusses the sedative properties and mechanisms of different classes of psychotropic drugs.

  8. Sedation with dexmedetomidine in the intensive care setting

    PubMed Central

    Gerlach, Anthony T; Murphy, Claire V

    2011-01-01

    Dexmedetomidine is an α-2 agonist that produces sedation and analgesia without compromising the respiratory drive. Use of dexmedetomidine as a sedative in the critically ill is associated with fewer opioid requirements compared with propofol and a similar time at goal sedation compared with benzodiazepines. Dexmedetomidine may produce negative hemodynamic effects including lower mean heart rates and potentially more bradycardia than other sedatives used in the critically ill. Recent studies have demonstrated that dexmedetomidine is safe at higher dosages, but more studies are needed to determine whether the efficacy of dexmedetomidine is dose dependent. In addition, further research is required to define dexmedetomidine’s role in the care of delirious critically ill patients, as many, but not all, studies have indicated favorable outcomes. PMID:27147855

  9. 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

  10. 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

  11. 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

  12. 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.

  13. Comparison of dexmedetomidine/fentanyl with midazolam/fentanyl combination for sedation and analgesia during tooth extraction.

    PubMed

    Yu, C; Li, S; Deng, F; Yao, Y; Qian, L

    2014-09-01

    Dexmedetomidine is an α2-adrenergic receptor agonist that causes minimal respiratory depression compared with alternative drugs. This study investigated whether combined dexmedetomidine/fentanyl offered better sedation and analgesia than midazolam/fentanyl in dental surgery. Sixty patients scheduled for unilateral impacted tooth extraction were randomly assigned to receive either dexmedetomidine and fentanyl (D/F) or midazolam and fentanyl (M/F). Recorded variables were patient preoperative anxiety scores, vital signs, visual analogue scale (VAS) pain scores, Observer's Assessment of Alertness/Sedation Scale (OAAS) scores after drug administration, surgeon and patient degree of satisfaction, and the duration of analgesia after surgery. The OAAS scores were significantly lower for patients administered D/F compared to those who received M/F. The duration of analgesia after the surgical procedure was significantly longer in patients who received D/F (5.3 h) than in those who received M/F (4.1 h; P=0.017). The number of surgeons satisfied with the level of sedation/analgesia provided by D/F was significantly higher than for M/F (P=0.001). Therefore, dexmedetomidine/fentanyl appears to provide better sedation, stable haemodynamics, surgeon satisfaction, and postoperative analgesia than midazolam/fentanyl during office-based unilateral impacted tooth extraction.

  14. Agitated granular rod monolayers: Tetratic or uniaxial nematic?

    NASA Astrophysics Data System (ADS)

    Mueller, Thomas; de Las Heras, Daniel; Rehberg, Ingo; Huang, Kai

    The ordering of granular rod monolayers under vertical agitations against gravity is investigated experimentally and compared quantitatively with equilibrium Monte Carlo simulations and density functional theory. At sufficiently high number density, short rods form a tetratic state and long rods form a uniaxial nematic state. The ordering transitions are found to be independent of the agitation frequency and strength, suggesting that the detailed nature of energy injection into such a nonequilibrium system does not play a crucial role. Interestingly, the length-to-width ratio at which the order changes from tetratic to uniaxial is around 7 . 3 in both experiments and simulations. This quantitative agreement indicates that, despite of driven far from thermodynamic equilibrium, agitated granular systems may share similar features with corresponding equilibrium systems. Finally, we summarize the universal and non-universal aspects between nonequilibrium granular rod and equilibrium liquid crystal systems in a state diagram. Tm and KH acknowledge the support from the DFG through Grant No. HU1939/2-1.

  15. Patient-controlled sedation and analgesia during SWL.

    PubMed

    Uyar, M; Uyar, M; Uğur, G; Bílge, S; Ozyar, B; Ozyurt, C

    1996-10-01

    Sixty unpremedicated outpatients undergoing elective extracorporeal shockwave lithotripsy (SWL) using a Dornier MPL 9000 lithotripter were randomly assigned to receive either propofol-alfentanil (PA group; N = 30) or midazolam-alfentanil (MA group; N = 30) by a patient-controlled analgesia (PCA) device for sedation and analgesia. Although pain intensity scores were lower after 20 minutes and sedation was more pronounced in the MA group, both drug regimens produced satisfactory sedation and analgesia and allowed the maximum number of shockwaves to be given. Alfentanil consumption was less in the MA group (P < 0.05). Both groups were hemodynamically stable. The patients in the MA group had slower ventilation rates, lower oxygen saturation, and higher end-tidal carbon dioxide levels. Use of MA was associated with more episodes of oxygen desaturation to < 90% (30% vs. 11%; P < 0.05). One patient in the PA group and three patients in the MA group developed bradypnea (< 10 breaths/min). Patient satisfaction was very high with the two sedative-analgesic techniques. Propofol and midazolam, when given in combination with alfentanil using a PCA pump, may provide safe, effective analgesia and sedation during lithotripsy. Patient-controlled sedation and analgesia may provide optimal conditions for SWL of urinary tract stones and is a useful alternative to other forms of anesthesia and analgesia.

  16. Association of sedative-hypnotic medications with suicidality.

    PubMed

    Pae, Chi-Un; Koh, Jun Sung; Lee, Soo-Jung; Han, Changsu; Patkar, Ashwin A; Masand, Prakash S

    2011-03-01

    Evaluation of: Brower KJ, McCammon RJ, Wojnar M, Ilgen MA, Wojnar J, Valenstein M. Prescription sleeping pills, insomnia, and suicidality in the National Comorbidity Survey Replication. J. Clin. Psychiatry DOI: 10.4088/JCP.09m05484gry (2010) (Epub ahead of print). Several studies have investigated the association between sedative-hypnotics and suicidality, as such medications not only serve as a method for suicide, but are also involved in the usual options for treating psychiatric and medico-surgical disorders. According to population-based studies in Europe, Asia and the USA, sedative-hypnotic medications were significantly associated with suicide. However, these studies failed to address psychiatric comorbidities, new hypnotic medications, such as zolpidem, and the specific times at which such medications were used. Recently, Brower and colleagues have investigated the association of the prescription of sedative-hypnotic drugs with suicidality, to determine whether such medications were associated with suicidal ideation, suicide plans and suicide attempts in a large-cohort sample. They found that the use of sedative-hypnotic medications was significantly associated with suicidal ideation, suicide plans and suicide attempts. In addition, the use of sedative-hypnotic medications was a stronger predictor than insomnia of both suicidal ideation and suicide attempts. This article will discuss the relationship between prescription of sedative-hypnotic medications and suicide in the context of the potential limitations and significance of this recent research. PMID:21375440

  17. Sedation for Percutaneous Endoscopic Lumbar Discectomy

    PubMed Central

    2016-01-01

    Although anesthetic requirements for minimally invasive neurosurgical techniques have been described in detail and applied successfully since the early 2000s, most of the literature on this subject has dealt with cranial cases that were operated on in the supine or sitting positions. However, spinal surgery has also used minimally invasive techniques that were performed in prone position for more than 30 years to date. Although procedures in both these neurosurgical techniques require the patient to be awake for a certain period of time, the main surgical difference with minimally invasive spinal surgery is that the patients are in the prone position, which may result in increased requirement of airway management because of deep sedation. In addition, although minimally invasive spinal surgery progresses slowly and different techniques are used with no agreement on the terminology used to describe these techniques thus far, the anesthetist needs to understand the surgical and anesthetic requirements for each type of intervention in order to take necessary precautions. This paper reviews the literature on this topic and discusses the anesthetic necessities for percutaneous endoscopic laser surgery. PMID:27738652

  18. Sevoflurane-emergence agitation: Effect of supplementary low-dose oral ketamine premedication in preschool children undergoing dental surgery

    PubMed Central

    Khattab, Ahmed Metwally; El-Seify, Zeinab Ahmed

    2009-01-01

    Background and Objectives: The use of sevoflurane in pediatric anesthesia, which could enable a more rapid emergence and recovery, is complicated by the frequent occurrence of post-anesthesia agitation. This study aims to test the efficacy of adding a low dose of ketamine orally, as a supplement to the midazolam-based oral premedication for reducing sevoflurane-related emergence agitation. Materials and Methods: Ninety-two preschool children, aged between two and six years, with an American Society of Anesthesiologists physical status I or II, scheduled for elective dental filling and extractions under general anesthesia were included. The patients were allocated into two groups: Group M (46 patients) received oral midazolam 0.5 mg/kg, mixed with ibuprofen 10 mg/kg, while group KM (46 patients) received a similar premedication mixture, in addition to ketamine 2 mg/kg. The acceptance of the drug mixture, the onset of action, and the occurrence of vomiting were monitored over the next 30 minutes. Induction of anesthesia was carried out using sevoflurane 8 Vol% in 100% oxygen via face mask. Anesthesia was maintained with sevoflurane 1.5-2 Vol% in an oxygen-nitrous oxide mixture. After extubation, the standard scoring scale was used for assessing the quality of emergence. Agitation parameters were measured using a five-point scale. Agitated children were managed by giving intravenous increments of fentanyl 1 μg/ kg. The time of hospital discharge allowance was recorded. Results: Drug palatability, vomiting, and onset of action of premedication; showed no significant differences between both groups. Time of eye opening after discontinuation of sevoflurane showed no significant differences between both groups. Postoperative agitation score and rescue fentanyl consumption were higher in group M than in group KM on admission to the PACU (P < 0.01). The time of hospital discharge allowance in group M was longer than in group KM (P < 0.05). Conclusion: Adding a low dose of

  19. Effect of agitation of EDTA with 808-nm diode laser on dentin microhardness.

    PubMed

    Arslan, Hakan; Yeter, Kübra Y; Karatas, Ertugrul; Yilmaz, Cenk B; Ayranci, Leyla B; Ozsu, Damla

    2015-02-01

    The aim of this study is to analyze the effect of agitation of ethylenediaminetetraacetic acid (EDTA) with diode laser at different agitation times on root dentin microhardness. Eighty-four specimens were divided randomly into seven groups, as follows: (1) distilled water, (2) 17% EDTA, (3) EDTA with 60 s ultrasonic agitation, (4) EDTA with 10 s laser agitation, (5) EDTA with 20 s laser agitation, (6) EDTA with 30 s laser agitation, and (7) EDTA with 40 s laser agitation. All of the specimens were irrigated with 5% NaOCl and distilled water except the distilled water group. Microhardness values were calculated before and after the procedures. Statistical analyses were performed using one-way ANOVA and Tukey post hoc tests. Statistically significant differences were determined between the distilled water and other groups. Also, statistically significant differences were observed between EDTA with 40 s laser agitation and EDTA, and EDTA with 10 and 20 s laser agitations. Ultrasonic agitation of EDTA affected microhardness of root dentin similar to EDTA (p > .05). All applications decreased the microhardness of root dentin when compared with distilled water. Agitation of EDTA with diode laser for 40 s caused more reduction in microhardness of root dentin when compared with EDTA.

  20. Effect of agitation of EDTA with 808-nm diode laser on dentin microhardness.

    PubMed

    Arslan, Hakan; Yeter, Kübra Y; Karatas, Ertugrul; Yilmaz, Cenk B; Ayranci, Leyla B; Ozsu, Damla

    2015-02-01

    The aim of this study is to analyze the effect of agitation of ethylenediaminetetraacetic acid (EDTA) with diode laser at different agitation times on root dentin microhardness. Eighty-four specimens were divided randomly into seven groups, as follows: (1) distilled water, (2) 17% EDTA, (3) EDTA with 60 s ultrasonic agitation, (4) EDTA with 10 s laser agitation, (5) EDTA with 20 s laser agitation, (6) EDTA with 30 s laser agitation, and (7) EDTA with 40 s laser agitation. All of the specimens were irrigated with 5% NaOCl and distilled water except the distilled water group. Microhardness values were calculated before and after the procedures. Statistical analyses were performed using one-way ANOVA and Tukey post hoc tests. Statistically significant differences were determined between the distilled water and other groups. Also, statistically significant differences were observed between EDTA with 40 s laser agitation and EDTA, and EDTA with 10 and 20 s laser agitations. Ultrasonic agitation of EDTA affected microhardness of root dentin similar to EDTA (p > .05). All applications decreased the microhardness of root dentin when compared with distilled water. Agitation of EDTA with diode laser for 40 s caused more reduction in microhardness of root dentin when compared with EDTA. PMID:23793370

  1. Estimation of turbulence dissipation rate by Large eddy PIV method in an agitated vessel

    NASA Astrophysics Data System (ADS)

    Kysela, Bohuš; Jašíková, Darina; Konfršt, Jiří; Šulc, Radek; Ditl, Pavel

    2015-05-01

    The distribution of turbulent kinetic energy dissipation rate is important for design of mixing apparatuses in chemical industry. Generally used experimental methods of velocity measurements for measurement in complex geometries of an agitated vessel disallow measurement in resolution of small scales close to turbulence dissipation ones. Therefore, Particle image velocity (PIV) measurement method improved by large eddy Ply approach was used. Large eddy PIV method is based on modeling of smallest eddies by a sub grid scale (SGS) model. This method is similar to numerical calculations using Large Eddy Simulation (LES) and the same SGS models are used. In this work the basic Smagorinsky model was employed and compared with power law approximation. Time resolved PIV data were processed by Large Eddy PIV approach and the obtained results of turbulent kinetic dissipation rate were compared in selected points for several operating conditions (impeller speed, operating liquid viscosity).

  2. 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

  3. 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

  4. Identifying pediatric emergence delirium by using the PAED Scale: a quality improvement project.

    PubMed

    Stamper, Matthew J; Hawks, Sharon J; Taicher, Brad M; Bonta, Juliet; Brandon, Debra H

    2014-04-01

    Pediatric emergence delirium is a postoperative phenomenon characterized by aberrant cognitive and psychomotor behavior, which can place the patient and health care personnel at risk for injury. A common tool for identifying emergence delirium is the Level of Consciousness-Richmond Agitation and Sedation Scale (LOC-RASS), although it has not been validated for use in the pediatric population. The Pediatric Anesthesia Emergence Delirium Scale (PAED) is a newly validated tool to measure emergence delirium in children. We chose to implement and evaluate the effectiveness and fidelity of using the PAED Scale to identify pediatric emergence delirium in one eight-bed postanesthesia care unit in comparison with the traditional LOC-RASS. The overall incidence of pediatric emergence delirium found by using the LOC-RASS with a retrospective chart review (3%) was significantly lower than the incidence found by using the LOC-RASS (7.5%) and PAED Scale (11.5%) during the implementation period. Our findings suggest that the PAED Scale may be a more sensitive measure of pediatric emergence delirium, and, in the future, we recommend that health care personnel at our facility use the PAED Scale rather than the LOC-RASS. PMID:24674794

  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. 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

  7. 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

  8. 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.

  9. Heat-transfer coefficients in agitated vessels. Latent heat models

    SciTech Connect

    Kumpinsky, E.

    1996-03-01

    Latent heat models were developed to calculate heat-transfer coefficients in agitated vessels for two cases: (1) heating with a condensable fluid flowing through coils and jackets; (2) vacuum reflux cooling with an overhead condenser. In either case the mathematical treatment, based on macroscopic balances, requires no iterative schemes. In addition to providing heat-transfer coefficients, the models predict flow rates of service fluid through the coils and jackets, estimate the percentage of heat transfer due to latent heat, and compute reflux rates.

  10. Decay of isotropic turbulence generated by a mechanically agitated grid.

    NASA Technical Reports Server (NTRS)

    Ling, S. C.; Wan, C. A.

    1972-01-01

    Experimental study of weak isotropic turbulence, created by a mechanically agitated grid, has indicated that in the absence of large linear-momentum wakes the energy of turbulence relaxes very quickly into a stable self-preserving structure, which, depending on the initial Reynolds number of turbulence, decays at different constant inverse powers of time. Both the longitudinal correlation coefficients and the corresponding spectral distributions, except for the difference in the parametric constants, are of the same functional type as those found previously for a passive grid.

  11. Preemptive Oral Clonidine Provides Better Sedation Than Intravenous Midazolam in Brachial Plexus Nerve Blocks

    PubMed Central

    Mosaffa, Faramarz; Mohajerani, Seyed Amir; Aminnejad, Reza; Solhpour, Ali; Dabir, Shideh; Mohseni, Gholam Reza

    2016-01-01

    Background Preemptive analgesia is the blocking of pain perception afferent pathways before noxious painful stimuli. Clonidine is an alpha agonist drug that is partially selective for α-2 adrenoreceptors. Clonidine is used as anti-anxiety medication and an, analgesic, and it prolongs the duration of the block in the brachial plexus block. Objectives To compare the effect of preemptive clonidine with midazolam on intraoperative sedation, duration of block, and postoperative pain scores. Patients and Methods In a randomized clinical trial, 80 patients with orthopedic fractures of an upper extremity who underwent supraclavicular nerve block were randomly assigned to receive 0.2 mg oral clonidine or 2 mg oral midazolam. Intraoperative sedation was measured at one hour after the start of urgery and again in the PACU (Post-Anesthesia Care Unit) using the Ramsay scale. The duration of sensory blockade was measured. Postoperative pain scores were measured using the VAS (Visual Analogue Scale) after entrance to recovery up to 2 hours. Results The percentages of patients in the calm and sedated scale were significantly higher in clonidine group (35 and 42.5%, respectively), compared to the midazolam group (17.5 and 17.5%, respectively) (P = 0.042, 0.029; respectively). Those administered fentanyl in the clonidine group 105 ± 30.8 was significantly lower than that for the midazolam group 165 ± 34.5 (P = 0.0018). The percentages of patients in the calm scale were significantly higher in the clonidine group (52.5), compared to the midazolam group (17.5) (P = 0.001) in the post-operative period. VAS scores were significantly lower at one (P = 0.01) and two hours (P = 0.001) after operation in the clonidine group, compared to the midazolam group. Conclusions Preemptive clonidine has many marvelous advantages over midazolam, including better sedation inside the operating room and then in the post-operative care unit, lower fentanyl doses are required during surgery, more stable

  12. Effects of soil temperature and agitation on the removal of 1,2-dichloroethane from contaminated soil.

    PubMed

    Shi, Yi; Du, Xiaoming; Li, Huiying; Xu, Zhu; Wang, Qunhui; Meng, Xiaoguang; Li, Fasheng

    2012-04-15

    Mechanical soil aeration is an effective and low cost ex-situ remediation technique suitable for large sites contaminated by volatile organic compounds. However, this technique is still in the testing and development phase. To understand the effectiveness of this remediation technique and the main factors influencing its efficacy, an abandoned typical chlor-alkali chemical industry site was remediated using this technology on a pilot-scale. The results showed that this technology is effective for the remediation of volatile organic compounds, with a removal efficiency of greater than 99%. During the experiment, a better result was observed in the first 120 h than the last 120 h. Both temperature and agitation affected the remediation. Higher environmental or soil temperatures resulted in more rapid attenuation of 1,2-dichloroethane (1,2-DCA). Agitation had an obvious effect during the first 120 h. A preliminary dynamic characteristic study showed that the volatilization process can be described by a function similar to y=a+be((-kt)). Temperature (both environmental and soil temperature) had a greater effect on the reaction rate constant and the half-life of 1,2-DCA compared with agitation. This study aims to improve the remediation of contaminated sites, especially large areas contaminated by volatile organic contaminants.

  13. An approach to long-term sedative-hypnotic use

    PubMed Central

    Shahid, Azmeh; Chung, Sharon A; Phillipson, Ron; Shapiro, Colin M

    2012-01-01

    Insomnia is a common, often chronic medical disorder with significant medical and socioeconomic repercussions. However, unlike other medical conditions, there is intense debate as to whether the long-term treatment of insomnia is clinically appropriate. The perceived deleterious side effect of sedative-hypnotic medications may result in patients remaining untreated or undertreated. This review proposes that a more subtle approach needs to be taken in the management of patients with chronic insomnia and that long-term use of the newer sedative-hypnotics may be a feasible and effective treatment option when used in conjunction with thorough medical assessment and regular patient follow-up. This review discusses these issues and discusses the pros and cons of long-term sedative-hypnotic use. PMID:23620678

  14. [Sedation using ketamine for pain procedures in Pediatric Oncology.].

    PubMed

    Ricard, C; Tichit, R; Troncin, R; Bernard, F

    2009-09-01

    Procedural sedation and analgesia for children is widely practiced. Since 2005 to 2007, we evaluated the safety and efficacy of ketamine to control pain induced by diagnostic procedures in pediatric oncology patients. Eight hundred fifty procedures were carried out in 125 patients aged 2 to 16 years. We associated EMNO (inhaled equimolar mixture of nitrous oxide and oxygen), atropin (oral or rectal), midazolam (oral or rectal) and ketamin (intravenous). An anesthesiologist injected ketamin. Average dose of ketamine was 0.33 to 2 mg/kg depending on number and invasiveness of procedures. This method requires careful monitoring and proper precautions. With these conditions, no complication was observed. All patients were effectively sedated. These results indicate that ketamine - in association with EMNO, atropine and midazolam - is safe and effective in pain management induced by diagnostic procedures in pediatric oncology patients. The sedative regimen of intravenous ketamine has greatly reduced patient, family and practitioners anxiety for diagnostic and therapeutic procedures.

  15. Remediating agitation-induced antibody aggregation by eradicating exposed hydrophobic motifs

    PubMed Central

    Clark, Rutilio H; Latypov, Ramil F; De Imus, Cyr; Carter, Jane; Wilson, Zien; Manchulenko, Kathy; Brown, Michael E; Ketchem, Randal R

    2014-01-01

    Therapeutic antibodies must encompass drug product suitable attributes to be commercially marketed. An undesirable antibody characteristic is the propensity to aggregate. Although there are computational algorithms that predict the propensity of a protein to aggregate from sequence information alone, few consider the relevance of the native structure. The Spatial Aggregation Propensity (SAP) algorithm developed by Chennamsetty et. al. incorporates structural and sequence information to identify motifs that contribute to protein aggregation. We have utilized the algorithm to design variants of a highly aggregation prone IgG2. All variants were tested in a variety of high-throughput, small-scale assays to assess the utility of the method described herein. Many variants exhibited improved aggregation stability whether induced by agitation or thermal stress while still retaining bioactivity. PMID:25484048

  16. Pain assessment during blood collection from sedated and mechanically ventilated children

    PubMed Central

    Dantas, Layra Viviane Rodrigues Pinto; Dantas, Thiago Silveira Pinto; Santana-Filho, Valter Joviniano; Azevedo-Santos, Isabela Freire; DeSantana, Josimari Melo

    2016-01-01

    Objective This study assessed pain and observed physiological parameters in sedated and mechanically ventilated children during a routine procedure. Methods This observational study was performed in a pediatric intensive care unit. Thirty-five children between 1 month and 12 years of age were assessed before, during, and five minutes after an arterial blood collection for gas analysis (painful procedure). Face, Legs, Activity, Cry and Consolability scale was used to assess pain. In addition, patients' heart rate, respiratory rate, peripheral saturation of oxygen and blood pressure (diastolic and systolic) were recorded. COMFORT-B scale was applied before the pain and physiological parameter assessments to verify sedation level of the subjects. Results There was an increase in Face, Legs, Activity, Cry and Consolability score (p = 0.0001) during painful stimuli. There was an increase in heart rate (p = 0.03), respiratory rate (p = 0.001) and diastolic blood pressure (p = 0.006) due to pain caused by the routine procedure. Conclusions This study suggests that assessments of pain using standard scales, such as Face, Legs, Activity, Cry and Consolability score, and other physiological parameters should be consistently executed to optimize pain management in pediatric intensive care units. PMID:27096676

  17. Effect of viscosity on the mixing efficiency in a self-agitation anaerobic baffled reactor.

    PubMed

    Qi, Wei-Kang; Guo, Yi-Ling; Xue, Mei; Du, Jing-Ru; Li, Weicheng; Li, Yu-You

    2015-05-01

    One special self-agitation reactor, which does not require a mechanical mixer or other equipment for mixing, has been introduced. Self-agitation is affected by variation in viscosity property. To obtain and research the effect of viscosity on mixing behavior in the self-agitation reactor, Fluent® was used to create numerical simulations and to visualize the fluid flow status. The results show that when the viscosity of the liquid is 1 mPa s, the entire self-agitation results in an almost completely mixed reactor. The substrate becomes difficult to agitate, and the diffusion of the substrate and the tracer become quite after every self-agitation, as the viscosity increases. Once the viscosity is higher than 25 mPa s, the substrate and tracer could not be mixed in the entire reactor, and the reactor is recognized as the combination of several completely mixed reactors between which little exchange of liquid occurs.

  18. Effect of viscosity on the mixing efficiency in a self-agitation anaerobic baffled reactor.

    PubMed

    Qi, Wei-Kang; Guo, Yi-Ling; Xue, Mei; Du, Jing-Ru; Li, Weicheng; Li, Yu-You

    2015-05-01

    One special self-agitation reactor, which does not require a mechanical mixer or other equipment for mixing, has been introduced. Self-agitation is affected by variation in viscosity property. To obtain and research the effect of viscosity on mixing behavior in the self-agitation reactor, Fluent® was used to create numerical simulations and to visualize the fluid flow status. The results show that when the viscosity of the liquid is 1 mPa s, the entire self-agitation results in an almost completely mixed reactor. The substrate becomes difficult to agitate, and the diffusion of the substrate and the tracer become quite after every self-agitation, as the viscosity increases. Once the viscosity is higher than 25 mPa s, the substrate and tracer could not be mixed in the entire reactor, and the reactor is recognized as the combination of several completely mixed reactors between which little exchange of liquid occurs. PMID:25502876

  19. Particulate contamination removal from wafers using plasmas and mechanical agitation

    DOEpatents

    Selwyn, G.S.

    1998-12-15

    Particulate contamination removal from wafers is disclosed using plasmas and mechanical agitation. The present invention includes the use of plasmas with mechanical agitation for removing particulate matter from the surface of a wafer. The apparatus hereof comprises a mechanical activator, at least one conducting contact pin for transferring the vibration from the activator to the wafer, clamp fingers that maintain the wafer`s position, and means for generating a plasma in the vicinity of the surface of the wafer, all parts of the cleaning apparatus except the mechanical activator and part of the contact pin being contained inside the processing chamber. By exposing a wafer to a plasma and providing motion thereto in a direction perpendicular to its surface, the bonding between the particulate matter and the surface may be overcome. Once free of the wafer surface, the particulates become charged by electrons from the plasma and are drawn into the plasma by attractive forces which keep them from redepositing. The introduction of a flowing gas through the plasma sweeps the particulates away from the wafer and out of the plasma. The entire surface is cleaned during one cleaning step. The use of an rf plasma to accomplish the particulate removal was found to remove more than 90% of the particulates. 4 figs.

  20. Particulate contamination removal from wafers using plasmas and mechanical agitation

    DOEpatents

    Selwyn, Gary S.

    1998-01-01

    Particulate contamination removal from wafers using plasmas and mechanical agitation. The present invention includes the use of plasmas with mechanical agitation for removing particulate matter from the surface of a wafer. The apparatus hereof comprises a mechanical activator, at least one conducting contact pin for transferring the vibration from the activator to the wafer, clamp fingers that maintain the wafer's position, and means for generating a plasma in the vicinity of the surface of the wafer, all parts of the cleaning apparatus except the mechanical activator and part of the contact pin being contained inside the processing chamber. By exposing a wafer to a plasma and providing motion thereto in a direction perpendicular to its surface, the bonding between the particulate matter and the surface may be overcome. Once free of the wafer surface, the particulates become charged by electrons from the plasma and are drawn into the plasma by attractive forces which keep them from redepositing. The introduction of a flowing gas through the plasma sweeps the particulates away from the wafer and out of the plasma. The entire surface is cleaned during one cleaning step. The use of an rf plasma to accomplish the particulate removal was found to remove more than 90% of the particulates.

  1. LDA measurements and turbulence spectral analysis in an agitated vessel

    NASA Astrophysics Data System (ADS)

    Kysela, Bohuš; Konfršt, Jiří; Chára, Zdeněk

    2013-04-01

    During the last years considerable improvement of the derivation of turbulence power spectrum from Laser Doppler Anemometry (LDA) has been achieved. The irregularly sampled LDA data is proposed to approximate by several methods e.g. Lomb-Scargle method, which estimates amplitude and phase of spectral lines from missing data, methods based on the reconstruction of the auto-correlation function (referred to as correlation slotting technique), methods based on the reconstruction of the time series using interpolation between the uneven sampling and subsequent resampling etc. These different methods were used on the LDA data measured in an agitated vessel and the results of the power spectrum calculations were compared. The measurements were performed in the mixing vessel with flat bottom. The vessel was equipped with four baffles and agitated with a six-blade pitched blade impeller. Three values of the impeller speed (Reynolds number) were tested. Long time series of the axial velocity component were measured in selected points. In each point the time series were analyzed and evaluated in a form of power spectrum.

  2. 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

  3. [Sexual hallucinations and dreams under anesthesia and sedation : medicolegal aspects].

    PubMed

    Schneemilch, C; Schiltz, K; Meinshausen, E; Hachenberg, T

    2012-03-01

    Dreams and hallucinations under sedation or anesthesia have been well known phenomena since the introduction of anesthesia. Sexual hallucinations may lead to allegations of sexual molestation or assault by medical doctors or professional nursing staff. Hallucinations under the influence of sedative or hypnotic drugs may be very vivid and as misinterpreted as being real and it is therefore often difficult to disprove the resulting false allegations. In this report the terms drug-induced dreams and hallucinations are defined and the probable mechanism described. By a historical review and case reports the medicolegal consequences are demonstrated and procedures recommended to avoid allegations of sexual assault.

  4. Enhanced riboflavin production by recombinant Bacillus subtilis RF1 through the optimization of agitation speed.

    PubMed

    Man, Zai-wei; Rao, Zhi-ming; Cheng, Yi-peng; Yang, Tao-wei; Zhang, Xian; Xu, Mei-juan; Xu, Zheng-hong

    2014-02-01

    Dissolved oxygen is one of the most important bioprocess parameters that could affect cell growth and product formation, and it is easy to control by changing agitation speed. In this work, the effects of agitation speed on the performance of riboflavin production by recombinant Bacillus subtilis RF1 was investigated in fed-batch fermentation. The lower agitation speed (600 rpm) was beneficial for cell growth and riboflavin biosynthesis in the initial phase of fermentation process. While, during the later phase, higher agitation speed (900 rpm) was favor for cell growth and riboflavin biosynthesis. Thus, a two-stage agitation speed control strategy was proposed based on kinetic analysis, in which the agitation speed was controlled at 600 rpm in the first 26 h and then switched to 900 rpm to maintain high μ for cell growth and high q(p) for riboflavin production during the entire fermentation process. However, it was observed that a sharp increase of agitation speed resulted in an adverse effect on cell growth and riboflavin synthesis within a short time. To avoid this phenomenon, a multi-stage agitation speed control strategy was set up based on the two-stage control strategy, the maximum concentration of riboflavin reached 9.4 g l(-1) in 48 h with the yield of 0.051 g g(-1) by applying this strategy, which were 20.5 and 21.4% over the best results controlled by constant agitation speeds. PMID:24068533

  5. [The effects of long-term sedation on intestinal function].

    PubMed

    Zielmann, S; Grote, R

    1995-12-01

    Gastrointestinal integrity with intact function are of main importance in critically ill patients, and not only as a route of nutritional support. Drugs used for long-term sedation can lead to disordered gastrointestinal motility. In this study we compared the influence of different combinations of analgesics and sedatives on the intestinal function in mechanically ventilated, critically ill patients. METHODS. A total of 190 patients were evaluated retrospectively. All patients required controlled mechanical ventilation and deep sedation (Ramsay Score 5-6) for 7 days or more due to acute respiratory failure or elevated intracranial pressure. In none of these patients was enteric tube feeding contraindicated. Intact intestinal function was assumed when full enteric tube feeding was achieved on days 5 and 6 of the treatment period. Furthermore, other gastrointestinal motility disorders (e.g. constipation) had to be absent. In all patients the feeding tube was placed in the stomach by the nasogastric route. Corresponding to different combinations of analgesics and sedatives, the 190 patients were divided into 11 groups. The following combinations were used: group 1 (n = 20), fentanyl+flunitrazepam; group 2 (n = 20), fentanyl+midazolam; group 3 (n = 20), fentanyl+thiopentone; group 4 (n = 20) piritramide+midazolam; group 5 (n = 20), piritramide and continuous epidural administration of bupivacaine+midazolam; group 6 (n = 20), piritramide+gamma-aminobutyric acid (GABA); group 7 (n = 20), ketamine+midazolam; group 8 (n = 10), ketamin+methohexitone; group 9 (n = 20), ketamine+propofol; group 10 (n = 10), ketamine+midazolam and GABA; group 11 (n = 10), sufentail+midazolam and methohexitone. Patients in groups 3, 8, 9, 10, and 11 all had severe head injury and elevated intracranial pressure. Group 6 was made up exclusively of elderly patients (> 65 years) without head trauma. RESULTS. The patients in groups 1, 2, and 3 received fentanyl for analgesia and were completely fed

  6. Oral dexmedetomidine for preoperative sedation in an adult uncooperative autistic patient.

    PubMed

    Konia, Mojca Remskar

    2016-11-01

    We describe preoperative sedation with oral dexmedetomidine 5 mcg/kg in an uncooperative adult with autism and developmental delay. The sedation with oral dexmedetomidine achieved good sedation level (Ramsey 4-5), allowing for calm transfer of the patient to the operating room and uneventful induction of anesthesia. PMID:27687341

  7. Risk factors with intravenous sedation for patients with disabilities.

    PubMed

    Yoshikawa, Fumihiro; Tamaki, Yoh; Okumura, Hisa; Miwa, Zenzo; Ishikawa, Masaaki; Shimoyama, Kazuhiro; Nakamura, Zenkou; Kunimori, Hitomi; Jinno, Shigeharu; Kohase, Hikaru; Fukayama, Haruhisa

    2013-01-01

    The purpose of this study was to identify the risk factors associated with low peripheral oxygen saturation (SpO2) and delayed recovery of dental patients with disabilities after intravenous sedation. A total of 1213 patients with disabilities were retrospectively investigated with respect to demographic parameters and sedation conditions. Multivariate logistic analyses were conducted for patients with an SpO2 <90% and a recovery period of >60 minutes to identify the risk factors for poor sedation conditions. A significant odds ratio related to decreased SpO2 was observed for age, sex, midazolam and propofol levels, concurrent use of nitrous oxide, cerebral palsy, Down syndrome, and mental retardation. The most problematic patients were those diagnosed with Down syndrome (odds ratio, 3.003-7.978; 95% confidence interval; P < .001). Decision tree analysis showed an increased risk of decreased SpO2 in males with Down syndrome or after administration of >0.493 mg/kg propofol in combination with midazolam. An increased risk of delayed awakening was seen in patients aged less than 21 years and in males administered >0.032 mg/kg of midazolam. Intravenous sedation for dental patients with disabilities, particularly those with cerebral palsy, Down syndrome, or mental retardation, increases the risk of decreased SpO2. In addition, delayed recovery is expected after midazolam administration. PMID:24423418

  8. Intravenous Sedation for Dental Patients with Intellectual Disability

    ERIC Educational Resources Information Center

    Miyawaki, T.; Kohjitani, A.; Maeda, S.; Egusa, M.; Mori, T.; Higuchi, H.; Kita, F.; Shimada, M.

    2004-01-01

    The poor quality of oral health care for people with intellectual disability (ID) has been recognized, and the strong fears about dental treatment suggested as a major reason for disturbances of visits to dentists by such patients. Intravenous sedation is a useful method for relieving the anxiety and fear of such patients about dental treatment,…

  9. Can antidepressant medication relieve agitation in Alzheimer's disease?

    PubMed

    Porsteinsson, Anton P; Smith, Jessica S; Keltz, Melanie A; Antonsdottir, Inga M

    2014-09-01

    Neuropsychiatric symptoms (NPS) are a major concern in the treatment of Alzheimer's disease. Historically, NPS are difficult to treat effectively due to a high side-effect burden associated with commonly used medications, such as atypical antipsychotics. Non-pharmacological treatment approaches have become the first line option. However, when such treatment fails, pharmacological options are often used. Thus, a push toward finding safer alternative pharmacological treatments has occurred. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) have shown promise in clinical trials for alleviating the burden of NPS. Lower overall agitation and caregiver stress has been reported to correlate to treatment with the SSRI citalopram. However, certain side effects of citalopram, such as QTc interval prolongation and increased cognitive decline, carry clinical concern and should be weighed when prescribing their use. PMID:25148535

  10. Power consumption in gas-inducing-type mechanically agitated contactors

    SciTech Connect

    Saravanan, K.; Mundale, V.D.; Patwardhan, A.W.; Joshi, J.B.

    1996-05-01

    Power consumption was measured in 0.57, 1.0, and 1.5 m i.d. gas inducing type of mechanically agitated contactors (GIMAC) using single and multiple impellers. The ratio of impeller diameter to vessel diameter was varied in the range of 0.13 < D/T < 0.59. The effect of liquid submergence from the top and impeller clearance from the vessel bottom was investigated in detail. In the case of multiple impeller systems, six different designs were investigated. The designs included pitched blade downflow turbine (PBTD), pitched blade upflow turbine (PBTU), downflow propeller (PD), upflow propeller (PU), straight bladed turbine (SBT) and disc turbine (DT). The effect of interimpeller clearance was studied for the multiple impeller system. The effect of impeller speed was studied in the range of 0.13 < N < 13.5 rotations/s. A mathematical model has been developed for power consumption before and after the onset of gas induction.

  11. Time resolved PIV measurement of fluid dynamics in agitated vessels

    NASA Astrophysics Data System (ADS)

    Jasikova, D.; Kotek, M.; Kopecky, V.

    2015-01-01

    Here we present the results obtained by TR PIV measurements focused on detailed flow analysis in the selected region. The investigated area was placed 3mm above the blades axis and 5mm far from the blade edge. The captured images were firstly analysed on the mean velocity distribution and the intensity of turbulence {UV} statistics. Here we used the time resolved technique for the experimental study of the flow field in the agitated vessel. The results of the application POD and ODP algorithm on the captured datasets uncovered the existence of unsteady structures in the area that was assumed to be stable. The existence of these structures is bringing a novel view on the mixing process.

  12. Analgesic and physiological effects in conscious sedation with different nitrous oxide concentrations

    PubMed Central

    Bonafé-Monzó, Neus; Rojo-Moreno, Juan

    2015-01-01

    Objectives: to study the physiological changes, as well as the psychosedative and analgesic effects of nitrous oxide, in experimental conditions. Study Design: 101 dental students volunteers participated in a single nitrous oxide sedation session without dental treatment. Signs and symptoms were registered during and after the procedure. Pulse rate and hemoglobin oxygen saturation were monitored at: 100 per cent O2, 30 per cent N2O, 50 per cent N2O and 5 minutes after 100 per cent O2. A Likert scale was used to evaluate pain perception. The analgesic effects of nitrous oxide were evaluated at: 30 per cent N2O, 50 per cent N2O, and five minutes postoperatively. Results: Pulse rate and hemoglobin oxygen saturation decreased significantly through all the procedure and after recovery. However, oxygen saturation recovered after the final oxygenation. Only 8.2% of subjects reported the pain stimulus as being quite annoying when they inhaled 30 per cent N2O, while this percentage was of 15.8 % when inhaling 50 per cent N2O, and of 32.7 % during the recovery period. The most common effects of nitrous oxide sedation were bright eyes (99%), voice change (98%) and smiling (91%). Most of the subjects reported tingling (98%) and relax (91.1%) Conclusions: nitrous oxide causes a significant decrease in heart rate and oxygen saturation, but always within safety limits. Maintaining an appropriate level of consciousness was confirmed as a feature in 50 per cent dose in this study. The analgesic effect of nitrous oxide was confirmed but a dose dependency could not be established. Key words:Nitrous oxide, conscious sedation, anxiolysis, safety, physiogical parameters, signs, symptoms, analgesia. PMID:25810844

  13. Automated Agitation-Assisted Demulsification Dispersive Liquid-Liquid Microextraction.

    PubMed

    Guo, Liang; Chia, Shao Hua; Lee, Hian Kee

    2016-03-01

    Dispersive liquid-liquid microextraction (DLLME) is an extremely fast and efficient sample preparation procedure. For its capability and applicability to be fully exploited, full automation of its operations seamlessly integrated with analysis is necessary. In this work, for the first time, fully automated agitation-assisted demulsification (AAD)-DLLME integrated with gas chromatography/mass spectrometry was developed for the convenient and efficient determination of polycyclic aromatic hydrocarbons in environmental water samples. The use of a commercially available multipurpose autosampler equipped with two microsyringes of different capacities allowed elimination or significant reduction of manpower, labor, and time with the large-volume microsyringe used for liquid transfers and the small-volume microsyringe for extract collection and injection for analysis. Apart from enhancing accessibility of DLLME, the procedure was characterized by the application of agitation after extraction to break up the emulsion (that otherwise would need centrifugation or a demulsification solvent), further improving overall operational efficiency and flexibility. Additionally, the application of low-density solvent as extractant facilitated the easy collection of extract as the upper layer over water. Some parameters affecting the automated AAD-DDLME procedure were investigated. Under the optimized conditions, the procedure provided good linearity (ranging from a minimum of 0.1-0.5 μg/L to a maximum of 50 μg/L), low limits of detection (0.010-0.058 μg/L), and good repeatability of the extractions (relative standard deviations, below 5.3%, n = 6). The proposed method was applied to analyze PAHs in real river water samples. PMID:26818217

  14. The risk of shorter fasting time for pediatric deep sedation

    PubMed Central

    Clark, Mathew; Birisci, Esma; Anderson, Jordan E.; Anliker, Christina M.; Bryant, Micheal A.; Downs, Craig; Dalabih, Abdallah

    2016-01-01

    Background: Current guidelines adopted by the American Academy of Pediatrics calls for prolonged fasting times before performing pediatric procedural sedation and analgesia (PSA). PSA is increasingly provided to children outside of the operating theater by sedation trained pediatric providers and does not require airway manipulation. We investigated the safety of a shorter fasting time compared to a longer and guideline compliant fasting time. We tried to identify the association between fasting time and sedation-related complications. Methods: This is a prospective observational study that included children 2 months to 18 years of age and had an American Society of Anesthesiologists physical status classification of I or II, who underwent deep sedation for elective procedures, performed by pediatric critical care providers. Procedures included radiologic imaging studies, electroencephalograms, auditory brainstem response, echocardiograms, Botox injections, and other minor surgical procedures. Subjects were divided into two groups depending on the length of their fasting time (4–6 h and >6 h). Complication rates were calculated and compared between the three groups. Results: In the studied group of 2487 subjects, 1007 (40.5%) had fasting time of 4–6 h and the remaining 1480 (59.5%) subjects had fasted for >6 h. There were no statistically significant differences in any of the studied complications between the two groups. Conclusions: This study found no difference in complication rate in regard to the fasting time among our subjects cohort, which included only healthy children receiving elective procedures performed by sedation trained pediatric critical care providers. This suggests that using shorter fasting time may be safe for procedures performed outside of the operating theater that does not involve high-risk patients or airway manipulation. PMID:27746560

  15. System for agitating the acid in a lead-acid battery

    DOEpatents

    Weintraub, Alvin; MacCormack, Robert S.

    1987-01-01

    A system and method for agitating the acid in a large lead-sulfuric acid storage battery of the calcium type. An air-lift is utilized to provide the agitation. The air fed to the air-lift is humidified prior to being delivered to the air-lift.

  16. The Relationship between Agitated Behavior and Cognitive Functioning in Nursing Home Residents: Preliminary Results.

    ERIC Educational Resources Information Center

    Cohen-Mansfield, Jiska

    Agitation is a significant problem for nursing home residents, their families, and their caretakers. Agitation is defined as inappropriate verbal, vocal, or motor activity which is not explained by needs or confusion per se. It includes behaviors such as aimless wandering, pacing, cursing, screaming, biting, and fighting. The inappropriate nature…

  17. Behavioral Characteristics of Agitated Nursing Home Residents with Dementia at the End of Life

    ERIC Educational Resources Information Center

    Allen, Rebecca S.; Burgio, Louis D.; Fisher, Susan E.; Hardin, J. Michael; Shuster, John L., Jr.

    2005-01-01

    Purpose: The purpose of this study was to examine group differences in verbal agitation, verbal interaction, bed restraint, pain, analgesic and neuroleptic medication use, and medical comorbidity among agitated nursing home residents who died during a 6-month clinical trial compared with residents of the same gender and similar initial cognitive…

  18. A Longitudinal Examination of Agitation and Resident Characteristics in the Nursing Home

    ERIC Educational Resources Information Center

    Burgio, Louis D.; Park, Nan Sook; Hardin, J. Michael; Sun, Fei

    2007-01-01

    Purpose: Agitation frequently accompanies cognitive decline among nursing home residents. This study used cross-sectional and longitudinal (up to 18 months) methods to examine agitation among profoundly and moderately impaired residents using both staff report and direct observation methods. Design and Methods: The study included participants (N =…

  19. 40 CFR 63.169 - Standards: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., and agitators in heavy liquid service; instrumentation systems; and pressure relief devices in liquid...: Pumps, valves, connectors, and agitators in heavy liquid service; instrumentation systems; and pressure..., pressure relief devices in light liquid or heavy liquid service, and instrumentation systems shall...

  20. 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.

  1. 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

  2. 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

  3. Safety and Effectiveness of Moderate Sedation for Radiologic Non-Vascular Intervention

    PubMed Central

    2006-01-01

    Objective The purpose of this study was to prospectively characterize the safety and effectiveness of moderate sedation/analgesia for performing radiologic non-vascular abdominal intervention. Materials and Methods During a 3-month period, a total of 63 adult patients with a mean age of 64 years (range: 27-82) underwent moderate sedation for 72 radiologic non-vascular interventional procedures. A combination of fentanyl citrate and midazolam hydrochloride, based on the patient's body weight, was intravenously administered until the patient was drowsy and tranquil. The adverse events associated with this moderate sedation were assessed. The visual analog scale format was used to measure the subjective feelings of the patient's pre-procedural anxiety and intraprocedural pain. Results The mean total dose per kilogram of body weight of fentanyl used in PTBD was 1.148 µg, it was 1.157 µg for PTGBD, 1 µg for AD, 1 µg for PCN, 1.641 µg for TDC, 1 µg for DJS, 2 µg for BS, 1 µg for GS and 2 µg for RFA. The mean total dose per kilogram of body weight of midazolam was 0.035 mg in PTBD, PTGBD, AD, PCN, DJS, GS and RFA, 0.039 mg in TDC, and 0.043 mg in BS. A temporary reduction of systolic blood pressure to less than 80 mmHg was observed during 5 procedures (6.9%), whereas a temporary elevation of systolic blood pressure above 150 mmHg was observed during 10 procedures (13.8%). A reduction of arterial oxygen saturation to less than 90% was observed during 14 procedures (19.4%). None of the patients required pharmacologic reversal agents or cardiopulmonary resuscitation. The mean anxiety score recorded before all procedures was 5.2 (distressing). The mean pain score during the procedure, which was recorded after all procedures, was 2.9 (mild). Conclusion Moderate sedation allows performance of safe and effective radiologic non-vascular intervention, and it is also easy for an interventional radiologist to use. The patients should be continuously monitored to check their

  4. Effect of Aromatherapy Massage on Agitation and Depressive Mood in Individuals With Dementia.

    PubMed

    Yang, Ya-Ping; Wang, Chi-Jane; Wang, Jing-Jy

    2016-09-01

    The current study examined the effects of aromatherapy massage on alleviating agitation and depressive mood in individuals with dementia. A randomized controlled trial and repeated measures design was conducted. A total of 59 participants were randomly assigned to intervention or control groups. The intervention group received aromatherapy massage once per week for 8 weeks. Results indicated no significant changes over time in overall agitation for either group, but agitation decreased from Week 1 to Week 5 for the intervention group. In addition, the overall depressive symptoms decreased significantly over time for the intervention group compared to the control group (p < 0.001). However, changes in agitation within 24 hours following aromatherapy massage showed some significant changes in Weeks 5 and 9. Aromatherapy massage can be an effective and safe intervention to alleviate specific agitated behaviors and depressive mood in individuals with dementia. [Journal of Gerontological Nursing, 42(9), 38-46.]. PMID:27319407

  5. [Application of music therapy for managing agitated behavior in older people with dementia].

    PubMed

    Sung, Huei-Chuan; Chang, Anne M; Abbey, Jennifer

    2006-10-01

    Older people with dementia may display negative emotions, memory problems, sleep disturbance, and agitated behavior. Among these symptoms, agitated behavior has been identified by families and nursing staff as the care problem that presents the greatest challenge. Several studies have found that music therapy reduced agitated behaviors in those with dementia and recommended use of music as an effective strategy in managing this behavioral problem. Music therapy represents a lower cost, effective care approach that nursing staff can easily learn and apply to those with dementia. Furthermore, reductions in agitated behavior in dementia patients that result from music therapy can also alleviate caregiver stress and burden of care, leading to improvements in the health and quality of life of both dementia patients and their caregivers. This paper aims to introduce the principles and application of music therapy in the management of agitated behavior in those with dementia.

  6. CFD investigation of turbulence models for mechanical agitation of non-Newtonian fluids in anaerobic digesters.

    PubMed

    Wu, Binxin

    2011-02-01

    This study evaluates six turbulence models for mechanical agitation of non-Newtonian fluids in a lab-scale anaerobic digestion tank with a pitched blade turbine (PBT) impeller. The models studied are: (1) the standard k-ɛ model, (2) the RNG k-ɛ model, (3) the realizable k-ɛ model, (4) the standard k-ω model, (5) the SST k-ω model, and (6) the Reynolds stress model. Through comparing power and flow numbers for the PBT impeller obtained from computational fluid dynamics (CFD) with those from the lab specifications, the realizable k-ɛ and the standard k-ω models are found to be more appropriate than the other turbulence models. An alternative method to calculate the Reynolds number for the moving zone that characterizes the impeller rotation is proposed to judge the flow regime. To check the effect of the model setup on the predictive accuracy, both discretization scheme and numerical approach are investigated. The model validation is conducted by comparing the simulated velocities with experimental data in a lab-scale digester from literature. Moreover, CFD simulation of mixing in a full-scale digester with two side-entry impellers is performed to optimize the installation. PMID:21216428

  7. Bathyphotometer bioluminescence potential measurements: A framework for characterizing flow agitators and predicting flow-stimulated bioluminescence intensity

    NASA Astrophysics Data System (ADS)

    Latz, Michael I.; Rohr, Jim

    2013-07-01

    Bathyphotometer measurements of bioluminescence are used as a proxy for the abundance of luminescent organisms for studying population dynamics; the interaction of luminescent organisms with physical, chemical, and biological oceanographic processes; and spatial complexity especially in coastal areas. However, the usefulness of bioluminescence measurements has been limited by the inability to compare results from different bathyphotometer designs, or even the same bathyphotometer operating at different volume flow rates. The primary objective of this study was to compare measurements of stimulated bioluminescence of four species of cultured dinoflagellates, the most common source of bioluminescence in coastal waters, using two different bathyphotometer flow agitators as a function of bathyphotometer volume flow rate and dinoflagellate concentration. For both the NOSC and BIOLITE flow agitators and each species of dinoflagellate tested, there was a critical volume flow rate, above which average bioluminescence intensity, designated as bathyphotometer bioluminescence potential (BBP), remained relatively constant and scaled directly with dinoflagellate cell concentration. At supra-critical volume flow rates, the ratio of BIOLITE to NOSC BBP was nearly constant for the same species studied, but varied between species. The spatial pattern and residence time of flash trajectories within the NOSC flow agitator indicated the presence of dominant secondary recirculating flows, where most of the bioluminescence was detected. A secondary objective (appearing in the Appendix) was to study the feasibility of using NOSC BBP to scale flow-stimulated bioluminescence intensity across similar flow fields, where the contributing composition of luminescent species remained the same. Fully developed turbulent pipe flow was chosen because it is hydrodynamically well characterized. Average bioluminescence intensity in a 2.54-cm i.d. pipe was highly correlated with wall shear stress and

  8. Plasma catecholamine concentration during sedation in ventilated patients requiring intensive therapy.

    PubMed

    Kong, K L; Willatts, S M; Prys-Roberts, C; Harvey, J T; Gorman, S

    1990-01-01

    The effects of isoflurane and midazolam sedation on the catecholamine responses of ventilated patients were studied over a 24-h period. Sixty ventilated patients admitted to our intensive therapy unit were allocated randomly to receive either isoflurane or midazolam sedation. Arterial blood samples for plasma catecholamine concentrations were taken at baseline, 6 h after starting sedation and at the end of the study period. Patients sedated with isoflurane showed a progressive reduction in both adrenaline and noradrenaline concentrations during the period of sedation which reached statistical significance for adrenaline at 6 h (p less than 0.02) and at the end of the study (p less than 0.001). Patients sedated with midazolam showed no significant changes of adrenaline or noradrenaline concentrations. Overall, a more satisfactory degree of sedation was achieved with isoflurane.

  9. Functional magnetic resonance imaging reflects changes in brain functioning with sedation.

    PubMed

    Starbuck, Victoria N; Kay, Gary G; Platenberg, R. Craig; Lin, Chin-Shoou; Zielinski, Brandon A

    2000-12-01

    Functional magnetic resonance imaging (fMRI) studies have demonstrated localized brain activation during cognitive tasks. Brain activation increases with task complexity and decreases with familiarity. This study investigates how sleepiness alters the relationship between brain activation and task familiarity. We hypothesize that sleepiness prevents the reduction in activation associated with practice. Twenty-nine individuals rated their sleepiness using the Stanford Sleepiness Scale before fMRI. During imaging, subjects performed the Paced Auditory Serial Addition Test, a continuous mental arithmetic task. A positive correlation was observed between self-rated sleepiness and frontal brain activation. Fourteen subjects participated in phase 2. Sleepiness was induced by evening dosing with chlorpheniramine (CP) (8 mg or 12 mg) and terfenadine (60 mg) in the morning for 3 days before the second fMRI scan. The Multiple Sleep Latency Test (MSLT) was also performed. Results revealed a significant increase in fMRI activation in proportion to the dose of CP. In contrast, for all subjects receiving placebo there was a reduction in brain activation. MSLT revealed significant daytime sleepiness for subjects receiving CP. These findings suggest that sleepiness interferes with efficiency of brain functioning. The sleepy or sedated brain shows increased oxygen utilization during performance of a familiar cognitive task. Thus, the beneficial effect of prior task exposure is lost under conditions of sedation. Copyright 2000 John Wiley & Sons, Ltd. PMID:12404614

  10. Premedication with oral midazolam in children--an assessment of psychomotor function, anxiolysis, sedation and pharmacokinetics.

    PubMed

    Jones, R D; Visram, A R; Kornberg, J P; Irwin, M G; Gunawardene, W M

    1994-10-01

    We studied 30 children, aged 4 to 12 years, undergoing elective circumcision, premedicated with midazolam 0.5 mg.kg-1 and atropine 0.02 mg.kg-1 by mouth. A modified postbox test and the coding component of the Wechsler intelligence scale (WISC-R) was used to assess the preoperative effect of premedication on psychomotor function. Mood and sedation were also scored and related to serum midazolam concentrations. The children showed a significant decline in psychomotor performance 30 and 60 minutes after premedication when compared with their best unmedicated performance recorded the previous evening. This decline in psychomotor performance was only weakly associated with serum midazolam concentrations (r = 0.1). The postbox toy ratio is a suitable measurement of psychomotor performance in children because of its simplicity and ease of use in the clinical environment, although it may suffer the "test-retest" limitations of similar types of assessment. The sedative and anxiolytic effects of midazolam provide a quiet environment for a smooth induction of anaesthesia. PMID:7818057

  11. Micro acoustic resonant chambers for heating/agitating/mixing (MARCHAM)

    NASA Astrophysics Data System (ADS)

    Sherrit, Stewart; Noell, Aaron C.; Fisher, Anita M.; Takano, Nobuyuki; Grunthaner, Frank

    2016-04-01

    A variety of applications require the mixing and/or heating of a slurry made from a powder/fluid mixture. One of these applications, Sub Critical Water Extraction (SCWE), is a process where water and an environmental powder sample (sieved soil, drill cuttings, etc.) are heated in a sealed chamber to temperatures greater than 200 degrees Celsius by allowing the pressure to increase, but without reaching the critical point of water. At these temperatures, the ability of water to extract organics from solid particulate increases drastically. This paper describes the modeling and experimentation on the use of an acoustic resonant chamber which is part of an amino acid detection instrument called Astrobionibbler [Noell et al. 2014, 2015]. In this instrument we use acoustics to excite a fluid- solid fines mixture in different frequency/amplitude regimes to accomplish a variety of sample processing tasks. Driving the acoustic resonant chamber at lower frequencies can create circulation patterns in the fluid and mixes the liquid and fines, while driving the chamber at higher frequencies one can agitate the fluid and powder and create a suspension. If one then drives the chamber at high amplitude at resonance heating of the slurry occurs. In the mixing and agitating cell the particle levitation force depends on the relative densities and compressibility's of the particulate and fluid and on the kinetic and potential energy densities associated with the velocity and pressure fields [Glynne-Jones, Boltryk and Hill 2012] in the cell. When heating, the piezoelectric transducer and chamber is driven at high power in resonance where the solid/fines region is modelled as an acoustic transmission line with a large loss component. In this regime, heat is pumped into the solution/fines mixture and rapidly heats the sample. We have modeled the piezoelectric transducer/chamber/ sample using Mason's equivalent circuit. In order to assess the validity of the model we have built and

  12. Sedative effect of monoterpene alcohols in mice: a preliminary screening.

    PubMed

    de Sousa, Damião Pergentino; Raphael, Ellen; Brocksom, Ursula; Brocksom, Timothy John

    2007-01-01

    Many essential oils and monoterpenes are used therapeutically as relaxing drugs and tranquilizers. In this study, ten structurally related monoterpene alcohols, present in many essential oils, were evaluated in mice to investigate their pharmacological potential in the central nervous system. Isopulegol (1), neoisopulegol (2), (+/-)-isopinocampheol (3), (-)-myrtenol (4), (-)-cis-myrtanol (5), (+)-p-menth-1-en-9-ol (6) and (+/-)-neomenthol (8) exhibited a depressant effect in the pentobarbital-induced sleep test, indicating a sedative property. (-)-Menthol (7), (+)-dihydrocarveol (9), and (+/-)-isoborneol (10) were ineffective in this test. The results show that these psychoactive monoterpenes have the profile of sedative drugs, and this pharmacological effect is influenced by the structural characteristics of the molecules. PMID:17913072

  13. Removal of salt from high-level waste tanks by density-driven circulation or mechanical agitation

    SciTech Connect

    Kiser, D.L.

    1981-01-01

    Twenty-two high-level waste storage tanks at the Savannah River Plant are to be retired in the tank replacement/waste transfer program. The salt-removal portion of this program requires dissolution of about 19 million liters of salt cake. Steam circulation jets were originally proposed to dissolve the salt cake. However, the jets heated the waste tank to 80 to 90/sup 0/C. This high temperature required a long cooldown period before transfer of the supernate by jet, and increased the risk of stress-corrosion cracking in these older tanks. A bench-scale investigation at the Savannah River Laboratory developed two alternatives to steam-jet circulation. One technique was density-driven circulation, which in bench tests dissolved salt at the same rate as a simulated steam circulation jet but at a lower temperature. The other technique was mechanical agitation, which dissolved the salt cake faster and required less fresh water than either density-driven circulation or the simulated steam circulation jet. Tests in an actual waste tank verified bench-scale results and demonstrated the superiority of mechanical agitation.

  14. Thermoregulation: physiological and clinical considerations during sedation and general anesthesia.

    PubMed

    Díaz, Marcos; Becker, Daniel E

    2010-01-01

    Mild hypothermia is common during deep sedation or general anesthesia and is frequently associated with patient discomfort and shivering. Greater declines in temperature can produce an even greater number of significant detrimental effects. This article reviews principles of thermoregulation and influences of anesthetic agents. An understanding of these will provide a foundation for strategies to reduce heat loss and better manage patient discomfort when it occurs. PMID:20331336

  15. Use of Opioids and Sedatives at End-of-Life

    PubMed Central

    Sim, Shin Wei; Ho, Shirlynn; Kumar, Radha Krishna Lalit

    2014-01-01

    Despite their proven efficacy and safety, opioid and sedative use for palliation in patients afflicted with cancer in Singapore have been shown to be a fraction of that in other countries. This paper explores the various psychosocial and system-related factors that appear to propagate this conservative approach to care in what is largely a western-influenced care practice. A search for publications relating to sedative and opioid usage in Asia was performed on PubMed, Google, Google Scholar, World Health Organization, and Singapore's government agency websites using search terms such as “opioids,” “sedatives,” “palliation,” “end-of-life-care,” “pain management,” “palliative care,” “cancer pain,” “Asia,” “Singapore,” and “morphine.” Findings were classified into three broad groups – system-related, physician-related, and patient-related factors. A cautious medico-legal climate, shortage of physicians trained in palliative care, and lack of instruments for symptom assessment of patients at the end of life contribute to system-related barriers. Physician-related barriers include delayed access to palliative care due to late referrals, knowledge deficits in non-palliative medicine physicians, and sub-optimal care provided by palliative physicians. Patients' under-reporting of symptoms and fear of addiction, tolerance, and side effects of opioids and sedatives may lead to conservative opioid use in palliative care as well. System-related, physician-related, and patient-related factors play crucial roles in steering the management of palliative patients. Addressing and increasing the awareness of these factors may help ensure patients receive adequate relief and control of distressing symptoms. PMID:25125876

  16. Disruption of cortical integration during midazolam‐induced light sedation

    PubMed Central

    Liang, Peipeng; Zhang, Han; Xu, Yachao; Jia, Wenbin; Zang, Yufeng

    2015-01-01

    Abstract This work examines the effect of midazolam‐induced light sedation on intrinsic functional connectivity of human brain, using a randomized, double‐blind, placebo‐controlled, cross‐over, within‐subject design. Fourteen healthy young subjects were enrolled and midazolam (0.03 mg/kg of the participant's body mass, to a maximum of 2.5 mg) or saline were administrated with an interval of one week. Resting‐state fMRI was conducted before and after administration for each subject. We focus on two types of networks: sensory related lower‐level functional networks and higher‐order functions related ones. Independent component analysis (ICA) was used to identify these resting‐state functional networks. We hypothesize that the sensory (visual, auditory, and sensorimotor) related networks will be intact under midazolam‐induced light sedation while the higher‐order (default mode, executive control, salience networks, etc.) networks will be functionally disconnected. It was found that the functional integrity of the lower‐level networks was maintained, while that of the higher‐level networks was significantly disrupted by light sedation. The within‐network connectivity of the two types of networks was differently affected in terms of direction and extent. These findings provide direct evidence that higher‐order cognitive functions including memory, attention, executive function, and language were impaired prior to lower‐level sensory responses during sedation. Our result also lends support to the information integration model of consciousness. Hum Brain Mapp 36:4247–4261, 2015. © 2015 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc. PMID:26314702

  17. Oral sedation allows for comfort and amnesia during office surgery.

    PubMed

    Gatti, J E

    2000-05-01

    Surgical procedures commonly associated with parenteral sedation or general anesthesia were completed in an office operating room with local anesthesia and oral medication. Diazepam and alprazolam were used in combination to produce a relaxed state, allowing local anesthesia to be instilled. Surgery was completed successfully in all patients, and no untoward effects were seen in the patients. Amnesia was associated with the drug combination, and a protective action of the long-lived drugs against lidocaine toxicity is theorized.

  18. Sedation or general anesthesia for transcatheter aortic valve implantation (TAVI).

    PubMed

    Mayr, N Patrick; Michel, Jonathan; Bleiziffer, Sabine; Tassani, Peter; Martin, Klaus

    2015-09-01

    Transfemoral transcatheter aortic valve implantation (TAVI) is nowadays a routine therapy for elderly patients with severe aortic stenosis (AS) and high perioperative risk. With growing experience, further development of the devices, and the expansion to "intermediate-risk" patients, there is increasing interest in performing this procedure under conscious sedation (TAVI-S) rather than the previously favoured approach of general anesthesia (TAVI-GA). The proposed benefits of TAVI-S include; reduced procedure time, shorter intensive care unit (ICU) length of stay, reduced need for intraprocedural vasopressor support, and the potential to perform the procedure without the direct presence of an anesthetist for cost-saving reasons. To date, no randomized trial data exists. We reviewed 13 non-randomized studies/registries reporting data from 6,718 patients undergoing TAVI (3,227 performed under sedation). Patient selection, study methods, and endpoints have differed considerably between published studies. Reported rates of in-hospital and longer-term mortality are similar for both groups. Up to 17% of patients undergoing TAVI-S require conversion to general anesthesia during the procedure, primarily due to vascular complications, and urgent intubation is frequently associated with hemodynamic instability. Procedure related factors, including hypotension, may compound preexisting age-specific renal impairment and enhance the risk of acute kidney injury. Hypotonia of the hypopharyngeal muscles in elderly patients, intraprocedural hypercarbia, and certain anesthetic drugs, may increase the aspiration risk in sedated patients. General anesthesia and conscious sedation have both been used successfully to treat patients with severe AS undergoing TAVI with similar reported short and long-term mortality outcomes. The authors believe that the significant incidence of complications and unplanned conversion to general anesthesia during TAVI-S mandates the start-to-finish presence

  19. Standing sedation in captive zebra (Equus grevyi and Equus burchellii).

    PubMed

    Hoyer, Mark; de Jong, Sara; Verstappen, Frank; Wolters, Marno

    2012-03-01

    Nine Grevy's zebras (Equus grevyi) and three Burchell's zebras (Equus burchellii) were immobilized in a standing position a total of 70 times for minor, nonpainful procedures over a 9-yr period. Standing sedation was successfully obtained with a combination of detomidine and butorphanol on 47 occasions (67.1%). Detomidine i.m. (median 0.10 mg/kg; range: 0.07-0.21) was administered by dart, followed 10 min later by butorphanol i.m. (median 0.13 mg/kg; range 0.04-0.24). The dosages were varied depending on the initial demeanor of the animal. On 23 occasions (32.9%), small amounts of etorphine (median 2.5 microg/kg; range 1.1-12.3 microg/kg) plus acepromazine (median 10 microg/kg; range 4.4-50 microg/kg) (as in Large Animal-Immobilon) had to be administered i.m. to gain sufficient sedation. In these latter cases, the animals were either excited or known for their aggressive character. The zebras were sufficiently immobilized for the length of most procedures (<45 min) without supplementation. At the end of the procedure, the animals were given atipamezole (2 mg per 1 mg detomidine used) and naltrexone (0.1 mg/kg) to reverse the sedative effects, irrespective of whether etorphine was used or not. Standing sedation, using the combination of the alpha-2 agonist detomidine and the partial agonist-antagonist opioid butorphanol (in some cases supplemented with etorphine + acepromazine), proved to be a very efficacious and safe method to be used in zebras under zoo conditions for short-lasting, nonpainful procedures.

  20. Effects of agitation on the microalgae Phaeodactylum tricornutum and Porphyridium cruentum.

    PubMed

    Sobczuk, T Mazzuca; Camacho, F García; Grima, E Molina; Chisti, Yusuf

    2006-03-01

    The effect of mechanical agitation on the microalgae Phaeodactylum tricornutum and Porphyridium cruentum was investigated in aerated continuous cultures with and without the added shear protectant Pluronic F68. Damage to cells was quantified through a decrease in the steady state concentration of the biomass in the photobioreactor. For a given aeration rate, the steady state biomass concentration rose with increasing rate of mechanical agitation until an upper limit on agitation speed was reached. This maximum tolerable agitation speed depended on the microalgal species. Further increase in agitation speed caused a decline in the steady state concentration of the biomass. An impeller tip speed of >1.56 m s(-1) damaged P. tricornutum in aerated culture. In contrast, the damage threshold tip speed for P. cruentum was between 2.45 and 2.89 m s(-1). Mechanical agitation was not the direct cause of cell damage. Damage occurred because of the rupture of small gas bubbles at the surface of the culture, but mechanical agitation was instrumental in generating the bubbles that ultimately damaged the cells. Pluronic F68 protected the cells against damage and increased the steady state concentration of the biomass relative to operation without the additive. The protective effect of Pluronic was concentration-dependent over the concentration range of 0.01-0.10% w/v.

  1. Individual music therapy for agitation in dementia: an exploratory randomized controlled trial

    PubMed Central

    Stige, Brynjulf; Qvale, Liv Gunnhild; Gold, Christian

    2013-01-01

    Objectives: Agitation in nursing home residents with dementia leads to increase in psychotropic medication, decrease in quality of life, and to patient distress and caregiver burden. Music therapy has previously been found effective in treatment of agitation in dementia care but studies have been methodologically insufficient. The aim of this study was to examine the effect of individual music therapy on agitation in persons with moderate/severe dementia living in nursing homes, and to explore its effect on psychotropic medication and quality of life. Method: In a crossover trial, 42 participants with dementia were randomized to a sequence of six weeks of individual music therapy and six weeks of standard care. Outcome measures included agitation, quality of life and medication. Results: Agitation disruptiveness increased during standard care and decreased during music therapy. The difference at −6.77 (95% CI (confidence interval): −12.71, −0.83) was significant (p = 0.027), with a medium effect size (0.50). The prescription of psychotropic medication increased significantly more often during standard care than during music therapy (p = 0.02). Conclusion: This study shows that six weeks of music therapy reduces agitation disruptiveness and prevents medication increases in people with dementia. The positive trends in relation to agitation frequency and quality of life call for further research with a larger sample. PMID:23621805

  2. Modeling Air Stripping of Ammonia in an Agitated Vessel

    SciTech Connect

    Kofi, Adu-Wusu; Martino, Christopher J.; Wilmarth, William R.; Bennett, William M.; Peters, Robert s.

    2005-11-29

    A model has been developed to predict the rate of removal of ammonia (NH{sub 3}) from solution in a sparged agitated vessel. The model is first-order with respect to liquid-phase concentration of NH{sub 3}. The rate constant for the first-order equation is a function of parameters related to the vessel/impeller characteristics, the air/liquid properties as well as the process conditions. However, the vessel/impeller characteristics, the air/liquid properties, and the process conditions reduce the rate constant dependence to only three parameters, namely, the air sparge rate, the liquid volume or batch size, and the Henry's law constant of NH{sub 3} for the liquid or solution. Thus, the rate of removal is not mass-transfer limited. High air sparge rates, high temperatures, and low liquid volumes or batch sizes increase the rate of removal of NH{sub 3} from solution. The Henry's law constant effect is somewhat reflected in the temperature since Henry's law constant increases with increasing temperature. Data obtained from actual air stripping operation agree fairly well with the model predictions.

  3. EFFECTS OF MECHANICAL AGITATION AND OF TEMPERATURE UPON COMPLEMENT.

    PubMed

    Noguchi, H; Bronfenbrenner, J

    1911-02-01

    1. Under certain conditions, mechanical agitation destroys the complementary activity of guinea pig serum. It is most injurious when carried out constantly at a temperature of 37 degrees C., but it is extremely insignificant at 10 degrees C. After the first few hours at 37 degrees C., the destruction of complement proceeded much more rapidly, and after six hours it was almost complete. On the other hand, within one hour shaking had almost no destructive effect on complement, even at 37 degrees C. From this we may conclude that the several shakings which are necessary for fixation experiments during incubation do not modify perceptibly the outcome of the reactions. 2. The rate of destruction of the complement of guinea pig serum at temperatures above 45 degrees C. is progressively greater as it approaches 55 degrees C., at which temperature the activity is reduced in thirty minutes to one-thirtieth to one-fortieth of the original strength of the unheated serum; but it is not completely destroyed, as is commonly assumed. The velocity of destruction of guinea pig complement when exposed to 55 degrees C. for various lengths of time is found to be quite irregular, and not proportional to the length of time. This irregularity, however, presents a certain rhythm, a period of greater destruction alternating with one of less destruction.

  4. Illinois Dental Anesthesia and Sedation Survey for 1996.

    PubMed

    Flick, W G; Green, J; Perkins, D

    1998-01-01

    Dentists in the state of Illinois who possess a permit to administer sedation or general anesthesia were surveyed. A 71% response rate was achieved. Of the respondents, 86% held permits for deep sedation/general anesthesia and 14% held permits for parenteral conscious sedation. By practice specialty, 84% were oral and maxillofacial surgeons, 11% were general dentists, 5% were periodontists, and fewer than 1% were dental anesthesiologists. Advanced Cardiac Life Support training was possessed by 85% of the respondents. The most common anesthesia team configuration (82%) was a single operator-anesthetist and two additional assistants. Only 4% reported use of a nurse anesthetist, and 2% used an additional MD or DDS anesthesiologist. The vast majority (97%) of the practitioners do not intubate in the office on a routine basis. Supplemental oxygen was used by 81% of the respondents whenever intravenous agents were used. A total of 151,335 anesthetics were administered during the year. One mortality occurred in a patient with an undisclosed pre-existing cardiac condition. Four other events were reported that required medical intervention or hospital evaluation; however, no permanent injuries were reported. Other practice characteristics were described. PMID:10356432

  5. Moral differences in deep continuous palliative sedation and euthanasia.

    PubMed

    Juth, Niklas; Lindblad, Anna; Lynöe, Niels; Sjöstrand, Manne; Helgesson, Gert

    2013-06-01

    In palliative care there is much debate about which end of life treatment strategies are legitimate and which are not. Some writers argue that there is an important moral dividing-line between palliative sedation and euthanasia, making the first acceptable and the latter not. We have questioned this. In a recent article, Lars Johan Materstvedt has argued that we are wrong on two accounts: first, that we fail to account properly for the moral difference between continuous deep palliative sedation at the end of life and euthanasia, and, second, that we fail to account properly for the difference between permanent loss of consciousness and death. Regarding the first objection, we argue that Materstvedt misses the point: we agree that there is a difference in terms of intentions between continuous deep palliative sedation and euthanasia, but we question whether this conceptual difference makes up for a moral difference. Materstvedt fails to show that it does. Regarding the second objection, we argue that if nothing else is at stake than the value of the patient's life, permanent unconsciousness and death are morally indifferent.

  6. Sedative hypnotic activity of manahshila (realgar) -an experimental evaluation.

    PubMed

    Kodlady, Naveena; Doddamani, M S; Vishwanath, Y; Patgiri, B J

    2011-01-01

    Manahshila (Realgar) is one of the three major Arsenicals used in Ayurvedic therapeutics since ages. It is indicated in skin, respiratory, ophthalmic and psychological disorders. It is mentioned to be the best among Rasayanas and a good aphrodisiac. As Manahshila is indicated in Unmada (Psychological disorder); wide use of Manahshila in the formulations mentioned for psychological disorders; some of those formulations are used in treatment of sleeplessness and Ardraka (Zingiber officinale Roscoe) which is a commonly used Shodhana reagent of Manahshila is reported to be sedative, the potential sedative hypnotic activity is inferred and an experimental study was carried out to evaluate the sedative hypnotic activity of Manahshila. Effect of Ardraka Shodhita Manahshila (ASM) on the spontaneous motor activity of albino rats in actophotometer and on diazepam induced sleeping time was evaluated. There was a statistically significant reduction in the spontaneous motor activity (P<0.001) in the ASM treated Manahshila and there was early onset and hypnotic potentiation in the diazepam induced sleep in rats (P<0.01). PMID:22557432

  7. Standing sedation and pain management for ophthalmic patients.

    PubMed

    Robertson, Sheilah A

    2004-08-01

    Several ocular procedures, including examination, removal of corneal foreign bodies, nictitans surgery, eyelid repair, and tumor excision,can be successfully performed in the appropriately restrained and sedated standing horse. Sedation is best achieved with xylazine,with or without the addition of acepromazine. Additional analgesia can be provided with appropriate local anesthetic blocks. Surgical conditions are greatly improved by using an auriculopalpebral and supraorbital block and topical anesthetics. More elaborate standing sedation involving continuous rate infusions of lidocaine or detomidine combined with butorphanol may facilitate more involved surgery with appropriate support staff and equipment in animals that are at high risk for general anesthesia or when the latter is not an option. Short-term or long-term analgesia is most commonly provided with nonsteroidal anti-inflammatory drugs, but several newer techniques, including lidocaine and butorphanol infusions, may be effective. Topical treatment with opioids to provide analgesia and opioid antagonists to enhance corneal healing is an exciting new development that may revolutionize our approach to corneal ulcer therapy in the future if current research findings are supportive. PMID:15271436

  8. Measurement of Heart Rate Variability to Assess Pain in Sedated Critically Ill Patients: A Prospective Observational Study

    PubMed Central

    Broucqsault-Dédrie, Céline; De Jonckheere, Julien; Jeanne, Mathieu; Nseir, Saad

    2016-01-01

    Introduction The analgesia nociception index (ANI) assesses the relative parasympathetic tone as a surrogate for antinociception/nociception balance in sedated patients. The aim of this study is to determine the effectiveness of ANI in detecting pain in deeply sedated critically ill patients. Methods This prospective observational study was performed in two medical ICUs. All patients receiving invasive mechanical ventilation and deep sedation were eligible. In all patients, heart rate and ANI were continuously recorded using the Physiodoloris® device during 5 minutes at rest (T1), during a painful stimulus (T2), and during 5 minutes after the end of the painful stimulus (T3). The chosen painful stimulus was patient turning for washstand. Pain was evaluated at T2, using the behavioral pain scale (BPS). The primary objective was to determine the effectiveness of ANI in detecting pain. Secondary objectives included the impact of norepinephrine on the effectiveness of ANI in detecting pain, and the correlation between ANI and BPS. Results Forty-one patients were included. ANI was significantly lower at T2 (Med (IQR) 69(55–78)) compared with T1 (85(67–96), p<0.0001), or T3 (81(63–89), p<0.0001). Similar results were found in the subgroups of patients with (n = 21) or without (n = 20) norepinephrine. ANI values were significantly higher in patients with norepinephrine compared with those without norepinephrine at T1, and T2. No significant correlation was found between ANI and BPS at T2. Conclusions ANI is effective in detecting pain in deeply sedated critically ill patients, including those patients treated with norepinephrine. No significant correlation was found between ANI and BPS. PMID:26808971

  9. Optimal nonpharmacological management of agitation in Alzheimer's disease: challenges and solutions.

    PubMed

    Millán-Calenti, José Carlos; Lorenzo-López, Laura; Alonso-Búa, Begoña; de Labra, Carmen; González-Abraldes, Isabel; Maseda, Ana

    2016-01-01

    Many patients with Alzheimer's disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation) that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs) focused on the nonpharmacological management of agitation in Alzheimer's disease (AD) patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD. Further research in clinical trials is required to confirm the effectiveness and long-term effects of nonpharmacological interventions for managing agitation in AD. These types of studies may lead to the development of future intervention protocols to improve the well-being and daily functioning of these patients, thereby avoiding residential care placement. PMID:26955265

  10. Optimal nonpharmacological management of agitation in Alzheimer’s disease: challenges and solutions

    PubMed Central

    Millán-Calenti, José Carlos; Lorenzo-López, Laura; Alonso-Búa, Begoña; de Labra, Carmen; González-Abraldes, Isabel; Maseda, Ana

    2016-01-01

    Many patients with Alzheimer’s disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation) that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs) focused on the nonpharmacological management of agitation in Alzheimer’s disease (AD) patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD. Further research in clinical trials is required to confirm the effectiveness and long-term effects of nonpharmacological interventions for managing agitation in AD. These types of studies may lead to the development of future intervention protocols to improve the well-being and daily functioning of these patients, thereby avoiding residential care placement. PMID:26955265

  11. Optimal nonpharmacological management of agitation in Alzheimer's disease: challenges and solutions.

    PubMed

    Millán-Calenti, José Carlos; Lorenzo-López, Laura; Alonso-Búa, Begoña; de Labra, Carmen; González-Abraldes, Isabel; Maseda, Ana

    2016-01-01

    Many patients with Alzheimer's disease will develop agitation at later stages of the disease, which constitutes one of the most challenging and distressing aspects of dementia. Recently, nonpharmacological therapies have become increasingly popular and have been proven to be effective in managing the behavioral symptoms (including agitation) that are common in the middle or later stages of dementia. These therapies seem to be a good alternative to pharmacological treatment to avoid unpleasant side effects. We present a systematic review of randomized controlled trials (RCTs) focused on the nonpharmacological management of agitation in Alzheimer's disease (AD) patients aged 65 years and above. Of the 754 studies found, eight met the inclusion criteria. This review suggests that music therapy is optimal for the management of agitation in institutionalized patients with moderately severe and severe AD, particularly when the intervention includes individualized and interactive music. Bright light therapy has little and possibly no clinically significant effects with respect to observational ratings of agitation but decreases caregiver ratings of physical and verbal agitation. Therapeutic touch is effective for reducing physical nonaggressive behaviors but is not superior to simulated therapeutic touch or usual care for reducing physically aggressive and verbally agitated behaviors. Melissa oil aromatherapy and behavioral management techniques are not superior to placebo or pharmacological therapies for managing agitation in AD. Further research in clinical trials is required to confirm the effectiveness and long-term effects of nonpharmacological interventions for managing agitation in AD. These types of studies may lead to the development of future intervention protocols to improve the well-being and daily functioning of these patients, thereby avoiding residential care placement.

  12. What sedation to use during endoscopic procedure.

    PubMed

    Tonnarini, G F; Parlapiano, C; Pironti, E; Pantone, P; Chinazzi, A; Restuccia, M R; Antonaci, A

    2003-01-01

    Many endoscopists sometimes prefer to perform endoscopies without anaesthetic support, using only benzodiazepines. Endogenous opioid peptides are believed to play an important role in the modulation of pain within the endogenous analgesic system. A group of 40 patients undergoing diagnostic and therapeutic Endoscopic Retrograde Cholangiography and Pancreatography (ERCP) was recruited. Patients were divided into 2 groups according to Visual Analog Scale: pain 1-5 (Group A) and pain 6-10 (Group B). The beta-endorphin baseline values were significantly different between patients of Group A and Group B. Our data show that patients with levels of beta-endorphin over 8 pmol/L were less sensitive to pain, so that they become candidates for a traditional utilization of the benzodiazepines. However in the patients with beta-end levels less of 8 pmol/L should be suitable an anaesthetic as propofol because strong pain might provoke neurohumoral reflexes, cardiovascular alterations, and even a heart attack. PMID:15206488

  13. Volatile Anesthetics. Is a New Player Emerging in Critical Care Sedation?

    PubMed

    Jerath, Angela; Parotto, Matteo; Wasowicz, Marcin; Ferguson, Niall D

    2016-06-01

    Volatile anesthetic agent use in the intensive care unit, aided by technological advances, has become more accessible to critical care physicians. With increasing concern over adverse patient consequences associated with our current sedation practice, there is growing interest to find non-benzodiazepine-based alternative sedatives. Research has demonstrated that volatile-based sedation may provide superior awakening and extubation times in comparison with current intravenous sedation agents (propofol and benzodiazepines). Volatile agents may possess important end-organ protective properties mediated via cytoprotective and antiinflammatory mechanisms. However, like all sedatives, volatile agents are capable of deeply sedating patients, which can have respiratory depressant effects and reduce patient mobility. This review seeks to critically appraise current volatile use in critical care medicine including current research, technical consideration of their use, contraindications, areas of controversy, and proposed future research topics.

  14. Creation of a registered nurse-administered nitrous oxide sedation program for radiology and beyond.

    PubMed

    Farrell, Mary Kay; Drake, Gloria J; Rucker, Denise; Finkelstein, Marsha; Zier, Judith L

    2008-01-01

    Children undergoing urethral catheterization for urologic imaging under existing sedation practices were identified as an underserved patient population. Using a multidisciplinary approach, a registered nurse (RN)-administered nitrous oxide sedation program was developed to meet the needs of these children. Program development required delineation of RN scope of practice, evaluation of equipment, formulation of an educational program, and compliance with occupational safety standards. The program was implemented in 2004 using standard "dental" nitrous oxide equipment coupled with distraction and imagery to enhance the efficacy of the sedation experience. Initial assessment via telephone questionnaire indicated fewer adverse effects and more rapid return to baseline than oral midazolam, the sedative previously used for these procedures. Ongoing evaluation continues to confirm patient and environmental safety. The nitrous oxide program has expanded to provide sedation for additional tests in radiology as well as in other hospital departments. By implementing an RN-administered nitrous oxide program, children's access to this sedative/analgesic agent is increased.

  15. Volatile Anesthetics. Is a New Player Emerging in Critical Care Sedation?

    PubMed

    Jerath, Angela; Parotto, Matteo; Wasowicz, Marcin; Ferguson, Niall D

    2016-06-01

    Volatile anesthetic agent use in the intensive care unit, aided by technological advances, has become more accessible to critical care physicians. With increasing concern over adverse patient consequences associated with our current sedation practice, there is growing interest to find non-benzodiazepine-based alternative sedatives. Research has demonstrated that volatile-based sedation may provide superior awakening and extubation times in comparison with current intravenous sedation agents (propofol and benzodiazepines). Volatile agents may possess important end-organ protective properties mediated via cytoprotective and antiinflammatory mechanisms. However, like all sedatives, volatile agents are capable of deeply sedating patients, which can have respiratory depressant effects and reduce patient mobility. This review seeks to critically appraise current volatile use in critical care medicine including current research, technical consideration of their use, contraindications, areas of controversy, and proposed future research topics. PMID:27002466

  16. Flocculation of colloidal sols: Diffusion-controlled vs agitation-induced flocculation

    NASA Technical Reports Server (NTRS)

    1979-01-01

    A proposal for carrying out flocculation experiments in microgravity is presented. These experiments might allow a correlation between theory and experiment. First, all particles, whether single primary particles or aggregates of primary particles would not settle or cream at any agitation rate, or even in the absence of agitation. This failure to separate would keep all aggregates active, still serving as centers for diffusion-controlled flocculation. Keeping all particles suspended would allow the possibility of determining the total number of particles as a function of time from beginning to end of flocculation. Finally, the experiments would allow a definite separation diffusion-controlled and agitation-induced flocculation by studying diffusion-controlled flocculation with and without agitation.

  17. Role of citalopram in the treatment of agitation in Alzheimer’s disease

    PubMed Central

    Porsteinsson, Anton P; Keltz, Melanie A; Smith, Jessica S

    2014-01-01

    SUMMARY Neuropsychiatric symptoms (NPS) are common among individuals with Alzheimer’s disease (AD), associated with excess morbidity and mortality, greater healthcare use, earlier institutionalization, and caregiver burden. Agitation presents as emotional distress, excessive psychomotor activity, aggressive behaviors, disruptive irritability and dishibition. There is an unmet need to find pharmacologic treatment for agitation in patients with AD that can be safely and effectively used as a concurrent treatment alongside psychosocial interventions. A recent, multicenter, randomized, placebo-controlled trial explored the efficacy of a 30-mg daily dose of citalopram for agitation in patients with AD and showed a significant decrease in agitation for citalopram compared with placebo. Both QTc prolongation and cognitive worsening, as measured by the Mini Mental State Examination, were observed in the citalopram group and present a concern to clinicians. Citalopram at a 20-mg daily dose should be considered as a possible first-line treatment in addition to psychosocial intervention. PMID:25405648

  18. Hydraulic characteristics simulation of an innovative self-agitation anaerobic baffled reactor (SA-ABR).

    PubMed

    Qi, Wei-Kang; Hojo, Toshimasa; Li, Yu-You

    2013-05-01

    An investigation was conducted on a self-agitation anaerobic baffled reactor (SA-ABR) with agitation caused solely by the release of stored gas. The compound in the reactor is mixed without the use of any mechanical equipment and electricity. The computational fluid dynamics (CFD) simulation used to provide details of the flow pattern and information about the agitation process and a solid basis for design and optimization purposes. Every self-agitation cycle could be separated into the pressure energy storage process, the exergonic process and the buffer stage. The reactor is regarded as the combination of continuous stirred tank reactor and a small plug flow reactor. The liquid level and diffusion varies widely depending on the length of the U-tube. The compound transition phenomenon in the 1st chamber mainly occurs during the energy exergonic process and buffer stage. The fluid-diffusion in the 3rd and 4th chambers mainly happens after the buffer period.

  19. Biological activity of insulin in GMO gels and the effect of agitation.

    PubMed

    Sadhale, Y; Shah, J C

    1999-11-25

    Glyceryl monooleate (GMO)-water cubic phase gel was previously shown to protect insulin from agitation induced aggregation. However, it is not known if insulin is biologically active in the gel and what effect agitation has on insulin in the gel. Therefore, the objective was to determine the stability of insulin in cubic phase gel in terms of its biological activity in a suitable animal model such as Sprague-Dawley rats. Effect of agitation on biological activity of insulin in cubic phase GMO gel was determined by subcutaneous injections of the agitated and non-agitated gels to two groups of previously fasted rats and measuring the effect on their blood glucose levels. Two groups of rats administered with agitated insulin solution and normal saline were used as controls. The biological activity of insulin was evaluated by comparing AAC (area above the blood glucose level-time curve, in %-h), C(max) (maximum % decrease in blood glucose levels) and t(max) (time required to attain C(max), in h) values for the four groups of rats. Since cubic phase gel is highly viscous, therapeutic equivalency of insulin in the lamellar phase gel, which converts in situ into cubic phase gel, was compared to insulin solution with normal saline as the control, using AAC, C(max) and t(max) of the blood glucose profile. Insulin was biologically active in both agitated and non-agitated gels; however, upon agitation, insulin in solution totally lost its hypoglycemic activity. Agitation of insulin in the cubic phase gel was seen to have very little deleterious effect on its biological activity. Insulin in the lamellar phase gel was not only biologically active but also therapeutically equivalent to insulin solution based on AAC (327.9+/-100.8 and 431.7+/-113.3), C(max) (57. 1+/-7.0 and 70.2+/-6.5) and t(max) (2.8+/-0.7 and 4.0+/-1.7) for the lamellar phase gel and insulin solution, respectively (no significant difference, P0.05). In summary, GMO cubic phase gel protected insulin from

  20. Intravenous labetolol in treating hypertensive crisis following dexmedetomidine infusion for procedural sedation.

    PubMed

    Muthiah, Thilaka; Moni, Amarnath; Mathews, Lailu; Balaji, Sudarshan

    2016-03-01

    Dexmedetomidine is widely used for procedural sedation because of its unique combination of sedation, analgesia, and anxiolysis with minimal respiratory depression. Transient hypertension has been reported during the use of dexmedetomidine which is usually benign and is taken over by the hypotensive response on continuing the infusion. We report a case of hypertensive crisis following dexmedetomidine infusion used for procedural sedation, necessitating discontinuation of the infusion and treatment of hypertension. The dilemmas involved in treating hypertension caused by dexmedetomidine are discussed.

  1. Sedative activity of two flavonol glycosides isolated from the flowers of Albizzia julibrissin Durazz.

    PubMed

    Kang, T H; Jeong, S J; Kim, N Y; Higuchi, R; Kim, Y C

    2000-07-01

    The flowers of Albizzia julibrissin are used as a sedative in oriental traditional medicine. The phytochemical study of this plant allowed the isolation of two flavonol glycosides, quercitrin (1) and isoquercitrin (2). The sedative activity of these compounds was evaluated, and both compounds 1 and 2 increased pentobarbital-induced sleeping time in dose-dependent manner in mice. These results support the use of the flowers of this plant as a sedative agent. PMID:10904180

  2. Comparative evaluation of dexmedetomidine and midazolam-ketamine combination as sedative agents in pediatric dentistry: A double-blinded randomized controlled trial

    PubMed Central

    Malhotra, Parul Uppal; Thakur, Seema; Singhal, Parul; Chauhan, Deepak; Jayam, Cheranjeevi; Sood, Ritu; Malhotra, Yagyeshwar

    2016-01-01

    Background: Pharmacological methods have been used as an adjunct to enhance child cooperativeness and facilitate dental treatment. Objective: Purpose of this study was to evaluate and compare the effect of sedation by intranasal dexmedetomidine and oral combination drug midazolam–ketamine in a group of children with uncooperative behavior requiring dental treatment. Materials and Methods: This was a prospective, randomized, double-blind study that included patients 3–9 years old with American Society of Anesthesiologists-I status. About 36 children presenting early childhood caries were randomly assigned to one of three groups studied: Group MK received intranasal saline and oral midazolam (0.5 mg/kg) with ketamine (5 mg/kg) mixed in mango juice; Group DX received intranasal dexmedetomidine (1 μg/kg) and oral mango juice; and Group C received intranasal saline and oral mango juice. Patients' heart rate, blood pressure, and oxygen saturation were recorded before, during, and at the end of the procedure. Patients' behavior, sedation status, and wake up behavior were evaluated with modified observer assessment of alertness and sedation scale. Ease of treatment completion was evaluated according to Houpt scale. Results: Hemodynamic changes were statistically insignificant in Group MK and Group DX. About 75% patients in Group MK were successfully sedated as compared to 53.9% Group DX and none of the patients in Group C. Ease of treatment completion was better with Group MK as compared to Group DX and least with Group C. Around 50% patients in Group MK had postoperative complications. Conclusion: Oral midazolam–ketamine combination and intranasal dexmedetomidine evaluated in the present study can be used safely and effectively in uncooperative pediatric dental patients for producing conscious sedation. PMID:27307665

  3. Retrospective analysis of psychomotor agitation, hypomanic symptoms, and suicidal ideation in unipolar depression.

    PubMed

    Olgiati, Paolo; Serretti, Alessandro; Colombo, Cristina

    2006-01-01

    In bipolar depression, psychomotor agitation is relatively common and often is associated with other noneuphoric hypomanic symptoms and suicidal ideation. Our goal in this retrospective study was to ascertain the co-occurrence of agitation, bipolar features, and suicidal ideation in unipolar disorder. We retrospectively evaluated 314 inpatients with DSM-IV major depressive disorder (MDD) and no other Axis I diagnosis with the National Institutes of Mental Health (NIMH) Life Chart Method and the Operational Criteria for Psychotic Illness (OPCRIT) checklist to ascertain their symptom profiles across all episodes. Univariate and multivariate comparisons were performed between the subgroups with and without psychomotor agitation (OPCRIT item 23> or =1). Agitated depression (AD, a major depressive episode with psychomotor agitation) was present in 19% of the sample. Compared to nonagitated counterparts, patients with AD were older and had lower educational levels and more dysphoria, insomnia, positive thought disorder, and psychotic manifestations. Hypomanic symptoms other than agitation were relatively uncommon (<10%) and more represented in subjects with AD. No significant differences emerged between AD and control groups with respect to most bipolar validators (gender, familiarity, recurrence). Patients with AD had higher levels of suicidal ideation than non-AD controls; however, such a difference was no longer significant after controlling for psychotic features. Excessive self-reproach, early awakening, diurnal changes, poor appetite, and hypomanic symptoms were independently associated with suicidal thoughts in nonpsychotic MDD. Incomplete information on drug treatment, exclusion of patients with Axis I comorbidity, and tertiary care setting were the most important limitations of the study. Although we failed to support the bipolar nature of MDD-AD by common validators, probably because we used a more heterogeneous definition of agitation compared to similar

  4. [Study of the action of sultopride on psychomotor agitation. Apropos of 31 cases].

    PubMed

    Mouren, P; Poinso, Y; Guigou, G

    1976-06-23

    A study of sultopride, a new derivative of the substituted anisamides, has shown that this neuroleptic drug reduces markedly and rapidly psychomotor agitation, especially its aggressive component. It also has an action on hallucinations. Its indications, in order of efficacy, are states of acute agitation, psychotic states during the active phase, acute manifestations of alcoholism and behaviour disorders such as expansivity, impulsivity and agressivity. Its tolerance is good considering its strong activity.

  5. Using a therapy dog to alleviate the agitation and desocialization of people with Alzheimer's disease.

    PubMed

    Churchill, M; Safaoui, J; McCabe, B W; Baun, M M

    1999-04-01

    1. Short-term exposure to a therapy dog can reduce the number of agitation behaviors in institutionalized persons with Alzheimer's disease (AD), particularly during the period of agitation known as sundown syndrome. 2. The presence of a therapy dog can increase socialization behaviors among a group of persons with AD. 3. A therapy dog can be used as an adjunct to other calming interventions for persons with AD.

  6. Simple and Reproducible Two-Stage Agitation Speed Control Strategy for Enhanced Triterpene Production by Lingzhi or Reishi Medicinal Mushrooms, Ganoderma lucidum ACCC G0119 (Higher Basidiomycetes) Based on Submerged Liquid Fermentation.

    PubMed

    Feng, Jie; Feng, Na; Yang, Yan; Liu, Fang; Zhang, Jingsong; Jia, Wei; Lin, Chi-Chung

    2015-01-01

    Triterpenes are important anticancer agents produced by batch submerged liquid fermentation, with the medicinal mushroom Ganoderma lucidum ACCC G0119, which was investigated under various dissolved oxygen levels by varying agitation speeds. Three kinetic parameters were analyzed: specific mycelial growth rate (μsmg), specific glucose consumption rate (qsgc), and specific triterpene production rate (qstp). High concentration, yield, and productivity of triterpenes were achieved by developing a simple and reproducible two-stage agitation speed control strategy. At the first 40 h, agitation speed was controlled at 150 rpm to obtain the quickest peak qstp for triterpene production, subsequently agitation speed was controlled at 100 rpm to maintain high qstp for high triterpene accumulation. The maximum concentration of triterpenes reached 0.086 g/l with the yield of 6.072 g/kg and the productivity of 6.532 × 10-4 g/(l·h), which were 39.61%, 36.48%, and 49.22%, respectively, better than the best results controlled by fixed agitation speeds. Conceivably, such a triterpene fermentation production strategy would be useful for industrial large-scale production of triterpenes with G. lucidum. PMID:26854102

  7. Studies on heat transfer to Newtonian and non-Newtonian fluids in agitated vessel

    NASA Astrophysics Data System (ADS)

    Triveni, B.; Vishwanadham, B.; Venkateshwar, S.

    2008-09-01

    Heat transfer studies to Newtonian and non-Newtonian fluids are carried out in a stirred vessel fitted with anchor/turbine impeller and a coil for heating/cooling with an objective of determining experimentally the heat transfer coefficient of few industrially important systems namely castor oil and its methyl esters, soap solution, CMC and chalk slurries. The effect of impeller geometry, speed and aeration is investigated. Generalized Reynolds and Prandtl numbers are calculated using an apparent viscosity for non-Newtonian fluids. The data is correlated using a Sieder-Tate type equation. A trend of increase in heat transfer coefficient with RPM in presence and absence of solids has been observed. Relatively high values of Nusselt numbers are obtained for non-Newtonian fluids when aeration is coupled with agitation. The contribution of natural convection to heat transfer has been accounted for by incorporating the Grashof number. The correlations developed based on these studies are applied for design of commercial scale soponification reactor. Power per unit volume resulted in reliable design of a reactor.

  8. Computational Fluid Dynamics (CFD) Simulations on Multiphase Flow in Mechanically Agitated Seed Precipitation Tank

    NASA Astrophysics Data System (ADS)

    Zhao, Hong-Liang; Liu, Yan; Zhang, Ting-An; Gu, Songqing; Zhang, Chao

    2014-07-01

    The large-scale mechanically agitated tank has been widely used in the decomposition process of sodium aluminate solution in the alumina industry. The mixing process in three types of seed precipitation tanks (Robin, Ekato, and improved Ekato) stirred with multiple impellers was compared by using computational fluid dynamics, respectively. The flow field, solid distribution, mixing time, and power consumption were numerically simulated by adopting a Eulerian granular multiphase model and a standard k- ɛ turbulence model. A steady multiple reference frame approach was used to represent impeller rotation. Compared with the Robin tank, the Ekato tank can generate an axial circulation loop, which is better for fluid mixing and solid suspension; meanwhile about half of the power can be saved. With future improvements in the Ekato tank, the fluid mixing and exchanging can be enhanced under the interaction of a lengthened Intermig impeller coupled with sloped baffles. With a little increase in power consumption, the maximum of the relative solid concentration difference in the whole tank can be maintained within 3%, which meets the design requirement.

  9. A case of accidental aspiration of an endodontic instrument by a child treated under conscious sedation.

    PubMed

    Mahesh, R; Prasad, Vishnu; Menon, Padma A

    2013-04-01

    Dental management of children with attention-deficit hyperactivity disorder (ADHD) often requires the need for pharmacological behavior management techniques such as the use of sedation. The purpose of this article is to describe a clinical case involving accidental aspiration of an Endodontic instrument during root canal therapy under sedation. To our knowledge, this is the first case report of aspiration of an Endodontic instrument and should serve to heighten the awareness with regard to aspiration during dental procedures under sedation. It also emphasizes the need for proper isolation techniques in patients treated under sedation, thereby preventing such complications.

  10. Review of palliative sedation and its distinction from euthanasia and lethal injection.

    PubMed

    Hahn, Michael P

    2012-01-01

    Palliative sedation evolved from within the practice of palliative medicine and has become adopted by other areas of medicine, such as within intensive care practice. Clinician's usually come across this practice for dying patients who are foregoing or having life support terminated. A number of intolerable and intractable symptom burdens can occur during the end of life period that may require the use of palliative sedation. Furthermore, when patients receive palliative sedation, the continued use of hydration and nutrition becomes an issue of consideration and there are contentious bioethical issues involved in using or withholding these life-sustaining provisions. A general understanding of biomedical ethics helps prevent abuse in the practice of palliative sedation. Various sedative drugs can be employed in the provision of palliative sedation that can produce any desired effect, from light sedation to complete unconsciousness. Although there are some similarities in the pharmacotherapy of palliative sedation, euthanasia, physician-assisted suicide, and lethal injection, there is a difference in how the drugs are administered with each practice. There are some published guidelines about how palliative sedation should be practiced, but currently there is not any universally accepted standard of practice.

  11. A case of accidental aspiration of an endodontic instrument by a child treated under conscious sedation.

    PubMed

    Mahesh, R; Prasad, Vishnu; Menon, Padma A

    2013-04-01

    Dental management of children with attention-deficit hyperactivity disorder (ADHD) often requires the need for pharmacological behavior management techniques such as the use of sedation. The purpose of this article is to describe a clinical case involving accidental aspiration of an Endodontic instrument during root canal therapy under sedation. To our knowledge, this is the first case report of aspiration of an Endodontic instrument and should serve to heighten the awareness with regard to aspiration during dental procedures under sedation. It also emphasizes the need for proper isolation techniques in patients treated under sedation, thereby preventing such complications. PMID:24883031

  12. Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: a longitudinal cohort study.

    PubMed

    Sampson, Elizabeth L; White, Nicola; Lord, Kathryn; Leurent, Baptiste; Vickerstaff, Victoria; Scott, Sharon; Jones, Louise

    2015-04-01

    Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen-Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (β = 0.20, 95% confidence interval [CI] = 0.07-0.32, P = 0.002) and at rest (β = 0.41, 95% CI = 0.14-0.69, P = 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia. PMID:25790457

  13. Pain, agitation, and behavioural problems in people with dementia admitted to general hospital wards: a longitudinal cohort study.

    PubMed

    Sampson, Elizabeth L; White, Nicola; Lord, Kathryn; Leurent, Baptiste; Vickerstaff, Victoria; Scott, Sharon; Jones, Louise

    2015-04-01

    Pain is underdetected and undertreated in people with dementia. We aimed to investigate the prevalence of pain in people with dementia admitted to general hospitals and explore the association between pain and behavioural and psychiatric symptoms of dementia (BPSD). We conducted a longitudinal cohort study of 230 people, aged above 70, with dementia and unplanned medical admissions to 2 UK hospitals. Participants were assessed at baseline and every 4 days for self-reported pain (yes/no question and FACES scale) and observed pain (Pain Assessment in Advanced Dementia scale [PAINAD]) at movement and at rest, for agitation (Cohen-Mansfield Agitating Inventory [CMAI]) and BPSD (Behavioural Pathology in Alzheimer Disease Scale [BEHAVE-AD]). On admission, 27% of participants self-reported pain rising to 39% on at least 1 occasion during admission. Half of them were able to complete the FACES scale, this proportion decreasing with more severe dementia. Using the PAINAD, 19% had pain at rest and 57% had pain on movement on at least 1 occasion (in 16%, this was persistent throughout the admission). In controlled analyses, pain was not associated with CMAI scores but was strongly associated with total BEHAVE-AD scores, both when pain was assessed on movement (β = 0.20, 95% confidence interval [CI] = 0.07-0.32, P = 0.002) and at rest (β = 0.41, 95% CI = 0.14-0.69, P = 0.003). The association was the strongest for aggression and anxiety. Pain was common in people with dementia admitted to the acute hospital and associated with BPSD. Improved pain management may reduce distressing behaviours and improve the quality of hospital care for people with dementia.

  14. Use of seagrass meadows as an adaptation measure to climate change for reducing port agitation

    NASA Astrophysics Data System (ADS)

    Sánchez-Arcilla, Agustín; Lin, Jue; Pau Sierra, Joan; Gracia, Vicenç; Casas-Prat, Merce; Virgili, Marc

    2014-05-01

    the obtained wave projections to identify harbours where wave oscillation is expected to have a negative effect. One of these harbours, where agitation clearly increases, is selected to study the effectiveness of sea-grass for reducing wave heights within the harbour. Moreover, a sensitivity analysis is carried out to relate wave height decrease with sea-grass parameters such as meadow surface, plant density or submergence ratio (ratio between water depth and stem length). Acknowledgments The work described in this publication was supported by the European Community's Seventh Framework Programme through the grant to the budget of the Collaborative Project RISES-AM-, Contract FP7-ENV-2013-two-stage-603396. References Casas-Prat M, Sierra JP (2012). Trend analysis of wave direction and associated impacts on the Catalan Coast. Climatic Change 115:667-691. Casas-Prat M, Sierra JP (2013). Projected future wave climate in the NW Mediterranean Sea. Journal of Geophysical Research: Oceans 118:3548-3568. Koftis T, Prinos P, Stratigaki V (2013). Wave damping over artificial posidonia oceanica meadow: A large-scale experimental study. Coastal Engineering 73:71-83.

  15. Silicone Oil- and Agitation-Induced Aggregation of a Monoclonal Antibody in Aqueous Solution

    PubMed Central

    Thirumangalathu, Renuka; Krishnan, Sampathkumar; Ricci, Margaret Speed; Brems, David N.; Randolph, Theodore W.; Carpenter, John F.

    2009-01-01

    Silicone oil, which is used as a lubricant or coating in devices such as syringes, needles and pharmaceutical containers, has been implicated in aggregation and particulation of proteins and antibodies. Aggregation of therapeutic protein products induced by silicone oil can pose a challenge to their development and commercialization. To systematically characterize the role of silicone oil on protein aggregation, the effects of agitation, temperature, pH and ionic strength on silicone oil-induced loss of monomeric anti-streptavidin IgG 1 antibody were examined. Additionally, the influences of excipients polysorbate20 and sucrose on protein aggregation were investigated. In the absence of agitation, protein absorbed to silicone oil with approximately monolayer coverage, however silicone oil did not stimulate aggregation during isothermal incubation unless samples were also agitated. A synergistic stimulation of aggregation by a combination of agitation and silicone oil was observed. Solution conditions which reduced colloidal stability of the antibody, as assessed by determination of osmotic second virial coefficients, accelerated aggregation during agitation with silicone oil. Polysorbate20 completely inhibited silicone oil-induced monomer loss during agitation. A formulation strategy optimizing colloidal stability of the antibody as well as incorporation of surfactants such as polysorbate20 is proposed to reduce silicone oil-induced aggregation of therapeutic protein products. PMID:19360857

  16. Comparison of two different sevoflurane expelling methods on emergence agitation in infants following sevoflurane anesthesia

    PubMed Central

    Yang, Yunliang; Song, Tieying; Wang, Hong; Gu, Kunfeng; Ma, Pengyu; Ma, Xiaojing; Zhao, Jianhui; Li, Yuxia; Zhao, JianHui; Yang, Guangyao; Yan, Ruyu

    2015-01-01

    Purpose: To investigate the effects of two different inhalation anesthetic expelling methods on emergence agitation in infants following sevoflurane anesthesia. Methods: 100 infants (1~3 years old) with cleft lip and palate and ASA classification I~II were randomized into two groups, a sevoflurane concentration decreasing expelling group (group n = 50 cases) and a low fresh gas flow expelling group (group D = 50 cases). The operation for cleft lip and palate repair was under general anesthesia, in which 30 minutes after initiation of narcosis ending extubation was indicated and after the tubes were removed the patients were sent to the post-anesthesia care unit (PACU) to record anesthesia times, emergence agitation scores, Ramsay scores and adverse reactions including drowsiness, respiratory depression, nausea and vomiting, chills, hiccough or laryngospasms. Results: There were no differences in anesthesia times, awaking time and time until extubation between the two groups. 10 min after start of expelling sevoflurane, blood pressure and heart rates were higher in group N than in group D (P < 0.05). The postoperative agitation incidence and the degree of agitation were lower in group D than in group N (P < 0.05). Conclusion: Postoperative agitation is prone to occur in patients with sevoflurane concentration decreasing expelling. Avoiding sevoflurane application maintenance in the stage of sevoflurane expelling reduces the occurrence of postoperative agitation and diminishes physiological and psychological harm. PMID:26131225

  17. Computational fluid dynamics (CFD) insights into agitation stress methods in biopharmaceutical development.

    PubMed

    Bai, Ge; Bee, Jared S; Biddlecombe, James G; Chen, Quanmin; Leach, W Thomas

    2012-02-28

    Agitation of small amounts of liquid is performed routinely in biopharmaceutical process, formulation, and packaging development. Protein degradation commonly results from agitation, but the specific stress responsible or degradation mechanism is usually not well understood. Characterization of the agitation stress methods is critical to identifying protein degradation mechanisms or specific sensitivities. In this study, computational fluid dynamics (CFD) was used to model agitation of 1 mL of fluid by four types of common laboratory agitation instruments, including a rotator, orbital shaker, magnetic stirrer and vortex mixer. Fluid stresses in the bulk liquid and near interfaces were identified, quantified and compared. The vortex mixer provides the most intense stresses overall, while the stir bar system presented locally intense shear proximal to the hydrophobic stir bar surface. The rotator provides gentler fluid stresses, but the air-water interfacial area and surface stresses are relatively high given its low rotational frequency. The orbital shaker provides intermediate-level stresses but with the advantage of a large stable platform for consistent vial-to-vial homogeneity. Selection of experimental agitation methods with targeted types and intensities of stresses can facilitate better understanding of protein degradation mechanisms and predictability for "real world" applications. PMID:22172288

  18. Effect of agitation on ligninase activity and ligninase production by Phanerochaete chrysosporium

    SciTech Connect

    Venkatadri, R.; Irvine, R.L. )

    1990-09-01

    The white rot fungus Phanerochaete chrysosporium produces extracellular ligninases as part of its idiophasic ligninolytic system. Agitation has been widely reported to suppress both ligninase production and lignin degradation. Results show that mechanical inactivation of ligninase is possibly the reason why ligninase accumulation is low or absent in agitated shake-flask cultures. Agitation seems to affect the catalytic activity of ligninase and has no apparent effect on either the rate of ligninase production or the physiology of P. chrysosporium. The detergents Tween 20, Tween 40, Tween 60, Tween 80, and 3-((3-cholamidopropyl)dimethylammonio)-1-propanesuflonate (CHAPS) are able to protect both purified ligninase and extant ligninase in culture fluids (free of biomass) against mechanical inactivation due to agitation. Addition of Tween 80 at the end of primary growth to agitated shake flasks containing either pelleted or immobilized mycelial cultures results in production and maintenance of high levels of ligninase activity over several days under conditions of high agitation. Possible mechanisms by which the detergents could protect ligninase are discussed.

  19. Prevention of sevoflurane related emergence agitation in children undergoing adenotonsillectomy: A comparison of dexmedetomidine and propofol

    PubMed Central

    Ali, Monaz Abdulrahman; Abdellatif, Ashraf Abualhasan

    2013-01-01

    Background: Emergence agitation (EA) in children is increased after sevoflurane anesthesia. Propofol and dexmedetomidine have been used for prophylactic treatment with controversial results. The aim of the present study was to compare the effect of a single dose of propofol or dexmedetomidine prior to termination of sevoflurane-based anesthesia on the incidence and severity of EA in children. Methods: One hundred and twenty children, American Society of Anesthesiologists I-II, 2-6 years old undergoing adenotonsillectomy under sevoflurane based anesthesia were enrolled in the study. Children were randomly allocated to one of the three equal groups: (Group C) received 10 ml saline 0.9%, (Group P) received propofol 1 mg/kg or (group D) received dexmedetomidine 0.3 ug/kg-1. The study drugs were administered 5 min before the end of surgery. In post anesthesia care unit (PACU), the incidence of EA was assessed with Aonos four point scale and the severity of EA was assessed with pediatric anesthesia emergence delirium scale upon admission (T0), after 5 min (T5), 15 min (T15) and 30 min (T30). Extubation time, emergence time, duration of PACU stay and pain were assessed. Results: The incidence and severity of EA were lower in group P and group D compared to group C at T0, T5 and T15. The incidence and severity of EA in group P were significantly higher than group D at the same times. The incidence and severity of EA decreased significantly over time in all groups. The modified Children's Hospital of Eastern Ontario Pain Scale was significantly lower in group D compared to group C and group P. Conclusions: Dexmedetomidine 0.3 ug/kg1 was more effective than propofol 1 mg/kg in decreasing the incidence and severity of EA, when administered 5 min before the end of surgery in children undergoing adenotonsillectomy under sevoflurane anesthesia. PMID:24015133

  20. Respiratory and sedative effects of clobazam and clonazepam in volunteers.

    PubMed Central

    Wildin, J D; Pleuvry, B J; Mawer, G E; Onon, T; Millington, L

    1990-01-01

    1. The respiratory and psychomotor effects of two benzodiazepines used mainly as anticonvulsants were compared in healthy volunteers, using a double-blind placebo controlled design. 2. Clobazam (10 and 20 mg) produced significantly fewer psychomotor side effects than clonazepam (0.5 and 1 mg). Neither drug at either dose affected the ventilatory response to CO2. 3. Although clonazepam produced significant effects on psychomotor performance, these did not correlate with plasma drug concentration. 4. Our studies provide further evidence that at the doses chosen clobazam is considerably less sedating than clonazepam. Further investigation is required into the tolerance profile of both drugs in patients. PMID:2106335

  1. Scales

    MedlinePlus

    Scales are a visible peeling or flaking of outer skin layers. These layers are called the stratum ... Scales may be caused by dry skin, certain inflammatory skin conditions, or infections. Eczema , ringworm , and psoriasis ...

  2. Can Agitated Behavior of Nursing Home Residents with Dementia be Prevented With the Use of Standardized Stimuli?

    PubMed Central

    Cohen-Mansfield, Jiska; Marx, Marcia S.; Dakheel-Ali, Maha; Regier, Natalie G.; Thein, Khin; Freedman, Laurence

    2010-01-01

    Objectives The objective of this paper was to assess the relative impact of different types of stimuli on agitated behaviors of nursing home residents with dementia. Design Setting/Participants Participants were 111 residents of 7 Maryland nursing homes with a diagnosis of dementia who exhibited agitation. Intervention Different types of stimuli (music, social stimuli, simulated social stimuli, and individualized stimuli based on the person’s self-identity) to prevent behavior problems. Measurements Agitation was directly observed and recorded via the Agitated Behaviors Mapping Instrument. Results All stimulus categories were associated with significantly less physical agitation than baseline observations, and all except for manipulative stimuli were associated with significantly less total agitation. Live social stimuli were associated with less agitation than music, self-identity, work, simulated social, and manipulative stimulus categories. Task and reading stimulus categories were each associated with significantly less agitation than work, simulated social, and manipulative stimulus categories. Music and self-identity stimuli were associated with less agitation than simulated social and manipulative stimuli. Conclusion Providing stimuli offers a proactive approach to preventing agitation in persons with dementia, with live social stimuli being most successful. PMID:20579167

  3. Effects of Agitation and Storage Temperature on Measurements of Hydration Status

    PubMed Central

    Adams, Heather M; Eberman, Lindsey E; Yeargin, Susan W; Niemann, Andrew J; Mata, Heather L; Dziedzicki, David J

    2015-01-01

    Background: Hypohydration can have significant implications on normal physiological functions of the body. Objectives: This study aimed to determine the impact of agitation, storage temperature, and storage time on urine osmolality compared to the criterion control. Patients and Methods: We used a descriptive diagnostic validity test design. To investigate agitation, we recruited 75 healthy individuals (males = 41, females = 34; mean age = 22 ± 5 years; mean self-reported height = 172 ± 23 cm and mass = 77 ± 17 kg) who provided one or more samples (total = 81). The independent variables were agitation (vortex, hand shaken, no agitation) and temperature (room temperature, freezer, and refrigerator) type. Participants completed informed consent, a health questionnaire and were asked to provide a urine sample, which was split and labeled according to agitation type or storage temperature. Urine osmolality was used to determine hydration status at two time points (within 2 hours [control], 48 hours). We used t-tests to determine the difference between each condition and the control and calculated percent error for each condition. Results: No significant differences for no agitation (t79 = -0.079, P = 0.937), hand shaken (t79 = 1.395, P = 0.167) or vortex mixed (t79 = -0.753, P = 0.453) were identified when compared to the criterion control. No significant differences for room temperature (t82 = -0.720, P = 0.474), refrigerator (t82 = -2.697, P = 0.008) or freezer (t82 = 2.576, P = 0.012) were identified when compared to the criterion control. Conclusions: Our findings suggest agitation of urine specimen is not necessary and samples do not require refrigeration or freezing if assessed within 48 hours. Analysis within two hours of collection is not necessary and samples can be stored for up to 48 hours without impacting the hydration status of the sample. PMID:26715967

  4. Delayed egg hatching of Anopheles gambiae (Diptera: Culicidae) pending water agitation.

    PubMed

    Ebrahimi, Babak; Shakibi, Sanam; Foster, Woodbridge A

    2014-05-01

    Mosquito eggs laid on water surfaces typically hatch spontaneously soon after the embryos within them become fully formed first-instar larvae. However, we have found that Anopheles gambiae Giles, an important vector of malaria in Africa, exhibits delayed hatching until the water surface is agitated, a feature overlooked in most laboratory colonies. Agitation within 24 h postoviposition, before embryonation was complete, failed to stimulate delayed postembryonic hatching of isolated eggs on the following day (day 2), when < 1% had hatched spontaneously. However, 5 min of water agitation of these dormant pharate first-instar larvae on day 2 resulted in an almost immediate hatch of 63.3 versus 0% of nonagitated controls, plus another 3.9 versus 0.3%, respectively, during the following 24 h. With daily agitation, installment hatching occurred mainly during 2-6 d postoviposition. The mean cumulative hatch after 7 d of daily agitation was 83.1 versus 1.1% of nonagitated eggs. Experiments with eggs in groups demonstrated that egg density and activity of already-hatched larvae had no stimulatory effect. Eggs stored 1-4 wk at 25.5 or at 15.5 degrees C, and then agitated daily for 6 d at 25.5 degrees C, showed a gradual decline in viability. Viability was sustained longer at the lower temperature. Implications of agitation-induced egg hatching for rainy-season and dry-season ecology of An. gambiae are discussed. Suspended hatching and cool storage already are proving convenient for efficient mass rearing and accurate modeling of weather-based population dynamics.

  5. The use of Midazolam as an Intranasal Sedative in Dentistry.

    PubMed

    Greaves, Anwen

    2016-01-01

    The administration of midazolam intranasally exploits the unique structure of the nasopharynx thus ensuring rapid delivery to the systemic circulation (The Nose - Brain Pathway). The absorption of midazolam nasally is influenced by the volume and concentration of midazolam, its physicochemical properties and the characteristics of the nasal mucosa. Delivering midazolam intranasally is non-titratable. The level of conscious sedation may be equivalent to that achieved by intravenous routes but is approached in a less controlled manner. Randomised Control trials using intranasal sedation in children have shown the technique to be safe and effective in secondary care for dental procedures at concentrations varying from 0.2 mg/kg to 0.5 mg/kg. A combined technique of intranasal midazolam (to facilitate cannulation) and intravenous midazolam is used for adults with moderate to severe learning disabilities. This has revolutionised dental treatment for this group of patients as treatment under General Anaesthesia (GA) may be avoided. Intranasal delivery of midazolam is emerging as a significant tool in our dental armamentarium for the treatment of anxious children, phobic adult patients and patients with learning disabilities.

  6. Strategies to minimize sedation in pediatric body magnetic resonance imaging.

    PubMed

    Jaimes, Camilo; Gee, Michael S

    2016-05-01

    The high soft-tissue contrast of MRI and the absence of ionizing radiation make it a valuable tool for assessment of body pathology in children. Infants and young children are often unable to cooperate with awake MRI so sedation or general anesthesia might be required. However, given recent data on the costs and potential risks of anesthesia in young children, there is a need to try to decrease or avoid sedation in this population when possible. Child life specialists in radiology frequently use behavioral techniques and audiovisual support devices, and they practice with children and families using mock scanners to improve child compliance with MRI. Optimization of the MR scanner environment is also important to create a child-friendly space. If the child can remain inside the MRI scanner, a variety of emerging techniques can reduce the effect of involuntary motion. Using sequences with short acquisition times such as single-shot fast spin echo and volumetric gradient echo can decrease artifacts and improve image quality. Breath-holding, respiratory triggering and signal averaging all reduce respiratory motion. Emerging techniques such as radial and multislice k-space acquisition, navigator motion correction, as well as parallel imaging and compressed sensing reconstruction methods can further accelerate acquisition and decrease motion. Collaboration among radiologists, anesthesiologists, technologists, child life specialists and families is crucial for successful performance of MRI in young children. PMID:27229508

  7. 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

  8. The use of Midazolam as an Intranasal Sedative in Dentistry.

    PubMed

    Greaves, Anwen

    2016-01-01

    The administration of midazolam intranasally exploits the unique structure of the nasopharynx thus ensuring rapid delivery to the systemic circulation (The Nose - Brain Pathway). The absorption of midazolam nasally is influenced by the volume and concentration of midazolam, its physicochemical properties and the characteristics of the nasal mucosa. Delivering midazolam intranasally is non-titratable. The level of conscious sedation may be equivalent to that achieved by intravenous routes but is approached in a less controlled manner. Randomised Control trials using intranasal sedation in children have shown the technique to be safe and effective in secondary care for dental procedures at concentrations varying from 0.2 mg/kg to 0.5 mg/kg. A combined technique of intranasal midazolam (to facilitate cannulation) and intravenous midazolam is used for adults with moderate to severe learning disabilities. This has revolutionised dental treatment for this group of patients as treatment under General Anaesthesia (GA) may be avoided. Intranasal delivery of midazolam is emerging as a significant tool in our dental armamentarium for the treatment of anxious children, phobic adult patients and patients with learning disabilities. PMID:27145560

  9. IV ATP potentiates midazolam sedation as assessed by bispectral index.

    PubMed

    Sakurai, Satoru; Fukunaga, Atsuo; Ichinohe, Tatsuya; Kaneko, Yuzuru

    2014-01-01

    In this study, by measuring bispectral index (BIS), we tested the hypothesis that intravenous adenosine 5'-triphosphate (ATP) infusion would deepen the level of midazolam-induced sedation. Ten healthy volunteers underwent 2 experiments with at least 2 weeks' interval: immediately after intravenous bolus administration of midazolam (0.04 mg/kg), they received continuous infusion of either ATP infusion (100 μg/kg/min) or placebo (saline) for 40 minutes in a double-blind, randomized, crossover manner. Changes in BIS values and responsiveness to verbal command as well as cardiorespiratory variables were observed throughout the study periods. Administration of midazolam alone reduced BIS value from control: 97 ± 1 to 68 ± 18 at 25 minutes, which was accompanied by significant cardiopulmonary depressant effects, while maintaining responsiveness to verbal command (consciousness) throughout the study period. Coadministration of ATP with midazolam further reduced BIS value to 51 ± 13, associated with complete loss of consciousness without adverse effect on the cardiorespiratory systems. We conclude that the addition of ATP infusion to midazolam significantly enhances midazolam sedation without disturbing cardiorespiratory functions. PMID:25191981

  10. IV ATP Potentiates Midazolam Sedation as Assessed by Bispectral Index

    PubMed Central

    Sakurai, Satoru; Fukunaga, Atsuo; Ichinohe, Tatsuya; Kaneko, Yuzuru

    2014-01-01

    In this study, by measuring bispectral index (BIS), we tested the hypothesis that intravenous adenosine 5′-triphosphate (ATP) infusion would deepen the level of midazolam-induced sedation. Ten healthy volunteers underwent 2 experiments with at least 2 weeks' interval: immediately after intravenous bolus administration of midazolam (0.04 mg/kg), they received continuous infusion of either ATP infusion (100 μg/kg/min) or placebo (saline) for 40 minutes in a double-blind, randomized, crossover manner. Changes in BIS values and responsiveness to verbal command as well as cardiorespiratory variables were observed throughout the study periods. Administration of midazolam alone reduced BIS value from control: 97 ± 1 to 68 ± 18 at 25 minutes, which was accompanied by significant cardiopulmonary depressant effects, while maintaining responsiveness to verbal command (consciousness) throughout the study period. Coadministration of ATP with midazolam further reduced BIS value to 51 ± 13, associated with complete loss of consciousness without adverse effect on the cardiorespiratory systems. We conclude that the addition of ATP infusion to midazolam significantly enhances midazolam sedation without disturbing cardiorespiratory functions. PMID:25191981

  11. 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

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

    PubMed Central

    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

  13. 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

  14. Admixture of propofol and alfentanil. Use for intravenous sedation and analgesia during transvaginal oocyte retrieval.

    PubMed

    Sherry, E

    1992-06-01

    An admixture of propofol and alfentanil provides adequate sedation and analgesia during transvaginal oocyte retrieval in the absence of a paracervical block. In 100 patients the technique provided haemodynamic stability, sedation which was easily controlled, rapid recovery and universal patient acceptance.

  15. Comparison of Intravenous Dexmedetomidine and Midazolam for Bispectral Index-Guided Sedation During Spinal Anesthesia

    PubMed Central

    Jo, Youn Yi; Lee, Dongchul; Jung, Wol Seon; Cho, Noo Ree; Kwak, Hyun Jeong

    2016-01-01

    Background Despite the high frequency of hypotension during spinal anesthesia with proper sedation, no previous report has compared the hemodynamic effects of dexmedetomidine and midazolam sedation during spinal anesthesia. We compared the effects of bispectral index (BIS)-guided intravenous sedation using midazolam or dexmedetomidine on hemodynamics and recovery profiles in patients who underwent spinal anesthesia. Material/Methods One hundred and sixteen adult patients were randomly assigned to receive either midazolam (midazolam group; n=58) or dexmedetomidine (dexmedetomidine group; n=58) during spinal anesthesia. Systolic, diastolic, and mean arterial pressures; heart rates; peripheral oxygen saturations; and bispectral index scores were recorded during surgery, and Ramsay sedation scores and postanesthesia care unit (PACU) stay were monitored. Results Hypotension occurred more frequently in the midazolam group (P<0.001) and bradycardia occurred more frequently in the dexmedetomidine group (P<0.001). Mean Ramsay sedation score was significantly lower in the dexmedetomidine group after arrival in the PACU (P=0.025) and PACU stay was significantly longer in the dexmedetomidine group (P=0.003). Conclusions BIS-guided dexmedetomidine sedation can attenuate intraoperative hypotension, but induces more bradycardia, prolongs PACU stay, and delays recovery from sedation in patients during and after spinal anesthesia as compared with midazolam sedation. PMID:27701366

  16. Sedative load among community-dwelling older individuals: change over time and association with mortality.

    PubMed

    Taipale, Heidi T; Bell, J Simon; Hartikainen, Sirpa

    2012-07-01

    The aim of this study was to investigate the change in sedative load over time and the corresponding risk of death among community-dwelling older individuals. A random sample of 1000 individuals aged at least 75 years was invited to participate in 2004, of whom 700 were community dwelling. Demographic, diagnostic, and drug use data were obtained during annual nurse interviews. Sedative load was calculated according to a previously published model. The prevalence of sedative use increased from 29.3 to 36.1% from 2004 to 2007. In unadjusted analyses, sedative load was associated with an increased risk of death. After adjusting for clinically important covariates, sedative load was not associated with an increased risk of death [sedative load 1-2; hazard ratio 1.12 (95% confidence interval 0.76-1.64), sedative load of at least 3; hazard ratio 0.92 (95% confidence interval 0.55-1.56)]. In conclusion, sedative use increased during the follow-up but was not associated with an increased risk of death.

  17. Physician Responses to an Educational Intervention on Improving Their Long-Term Prescribing of Sedatives.

    ERIC Educational Resources Information Center

    Sleath, Betsy; Collins, Ted

    1997-01-01

    A Medicaid retrospective therapeutic intervention was designed to notify physicians about their patients' long-term use of sedatives and suggest to them that they reevaluate the patient's need for sedative hypnotic medication. Physicians' responses and follow-up actions are reported. Practice implications and the need for physician education are…

  18. Admixture of propofol and alfentanil. Use for intravenous sedation and analgesia during transvaginal oocyte retrieval.

    PubMed

    Sherry, E

    1992-06-01

    An admixture of propofol and alfentanil provides adequate sedation and analgesia during transvaginal oocyte retrieval in the absence of a paracervical block. In 100 patients the technique provided haemodynamic stability, sedation which was easily controlled, rapid recovery and universal patient acceptance. PMID:1616081

  19. 21 CFR 310.519 - Drug products marketed as over-the-counter (OTC) daytime sedatives.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 5 2011-04-01 2011-04-01 false Drug products marketed as over-the-counter (OTC... or Devices § 310.519 Drug products marketed as over-the-counter (OTC) daytime sedatives. (a... ingredients in over-the-counter (OTC) drug products for use as daytime sedatives. The following claims...

  20. Flurbiprofen Axetil Enhances Analgesic Effects of Sufentanil and Attenuates Postoperative Emergence Agitation and Systemic Proinflammation in Patients Undergoing Tangential Excision Surgery

    PubMed Central

    Geng, Wujun; Hong, Wandong; Wang, Junlu; Dai, Qinxue; Mo, Yunchang; Shi, Kejian; Sun, Jiehao; Qin, Jinling; Li, Mei; Tang, Hongli

    2015-01-01

    Objective. Our present study tested whether flurbiprofen axetil could reduce perioperative sufentanil consumption and provide postoperative analgesia with decrease in emergency agitation and systemic proinflammatory cytokines release. Methods. Ninety patients undergoing tangential excision surgery were randomly assigned to three groups: (1) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by patient-controlled analgesia (PCA) pump, (2) preoperative dose of 100 mg flurbiprofen axetil and a postoperative dose of 2 μg/kg sufentanil and 100 mg flurbiprofen axetil by PCA pump, and (3) 10 mL placebo and a postoperative dose of 2 μg/kg sufentanil and 10 mL placebo by PCA pump. Results. Preoperative administration of flurbiprofen axetil decreased postoperative tramadol consumption and the visual analog scale at 4, 6, 12, and 24 h after surgery, which were further decreased by postoperative administration of flurbiprofen axetil. Furthermore, flurbiprofen axetil attenuated emergency agitation score and Ramsay score at 0, 5, and 10 min after extubation and reduced the TNF-α and interleukin- (IL-) 6 levels at 24 and 48 h after the operation. Conclusion. Flurbiprofen axetil enhances analgesic effects of sufentanil and attenuates emergence agitation and systemic proinflammation in patients undergoing tangential excision surgery. PMID:26273138

  1. Tailored lighting intervention improves measures of sleep, depression, and agitation in persons with Alzheimer’s disease and related dementia living in long-term care facilities

    PubMed Central

    Figueiro, Mariana G; Plitnick, Barbara A; Lok, Anna; Jones, Geoffrey E; Higgins, Patricia; Hornick, Thomas R; Rea, Mark S

    2014-01-01

    Background Light therapy has shown great promise as a nonpharmacological method to improve symptoms associated with Alzheimer’s disease and related dementias (ADRD), with preliminary studies demonstrating that appropriately timed light exposure can improve nighttime sleep efficiency, reduce nocturnal wandering, and alleviate evening agitation. Since the human circadian system is maximally sensitive to short-wavelength (blue) light, lower, more targeted lighting interventions for therapeutic purposes, can be used. Methods The present study investigated the effectiveness of a tailored lighting intervention for individuals with ADRD living in nursing homes. Low-level “bluish-white” lighting designed to deliver high circadian stimulation during the daytime was installed in 14 nursing home resident rooms for a period of 4 weeks. Light–dark and rest–activity patterns were collected using a Daysimeter. Sleep time and sleep efficiency measures were obtained using the rest–activity data. Measures of sleep quality, depression, and agitation were collected using standardized questionnaires, at baseline, at the end of the 4-week lighting intervention, and 4 weeks after the lighting intervention was removed. Results The lighting intervention significantly (P<0.05) decreased global sleep scores from the Pittsburgh Sleep Quality Index, and increased total sleep time and sleep efficiency. The lighting intervention also increased phasor magnitude, a measure of the 24-hour resonance between light–dark and rest–activity patterns, suggesting an increase in circadian entrainment. The lighting intervention significantly (P<0.05) reduced depression scores from the Cornell Scale for Depression in Dementia and agitation scores from the Cohen–Mansfield Agitation Inventory. Conclusion A lighting intervention, tailored to increase daytime circadian stimulation, can be used to increase sleep quality and improve behavior in patients with ADRD. The present field study, while

  2. 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

  3. [Analgesia, sedation and delir – Treatment of patients in the neuro intensive care unit].

    PubMed

    Jungk, Christine

    2015-11-01

    Analgesia and sedation of patients in the neuro intensive care unit, in particular in case of intracranial hypertension, remains a challenge even today. A goal for analgesia and sedation should be set for each individual patient (RASS -5 in case of intracranial hypertension) and should be re-evaluated repeatedly based on standardized scores (RASS plus EEG monitoring where appropriate, NCS). There are no sufficient evidence-based sedation algorithms in this patient cohort. Remifentanil, sufentanil and fentanyl have been proven safe and effective for continuous application; however, bolus application should be avoided. (S-)Ketamin can be considered safe when mechanical ventilation and sedation with GABA receptor agonists are applied. Propofol and benzodiazepines are equally safe and effective with shorter wake up times for propofol. The use of barbitarutes is restricted to intractable intracranial hypertension or status epilepicus. Evidence for alpha-2-adrenoceptoragonists and inhalative sedation is poor and requires further research.

  4. An investigation of long-term effects of group music therapy on agitation levels of people with Alzheimer's Disease.

    PubMed

    Ledger, Alison J; Baker, Felicity A

    2007-05-01

    This study aimed to investigate the long-term effects of group music therapy on agitation manifested by nursing home residents with Alzheimer's disease. A non-randomised experimental design was employed with one group receiving weekly music therapy (n = 26) and another group receiving standard nursing home care (n = 19). Agitation levels were measured five times over one year using the Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, J. (1989). Agitation in the elderly. In N. Billig & P. V. Rabins (Eds.), Issues in geriatric psychiatry (pp. 101-113). Basel, Switzerland: Karger). Although music therapy participants showed short-term reductions in agitation, there were no significant differences between the groups in the range, frequency, and severity of agitated behaviours manifested over time. Multiple measures of treatment efficacy are necessary to better understand the long-term effects music therapy programs have on this population.

  5. Cannabinoids for the Treatment of Agitation and Aggression in Alzheimer's Disease.

    PubMed

    Liu, Celina S; Chau, Sarah A; Ruthirakuhan, Myuri; Lanctôt, Krista L; Herrmann, Nathan

    2015-08-01

    Alzheimer's disease (AD) is frequently associated with neuropsychiatric symptoms (NPS) such as agitation and aggression, especially in the moderate to severe stages of the illness. The limited efficacy and high-risk profiles of current pharmacotherapies for the management of agitation and aggression in AD have driven the search for safer pharmacological alternatives. Over the past few years, there has been a growing interest in the therapeutic potential of medications that target the endocannabinoid system (ECS). The behavioural effects of ECS medications, as well as their ability to modulate neuroinflammation and oxidative stress, make targeting this system potentially relevant in AD. This article summarizes the literature to date supporting this rationale and evaluates clinical studies investigating cannabinoids for agitation and aggression in AD. Letters, case studies, and controlled trials from four electronic databases were included. While findings from six studies showed significant benefits from synthetic cannabinoids—dronabinol or nabilone—on agitation and aggression, definitive conclusions were limited by small sample sizes, short trial duration, and lack of placebo control in some of these studies. Given the relevance and findings to date, methodologically rigorous prospective clinical trials are recommended to determine the safety and efficacy of cannabinoids for the treatment of agitation and aggression in dementia and AD.

  6. Cannabinoids for the Treatment of Agitation and Aggression in Alzheimer's Disease.

    PubMed

    Liu, Celina S; Chau, Sarah A; Ruthirakuhan, Myuri; Lanctôt, Krista L; Herrmann, Nathan

    2015-08-01

    Alzheimer's disease (AD) is frequently associated with neuropsychiatric symptoms (NPS) such as agitation and aggression, especially in the moderate to severe stages of the illness. The limited efficacy and high-risk profiles of current pharmacotherapies for the management of agitation and aggression in AD have driven the search for safer pharmacological alternatives. Over the past few years, there has been a growing interest in the therapeutic potential of medications that target the endocannabinoid system (ECS). The behavioural effects of ECS medications, as well as their ability to modulate neuroinflammation and oxidative stress, make targeting this system potentially relevant in AD. This article summarizes the literature to date supporting this rationale and evaluates clinical studies investigating cannabinoids for agitation and aggression in AD. Letters, case studies, and controlled trials from four electronic databases were included. While findings from six studies showed significant benefits from synthetic cannabinoids—dronabinol or nabilone—on agitation and aggression, definitive conclusions were limited by small sample sizes, short trial duration, and lack of placebo control in some of these studies. Given the relevance and findings to date, methodologically rigorous prospective clinical trials are recommended to determine the safety and efficacy of cannabinoids for the treatment of agitation and aggression in dementia and AD. PMID:26271310

  7. The use of anaesthetic agents to provide anxiolysis and sedation in dentistry and oral surgery.

    PubMed

    O'Halloran, Michael

    2013-12-31

    Throughout the world there is considerable variation in the techniques used to manage anxious dental patients requiring treatment. Traditionally anxious or phobic dental patients may have been sent for general anaesthesia to allow dental treatment be undertaken. While this is still the case for the more invasive oral surgical procedures, such as wisdom teeth extraction, sedation in general dentistry is becoming more popular. Various sedation techniques using many different anaesthetic agents have gained considerable popularity over the past 30 years. While the practice of sedating patients for dental procedures is invaluable in the management of suitably assessed patients, patient safety must always be the primary concern. Medical, dental and psychosocial considerations must be taken into account when evaluating the patient need and the patient suitability for sedation or general anaesthesia. The regulations that govern the practice of dental sedation vary throughout the world, in particular regarding the techniques used and the training necessary for dental practitioners to sedate patients. It is necessary for medical and dental practitioners to be up to date on current practice to ensure standards of practice, competence and safety throughout our profession. This article, the first in a two-part series, will provide information to practitioners on the practice of sedation in dentistry, the circumstances where it may be appropriate instead of general anaesthesia and the risks involved with sedation. It will also discuss the specific training and qualifications required for dental practitioners to provide sedation. The second article in this series will outline the different techniques used to administer inhalation, oral and intravenous sedation in dentistry and will focus on specific methods that are practiced.

  8. Feeding response of sport fish after electrical immobilization, chemical sedation, or both

    USGS Publications Warehouse

    Meinertz, Jeffery R.; Fredricks, Kim T.; Ambrose, Ryan D.; Jackan, Leanna M.; Wise, Jeremy K.

    2012-01-01

    Fishery managers frequently capture wild fish for a variety of fishery management activities. Though some activities can be accomplished without immobilizing the fish, others are accomplished more readily, humanely, and safely (for both the handler and the fish) when fish are immobilized by physical (e.g., electrical immobilization) or chemical sedation. A concern regarding the use of chemical sedatives is that chemical residues may remain in the fillet tissue after the fish recovers from sedation. If those residues are harmful to humans, there is some risk that a postsedated fish released to public waters may be caught and consumed by an angler. To characterize this risk, a series of four trials were conducted. Three trials assessed feeding activity after hatchery-reared fish were electrically immobilized, chemically sedated, or both, and one trial assessed the likelihood of an angler catching a wild fish that had been electrically immobilized and chemically sedated. Results from the first trial indicated that the feeding activity of laboratory habituated fish was variable among and within species after electrical immobilization, chemical sedation, or both. Results from the second trial indicated that the resumption of feeding activity was rapid after being mildly sedated for 45 min. Results from the third trial indicated that the feeding activity of outdoor, hatchery-reared fish was relatively aggressive after fish had been chemically sedated. Results from the fourth trial indicated that the probability of capturing wild fish in a more natural environment by angling after fish had been electrically immobilized and chemically sedated is not likely, i.e., in a group of five fish caught, 3 out of 100 times one would be a fish that had been sedated.

  9. Room for Quality Improvement in Endoscopist-Directed Sedation: Results from the First Nationwide Survey in Korea

    PubMed Central

    Lee, Chang Kyun; Dong, Seok Ho; Kim, Eun Sun; Moon, Sung-Hoon; Park, Hong Jun; Yang, Dong-Hoon; Yoo, Young Chul; Lee, Tae Hoon; Lee, Sang Kil; Hyun, Jong Jin

    2016-01-01

    Background/Aims This study sought to characterize the current sedation practices of Korean endoscopists in real-world settings. Methods All active members of the Korean Society of Gastrointestinal Endoscopy were invited to complete an anonymous 35-item questionnaire. Results The overall response rate was 22.7% (1,332/5,860). Propofol-based sedation was the dominant method used in both elective esophagogastroduodenoscopy (55.6%) and colonoscopy (52.6%). The mean satisfaction score for propofol-based sedation was significantly higher than that for standard sedation in both examinations (all p<0.001). The use of propofol was supervised exclusively by endoscopists (98.6%). Endoscopists practicing in nonacademic settings, gastroenterologists, or endoscopists with <10 years of endoscopic practice were more likely to use propofol than were their counterparts (all p<0.001). In total, 27.3% of all respondents performed sedation practices without having undergone sedation training, and 27.4% did so without any formal sedation protocols. The choice of propofol as the dominant sedation method was the only significant predictor of endoscopist experience with serious sedation-related adverse events (odds ratio, 1.854; 95% confidence interval, 1.414 to 2.432). Conclusions Endoscopist-directed propofol administration is the predominant sedation method used in Korea. This survey strongly suggests that there is much room for quality improvement regarding sedation training and patient vigilance in endoscopist-directed sedation. PMID:26696030

  10. The effects of researcher-composed music at mealtime on agitation in nursing home residents with dementia.

    PubMed

    Ho, Shu-Yuan; Lai, Hui-Ling; Jeng, Shaw-Yeu; Tang, Chih-Wei; Sung, Huei-Chuan; Chen, Pin-Wen

    2011-12-01

    This study examined the effects of music at mealtimes on agitation in 22 nursing home residents with dementia. We used a pretest-posttest research design. We played researcher-composed music to residents at each of two mealtimes daily over a consecutive 4-week period. We observed and recorded agitation 24 hours daily for the 4-week period and the following 2-week period. Results revealed a significant decline in mean agitation scores. A cumulative dose effect and a short-term linger effect were observed. Findings suggest that soothing music may be beneficial in managing agitation in nursing home residents with dementia.

  11. Stabilization of tetanus toxoid formulation containing aluminium hydroxide adjuvant against agitation.

    PubMed

    Solanki, Vipul A; Jain, Nishant K; Roy, Ipsita

    2012-02-28

    The aggregation of tetanus toxoid leads to reduced bioavailability of the vaccine and failure of immunization programmes in many parts of the globe. One of the main reasons for denaturation and aggregation of tetanus toxoid formulations is agitation of the protein during transport. We have identified that agitation leads to collapse of the gel matrix of aluminium hydroxide which is used as an adjuvant in these preparations. This results in desorption of the toxoid from the matrix, which then loses its antigenicity due to agitation-induced denaturation of the protein. We show that incorporation of some compatible osmolytes like sorbitol, glucose and arginine, but not trehalose, is able to protect the adjuvant matrix from degradation, and retain the integrity of the vaccine preparation in terms of its antigenicity.

  12. Evaluation and accuracy of the local velocity data measurements in an agitated vessel

    NASA Astrophysics Data System (ADS)

    Kysela, Bohuš; Konfršt, Jiří; Chára, Zdeněk; Kotek, Michal

    2014-03-01

    Velocity measurements of the flow field in an agitated vessel are necessary for the improvement and better understanding of the mixing processes. The obtained results are used for the calculations of the impeller pumping capacity, comparison of the power consumption etc. We performed various measurements of the local velocities in an agitated vessel final results of which should be processed for several purposes so it was necessary to make an analysis of the obtained data suitability and their quality. Analysed velocity data were obtained from the LDA (Laser Doppler Anemometry) and PIV (Particle Image Velocimetry) measurements performed on a standard equipment where the flat bottomed vessel with four baffles was agitated by the six-blade Rushton turbine. The results from both used methods were compared. The frequency analyses were examined as well as the dependency of the data rates, time series lengths etc. The demands for the data processed in the form of the ensemble-averaged results were also established.

  13. Flow-induced agitations create a granular fluid: Effective viscosity and fluctuations

    NASA Astrophysics Data System (ADS)

    Nichol, Kiri; van Hecke, Martin

    2012-06-01

    We fluidize a granular medium with localized stirring in a split-bottom shear cell. We probe the mechanical response of quiescent regions far from the main flow by observing the vertical motion of cylindrical probes rising, sinking, and floating in the grains. First, we find that the probe motion suggests that the granular material behaves in a liquid-like manner: high-density probes sink and low-density probes float at the depth given by Archimedes’ law. Second, we observe that the drag force on moving probes scales linearly with their velocity, which allows us to define an effective viscosity for the system. This effective viscosity is inversely proportional to the rotation rate of the disk which drives the split bottom flow. Moreover, the apparent viscosity depends on radius and mass of the probe: despite the linear dependence of the drag forces on sinking speed of the probe, the granular medium is not simply Newtonian, but exhibits a more complex rheology. The decrease of viscosity with filling height of the cell, combined with the poor correlation between local strain rate and viscosity, suggests that the fluid-like character of the material is set by agitations generated in the stirred region: the relation between applied stress and observed strain rate in one location depends on the strain rate in another location. We probe the nature of the granular fluctuations that we believe mediates these nonlocal interactions by characterizing the small and random up and down motion that the probe experiences. These Gaussian fluctuations exhibit a mix of diffusive and subdiffusive behavior at short times and saturate at a value of roughly 1/10th of a grain diameter longer times, consistent with the picture of a random walker in a potential well. The product of crossover time and effective viscosity is constant, evidencing a direct link between fluctuations and viscosity.

  14. Stabilization of insulin against agitation-induced aggregation by the GMO cubic phase gel.

    PubMed

    Sadhale, Y; Shah, J C

    1999-11-25

    The main objective of the study was to evaluate if the liquid crystalline cubic phase gel of glyceryl monooleate (GMO) protects insulin from agitation induced aggregation. The aggregation of Humulin(R), Regular Iletin I(R) and Regular Iletin II(R), in cubic phase GMO gels at 30 U/g of gel was compared with that in PBS at 100 oscillations/min at 37 degrees C using optical density at 600 nm. The effect of agitation on the secondary structure of insulin in solution and in the gels was determined with circular dichroism (CD) spectroscopy, and the time course of aggregation was also followed by HPLC. A sigmoidal increase in optical density of solution with time indicated formation of increasing amounts of insoluble insulin aggregates. However, in the gels, optical density values stayed at, or around, the initial optical density value, comparable with that of a blank gel suggesting that insulin had not aggregated in the gel. CD spectroscopy of the soluble insulin showed a total loss of native conformation upon aggregation of insulin in solution. In contrast, CD spectra of insulin in the gel were unaltered suggesting protection from aggregation during agitation. Furthermore, agitation of insulin in gels for a duration as long as 2 months at 37 degrees C, had very little adverse effect on the native conformation of insulin, as indicated by the lack of a significant change in its CD spectrum. Therefore, the cubic phase gel was indeed able to protect insulin from agitation-induced aggregation and subsequent precipitation. Although the majority of insulin in solution appeared to have aggregated and precipitated after 8 days by UV and CD spectroscopy, RP-HPLC results indicated the presence of some soluble aggregates of insulin. In summary, the liquid crystalline cubic phase gel of GMO protects peptides, like insulin, from agitation-induced aggregation.

  15. Revision of loop colostomy under regional anaesthesia and sedation

    PubMed Central

    Ng, Oriana; Thong, Sze Ying; Chia, Claramae Shulyn; Teo, Melissa Ching Ching

    2015-01-01

    Patients presenting for emergency abdominal procedures often have medical issues that cause both general anaesthesia and central neuraxial blockade to pose significant risks. Regional anaesthetic techniques are often used adjunctively for abdominal procedures under general anaesthesia, but there is limited published data on procedures done under peripheral nerve or plexus blocks. We herein report the case of a patient with recent pulmonary embolism and supraventricular tachycardia who required colostomy refashioning. Ultrasonography-guided regional anaesthesia was administered using a combination of ilioinguinal-iliohypogastric, rectus sheath and transversus abdominis plane blocks. This was supplemented with propofol and dexmedetomidine sedation as well as intermittent fentanyl and ketamine boluses to cover for visceral stimulation. We discuss the anatomical rationale for the choice of blocks and compare the anaesthetic conduct with similar cases that were previously reported. PMID:26034327

  16. 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

  17. Analgesics, sedatives, anticonvulsant drugs, and the cooled brain.

    PubMed

    Wassink, Guido; Lear, Christopher A; Gunn, Katherine C; Dean, Justin M; Bennet, Laura; Gunn, Alistair J

    2015-04-01

    Multiple randomized controlled trials have shown that prolonged, moderate cerebral hypothermia initiated within a few hours after severe hypoxia-ischemia and continued until resolution of the acute phase of delayed cell death reduces mortality and improves neurodevelopmental outcome in term infants. The challenge is now to find ways to further improve outcomes. In the present review, we critically examine the evidence that conventional analgesic, sedative, or anticonvulsant agents might improve outcomes, in relation to the known window of opportunity for effective protection with hypothermia. This review strongly indicates that there is insufficient evidence to recommend routine use of these agents during therapeutic hypothermia. Further systematic research into the effects of pain and stress on the injured brain, and their treatment during hypothermia, is essential to guide the rational development of clinical treatment protocols. PMID:25457080

  18. 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

  19. Pain, agitation, and delirium guidelines: nurses' involvement in development and implementation.

    PubMed

    Davidson, Judy E; Winkelman, Chris; Gélinas, Céline; Dermenchyan, Anna

    2015-06-01

    The 2013 American College of Critical Care Medicine/Society of Critical Care Medicine clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit serves as a living example of nurses' involvement in the development and implementation of professional guidelines. Nurses who served on this guideline-writing panel describe their experiences. Specific examples from the pain, agitation, and delirium guidelines for care are used to explore the roles of the nurse leader, nurse informaticist, staff nurse, and nurse researcher in relationship to guideline implementation. PMID:26033098

  20. Success rate of IR midazolam sedation in combination with C-CLAD in pediatric dental patients—a prospective observational study

    PubMed Central

    Baniel, Anat

    2014-01-01

    Objective. To evaluate the success rate of intra-rectal (IR) midazolam in combination with nitrous oxide/oxygen (N2O) sedation in young uncooperative dental patients when the local anesthesia is delivered by a computerized controlled local anesthetic delivery (C-CLAD). Study Design. This observational study consisted of 219 uncooperative children (age: 4.3 ± 1.69 y) who received IR midazolam (0.4 mg/kg) and N2O to complete their dental treatment. Measured variables included: child’s pain disruptive behavior during delivery of anesthesia by C-CLAD (CHEOP Scale), child behavior during treatment (Houpt scale), dental procedure performed, and side effects that appeared during treatment. Results. There was a high level of cooperation (mean score: 6.69 ± 2.1) during administration of local anesthesia. Good-to-excellent behavior was shown by 87% of the children during treatment. Planned treatment was completed by 184 (92%) patients. No statistically significant changes were noticed in the oxygen saturation levels before and after treatment. Children with side effects included 3 (1.3%) with nistagmus, 5 (2.3%) with diplopia, and 18 (8.2%) with hiccups. Three consecutive sedations decreased the overall behavior score by 5.7% compared to the first appointment (p < .05). Conclusions. IR midazolam-N2O sedation in combination with C-CLAD is very effective for delivery of dental treatment to young uncooperative children. PMID:24688838

  1. Effect of aripiprazole lauroxil on agitation and hostility in patients with schizophrenia.

    PubMed

    Citrome, Leslie; Du, Yangchun; Risinger, Robert; Stankovic, Srdjan; Claxton, Amy; Zummo, Jacqueline; Bose, Anjana; Silverman, Bernard L; Ehrich, Elliot W

    2016-03-01

    This study aimed to evaluate the effects of aripiprazole lauroxil on hostility and aggressive behavior in patients with schizophrenia. Patients aged 18-70 years with a diagnosis of schizophrenia and currently experiencing an acute exacerbation or relapse were randomized to intramuscular (IM) aripiprazole lauroxil 441 mg (n=207), 882 mg (n=208), or placebo (n=207) for 12 weeks. In post-hoc analyses, hostility and aggression were assessed by the Positive and Negative Syndrome Scale (PANSS) Hostility item (P7) and a specific antihostility effect was assessed by adjusting for positive symptoms of schizophrenia, somnolence, and akathisia. The PANSS excited component score [P4 (Excitement), P7 (Hostility), G4 (Tension), G8 (Uncooperativeness), and G14 (Poor impulse control)], and the Personal and Social Performance scale disturbing and aggressive behavior domain were also assessed. Of the 147 patients who received aripiprazole lauroxil 882 mg and with a baseline PANSS Hostility item P7 more than 1, there was a significant (P<0.05) improvement versus placebo on the PANSS Hostility item P7 score by mixed-model repeated-measures at the end of the study, which remained significant when PANSS-positive symptoms and somnolence or akathisia were included as additional covariates. The proportion with PANSS Hostility item P7 more than 1 at endpoint was significantly (P<0.05) lower with aripiprazole lauroxil versus placebo (53.6, 46.1, and 66.3% for 441, 882 mg, and placebo). A significant (P<0.05) improvement was found with aripiprazole lauroxil versus placebo for change from baseline in the PANSS excited component score. The proportion of patients with aggressive behavior on the Personal and Social Performance scale was significantly (P<0.05) lower for aripiprazole lauroxil: 30.0% for 441 mg versus 44.1% for placebo (P=0.006) and 22.2% for 881 mg (P<0.001 versus placebo). Treatment with aripiprazole lauroxil resulted in decreases in agitation and hostility in patients

  2. [Terminal sedation: consultation with a second physician as is the case in euthanasia and assisted suicide].

    PubMed

    Ponsioen, B P; Schuurman, W H A Elink; van den Hurk, A J P M; van der Poel, B N M; Runia, E H

    2005-02-26

    In terminally-ill patients in the Netherlands deep sedation by means of a continuous subcutaneous infusion with midazolam occurs more frequently than euthanasia and assisted suicide. Deep terminal sedation is applied to relieve symptoms during the phase of dying, but in contrast to euthanasia and assisted suicide, does not hasten death. In three terminally-ill patients, a 65-year-old man suffering from pulmonary carcinoma, a 94-year-old woman with general malaise, nausea and anorexia, and a 79-year-old woman in the final stage of ovarian carcinoma, a general-practitioner advisor was consulted about an end-of-life decision--deep terminal sedation versus euthanasia or assisted suicide. The first two patients were given deep sedation until death, in both cases a day and a half later. The third patient's request for euthanasia was considered to meet the legal criteria for euthanasia. Compliance with the Dutch statutory criteria for due care in euthanasia and assisted suicide might also be helpful when deciding about terminal deep sedation, but the role and responsibility of the attending physician may differ. However, the radical effects of sedation on the terminally-ill patient and the rapid changes in the clinical situation of the patient when the decision to sedate is taken, both emphasize the need for consultation with another physician.

  3. Neuronal ensembles sufficient for recovery sleep and the sedative actions of α2 adrenergic agonists.

    PubMed

    Zhang, Zhe; Ferretti, Valentina; Güntan, İlke; Moro, Alessandro; Steinberg, Eleonora A; Ye, Zhiwen; Zecharia, Anna Y; Yu, Xiao; Vyssotski, Alexei L; Brickley, Stephen G; Yustos, Raquel; Pillidge, Zoe E; Harding, Edward C; Wisden, William; Franks, Nicholas P

    2015-04-01

    Do sedatives engage natural sleep pathways? It is usually assumed that anesthetic-induced sedation and loss of righting reflex (LORR) arise by influencing the same circuitry to lesser or greater extents. For the α2 adrenergic receptor agonist dexmedetomidine, we found that sedation and LORR were in fact distinct states, requiring different brain areas: the preoptic hypothalamic area and locus coeruleus (LC), respectively. Selective knockdown of α2A adrenergic receptors from the LC abolished dexmedetomidine-induced LORR, but not sedation. Instead, we found that dexmedetomidine-induced sedation resembled the deep recovery sleep that follows sleep deprivation. We used TetTag pharmacogenetics in mice to functionally mark neurons activated in the preoptic hypothalamus during dexmedetomidine-induced sedation or recovery sleep. The neuronal ensembles could then be selectively reactivated. In both cases, non-rapid eye movement sleep, with the accompanying drop in body temperature, was recapitulated. Thus, α2 adrenergic receptor-induced sedation and recovery sleep share hypothalamic circuitry sufficient for producing these behavioral states.

  4. Sedation and analgesia for critically ill pediatric burn patients: the current state of practice.

    PubMed

    Singleton, Andrew; Preston, Robert J; Cochran, Amalia

    2015-01-01

    The objective of this study was to assess current practice patterns and attitudes toward pediatric sedation and analgesia in United States (US) burn centers for critically ill patients. Survey-based questionnaire was sent to 119 Directors at US burn centers that care for pediatric patients. Forty-one surveys (34%) were analyzed. 48.8% of responding centers mandate pediatric consultation for pediatric burn patients based on factors such as age and burn size. The most common sedation and analgesic agents used were midazolam, fentanyl, morphine, ketamine, and diphenhydramine. Written sedation policies exist at 63.4% of centers. 90.2% of centers employ scoring systems to guide agent titration. 60.9% of respondents practice sedation holidays "always" or "usually." 90.2% of centers perceive the medications they routinely use are "always" or "often" efficacious in pediatric sedation and analgesia. 53.7% of respondents reported the presence of withdrawal signs and symptoms in their patient population. The lack of consensus guidelines for sedation and analgesia delivery to pediatric intensive care unit patients results in practice variation. The majority of centers perceive their sedation and analgesia strategies to be efficacious despite the heavy reliance on propofol and midazolam, both of which have questionable safety profiles in critically ill children.

  5. 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.

  6. [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.

  7. Neuronal ensembles sufficient for recovery sleep and the sedative actions of α2 adrenergic agonists

    PubMed Central

    Güntan, İlke; Moro, Alessandro; Steinberg, Eleonora A.; Ye, Zhiwen; Zecharia, Anna Y.; Yu, Xiao; Vyssotski, Alexei L.; Brickley, Stephen G.; Yustos, Raquel; Pillidge, Zoe E.; Harding, Edward C.; Wisden, William; Franks, Nicholas P.

    2015-01-01

    Do sedatives engage natural sleep pathways? It is usually assumed that anesthetic-induced sedation and loss-of-righting-reflex (LORR) arise by influencing the same circuitry to lesser or greater extents. For the α2 adrenergic receptor agonist dexmedetomidine, we find that sedation and LORR are in fact distinct states, requiring different brain areas, the preoptic hypothalamic area and locus coeruleus (LC) respectively. Selective knockdown of α2A adrenergic receptors from the LC abolished dexmedetomidine-induced LORR, but not sedation. Instead, we found that dexmedetomidine-induced sedation resembles the deep recovery sleep that follows sleep deprivation. We used TetTag-pharmacogenetics in mice to functionally mark neurons activated in the preoptic hypothalamus during dexmedetomidine-induced sedation or recovery sleep. The neuronal ensembles could then be selectively reactivated. In both cases NREM sleep, with the accompanying drop in body temperature, was recapitulated. Thus α2 adrenergic receptor-induced sedation and recovery sleep share hypothalamic circuitry sufficient for producing these behavioral states. PMID:25706476

  8. Safety and effectiveness using dexmedetomidine versus propofol TCI sedation during oesophagus interventions: a randomized trial

    PubMed Central

    2013-01-01

    Background Endoscopic treatment of early neoplastic lesions in oesophagus has evolved as a valid and less invasive alternative to surgical resection. These endoscopic interventions are minimal invasive treatment options usually done with sedation on an outpatient basis. The aim of this trial is to determine the safety and effectiveness of dexmedetomidine sedation compared to the standard used propofol TCI sedation during endoscopic oesophageal interventions. Methods The study will be performed as a randomized controlled trial. The first 64 consenting patients will be randomized to either the propofol or the dexmedetomidine group. Following endoscopy patients and gastroenterologists have to fill in questionnaires (PSSI, CSSI) (see abbreviations) about their sedation experiences. Additionally, patients have to accomplish the Trieger test before and after the procedure. Patient monitoring includes time adapted HR, SO2, ECG, NIBP, exCO2, NICO, sweat conductance measurement, OAA/S, and the Aldrete score. Effectiveness of sedation, classified by satisfaction levels and pain and sedation score measured by questionnaires is the primary outcome parameter. Respiratory and hemodynamic complications are surrogate parameters for the secondary outcome parameter “safety”. Discussion The acceptance level among patients after propofol sedation is high. Dexmedetomidine is a relatively new representative for procedural sedation. Has this new form of conscious sedation the potential to be safer and more effective for patients and endoscopists than propofol during endoscopic oesophageal interventions? Trial registration This trial is registered in the ISRCTN Register (ISRCTN 68599804). It will be conducted in accordance with the protocol and in compliance with the moral, ethical, and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989) and Good Clinical Practice (GCP). The Departments of Anesthesiology and Gastroenterology & Hepatology

  9. Attitudes Regarding Palliative Sedation and Death Hastening Among Swiss Physicians: A Contextually Sensitive Approach.

    PubMed

    Foley, Rose-Anna; Johnston, Wendy S; Bernard, Mathieu; Canevascini, Michela; Currat, Thierry; Borasio, Gian D; Beauverd, Michel

    2015-01-01

    In Switzerland, where assisted suicide but not euthanasia is permitted, the authors sought to understand how physicians integrate palliative sedation in their practice and how they reflect on existential suffering and death hastening. They interviewed 31 physicians from different care settings. Five major attitudes emerged. Among specialized palliative care physicians, convinced, cautious and doubtful attitudes were evident. Within unspecialized settings, palliative sedation was more likely to be considered as death hastening: clinicians either avoid it with an inexperienced attitude or practice it with an ambiguous attitude, raising the issue of unskilled and abusive uses of sedatives at the end of life.

  10. Attitudes Regarding Palliative Sedation and Death Hastening Among Swiss Physicians: A Contextually Sensitive Approach.

    PubMed

    Foley, Rose-Anna; Johnston, Wendy S; Bernard, Mathieu; Canevascini, Michela; Currat, Thierry; Borasio, Gian D; Beauverd, Michel

    2015-01-01

    In Switzerland, where assisted suicide but not euthanasia is permitted, the authors sought to understand how physicians integrate palliative sedation in their practice and how they reflect on existential suffering and death hastening. They interviewed 31 physicians from different care settings. Five major attitudes emerged. Among specialized palliative care physicians, convinced, cautious and doubtful attitudes were evident. Within unspecialized settings, palliative sedation was more likely to be considered as death hastening: clinicians either avoid it with an inexperienced attitude or practice it with an ambiguous attitude, raising the issue of unskilled and abusive uses of sedatives at the end of life. PMID:26107119

  11. Scale

    ERIC Educational Resources Information Center

    Schaffhauser, Dian

    2009-01-01

    The common approach to scaling, according to Christopher Dede, a professor of learning technologies at the Harvard Graduate School of Education, is to jump in and say, "Let's go out and find more money, recruit more participants, hire more people. Let's just keep doing the same thing, bigger and bigger." That, he observes, "tends to fail, and fail…

  12. 40 CFR 63.1029 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation systems..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... in heavy liquid service; pressure relief devices in light liquid or heavy liquid service;...

  13. 40 CFR 63.1010 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation systems..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... heavy liquid service; pressure relief devices in light liquid or heavy liquid service;...

  14. 40 CFR 63.1029 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation systems..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... in heavy liquid service; pressure relief devices in light liquid or heavy liquid service;...

  15. 40 CFR 63.1010 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation systems..., connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... heavy liquid service; pressure relief devices in light liquid or heavy liquid service;...

  16. 40 CFR 63.1029 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... (CONTINUED) National Emission Standards for Equipment Leaks-Control Level 2 Standards § 63.1029 Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation...

  17. 40 CFR 63.1010 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... (CONTINUED) National Emission Standards for Equipment Leaks-Control Level 1 § 63.1010 Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation...

  18. 40 CFR 63.1029 - Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... (CONTINUED) National Emission Standards for Equipment Leaks-Control Level 2 Standards § 63.1029 Pumps, valves, connectors, and agitators in heavy liquid service; pressure relief devices in liquid service; and... agitators in heavy liquid service; pressure relief devices in liquid service; and instrumentation...

  19. Effect of agitation on the performance of an anaerobic sequencing batch biofilm reactor in the treatment of dairy effluents.

    PubMed

    Penteado, T Z; Santana, R S S; Dibiazi, A L B; de Pinho, S C; Ribeiro, R; Tommaso, G

    2011-01-01

    Agitation rate is an important parameter in the operation of Anaerobic Sequencing Biofilm Batch Reactors (ASBBRs), and a proper agitation rate guarantees good mixing, improves mass transfer, and enhances the solubility of the particulate organic matter. Dairy effluents have a high amount of particulate organic matter, and their anaerobic digestion presents inhibitory intermediates (e.g., long-chain fatty acids). The importance of studying agitation in such batch systems is clear. The present study aimed to evaluate how agitation frequency influences the anaerobic treatment of dairy effluents. The ASBBR was fed with wastewater from milk pasteurisation process and cheese manufacture with no whey segregation. The organic matter concentration, measured as chemical oxygen demand (COD), was maintained at approximately 8,000 mg/L. The reactor was operated with four agitation frequencies: 500 rpm, 350 rpm, 200 rpm, and no agitation. In terms of COD removal efficiency, similar results were observed for 500 rpm and 350 rpm (around 90%) and for 200 rpm and no agitation (around 80%). Increasing the system's agitation thus not only improved the global efficiency of organic matter removal but also influenced volatile acid production and consumption and clearly modified this balance in each experimental condition. PMID:21411951

  20. Effect of agitation on the performance of an anaerobic sequencing batch biofilm reactor in the treatment of dairy effluents.

    PubMed

    Penteado, T Z; Santana, R S S; Dibiazi, A L B; de Pinho, S C; Ribeiro, R; Tommaso, G

    2011-01-01

    Agitation rate is an important parameter in the operation of Anaerobic Sequencing Biofilm Batch Reactors (ASBBRs), and a proper agitation rate guarantees good mixing, improves mass transfer, and enhances the solubility of the particulate organic matter. Dairy effluents have a high amount of particulate organic matter, and their anaerobic digestion presents inhibitory intermediates (e.g., long-chain fatty acids). The importance of studying agitation in such batch systems is clear. The present study aimed to evaluate how agitation frequency influences the anaerobic treatment of dairy effluents. The ASBBR was fed with wastewater from milk pasteurisation process and cheese manufacture with no whey segregation. The organic matter concentration, measured as chemical oxygen demand (COD), was maintained at approximately 8,000 mg/L. The reactor was operated with four agitation frequencies: 500 rpm, 350 rpm, 200 rpm, and no agitation. In terms of COD removal efficiency, similar results were observed for 500 rpm and 350 rpm (around 90%) and for 200 rpm and no agitation (around 80%). Increasing the system's agitation thus not only improved the global efficiency of organic matter removal but also influenced volatile acid production and consumption and clearly modified this balance in each experimental condition.

  1. Effect of the Bace Intervention on Agitation of People with Dementia

    ERIC Educational Resources Information Center

    Kovach, Christine R.; Taneli, Yavuz; Dohearty, Paul; Schlidt, Andrea Matovina; Cashin, Susan; Silva-Smith, Amy L.

    2004-01-01

    Purpose: This study tests the effectiveness of the theoretically driven BACE (i.e., Balancing Arousal Controls Excesses) intervention in decreasing agitation in residents of long-term care with moderate or severe dementia. Design and Methods: A pretest-posttest double-blinded experimental design with random assignment was used with a sample of 78…

  2. Women, Scientists, Agitators: Magazine Portrayal of Rachel Carson and Theo Colborn.

    ERIC Educational Resources Information Center

    Corbett, Julia B.

    2001-01-01

    Utilizes a theoretical framework of the media's role in reporting conflict and uncertain science, and feminism and science in a thematic analysis of magazine coverage given Rachel Carson and "the Rachel Carson of '90s," Theo Colborn. Notes that Carson and Colborn's identities as women, scientists, and agitators led critics to charge that their…

  3. Hydraulic characteristics simulation of an innovative self-agitation anaerobic baffled reactor (SA-ABR).

    PubMed

    Qi, Wei-Kang; Hojo, Toshimasa; Li, Yu-You

    2013-05-01

    An investigation was conducted on a self-agitation anaerobic baffled reactor (SA-ABR) with agitation caused solely by the release of stored gas. The compound in the reactor is mixed without the use of any mechanical equipment and electricity. The computational fluid dynamics (CFD) simulation used to provide details of the flow pattern and information about the agitation process and a solid basis for design and optimization purposes. Every self-agitation cycle could be separated into the pressure energy storage process, the exergonic process and the buffer stage. The reactor is regarded as the combination of continuous stirred tank reactor and a small plug flow reactor. The liquid level and diffusion varies widely depending on the length of the U-tube. The compound transition phenomenon in the 1st chamber mainly occurs during the energy exergonic process and buffer stage. The fluid-diffusion in the 3rd and 4th chambers mainly happens after the buffer period. PMID:23567669

  4. Using Simulation to Train Junior Psychiatry Residents to Work with Agitated Patients: A Pilot Study

    ERIC Educational Resources Information Center

    Zigman, Daniel; Young, Meredith; Chalk, Colin

    2013-01-01

    Objective: This article examines the benefit and feasibility of introducing a new, simulation-based learning intervention for junior psychiatry residents. Method: Junior psychiatry residents were invited to participate in a new simulation-based learning intervention focusing on agitated patients. Questionnaires were used to explore the success of…

  5. Effect of agitation and aeration on the citric acid production by Yarrowia lipolytica grown on glycerol.

    PubMed

    Rywińska, Anita; Musiał, Izabela; Rymowicz, Waldemar; Zarowska, Barbara; Boruczkowski, Tomasz

    2012-01-01

    The effects of agitation rates from 400 to 900 rpm and aeration rates ranging from 0.18 to 0.6 vvm on biomass and citric acid production on glycerol media by acetate-negative mutants of Yarrowia lipolytica, Wratislavia 1.31 and Wratislavia AWG7, in batch culture were studied. The agitation rates of 800 and 900 rpm (at a constant aeration rate of 0.36 vvm) and aeration rates within the range of 0.24-0.48 vvm (at a constant agitation rate of 800 rpm), which generated dissolved oxygen concentration (DO) higher than 40%, were found the best for citric acid biosynthesis from glycerol. An increase in agitation rate (higher than 800 rpm) and aeration rate (higher than 0.36 vvm) had no impact on DO and citric acid production. The highest citric acid concentration (92.8 g/L) and yield (0.63 g/g) were obtained with Wratislavia 1.31 strain at 0.24 vvm. The highest volumetric citric acid production rate (1.15 g/Lh) and specific citric acid production rate (0.071 g/gh) were reached at 0.48 vvm.

  6. Brief Report: Retrospective Case Series of Oxcarbazepine for Irritability/Agitation Symptoms in Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Douglas, Jessica F.; Sanders, Kevin B.; Benneyworth, M. Hannah; Smith, Jessica L.; DeJean, Virginia M.; McGrew, Susan G.; Veenstra-VanderWeele, Jeremy

    2013-01-01

    We examined response to oxcarbazepine prescribed for irritability/agitation symptoms in a retrospective case series of 30 patients with Autism Spectrum Disorder (ASD). The average patient was 12.0 years old (range 5-21) and taking two other psychotropic medications (range 0-4). Fourteen patients (47 %) had a clinical global impression of…

  7. Pharmacological Management of Agitation and Aggression in an Adolescent with Autism

    ERIC Educational Resources Information Center

    Kratochvil, Christopher J.; Findling, Robert L.; McDougle, Christopher J.; Scahill, Lawrence; Hamarman, Stephanie

    2005-01-01

    This article provides an "autism vignette" and then poses an evaluative question to several autism specialists, documenting their varied responses to the scenario and question posed. A 13-year-old boy with autism and severe mental retardation presented to the inpatient psychiatric unit due to a recent increase in agitation and physical aggression.…

  8. Mass transfer in a bubble-agitated liquid-liquid system

    SciTech Connect

    Clinton, S.D.; Perona, J.J.

    1980-01-01

    A polarographic method was used to measure the mass transfer coefficients between a mercury layer and an aqueous layer agitated by gas bubbles. The effects of gas rate, vessel size, and sparge-tube diameter were studied. The Schmidt number of the aqueous phase was varied by the use of sucrose solutions.

  9. Boiling heat transfer enhancement of nanofluids on a smooth surface with agitation

    NASA Astrophysics Data System (ADS)

    Kong, Xin; Qi, Baojin; Wei, Jinjia; Li, Wei; Ding, Jie; Zhang, Yonghai

    2016-02-01

    The pool boiling heat transfer performance on a smooth silicon chip surface with agitation was experimentally investigated in this study. The nanofluids (Ag/alcohol) of 0.02 % volume concentration and ethyl alcohol with purification over 99.9 % were the two contrast working fluids. For each group, subcoolings of 40, 50 and 60 K were conducted under atmospheric pressure. To enhance the heat transfer performance, an agitating device was fixed above the top of the chip. The experimental results indicated that nanofluids could enhance the heat transfer performance especially in the nucleate boiling region. The heat transfer coefficient was significantly increased with nanofluids, while the critical heat flux (CHF) was nearly not changed. In the agitation Reynolds number of 20,300, the heat transfer performance of nanofluids was significantly enhanced in the convection region, and the CHF was increased by more than 25 % for all groups. This boiling phenomenon was observed for both nanofluids and alcohol groups. Meanwhile, the boiling curves of different liquid subcoolings in the nucleate region were quite similar to each other under agitation.

  10. The effect of agitation state on polyol synthesis of silver nanowire

    NASA Astrophysics Data System (ADS)

    Amirjani, Amirmostafa; Marashi, Pirooz; Fatmehsari, Davoud Haghshenas

    2016-11-01

    In the present work, the effect of agitation rate on the growth mechanism of silver nanowires is evaluated during polyol process. It was found that increasing the agitation rate leads to the increase in the oxygen transfer rate which in turn enhances the oxidative etching conditions leading to the formation of a variety of nanostructures (nanoparticles, nanorods and nanowires). In light of the obtained experimental results, it can be stated that agitation is not essential for synthesizing silver nanowires by polyol method and it is possible to obtain uniform nanowires with ~200 nm diameters in the length of 20-30 microns several microns length in the stagnant condition. By setting the stirring rate at 200 rpm, it is possible to reduce the nanowires diameters to ~130 nm and the obtained nanostructures are still mono-dispersed. This paper provides complete information about the effect of agitation state on the polyol synthesis of silver nanowires which is truly useful for further studies in this case.

  11. Effects of hydrostatic pressure, agitation and CO2 stress on Phytophthora nicotianae zoospore survival

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Phytophthora nicotianae Breda de Haan was used as a model pathogen to investigate the effects of hydrostatic pressure, agitation, and aeration with CO2 or breathable air on the survival of Phytophthora zoospores in water. Injecting CO2 into 2 liters of zoospore-infested water for 5 min at 110.4 ml ...

  12. Maximization of beta-galactosidase production: a simultaneous investigation of agitation and aeration effects.

    PubMed

    Alves, Fernanda Germano; Filho, Francisco Maugeri; de Medeiros Burkert, Janaína Fernandes; Kalil, Susana Juliano

    2010-03-01

    In this work, the agitation and aeration effects in the maximization of the beta-galactosidase production from Kluyveromyces marxianus CCT 7082 were investigated simultaneously, in relation to the volumetric enzyme activity and the productivity, as well as the analysis of the lactose consumption and production of glucose, and galactose of this process. Agitation and aeration effects were studied in a 2 L batch stirred reactor. A central composite design (2(2) trials plus three central points) was carried out. Agitation speed varied from 200 to 500 rpm and aeration rate from 0.5 to 1.5 vvm. It has been shown in this study that the volumetric enzyme production was strongly influenced by mixing conditions, while aeration was shown to be less significant. Linear models for activity and productivity due to agitation and aeration were obtained. The favorable condition was 500 rpm and 1.5 vvm, which lead to the best production of 17 U mL(-1) for enzymatic activity, 1.2 U mL(-1) h(-1) for productivity in 14 h of process, a cellular concentration of 11 mg mL(-1), and a 167.2 h(-1) volumetric oxygen transfer coefficient. PMID:19517069

  13. Escherichia coli O8-antigen enhances biofilm formation under agitated conditions.

    PubMed

    Kumar, Akash; Mallik, Dhriti; Pal, Shilpa; Mallick, Sathi; Sarkar, Sujoy; Chanda, Ajoy; Ghosh, Anindya S

    2015-08-01

    Bacterial surface components have a major role in the development of biofilms. In the present study, the effect of Escherichia coli O8-antigen on biofilms was investigated using two E. coli K-12 derived strains that differed only in the O8-antigen biosynthesis. In the presence of O8-antigen both bacterial adhesion and biofilm formation slightly decreased under static conditions whereas a substantial increase in adhesion and biofilm formation was observed under agitated conditions. It was noted that, irrespective of the O8-antigen status, the hydrophobic interactions played an important role in bacterial adhesion under both static and agitated conditions. However, under agitated conditions, the extent of bacterial adhesion in the O8-antigen bearing strain was predominantly determined by the electrostatic interactions. Results showed that the presence of O8-antigen decreases the surface hydrophobicity and surface charge. Moreover, O8-antigen facilitates adhesion on hydrophilic and hydrophobic surfaces as revealed through tests with modified substrata. Our results indicate that O8-antigen, which appears dispensable for biofilm formation under static conditions, actually enhances E. coli biofilm formation under agitated conditions. PMID:26187746

  14. Enhancing the adhesion strength of micro electroforming layer by ultrasonic agitation method and the application.

    PubMed

    Zhao, Zhong; Du, Liqun; Tao, Yousheng; Li, Qingfeng; Luo, Lei

    2016-11-01

    Micro electroforming is widely used for fabricating micro metal devices in Micro Electro Mechanism System (MEMS). However, there is the problem of poor adhesion strength between micro electroforming layer and substrate. This dramatically influences the dimensional accuracy of the device. To solve this problem, ultrasonic agitation method is applied during the micro electroforming process. To explore the effect of the ultrasonic agitation on the adhesion strength, micro electroforming experiments were carried out under different ultrasonic power (0W, 100W, 150W, 200W, 250W) and different ultrasonic frequencies (0kHz, 40kHz, 80kHz, 120kHz, 200kHz). The effects of the ultrasonic power and the ultrasonic frequency on the micro electroforming process were investigated by polarization method and alternating current (a.c.) impedance method. The adhesion strength between the electroforming layer and the substrate was measured by scratch test. The compressive stress of the electroforming layer was measured by X-ray Diffraction (XRD) method. The crystallite size of the electroforming layer was measured by Transmission Electron Microscopy (TEM) method. The internal contact surface area of the electroforming layer was measured by cyclic voltammetry (CV) method. The experimental results indicate that the ultrasonic agitation can decrease the polarization overpotential and increase the charge transfer process. Generally, the internal contact surface area is increased and the compressive stress is reduced. And then the adhesion strength is enhanced. Due to the different depolarization effects of the ultrasonic power and the ultrasonic frequency, the effects on strengthening the adhesion strength are different. When the ultrasonic agitation is 200W and 40kHz, the effect on strengthening the adhesion strength is the best. In order to prove the effect which the ultrasonic agitation can improve the adhesion strength of the micro devices, micro pillar arrays were fabricated under

  15. Non-biodegradable landfill leachate treatment by combined process of agitation, coagulation, SBR and filtration

    SciTech Connect

    Abood, Alkhafaji R.; Bao, Jianguo; Du, Jiangkun; Zheng, Dan; Luo, Ye

    2014-02-15

    Highlights: • A novel method of stripping (agitation) was investigated for NH{sub 3}-N removal. • PFS coagulation followed agitation process enhanced the leachate biodegradation. • Nitrification–denitrification achieved by changing operation process in SBR treatment. • A dual filter of carbon-sand is suitable as a polishing treatment of leachate. • Combined treatment success for the complete treatment of non-biodegradable leachate. - Abstract: This study describes the complete treatment of non-biodegradable landfill leachate by combined treatment processes. The processes consist of agitation as a novel stripping method used to overcome the ammonia toxicity regarding aerobic microorganisms. The NH{sub 3}-N removal ratio was 93.9% obtained at pH 11.5 and a gradient velocity (G) 150 s{sup −1} within a five-hour agitation time. By poly ferric sulphate (PFS) coagulation followed the agitation process; chemical oxygen demand (COD) and biological oxygen demand (BOD{sub 5}) were removed at 70.6% and 49.4%, respectively at an optimum dose of 1200 mg L{sup −1} at pH 5.0. The biodegradable ratio BOD{sub 5}/COD was improved from 0.18 to 0.31 during pretreatment step by agitation and PFS coagulation. Thereafter, the effluent was diluted with sewage at a different ratio before it was subjected to sequencing batch reactor (SBR) treatment. Up to 93.3% BOD{sub 5}, 95.5% COD and 98.1% NH{sub 3}-N removal were achieved by SBR operated under anoxic–aerobic–anoxic conditions. The filtration process was carried out using sand and carbon as a dual filter media as polishing process. The final effluent concentration of COD, BOD{sub 5}, suspended solid (SS), NH{sub 3}-N and total organic carbon (TOC) were 72.4 mg L{sup −1}, 22.8 mg L{sup −1}, 24.2 mg L{sup −1}, 18.4 mg L{sup −1} and 50.8 mg L{sup −1} respectively, which met the discharge standard. The results indicated that a combined process of agitation-coagulation-SBR and filtration effectively eliminated

  16. Comparisons between cellulase production by Aspergillus fumigatus in agitated vessels and in an air-lift fermentor

    SciTech Connect

    Wase, D.A.J.; McManamey, W.J.; Raymahasay, S.; Vaid, A.K.

    1985-08-01

    Aspergillus fumigatus was cultured in disc-turbine-agitated vessels and in an air-lift fermentor. In the agitated vessels the yield of cellulase was reduced when the agitation rate was increased, although extracellular protein levels rose. The enzyme complex itself was shown to be exceptionally stable under conditions similar to those in the agitated vessels, so probably shear damage to the mycelium had occurred, liberating intracellular contents. These appeared to contain an inhibitor that could be removed by fabricated inorganic protein absorbents, such as kieselguhr and alumina. However, the inhibitor was not likely to be protease, since only relatively low levels could be detected and its identity has not been established. The use of an air-lift fermentor avoided the shear effects due to use of the disc turbine agitator in the conventional fermentors, and yields of enzyme were then found to increase by about 20%, maximum yields being obtained at maximum Kla values.

  17. Respiratory system mechanics in sedated, paralyzed, morbidly obese patients.

    PubMed

    Pelosi, P; Croci, M; Ravagnan, I; Cerisara, M; Vicardi, P; Lissoni, A; Gattinoni, L

    1997-03-01

    The effects of inspiratory flow and inflation volume on the mechanical properties of the respiratory system in eight sedated and paralyzed postoperative morbidly obese patients (aged 37.6 +/- 11.8 yr who had never smoked and had normal preoperative seated spirometry) were investigated by using the technique of rapid airway occlusion during constant-flow inflation. With the patients in the supine position, we measured the interrupter resistance (Rint,rs), which in humans probably reflects airway resistance, the "additional" resistance (delta Rrs) due to viscoelastic pressure dissipation and time-constant inequalities, and static respiratory elastance (Est,rs). Intra-abdominal pressure (IAP) was measured by using a bladder catheter, and functional residual capacity was measured by the heliumdilution technique. The results were compared with a previous study on 16 normal anesthetized paralyzed humans. Compared with normal persons, we found that in obese subjects: 1) functional residual capacity was markedly lower (0.645 +/- 0.208 liter) and IAP was higher (24 +/- 2.2 cmH2O); 2) alveolar-arterial oxygenation gradient was increased (178 +/- 59 mmHg); 3) the volume-pressure curve of the respiratory system was curvilinear with an "inflection" point; 4) Est,rs, Rint,rs, and delta Rrs were higher than normal (29.3 +/- 5.04 cmH2O/l, 5.9 +/- 2.4 cmH2O.l-1.s, and 6.4 +/- 1.6 cmH2O.l-1.s, respectively); 5) Rint,rs increased with increasing inspiratory flow, Est,rs did not change, and delta Rrs decreased progressively; and 6) with increasing inflation volume, Rint,rs and Est,rs decreased, whereas delta Rrs rose progressively. Overall, our data suggest that obese subjects during sedation and paralysis are characterized by hypoxemia and marked alterations of the mechanical properties of the respiratory system, largely explained by a reduction in lung volume due to the excessive unopposed IAP. PMID:9074968

  18. Comparison of general anesthesia and intravenous sedation-analgesia for SWL.

    PubMed

    Zommick, J; Leveillee, R; Zabbo, A; Colasanto, L; Barrette, D

    1996-12-01

    We compared general anesthesia and intravenous sedation-analgesia for SWL on a Dornier HM3 lithotripter with respect to treatment and anesthesia time, X-ray exposure, shockwaves administered, and efficacy. The case records of 49 patients receiving general anesthesia and 118 patients who underwent intravenous sedation-analgesia were examined. Follow-up plain abdominal radiographs were evaluated for residual stones. Treatments accomplished under intravenous sedation-analgesia required less anesthesia time and less SWL time. The amount of fluoroscopy time was increased. The success rate in treating patients with these two types of anesthesia was not significantly different. Intravenous sedation-analgesia is safe and effective for shockwave lithotripsy in the HM3 lithotripter. This technique facilitates more rapid outpatient treatment and has excellent patient tolerance.

  19. [Anesthesia and sedation by admixture of xenon-oxygen in dentistry. Part I].

    PubMed

    Rabinovich, S A; Zavodilenko, L A; Babikov, A S

    2014-01-01

    The modern out-patient dental treatment which is performed under combined anesthesia with of xenon-oxygen inhalations provides comfortable conditions for the doctor and the patient, effective anesthesia and safe level of the sedation controlled by dentist.

  20. Analgesia, sedation, and neuromuscular blockade during targeted temperature management after cardiac arrest.

    PubMed

    Riker, Richard R; Gagnon, David J; May, Teresa; Seder, David B; Fraser, Gilles L

    2015-12-01

    The approach to sedation, analgesia, and neuromuscular blockade during targeted temperature management (TTM) remains largely unstudied, forcing clinicians to adapt previous research from other patient environments. During TTM, very little data guide drug selection, doses, and specific therapeutic goals. Sedation should be deep enough to prevent awareness during neuromuscular blockade, but titration is complex as metabolism and clearance are delayed for almost all drugs during hypothermia. Deeper sedation is associated with prolonged intensive care unit (ICU) and ventilator therapy, increased delirium and infection, and delayed wakening which can confound early critical neurological assessments, potentially resulting in erroneous prognostication and inappropriate withdrawal of life support. We review the potential therapeutic goals for sedation, analgesia, and neuromuscular blockade during TTM; the adverse events associated with that treatment; data suggesting that TTM and organ dysfunction impair drug metabolism; and controversies and potential benefits of specific monitoring. We also highlight the areas needing better research to guide our therapy. PMID:26670815

  1. Propofol infusion for sedation in the intensive care unit: preliminary report.

    PubMed Central

    Grounds, R M; Lalor, J M; Lumley, J; Royston, D; Morgan, M

    1987-01-01

    Propofol (2,6,di-isopropylphenol) was given by continuous intravenous infusion to provide sedation after cardiac surgery in 30 patients and its effects compared with those of midazolam given to a further 30 patients. Propofol infusion allowed rapid and accurate control of the level of sedation, which was satisfactory for longer than with midazolam. Patients given propofol recovered significantly more rapidly from their sedation once they had fulfilled the criteria for weaning from artificial ventilation and as a result spent a significantly shorter time attached to a ventilator. There were no serious complications in either group. Both medical and nursing staff considered the propofol infusion to be superior to midazolam in these patients. These findings suggest that propofol is a suitable replacement for etomidate and alphaxalone-alphadolone for sedating patients receiving intensive care. PMID:3101895

  2. Personhood within the context of sedation at the end of life in Singapore

    PubMed Central

    Radha Krishna, Lalit Kumar

    2013-01-01

    The concept of personhood is critical to the provision of holistic, patient-centred, palliative care yet no common definition of this term exists. Some characterise personhood by the presence of consciousness-related features such as self-awareness while others deem personhood present by virtue of Divine endowment or as a result of one's social relations. Efforts to appropriately delineate this concept come under scrutiny following suggestions that patients rendered deeply and irreversibly unconscious lack personhood and ought to be considered ‘dead’. This case report studies the views of a family caring for a deeply sedated terminally ill patient, to appropriately site local views of personhood within the context of sedation at the end of life. The resultant Ring Theory of Personhood dispenses with concerns that personhood is solely dependent upon consciousness and distances sedative treatments of last resort such as continuous deep sedation from euthanasia. PMID:23749859

  3. The Impact of Procedural Sedation on Diagnostic Errors in Pediatric Echocardiography

    PubMed Central

    Stern, Kenan W.D.; Gauvreau, Kimberlee; Geva, Tal; Benavidez, Oscar J.

    2014-01-01

    Background Infants and young children frequently have difficulty remaining still for an echocardiogram, potentially leading to poor study quality, increasing the likelihood of diagnostic errors. Sedation is believed to improve echocardiography quality; however, its effectiveness has not been demonstrated. We hypothesized that sedation would improve study quality and reduce diagnostic errors. Methods We examined outpatient echocardiograms in children ≤ 36 months from January 2008 – June 2009. We collected variables related to image quality, report completeness and sedation use. Diagnostic errors were identified and categorized. Multivariable analysis identified the odds ratio (OR) and 95% confidence interval (CI) for risk factors for potentially preventable diagnostic errors and the impact of sedation on these errors. Results Among 2,003 echocardiograms, sedation was used in 498 (25%). The overall diagnostic error rate was 6.5%. Most errors (66%) were potentially preventable. Multivariable analysis identified the following risk factors for potentially preventable errors: pre-cardiac procedure (OR 2.19, 95% CI 1.05 to 4.59, P=0.04); moderate anatomic complexity (OR 3.91, 95% CI 2.25 to 6.81, P<0.001); and high anatomic complexity (OR 8.36; 95% CI 3.57 to 19.6, P<0.001). Sedation was independently associated with lower odds for potentially preventable diagnostic error (OR 0.47, 95% CI 0.27 to 0.80, P=0.006). Echocardiograms with sedation had fewer image quality concerns (22% vs. 60%) and fewer incomplete reports (3% vs. 20%) (P<0.001). Conclusions Most echocardiographic diagnostic errors among infants and young children are potentially preventable. Sedation is associated with a lower likelihood of these diagnostic errors, fewer imaging quality concerns, and fewer incomplete reports. PMID:24930122

  4. 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

  5. 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

  6. Sedative effect of galphimine B, a nor-seco-triterpenoid from Galphimia glauca.

    PubMed

    Tortoriello, J; Ortega, A

    1993-10-01

    Galphimia glauca Cav. (Malpighiaceae) is used in Mexican traditional medicine as a sedative in the treatment of mental disorders. Sedative properties of a methanolic extract of the aerial parts of this plant have been established in animal trials and an active compound, named galphimine B, has already been isolated. This compound was submitted to neuropharmacological testing, where it was shown that galphimine B had no significant effect as an anticonvulsant, while it exhibited a strong depressant activity on the nervous system. PMID:8255929

  7. 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

  8. Sedative effect of galphimine B, a nor-seco-triterpenoid from Galphimia glauca.

    PubMed

    Tortoriello, J; Ortega, A

    1993-10-01

    Galphimia glauca Cav. (Malpighiaceae) is used in Mexican traditional medicine as a sedative in the treatment of mental disorders. Sedative properties of a methanolic extract of the aerial parts of this plant have been established in animal trials and an active compound, named galphimine B, has already been isolated. This compound was submitted to neuropharmacological testing, where it was shown that galphimine B had no significant effect as an anticonvulsant, while it exhibited a strong depressant activity on the nervous system.

  9. Scales

    SciTech Connect

    Murray Gibson

    2007-04-27

    Musical scales involve notes that, sounded simultaneously (chords), sound good together. The result is the left brain meeting the right brain — a Pythagorean interval of overlapping notes. This synergy would suggest less difference between the working of the right brain and the left brain than common wisdom would dictate. The pleasing sound of harmony comes when two notes share a common harmonic, meaning that their frequencies are in simple integer ratios, such as 3/2 (G/C) or 5/4 (E/C).

  10. Scales

    ScienceCinema

    Murray Gibson

    2016-07-12

    Musical scales involve notes that, sounded simultaneously (chords), sound good together. The result is the left brain meeting the right brain — a Pythagorean interval of overlapping notes. This synergy would suggest less difference between the working of the right brain and the left brain than common wisdom would dictate. The pleasing sound of harmony comes when two notes share a common harmonic, meaning that their frequencies are in simple integer ratios, such as 3/2 (G/C) or 5/4 (E/C).

  11. Standing sedation with medetomidine and butorphanol in captive African elephants (Loxodonta africana).

    PubMed

    Lüders, I; Tindall, B; Young, D; van der Horst, G; Botha, S; Luther, I; Maree, L; Bertschinger, H J

    2016-03-01

    Doses for standing sedation allowing for various procedures in otherwise inaccessible, untrained captive African elephant bulls are presented. Thirty-three standing sedations were performed in 12 males aged 8-30 years (one to four sedations per animal). Each bull received a combination of 0.009 ± 0.002 mg/kg medetomidine and 0.03 ± 0.007 mg/kg butorphanol. Full sedation was reached on average 25.5 min after injection. The addition of hyaluronidase (1000-2000 IU) significantly reduced time to full sedation to 16.5 min (paired t test, P = 0.024). Reversal was induced with intramuscular atipamezole 0.008 (±0.002) and naltrexone 0.035 (±0.015) mg/kg. Recovery took on average 7 min (3-18 min). The medetomidine/butorphanol combination provided safe standing sedation for smaller procedures. PMID:26831175

  12. Sedatives and Analgesics Given to Infants in Neonatal Intensive Care Units at the End of Life

    PubMed Central

    Zimmerman, Kanecia O.; Hornik, Christoph P.; Ku, Lawrence; Watt, Kevin; Laughon, Matthew M.; Bidegain, Margarita; Clark, Reese H.; Smith, P. Brian

    2015-01-01

    Objective To describe the administration of sedatives and analgesics at the end of life in a large cohort of infants in North American neonatal intensive care units (NICUs). Study design Data on mortality and sedative and analgesic administration were obtained from infants who died from 1997–2012 in 348 NICUs managed by the Pediatrix Medical Group. Sedatives and analgesics of interest included opioids (fentanyl, methadone, morphine), benzodiazepines (clonazepam, diazepam, lorazepam, midazolam), central alpha-2 agonists (clonidine, dexmedetomidine), ketamine, and pentobarbital. We used multivariable logistic regression to evaluate the association between administration of these drugs on the day of death and infant demographics and illness severity. Results We identified 19,726 infants who died. Of these, 6188 (31%) received a sedative or analgesic on the day of death; opioids were most frequently administered, 5366/19,726 (27%). Administration of opioids and benzodiazepines increased during the study period, from 16/283 (6%) for both in 1997 to 523/1465 (36%) and 295/1465 (20%) in 2012, respectively. Increasing gestational age, increasing postnatal age, invasive procedure within 2 days of death, more recent year of death, mechanical ventilation, inotropic support, and antibiotics on the day of death were associated with exposure to sedatives or analgesics. Conclusions Administration of sedatives and analgesics increased over time. Infants of older gestational age and those more critically ill were more likely to receive these drugs on the day of death. These findings suggest that drug administration may be driven by severity of illness. PMID:26012893

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

    PubMed Central

    2014-01-01

    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

  14. Review on sedation for gastrointestinal tract endoscopy in children by non-anesthesiologists

    PubMed Central

    Orel, Rok; Brecelj, Jernej; Dias, Jorge Amil; Romano, Claudio; Barros, Fernanda; Thomson, Mike; Vandenplas, Yvan

    2015-01-01

    AIM: To present evidence and formulate recommendations for sedation in pediatric gastrointestinal (GI) endoscopy by non-anesthesiologists. METHODS: The databases MEDLINE, Cochrane and EMBASE were searched for the following keywords “endoscopy, GI”, “endoscopy, digestive system” AND “sedation”, “conscious sedation”, “moderate sedation”, “deep sedation” and “hypnotics and sedatives” for publications in English restricted to the pediatric age. We searched additional information published between January 2011 and January 2014. Searches for (upper) GI endoscopy sedation in pediatrics and sedation guidelines by non-anesthesiologists for the adult population were performed. RESULTS: From the available studies three sedation protocols are highlighted. Propofol, which seems to offer the best balance between efficacy and safety is rarely used by non-anesthesiologists mainly because of legal restrictions. Ketamine and a combination of a benzodiazepine and an opioid are more frequently used. Data regarding other sedatives, anesthetics and adjuvant medications used for pediatric GI endoscopy are also presented. CONCLUSION: General anesthesia by a multidisciplinary team led by an anesthesiologist is preferred. The creation of sedation teams led by non-anesthesiologists and a careful selection of anesthetic drugs may offer an alternative, but should be in line with national legislation and institutional regulations. PMID:26240691

  15. Continuous sedation until death as physician-assisted suicide/euthanasia: a conceptual analysis.

    PubMed

    Lipuma, Samuel H

    2013-04-01

    A distinction is commonly drawn between continuous sedation until death and physician-assisted suicide/euthanasia. Only the latter is found to involve killing, whereas the former eludes such characterization. I argue that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia in that both involve killing. This is established by first defining and clarifying palliative sedation therapies in general and continuous sedation until death in particular. A case study analysis and a look at current practices are provided. This is followed by a defense of arguments in favor of definitions of death centering on higher brain (neocortical) functioning rather than on whole brain or cardiopulmonary functioning. It is then shown that continuous sedation until death simulates higher brain definitions of death by eliminating consciousness. Appeals to reversibility and double effect fail to establish any distinguishing characteristics between the simulation of death that occurs in continuous sedation until death and the death that occurs as a result of physician-assisted suicide/euthanasia. Concluding remarks clarify the moral ramifications of these findings.

  16. Conscious sedation procedures using intravenous midazolam for dental care in patients with different cognitive profiles: a prospective study of effectiveness and safety.

    PubMed

    Collado, Valérie; Faulks, Denise; Nicolas, Emmanuel; Hennequin, Martine

    2013-01-01

    The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N₂O/O₂ was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N₂O/O₂), were shown to be safe and effective in patients with intellectual disability when administered by dentists.

  17. Conscious Sedation Procedures Using Intravenous Midazolam for Dental Care in Patients with Different Cognitive Profiles: A Prospective Study of Effectiveness and Safety

    PubMed Central

    Collado, Valérie; Faulks, Denise; Nicolas, Emmanuel; Hennequin, Martine

    2013-01-01

    The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N2O/O2 was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N2O/O2), were shown to be safe and effective in patients with intellectual disability when administered by dentists. PMID:23940729

  18. To study the effectiveness and safety of ketamine and midazolam procedural sedation in the incision and drainage of abscesses in the adult emergency department.

    PubMed

    Sim, Tiong Beng; Seet, Chong Meng

    2008-06-01

    The objective of the report was to study the efficacy and safety of ketamine and midazolam combination in the procedural sedation of incision and drainage of abscesses in the adult emergency department (ED) patients. This prospective observational study enrolled patients aged 16-60 years (American Society of Anesthesiologists class I) requiring abscess drainage in an adult ED. Patients received 2 mg/kg of ketamine infusion over 5 min and midazolam 2-5 mg titrated to deep sedation according to Ramsay sedation scale. Primary outcome was patient satisfaction using pain score after procedure. Secondary outcomes included adverse effects, hemodynamics alterations and recovery time. Descriptive statistics were calculated using SPSS software. Fifteen patients were recruited. One patient was excluded because of difficulty with pain score interpretation. Seventy-nine percent were male patients. The mean age was 29. The mean size of abscess was 3.4 cm. The mean dose of midazolam was 3.2 mg. Eighty-six percent did not experience any pain for the procedure. Only two patients (14%) reported mild pain during the procedure. There were no significant adverse events or complications. Three patients had giddiness, two had vomiting and only one reported an unpleasant dream. The median systolic blood pressure and heart rate elevation were 30+/-5.1 mmHg and 12.5+/-3.2/min, respectively. The median time for blood pressure and pulse rate to return to baseline was 20+/-2.7 min. The use of ketamine and midazolam sedation is both well tolerated and effective for adults in the ED undergoing incision and drainage of abscesses. This study is limited by the small sample size. PMID:18460960

  19. Effect of an analgo-sedation protocol for neurointensive patients: a two-phase interventional non-randomized pilot study

    PubMed Central

    2010-01-01

    Introduction Sedation protocols are needed for neurointensive patients. The aim of this pilot study was to describe sedation practice at a neurointensive care unit and to assess the feasibility and efficacy of a new sedation protocol. The primary outcomes were a shift from sedation-based to analgesia-based sedation and improved pain management. The secondary outcomes were a reduction in unplanned extubations and duration of sedation. Methods This was a two-phase (before-after), prospective controlled study at a university-affiliated, 14-bed neurointensive care unit in Denmark. The sample included patients requiring mechanical ventilation for at least 48 hours treated with continuous sedative and analgesic infusions or both. During the observation phase the participants (n = 106) were sedated as usual (non-protocolized), and during the intervention phase the participants (n = 109) were managed according to a new sedation protocol. Results Our study showed a shift toward analgo-sedation, suggesting feasibility of the protocol. We found a significant reduction in the use of propofol (P < .001) and midazolam (P = .001) and an increase in fentanyl (P < .001) and remifentanil (P = .003). Patients selected for daily sedation interruption woke up faster, and estimates of pain free patients increased from 56.8% to 82.7% (P < .001), suggesting efficacy of the protocol. The duration of sedation and unplanned extubations were unchanged. Conclusions Our pilot study showed feasibility and partial efficacy of our protocol. Some neurointensive patients might not benefit from protocolized practice. We recommend an interdisciplinary effort to target patients requiring less sedation, as issues of oversedation and inadequate pain management still need more attention. Trial registration ISRCTN80999859. PMID:20403186

  20. Dutasteride reduces alcohol's sedative effects in men in a human laboratory setting and reduces drinking in the natural environment

    PubMed Central

    Covault, Jonathan; Pond, Timothy; Feinn, Richard; Arias, Albert J.; Oncken, Cheryl; Kranzler, Henry R.

    2014-01-01

    Rationale Preclinical studies support the hypothesis that endogenous neuroactive steroids mediate some effects of alcohol. Objectives The aim of this study was to examine the effect of dutasteride inhibition of 5α-reduced neuroactive steroid production on subjective responses to alcohol in adult men. Methods Using a within-subject factorial design, 70 men completed four randomly ordered monthly sessions in which pretreatment with 4 mg dutasteride or placebo was paired with a moderate dose of alcohol (0.8 g/kg) or placebo beverage. The pharmacologic effect of dutasteride was measured by an assay of serum androstanediol glucuronide. Self-reports of alcohol effects were obtained at 40-min intervals following alcohol administration using the Biphasic Alcohol Effects Scale (BAES) and the Alcohol Sensation Scale (SS). We used linear mixed models to examine the effects of dutasteride and alcohol on BAES and SS responses and the interaction of dutasteride with the GABRA2 alcohol dependence-associated polymorphism rs279858. We also examined whether exposure to dutasteride influenced drinking in the weeks following each laboratory session. Results A single 4-mg dose of dutasteride produced a 70 % reduction in androstanediol glucuronide. Dutasteride pretreatment reduced alcohol effects on the BAES sedation and SS anesthesia scales. There was no interaction of dutasteride with rs279858. Heavy drinkers had fewer heavy drinking days during the 2 weeks following the dutasteride sessions and fewer total drinks in the first week after dutasteride. Conclusions These results provide evidence that neuroactive steroids mediate some of the sedative effects of alcohol in adult men and that dutasteride may reduce drinking, presumably through its effects on neuroactive steroid concentrations. PMID:24557088

  1. Corelation between Machines Assisted Endodontic Irrigant Agitation and Apical Extrusion of Debris and Irrigant: A Laboratory Study

    PubMed Central

    Gupta, Jatin; Jha, Padmanabh

    2014-01-01

    Aims. To compare amount of root canal debris and irrigant extruded apically after irrigants agitation using closed and open chambers. Methods and Material. Sixty maxillary central incisors were selected, decoronated, and mounted in preweighed glass vials filled with distilled water. Biomechanical preparation was completed using ProTaper rotary files until number F4 and 1 mL of 3% NaOCl solution after each file use. Samples were randomly divided into closed or open chamber sets which were further subdivided into 6 groups, based on the agitation techniques: no agitation (control), canalBrush, lentulospiral, passive ultrasonic agitation (PUA), EndoActivator, and EndoVac. Canals were irrigated with 1 mL of 17% EDTA and agitated for 30 s and then flushed with 2 mL of distilled water. Apically extruded irrigant was measured and vials were kept in incubator for 5 days at 68°C for drying for weight calculation. Statistical Analysis. Analysis was done using Student's t-test, one-way ANOVA, and post-hoc. Results. All agitation techniques showed apical extrusion of the debris and irrigant. The closed chamber apparatus showed significantly less extrusion of debris and irrigant than open chamber (P < 0.05). Conclusions. EndoVac was found to be the safest agitation system among all test groups with regard to apical extrusion of debris and irrigant. PMID:25386593

  2. Identifying proper agitation interval to prevent floating layers formation of corn stover and improve biogas production in anaerobic digestion.

    PubMed

    Tian, Libin; Zou, Dexun; Yuan, Hairong; Wang, Linfeng; Zhang, Xin; Li, Xiujin

    2015-06-01

    Floating tests were conducted in anaerobic digestion with different OLR of corn stover to investigate formation of floating layers and to find proper agitation interval for preventing floating layer formation. Floating layers were formed in the early stage of no-agitation period. The daily biogas production was decreased by 81.87-87.90% in digesters with no agitation and feeding compared with digesters having agitation. Reduction of biogas production was mainly attributed to poor contact of substrate-microorganisms. Agitation intervals of 10 h, 6 h, and 2 h were found to be proper for eliminating floating layer at OLR of 1.44, 1.78 and 2.11 g(TS) L(-1) d(-1), respectively. The proper agitation interval was further validated by anaerobic experiments. It showed that proper agitation interval could not only prevent floating layer formation and achieve high biogas production but also increase energy efficiency of anaerobic digestion. The finding is useful for operating anaerobic digester with corn stover in a cost-effective way.

  3. Effects of hydrogen peroxide on diazepam and xylazine sedation in chicks

    PubMed Central

    Mousa, Yaareb J.

    2012-01-01

    Oxidative stress may cause various neuronal dysfunctions and modulate responses to many centrally acting drugs. This study examines the effects of oxidative stress produced by hydrogen peroxide (H2O2) on sedation induced by diazepam or xylazine as assessed in 7–14 day-old chicks. Day-old chicks were provided with either plane tap water (control group) or H2O2 in tap water as 0.5% v/v drinking solution for two weeks in order to produce oxidative stress. Spectrophotometric methods were used to determine glutathione and malondialdehyde concentrations in plasma and whole brain. Drug-induced sedation in the chicks was assessed by monitoring the occurrence of signs of sedation manifested as drooping of the head, closed eyelids, reduced motility or immotility, decreased distress calls, and recumbency. The latency to onset of sedation and its duration were also recorded. H2O2 treatment for two weeks significantly decreased glutathione and increased malondialdehyde concentrations in plasma and whole brain of the chicks on days 7, 10 and 14 as compared with respective age-matched control groups. H2O2 decreased the median effective doses of diazepam and xylazine for the induction of sedation in chicks by 46% and 63%, respectively. Injection of diazepam at 2.5, 5 and 10 mg/kg, i.m. or xylazine at 2, 4 and 8 mg/kg, i.m. induced sedation in both control and H2O2-treated chicks in a dose dependent manner, manifested by the above given signs of sedation. H2O2 significantly decreased the latency to onset of sedation in chicks treated with diazepam at 5 and 10 mg/kg, increased the duration of sedation and prolonged the total recovery time in comparison with respective non-stressed control chicks. A similar trend occurred with xylazine in the H2O2-treated chicks, though the differences from control counterparts did not attain the statistical significance, except for the recovery time of the lowest dose of the drug. The data suggest that H2O2-induced oxidative stress sensitizes the

  4. Bispectral Index in Evaluating Effects of Sedation Depth on Drug-Induced Sleep Endoscopy

    PubMed Central

    Lo, Yu-Lun; Ni, Yung-Lun; Wang, Tsai-Yu; Lin, Ting-Yu; Li, Hsueh-Yu; White, David P.; Lin, Jr-Rung; Kuo, Han-Pin

    2015-01-01

    Objective: To evaluate the effect of sedation depth on drug-induced sleep endoscopy (DISE). Methods: Ninety patients with obstructive sleep apnea (OSA) and 18 snorers underwent polysomnography and DISE under bispectral index (BIS)-guided propofol infusion at two different sedation levels: BIS 65–75 (light sedation) and 50–60 (deep sedation). Results: For the patients with OSA, the percentages of velopharynx, oropharynx, hypopharynx, and larynx obstructions under light sedation were 77.8%, 63.3%, 30%, and 33.3%, respectively. Sedation depth was associated with the severity of velopharynx and oropharynx obstruction, oropharynx obstruction pattern, tongue base obstruction, epiglottis anteroposterior prolapse and folding, and arytenoid prolapse. In comparison, OSA severity was associated with the severity of velopharynx obstruction, severity of oropharynx obstruction, and arytenoid prolapse (odds ratio (95% confidence interval); 14.3 (4.7–43.4), 11.7 (4.2–32.9), and 13.2 (2.8–62.3), respectively). A good agreement was noted between similar DISE findings at different times and different observers (kappa value 0.6 to 1, respectively). A high percentage of arytenoid prolapse (46.7% among the patients with OSA under light sedation) was noted. Conclusions: Greater sedative depth increased upper airway collapsibility under DISE assessment. DISE under BIS-guided propofol infusion, and especially a level of 65–75, offers an objective and reproducible method to evaluate upper airway collapsibility. Some findings were induced by drug sedation and need careful interpretation. Specific arytenoid prolapse patterns were noted for which further investigations are warranted. Clinical Trials Registration: http://www.clinicaltrials.gov, identifier: NCT01100554 Commentary: A commentary on this article appears in this issue on page 965. Citation: Lo YL, Ni YL, Wang TY, Lin TY, Li HY, White DP, Lin JR, Kuo HP. Bispectral index in evaluating effects of sedation depth on drug

  5. Some Problems of Industrial Scale-Up.

    ERIC Educational Resources Information Center

    Jackson, A. T.

    1985-01-01

    Scientific ideas of the biological laboratory are turned into economic realities in industry only after several problems are solved. Economics of scale, agitation, heat transfer, sterilization of medium and air, product recovery, waste disposal, and future developments are discussed using aerobic respiration as the example in the scale-up…

  6. Influence of thermal agitation on the electric field induced precessional magnetization reversal with perpendicular easy axis

    SciTech Connect

    Cheng, Hongguang Deng, Ning

    2013-12-15

    We investigated the influence of thermal agitation on the electric field induced precessional magnetization switching probability with perpendicular easy axis by solving the Fokker-Planck equation numerically with finite difference method. The calculated results show that the thermal agitation during the reversal process crucially influences the switching probability. The switching probability can be achieved is only determined by the thermal stability factor Δ of the free layer, it is independent on the device dimension, which is important for the high density device application. Ultra-low error rate down to the order of 10{sup −9} can be achieved for the device of thermal stability factor Δ of 40. Low damping factor α material should be used for the free layer for high reliability device applications. These results exhibit potential of electric field induced precessional magnetization switching with perpendicular easy axis for ultra-low power, high speed and high density magnetic random access memory (MRAM) applications.

  7. Psychosis-related disturbances. Psychosis, agitation, and disinhibition in Alzheimer's disease: definitions and treatment options.

    PubMed

    Lesser, Jary M; Hughes, Susan

    2006-12-01

    Approximately 50% to 80% of persons diagnosed with Alzheimer's disease (AD) have some type of behavioral or psychiatric condition (eg, agitation, psychosis, and/or disinhibition). Agitation is defined in the context of restlessness, irritability, and resistiveness. Psychosis is recognized as a disturbance in the perception of objective reality. Disinhibition means a chronic loss of social restraint. In the case of AD, disinhibition can present as aggression, hyperactivity, and socially intrusive behavior. Such conditions can be burdensome for physicians and caregivers to manage. Consequences may include caregiver burnout or illness, patient abuse, and even institutionalization for the patient. Management of behavioral disturbances is no longer primarily handled by psychiatrists, but is now entering the realm of family practice and primary care. This article provides evaluation methods and treatment options for the aforementioned behavioral disturbances.

  8. [Sultopride, treatment of choice for psychomotor agitation in severe encephalopathy. 33 cases in a neuropediatric milieu].

    PubMed

    Gadisseux, J F; Fournaux, J; Hallet, J; Ferriere, G

    1982-01-01

    Thirty-three patients showing a definite group of symptoms including chiefly agitation or self-mutilation often dramatic have been treated with sultopride at doses ranging from 7 to 50 mg/kg/day at the Institut Médico-Pédagogique de l'Enfant-Jésus at Ciney. Forty-eight per cent showing this particular symptoms have been cured or greatly improved with sultopride. In 36% the response was incomplete in that it appeared to be identical with sultopride solely or with the previous medications. An opposite result has been noted in 16% only. Side-effects consisted in extra-pyramidal symptoms, drowsiness and digestive disorders. This study leads to the conclusion that sultopride can be considered as the most efficient therapeutical approach to the management of agitation or self-mutilation in severe encephalopathy.

  9. Particle-liquid mass transfer in three-phase mechanically agitated contactors

    SciTech Connect

    Kushalkar, K.B.; Pangarkar, V.G. . Dept. of Chemical Technology)

    1994-07-01

    Mass transfer to or from solid particles suspended in an agitated liquid is relevant to many chemical processes such as adsorption, crystallization, fermentation, slurry reactors, extraction of metals, polymer processing, waste water treatment, etc. Particle-liquid mass transfer in a three-phase mechanically agitated contactor has been studied. The experiments covered a broad range of particle sizes, liquid viscosities, and gas velocities besides variations in system geometry. The impellers used were upflow pitched blade turbine (PTU), downflow pitched blade turbine (PTD), the disk turbine (DT). The results indicated a unique relationship of the particle-liquid mass-transfer coefficient with respect to the critical suspension speed under gassed conditions, N[sub sg]. This observation has resulted in a simplified correlation for the particle-liquid mass-transfer coefficient.

  10. Highly sensitive detection and stochastic analysis of magnetization agitation induced in a single layered magnetic wire

    NASA Astrophysics Data System (ADS)

    Yamaguchi, Akinobu; Motoi, Keiichi; Miyajima, Hideki

    2016-03-01

    This study shows that broadband magnetic noise in a ferromagnetic wire can be detected over a wide frequency range between 500 MHz and 8 GHz using a lock-in detection technique. The magnetic noise spectrum from a 20 nm-thick single-layered Fe19Ni81 wire biased with a dc current is measured as functions of an external field and dc current. This noise is caused by thermal agitation in magnetization due to ambient temperature and Joule heating. The noise behaviors are well reproduced by a stochastic model. Thus, this paper presents a stochastic analysis of magnetic noise behaviors induced by thermal agitation using a highly sensitive technique for detecting the magnetic noise in a single layered ferromagnetic wire.

  11. Mixing and solid suspension of up-down agitators in a slab tank

    SciTech Connect

    Ramsey, C.J. . Dept. of Mechanical Engineering); Kyser, E.A. III; Tatterson, G.B. )

    1989-01-01

    Seven different up-down agitators were studied for their ability to produce mixing and solid suspension in a slab tank. Mixing times were measured as the time needed to disperse injected dye. The solid suspension studies determined the minimum stroke frequency of the agitators needed for complete off-bottom suspension. The effects of stroke frequency, n; amplitude, a; blade width, w; blade clearance, c; and liquid depth, h, and weight percent solids, X, were studied. The most effective geometry, in terms of mixing, solid suspension and design simplicity, was a single flat blade with minimum off-bottom clearance and a blade width/tank thickness ratio, w/T, of 0.74 at the maximum stroke amplitude studied. 15 refs., 7 figs.

  12. The effect of agitation on the biodegradation of hydrocarbon contaminants in soil slurries.

    PubMed

    Stroud, Jacqueline L; Paton, Graeme I; Semple, Kirk T

    2009-09-01

    Slurry-based mineralisation assays are widely used to investigate contaminant biodegradation in soil; however, the importance of shaking speed on microbial degradation has not been considered. This study investigated the mineralisation of (14)C-analogues of phenanthrene, hexadecane and octacosane, shaken at 0, 25 and 100 rpm. The results showed that the fastest rates and highest levels of mineralisation in 0 d aged soils were in the highly agitated conditions (100 rpm). However, the highest levels of mineralisation in 500 d aged soil were found in the gently shaken conditions (25 rpm), with the levels of mineralisation significantly (p<0.05) one third higher than under the highly agitated conditions (100 rpm). Consequently, estimation of the maximum levels of biodegradation of organic contaminants in aged soil systems should be considered under gentle mixing conditions. PMID:19487012

  13. Subtypes of Adolescent Sedative/Anxiolytic Misusers: A Latent Profile Analysis

    PubMed Central

    Hall, Martin T.; Howard, Matthew O.; McCabe, Sean Esteban

    2010-01-01

    Background Few empirically-based taxonomies of nonmedical prescription drug misusers have been published. This study used latent profile analysis (LPA) to identify classes of adolescent sedative/anxiolytic misusers. Methods Interviews assessing substance use, psychiatric symptoms, antisocial traits/behavior, and traumatic life experiences were conducted with 723 Missouri youth in residential care for antisocial behavior. Sedative/anxiolytic misusers (N = 247) averaged 15.8 (S.D. = 1.1) years of age; a majority were male (83.8%), White (70.0%), and resided in rural/small town areas (53.8%). Results LPA yielded a three-class solution. Class 1 (59.1%) was comprised of youth with significantly lower levels of currently distressing psychiatric symptoms, fewer lifetime traumatic experiences, less problematic substance use histories, less frequent antisocial behavior, and less impulsivity than youth in Classes 2 and 3. Class 2 (11.3%) youth had high levels of currently distressing psychiatric symptoms and more frequent antisocial behavior compared to youth in Classes 1 and 3. Class 3 (29.5%) youth evidenced levels of psychiatric and behavioral problems that were intermediate to those of Class 1 and 2 youth. Frequency of sedative/anxiolytic misuse was significantly higher in Classes 2 and 3 compared to Class 1. Members of Class 2 and Class 3 also had the highest levels of psychiatric symptoms for which sedatives/anxiolytics are commonly prescribed. Significant differences between classes were observed across a range of health, mental health, personality, and behavioral variables. Conclusions Adolescents who misused prescription sedatives/anxiolytics evidenced significant heterogeneity across measures of psychiatric and behavioral dysfunction. Youth with comparatively high levels of anxiety and depression reported significantly more intensive sedative/anxiolytic misuse than their counterparts and may be at high risk for sedative/anxiolytic abuse and dependence. PMID

  14. Bispectral EEG index monitoring of high-dose nitrous oxide and low-dose sevoflurane sedation.

    PubMed Central

    Hall, David L.; Weaver, Joel; Ganzberg, Steven; Rashid, Robert; Wilson, Stephen

    2002-01-01

    This single-blind controlled clinical study characterized the effects of 30-70% nitrous oxide (N2O) and 0.2-0.8% sevoflurane conscious sedation on quantitative electroencephalographic (EEG) readings of 22 healthy dental students as measured by the bispectral index (BIS). The study verified the 2 previously published BIS/N2O investigations showing no correlation between N2O dosage up to 70% and BIS. Observer's Assessment of Alertness and Sedation scores (OAA/S), however, correlated well with increasing doses of N2O from approximately 35 to 70%. A near linear dose-response relationship was established between OAA/S and end tidal (ET) sevoflurane concentrations of 0.4-0.7%. Only at the highest level of end tidal sevoflurane recorded, 0.7%, was statistically significant BIS depression seen. Subjects evaluated the acceptability of the sedative effect of the 2 gases, showing a slight preference for N2O. Comparable partial anterograde amnesia and sedation (OAA/S) were produced by both agents in administered concentrations of 40-70% N2O and 0.6-0.8% sevoflurane. Female subjects exhibited better memory and significantly less amnesia than males. No statistically significant changes occurred in any of the monitored vital signs. EMG readings demonstrated a statistically significant difference from control values only at the highest, 0.7%, ET concentration of sevoflurane. BIS does not appear useful for evaluating the level of nitrous oxide sedation in the dental setting but may have some value in assessing depth of sedation at deeper levels of sevoflurane sedation. Images Figure 1 Figure 2 PMID:15384293

  15. 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

  16. 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

  17. 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

  18. Effect Of Developer Type And Agitation On Dissolution Of Positive Photoresist

    NASA Astrophysics Data System (ADS)

    Zee, Cynthia; Bell, W. R.; Neureuther, A. R.

    1988-01-01

    The role of surfactants and agitation in improving the performance of diazo type positive photoresist is explored through dissolution measurements, quantitative models for process simulation with SAM-PLE and SEM profile comparison. In-situ dissolution measurements of a commercial resist, Shipley 1400-31 in MF312, 314 and 319 developers were made on a Perkin Elmer development rate monitor (DRM) with and without moderate agitation. The quality of the measurement data was improved by using a nitride-oxide-nitride thin-film coating to reduce standing wave effects within the resist. Both developers with surfactants, MF314 and 319, show improved contrast over MF312 in plots of thickness remaining versus exposure dose. Although contrast was improved in all three cases by agitation, the effect was most pronounced with MF314. R(M) plots, obtained from combining dissolution rate data with exposure state, distinguish surface retardation effects from bulk effects and suggest that the improvement in contrast for MF314 is due to enhanced surface rate retardation. Using the rate parameters extracted from the R(M) plots, resist profiles were simulated and compared to SEM profiles of fine-lines.

  19. Performance and characterization of a newly developed self-agitated anaerobic reactor with biological desulfurization.

    PubMed

    Kobayashi, Takuro; Li, Yu-You

    2011-05-01

    The continuous operation of a newly developed methane fermentation reactor, which requires no electricity for the agitation of the fermentation liquid was investigated, and the extent of the biological desulfurization was monitored. Inside the reactor, the continual change in the liquid level and the self-agitation, occurring between 5 and 16 times every day, distributed the organic load near the inlet port of the reactor, as well as providing a nutrient supply to the hydrogen sulfide oxidizing bacteria. At different COD(Cr) loading rates (5, 7, 10 kg m(3)d(-1)), the reactor achieved a biogas production yield of 0.72-0.82 m(3)g(-1)-TS, a COD(Cr) reduction of 79.4-85.5% and an average of 99% hydrogen sulfide removal. This investigation demonstrated that the self-agitated reactor is comparable in digestion performance to the completely stirred tank reactor (CSTR) investigated in a previous study, and that the desulfurization performance was significantly enhanced compared to the CSTR.

  20. Impacts on wave-driven harbour agitation due to climate change in Catalan ports

    NASA Astrophysics Data System (ADS)

    Sierra, J. P.; Casas-Prat, M.; Virgili, M.; Mosso, C.; Sanchez-Arcilla, A.

    2015-08-01

    The objective of the present work is to analyse how changes in wave patterns due to the effect of climate change can affect harbour agitation (oscillations within the port due to wind waves). The study focuses on 13 harbours located on the Catalan coast (NW Mediterranean) using a methodology with general applicability. To obtain the patterns of agitation, a Boussinesq-type model is used, which is forced at the boundaries by present/future offshore wave conditions extracted from recently developed high-resolution wave projections in the NW Mediterranean. These wave projections were obtained with the SWAN model forced by present/future surface wind fields projected, respectively, by five different combinations of global and regional circulation models (GCMs and RCMs) for the A1B scenario. The results show a general slight reduction in the annual average agitation for most of the ports, except for the northernmost and southernmost areas of the region, where a slight increase is obtained. A seasonal analysis reveals that the tendency to decrease is accentuated in winter. However, the inter-model variability is large for both the winter and the annual analysis. Conversely, a general increase with a larger agreement among models is found during summer, which is the period with greater activity in most of the studied ports (marinas). A qualitative assessment of the factors of variability seems to indicate that the choice of GCM tends to affect the spatial pattern, whereas the choice of RCM induces a more homogeneous bias over the regional domain.

  1. Pumping Characteristics of a Helical Screw Agitator with a Draught Tube

    NASA Astrophysics Data System (ADS)

    Hwang, Jung-Hoon; Kim, Youn-Jea

    In the use of helical type agitator, the mixing process is usually restricted to the laminar flow regime. Common examples of laminar mixing are found where the fluid has a very high viscosity, i.e., pseudoplastic fluids. It can be indicated that a helical type agitator is sufficiently suited to the creeping flow mixing. The pumping characteristic of a Helical Screw Agitator with a draught tube (HSA) is required to evaluate its capacity for the optimal configuration of the mixing chamber. It could be executed by changing some parameters such as the number of helix, the angular velocity and the rotating direction and so on. In this study, the numerical simulation was carried out with the Eulerian multiphase mixture model and the moving mesh approximation. Some of the optimum design parameters have been developed with the aid of numerical data from the Computational Fluid Dynamics (CFD) analysis. Using the commercial code, Fluent, the pumping characteristics in the HSA are investigated from the rheological properties, and the results are graphically depicted.

  2. An open-label, randomized, controlled trial of zotepine and risperidone for acutely ill, hospitalized, schizophrenic patients with symptoms of agitation.

    PubMed

    Chan, Hung-Yu; Lin, An-Sheng; Chen, Kun-Po; Cheng, Jror-Serk; Chen, Ying-Yeh; Tsai, Chang-Jer

    2013-12-01

    Acutely ill, schizophrenic patients frequently require management of agitation. This study was conducted to compare the efficacy of oral zotepine and risperidone in hospitalized, acutely ill schizophrenic patients with symptoms of agitation.This was a 6-week, multicenter, randomized, open-label, parallel-group, flexible dosing study. Thirty-nine patients with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) who met the criteria of a Positive and Negative Syndrome Scale (PANSS) total score of greater than or equal to 60 points, PANSS-excitement component (EC) score of greater than or equal to 14 points, and at least 1 PANSS-EC score of greater than or equal to 4 were randomly assigned to either the zotepine or risperidone group. The primary outcome was a comparison of the change in the PANSS-EC total score from baseline to the end of the study between groups.There was no significant between-group difference in dropout rates (zotepine, 15.8% [3/19]; risperidone, 20.0% [4/20]). The mean (SD) daily dose of zotepine from baseline to study end point ranged from 127.6 (62.3) to 236.8 (74.2) mg/d; the corresponding values for risperidone ranged from 3.3 (1.6) to 4.8 (1.7) mg/d. There were no statistically significant differences in patient characteristics, PANSS total score, and PANSS-EC total score between the zotepine and risperidone groups at baseline. Both groups showed significant reductions in the PANSS-EC total scores (zotepine, -10.1 [4.7], P < 0.001; risperidone, -8.0 [5.3], P < 0.001) and PANSS total scores (zotepine, -34.7 [15.8], P < 0.001; risperidone, -28.6 [14.3], P < 0.001). However, there were no significant differences in PANSS-EC total score (P = 0.265) and PANSS total score (P = 0.125) changes from baseline to study end point between the 2 treatment groups. Serum uric acid and prolactin decreased more in the zotepine group than the risperidone group (P < 0.001 and P = 0.018, respectively).Zotepine seemed to be as

  3. Combined sedation with midazolam/propofol for gastrointestinal endoscopy in elderly patients

    PubMed Central

    2010-01-01

    Background Although gastrointestinal endoscopy with sedation is increasingly performed in elderly patients, data on combined sedation with midazolam/propofol are very limited for this age group. Methods We retrospectively analyzed 454 endoscopic procedures in 347 hospitalized patients ≥ 70 years who had received combined sedation with midazolam/propofol. 513 endoscopic procedures in 397 hospitalized patients < 70 years during the observation period served as controls. Characteristics of endoscopic procedures, co-morbidity, complications and mortality were compared. Results Elderly patients had a higher level of co-morbidity and needed lower mean propofol doses for sedation. We observed no major complication and no difference in the number of minor complications. The procedure-associated mortality was 0%; the 28-day mortality was significantly higher in the elderly (2.9% vs. 1.0%). Conclusions In this study on elderly patients with high level co-morbidity, a favourable safety profile was observed for a combined sedation with midazolam/propofol with a higher sensitivity to propofol in the elderly. PMID:20105314

  4. Dreaming during sevoflurane or propofol short-term sedation: a randomised controlled trial.

    PubMed

    Xu, G H; Liu, X S; Yu, F Q; Gu, E W; Zhang, J; Royse, A G; Wang, K

    2012-05-01

    Prior reports suggest that dreaming during anaesthesia is dependent on recovery time. Dreaming during sedation may impact patient satisfaction. The current study explores the incidence and content of dreaming during short-term sedation with sevoflurane or propofol and investigates whether dreaming is affected by recovery time. A total of 200 women undergoing first trimester abortion (American Society of Anesthesiologists physical status I) participated in the study. Patients were randomly assigned to receive either sevoflurane or propofol for short-term sedation. Patients were interviewed upon emergence with the modified Brice questionnaire. The results showed the incidence of dreaming was significantly different between anaesthesia groups with 60% (60/100) of the sevoflurane group and 33% (33/100) of the propofol group (P=0.000). However, recovery time did not significantly differ between groups. In the sevoflurane group, a greater number of dreamers could not recall what they had dreamed about (P=0.02) and more patients reported dreams that had no sound (P=0.03) or movement (P=0.001) compared with dreamers in the propofol group. Most participants reported dreams with positive emotional content and this did not significantly differ between groups. Anaesthesia administered had no effect on patient satisfaction. The results suggest that the incidence of dreaming was not affected by recovery time. Patient satisfaction was not influenced by choice of sedative and/or by the occurrence of dreaming during sevoflurane or propofol short-term sedation.

  5. The role of midazolam-induced sedation in bone marrow aspiration/trephine biopsies.

    PubMed

    Mainwaring, C J; Wong, C; Lush, R J; Smith, J G; Singer, C R

    1996-12-01

    This study was undertaken in 102 adult patients to evaluate the safety and efficacy of intravenous (i.v.) midazolam in the setting of bone marrow aspiration and trephine biopsy (BMAT). Combined local anaesthetic (LA) and sedation was used in 87% of patients and 13% received LA alone. Amnesia occurred in all sedated patients with only 9% experiencing a mild degree of post-procedure pain. This contrasted sharply with the non-sedated group, in whom 85% had intense pain during the biopsy followed by protracted local discomfort in approximately 54%. Drowsiness and some psychomotor impairment were the only notable sedation-related side-effects in approximately 20%. None required assisted ventilation. There was a resounding patient preference for BMAT with sedation. Considering the ease of use, safety and efficacy of i.v. midazolam, the availability of flumazenil as a reversal agent and the undoubted positive effects on quality of life, we would advocate using it in BMAT provided that there were no contraindications.

  6. Nociceptive transmission to rat primary somatosensory cortex--comparison of sedative and analgesic effects.

    PubMed

    Granmo, Marcus; Jensen, Tanja; Schouenborg, Jens

    2013-01-01

    CO(2)-laser C-fibre evoked cortical potentials (LCEPs) is a potentially useful animal model for studies of pain mechanisms. A potential confounding factor when assessing analgesic effects of systemically administered drugs using LCEP is sedation. This study aims to clarify: 1) the relation between level of anaesthesia and magnitude of LCEP, 2) the effects of a sedative and an analgesic on LCEP and dominant EEG frequency 3) the effects of a sedative and analgesic on LCEP when dominant EEG frequency is kept stable. LCEP and EEG were recorded in isoflurane/nitrous-oxide anaesthetized rats. Increasing isoflurane level gradually reduced LCEPs and lowered dominant EEG frequencies. Systemic midazolam (10 μmol/kg) profoundly reduced LCEP (19% of control) and lowered dominant EEG frequency. Similarly, morphine 1 and 3 mg/kg reduced LCEP (39%, 12% of control, respectively) and decreased EEG frequency. When keeping the dominant EEG frequency stable, midazolam caused no significant change of LCEP. Under these premises, morphine at 3 mg/kg, but not 1 mg/kg, caused a significant LCEP reduction (26% of control). In conclusion, the present data indicate that the sedative effects should be accounted for when assessing the analgesic effects of drug. Furthermore, it is suggested that LCEP, given that changes in EEG induced by sedation are compensated for, can provide information about the analgesic properties of systemically administrated drugs. PMID:23320109

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

    PubMed

    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

  8. Guidance for commissioning NHS England dental conscious sedation services: a framework tool.

    PubMed

    Howlett, Paul

    2014-01-01

    Conscious sedation is an integral part of modern day dental care and should be delivered through a high quality, effective and evidence-based approach. Commissioning of NHS dental services in England is currently under review by NHS England and the National Dental Commissioning Group. This group has identified the management of vulnerable people including anxious patients, as one of its priorities. The Society for the Advancement of Anaesthesia in Dentistry (SAAD) believes this provides an opportunity to influence the commissioning of NHS conscious sedation services. With this aim in mind,"Guidance for Commissioning NHS England Dental Conscious Sedation Services: A Framework Tool" was developed. This guidance proposes a common approach to the organisation of NHS dental conscious sedation services in England, advocating the provision of Tier 1 and Tier 2 services in all regions. Its ethos is a"hub and spoke" model of service delivery with patient assessment delivered by experienced and well trained dental sedationists at its core. In line with the recent Francis Report fundamental standards for all aspects of dental conscious sedation practice are outlined, supported by a robust and predictable quality assurance process. This work has been shared with key stakeholders in NHS England including the Chief Dental Officer and the Head of Primary Care Commissioning.

  9. Current role of non-anesthesiologist administered propofol sedation in advanced interventional endoscopy

    PubMed Central

    Burtea, Daniela Elena; Dimitriu, Anca; Maloş, Anca Elena; Săftoiu, Adrian

    2015-01-01

    Complex and lengthy endoscopic examinations like endoscopic ultrasonography and/or endoscopic retrograde cholangiopancreatography benefit from deep sedation, due to an enhanced quality of examinations, reduced discomfort and anxiety of patients, as well as increased satisfaction for both the patients and medical personnel. Current guidelines support the use of propofol sedation, which has the same rate of adverse effects as traditional sedation with benzodiazepines and/or opioids, but decreases the procedural and recovery time. Non-anesthesiologist administered propofol sedation has become an option in most of the countries, due to limited anesthesiology resources and the increasing evidence from prospective studies and meta-analyses that the procedure is safe with a similar rate of adverse events with traditional sedation. The advantages include a high quality of endoscopic examination, improved satisfaction for patients and doctors, as well as decreased recovery and discharge time. Despite the advantages of non-anesthesiologist administered propofol, there is still a continuous debate related to the successful generalization of the procedures. PMID:26265991

  10. Sedative Dosing of Propofol for Treatment of Migraine Headache in the Emergency Department: A Case Series

    PubMed Central

    Mosier, Jarrod; Roper, Grant; Hays, Daniel; Guisto, John

    2013-01-01

    Introduction: Migraine headaches requiring an emergency department visit due to failed outpatient rescue therapy present a significant challenge in terms of length of stay (LOS) and financial costs. Propofol therapy may be effective at pain reduction and reduce that length of stay given its pharmacokinetic properties as a short acting intravenous sedative anesthetic and pharmacodynamics on GABA mediated chloride flux. Methods: Case series of 4 patients presenting to an urban academic medical center with migraine headache failing outpatient therapy. Each patient was given a sedation dose (1 mg/kg) of propofol under standard procedural sedation precautions. Results: Each of the 4 patients experienced dramatic reductions or complete resolution of headache severity. LOS for 3 of the 4 patients was 50% less than the average LOS for patients with similar chief complaints to our emergency department. 1 patient required further treatment with standard therapy but had a significant reduction in pain and a shorter LOS. There were no episodes of hypotension, hypoxia, or apnea during the sedations. Conclusion: In this small case series, sedation dose propofol appears to be effective and safe for the treatment of refractory migraines, and may result in a reduced LOS. PMID:24381692

  11. Oral Midazolam Sedation For Uncooperative Children In Outpatient Paedodontics: Time For Reappraisal.

    PubMed

    Kapur, Aditi; Jain, Kajal; Goyal, A; Mahoney, Greg

    2016-01-01

    Sedation is frequently desired to facilitate dental procedures in uncooperative paediatric patients. Oromucosal Midazolam sedation is a popular choice among paediatric dentists world wide due to its many advantages such as ease of administration, good efficacy, presence of reversal agents and a wide margin of safety. On the other hand, many investigators have reported that midazolam sedation may not be successful for carrying out all types of dental procedures. This may be attributed to diverse nature of various treatment plans coupled with the extent of behavioural changes in the child and operator's experience. Due to the heterogeneity involved in treatment of paediatric dental procedures, the specific indications for oral midazolam use that ensure its success rate, probably need to be defined. This may enable the clinicians to have a convenient and quicker option for managing the cases rather than facing sedation failure or at times, ending up giving general anaesthetics. This article therefore brings forth the possible causes of midazolam sedation failure and proposes a 'case selection criterion'. PMID:27145554

  12. Dreaming during sevoflurane or propofol short-term sedation: a randomised controlled trial.

    PubMed

    Xu, G H; Liu, X S; Yu, F Q; Gu, E W; Zhang, J; Royse, A G; Wang, K

    2012-05-01

    Prior reports suggest that dreaming during anaesthesia is dependent on recovery time. Dreaming during sedation may impact patient satisfaction. The current study explores the incidence and content of dreaming during short-term sedation with sevoflurane or propofol and investigates whether dreaming is affected by recovery time. A total of 200 women undergoing first trimester abortion (American Society of Anesthesiologists physical status I) participated in the study. Patients were randomly assigned to receive either sevoflurane or propofol for short-term sedation. Patients were interviewed upon emergence with the modified Brice questionnaire. The results showed the incidence of dreaming was significantly different between anaesthesia groups with 60% (60/100) of the sevoflurane group and 33% (33/100) of the propofol group (P=0.000). However, recovery time did not significantly differ between groups. In the sevoflurane group, a greater number of dreamers could not recall what they had dreamed about (P=0.02) and more patients reported dreams that had no sound (P=0.03) or movement (P=0.001) compared with dreamers in the propofol group. Most participants reported dreams with positive emotional content and this did not significantly differ between groups. Anaesthesia administered had no effect on patient satisfaction. The results suggest that the incidence of dreaming was not affected by recovery time. Patient satisfaction was not influenced by choice of sedative and/or by the occurrence of dreaming during sevoflurane or propofol short-term sedation. PMID:22577917

  13. Union Agitators

    ERIC Educational Resources Information Center

    Honawar, Vaishali

    2006-01-01

    A decade has passed since a few union leaders formed the network known as Teacher Union Reform Network (TURN) to search for innovative ways to enhance education. Selling their message has not always been easy. Created in 1995, TURN was the brain child of Adam Urbanski, the president of the Rochester (N.Y.) Teachers Association for the past 25…

  14. Effects of viewing a preferred nature image and hearing preferred music on engagement, agitation, and mental status in persons with dementia

    PubMed Central

    Eggert, Julia; Vincent, Ellen; Parker, Veronica; Daily, Shaundra B; Pham, Hiep; Watson, Alison Turner; Summey, Hollie; Roy, Tania

    2015-01-01

    Background: The purpose of the described exploratory study was to test proactive strategies for enhancing engagement and cognitive ability while diminishing dementia-related disordered behaviors of those diagnosed with Alzheimer’s disease and other dementias. Study participants resided in an Memory Care unit of an assisted living community. Method: The researchers measured the effects of exposure to music and nature images on engagement using the Individualized Dementia Engagement and Activities Scale tool, on cognitive ability using the Montreal Cognitive Assessment, and on agitation using the Cohen-Mansfield Agitation Inventory. Result: The within-subject study design revealed that use of both music and nature images hold promise for reducing undesirable behaviors and improving engagement of residents. Conclusion: The authors suggest caregivers for those with Alzheimer’s disease and other dementias can effectively use nature images and music to improve engagement and reduce disordered behaviors, thus potentially enhancing quality of life for the care recipient as well as the caregiver while possibly reducing the costs of medications used to control dementia-related undesirable behaviors. PMID:26770801

  15. Toward an understanding of the effects of agitation and aeration on growth and laccases production by Pleurotus ostreatus.

    PubMed

    Tinoco-Valencia, Raunel; Gómez-Cruz, Cristina; Galindo, Enrique; Serrano-Carreón, Leobardo

    2014-05-10

    Mycelial growth and laccase production by Pleurotus ostreatus CP50 cultured in a 10-L mechanically agitated bioreactor were assessed through a 2(3) factorial experimental design. The main effects and interactions of three factors (agitation, aeration and copper induction) over five responses (μ, αLacc, βLacc, maximal volumetric laccase activity and maximal biomass concentration) were analyzed. P. ostreatus growth was significantly improved when culturing was conducted with high agitation (5.9kW/m(3)s) and aeration flow (0.5vvm) rates. Under the experimental conditions evaluated, no evidence of hydrodynamic stress affecting fungal growth was observed. However, the high agitation and aeration conditions were detrimental for the growth-associated laccase production constant (αLacc), leading to a very complex optimization of the process. The maximal laccase volumetric activity (1.2 and 3.8U/ml for non-induced and copper-induced cultures, respectively) was observed when the culturing was performed at a low agitation rate (0.9kW/m(3)s) and a high aeration flow rate (0.5vvm). Laccase proteolysis may explain the complex interactions observed between agitation and aeration and the effects of these factors on the laccase volumetric activity observed in the cultures.

  16. Association of Opioids and Sedatives with Increased Risk of In-Hospital Cardiopulmonary Arrest from an Administrative Database

    PubMed Central

    Overdyk, Frank J.; Dowling, Oonagh; Marino, Joseph; Qiu, Jiejing; Chien, Hung-Lun; Erslon, Mary; Morrison, Neil; Harrison, Brooke; Dahan, Albert; Gan, Tong J.

    2016-01-01

    Background While opioid use confers a known risk for respiratory depression, the incremental risk of in-hospital cardiopulmonary arrest, respiratory arrest, or cardiopulmonary resuscitation (CPRA) has not been studied. Our aim was to investigate the prevalence, outcomes, and risk profile of in-hospital CPRA for patients receiving opioids and medications with central nervous system sedating side effects (sedatives). Methods A retrospective analysis of adult inpatient discharges from 2008–2012 reported in the Premier Database. Patients were grouped into four mutually exclusive categories: (1) opioids and sedatives, (2) opioids only, (3) sedatives only, and (4) neither opioids nor sedatives. Results Among 21,276,691 inpatient discharges, 53% received opioids with or without sedatives. A total of 96,554 patients suffered CPRA (0.92 per 1000 hospital bed-days). Patients who received opioids and sedatives had an adjusted odds ratio for CPRA of 3.47 (95% CI: 3.40–3.54; p<0.0001) compared with patients not receiving opioids or sedatives. Opioids alone and sedatives alone were associated with a 1.81-fold and a 1.82-fold (p<0.0001 for both) increase in the odds of CPRA, respectively. In opioid patients, locations of CPRA were intensive care (54%), general care floor (25%), and stepdown units (15%). Only 42% of patients survived CPRA and only 22% were discharged home. Opioid patients with CPRA had mean increased hospital lengths of stay of 7.57 days and mean increased total hospital costs of $27,569. Conclusions Opioids and sedatives are independent and additive risk factors for in-hospital CPRA. The impact of opioid sparing analgesia, reduced sedative use, and better monitoring on CPRA incidence deserves further study. PMID:26913753

  17. Management of a high risk epileptic patient under conscious sedation: A multidisciplinary approach

    PubMed Central

    Chellathurai, Burnice Nalina Kumari; Thiagarajan, Ramakrishnan; Jayakumaran, SelvaKumar; Devadoss, Pradeep; Elavazhagan

    2016-01-01

    Epilepsy, characterized by the risk of recurrent seizures, is a chronic disease that afflicts about 5% of the world's population. The main dental problems associated with epileptic patients include gingival hyperplasia, minor oral injuries, tooth trauma, and prosthodontic problems, which require the dental treatment. Stress and fear are the most common triggering factors for the epilepsy in dental chair. Therefore, a more appropriate method of treating such epileptic patients may be warranted. Conscious sedation is a technique of providing good anesthesia and analgesia to patients, the main advantage of which is the patient's rapid return to presentation levels. Midazolam used as a sedative agent has anticonvulsant properties. This case report highlights a case requiring multiple dental procedures carried out in a high risk epileptic patient under conscious sedation. PMID:27041847

  18. Sedation, alimentation, hydration, and equivocation: careful conversation about care at the end of life.

    PubMed

    Jansen, Lynn A; Sulmasy, Daniel P

    2002-06-01

    In the recent medical ethics literature, several authors have recommended terminal sedation and refusal of hydration and nutrition as important, morally acceptable, and relatively uncontroversial treatment options for end-of-life suffering. However, not all authors use these terms to refer to the same practices. This paper examines the various ways that the terms terminal sedation and refusal of hydration and nutrition have been used in the medical literature. Although some of these practices are ethically appropriate responses to end-of-life suffering, others (at least as they are currently described in the medical ethics literature) are not. This paper identifies and discusses the principles that morally distinguish these practices from one another and specifically describes different features of medical practices and moral principles that affect the moral acceptability of various medical treatments. These distinctions reveal the complexity of the issues surrounding terminal sedation and refusal of hydration and nutrition, a complexity that has not been adequately addressed in recent discussions.

  19. [Adrenaline potentiates antiepileptic but not sedative action of diazepam in rats].

    PubMed

    Serdiuk, S E; Gmiro, V E

    2012-02-01

    Intramuscular (i.m.) administration ofdiazepam in a dose of 10 mg/kg and adrenaline in a dose of 0.2 mg/kg prevents generalized clonic-tonic pentylenetetrazol (PTZ) seizures in 75-80 % of rats, but only in 35-40 % of rats it prevents local clonic PTZ seizures. In the above mentioned dose, diazepam causes a strong sedation, but adrenaline does not cause a sedative effects. The combined administration of diazepam and adrenaline in threshold independently ineffective doses prevents both clonic-tonic and clonic PTZ seizures in 80 % of rats without a sedation development. The basis for mechanism of potentiation of anticonvulsant action of diazepam is the stimulation of gastric mucosa afferents by adrenaline. PMID:22650067

  20. Humane terminal extubation reconsidered: the role for preemptive analgesia and sedation.

    PubMed

    Billings, J Andrew

    2012-02-01

    Patient comfort is not assured by common practices for terminal extubation. Treatment guidelines suggest minimizing dosage of opioids and sedatives. Multiple lines of evidence indicate that clinicians are limited in their ability to recognize distress in such patients and tend to undermedicate patients in distress. Yet suffering of any significant degree should be unacceptable. For painful procedures, such as surgery, the analogous practice of postponing anesthesia until the patient evidences discomfort would never be tolerated. Waiting for signs of suffering before initiating excellent analgesia and sedation inexorably subjects patients to distress. Therefore, when death is inevitable and imminent after extubation, suffering should be anticipated, concerns about respiratory depression dismissed, and vigorous preemptive deep sedation or anesthesia provided.

  1. Basic requirements for monitoring sedated patients: blood pressure, pulse oximetry, and EKG.

    PubMed

    Maurer, Walter G; Walsh, Michael; Viazis, Nikos

    2010-01-01

    The American Society of Anesthesiologists published monitoring requirements for non-anesthesia providers performing sedation and analgesia in 2002. This manuscript covered not only the monitoring of patients under sedation and analgesia but pre-procedure evaluation and preparation, personnel availability and training, emergency equipment availability, use of supplemental oxygen, sedative-analgesic agents, and discharge criteria. Current recommendations for monitoring include patient responsiveness, blood pressure, respiratory rate, heart rate, and oxygen saturation. Oxygen saturation is a critical vital sign, but there can be a significant delay between inadequate ventilation and desaturation. Supplemental oxygen can dangerously increase this disconnect. Thus, one must monitor adequacy of ventilation by direct observation, auscultation, and/or end-tidal CO(2) monitoring. The most important admonition is that 'ventilation' and 'oxygenation' are not the same.

  2. Evaluation of the sedative effect of fragrance on Filipinas using a biochemical marker.

    PubMed

    Yamaguchi, Masaki; Sakakima, Josaku; Sato, Kimiharu; Nakano, Kimihiro

    2007-03-01

    The purpose of this study is to evaluate the usefulness of salivary amylase activity as an indicator of the acute psychological sedative effects of fragrances used in household products such as clothing softeners. Twenty seven healthy Philippine female subjects in their late 30 s were enrolled (38.7+/-5.2 yr). This study was undertaken to investigate the favorite fragrance of Asian and Pacific Islander women. Our results indicated that (i) a mixed floral fragrance might be a favorite fragrance for Filipinas; (ii) fragrances contained in a softener significantly induced a sedative effect in humans, as assessed by both analysis of the biochemical marker and subjective evaluation; (iii) salivary amylase activity has the potential to be an excellent indicator for the evaluation of the acute psychological sedative effects of fragrance.

  3. Interest of 50% nitrous oxide and oxygen premix sedation in gerodontology

    PubMed Central

    Nicolas, Emmanuel; Lassauzay, Claire

    2009-01-01

    Elderly patients presenting cardiovascular, respiratory, or neurological disorders require a specific dental care approach, especially patients presenting Alzheimer’s disease. Sedative procedures can prevent dental care-induced stress, even when there is effective pain control, but they have to be adapted to accommodate age-induced physiological modifications, age-related pathologies, and the concomitant treatments. In many situations, routine sedative prescriptions for dental care, such as benzodiazepine or antihistaminics, are not recommended for these patients. Nitrous oxide inhalation together with a specific behavioral threshold is currently the only sedative procedure adapted to cognitively-impaired elderly patients. Nitrous oxide is able to curb stress and its cardiovascular consequences, improve oxygenation, and optimize cooperation during dental care, making not only rehabilitation treatments but also routine dental care a viable option. PMID:19503768

  4. Norwegian nurses' thoughts and feelings regarding the ethics of palliative sedation.

    PubMed

    Venke Gran, Siv; Miller, Jean

    2008-11-01

    The purpose of this descriptive study was to explore whether or not nurses viewed deep palliative sedation as an ethical problem; and, if so, why they felt it posed a problem for them. An exploratory descriptive design with quantitative and qualitative sections was used. A questionnaire, consisting of open- and closed-ended questions, was answered by a sample of 73 nurses employed in three settings in Norway. The results were analyzed using descriptive statistics and content analysis. The findings indicated that 88% of the respondents had provided care for patients with great suffering; 78% had provided care for patients who received palliative sedation; and 63% felt that deep palliative sedation posed ethical problems. The respondents felt it was ethically difficult when patients were not involved in the decision, when families had continued needs to communicate with their loved ones, and when nurses felt uncertain about the relief of symptoms due to patients' inability to communicate.

  5. Rectal administration of midazolam versus diazepam for preanesthetic sedation in children.

    PubMed Central

    Holm-Knudsen, R.; Clausen, T. G.; Enø, D.

    1990-01-01

    Sixty children were included in the trial. Each subject received midazolam 0.4 mg/kg body weight of diazepam 0.75 mg/kg body weight rectally in a double-blind randomized order. The degree of sedation of the children was assessed on arrival in the operating unit and during the induction of anesthesia. Adequate sedation on arrival in the operating unit and during induction of anesthesia was obtained in 84% and 67%, respectively, following administration of midazolam compared with 80% and 70% in the diazepam group. No side effects were noted. It is concluded that rectally administered midazolam 0.4 mg/kg is comparable to diazepam 0.75 mg/kg with respect to preanesthetic sedation in children. PMID:2077983

  6. [Use of analgesia and sedation in dental implantology in patients with concomitant hypertension].

    PubMed

    Sitkin, S I; Davydova, O B; Kostin, I O; Gasparian, A L

    2015-01-01

    Dental implants surgery in patients with hypertension increases the risk of vascular complications. The aim of the study was to examine the effect of analgesia and sedation on blood pressure and postoperative pain in dental implantology. In 76 patients with hypertension implant surgery was performed under local anesthesia only (40 patients) or under local anesthesia with propofol sedation and pre-emptive analgesia with ketorolac (36 patients). Intraoperative systolic blood pressure in the second group was 20% less than in the first group while the intensity of pain in the postoperative period in the second group was three times less than in the first one. Propofol sedation in dental implantology provides hemodynamic stability in patients with concomitant hypertension and preemptive analgesia with ketorolac allows minimizing postoperative pain.

  7. Sedation and memory: studies with a histamine H-1 receptor antagonist.

    PubMed

    Turner, Claire; Handford, Alison D F; Nicholson, Anthony N

    2006-07-01

    The influence of sedation on the effect of an H-1 receptor antagonist on various cognitive functions, including memory, were evaluated. Diphenhydramine (50, 75 and 100 mg) and lorazepam (0.5 and 1.5 mg) were given on single occasions to 12 healthy volunteers (six males, six females) aged 20-33 (mean 23.4) years. Subjective assessments of sedation, sleep latencies, digit symbol substitution, choice reaction time, sustained attention and memory recall were studied 1.0 h before and 0.5, 2.0 and 3.5 h after drug ingestion. The study was double blind, placebo controlled and with a crossover design. With all doses of diphenhydramine there was subjective sedation, reduced sleep latencies and impairments in performance on the digit symbol substitution, choice reaction time and sustained attention tasks. No effects were observed with 0.5 mg lorazepam. With 1.5 mg lorazepam there was subjective sedation, fewer digit symbol substitutions, slowed choice reaction time, impaired attention and memory, but no effect on sleep latencies. Contrast analysis of data measured at all time points showed that although there was no difference in the effect of diphenhydramine (100 mg) and lorazepam (1.5 mg) on those tasks without a memory component, response times were slower with lorazepam on those tasks with a memory component. However, both 100 mg diphenhydramine and 1.5 mg lorazepam impaired prompted recall measured at 2 h post-ingestion only. It is considered that impaired memory is not necessarily associated with sedation, and that impairment of memory with drugs that lead to sedation may be effected through neuronal systems independent of those that affect arousal. PMID:16401664

  8. Modeling the costs and benefits of capnography monitoring during procedural sedation for gastrointestinal endoscopy

    PubMed Central

    Saunders, Rhodri; Erslon, Mary; Vargo, John

    2016-01-01

    Background and study aims: The addition of capnography to procedural sedation/analgesia (PSA) guidelines has been controversial due to limited evidence of clinical utility in moderate PSA and cost concerns. Patients and methods: A comprehensive model of PSA during gastrointestinal endoscopy was developed to capture adverse events (AEs), guideline interventions, outcomes, and costs. Randomized, controlled trials and large-scale studies were used to inform the model. The model compared outcomes using pulse oximetry alone with pulse oximetry plus capnography. Pulse oximetry was assumed at no cost, whereas capnography cost USD 4,000 per monitor. AE costs were obtained from literature review and Premier database analysis. The model population (n = 8,000) had mean characteristics of age 55.5 years, body mass index 26.2 kg/m2, and 45.3 % male. Results: The addition of capnography resulted in a 27.2 % and 18.0 % reduction in the proportion of patients experiencing an AE during deep and moderate PSA, respectively. Sensitivity analyses demonstrated significant reductions in apnea and desaturation with capnography. The median (95 % credible interval) number needed to treat to avoid any adverse event was 8 (2; 72) for deep and 6 (−59; 92) for moderate. Reduced AEs resulted in cost savings that accounted for the additional upfront purchase cost. Capnography was estimated to reduce the cost per procedure by USD 85 (deep) or USD 35 (moderate). Conclusions: Capnography is estimated to be cost-effective if not cost saving during PSA for gastrointestinal endoscopy. Savings were driven by improved patient safety, suggesting that capnography may have an important role in the safe provision of PSA. PMID:27004254

  9. Propofol: a review of its role in pediatric anesthesia and sedation.

    PubMed

    Chidambaran, Vidya; Costandi, Andrew; D'Mello, Ajay

    2015-07-01

    Propofol is an intravenous agent used commonly for the induction and maintenance of anesthesia, procedural, and critical care sedation in children. The mechanisms of action on the central nervous system involve interactions at various neurotransmitter receptors, especially the gamma-aminobutyric acid A receptor. Approved for use in the USA by the Food and Drug Administration in 1989, its use for induction of anesthesia in children less than 3 years of age still remains off-label. Despite its wide use in pediatric anesthesia, there is conflicting literature about its safety and serious adverse effects in particular subsets of children. Particularly as children are not "little adults", in this review, we emphasize the maturational aspects of propofol pharmacokinetics. Despite the myriad of propofol pharmacokinetic-pharmacodynamic studies and the ability to use allometrical scaling to smooth out differences due to size and age, there is no optimal model that can be used in target controlled infusion pumps for providing closed loop total intravenous anesthesia in children. As the commercial formulation of propofol is a nutrient-rich emulsion, the risk for bacterial contamination exists despite the Food and Drug Administration mandating addition of antimicrobial preservative, calling for manufacturers' directions to discard open vials after 6 h. While propofol has advantages over inhalation anesthesia such as less postoperative nausea and emergence delirium in children, pain on injection remains a problem even with newer formulations. Propofol is known to depress mitochondrial function by its action as an uncoupling agent in oxidative phosphorylation. This has implications for children with mitochondrial diseases and the occurrence of propofol-related infusion syndrome, a rare but seriously life-threatening complication of propofol. At the time of this review, there is no direct evidence in humans for propofol-induced neurotoxicity to the infant brain; however

  10. PROPOFOL: A REVIEW OF ITS ROLE IN PEDIATRIC ANESTHESIA AND SEDATION

    PubMed Central

    Chidambaran, Vidya; Costandi, Andrew; D’Mello, Ajay

    2015-01-01

    Propofol is an intravenous agent used commonly for induction and maintenance of anesthesia, procedural and critical care sedation in children. The mechanisms of action on the central nervous system involve interactions at various neurotransmitter receptors, especially gamma-aminobutyric acid A receptor. Approved for use in the United States by the Federal Drugs and Administration (FDA) in 1989, its use for induction of anesthesia in children less than 3 years of age still remains off-label. Despite its wide use in pediatric anesthesia, there is conflicting literature about its safety and serious adverse effects in particular subsets of children. Particularly as children are not “little adults”, in this review, we emphasize the maturational aspects of propofol pharmacokinetics. Despite the myriad of propofol pharmacokinetic-pharmacodynamic studies and the ability to use allometrical scaling to smooth out differences due to size and age, there is no optimal model that can be used in target controlled infusion pumps for providing closed loop total intravenous anesthesia in children. As the commercial formulation of propofol is a nutrient-rich emulsion, the risk for bacterial contamination exist despite the FDA mandating addition of antimicrobial preservative, calling for manufacturers’ directions to discard open vials after six hours. While propofol has advantages over inhalation anesthesia like less postoperative nausea and emergence delirium in children, pain on injection remains a problem even with newer formulations. Propofol is known to depress mitochondrial function by its action as an uncoupling agent in oxidative phosphorylation. This has implications for children with mitochondrial diseases and the occurrence of propofol-related infusion syndrome, a rare but seriously life-threatening complication of propofol. At the time of this review, there is no direct evidence in humans for propofol induced neurotoxicity to the infant brain; however, current

  11. Alcohol and drug expectancies as anticipated changes in affect: negative reinforcement is not sedation.

    PubMed

    Wiers, Reinout W

    2008-01-01

    Goldman and Darkes (2004) argued that all three basic alcohol-expectancy factors can be assessed with a brief questionnaire (AEMax), related to the circumplex model of emotion. I argue that negative reinforcement, one of the three basic expectancy factors, is not assessed with the AEMax. Importantly, negative reinforcement is positively related to problem drinking while sedation (the AEMax-factor that comes closest) is not. In a new dataset (from 119 students, collected in 2002), I demonstrate that sedation is related to negative expectancies and not to negative reinforcement. Different ways to assess all major expectancy factors are proposed.

  12. Tetany During Intravenous Conscious Sedation in Dentistry Resulting From Hyperventilation-Induced Hypocapnia

    PubMed Central

    McCarthy, Caroline; Brady, Paul; O'Halloran, Ken D.; McCreary, Christine

    2016-01-01

    Hyperventilation can be a manifestation of anxiety that involves abnormally fast breathing (tachypnea) and an elevated minute ventilation that exceeds metabolic demand. This report describes a case of hyperventilation-induced hypocapnia resulting in tetany in a 16-year-old girl undergoing orthodontic extractions under intravenous conscious sedation. Pulse oximetry is the gold standard respiratory-related index in conscious sedation. Although the parameter has great utility in determining oxygen desaturation, it provides no additional information on respiratory function, including, for example, respiratory rate. In this case, we found capnography to be a very useful aid to monitor respiration in this patient and also to treat the hypocapnia. PMID:26866408

  13. Synthesis, Anticonvulsant, Sedative and Anxiolytic Activities of Novel Annulated Pyrrolo[1,4]benzodiazepines

    PubMed Central

    Sorra, Kumaraswamy; Chen, Chien-Shu; Chang, Chi-Fen; Pusuluri, Srinivas; Mukkanti, Khagga; Wu, Chi-Rei; Chuang, Ta-Hsien

    2014-01-01

    Four new pentacyclic benzodiazepine derivatives (PBDTs 13–16) were synthesized by conventional thermal heating and microwave-assisted intramolecular cyclocondensation. Their anticonvulsant, sedative and anxiolytic activities were evaluated by drug-induced convulsion models, a pentobarbital-induced hypnotic model and an elevated plus maze in mice. PBDT 13, a triazolopyrrolo[2,1-c][1,4]benzodiazepin-8-one fused with a thiadiazolone ring, exhibited the best anticonvulsant, sedative and anxiolytic effects in our tests. There was no significant difference in potency between PBDT 13 and diazepam, and we proposed that the action mechanism of PBDT 13 could be similar to that of diazepam via benzodiazepine receptors. PMID:25238414

  14. Distinct roles of the Y1 and Y2 receptors on neuropeptide Y-induced sensitization to sedation.

    PubMed

    Naveilhan, P; Canals, J M; Arenas, E; Ernfors, P

    2001-09-01

    Intracranial injection of neuropeptide Y (NPY) increases the sensitivity to sodium pentobarbital and ketamin sedation and has similar properties as GABA agonists on sleep. Mice sensitive to sedation have increased levels of NPY in many brain regions and Y1(-/-) mice show a marked resistance to barbiturates. Here we characterized the role of the NPY Y receptors in anesthetic-induced sedation. We show that Y1 and Y2, but not Y5, receptors participate in the modulation of sedation. Administration of a Y1 agonist increased the sodium pentobarbital-induced sedation and Y1(-/-) mice were less sensitive to this anesthetic. However, Y2(-/-) mice display increased sensitivity, showing that Y2 modulates GABAergic induced sedation both pharmacologically and physiologically and has a functionally opposing role to the Y1 receptor. Analysis of Y1(-/-)/Y2(-/-) double mutant mice show that increased sensitivity by Y1 occurs independent of the Y2 receptor, while the decreased sensitivity mediated by Y2 depend on an intact Y1 receptor. In contrast to sodium pentobarbital, both Y1 and Y2 receptors increase the sensitivity in a collaborative fashion to NMDA antagonist-induced sedation. These data demonstrate the physiological and pharmacological impact of the Y1 and Y2 receptors on sedation.

  15. Growth kinetics of potassium alum crystal in a well-agitated vessel

    NASA Astrophysics Data System (ADS)

    Tai, Clifford Y.; Yu, K. H.

    1989-08-01

    Growth rates of potassium alum crystal in a well-agitated vessel were determined from the de-supersaturation curve of the solution. The mass transfer and surface integration coefficients were then estimated using the two-step model. Both coefficients were found to increase with increasing crystal size. Judging from the Damköhler number for crystal growth and the over-all order of the growth rate equation, it is concluded that both mass transfer resistance and surface integration resistance are significant in the growth process.

  16. High-quality fiber fabrication in buffered hydrofluoric acid solution with ultrasonic agitation.

    PubMed

    Zhong, Nianbing; Liao, Qiang; Zhu, Xun; Wang, Yongzhong; Chen, Rong

    2013-03-01

    An etching method for preparing high-quality fiber-optic sensors using a buffered etchant with ultrasonic agitation is proposed. The effects of etching conditions on the etch rate and surface morphology of the etched fibers are investigated. The effect of surface roughness is discussed on the fibers' optical properties. Linear etching behavior and a smooth fiber surface can be repeatedly obtained by adjusting the ultrasonic power and etchant pH. The fibers' spectral quality is improved as the ratio of the pit depth to size decreases, and the fibers with smooth surfaces are more sensitive to a bacterial suspension than those with rough surfaces.

  17. Methods for determining enzymatic activity comprising heating and agitation of closed volumes

    DOEpatents

    Thompson, David Neil; Henriksen, Emily DeCrescenzo; Reed, David William; Jensen, Jill Renee

    2016-03-15

    Methods for determining thermophilic enzymatic activity include heating a substrate solution in a plurality of closed volumes to a predetermined reaction temperature. Without opening the closed volumes, at least one enzyme is added, substantially simultaneously, to the closed volumes. At the predetermined reaction temperature, the closed volumes are agitated and then the activity of the at least one enzyme is determined. The methods are conducive for characterizing enzymes of high-temperature reactions, with insoluble substrates, with substrates and enzymes that do not readily intermix, and with low volumes of substrate and enzyme. Systems for characterizing the enzymes are also disclosed.

  18. Kinetics of insulin aggregation in aqueous solutions upon agitation in the presence of hydrophobic surfaces.

    PubMed Central

    Sluzky, V; Tamada, J A; Klibanov, A M; Langer, R

    1991-01-01

    The stability of protein-based pharmaceuticals (e.g., insulin) is important for their production, storage, and delivery. To gain an understanding of insulin's aggregation mechanism in aqueous solutions, the effects of agitation rate, interfacial interactions, and insulin concentration on the overall aggregation rate were examined. Ultraviolet absorption spectroscopy, high-performance liquid chromatography, and quasielastic light scattering analyses were used to monitor the aggregation reaction and identify intermediate species. The reaction proceeded in two stages; insulin stability was enhanced at higher concentration. Mathematical modeling of proposed kinetic schemes was employed to identify possible reaction pathways and to explain greater stability at higher insulin concentration. Images PMID:1946348

  19. Mass transfer in a bubble-agitated liquid-liquid system

    SciTech Connect

    Clinton, S.D.; Perona, J.J.

    1982-08-01

    A polarographic method was used to measure the mass transfer coefficients between a mercury layer and an aqueous layer agitated by gas bubbles. The effects of gas rate, vessel size, and sparge-tube diameter were studied. The Schmidt number of the aqueous phase was varied by the use of sucrose solutions. The data are well represented by N/sub Sh/.1.33N/sub Re//sup 0.70/N/sub SC//sup 1/3/. 4 refs.

  20. Persistent Genital Arousal Disorder: Confluent Patient History of Agitated Depression, Paroxetine Cessation, and a Tarlov Cyst

    PubMed Central

    Jensen, Hans Mørch

    2014-01-01

    We report a case of a woman suffering from persistent genital arousal disorder (PGAD) after paroxetine cessation. She was admitted to a psychiatric department and diagnosed with agitated depression. Physical investigation showed no gynaecological or neurological explanation; however, a pelvic MRI scan revealed a Tarlov cyst. Size and placement of the cyst could not explain the patient's symptoms; thus neurosurgical approach would not be helpful. Her depression was treated with antidepressant with little effect. Electroconvulsive therapy improved the patient's symptoms though they did not fully resolve. More awareness of PGAD and thorough interdisciplinary conferences are necessary to insure an unequivocal treatment strategy. PMID:25525548

  1. Medication Development for Agitation and Aggression in Alzheimer Disease: Review and Discussion of Recent Randomized Clinical Trial Design

    PubMed Central

    Soto, Maria; Andrieu, Sandrine; Nourhashemi, Fati; Ousset, Pierre Jean; Ballard, Clive; Robert, Philippe; Vellas, Bruno; Lyketsos, Constantine; Rosenberg, Paul

    2014-01-01

    Background The management of disruptive neuropsychiatric symptom (NPS) such as agitation and aggression (A/A) is a major priority in caring for people with Alzheimer’s disease (AD). Few effective pharmacological or non-pharmacological options are available. Results of randomized clinical trials (RCTs) of drugs for A/A have been disappointing. This may result from the absence of biological efficacy for medications tested in treating A/A. It may also be related to methodological issues such as the choice of outcomes. The aim of this review was to highlight key methodological issues pertaining to RCTs of current and emerging medications for the treatment of A/A in AD. Methods We searched PubMed/Medline, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for RCTs comparing medications with either placebo or other drugs in the treatment of A/A in AD, between January 2008 and December 2013. Results We identified a total of 18 RCTs; of these, 11 were completed and 7 ongoing. Of the ongoing RCTs, only one is in Phase III. Seven of 10 completed RCTs with reported results did not report greater benefit from drug than placebo. Each of the completed RCTs used a different definition of “clinically significant A/A”. There was considerable heterogeneity in study desin. The primary endpoints were largely proxy-based but a variety of scales were used. The definition of caregiver and scales used to assess caregiver outcomes were similarly heterogeneous. Placebo response was notable in all trials. Conclusions This review highlights a great heterogeneity in RCTs design of drugs for A/A in AD and some key methodological issues such as definition of A/A, choice of outcome measures and caregiver participation that could be addressed by an expert consensus to optimize future trials design. PMID:25226218

  2. 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

  3. Sedative Medication Use: Prevalence, Risk Factors, and Associations with Body Mass Index Using Population-Level Data

    PubMed Central

    Vozoris, Nicholas T.; Leung, Richard S.

    2011-01-01

    Study Objectives: To estimate the prevalence of and identify sociodemographic risk factors for sedative medication use in the general Canadian population, and to examine the association between sedative medication use and body mass index (BMI). Design: Cross-sectional study Setting: Canadian population Participants: Participants from the 1994-2003 Canadian national health surveys, the National Population Health Survey (NPHS) and the Canadian Community Health Survey (CCHS). For the 2003 CCHS, n = 134,072, ages 12-80+ years. Interventions: Not applicable Measurements and Results: The overall prevalence of sedative medication use in Canada in 2003 was 5.5%, having more than doubled since 1994. Notable rises in sedative medication use have occurred among men, non-elderly, and obese individuals. After adjusting for potential sociodemographic and health status confounders, including psychiatric comorbidities, the odds of sedative use were significantly greater among morbidly obese (BMI ≥ 35 kg/m2) men (OR = 1.89, 95%CI = 1.02-3.53) and underweight (BMI < 18.5 kg/m2) women (OR = 2.11, 95%CI = 1.26-3.53). Conclusions: The use of sedative medications has substantially risen among the general Canadian population, and among particular population subgroups. The greater odds of sedative medication use found among morbidly obese men may reflect the presence of underlying obstructive sleep apnea, which may in turn serve to explain in part the known relationship between sedative medications and mortality. The increase in sedative medications coupled with their known adverse health associations raises potential public health concerns. Citation: Vozoris NT; Leung RS. Sedative medication use: prevalence, risk factors, and associations with body mass index using population-level data. SLEEP 2011;34(7):869-874. PMID:21731136

  4. 21 CFR 310.519 - Drug products marketed as over-the-counter (OTC) daytime sedatives.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... irritability that ruins your day,” “helps you relax,” “restlessness,” “when you're under occasional stress . . . helps you work relaxed.” Based on evidence presently available, there are no ingredients that can be... is labeled, represented, or promoted as an OTC daytime sedative (or any similar or related...

  5. Brief Report: Brain Activation to Social Words in a Sedated Child with Autism

    ERIC Educational Resources Information Center

    Carmody, Dennis P.; Moreno, Rosanne; Mars, Audrey E.; Seshadri, Kapila; Lambert, George H.; Lewis, Michael

    2007-01-01

    A functional magnetic resonance imaging (fMRI) study was performed on a 4-year-old girl with autism. While sedated, she listened to three utterances (numbers, hello, her own first name) played through headphones. Based on analyses of the fMRI data, the amount of total brain activation varied with the content of the utterance. The greatest volume…

  6. Eminectomy for Habitual Luxation of the Temporomandibular Joint with Sedation and Local Anesthesia: A Case Series

    PubMed Central

    Nakamura, Yoshiaki; Kusukawa, Jingo; Tubbs, R. Shane

    2016-01-01

    Eminectomy which is one of the popular and most effective treatments for habitual temporomandibular joint luxation was first described by Myrhaug in 1951. There are few reports which described eminectomy being performed under local anesthesia and conscious sedation. We present a case series of habitual luxation of the TMJ treated by eminectomy performed under local anesthesia and conscious sedation and general anesthesia. Five patients were examined and found to have recurrent luxation of the TMJ. The age of patients ranged from 18 to 93 years. Bilateral eminectomy of the TMJ was performed for two patients, and unilateral eminectomy was performed for three patients. Two were examined under intravenous propofol sedation and local anesthesia, while three patients were examined under general anesthesia. One patient died from ileus one month after surgery. The follow-up period except for the case that died from ileus ranged from 12 to 33 months. No recurrent dislocation of the TMJ has been identified. Based on our experience and two other series in the literature, eminectomy with sedation and local anesthesia can be considered and might be a good option in elderly patients.

  7. About sedately growing solutions of one generalized Cauchy-Riemann system

    NASA Astrophysics Data System (ADS)

    Tokibetov, Zhanuzak; Abduakhitova, Gulzhan; Kusherbayeva, Ulbike

    2016-08-01

    In this paper, the existence of only zeroth sedately growing solution of the generalized Cauchy-Riemann system is proved in the case when the coefficients of the generalized Cauchy-Riemann system do not belong to the class Lp,2(E), p > 2, namely A(z) = az, B (z )=b z ¯ , where a, b are constants.

  8. Plants used by Mexican traditional medicine with presumable sedative properties: an ethnobotanical approach.

    PubMed

    Tortoriello, J; Romero, O

    1992-01-01

    An ethnobotanical study of plants used in Mexican traditional medicine was made. The source was the national inquiry done by the IMSS-COPLAMAR health program (1983-1985) in which the plants used to treat mental disorders were selected and analyzed, in order to select the most frequent botanical species used in traditional medicine as sedatives, anticonvulsants and hypnotics. PMID:1308799

  9. Palliative sedation until death: an approach from Kant's ethics of virtue.

    PubMed

    Hasselaar, Jeroen G J

    2008-01-01

    This paper is concerned with the moral justification for palliative sedation until death. Palliative sedation involves the intentional lowering of consciousness for the relief of untreatable symptoms. The paper focuses on the moral problems surrounding the intentional lowering of consciousness until death itself, rather than possible adjacent life-shortening effects. Starting from a Kantian perspective on virtue, it is shown that continuous deep sedation until death (CDS) does not conflict with the perfect duty of moral self-preservation because CDS does not destroy capacities for agency. In addition, it is argued that CDS can frustrate the imperfect duty of self-cultivation by reducing consciousness permanently. Nevertheless, there are cases where CDS is morally acceptable, namely, cases where the agent has already permanently lost the possibility for free action in advance of sedation--for example, due to excruciating and ongoing pain. Because the latter can be difficult to diagnose properly, safeguards may be needed in order to prevent the application of CDS for the wrong reasons. PMID:19132549

  10. 76 FR 68197 - Clinical Development Programs for Sedation Products; Public Workshop; Request for Comments

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-03

    ... HUMAN SERVICES Food and Drug Administration Clinical Development Programs for Sedation Products; Public... advance. SUPPLEMENTARY INFORMATION: I. Introduction In the Federal Register of November 29, 2010 (75 FR... be considered clinically meaningful (e.g., subjective and objective assessments of memory,...

  11. Propofol sedation during endoscopic treatment for early gastric cancer compared to midazolam

    PubMed Central

    Kiriyama, Shinsuke; Naitoh, Hiroshi; Kuwano, Hiroyuki

    2014-01-01

    Endoscopic submucosal dissection (ESD) has been proposed as the gold standard in the treatment of early gastric cancer because it facilitates a more accurate histological assessment and reduces the risk of tumor recurrence. However, the time course of ESD for large gastric tumors is frequently prolonged because of the tumor size and technical difficulties and typically requires higher doses of sedative and pain-controlling drugs. Sedative or anesthetic drugs such as midazolam or propofol are used during the procedure. Therapeutic endoscopy of early gastric cancers can often be performed with only moderate sedation. Compared with midazolam, propofol has a very fast onset of action, short plasma half-life and time to achieve sedation, faster time to recovery and discharge, and results in higher patient satisfaction. For overall success, maintaining safety and stability not only during the procedure but also subsequently in the recovery room and ward is necessary. In obese patients, it is recommended that the injected dose be based on a calculated standard weight. Cooperation between gastroenterologists, surgeons, and anesthesiologists is imperative for a successful ESD procedure. PMID:25232235

  12. Plants used by Mexican traditional medicine with presumable sedative properties: an ethnobotanical approach.

    PubMed

    Tortoriello, J; Romero, O

    1992-01-01

    An ethnobotanical study of plants used in Mexican traditional medicine was made. The source was the national inquiry done by the IMSS-COPLAMAR health program (1983-1985) in which the plants used to treat mental disorders were selected and analyzed, in order to select the most frequent botanical species used in traditional medicine as sedatives, anticonvulsants and hypnotics.

  13. 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.

  14. Analysis of Oxygen Saturations Recorded During Dental Intravenous Sedations: A Retrospective Quality Assurance of 3500 Cases

    PubMed Central

    Viljoen, Andre; Byth, Karen; Coombs, Malcolm; Mahoney, Greg; Stewart, Douglas

    2011-01-01

    The death of a patient under sedation in New South Wales, Australia, in 2002 has again raised the question of the safety of dental sedation. This study sought answers to 2 questions: Can safe oxygen saturation levels (≥94%) be consistently maintained by a single operator/sedationist? Does the additional use of propofol, in subanesthetic doses, increase the risk of exposure to hypoxemia? Three thousand five hundred cases generated between 1996 and 2006 were randomly examined and divided into 2 subcohorts: 1750 patients were sedated with midazolam and fentanyl, and 1750 patients received propofol, in subanesthetic increments, in addition to midazolam and fentanyl. Initial sedation was established using midazolam and fentanyl in both subcohorts. The second subcohort received propofol during times of noxious stimulation. Patient exposure to 2 or more oxygen desaturations below 94% was uncommon. The variables that were significantly associated with low saturations were age, gender, and weight. Neither the dose of midazolam nor the additional use of propofol was a significant risk factor. ASA classification (I or II) was not a determinant of risk. The data, within the limitations of the study, showed that a single operator/sedationist, supported by a well-trained team of nurses, can consistently maintain safe oxygen saturation levels. The additional use of propofol did not increase exposure to hypoxemia. PMID:21882986

  15. Short Report. Audit of Conscious Sedation Provision in a Salaried Dental Service.

    PubMed

    Jones, Stephen G

    2016-01-01

    Clinical audit is a tool that may be used to improve the quality of care and outcomes for patients in a health care setting as well as a mechanism for clinicians to reflect on their performance. The audit described in this short report involved the collection and analysis of data related to the administration of 1,756 conscious sedations, categorised as standard techniques, by clinicians employed by an NHS Trust-based dental service during the year 2014. Data collected included gender, age and medical status of subject, the type of care delivered, the dose of drug administered and the quality of the achieved sedation and any sedation-related complications. This was the first time that a service-wide clinical audit had been undertaken with the objective of determining the safety and effectiveness of this aspect of care provision. Evaluation of the analysed data supported the perceived view that such care was being delivered satisfactorily. This on-going audit will collect data during year 2016 on the abandonment of clinical sessions, in which successful sedation had been achieved, due to the failure to obtain adequate local anaesthesia.

  16. Optimizing Sedation Management to Promote Early Mobilization for Critically Ill Children

    PubMed Central

    Saliski, Mary; Kudchadkar, Sapna R.

    2015-01-01

    Achieving successful early mobilization for the intubated, critically ill child is dependent on optimizing sedation and analgesia. Finding the fine balance between oversedation and undersedation can be challenging. The ideal is for a child to be lucid and interactive during the daytime and demonstrate normal circadian rhythm for sleep with rest at night. Being alert during the day facilitates active participation in therapy including potential ambulation, while decreasing the risk of delirium during mechanical ventilation. An active state during the day with frequent mobilization promotes restorative sleep at night, which brings with it multiple benefits for healing and recovery. Indeed, this ideal may not be physiologically feasible given a child’s critical illness and trajectory, but defining it as the “gold standard” for early mobilization provides a consistent goal for the pediatric intensive care unit (PICU) hospitalization. As such, goal-directed, patient-specific sedation plans are integral to creating a culture of mobility in the PICU. We review currently available sedation strategies for mechanically ventilated children for successful implementation of early mobilization in the PICU, as well as pharmacologic considerations for specific classes of sedative-analgesics. PMID:26702363

  17. Endoscopic treatment for esophageal varices complicated by Isaacs' syndrome involving difficulty with conventional sedation.

    PubMed

    Suzuki, Yuhei; Yamazaki, Yuichi; Hashizume, Hiroaki; Kobayashi, Takeshi; Ohyama, Tatsuya; Horiguchi, Norio; Sato, Ken; Kakizaki, Satoru; Kusano, Motoyasu; Yamada, Masanobu

    2016-02-01

    A 54-year-old male consulted a local doctor with a chief complaint of systemic convulsions and muscle stiffness and was diagnosed with Isaacs' syndrome based on positive findings for antibodies against voltage-gated potassium channels in 2009. He subsequently experienced repeated hematemesis in 2013, at which time he was taken to our hospital by ambulance. Emergent endoscopy revealed esophageal varices with spurting bleeding. The bleeding was stopped with urgent endoscopic variceal ligation. Three days later, the patient developed sudden dyspnea with stridor during inspiration under sedation with an intravenous injection of low-dose flunitrazepam prior to receiving additional treatment and was aroused with intravenous flumazenil, after which his dyspnea immediately improved. Dyspnea may be induced by muscle cramps associated with Isaacs' syndrome exacerbated by sedation. Endoscopic variceal ligation was performed safely using multiple ligation devices in an awake state following pre-medication with hydroxyzine, without sudden dyspnea. Endoscopists should be cautious of the use of sedatives in patients with diseases associated with muscle twitching or stiffness, as in the current case. In addition, it is necessary to administer endoscopic treatment in an awake state or under conscious sedation in patients with a high risk of dyspnea. PMID:26862027

  18. Shear and mixing effects on cells in agitated microcarrier tissue culture reactors

    NASA Technical Reports Server (NTRS)

    Cherry, Robert S.; Papoutsakis, E. Terry

    1987-01-01

    Tissue cells are known to be sensitive to mechanical stresses imposed on them by agitation in bioreactors. The amount of agitation provided in a microcarrier or suspension bioreactor should be only enough to provide effective homogeneity. Three distinct flow regions can be identified in the reactor: bulk turbulent flow, bulk laminar flow and boundary-layer flows. Possible mechanisms of cell damage are examined by analyzing the motion of microcarriers or free cells relative to the surrounding fluid, to each other and to moving or stationary solid surfaces. The primary mechanisms of cell damage appear to result from: (1) direct interaction between microcarriers and turbulent eddies; (2) collisions between microcarriers in turbulent flow; and (3) collisions against the impeller or other stationary surfaces. If the smallest eddies of turbulent flow are of the same size as the microcarrier beads, they may cause high shear stresses on the cells. Eddies the size of the average interbead spacing may cause bead-bead collisions which damage cells. The severity of the collisions increases when the eddies are also of the same size as the beads. Impeller collisions occur when beads cannot avoid the impeller leading edge as it advances through the liquid. The implications of the results of this analysis on the design and operation of tissue culture reactors are discussed.

  19. Magnetically agitated photocatalytic reactor for photocatalytic oxidation of aqueous phase organic pollutants.

    PubMed

    Kostedt, William L; Drwiega, Jack; Mazyck, David W; Lee, Seung-Woo; Sigmund, Wolfgang; Wu, Chang-Yu; Chadik, Paul

    2005-10-15

    A magnetically agitated photocatalytic reactor (MAPR) has been developed and assessed for oxidation of phenol. The MAPR uses a titanium dioxide composite photocatalyst with a ferromagnetic barium ferrite core. The catalyst motion was controlled with a dual-component magnetic field. First, a permanent magnet above the reactor provided a static magnetic field to counteract the force of gravity, hence increasing catalyst exposure to UV. Second, an alternating magnetic field generated by a solenoid was used to agitate the catalyst, thus increasing mass transfer between pollutants and byproducts to the catalyst. Optimal performance of the MAPR was achieved with the permanent magnet present and 1 A of alternating current to the solenoid between 20 and 80 Hz. Operating with a 60-Hz signal at 1 A with the permanent magnet present and 100 mg of catalyst, the system reduced an 11 mg/L phenol concentration by97% and decreased nonpurgeable dissolved organic carbon by 93% in 7 h using three 8-W 365-nm peak UV lamps.

  20. [Aconite in homeopathic relief of post-operative pain and agitation in children].

    PubMed

    Alibeu, J P; Jobert, J

    1990-01-01

    Despite the use of modern analgesic methods and an improved use of narcotics, the combination pain-agitation sometimes persists in the recovery-room. Aconit seems to be an appropriate homeopathic treatment in this case. To prescribe it, the following conditions must be combined: violence and suddeness of the stress bringing about intense and anguish. The study included 50 children with such symptoms; it was carried out double-blind, the children being given either placebo or Aconit. Aconit proved to be effective for children's postoperative agitation with 95% good results. It is usually stated in such studies that the placebo effect is high and may reach rates higher than 30%. Aconit is an amazing cure when well prescribed, as much for the speediness of its action as for its efficiency. This remedy has a place in the recovery-room and should be in every physician's emergency case. The fundamental research could specify how the remedy works and may be discover other molecules effective for stress.

  1. The Interactive Relationship between Pain, Psychosis, and Agitation in People with Dementia: Results from a Cluster-Randomised Clinical Trial.

    PubMed

    Habiger, Torstein F; Flo, Elisabeth; Achterberg, Wilco P; Husebo, Bettina S

    2016-01-01

    Background. Neuropsychiatric symptoms are common in people with dementia, and pain is thought to be an important underlying factor. Pain has previously been associated with agitation, and pain treatment has been shown to ameliorate agitated behaviour. So far, the association between pain and psychosis and the effect of pain treatment on psychotic symptoms is unclear. Furthermore, the impact of opioid treatment on psychosis is not established. Aim. To investigate the efficacy of a stepwise protocol for treating pain (SPTP) on psychosis and agitation measured with the Neuropsychiatric Inventory, Nursing Home version, and to explore the impact of opioid analgesics on psychosis. Method. Secondary analyses are from a cluster-randomised controlled trial including 352 patients with advanced dementia and agitation from 18 nursing homes in Western Norway. The intervention group received pain treatment according to SPTP. Results. Pain was associated with disinhibition (adjusted OR: 1.21, 95% CI: 1.10-1.34) and irritability (adjusted OR: 1.10, 95% CI: 1.01-1.21) at baseline. Pain treatment reduced agitation (p < 0.001, df = 1; 300) and aberrant motor behaviour (p = 0.017, df = 1; 300). Psychosis was reduced in people with at least one symptom at baseline (p = 0.034, df = 1; 135). The use of opioid analgesics did not increase psychotic symptoms. Study Registration. This trial is registered with ClinicalTrials.gov (NCT01021696), Norwegian Medicines Agency, EudraCT (EudraCTnr: 2008-007490-20). PMID:27247487

  2. Effect of agitation regimen on the in vitro release of leuprolide from poly(lactic-co-glycolic) acid microparticles.

    PubMed

    Schoubben, Aurélie; Blasi, Paolo; Deluca, Patrick P

    2012-03-01

    Because of the importance of in vitro release tests in establishing batch-to-batch reproducibility and in vitro-in vivo correlation, this study investigated the influence of agitation regimen on the in vitro release behavior of leuprolide from poly(lactic-co-glycolic) acid microparticles. Leuprolide-loaded microspheres were prepared using Resomer(®) RG502H and RG503H as polymers. Leuprolide in vitro release was performed in phosphate buffer solution under continuous or once-a-week agitation. At predetermined intervals, leuprolide release, polymer mass loss, and degree of hydration were investigated. Leuprolide release and polymer mass loss were higher under continuous agitation with respect to that under intermittent agitation. Using a modified version of Koizumi equation, it was possible to fit leuprolide release profiles. Similarity factor comparison showed a high level of similarity between experimental and modeled data in the case of once-a-week agitation regimen. This work highlights the importance of the in vitro release conditions on peptide release behavior from polyester microparticles.

  3. The effect of ketamine versus fentanyl on the incidence of emergence agitation after sevoflurane anesthesia in pediatric patients undergoing tonsillectomy with or without adenoidectomy

    PubMed Central

    Abdelhalim, Ashraf Arafat; Alarfaj, Ahmed Mohamed

    2013-01-01

    Background: Emergence agitation (EA) has been documented as a common side-effect of sevoflurane anesthesia. This prospective, randomized, double-blind, placebo-controlled study was designed to compare the effects of ketamine versus fentanyl, administered 10 min before the end of surgery on the development of EA. Methods: A total of 120 children aged 3-7 years of American Society of Anesthesiologists I-II physical status were randomly assigned to one of three equal groups receiving either ketamine 0.5 mg/kg (Group K), fentanyl 1 μg/kg (Group F) or saline (Group C) at 10 min before the end of surgery. Post-operative EA was assessed with Aono's four point scale. Recovery times, the post-operative pain and adverse reactions were assessed. Results: There was no significant difference between the three groups regarding recovery and discharge times from post-anesthesia care unit. The incidence of EA was significantly low in Group K and Group F (15% and 17.5%, respectively) compared to the control group (42.5%), with no significant difference between Group K and Group F. There were no significant differences in Children's Hospital of Eastern Ontario Pain Scale between the three groups. The incidence of nausea or vomiting was significantly more in Group F compared to that in other two groups. However, no complications such as somnolence, oxygen desaturation or respiratory depression occurred during the study period and there were no episodes of hallucinations or bad dreams in the ketamine group. Conclusion: The intravenous administration of either ketamine 0.5 mg/kg or fentanyl 1 μg/kg before the end of surgery in sevoflurane-anesthetized children undergoing tonsillectomy with or without adenoidectomy reduces the incidence of post-operative agitation without delaying emergence. PMID:24348289

  4. Music during interventional radiological procedures, effect on sedation, pain and anxiety: a randomised controlled trial

    PubMed Central

    Kulkarni, S; Johnson, P C D; Kettles, S; Kasthuri, R S

    2012-01-01

    Objective : To assess the effects of playing patient-selected music during interventional procedures on (1) the doses of sedation and analgesia and (2) anxiety levels. Methods : Patients undergoing interventional radiological procedures were randomised to either the intervention (music) or the control (no music) group. Patients in the intervention group had music of their choice played via headphones during the procedure. The primary outcomes were reductions in the doses of drugs for sedation (midazolam) and analgesia (fentanyl). Anxiety levels were assessed both before and after the procedure using the validated State Anxiety Inventory. Mean pulse rate and average of mean blood pressures were also recorded before and during the procedures as surrogate indicators of anxiety levels. Results : 100 patients were randomised in a 1:1 ratio. There were 58 males and 42 females, with a mean age of 58 years. Sedation was required in 21 (42%) patients in the music group compared with 30 (60%) patients in the control group (p=0.046). The mean [standard deviation (SD)] midazolam dose was 2.1 mg (2.3 mg) in the control group and 1.3 mg (2.2 mg) in the music group (p=0.027). The mean (SD) fentanyl dose was 29 mg (40 mg) in the control group and 18 mg (34 mg) in the music group (p=0.055). There was no significant effect of music on the change from baseline in anxiety levels (p=0.74), pulse rate (p=0.56) or blood pressure (p=0.34). Conclusion : Sedation requirements are significantly reduced by playing self-selected music to the patient during interventional radiology procedures. By lowering sedation during interventional radiology, music makes the procedure safer. It also contributes favourably to the overall patient experience. PMID:22422386

  5. 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

  6. Sex differences in dreaming during short propofol sedation for upper gastrointestinal endoscopy.

    PubMed

    Xu, Guanghong; Liu, Xuesheng; Sheng, Qiying; Yu, Fengqiong; Wang, Kai

    2013-10-01

    Previous reports suggest that sex differences may exist in dreaming under anesthesia, but their results were inconclusive. The current study explored sex differences in the incidence and content of dreams during short propofol sedation for upper gastrointestinal endoscopy and investigated whether sex differences or dream content affect patient satisfaction with sedation. A total of 200 patients (100 men and 100 women) undergoing upper gastrointestinal endoscopy participated in this study. Patients were interviewed with the modified Brice questionnaire about the incidence and the content of dreams, and satisfaction with sedation was assessed. The results showed that the incidence of dreaming was significantly higher in men (31%) than in women (17%) (P=0.02), but recovery time was similar. In men, 45% (14/31) of dreamers reported positive emotional content and only 6% (2/31) reported negative emotional content. In contrast, in women, 18% (3/17) reported positive and 29% (5/17) reported negative content (P=0.04). Men reported dreams that were more vivid, meaningful, familiar, and memorable (P<0.01). No significant sex differences were observed in the emotional intensity of dreams, and emotional content did not influence patients' satisfaction. In sum, sex differences existed in dreaming during short propofol sedation despite similar recovery time and matching in terms of age. Men reported dreaming more frequently and had a higher incidence of recall for their dream narratives. In particular, men reported significantly more positive emotional content, less negative emotional content, and more meaningful content. Dreamer satisfaction with sedation was not influenced by sex or dream content.

  7. 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.

  8. Virtual Reality for Pediatric Sedation: A Randomized Controlled Trial Using Simulation

    PubMed Central

    Davis, Aisha B; O'Connell, Karen J; Willner, Emily; Aronson Schinasi, Dana A; Ottolini, Mary

    2016-01-01

    Introduction: Team training for procedural sedation for pediatric residents has traditionally consisted of didactic presentations and simulated scenarios using high-fidelity mannequins. We assessed the effectiveness of a virtual reality module in teaching preparation for and management of sedation for procedures. Methods: After developing a virtual reality environment in Second Life® (Linden Lab, San Francisco, CA) where providers perform and recover patients from procedural sedation, we conducted a randomized controlled trial to assess the effectiveness of the virtual reality module versus a traditional web-based educational module. A 20 question pre- and post-test was administered to assess knowledge change. All subjects participated in a simulated pediatric procedural sedation scenario that was video recorded for review and assessed using a 32-point checklist. A brief survey elicited feedback on the virtual reality module and the simulation scenario. Results: The median score on the assessment checklist was 75% for the intervention group and 70% for the control group (P = 0.32). For the knowledge tests, there was no statistically significant difference between the groups (P = 0.14). Users had excellent reviews of the virtual reality module and reported that the module added to their education. Conclusions: Pediatric residents performed similarly in simulation and on a knowledge test after a virtual reality module compared with a traditional web-based module on procedural sedation. Although users enjoyed the virtual reality experience, these results question the value virtual reality adds in improving the performance of trainees. Further inquiry is needed into how virtual reality provides true value in simulation-based education. PMID:27014520

  9. 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.

  10. A simple collapse, agitation and pathological crying in a young woman? - Atypical onset of a basilar thrombosis

    PubMed Central

    Etgen, Thorleif; Milankovic-Eberl, Dragana; Rieder, Georg

    2014-01-01

    Background A collapse and agitation in a young person comprises many differential diagnoses, but usually does not include a life-threatening basilar thrombosis. Methods and Results We report the case of a 19-year old woman who presented mainly with a collapse and agitation. CT and CT-angiography yielded distal basilar thrombosis which was successfully treated by intraarterial thrombolysis. MRI confirmed multiple small ischemic lesions in the vertebrobasilar territory. The patient improved quickly and returned to her normal daily activities of life after a few months. Conclusions Posterior circulation ischemia should be included among the possible differential diagnoses of any acute onset of an agitated or confusional state. Conflicts of interest/Disclosures None to declare. Ethics Written informed consent of the patient has been obtained. PMID:25422712

  11. Dewaxing process using agitated heat exchanger to chill solvent-oil and wax slurry to wax filtration temperature

    SciTech Connect

    Broadhurst, Th.E.

    1984-04-10

    In an improved process for dewaxing waxy hydrocarbon oils, wherein said waxy oil is cooled in an indirect chilling zone to a temperature greater than the wax separation temperature whereby wax is precipitated to form a wax-oil-solvent slurry, cooling the slurry to the wax separation temperature in an indirect chilling zone thereby precipitating a further portion of wax from said waxy oil and separating said precipitated wax from the wax-oil-solvent slurry in solid-liquid separation means, the improvement comprises using as the indirect chilling zone an indirect heat exchanger means operated at a high level of agitation. Expressed in terms of Impeller Reynolds Number the agitation is on the order of about 1,000 to 1,000,000. Alternatively, the direct chilling zone is totally replaced by the high agitation indirect heat exchanger means.

  12. [Effective Dexmedetomidine Administration for the Prevention of Emergence Agitation and Postoperative Delirium in Patients with a History of Postoperative Delirium].

    PubMed

    Fujisawa, Takanobu; Komasawa, Nobuyasu; Fujiwara, Atsushi; Kido, Haruki; Minami, Toshiaki

    2016-04-01

    We successfully performed intraoperative dexmedetomidine (DEX) administration for the prevention of emergence agitation or postoperative delirium after lung resection in four patients (71.3 ± 5.7 year old, 3 males and 1 female) with a past history of postoperative delirium. DEX was started at 0.35-0.45 μg x kg(-1) x hr(-1) continuously without loading. The average time from DEX initiation to extubation was 141.3 ± 94.4 minutes. No patient had emergence agitation, and DEX administration was continued until the following morning with monitoring in all patients without any symptoms of delirium. Intraoperative DEX administration may be beneficial for the prevention of emergence agitation or postoperative delirium in patients with a past history of postoperative delirium. PMID:27188116

  13. [Effective Dexmedetomidine Administration for the Prevention of Emergence Agitation and Postoperative Delirium in Patients with a History of Postoperative Delirium].

    PubMed

    Fujisawa, Takanobu; Komasawa, Nobuyasu; Fujiwara, Atsushi; Kido, Haruki; Minami, Toshiaki

    2016-04-01

    We successfully performed intraoperative dexmedetomidine (DEX) administration for the prevention of emergence agitation or postoperative delirium after lung resection in four patients (71.3 ± 5.7 year old, 3 males and 1 female) with a past history of postoperative delirium. DEX was started at 0.35-0.45 μg x kg(-1) x hr(-1) continuously without loading. The average time from DEX initiation to extubation was 141.3 ± 94.4 minutes. No patient had emergence agitation, and DEX administration was continued until the following morning with monitoring in all patients without any symptoms of delirium. Intraoperative DEX administration may be beneficial for the prevention of emergence agitation or postoperative delirium in patients with a past history of postoperative delirium.

  14. Dexmedetomidine Injection during Strabismus Surgery Reduces Emergence Agitation without Increasing the Oculocardiac Reflex in Children: A Randomized Controlled Trial

    PubMed Central

    Oh, Ah-Young; Baik, Ji-Seok; Kim, Jin Hee; Hwang, Jung- Won; Jeon, Young-Tae

    2016-01-01

    Objective Dexmedetomidine is known to reduce the incidence of emergence agitation, which is a common complication after inhalational anesthesia like sevoflurane or desflurane in children. However, the dose of dexmedetomidine used for this purpose is reported variously and the most effective dose is not known. In this study, we tried to find the most effective dose of dexmedetomidine to reduce the incidence of emergence agitation in children undergoing strabismus surgery without the complications like oculocardiac reflex (OCR) or postoperative vomiting. Methods We randomized 103 pediatric patients aged 2–6 years and undergoing elective strabismus surgery into four groups. Anesthesia was induced with sevoflurane and maintained with desflurane. At the start of induction, dexmedetomidine, delivered at 0.25, 0.5, or 1 μg/kg, or saline was infused intravenously in the D0.25, D0.5, D1 groups, respectively. The primary outcome measure was the incidence of emergence agitation and the secondary outcome measure was the incidence of intraoperative OCR, postoperative vomiting, and desaturation events. Results The incidence of emergence agitation was 60, 48, 44, and 21% (P = 0.005) and the incidence of intraoperative OCR was 36, 36, 36, and 37% (P = 0.988) in the control, D0.25, D0.5, and D1 groups, respectively. And, postoperative vomiting rate and desaturation events were low in the all groups. Conclusion Dexmedetomidine decreased the incidence of emergence agitation without increasing intraoperative oculocardiac reflex. Dexmedetomidine delivered at 1 μg/kg was more effective at reducing emergence agitation than lower doses in children undergoing strabismus surgery under desflurane anesthesia. Trial Registration Clinical Research Information Service KCT0000141 PMID:27617832

  15. The Effects of Nutrient Concentration, Addition of Thickeners, and Agitation Speed on Liquid Fermentation of Steinernema feltiae.

    PubMed

    Leite, Luis G; Shapiro-Ilan, David I; Hazir, Selcuk; Jackson, Mark A

    2016-06-01

    Entomopathogenic nematode production in liquid fermentation still requires improvements to maximize efficiency, yield, and nematode quality. Therefore, this study was aimed at developing a more suitable liquid medium for mass production of Steinernema feltiae, by assessing the effects of nutrient concentration, thickeners (primarily agar), and agitation speed on infective juvenile (IJ) yield. Base medium (BM) contained yeast extract (2.3%), egg yolk (1.25%), NaCl (0.5%), and corn oil (4%). All media were inoculated with Xenorhabdus bovienii, and 2 d later, with 2-d-old S. feltiae juveniles. For the nutrient concentration experiment, we evaluated the base medium versus a modified base medium containing all the components, but with 3× concentrations of yeast extract (6.9%), egg yolk (3.75%), and corn oil (12%). The nematodes and bacteria were cultured in 150-ml Erlenmeyer flasks containing 50 ml of liquid medium at (25°C) and 180 rpm on a rotary shaker incubator. To assess the effect of thickeners, IJs were inoculated in BM with agar (0.2%), carrageen (0.2%), and carboxymethyl cellulose (0.2% and 0.5%). The addition of 3× more nutrients relative to the BM resulted in a significantly lower yield of nematodes. For agar and agitation speed experiments, five levels of agar in the BM (0%, 0.2%, 0.4%, 0.6%, and 0.8% agar) and two agitation speeds (180 and 280 rpm) were evaluated for production. Increasing agitation speed from 180 to 280 rpm and higher levels of agar in the medium (> 0.2%) significantly increased the yield of bacteria. At the lower agitation speed, media amended with 0.4% and 0.6% agar produced higher nematode yields compared to media without agar. Media with 0.2% and 0.8% agar resulted in intermediate levels of nematode production. At the higher agitation speed, media supplemented with 0.8% agar resulted in the lowest yield of nematodes when compared to the other media tested. Results indicated that increasing nutrient concentration levels was

  16. The Effects of Nutrient Concentration, Addition of Thickeners, and Agitation Speed on Liquid Fermentation of Steinernema feltiae

    PubMed Central

    Leite, Luis G.; Shapiro-Ilan, David I.; Hazir, Selcuk; Jackson, Mark A.

    2016-01-01

    Entomopathogenic nematode production in liquid fermentation still requires improvements to maximize efficiency, yield, and nematode quality. Therefore, this study was aimed at developing a more suitable liquid medium for mass production of Steinernema feltiae, by assessing the effects of nutrient concentration, thickeners (primarily agar), and agitation speed on infective juvenile (IJ) yield. Base medium (BM) contained yeast extract (2.3%), egg yolk (1.25%), NaCl (0.5%), and corn oil (4%). All media were inoculated with Xenorhabdus bovienii, and 2 d later, with 2-d-old S. feltiae juveniles. For the nutrient concentration experiment, we evaluated the base medium versus a modified base medium containing all the components, but with 3× concentrations of yeast extract (6.9%), egg yolk (3.75%), and corn oil (12%). The nematodes and bacteria were cultured in 150-ml Erlenmeyer flasks containing 50 ml of liquid medium at (25°C) and 180 rpm on a rotary shaker incubator. To assess the effect of thickeners, IJs were inoculated in BM with agar (0.2%), carrageen (0.2%), and carboxymethyl cellulose (0.2% and 0.5%). The addition of 3× more nutrients relative to the BM resulted in a significantly lower yield of nematodes. For agar and agitation speed experiments, five levels of agar in the BM (0%, 0.2%, 0.4%, 0.6%, and 0.8% agar) and two agitation speeds (180 and 280 rpm) were evaluated for production. Increasing agitation speed from 180 to 280 rpm and higher levels of agar in the medium (> 0.2%) significantly increased the yield of bacteria. At the lower agitation speed, media amended with 0.4% and 0.6% agar produced higher nematode yields compared to media without agar. Media with 0.2% and 0.8% agar resulted in intermediate levels of nematode production. At the higher agitation speed, media supplemented with 0.8% agar resulted in the lowest yield of nematodes when compared to the other media tested. Results indicated that increasing nutrient concentration levels was

  17. Effect of placement agitation and placement time on the shear bond strength of 3 self-etching adhesives.

    PubMed

    Velasquez, Lina Maria; Sergent, Robert S; Burgess, John O; Mercante, D E

    2006-01-01

    This study measured the shear bond strength (SBS) of 3 self-etching bonding agents to enamel and dentin with and without agitation at 3 different application times. The null hypotheses tested were that agitation and application time have no effect on bond strength. Occlusal surfaces of 180 recently extracted caries-free human molars were wet ground with 600 grit wet-dry silica carbide abrasive paper to obtain a flat enamel surface. The teeth were divided into 18 groups of 10 teeth. Three self-etching bonding agents, Clearfil SE BOND (Kuraray America), Xeno III (Dentsply) and AdheSE (Ivoclar-Vivadent) were applied using application times of 10, 20 or 30 seconds with or without agitation, thinned with a gentle stream of air and cured for 10 seconds, according to manufacturers' directions. Z100 (3M ESPE) composite, A2 shade, was placed over the cured adhesive and cured for 40 seconds. The samples were stored in distilled water at room temperature until testing. The samples were tested in shear to failure with a 1-mm/minute crosshead speed. After enamel shear bond strength testing, the teeth were again ground with 400 and 600-grit wet-dry SiC paper to obtain a flat dentin surface. The protocol used for preparing the enamel bond test samples was repeated, and the teeth were stored until testing in distilled water at room temperature. The samples were again tested in shear at a 1-mm/minute crosshead speed. Values were converted to MPa and data analyzed for intergroup differences using ANOVA and Tukey post-hoc tests. Agitation did not improve enamel SBS for any of the materials tested, but there was a significant difference in enamel SBS among materials: Clearfil SE Bond shear bond strength was greater than Xeno III, which was greater than AdheSE. At 10 seconds application time on dentin, agitation improved the Clearfil SE Bond SBS and, at 20 seconds application time on dentin, agitation significantly improved SBS to dentin for all systems tested. Agitation had no affect

  18. Physiologic changes induced by endotracheal instillation and suctioning in critically ill preterm infants with and without sedation.

    PubMed

    Ninan, A; O'Donnell, M; Hamilton, K; Tan, L; Sankaran, K

    1986-04-01

    Endotracheal instillation and subsequent suctioning produces fluctuations of intracranial pressure (ICP), mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) in sick preterm infants. In an attempt to observe if these fluctuations could be minimized using sedation, we studied a group of seven sick mechanically ventilated preterm infants with and without sedation. Continuous monitoring of ICP, MAP, heart rate, CPP, and arterial oxygen tension (PaO2) were obtained. The statistical analysis of the data revealed significant blunting of fluctuations of MAP, ICP, and CPP with sedation.

  19. 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

  20. Scale-down/scale-up studies leading to improved commercial beer fermentation.

    PubMed

    Nienow, Alvin W; Nordkvist, Mikkel; Boulton, Christopher A

    2011-08-01

    Scale-up/scale-down techniques are vital for successful and safe commercial-scale bioprocess design and operation. An example is given in this review of recent studies related to beer production. Work at the bench scale shows that brewing yeast is not compromised by mechanical agitation up to 4.5 W/kg; and that compared with fermentations mixed by CO(2) evolution, agitation ≥ 0.04 W/kg is able to reduce fermentation time by about 20%. Work at the commercial scale in cylindroconical fermenters shows that, without mechanical agitation, most of the yeast sediments into the cone for about 50% of the fermentation time, leading to poor temperature control. Stirrer mixing overcomes these problems and leads to a similar reduction in batch time as the bench-scale tests and greatly reduces its variability, but is difficult to install in extant fermenters. The mixing characteristics of a new jet mixer, a rotary jet mixer, which overcomes these difficulties, are reported, based on pilot-scale studies. This change enables the advantages of stirring to be achieved at the commercial scale without the problems. In addition, more of the fermentable sugars are converted into ethanol. This review shows the effectiveness of scale-up/scale-down studies for improving commercial operations. Suggestions for further studies are made: one concerning the impact of homogenization on the removal of vicinal diketones and the other on the location of bubble formation at the commercial scale. PMID:21744501