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Sample records for mac sedation clinical

  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. 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

  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. 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

  5. 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

  6. 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,...

  7. Monolithic moral frameworks: how are the ethics of palliative sedation discussed in the clinical literature?

    PubMed

    Billings, J Andrew; Churchill, Larry R

    2012-06-01

    A variety of moral frameworks can assist clinicians in making ethical decisions. In examining articles on palliative sedation and terminal extubation, we were struck that bioethical discussions uniformly appealed to principlism and especially to the rule of double effect. Other moral frameworks were rarely invoked, an observation consistent with Daniel Callahan's assertion that principlism has a "blocking effect" on broader ethical deliberation. We review here the principle of double effect as it applies to clinical acts that may hasten death, and present one radically different ethical formulation developed by Dan Brock. We then offer brief examples of how clinicians might use other moral frameworks to assess the ethics of preemptive sedation for terminal extubation. We argue for greater moral pluralism in approaching end-of-life decisions.

  8. 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.

  9. 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

  10. 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.

  11. 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.

  12. [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.

  13. THE CHALLENGE OF SEDATION WITH ADOLESCENTS: CASE STUDIES AND CLINICAL RECOMMENDATIONS

    PubMed Central

    Coolidge, Trilby; Heaton, Lisa J.; Milgrom, Peter

    2010-01-01

    Adolescent dental patients pose a unique challenge to providers, particularly when intravenous sedation is introduced to the treatment plan. Surveys show many adolescents are afraid of the dentist. Five to six per cent overall are fearful of dental injections and may avoid care or have irregular attendance. At the same time, adolescents may assert their independence by refusing to cooperate with providers’ and parents’ requests even while accepting that the goal of better health is reasonable. Successful treatment of – and rapport with – the adolescent dental patient, however, can ensure that adolescents’ oral needs are met. Successful providers recognise that adolescents alternate between childlike and mature coping strategies during the course of dental treatment. Identifying an adolescent’s current coping style can help the dental team select appropriate strategies to help treatment proceed more smoothly for the adolescent and clinical team. Working with adolescents’ individual coping styles, rather than expecting consistently adult behaviour, will ideally help decrease frustration and improve treatment outcome. PMID:19267138

  14. 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...

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

    PubMed Central

    2010-01-01

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

  16. [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.

  17. 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.

  18. Uptake of Web-based clinical resources from the MacArthur Initiative on Depression and Primary Care.

    PubMed

    Han, Changsu; Voils, Corrine I; Williams, John W

    2013-04-01

    This study assessed the usability and desired enhancements for the MacArthur Foundation's Depression and Primary Care (MDPC) Web site to determine if resources for integrated depression care that are disseminated through the Web site are incorporated into routine clinical care. Since its launch in 2003, more than 20,000 users registered as members of the MDPC website to read and download depression care resources. Subjects were randomly selected from MDPC Web site users who had previously downloaded the depression toolkit. Web-based survey, which was administered anonymously, included the following domains: (1) socio-demographic data, (2) confidence in managing depression (3) Web site content and design features, (4) desired enhancements to Web site and content, (5) use of resources downloaded from the Web site, and (6) importance of depression care resources. Of the 3,478 randomly selected participants, 666 (19.1%) responded. Web site content was rated "good" or "excellent" for screening and diagnosis (84.3%), treatment (69.8%), patient education (66.2%), and care management (66.9%). The Patient Health Questionnaire-9 (PHQ-9) was rated "very useful" by 68.3%; 47.1% reported using it in at least 25% of encounters with patients who are depressed. PHQ-9 use was significantly associated with higher self-confidence in managing depression (P = 0.05). Evidence-based resources for depression care can be disseminated effectively through a dedicated Web site and may help clinicians incorporate effective care models into routine practice.

  19. Newly described clinical features in two siblings with MACS syndrome and a novel mutation in RIN2.

    PubMed

    Aslanger, Ayca D; Altunoglu, Umut; Aslanger, Emre; Satkın, Bilge N; Uyguner, Zehra Oya; Kayserili, Hülya

    2014-02-01

    The disorder comprising Macrocephaly, Alopecia, Cutis laxa, and Scoliosis has been designated MACS syndrome. It is a rare condition, inherited in an autosomal recessive pattern. Three families from different ethnic origins have so far been reported and were all linked to homozygous mutations in RIN2, a gene encoding the Ras and Rab interactor 2 protein involved in cell trafficking. We describe herein the fourth family with MACS syndrome in two siblings carrying a novel homozygous mutation, c.1878_1879insC in exon 8 of the RIN2 gene, which predicts p.Ile627Hisfs*7. We also report on additional findings not previously described in MACS syndrome, including bronchiectasis and hypergonadotropic hypogonadism. Finally, our overall data support the argument that RIN2 syndrome is a more appropriate name for the disorder.

  20. 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

  1. 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.

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

    PubMed Central

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

    2016-01-01

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

  3. An evaluation of analgesic efficacy and clinical acceptability of intravenous tramadol as an adjunct to propofol sedation for third molar surgery.

    PubMed Central

    Shipton, E. A.; Roelofse, J. A.; Blignaut, R. J.

    2003-01-01

    This article details a double-blind, randomized, placebo-controlled pilot study evaluating the analgesic efficacy and clinical acceptability of intravenous tramadol in patients undergoing surgical removal of an impacted third molar tooth under local anesthesia and intravenous sedation with propofol. Forty-five ASA status 1 dental outpatients were randomly allocated to 2 groups of 22 (group A) and 23 (group B) patients each (n = 45). Group A (T/P) received intravenous tramadol 1.5 mg/kg injected over 2 minutes, followed by a bolus dose of intravenous propofol 0.4 mg/ kg. Maintenance consisted of a continuous infusion of propofol 3 mg/kg/h, with an additional bolus dose of 0.4 mg/kg intravenously 2-3 minutes prior to the infiltration of the local anesthetic solution. Group B (P/P) patients received no tramadol but instead a saline placebo solution and an identical amount of propofol. Overall, in this study, postoperative pain was much better controlled in the group receiving tramadol 1.5 mg/kg intravenously despite there being no significant difference in the dose of propofol administered in both groups. Intravenous tramadol, when given with propofol, did not affect the cardiovascular, respiratory, and sedative effects of propofol. Following tramadol, despite being an opioid, no nausea and vomiting were reported in the early postoperative period, indicating the value of using tramadol with propofol. Thus, this pilot study demonstrated the potential use of intravenous tramadol with propofol in day-case dento-alveolar surgery. PMID:14558587

  4. 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

  5. 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

  6. Mycobacterium Avium Complex (MAC)

    MedlinePlus

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

  7. 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).

  8. 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

  9. 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

  10. Introduction to MAC CRM training

    NASA Technical Reports Server (NTRS)

    Brown, Donald D.

    1987-01-01

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

  11. 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.

  12. 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

  13. 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

  14. 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.

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. Recent results from MAC

    SciTech Connect

    MAC Collaboration

    1982-05-01

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

  1. MAC calorimeters and applications

    SciTech Connect

    MAC Collaboration

    1982-03-01

    The MAC detector at PEP features a large solid-angle electromagnetic/hadronic calorimeter system, augmented by magnetic charged-particle tracking, muon analysis and scintillator triggering. Its implementation in the context of electron-positron annihilation physics is described, with emphasis on the utilization of calorimetry.

  2. Shared decision making after MacIntyre.

    PubMed

    Tilburt, Jon

    2011-04-01

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

  3. 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. ...

  4. 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

  5. Monolithic MACS micro resonators

    NASA Astrophysics Data System (ADS)

    Lehmann-Horn, J. A.; Jacquinot, J.-F.; Ginefri, J. C.; Bonhomme, C.; Sakellariou, D.

    2016-10-01

    Magic Angle Coil Spinning (MACS) aids improving the intrinsically low NMR sensitivity of heterogeneous microscopic samples. We report on the design and testing of a new type of monolithic 2D MACS resonators to overcome known limitations of conventional micro coils. The resonators' conductors were printed on dielectric substrate and tuned without utilizing lumped element capacitors. Self-resonance conditions have been computed by a hybrid FEM-MoM technique. Preliminary results reported here indicate robust mechanical stability, reduced eddy currents heating and negligible susceptibility effects. The gain in B1 /√{ P } is in agreement with the NMR sensitivity enhancement according to the principle of reciprocity. A sensitivity enhancement larger than 3 has been achieved in a monolithic micro resonator inside a standard 4 mm rotor at 500 MHz. These 2D resonators could offer higher performance micro-detection and ease of use of heterogeneous microscopic substances such as biomedical samples, microscopic specimens and thin film materials.

  6. Monolithic MACS micro resonators.

    PubMed

    Lehmann-Horn, J A; Jacquinot, J-F; Ginefri, J C; Bonhomme, C; Sakellariou, D

    2016-10-01

    Magic Angle Coil Spinning (MACS) aids improving the intrinsically low NMR sensitivity of heterogeneous microscopic samples. We report on the design and testing of a new type of monolithic 2D MACS resonators to overcome known limitations of conventional micro coils. The resonators' conductors were printed on dielectric substrate and tuned without utilizing lumped element capacitors. Self-resonance conditions have been computed by a hybrid FEM-MoM technique. Preliminary results reported here indicate robust mechanical stability, reduced eddy currents heating and negligible susceptibility effects. The gain in B1/P is in agreement with the NMR sensitivity enhancement according to the principle of reciprocity. A sensitivity enhancement larger than 3 has been achieved in a monolithic micro resonator inside a standard 4mm rotor at 500MHz. These 2D resonators could offer higher performance micro-detection and ease of use of heterogeneous microscopic substances such as biomedical samples, microscopic specimens and thin film materials. PMID:27544845

  7. Results from MAC

    SciTech Connect

    Chadwick, G.B.

    1983-05-01

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

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

    PubMed Central

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

    2007-01-01

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

  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. 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

  11. McCay ("Mac") Vernon (1928-2013).

    PubMed

    Sherman, William A

    2014-09-01

    McCay ("Mac") Vernon, the founding and preeminent psychologist in the field of deafness. Mac was born at Walter Reed Hospital in Washington, DC, into a military family on October 14, 1928 and died on August 28, 2013, at the age of 84. Prior to Mac, research and clinical direction in the field were sparse. Mac became the icon for psychological services for deaf people, and his work extended into the education of deaf children, forensic and ethical practices with the deaf, and public understanding of deafness as a disability and of deaf persons as a psychosocial minority group. Mac will also be remembered for his sharp intellect, good humor, compassion, and advocacy for those who are misunderstood. PMID:25197842

  12. McCay ("Mac") Vernon (1928-2013).

    PubMed

    Sherman, William A

    2014-09-01

    McCay ("Mac") Vernon, the founding and preeminent psychologist in the field of deafness. Mac was born at Walter Reed Hospital in Washington, DC, into a military family on October 14, 1928 and died on August 28, 2013, at the age of 84. Prior to Mac, research and clinical direction in the field were sparse. Mac became the icon for psychological services for deaf people, and his work extended into the education of deaf children, forensic and ethical practices with the deaf, and public understanding of deafness as a disability and of deaf persons as a psychosocial minority group. Mac will also be remembered for his sharp intellect, good humor, compassion, and advocacy for those who are misunderstood.

  13. [Future and Current Status of Monitored Anesthesia Care (MAC) in Japan: Preface and Comments].

    PubMed

    Kawamata, Mikito

    2015-03-01

    American Society of Anesthesiologists defines that monitored anesthesia care (MAC) is a specific anesthesia service for a diagnostic or therapeutic procedure. Indications for monitored anesthesia care include the nature of the procedure, the patient's clinical condition and/or the potential need to convert to a general or regional anesthetic. In the USA, MAC is popular as an anesthesiologist service provided for an individual patient. MAC is also becoming increasingly popular in Japan. However, most Japanese anesthesiologists are not involved in MAC, and instead, physicians belonging to other departments such as internal medicine and pediatrics are in charge for MAC. Several guidelines for MAC during MRI in children and endoscopy in adults have recently been published in Japan. In the featured articles, we are dealing with the future and current status of MAC in Japan. Through the featured articles, I hope readers would know what to do next for us anesthesiologists in order to provide safe and useful MAC in Japan.

  14. 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

  15. 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.

  16. 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

  17. 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

  18. 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

  19. 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.

  20. 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

  1. 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.

  2. Fiverr MacGyver

    NASA Astrophysics Data System (ADS)

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

    2014-05-01

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

  3. 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

  4. 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

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

    PubMed

    Zielmann, S; Grote, R

    1995-12-01

    by enteric tube in 30%, 35%, and 15% of cases, respectively. In group 3 deep sedation was necessary because of elevated intracranial pressure. In groups 4, 5, and 6, piritramide was administered for analgesia, and normal enteric tube feeding was achieved in 70%, 75%, and 90% of cases. The best results were seen in group 6, and these elderly patients needed smaller amounts of piritramide for analgesia. In groups 7, 8, 9, and 10, ketamine was given for analgesia, and complete enteric tube feeding was carried out in 75%, 30%, 45%, and 60% of these patients. The best results in the ketamine groups were found in combination with midazolam as the sedating drug; however, the patients in group 7 did not have elevated intracranial pressure, in contrast to the patients in groups 8, 9, and 10. The last group received the combination of sufentanil, midazolam and methohexitone to achieve a deep sedation. The rate of normal enteric tube feeding in these patients with severe head trauma was 30%. CONCLUSIONS. In patients with severe head trauma who need deep sedation to prevent dangerous high intracranial pressure, gastrointestinal motility disorders are very commonly found. The results obtained suggest that ketamine should be regarded as the analgesic drug of choice, combined with propofol rather than a high-dose barbiturate therapy. The combination of ketamine with midazolam and GABA is an unusual strategy for long-term sedation, which resulted from our own clinical studies directed at an effective and well-tolerated regime for this high-risk patient group. Obviously, high-dose barbiturates and short-acting opioids, especially when combined, make enteric tube feeding more difficult. Therefore, we recommend piritramide or ketamine for analgesia. The basic sedating drug is midazolam, in special cases combined with or replaced by propofol. The position of GABA in long-term sedation is not yet clear, but a lack of side effects on the gastrointestinal tract became evident in this stud

  6. 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

  7. 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

  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. [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.

  10. 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.

  11. 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.

  12. 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.

  13. Refurbishing MacIntyre's Account of Practice

    ERIC Educational Resources Information Center

    Hager, Paul

    2011-01-01

    According to Alasdair MacIntyre's influential account of practices, "teaching itself is not a practice, but a set of skills and habits put to the service of a variety of practices" (MacIntyre and Dunne, 2002, p. 5). Various philosophers of education have responded to and critiqued MacIntyre's position, most notably in a Special Issue of the…

  14. Discriminative validity of the MacAndrew Alcoholism Scale with Cluster B personality disorders.

    PubMed

    Smith, S R; Hilsenroth, M J

    2001-06-01

    This study was designed to assess the ability of the Minnesota Multiphasic Personality Inventory (MMPI-2) MacAndrew Alcoholism Scale (MAC-R) to differentiate between outpatients with personality disorders with Substance-Related Disorders (SRDs) and without SRDs. MMPI-2 validity, clinical, and MAC-R scale scores were compared in an SRD Cluster B group (comprised of Narcissistic, Antisocial, Borderline, and Histrionic; n = 15), a non-SRD Cluster B group (n = 33), and a non-SRD group with personality disorders from Clusters A and C (n = 18). Results revealed that the substance-abusing Cluster B group scored significantly higher on the MAC-R ( p <.0001) as well as the Psychopathic Deviate scale ( p <.01). Dimensional analyses illustrated that MAC-R scores were related to the presence of an SRD diagnosis (rpb =.70, p <.0001) and diagnostic criteria for Antisocial Personality Disorder (r =.60, p <.0001). Stepwise regression revealed that (in order of magnitude) the presence of a substance-abuse diagnosis followed by diagnostic criteria for Antisocial and Histrionic Personality Disorders were most related to MAC-R scores (R =.78, R(2) =.60). This indicates that the MAC-R may be more related to the presence of an SRD than has been suggested, and when used in outpatient settings as MacAndrew (1965) intended, the MAC-R may be useful as a screening device for assessing SRD among outpatients with Axis II psychopathology.

  15. 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

  16. 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

  17. 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

  18. 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)

  19. 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.

  20. 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

  1. Mac OS X for Astronomy

    NASA Astrophysics Data System (ADS)

    Pierfederici, F.; Pirzkal, N.; Hook, R. N.

    Mac OS X is the new Unix based version of the Macintosh operating system. It combines a high performance DisplayPDF user interface with a standard BSD UNIX subsystem and provides users with simultaneous access to a broad range of applications which were not previously available on a single system such as Microsoft Office and Adobe Photoshop, as well as legacy X11-based scientific tools and packages like IRAF, SuperMongo, MIDAS, etc. The combination of a modern GUI layered on top of a familiar UNIX environment paves the way for new, more flexible and powerful astronomical tools to be developed while assuring compatibility with already existing, older programs. In this paper, we outline the strengths of the Mac OS X platform in a scientific environment, astronomy in particular, and point to the numerous astronomical software packages available for this platform; most notably the Scisoft collection which we have compiled.

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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.

  7. [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.

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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.

  13. 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

  14. 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

  15. 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

  16. [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

  17. 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

  18. 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

  19. 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

  20. 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

  1. [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.

  2. 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.

  3. 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.

  4. 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

  5. George MacDonald's Estimate of Childhood

    ERIC Educational Resources Information Center

    Pridmore, John

    2007-01-01

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

  6. MacIntyre, Rival Traditions and Education

    ERIC Educational Resources Information Center

    Stolz, Steven A.

    2016-01-01

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

  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. 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.)

  9. 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.

  10. 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

  11. 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.

  12. 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

  13. 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.

  14. 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

  15. Fast arithmetic in MacLISP

    NASA Technical Reports Server (NTRS)

    Steele, G. L., Jr.

    1977-01-01

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

  16. 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

  17. The psychometric assessment of alcoholism in forensic groups: the MacAndrew scale and response bias.

    PubMed

    Wasyliw, O E; Haywood, T W; Grossman, L S; Cavanaugh, J L

    1993-04-01

    Although the MacAndrew Alcoholism scale is the most widely used Minnesota Multiphasic Personality Inventory (MMPI) measure of vulnerability to alcohol abuse, its accuracy has not been studied in patients intrinsically motivated to exaggerate or minimize psychopathology. We examined the usefulness of the MAC in predicting alcohol abuse in a forensic clinical sample. Results indicate the MAC (a) was not more effective than direct inquiry in this group, (b) scores were correlated negatively with minimization and positively with exaggeration for subjects with histories of alcohol abuse, (c) offered advantages over direct inquiry both in screening for alcohol history (sensitivity) and in confirming it (specificity), and (d) scores were only moderately more accurate in valid than in minimized or exaggerated MMPI protocols. The results suggest that clinicians should use the MAC cautiously, particularly when they suspect motivation to minimize psychopathology.

  18. 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

  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. A Conversation with Patricia MacLachlan.

    ERIC Educational Resources Information Center

    Austin, Patricia

    1996-01-01

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

  1. User's manual for MacPASCO

    NASA Technical Reports Server (NTRS)

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

    1992-01-01

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

  2. MACS as a tool for international inspections

    SciTech Connect

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

    1995-08-01

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

  3. 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

  4. Genetic relatedness of Mycobacterium avium-intracellulare complex isolates from patients with pulmonary MAC disease and their residential soils.

    PubMed

    Fujita, K; Ito, Y; Hirai, T; Maekawa, K; Imai, S; Tatsumi, S; Niimi, A; Iinuma, Y; Ichiyama, S; Mishima, M

    2013-06-01

    Mycobacterium avium-intracellulare complex (MAC) strains were recovered from 48.9% of residential soil samples (agricultural farms (n = 7), residential yards (n = 79), and planting pots (n = 49)) of 100 pulmonary MAC patients and 35 non-infected control patients. The frequency of MAC recovery did not differ among soil types or among patients regardless of the presence of pulmonary MAC disease, infecting MAC species or period of soil exposure. Variable numbers of tandem repeats (VNTR) analysis for MAC clinical and soil isolates revealed 78 different patterns in 47 M. avium clinical isolates and 41 soil isolates, and 53 different patterns in 18 M. intracellulare clinical isolates and 37 soil isolates. Six clinical and corresponding soil isolate pairs with an identical VNTR genotype were from case patients with high soil exposure (≥2 h per week, 37.5% (6/16) with high exposure compared with 0.0% (0/19) with low or no exposure, p <0.01), suggesting that residential soils are a likely source of pulmonary MAC infection.

  5. 42 CFR 405.1130 - Effect of the MAC's decision.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Effect of the MAC's decision. 405.1130 Section 405....1130 Effect of the MAC's decision. The MAC's decision is final and binding on all parties unless a Federal district court issues a decision modifying the MAC's decision or the decision is revised as...

  6. 42 CFR 423.2126 - Case remanded by the MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Case remanded by the MAC. 423.2126 Section 423.2126... (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2126 Case remanded by the MAC. (a) When the MAC may remand a case to the...

  7. 12 CFR 615.5174 - Farmer Mac securities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Farmer Mac securities. 615.5174 Section 615....5174 Farmer Mac securities. (a) General authority. You may purchase and hold mortgage securities that... Corporation (Farmer Mac securities). You may purchase and hold Farmer Mac securities for the purposes...

  8. 42 CFR 423.2130 - Effect of the MAC's decision.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Effect of the MAC's decision. 423.2130 Section 423... (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2130 Effect of the MAC's decision. The MAC's decision is final and...

  9. 42 CFR 405.1120 - Filing briefs with the MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Filing briefs with the MAC. 405.1120 Section 405....1120 Filing briefs with the MAC. Upon request, the MAC will give the party requesting review, as well... ending with the date the brief is received by the MAC will not be counted toward the...

  10. 42 CFR 423.2120 - Filing briefs with the MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Filing briefs with the MAC. 423.2120 Section 423... (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2120 Filing briefs with the MAC. Upon request, the MAC will give...

  11. 42 CFR 423.2118 - Obtaining evidence from the MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Obtaining evidence from the MAC. 423.2118 Section..., MAC review, and Judicial Review § 423.2118 Obtaining evidence from the MAC. An enrollee may request... the costs of providing these items. If an enrollee requests evidence from the MAC and an...

  12. 42 CFR 423.1974 - Medicare Appeals Council (MAC) review.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Medicare Appeals Council (MAC) review. 423.1974..., MAC review, and Judicial Review § 423.1974 Medicare Appeals Council (MAC) review. An enrollee who is dissatisfied with an ALJ hearing decision may request that the MAC review the ALJ's decision or dismissal...

  13. 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.

  14. 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

  15. AeroMACS System Characterization and Demonstrations

    NASA Technical Reports Server (NTRS)

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

    2013-01-01

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

  16. AeroMACS System Characterization and Demonstrations

    NASA Technical Reports Server (NTRS)

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

    2013-01-01

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

  17. AeroMACS system characterization and demonstrations

    NASA Astrophysics Data System (ADS)

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

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

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

    PubMed Central

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

    2010-01-01

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

  19. 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.

  20. 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.

  1. 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

  2. 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

  3. 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

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

    PubMed

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

    2010-10-01

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

  5. 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.

  6. 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.

  7. 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

  8. HFGMC Enhancement of MAC/GMC

    NASA Technical Reports Server (NTRS)

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

    2006-01-01

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

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

    PubMed Central

    Jirapinyo, Pichamol; Abu Dayyeh, Barham K.

    2016-01-01

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

  10. UNITED STATES DENTAL PROFESSIONALS’ PERCEPTIONS OF DENTAL ANXIETY AND NEED FOR SEDATION IN PATIENTS WITH MENTAL ILLNESS

    PubMed Central

    Heaton, Lisa J.; Hyatt, Halee A.; Huggins, Kimberly Hanson; Milgrom, Peter

    2012-01-01

    Dental fear is a barrier to receiving dental care, particularly for those patients who also suffer from mental illnesses. The current study examined United States dental professionals’ perceptions of dental fear experienced by patients with mental illness, and frequency of sedation of patients with and without mental illness. Dentists and dental staff members (n = 187) completed a survey about their experiences in treating patients with mental illness. More participants agreed (79.8%) than disagreed (20.2%) that patients with mental illness have more anxiety regarding dental treatment (p < .001) than dental patients without mental illness. Further, significantly more participants reported mentally ill patients’ anxiety is “possibly” or “definitely” a barrier to both receiving (96.8%; p < .001) and providing (76.9%; p < .01) dental treatment. Despite reporting more fear in these patients, there were no significant differences in frequency of sedation procedures between those with and without mental illness, regardless of type of sedation (p’s > .05). This lack of difference in sedation for mentally ill patients suggests hesitancy on the part of dental providers to sedate patients with mental illness and highlights a lack of clinical guidelines for this population in the US. Suggestions are given for the assessment and clinical management of patients with mental illness. PMID:24876662

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

    PubMed Central

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

    2015-01-01

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

  12. 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

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

    PubMed Central

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

    2015-01-01

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

  14. 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

  15. 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.

  16. 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

  17. Pharmacological rationale for the treatment of chronic urticaria with second-generation non-sedating antihistamines at higher-than-standard doses.

    PubMed

    Zuberbier, T

    2012-01-01

    Chronic urticaria (CU) is a long-lasting and distressing condition that impairs patient quality of life (QoL) by disrupting sleep and diminishing work/school productivity. Thus treatment should not only be safe and effective but also not add to this impairment or increase risks to health or safety. Non-sedating second-generation antihistamines, with their long duration of action, pharmacodynamic properties that allow once-daily dosing and lack of drug-drug interactions and sedative effects, are the first-line symptomatic treatment option, but some patients have no adequate response to standard doses of these medications. Other therapeutic approaches to refractory urticaria have been suggested but have been limited by sparse clinical data and/or significant adverse effect profiles. Although discouraged by treatment guidelines, sedating antihistamines are frequently prescribed for nighttime use when urticaria symptoms are severe as add-on therapy to a non-sedating antihistamine. However, their pronounced effects on rapid eye movement sleep and hangover negatively impact QoL, learning and performance, and limit their use for patients in occupations that require alertness. For patients who do not respond adequately to standard doses of non-sedating second-generation antihistamines, increasing the dose of non-sedating antihistamines thus may represent the safest therapeutic approach. Given the fact that only few controlled studies have assessed the efficacy and safety of high-dose non-sedating antihistamines in CU, patient safety should be a key consideration when choosing a specific antihistamine.

  18. 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

  19. 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

  20. 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%.

  1. An Interview with Peter MacDonald.

    ERIC Educational Resources Information Center

    American Indian Journal, 1979

    1979-01-01

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

  2. Lifetime tests for MAC vertex chamber

    SciTech Connect

    Nelson, H.N.

    1986-07-01

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

  3. Managed Access by Controlled Sensing (MACS)

    SciTech Connect

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

    1994-08-01

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

  4. 42 CFR 405.1126 - Case remanded by the MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Case remanded by the MAC. 405.1126 Section 405.1126....1126 Case remanded by the MAC. (a) When the MAC may remand a case. Except as specified in § 405.1122(c), the MAC may remand a case in which additional evidence is needed or additional action by the ALJ...

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

    PubMed

    Mackey, Edward F

    2010-01-01

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

  6. Use of cefoperazone MacConkey agar for selective isolation of Laribacter hongkongensis.

    PubMed

    Lau, Susanna K P; Woo, Patrick C Y; Hui, Wai-ting; Li, Maria W S; Teng, Jade L L; Que, Tak-Lun; Luk, Wei-Kwang; Lai, Raymond W M; Yung, Raymond W H; Yuen, Kwok-yung

    2003-10-01

    A new selective medium, cefoperazone MacConkey agar (CMA), was developed for primary isolation of Laribacter hongkongensis from stool. Its performance in quantitative recovery and in a clinical evaluation of 4,741 human diarrheal stool specimens was superior to that of charcoal cefoperazone deoxycholate agar. In addition, with CMA, Arcobacter butzleri was unexpectedly isolated from the stools of six patients.

  7. 42 CFR 422.608 - Medicare Appeals Council (MAC) review.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Medicare Appeals Council (MAC) review. 422.608... and Appeals § 422.608 Medicare Appeals Council (MAC) review. Any party to the hearing, including the MA organization, who is dissatisfied with the ALJ hearing decision, may request that the MAC...

  8. 42 CFR 423.2128 - Action of the MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Action of the MAC. 423.2128 Section 423.2128 Public...) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2128 Action of the MAC. (a) After it has reviewed all the evidence in...

  9. 42 CFR 405.1118 - Obtaining evidence from the MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Obtaining evidence from the MAC. 405.1118 Section... Council Review § 405.1118 Obtaining evidence from the MAC. A party may request and receive a copy of all... these items. If a party requests evidence from the MAC and an opportunity to comment on that...

  10. 42 CFR 405.1128 - Action of the MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Action of the MAC. 405.1128 Section 405.1128 Public... the MAC. (a) After it has reviewed all the evidence in the administrative record and any additional evidence received, subject to the limitations on MAC consideration of additional evidence in §...

  11. Adolescent Responses to the MacAndrew Alcoholism Scale.

    ERIC Educational Resources Information Center

    Wolfson, Karen P.; Erbaugh, Susan E.

    1984-01-01

    Examined the ability of the MacAndrew Alcoholism Scale (MAC) to indicate drug abuse in high school students (N=135), adolescent psychiatric patients (N=171), and residents of a drug abuse treatment center (N=100). Results suggested the MAC can help discriminate between groups of adolescents with and without significant drug abuse. (JAC)

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

    PubMed

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

    2014-03-01

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

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

    PubMed

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

    2014-03-01

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

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

    PubMed

    Saraghi, Mana

    2015-01-01

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

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

    PubMed

    Saraghi, Mana

    2015-01-01

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

  16. 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

  17. 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

  18. 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

  19. Multiplication of different Legionella species in Mono Mac 6 cells and in Acanthamoeba castellanii.

    PubMed Central

    Neumeister, B; Schöniger, S; Faigle, M; Eichner, M; Dietz, K

    1997-01-01

    serogroup 2, and a fresh clinical isolate of L. pneumophila serogroup 6. Members of the seventh cluster are a strain of agar-adapted L. pneumophila serogroup 1 Bellingham and a strain of L. pneumophila serogroup 1 Bellingham which was passaged fewer than three times on BCYE alpha agar after inoculation and intraperitoneal growth in guinea pigs. In comparison to members of the sixth cluster, both strains showed a slightly enhanced multiplication in Mono Mac 6 cells but a reduced multiplication in amoebae. From our investigations, we could demonstrate a correlation between prevalence of a given Legionella species and their intracellular multiplication in Mono Mac 6 cells. Multiplication of members of the genus Legionella in A. castellanii seems to be dependent on mechanisms different from those in monocytes. PMID:9097418

  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. The role of sedation in endobronchial ultrasound-guided transbronchial needle aspiration: Systematic review

    PubMed Central

    Aswanetmanee, Pantaree; Limsuwat, Chok; Kabach, Mohamad; Alraiyes, Abdul Hamid; Kheir, Fayez

    2016-01-01

    Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure that has become an important tool in diagnosis and staging of mediastinal lymph node (LN) lesions in lung cancer. Adequate sedation is an important part of the procedure since it provides patient's comfort and potentially increases diagnostic yield. We aimed to compare deep sedation (DS) versus moderate sedation (MS) in patients undergoing EBUS-TBNA procedure. Methods: PubMed, EMBASE, MEDLINE, and Cochrane Library were searched for English studies of clinical trials comparing the two different methods of sedations in EBUS-TBNA until December 2015. The overall diagnostic yield, LN size sampling, procedural time, complication, and safety were evaluated. Results: Six studies with 3000 patients which compared two different modalities of sedation in patients performing EBUS-TBNA were included in the study. The overall diagnostic yield of DS method was 52.3%–100% and MS method was 46.1%–85.7%. The overall sensitivity of EBUS-TBNA of DS method was 98.15%–100% as compared with 80%–98.08% in MS method. The overall procedural times were 27.2–50.9 min and 20.6-44.1 min in DS and MS groups, respectively. The numbers of LN sampled were between 1.33–3.20 nodes and 1.36–2.80 nodes in DS and MS groups, respectively. The numbers of passes per LN were 3.21–3.70 passes in DS group as compared to 2.73–3.00 passes in MS group. The mean of LN size was indifferent between two groups. None of the studies included reported serious adverse events. Conclusions: Using MS in EBUS-TBNA has comparable diagnostic yield and safety profile to DS. The decision on the method of sedation for EBUS-TBNA should be individually selected based on operator experience, patient preference, as well as duration of the anticipated procedure. PMID:27803902

  2. Modeling MAC layer for powerline communications networks

    NASA Astrophysics Data System (ADS)

    Hrasnica, Halid; Haidine, Abdelfatteh

    2001-02-01

    The usage of electrical power distribution networks for voice and data transmission, called Powerline Communications, becomes nowadays more and more attractive, particularly in the telecommunication access area. The most important reasons for that are the deregulation of the telecommunication market and a fact that the access networks are still property of former monopolistic companies. In this work, first we analyze a PLC network and system structure as well as a disturbance scenario in powerline networks. After that, we define a logical structure of the powerline MAC layer and propose the reservation MAC protocols for the usage in the PLC network which provides collision free data transmission. This makes possible better network utilization and realization of QoS guarantees which can make PLC networks competitive to other access technologies.

  3. Non-MacAdam color discrimination ellipses

    NASA Astrophysics Data System (ADS)

    Goldstein, Peter

    2012-10-01

    MacAdam ellipses and the 1976 u'v' chromaticity space are commonly used in the illumination and LED industries. Delta E 2000 (ΔE) is the most up-to-date color difference metric endorsed by CIE and is more reliable than earlier metrics. This paper shows how the ΔE 2000 standard can be used to derive ellipses to be plotted in the well-known 1931 xy color space and examines the validity of MacAdam ellipses and the 1976 u'v' chromaticity space in terms of this metric. The 1976 u'v' chromaticity space is found, in quantitative terms, to be less uniform than the 1931 xy chromaticity space based on ΔE 2000. This paper recommends ΔE calculations as a quantitative tool, the proposed ellipses as a descriptive tool, and the total abandonment of the 1976 u'v' color space.

  4. Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists.

    PubMed

    Luetz, Alawi; Balzer, Felix; Radtke, Finn M; Jones, Christina; Citerio, Giuseppe; Walder, Bernhard; Weiss, Bjoern; Wernecke, Klaus-Dieter; Spies, Claudia

    2014-01-01

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

  5. 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.

  6. Visualization of integrin Mac-1 in vivo.

    PubMed

    Lim, Kihong; Hyun, Young-Min; Lambert-Emo, Kris; Topham, David J; Kim, Minsoo

    2015-11-01

    β2 integrins play critical roles in migration of immune cells and in the interaction with other cells, pathogens, and the extracellular matrix. Among the β2 integrins, Mac-1 (Macrophage antigen-1), composed of CD11b and CD18, is mainly expressed in innate immune cells and plays a major role in cell migration and trafficking. In order to image Mac-1-expressing cells both in live cells and mouse, we generated a knock-in (KI) mouse strain expressing CD11b conjugated with monomeric yellow fluorescent protein (mYFP). Expression of CD11b-mYFP protein was confirmed by Western blot and silver staining of CD11b-immunoprecipitates and total cell lysates from the mouse splenocytes. Mac-1-mediated functions of the KI neutrophils were comparable with those in WT cells. The fluorescence intensity of CD11b-mYFP was sufficient to image CD11b expressing cells in live mice using intravital two-photon microscopy. In vitro, dynamic changes in the intracellular localization of CD11b molecules could be measured by epifluorescent microscopy. Finally, CD11b-expressing immune cells from tissue were easily detected by flow cytometry without anti-CD11b antibody staining.

  7. Sevoflurane versus propofol sedation during periocular anesthetic injections in oculoplastic procedures: An open-label randomized comparison

    PubMed Central

    Tawfik, Hatem A.; Mostafa, Mohsen

    2014-01-01

    Purpose The purpose of the current investigation was to make an objective controlled comparison of pain tolerance, patient satisfaction and potential complications during the injection of local anesthesia in oculoplastic procedures under short-term sedation using inhalational versus parenteral sedatives. Methods This was an open-label, randomized clinical trial where patients were randomized to 3 groups. Group I: Sedation with intravenous propofol. Group II: Sedation with inhaled sevoflurane. Group 3: Control group receiving no sedation. Results A total of 396 patients were randomly assigned, and 375 were included in the final analysis. Study groups were similar in age, gender, and distribution of operative procedures performed. There was no statistically significant difference in the adjusted primary composite outcome measure between propofol and sevoflurane (pain scores and patient satisfaction). Significantly more patients in group I required restraining during periocular injections than group II or III (p < 0.001). Significantly more patients sneezed in group I than group II (p < 0.001) and none in the control group. Three patients in group II suffered severe excitation–disinhibition during emergence from sedation which was rapidly reversible, and 3 more suffered a severe bout of postoperative nausea and vomiting (PONV). Conclusion Sevoflurane and propofol during periocular anesthetic injections produce an equally favorable experience. Sevoflurane is introduced painlessly, and offers better patient control with less induction of the sneezing reflex which may provide a higher safety profile, however short-term aggression/disinhibition and PONV may be an issue in some patients. PMID:25892931

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

    SciTech Connect

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

    1991-11-01

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

  11. Buprenorphine/naloxone inhibition of remifentanil procedural sedation.

    PubMed

    Gilmore, Thomas; Saccheti, Al; Cortese, Teena

    2012-10-01

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

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

    PubMed Central

    Busettini, C.; Frölich, M. A.

    2014-01-01

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

  13. The influence of hydralazine on the vasculature, blood perfusion and chemosensitivity of MAC tumours.

    PubMed

    Quinn, P K; Bibby, M C; Cox, J A; Crawford, S M

    1992-08-01

    We have studied the influence of the peripheral vasodilator hydralazine (HDZ) on the vasculature and blood perfusion of two members of a series of subcutaneous murine adenocarcinomata of the colon (MAC tumours), and the influence of HDZ on the efficacy and/or toxicity of TCNU and melphalan. The fluorescent DNA stain Hoechst 33342, showed that HDZ caused a shutdown of tumour vasculature, related in magnitude to both dose and tumour differentiation state; 10 mg kg-1 caused an 80% vascular shutdown of well differentiated MAC 26 tumours, but only a 50% shutdown of the poorly differentiated MAC 15A tumours. 2.5 mg kg-1 was ineffective. The blood perfusion marker 99mTc-HMPAO showed that the normal perfusion of MAC tumours was consistently markedly less than that of lung, liver or kidneys (4-5% of lung perfusion). HDZ (10 mg kg-1) decreased MAC 26 perfusion by 63%, and that of MAC 15A by 20%. Again, 2.5 mg kg-1) was ineffective. Use of in vivo to in vitro clonogenic assays showed that HDZ (10 mg kg-1) potentiated the efficacy of melphalan (1-10 mg kg-1 i.p.) by a factor of 2.1, and increased the efficacy of TCNU (1-10 mg kg-1 i.v., factor = 1.7) when given 10 or 15 min respectively after dosing. However, the addition of HDZ increased the acute bone marrow toxicity of melphalan, but not that of TCNU. The clinical relevance of these results is discussed.

  14. Comparing Two Different Doses of Intravenous Midazolam in Pediatric Sedation and Analgesia

    PubMed Central

    Barzegari, Hassan; Masoumi, Kambiz; Motamed, Hassan; Zohrevandi, Behzad; Zeynadini Meymand, Shima

    2016-01-01

    Introduction: Midazolam has turned into a common drug for pediatric procedural sedation and analgesia. However, there is not much data regarding its proper dose and potential side effects in the Iranian children population. Therefore, the present study was done to compare 2 doses of IV midazolam in this regard. Methods: The present clinical trial was performed to compare 0.1 and 0.3 mg/kg doses of IV midazolam in induction of sedation for head trauma infant patients in need of brain computed tomography (CT) scan. Conscious infants under 2 years old, with stable hemodynamics were included. Onset and duration of action as well as probable side effects were compared between the two groups using SPSS version 22. Results: 110 infants with the mean age of 14.0 ± 5.9 months (range: 4 - 24) and mean weight of 9.7 ± 2 kg (range: 5 - 15) were randomly allocated to one of the 2 study groups (54.6% female). Success rate in 0.1 and 0.3 mg/kg groups were 38.2% (21 patients) and 60% (33 patients), respectively (p = 0.018). Overall, 56 (50.9%) patients did not reach proper sedation and were sedated receiving ketamine (22 patients) or another dose of midazolam (34 patients, mean additional dose needed was 2.1 ± 1.1 mg). Conclusion: The results of the present study demonstrated the higher success rate and longer duration of action for 0.3 mg/kg midazolam compared to 0.1 mg/kg. The groups were equal regarding onset of action, effect on vital signs and probable side effects. PMID:27800539

  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. 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

  17. 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.

  18. 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.

  19. 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

  20. 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

  1. W-MAC: a workload-aware MAC protocol for heterogeneous convergecast in wireless sensor networks.

    PubMed

    Xia, Ming; Dong, Yabo; Lu, Dongming

    2011-01-01

    The power consumption and latency of existing MAC protocols for wireless sensor networks (WSNs) are high in heterogeneous convergecast, where each sensor node generates different amounts of data in one convergecast operation. To solve this problem, we present W-MAC, a workload-aware MAC protocol for heterogeneous convergecast in WSNs. A subtree-based iterative cascading scheduling mechanism and a workload-aware time slice allocation mechanism are proposed to minimize the power consumption of nodes, while offering a low data latency. In addition, an efficient schedule adjustment mechanism is provided for adapting to data traffic variation and network topology change. Analytical and simulation results show that the proposed protocol provides a significant energy saving and latency reduction in heterogeneous convergecast, and can effectively support data aggregation to further improve the performance.

  2. 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.

  3. [Functioning of the anaesthetic conserving device: aspects to consider for use in inhalational sedation].

    PubMed

    Meiser, A; Bellgardt, M; Vogelsang, H; Sirtl, C; Weber, T

    2010-11-01

    expiration port of the ventilator should be scavenged. Inhalational compared to intravenous ICU sedation offers the advantages of better control of the sedation level, online drug monitoring, no accumulation in patients with renal or hepatic insufficiency and bronchodilation. With a lowered opioid dose spontaneous breathing and intestinal motility are well preserved. A clinical algorithm for the care of patients with respiratory insufficiency including inhalational sedation is proposed. Inhalational sedation with isoflurane has been widely used for more than 20 years in many countries and even for periods of up to several weeks. In the German S3 guidelines for the management of analgesia, sedation and delirium in intensive care (Martin et al. 2010), inhalational sedation is mentioned as an alternative sedation method for patients ventilated via an endotracheal tube or a tracheal cannula. Nevertheless, isoflurane is not officially licensed for ICU sedation and its use is under the responsibility of the prescribing physician.

  4. 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

  5. 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

  6. Wireless Sensor Networks Energy-Efficient MAC Protocol

    NASA Astrophysics Data System (ADS)

    Lijuan, Du; Yuanpeng, Wang; WeiPeng, Jing

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

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

    ERIC Educational Resources Information Center

    Traxler, Gene

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

  8. Best evidence topic reports. BET 2: Are patients who have used chewing gum at an increased risk of aspiration during sedation?

    PubMed

    Jaconelli, Tom; Townend, Will

    2014-05-01

    A short-cut review was carried out to establish whether patients who have chewed gum are at increased risk of aspiration during sedation. Twenty-nine papers were found, of which six presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. The clinical bottom line is that patients who have chewed gum in the past 6 h may theoretically be at increased risk of aspiration. This should be considered when making a balanced decision about the use of procedural sedation.

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

    PubMed Central

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

    2016-01-01

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

  10. APC-MAC/TA: Adaptive Power Controlled MAC Protocol with Traffic Awareness for Wireless Sensor Networks

    NASA Astrophysics Data System (ADS)

    Woo, Seok; Kim, Kiseon

    In this paper, we propose an adaptive power controlled MAC protocol with a traffic-aware scheme specifically designed to reduce both energy and latency in wireless sensor networks. Typically, existing MAC protocols for sensor networks sacrifice latency performance for node energy efficiency. However, some sensor applications for emergencies require rather fast transmissions of sensed data, where we need to consider both energy and latency together. The proposed MAC protocol includes two novel ideas: one is a transmission power control scheme for improving latency in high traffic loads, and the other is a traffic-aware scheme to save more energy in low traffic loads. The transmission power control scheme increases channel utilization by mitigating interference between nodes, and the traffic-aware scheme allows nodes to sleep to reduce idle energy consumption when there are no traffic loads in a network. Simulation results show that the proposed protocol significantly reduces the latency as well as the energy consumption compared to the S-MAC protocol specifically for a large transmission power of nodes and low network traffic.

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

    PubMed Central

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

    2015-01-01

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

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

    USGS Publications Warehouse

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

    2009-01-01

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

  13. 42 CFR 405.1122 - What evidence may be submitted to the MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false What evidence may be submitted to the MAC. 405.1122... Council Review § 405.1122 What evidence may be submitted to the MAC. (a) Appeal before the MAC on request for review of ALJ's decision. (1) If the MAC is reviewing an ALJ's decision, the MAC limits its...

  14. 42 CFR 423.2122 - What evidence may be submitted to the MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false What evidence may be submitted to the MAC. 423.2122..., MAC review, and Judicial Review § 423.2122 What evidence may be submitted to the MAC. (a) Appeal before the MAC on request for review of ALJ's decision. (1) If the MAC is reviewing an ALJ's...

  15. 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

  16. 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

  17. 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.

  18. MacCready awarded Outstanding Student Paper

    NASA Astrophysics Data System (ADS)

    Parker MacCready was selected by the Ocean Sciences Section to receive their Outstanding Student Paper Award from the 1989 Fall Meeting in San Francisco for his paper entitled “Stratified Spin-up Over a Slope.” Following receipt of his Bachelor's degree in architecture from Yale in 1982, MacCready went to China for 5 months to study the language. On his return to Pasadena he worked for 3 years for Aerovironment, Inc., concentrating on building and flying a human-powered aircraft and a giant wing-flapping replica of a pterosaur. Having become interested in the aerodynamics of flappingwing propulsion, he continued his studies at Caltech, where he received his Master's degree in 1986. His informal thesis project was a human-powered hydrofoil boat with flapping-wing propulsion. He is currently working on his doctorate in physical oceanography at the University of Washington, where he is studying the dynamics of stratified, rotating boundary layers over topography. His switch to oceanography was motivated by his feeling that environmental fluid mechanics would become an increasingly relevant subject in light of increasing world pollution. In the future he hopes to go into environmental politics, perhaps in a scientific advisory role.

  19. Per-packet reservation MAC protocols

    NASA Astrophysics Data System (ADS)

    Hrasnica, Halid

    2006-10-01

    Recent and future communications networks have to provide QoS guarantees for a rapidly growing number of various telecommunications services. Therefore, various communications systems, such as wireless and fixed access networks, apply reservation MAC protocols, providing a good network utilization, which is particularly important access networks with typically limited data rates, and ensuring realization of different QoS guarantees for various telecommunications services. This is important because of a hard competition among communications technologies applied in the access area. The considered MAC protocols apply a per-packet reservation method to avoid the transmission gaps caused by per-burst reservation, and accordingly to achieve a better network utilization. However, the per-packet reservation increases the network load caused by the signaling, which calls for an efficient resource sharing strategy in the signaling channel. There are two basic solutions for capacity sharing in the signaling channel: random access, usually using slotted ALOHA, and dedicated access, realized by a polling method. Performance improvement of basic protocols can be carried out in different ways; by protocol extensions, a combination of different protocol solutions, and the application of adaptive protocols providing a change of access parameters according to the current network status. The best network performance is achieved by application of two-step reservation protocol, which combined with additional features, such as appropriate signaling procedure, priority and fairness mechanisms, and combined reservation domains, can fulfill requirements of services with high QoS demands.

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

    PubMed Central

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

    2011-01-01

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

  1. [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.

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

    PubMed

    Radha Krishna, Lalit Kumar

    2014-06-01

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

  3. 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

  4. 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

  5. Sedation Agents Differentially Modulate Cortical and Subcortical Blood Oxygenation: Evidence from Ultra-High Field MRI at 17.2 T

    PubMed Central

    Uhrig, Lynn; Ciobanu, Luisa; Djemai, Boucif; Le Bihan, Denis; Jarraya, Béchir

    2014-01-01

    Background Sedation agents affect brain hemodynamic and metabolism leading to specific modifications of the cerebral blood oxygenation level. We previously demonstrated that ultra-high field (UHF) MRI detects changes in cortical blood oxygenation following the administration of sedation drugs commonly used in animal research. Here we applied the UHF-MRI method to study clinically relevant sedation drugs for their effects on cortical and subcortical (thalamus, striatum) oxygenation levels. Methods We acquired T2*-weighted images of Sprague-Dawley rat brains at 17.2T in vivo. During each MRI session, rats were first anesthetized with isoflurane, then with a second sedative agent (sevoflurane, propofol, midazolam, medetomidine or ketamine-xylazine) after stopping isoflurane. We computed a T2*-oxygenation-ratio that aimed at estimating cerebral blood oxygenation level for each sedative agent in each region of interest: cortex, hippocampus, thalamus and striatum. Results The T2*-oxygenation-ratio was consistent across scan sessions. This ratio was higher with inhalational agents than with intravenous agents. Under sevoflurane and medetomidine, T2*-oxygenation-ratio was homogenous across the brain regions. Intravenous agents (except medetomidine) induced a T2*-oxygenation-ratio imbalance between cortex and subcortical regions: T2*-oxygenation-ratio was higher in the cortex than the subcortical areas under ketamine-xylazine; T2*-oxygenation-ratio was higher in subcortical regions than in the cortex under propofol or midazolam. Conclusion Preclinical UHF MRI is a powerful method to monitor the changes in cerebral blood oxygenation level induced by sedative agents across brain structures. This approach also allows for a classification of sedative agents based on their differential effects on cerebral blood oxygenation level. PMID:25050866

  6. SuperMacLang: Development of an Authoring System.

    ERIC Educational Resources Information Center

    Frommer, Judith; Foelsche, Otmar K. E.

    1999-01-01

    Describes the development of "SuperMacLang, the 1990s version of the MacLang authoring system. An analysis of various features of the program explains the ways in which certain aspects of collaboration and funding affected developer and programming decisions. (Author/VWL)

  7. Steven MacCall: Winner of LJ's 2010 Teaching Award

    ERIC Educational Resources Information Center

    Berry, John N., III

    2010-01-01

    This article profiles Steven L. MacCall, winner of "Library Journal's" 2010 Teaching Award. An associate professor at the School of Library and Information Studies (SLIS) at the University of Alabama, Tuscaloosa, MacCall was nominated by Kathie Popadin, known as "Kpop" to the members of her cohort in the online MLIS program at SLIS. Sixteen of…

  8. Intel-Based Mac Computers Improve Teaching and Learning

    ERIC Educational Resources Information Center

    Technology & Learning, 2007

    2007-01-01

    Today, Mac computers offer schools an easy and powerful way to engage students in learning, foster 21st century skills and leverage existing software assets. Innovative software and hardware built into the Mac allows students to demonstrate their individual strengths--empowering them to be creators of content, rather than just consumers. Judging…

  9. [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.

  10. GENETIC FINGERPRINTING OF MYCOBACTERIUM AVIUM COMPLEX (MAC) ORGANISMS ISOLATED FROM HOSPITAL PATIENTS AND THE ENVIRONMENT

    EPA Science Inventory

    A particularly pathogenic group of mycobacteria belong to the Mycobacterium avium complex (MAC), which includes M. avium and M. intracellulare. MAC organisms cause disease in children, the elderly, and immuno-compromised individuals. A critical step in preventing MAC infections...

  11. Middle Atmosphere Cooperation/Summer in Northern Europe (MAC/SINE) and MAC/Epsilon

    NASA Technical Reports Server (NTRS)

    Thrane, E. V.

    1989-01-01

    Two major international campaigns dedicated to the study of middle atmosphere dynamics in high latitudes were successfully completed in 1987. MAC/SINE (Middle Atmosphere Cooperation/Summer in Northern Europe) was carried out during the period 7 June to 19 July, whereas MAC/Epsilon took place in the period 12 October to 15 November. In both campaigns a large number of ground based and rocket techniques were used in a concerted effort to map the dynamical structure of the middle atmosphere over Northern Europe. Although the analysis of the observations has only just started, it is clear that a large and unique data set was obtained, which is believed will provide new insight into the dynamical processes in this interesting region of the atmosphere. A brief overview of the campaigns, their scientific aims, organization and structure is presented.

  12. Paired lunar meteorites MAC88104 and MAC88105 - A new 'FAN' of lunar petrology. [ferroan anorthosite

    NASA Technical Reports Server (NTRS)

    Neal, Clive R.; Taylor, Lawrence A.; Lui, Yun-Gang; Schmitt, Roman A.

    1991-01-01

    To determine the chemical characteristics of the MAC88104/5 meteorite six thin sections and three bulk samples were analyzed by electron microprobe and instrumental neutron activation. It is concluded that this meteorite is dominated by lithologies of the ferroan anorthosite suite and contains abundant granulitized highland clasts, devitrified glass beads of impact origin, and two small clasts of basaltic origin. It is suggested that one of these basaltic clasts, clast E, is mesostasis material, and clast G is similar to the very low-Ti or low-Ti/high-alumina mare basalts. Impact melt clasts MAC88105, 69, and 72 have major and trace element compositions similar to the bulk meteorite.

  13. A ferroan region of the lunar highlands as recorded in meteorites MAC88104 and MAC88105

    SciTech Connect

    Jolliff, B.L.; Korotev, R.L.; Haskin, L.A. )

    1991-11-01

    MacAlpine Hills 88104 and 88105 (MAC88104/5) are paired meteorites of noritic anorthosite composition from the lunar highlands. MAC88105 is a breccia composed mainly of melt-breccia clasts in a fine-grained, fragmental, and partly glassy matrix. The most abundant melt lithologies are feldspathic and are similar in composition to the bulk meteorite. Other melt lithologies include feldspathic melt rocks, mafic melt breccias, and a rare melt breccia relatively enriched in incompatible trace elements. Subordinate lithic clasts are granulitic breccias and ferroan (relatively low Mg/(Mg + Fe)) igneous lithologies, including troctolitic anorthosite, anorthositic norite, gabbronorite, and anorthosite. Igneous clasts having mafic mineral compositions more magnesian than Fo{sub 55} and En{sub 60} were not observed. Rare fragments of glass spheres and shards as well as glass clasts indicate that the meteorite was derived from an immature regolith. The bulk composition of MAC88105 is characterized by a molar Mg/(Mg + Fe) ratio of 0.62, at the extreme low end of the range for meteorites from the lunar highlands. Its low concentrations of incompatible trace elements and feldspathic bulk composition (29% Al{sub 2}O{sub 3}), suggests that it, like the other lunar meteorites, formed at a site far removed from the areas sampled by the Apollo missions. Similarities in mineral compositions among the different lithologies of the breccia and the distribution of mineral fragments suggest that most components of the meteorite were derived from a crustal section dominated by material with a noritic anorthosite composition and an affinity of the ferroan suite of plutonic rocks.

  14. The effect of nitrous oxide on the minimum alveolar concentration (MAC) and MAC derivatives of isoflurane in dogs.

    PubMed

    Voulgaris, Debra A; Egger, Christine M; Seddighi, M Reza; Rohrbach, Barton W; Love, Lydia C; Doherty, Thomas J

    2013-04-01

    This study investigated the effects of 70% nitrous oxide (N2O) on the minimum alveolar concentration (MAC) of isoflurane (ISO) that prevents purposeful movement, the MAC of ISO at which there is no motor movement (MACNM), and the MAC of ISO at which autonomic responses are blocked (MACBAR) in dogs. Six adult, healthy, mixed-breed, intact male dogs were anesthetized with ISO delivered via mask. Baseline MAC, MACNM, and MACBAR of ISO were determined for each dog using a supra-maximal electrical stimulus (50 V, 50 Hz, 10 ms). Nitrous oxide (70%) was then administered and MAC and its derivatives (N2O-MAC, N2O-MACNM, and N2O-MACBAR) were determined using the same methodology. The values for baseline MAC, MACNM, and MACBAR were 1.39 ± 0.14, 1.59 ± 0.10, and 1.72 ± 0.16, respectively. The addition of 70% N2O decreased MAC, MACNM, and MACBAR by 32%, 15%, and 25%, respectively.

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

    USGS Publications Warehouse

    Song, W.-Z.; Huang, R.; Shirazi, B.; Husent, R.L.

    2009-01-01

    Earlier sensor network MAC protocols focus on energy conservation in low-duty cycle applications, while some recent applications involve real-time high-data-rate signals. This motivates us to design an innovative localized TDMA MAC protocol to achieve high throughput and low congestion in data collection sensor networks, besides energy conservation. TreeMAC divides a time cycle into frames and frame into slots. Parent determines children's frame assigmnent based on their relative bandwidth demand, and each node calculates its own slot assignment based on its hop-count to the sink. This innovative 2-dimensional frame-slot assignment algorithm has the following nice theory properties. Firstly, given any node, at any time slot, there is at most one active sender in its neighborhood (includ ing itself). Secondly, the packet scheduling with TreelMAC is bufferless, which therefore minimizes the probability of network congestion. Thirdly, the data throughput to gateway is at least 1/3 of the optimum assuming reliable links. Our experiments on a 24 node test bed demonstrate that TreeMAC protocol significantly improves network throughput and energy efficiency, by comparing to the TinyOS's default CSMA MAC protocol and a recent TDMA MAC protocol Funneling-MAC[8]. ?? 2009 IEEE.

  16. 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

  17. Bilateral Deep Brain Stimulation of the Subthalamic Nucleus under Sedation with Propofol and Fentanyl.

    PubMed

    Lee, Woong-Woo; Ehm, Gwanhee; Yang, Hui-Jun; Song, In Ho; Lim, Yong Hoon; Kim, Mi-Ryoung; Kim, Young Eun; Hwang, Jae Ha; Park, Hye Ran; Lee, Jae Min; Kim, Jin Wook; Kim, Han-Joon; Kim, Cheolyoung; Kim, Hee Chan; Park, Eunkyoung; Kim, In Young; Kim, Dong Gyu; Jeon, Beomseok; Paek, Sun Ha

    2016-01-01

    Awakening during deep brain stimulation (DBS) surgery may be stressful to patients. The aim of the current study was to evaluate the effect on MER signals and their applicability to subthalmic nucleus (STN) DBS surgery for patients with Parkinson's disease (PD) under sedation with propofol and fentanyl. Sixteen consecutive patients with PD underwent STN-DBS surgery with propofol and fentanyl. Their MER signals were achieved during the surgery. To identify the microelectrodes positions, the preoperative MRI and postoperative CT were used. Clinical profiles were also collected at the baseline and at 6 months after surgery. All the signals were slightly attenuated and contained only bursting patterns, compared with our previous report. All electrodes were mostly located in the middle one third part of the STN on both sides of the brain in the fused images. Six months later, the patients were improved significantly in the medication-off state and they met with less dyskinesia and less off-duration. Our study revealed that the sedation with propofol and fentanyl was applicable to STN-DBS surgery. There were no significant problems in precise positioning of bilateral electrodes. The surgery also improved significantly clinical outcomes in 6-month follow-up. PMID:27018855

  18. Bilateral Deep Brain Stimulation of the Subthalamic Nucleus under Sedation with Propofol and Fentanyl

    PubMed Central

    Lee, Woong-Woo; Ehm, Gwanhee; Yang, Hui-Jun; Song, In Ho; Lim, Yong Hoon; Kim, Mi-Ryoung; Kim, Young Eun; Hwang, Jae Ha; Park, Hye Ran; Lee, Jae Min; Kim, Jin Wook; Kim, Han-Joon; Kim, Cheolyoung; Kim, Hee Chan; Park, Eunkyoung; Kim, In Young; Kim, Dong Gyu

    2016-01-01

    Awakening during deep brain stimulation (DBS) surgery may be stressful to patients. The aim of the current study was to evaluate the effect on MER signals and their applicability to subthalmic nucleus (STN) DBS surgery for patients with Parkinson’s disease (PD) under sedation with propofol and fentanyl. Sixteen consecutive patients with PD underwent STN-DBS surgery with propofol and fentanyl. Their MER signals were achieved during the surgery. To identify the microelectrodes positions, the preoperative MRI and postoperative CT were used. Clinical profiles were also collected at the baseline and at 6 months after surgery. All the signals were slightly attenuated and contained only bursting patterns, compared with our previous report. All electrodes were mostly located in the middle one third part of the STN on both sides of the brain in the fused images. Six months later, the patients were improved significantly in the medication-off state and they met with less dyskinesia and less off-duration. Our study revealed that the sedation with propofol and fentanyl was applicable to STN-DBS surgery. There were no significant problems in precise positioning of bilateral electrodes. The surgery also improved significantly clinical outcomes in 6-month follow-up. PMID:27018855

  19. 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

  20. 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,…

  1. Reproducibility of Circumpapillary Retinal Nerve Fiber Layer Measurements Using Handheld Optical Coherence Tomography in Sedated Children

    PubMed Central

    Avery, Robert A.; Cnaan, Avital; Schuman, Joel S.; Chen, Chieh-Li; Glaug, Natalie C.; Packer, Roger J.; Quinn, Graham E.; Ishikawa, Hiroshi

    2014-01-01

    Purpose To determine the intra- and intervisit reproducibility of circumpapillary retinal nerve fiber layer (RNFL) measures using handheld optical coherence tomography (OCT) in sedated children. Design Prospective cross-sectional and longitudinal study Methods Children undergoing sedation for a clinically indicated MRI for an optic pathway glioma and or Neurofibromatosis type 1 (NF1) had multiple 6 × 6 mm volumes (isotropic 300×300 or non-isotropic 1000×100 samplings) acquired over the optic nerve. Children with two handheld OCT sessions within 6 months were included in the intervisit cohort. The intra- and inter-visit coefficient of variation (CV) and intraclass correlation coefficient (ICC) were calculated for the average and anatomic quadrant circumpapillary RNFL thickness. Results Fifty-nine subjects (mean age 5.1 years, range 0.8–13.0 years) comprised the intravisit cohort and 29 subjects (mean age 5.7 years, range 1.8–12.7 years) contributed to the intervisit cohort. Forty-nine subjects had an optic pathway glioma and 10 subjects had NF1 without an optic pathway glioma. The CV was comparable regardless of imaging with an isotropic and non-isotropic volume in both the intra- and intervisit cohorts. The average circumpapillary RNFL demonstrated the lowest CV and highest ICC compared to the quadrants. For the intervisit cohort, the average ICC was typically higher while the CV was typically lower, but not statistically different compared to the other quadrants. Discussion Circumpapillary RNFL measures acquired with handheld OCT during sedation demonstrate good intra- and intervisit reproducibility. Handheld OCT has the potential to monitor progressive optic neuropathies in young children who have difficulty cooperating with traditional OCT devices. PMID:24983792

  2. Evaluation of transcutaneous and end-tidal carbon dioxide levels during inhalation sedation in volunteers.

    PubMed

    Satoh, Kenichi; Chikuda, Mami; Ohashi, Ayako; Kumagai, Miho; Kuji, Akiyoshi; Joh, Shigeharu

    2016-08-01

    Measurement of end-tidal carbon dioxide (PETCO2) is useful because of its noninvasiveness, continuity, and response time when sudden changes in ventilation occur during inhalation sedation. We compared the accuracy of PETCO2 using a nasal mask and nasal cannula with the accuracy of transcutaneous carbon dioxide (TC-CO2) and determined which method is more useful during inhalation sedation in volunteers. We used a modified nasal mask (MNM) and modified nasal cannula (MNC) for measurement of PETCO2. The capnometer measured PETCO2 in the gas expired from the nasal cavity by means of two devices. The volunteers received supplemental O2 by means of each device at a flow rate of 6 L/min. After the volunteers lay quietly for 5 min with a supply of 100 % O2, they received supplemental N2O by means of each device at concentrations of 10, 20, and 25 % for 5 min and 30 % for 25 min. The correlation coefficient was poorer in the MNM than in the MNC, and the mean difference between TC-CO2 and PETCO2 in the MNM was greater than that in the MNC. The difference between the TC-CO2 and PETCO2 ranged from 3 to 6 mmHg in the MNM and from 2 to 5 mmHg in the MNC. The difference between two variables against the TC-CO2 and the CO2 waveforms obtained by means of the two devices were within the clinically acceptable range. Our two devices can provide continuous monitoring of PETCO2 with a supply of N2O/O2 in patients undergoing inhalation sedation. PMID:26178885

  3. Evaluation of transcutaneous and end-tidal carbon dioxide levels during inhalation sedation in volunteers.

    PubMed

    Satoh, Kenichi; Chikuda, Mami; Ohashi, Ayako; Kumagai, Miho; Kuji, Akiyoshi; Joh, Shigeharu

    2016-08-01

    Measurement of end-tidal carbon dioxide (PETCO2) is useful because of its noninvasiveness, continuity, and response time when sudden changes in ventilation occur during inhalation sedation. We compared the accuracy of PETCO2 using a nasal mask and nasal cannula with the accuracy of transcutaneous carbon dioxide (TC-CO2) and determined which method is more useful during inhalation sedation in volunteers. We used a modified nasal mask (MNM) and modified nasal cannula (MNC) for measurement of PETCO2. The capnometer measured PETCO2 in the gas expired from the nasal cavity by means of two devices. The volunteers received supplemental O2 by means of each device at a flow rate of 6 L/min. After the volunteers lay quietly for 5 min with a supply of 100 % O2, they received supplemental N2O by means of each device at concentrations of 10, 20, and 25 % for 5 min and 30 % for 25 min. The correlation coefficient was poorer in the MNM than in the MNC, and the mean difference between TC-CO2 and PETCO2 in the MNM was greater than that in the MNC. The difference between the TC-CO2 and PETCO2 ranged from 3 to 6 mmHg in the MNM and from 2 to 5 mmHg in the MNC. The difference between two variables against the TC-CO2 and the CO2 waveforms obtained by means of the two devices were within the clinically acceptable range. Our two devices can provide continuous monitoring of PETCO2 with a supply of N2O/O2 in patients undergoing inhalation sedation.

  4. End-tidal capnometry during emergency department procedural sedation and analgesia: a randomized, controlled study

    PubMed Central

    Campbell, Samuel G.; Magee, Kirk D.; Zed, Peter J.; Froese, Patrick; Etsell, Glenn; LaPierre, Alan; Warren, Donna; MacKinley, Robert R.; Butler, Michael B.; Kovacs, George; Petrie, David A.

    2016-01-01

    BACKGROUND: This prospective, randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry (ETC) to pulse oximetry (PO) in patients undergoing procedural sedation and analgesia (PSA) in the emergency department (ED). METHODS: The patients were randomized to monitoring with or without ETC in addition to the current standard of care. Primary endpoints included respiratory adverse events, with secondary endpoints of level of sedation, hypotension, other PSA-related adverse events and patient satisfaction. RESULTS: Of 986 patients, 501 were randomized to usual care and 485 to additional ETC monitoring. In this series, 48% of the patients were female, with a mean age of 46 years. Orthopedic manipulations (71%), cardioversion (12%) and abscess incision and drainage (12%) were the most common procedures, and propofol and fentanyl were the sedative/analgesic combination used for most patients. There was no difference in patients experiencing de-saturation (SaO2<90%) between the two groups; however, patients in the ETC group were more likely to require airway repositioning (12.9% vs. 9.3%, P=0.003). Hypotension (SBP<100 mmHg or <85 mmHg if baseline <100 mmHg) was observed in 16 (3.3%) patients in the ETC group and 7 (1.4%) in the control group (P=0.048). CONCLUSIONS: The addition of ETC does not appear to change any clinically significant outcomes. We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used. We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA. PMID:27006732

  5. 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

  6. Cooperative energy harvesting-adaptive MAC protocol for WBANs.

    PubMed

    Esteves, Volker; Antonopoulos, Angelos; Kartsakli, Elli; Puig-Vidal, Manel; Miribel-Català, Pere; Verikoukis, Christos

    2015-05-28

    In this paper, we introduce a cooperative medium access control (MAC) protocol, named cooperative energy harvesting (CEH)-MAC, that adapts its operation to the energy harvesting (EH) conditions in wireless body area networks (WBANs). In particular, the proposed protocol exploits the EH information in order to set an idle time that allows the relay nodes to charge their batteries and complete the cooperation phase successfully. Extensive simulations have shown that CEH-MAC significantly improves the network performance in terms of throughput, delay and energy efficiency compared to the cooperative operation of the baseline IEEE 802.15.6 standard.

  7. Cooperative Energy Harvesting-Adaptive MAC Protocol for WBANs

    PubMed Central

    Esteves, Volker; Antonopoulos, Angelos; Kartsakli, Elli; Puig-Vidal, Manel; Miribel-Català, Pere; Verikoukis, Christos

    2015-01-01

    In this paper, we introduce a cooperative medium access control (MAC) protocol, named cooperative energy harvesting (CEH)-MAC, that adapts its operation to the energy harvesting (EH) conditions in wireless body area networks (WBANs). In particular, the proposed protocol exploits the EH information in order to set an idle time that allows the relay nodes to charge their batteries and complete the cooperation phase successfully. Extensive simulations have shown that CEH-MAC significantly improves the network performance in terms of throughput, delay and energy efficiency compared to the cooperative operation of the baseline IEEE 802.15.6 standard. PMID:26029950

  8. Multichannel MAC Layer In Mobile Ad—Hoc Network

    NASA Astrophysics Data System (ADS)

    Logesh, K.; Rao, Samba Siva

    2010-11-01

    This paper we presented the design objectives and technical challenges in Multichannel MAC protocols in Mobile Ad-hoc Network. In IEEE 802.11 a/b/g standards allow use of multiple channels, only a single channel is popularly used, due to the lack of efficient protocols that enable use of Multiple Channels. Even though complex environments in ad hoc networks require a combined control of physical (PHY) and medium access control (MAC) layers resources in order to optimize performance. And also we discuss the characteristics of cross-layer frame and give a multichannel MAC approach.

  9. Handling Deafness Problem of Scheduled Multi-Channel Polling MACs

    NASA Astrophysics Data System (ADS)

    Jiang, Fulong; Liu, Hao; Shi, Longxing

    Combining scheduled channel polling with channel diversity is a promising way for a MAC protocol to achieve high energy efficiency and performance under both light and heavy traffic conditions. However, the deafness problem may cancel out the benefit of channel diversity. In this paper, we first investigate the deafness problem of scheduled multi-channel polling MACs with experiments. Then we propose and evaluate two schemes to handle the deafness problem. Our experiment shows that deafness is a significant reason for performance degradation in scheduled multi-channel polling MACs. A proper scheme should be chosen depending on the traffic pattern and the design objective.

  10. Cooperative energy harvesting-adaptive MAC protocol for WBANs.

    PubMed

    Esteves, Volker; Antonopoulos, Angelos; Kartsakli, Elli; Puig-Vidal, Manel; Miribel-Català, Pere; Verikoukis, Christos

    2015-01-01

    In this paper, we introduce a cooperative medium access control (MAC) protocol, named cooperative energy harvesting (CEH)-MAC, that adapts its operation to the energy harvesting (EH) conditions in wireless body area networks (WBANs). In particular, the proposed protocol exploits the EH information in order to set an idle time that allows the relay nodes to charge their batteries and complete the cooperation phase successfully. Extensive simulations have shown that CEH-MAC significantly improves the network performance in terms of throughput, delay and energy efficiency compared to the cooperative operation of the baseline IEEE 802.15.6 standard. PMID:26029950

  11. Reconstitution of the Escherichia coli macrolide transporter: the periplasmic membrane fusion protein MacA stimulates the ATPase activity of MacB.

    PubMed

    Tikhonova, Elena B; Devroy, Vishakha K; Lau, Sze Yi; Zgurskaya, Helen I

    2007-02-01

    Periplasmic membrane fusion proteins (MFPs) are essential components of the type I protein secretion systems and drug efflux pumps in Gram-negative bacteria. Previous studies suggested that MFPs connect the inner and outer membrane components of the transport systems and by this means co-ordinate the transfer of substrates across the two membranes. In this study, we purified and reconstituted the macrolide transporter MacAB from Escherichia coli. Here, MacA is a periplasmic MFP and MacB is an ABC-type transporter. Similar to other MFP-dependent transporters from E. coli, the in vivo function of MacAB requires the outer membrane channel TolC. The purified MacB displayed a basal ATPase activity in detergent micelles. This activity conformed to Michaelis-Menten kinetics but was unresponsive to substrates or accessory proteins. Upon reconstitution into proteoliposomes, the ATPase activity of MacB was strictly dependent on MacA. The catalytic efficiency of MacAB ATPase was more than 45-fold higher than the activity of MacB alone. Both the N- and C-terminal regions of MacA were essential for this activity. MacA stimulated MacB ATPase only in phospholipid bilayers and did not need the presence of macrolides. Our results suggest that MacA is a functional subunit of the MacB transporter. PMID:17214741

  12. 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

  13. Prior determination of baseline minimum alveolar concentration (MAC) of isoflurane does not influence the effect of ketamine on MAC in rabbits.

    PubMed

    Gianotti, Giacomo; Valverde, Alexander; Sinclair, Melissa; Dyson, Doris H; Gibson, Thomas; Johnson, Ron

    2012-10-01

    The objective of this study was to compare the effect on the minimum alveolar concentration (MAC) of isoflurane when ketamine was administered either after or without prior determination of the baseline MAC of isoflurane in rabbits. Using a prospective randomized crossover study, 8 adult, female New Zealand rabbits were allocated to 2 treatment groups. Anesthesia was induced and maintained with isoflurane. Group 1 (same-day determination) had the MAC-sparing effect of ketamine [1 mg/kg bodyweight (BW) bolus followed by a constant rate infusion (CRI) of 40 μg/kg BW per min, given by intravenous (IV)], which was determined after the baseline MAC of isoflurane was determined beforehand. A third MAC determination was started 30 min after stopping the CRI. Group 2 (separate-day determination) had the MAC-sparing effect of ketamine determined without previous determination of the baseline MAC of isoflurane. A second MAC determination was started 30 min after stopping the CRI. In group 1, the MAC of isoflurane (2.15 ± 0.09%) was significantly decreased by ketamine (1.63 ± 0.07%). After stopping the CRI, the MAC was significantly less (2.04 ± 0.11%) than the baseline MAC of isoflurane and significantly greater than the MAC during the CRI. In group 2, ketamine decreased isoflurane MAC (1.53 ± 0.22%) and the MAC increased significantly (1.94 ± 0.25%) after stopping the CRI. Minimum alveolar concentration (MAC) values did not differ significantly between the groups either during ketamine administration or after stopping ketamine. Under the study conditions, prior determination of the baseline isoflurane MAC did not alter the effect of ketamine on MAC. Both methods of determining MAC seemed to be valid for research purposes.

  14. PAD-MAC: primary user activity-aware distributed MAC for multi-channel cognitive radio networks.

    PubMed

    Ali, Amjad; Piran, Md Jalil; Kim, Hansoo; Yun, Jihyeok; Suh, Doug Young

    2015-01-01

    Cognitive radio (CR) has emerged as a promising technology to solve problems related to spectrum scarcity and provides a ubiquitous wireless access environment. CR-enabled secondary users (SUs) exploit spectrum white spaces opportunistically and immediately vacate the acquired licensed channels as primary users (PUs) arrive. Accessing the licensed channels without the prior knowledge of PU traffic patterns causes severe throughput degradation due to excessive channel switching and PU-to-SU collisions. Therefore, it is significantly important to design a PU activity-aware medium access control (MAC) protocol for cognitive radio networks (CRNs). In this paper, we first propose a licensed channel usage pattern identification scheme, based on a two-state Markov model, and then estimate the future idle slots using previous observations of the channels. Furthermore, based on these past observations, we compute the rank of each available licensed channel that gives SU transmission success assessment during the estimated idle slot. Secondly, we propose a PU activity-aware distributed MAC (PAD-MAC) protocol for heterogeneous multi-channel CRNs that selects the best channel for each SU to enhance its throughput. PAD-MAC controls SU activities by allowing them to exploit the licensed channels only for the duration of estimated idle slots and enables predictive and fast channel switching. To evaluate the performance of the proposed PAD-MAC, we compare it with the distributed QoS-aware MAC (QC-MAC) and listen-before-talk MAC schemes. Extensive numerical results show the significant improvements of the PAD-MAC in terms of the SU throughput, SU channel switching rate and PU-to-SU collision rate. PMID:25831084

  15. PAD-MAC: Primary User Activity-Aware Distributed MAC for Multi-Channel Cognitive Radio Networks

    PubMed Central

    Ali, Amjad; Piran, Md. Jalil; Kim, Hansoo; Yun, Jihyeok; Suh, Doug Young

    2015-01-01

    Cognitive radio (CR) has emerged as a promising technology to solve problems related to spectrum scarcity and provides a ubiquitous wireless access environment. CR-enabled secondary users (SUs) exploit spectrum white spaces opportunistically and immediately vacate the acquired licensed channels as primary users (PUs) arrive. Accessing the licensed channels without the prior knowledge of PU traffic patterns causes severe throughput degradation due to excessive channel switching and PU-to-SU collisions. Therefore, it is significantly important to design a PU activity-aware medium access control (MAC) protocol for cognitive radio networks (CRNs). In this paper, we first propose a licensed channel usage pattern identification scheme, based on a two-state Markov model, and then estimate the future idle slots using previous observations of the channels. Furthermore, based on these past observations, we compute the rank of each available licensed channel that gives SU transmission success assessment during the estimated idle slot. Secondly, we propose a PU activity-aware distributed MAC (PAD-MAC) protocol for heterogeneous multi-channel CRNs that selects the best channel for each SU to enhance its throughput. PAD-MAC controls SU activities by allowing them to exploit the licensed channels only for the duration of estimated idle slots and enables predictive and fast channel switching. To evaluate the performance of the proposed PAD-MAC, we compare it with the distributed QoS-aware MAC (QC-MAC) and listen-before-talk MAC schemes. Extensive numerical results show the significant improvements of the PAD-MAC in terms of the SU throughput, SU channel switching rate and PU-to-SU collision rate. PMID:25831084

  16. PAD-MAC: primary user activity-aware distributed MAC for multi-channel cognitive radio networks.

    PubMed

    Ali, Amjad; Piran, Md Jalil; Kim, Hansoo; Yun, Jihyeok; Suh, Doug Young

    2015-03-30

    Cognitive radio (CR) has emerged as a promising technology to solve problems related to spectrum scarcity and provides a ubiquitous wireless access environment. CR-enabled secondary users (SUs) exploit spectrum white spaces opportunistically and immediately vacate the acquired licensed channels as primary users (PUs) arrive. Accessing the licensed channels without the prior knowledge of PU traffic patterns causes severe throughput degradation due to excessive channel switching and PU-to-SU collisions. Therefore, it is significantly important to design a PU activity-aware medium access control (MAC) protocol for cognitive radio networks (CRNs). In this paper, we first propose a licensed channel usage pattern identification scheme, based on a two-state Markov model, and then estimate the future idle slots using previous observations of the channels. Furthermore, based on these past observations, we compute the rank of each available licensed channel that gives SU transmission success assessment during the estimated idle slot. Secondly, we propose a PU activity-aware distributed MAC (PAD-MAC) protocol for heterogeneous multi-channel CRNs that selects the best channel for each SU to enhance its throughput. PAD-MAC controls SU activities by allowing them to exploit the licensed channels only for the duration of estimated idle slots and enables predictive and fast channel switching. To evaluate the performance of the proposed PAD-MAC, we compare it with the distributed QoS-aware MAC (QC-MAC) and listen-before-talk MAC schemes. Extensive numerical results show the significant improvements of the PAD-MAC in terms of the SU throughput, SU channel switching rate and PU-to-SU collision rate.

  17. 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.

  18. Competition at the Wireless Sensor Network MAC Layer: Low Power Probing interfering with X-MAC

    NASA Astrophysics Data System (ADS)

    Zacharias, Sven; Newe, Thomas

    2011-08-01

    Wireless Sensor Networks (WSNs) combine sensors with computer networks and enable very dense, in-situ and live measurements of data over a large area. Since this emerging technology has the potential to be embedded almost everywhere for numberless applications, interference between different networks can become a serious issue. For most WSNs, it is assumed today that the network medium access is non-competitive. On the basis of X-MAC interfered by Low Power Probing, this paper shows the danger and the effects of different sensor networks communicating on a single wireless channel of the 2.4 GHz band, which is used by the IEEE 802.15.4 standard.

  19. MAC layer security issues in wireless mesh networks

    NASA Astrophysics Data System (ADS)

    Reddy, K. Ganesh; Thilagam, P. Santhi

    2016-03-01

    Wireless Mesh Networks (WMNs) have emerged as a promising technology for a broad range of applications due to their self-organizing, self-configuring and self-healing capability, in addition to their low cost and easy maintenance. Securing WMNs is more challenging and complex issue due to their inherent characteristics such as shared wireless medium, multi-hop and inter-network communication, highly dynamic network topology and decentralized architecture. These vulnerable features expose the WMNs to several types of attacks in MAC layer. The existing MAC layer standards and implementations are inadequate to secure these features and fail to provide comprehensive security solutions to protect both backbone and client mesh. Hence, there is a need for developing efficient, scalable and integrated security solutions for WMNs. In this paper, we classify the MAC layer attacks and analyze the existing countermeasures. Based on attacks classification and countermeasures analysis, we derive the research directions to enhance the MAC layer security for WMNs.

  20. Operational effectiveness of a Multiple Aquila Control System (MACS)

    NASA Technical Reports Server (NTRS)

    Brown, R. W.; Flynn, J. D.; Frey, M. R.

    1983-01-01

    The operational effectiveness of a multiple aquila control system (MACS) was examined under a variety of remotely piloted vehicle (RPV) mission configurations. The set of assumptions and inputs used to form the rules under which a computerized simulation of MACS was run is given. The characteristics that are to govern MACS operations include: the battlefield environment that generates the requests for RPV missions, operating time-lines of the RPV-peculiar equipment, maintenance requirements, and vulnerability to enemy fire. The number of RPV missions and the number of operation days are discussed. Command, control, and communication data rates are estimated by determining how many messages are passed and what information is necessary in them to support ground coordination between MACS sections.

  1. 5. Photocopy of drawing of Mac Dougall furnace in roaster ...

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

    5. Photocopy of drawing of Mac Dougall furnace in roaster building from John L. Bray, The Principles of Metallurgy Ginn & Co., New York, 1929. - International Smelting & Refining Company, Tooele Smelter, Roaster Building, State Route 178, Tooele, Tooele County, UT

  2. Aeronautical Mobile Airport Communications System (AeroMACS)

    NASA Technical Reports Server (NTRS)

    Budinger, James M.; Hall, Edward

    2011-01-01

    To help increase the capacity and efficiency of the nation s airports, a secure wideband wireless communications system is proposed for use on the airport surface. This paper provides an overview of the research and development process for the Aeronautical Mobile Airport Communications System (AeroMACS). AeroMACS is based on a specific commercial profile of the Institute of Electrical and Electronics Engineers (IEEE) 802.16 standard known as Wireless Worldwide Interoperability for Microwave Access or WiMAX (WiMax Forum). The paper includes background on the need for global interoperability in air/ground data communications, describes potential AeroMACS applications, addresses allocated frequency spectrum constraints, summarizes the international standardization process, and provides findings and recommendations from the world s first AeroMACS prototype implemented in Cleveland, Ohio, USA.

  3. MAC mini acceptance test procedure, software Version 3.0

    SciTech Connect

    Russell, V.K.

    1994-10-17

    The K Basins Materials Accounting (MAC) programs had some major improvements made to it to organize the main-tables by Location, Canister, and Material. This ATP describes how the code was to be tested to verify its correctness.

  4. Propofol with ketamine following sedation with xylazine for routine induction of general anaesthesia in horses.

    PubMed

    Posner, L P; Kasten, J I; Kata, C

    2013-12-01

    To document the suitability of intravenous propofol and ketamine following sedation with xylazine for routine anaesthetic induction in horses. Retrospective. 100 client-owned horses. Anaesthetic records were evaluated to determine: signalment, anaesthetic drug and dosages, need for additional induction agents, notation of any adverse events, duration of anaesthesia and recovery characteristics (rough or smooth, and rapid or prolonged). Horses were sedated with xylazine 0.99±(0.2) mg/kg intravenous and 23 horses were also administered butorphanol 0.02±(0.001) mg/kg intravenous. Horses were anaesthetised with a combination of propofol 0.40±(0.1) mg/kg intravenous and ketamine 2.8±(0.3) mg/kg intravenous. Six horses required additional ketamine. None became apnoeic and no adverse events were noted. Anaesthesia was maintained with isoflurane in 66 horses and a combination of guaifenesin, ketamine and xylazine (GKX) in 34 horses. Total anaesthesia time was 125.4±(46) minutes. Fifty-one horses were administered romifidine 0.016 (±0.008) mg/kg intravenous at recovery. Time from orotracheal extubation to standing was 27.6±(25) minutes. Of the 58 records with recovery characteristics, the number per category was: rapid n=6, prolonged n=3, smooth n=46, rough n=6. Intravenous propofol and ketamine following xylazine provided satisfactory anaesthetic inductions and recoveries in a varied population of horses without any clinically relevant adverse events. PMID:24218416

  5. Sedative-Hypnotic Use in Patients with Borderline Personality Disorder and Axis II Comparison Subjects

    PubMed Central

    Plante, David T.; Zanarini, Mary C.; Frankenburg, Frances R.; Fitzmaurice, Garrett M.

    2011-01-01

    Sleep disturbance is a common, yet poorly understood, phenomenon in borderline personality disorder (BPD). We examined the use of sedative-hypnotic medication in BPD, as part of a larger naturalistic study. In comparison to other personality disorder (OPD) comparison subjects, a significantly higher percentage of BPD subjects than OPD subjects used both as needed (prn) and standing medications to help them sleep. Specifically, over the course of the study, BPD subjects were approximately 4 times more likely to have used prn (OR = 4.27, 95% CI: 2.22–8.22) and standing sleeping medications (OR = 3.81, 95% CI: 1.88–7.72). When adjusted for differences in depression, anxiety, and age among BPD and OPD subjects, BPD subjects were approximately 3 times more likely to have used prn (adjusted OR = 3.38, 95% CI: 1.73–6.61) and standing sleeping medications (adjusted OR = 2.81, 95% CI: 1.33–5.95). These results indicate that sedative-hypnotic use is greater among BPD than OPD subjects. They also confirm clinical observations that subjective sleep disturbance is a significant problem in BPD. PMID:20001175

  6. The emerging use of ketamine for anesthesia and sedation in traumatic brain injuries.

    PubMed

    Chang, Lee C; Raty, Sally R; Ortiz, Jaime; Bailard, Neil S; Mathew, Sanjay J

    2013-06-01

    Traditionally, the use of ketamine for patients with traumatic brain injuries is contraindicated due to the concern of increasing intracranial pressure (ICP). These concerns, however, originated from early studies and case reports that were inadequately controlled and designed. Recently, the concern of using ketamine in these patients has been challenged by a number of published studies demonstrating that the use of ketamine was safe in these patients. This article reviews the current literature in regards to using ketamine in patients with traumatic brain injuries in different clinical settings associated with anesthesia, as well as reviews the potential mechanisms underlying the neuroprotective effects of ketamine. Studies examining the use of ketamine for induction, maintenance, and sedation in patients with TBI have had promising results. The use of ketamine in a controlled ventilation setting and in combination with other sedative agents has demonstrated no increase in ICP. The role of ketamine as a neuroprotective agent in humans remains inconclusive and adequately powered; randomized controlled trials performed in patients undergoing surgery for traumatic brain injury are necessary.

  7. 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

  8. Conformal holonomy in MacDowell-Mansouri gravity

    SciTech Connect

    Reid, James A.; Wang, Charles H.-T.

    2014-03-15

    The MacDowell-Mansouri formulation of general relativity is based on a gauge theory whose gauge algebra depends on the sign of the cosmological constant. In this article, we show that the gauge algebra is uniquely determined by the conformal structure of spacetime itself. Specifically, we show that in vacuum: the spacetime conformal holonomy algebra coincides with the MacDowell-Mansouri gauge algebra for both signs of the cosmological constant, in both Lorentzian and Euclidean metric signatures.

  9. A tribute to Lloyd D. MacLean

    PubMed Central

    Keith, Roger G.

    2015-01-01

    Summary Dr. Lloyd D. MacLean, long-time co-editor of the Canadian Journal of Surgery passed away earlier this year at the age of 90. In order to appreciate the contributions of Dr. MacLean to the journal, this commentary recognizes him as a humble surgeon–scientist who was one of — if not the — most outstanding Canadian ambassadors to academic surgery in North America. PMID:26204372

  10. 42 CFR 423.2050 - Removal of a hearing request from an ALJ to the MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Removal of a hearing request from an ALJ to the MAC..., ALJ Hearings, MAC review, and Judicial Review § 423.2050 Removal of a hearing request from an ALJ to the MAC. If a request for hearing is pending before an ALJ, the MAC may assume responsibility...

  11. 42 CFR 423.2102 - Request for MAC review when ALJ issues decision or dismissal.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Request for MAC review when ALJ issues decision or... Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2102 Request for MAC review when ALJ issues decision or dismissal. (a)(1) An enrollee to the ALJ hearing may request a MAC review if the enrollee...

  12. 42 CFR 421.404 - Assignment of providers and suppliers to MACs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Assignment of providers and suppliers to MACs. 421... (MACs) § 421.404 Assignment of providers and suppliers to MACs. (a) Definitions. As used in this section... MACs. (1) Providers enroll with and receive Medicare payment and other Medicare services from the...

  13. 42 CFR 423.2110 - MAC reviews on its own motion.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false MAC reviews on its own motion. 423.2110 Section 423... (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2110 MAC reviews on its own motion. (a) General rule. The MAC may decide...

  14. 42 CFR 423.2062 - Applicability of policies not binding on the ALJ and MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... and MAC. 423.2062 Section 423.2062 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2062 Applicability of policies not binding on the ALJ and MAC. (a) ALJs and the MAC are not bound by CMS program guidance, such as...

  15. 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

  16. 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

  17. 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

  18. 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.

  19. 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

  20. 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.

  1. Sedation and physiologic response to manual restraint after intranasal administration of midazolam in Hispaniolan Amazon parrots (Amazona ventralis).

    PubMed

    Mans, Christoph; Guzman, David Sanchez-Migallon; Lahner, Lesanna L; Paul-Murphy, Joanne; Sladky, Kurt K

    2012-09-01

    Administration of intranasal midazolam (2 mg/kg) was evaluated for sedation and effects on cloacal temperature, respiratory rate, and heart rate in manually restrained Hispaniolan Amazon parrots (Amazona ventralis). Adult parrots (n=9) were administered either midazolam (2 mg/kg) or an equal volume of saline solution intranasally before a 15-minute manual restraint in a complete crossover study. Respiratory rate and sedation scores were recorded before and during capture and during and after 15 minutes of manual restraint. Heart rate and cloacal temperature were recorded during manual restraint. After restraint, the parrots received intranasal flumazenil (0.05 mg/kg) or an equal volume of saline solution, and the recovery time was recorded. In those birds that received midazolam, sedation was observed within 3 minutes of administration, and vocalization, flight, and defense responses were significantly reduced during capture. During manual restraint, the mean rate of cloacal temperature increase was significantly slower and remained significantly lower in birds that received midazolam compared with controls. Mean respiratory rates were significantly lower for up to 12 minutes in parrots that received midazolam compared with those receiving saline solution. Flumazenil antagonized the effects of midazolam within 10 minutes. No overt clinical adverse effects to intranasal midazolam and flumazenil administration were observed. Further studies on the safety of intranasal midazolam and flumazenil in this species are warranted.

  2. 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

  3. 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.

  4. 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

  5. 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

  6. Anaesthesia with sevoflurane in pigeons: minimal anaesthetic concentration (MAC) determination and investigation of cardiorespiratory variables at 1 MAC.

    PubMed

    Botman, J; Gabriel, F; Dugdale, A H A; Vandeweerd, J-M

    2016-05-28

    The objective of the study was to determine the minimal anaesthetic concentration (MAC) of sevoflurane (SEVO) in pigeons and investigate the effects of 1 MAC SEVO anaesthesia on cardiovascular and respiratory variables compared with the awake state. This is a prospective, experimental study. Animals were seven healthy adult pigeons. After acclimatisation to handling, heart rate (HR), heart rhythm, respiratory rate (fR), end-expired carbon dioxide tension (PE'CO2), inspired CO2 tension, indirect systolic arterial blood pressure (SAP) and cloacal temperature were measured to determine baseline, 'awake' values. Pigeons were then anaesthetised with SEVO and MAC was determined by the 'bracketing' method. The same variables were monitored during a 40 minute period at 1.0 MAC SEVO for each bird. Mean MAC was 3.0±0.6 per cent for SEVO. During maintenance of anaesthesia at 1.0 MAC, SAP decreased significantly (P<0.001) without any significant change in HR. Although PE'CO2 increased significantly (P=0.001) despite an increase in fR, awake PE'CO2 values were unexpectedly low. Sinus arrhythmias were detected in two birds under SEVO anaesthesia. The times to tracheal intubation and to recovery were 2.5±0.7 and 6.4±1.7 minutes, respectively. Recovery was rapid and uneventful in all birds. In conclusion, SEVO is suitable for anaesthesia in pigeons.

  7. Role of ATP binding and hydrolysis in assembly of MacAB-TolC macrolide transporter.

    PubMed

    Lu, Shuo; Zgurskaya, Helen I

    2012-12-01

    MacB is a founding member of the Macrolide Exporter family of transporters belonging to the ATP-Binding Cassette superfamily. These proteins are broadly represented in genomes of both Gram-positive and Gram-negative bacteria and are implicated in virulence and protection against antibiotics and peptide toxins. MacB transporter functions together with MacA, a periplasmic membrane fusion protein, which stimulates MacB ATPase. In Gram-negative bacteria, MacA is believed to couple ATP hydrolysis to transport of substrates across the outer membrane through a TolC-like channel. In this study, we report a real-time analysis of concurrent ATP hydrolysis and assembly of MacAB-TolC complex. MacB binds nucleotides with a low millimolar affinity and fast on- and off-rates. In contrast, MacA-MacB complex is formed with a nanomolar affinity, which further increases in the presence of ATP. Our results strongly suggest that association between MacA and MacB is stimulated by ATP binding to MacB but remains unchanged during ATP hydrolysis cycle. We also found that the large periplasmic loop of MacB plays the major role in coupling reactions separated in two different membranes. This loop is required for MacA-dependent stimulation of MacB ATPase and at the same time, contributes to recruitment of TolC into a trans-envelope complex. PMID:23057817

  8. Influence of prior determination of baseline minimum alveolar concentration (MAC) of isoflurane on the effect of ketamine on MAC in dogs.

    PubMed

    Gianotti, Giacomo; Valverde, Alexander; Johnson, Ron; Sinclair, Melissa; Gibson, Thomas; Dyson, Doris H

    2014-07-01

    The objective of this study was to determine if prior measurement of the minimum alveolar concentration (MAC) of isoflurane influences the effect of ketamine on the MAC of isoflurane in dogs. Eight mixed-breed dogs were studied on 2 occasions. Anesthesia was induced and maintained using isoflurane. In group 1 the effect of ketamine on isoflurane MAC was determined after initially finding the baseline isoflurane MAC. In group 2, the effect of ketamine on isoflurane MAC was determined without previous measure of the baseline isoflurane MAC. In both groups, MAC was determined again 30 min after stopping the CRI of ketamine. Plasma ketamine concentrations were measured during MAC determinations. In group 1, baseline MAC (mean ± SD: 1.18 ± 0.14%) was decreased by ketamine (0.88 ± 0.14%; P < 0.05). The MAC after stopping ketamine was similar (1.09 ± 0.16%) to baseline MAC and higher than with ketamine (P < 0.05). In group 2, the MAC with ketamine (0.79 ± 0.11%) was also increased after stopping ketamine (1.10 ± 0.17%; P < 0.05). The MAC values with ketamine were different between groups (P < 0.05). Ketamine plasma concentrations were similar between groups during the events of MAC determination. The MAC of isoflurane during the CRI of ketamine yielded different results when methods of same day (group-1) versus separate days (group-2) are used, despite similar plasma ketamine concentrations with both methods. However, because the magnitude of this difference was less than 10%, either method of determining MAC is deemed acceptable for research purposes.

  9. Randomized Trial of Endobronchial Ultrasound–guided Transbronchial Needle Aspiration under General Anesthesia versus Moderate Sedation

    PubMed Central

    Lazarus, Donald R.; Kuhl, Kristine; Nogueras-González, Graciela; Perusich, Sarah; Green, Linda K.; Ost, David E.; Sarkiss, Mona; Jimenez, Carlos A.; Eapen, Georgie A.; Morice, Rodolfo C.; Cornwell, Lorraine; Austria, Sheila; Sharafkanneh, Amir; Rumbaut, Rolando E.; Grosu, Horiana; Kheradmand, Farrah

    2015-01-01

    Rationale: Data about the influence of the type of sedation on yield, complications, and tolerance of endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) are based mostly on retrospective studies and are largely inconsistent. Objectives: To determine whether the type of sedation influences the diagnostic yield of EBUS-TBNA, its complication rates, and patient tolerance. Methods: Patients referred for EBUS-TBNA were randomized (1:1) to undergo this procedure under general anesthesia (GA) or moderate sedation (MS). Pathologists were blinded to group allocation. Measurements and Main Results: The main outcome was “diagnostic yield,” defined as the percentage of patients for whom EBUS-TBNA rendered a specific diagnosis. One hundred and forty-nine patients underwent EBUS-TBNA, 75 under GA and 74 under MS. Demographic and baseline clinical characteristics were well balanced. Two hundred and thirty-six lymph nodes (LNs) and six masses were sampled in the GA group (average, 3.2 ± 1.9 sites/patient), and 200 LNs and six masses in the MS group (average, 2.8 ± 1.5 sites/patient) (P = 0.199). The diagnostic yield was 70.7% (53 of 75) and 68.9% (51 of 74) for the GA group and MS group, respectively (P = 0.816). The sensitivity was 98.2% in the GA group (confidence interval, 97–100%) and 98.1% in the MS group (confidence interval, 97–100%) (P = 0.979). EBUS was completed in all patients in the GA group, and in 69 patients (93.3%) in the MS group (P = 0.028). There were no major complications or escalation of care in either group. Minor complications were more common in the MS group (29.6 vs. 5.3%) (P < 0.001). Most patients stated they “definitely would” undergo this procedure again in both groups (P = 0.355). Conclusions: EBUS-TBNA performed under MS results in comparable diagnostic yield, rate of major complications, and patient tolerance as under GA. Future prospective multicenter studies are required to

  10. 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.

  11. 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.

  12. 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

  13. Addressing the Concerns Surrounding Continuous Deep Sedation in Singapore and Southeast Asia: A Palliative Care Approach.

    PubMed

    Krishna, Lalit Kumar Radha

    2015-09-01

    The application of continuous deep sedation (CDS) in the treatment of intractable suffering at the end of life continues to be tied to a number of concerns that have negated its use in palliative care. Part of the resistance towards use of this treatment option of last resort has been the continued association of CDS with physician-associated suicide and/or euthanasia (PAS/E), which is compounded by a lack clinical guidelines and a failure to cite this treatment under the aegis of a palliative care approach. I argue that reinstituting a palliative care-inspired approach that includes a holistic review of the patient's situation and the engagement of a multidisciplinary team (MDT) guided by clearly defined practice requirements that have been lacking amongst many prevailing guidelines will overcome prevailing objections to this practice and allow for the legitimization of this process.

  14. Addressing the Concerns Surrounding Continuous Deep Sedation in Singapore and Southeast Asia: A Palliative Care Approach.

    PubMed

    Krishna, Lalit Kumar Radha

    2015-09-01

    The application of continuous deep sedation (CDS) in the treatment of intractable suffering at the end of life continues to be tied to a number of concerns that have negated its use in palliative care. Part of the resistance towards use of this treatment option of last resort has been the continued association of CDS with physician-associated suicide and/or euthanasia (PAS/E), which is compounded by a lack clinical guidelines and a failure to cite this treatment under the aegis of a palliative care approach. I argue that reinstituting a palliative care-inspired approach that includes a holistic review of the patient's situation and the engagement of a multidisciplinary team (MDT) guided by clearly defined practice requirements that have been lacking amongst many prevailing guidelines will overcome prevailing objections to this practice and allow for the legitimization of this process. PMID:26173777

  15. The many faces of Mac-1 in autoimmune disease.

    PubMed

    Rosetti, Florencia; Mayadas, Tanya N

    2016-01-01

    Mac-1 (CD11b/CD18) is a β2 integrin classically regarded as a pro-inflammatory molecule because of its ability to promote phagocyte cytotoxic functions and enhance the function of several effector molecules such as FcγR, uPAR, and CD14. Nevertheless, recent reports have revealed that Mac-1 also plays significant immunoregulatory roles, and genetic variants in ITGAM, the gene that encodes CD11b, confer risk for the autoimmune disease systemic lupus erythematosus (SLE). This has renewed interest in the physiological roles of this integrin and raised new questions on how its seemingly opposing biological functions may be regulated. Here, we provide an overview of the CD18 integrins and how their activation may be regulated as this may shed light on how the opposing roles of Mac-1 may be elicited. We then discuss studies that exemplify Mac-1's pro-inflammatory versus regulatory roles particularly in the context of IgG immune complex-mediated inflammation. This includes a detailed examination of molecular mechanisms that could explain the risk-conferring effect of rs1143679, a single nucleotide non-synonymous Mac-1 polymorphism associated with SLE.

  16. 1919: psychology and psychoanalysis, Cambridge and London - Myers, Jones and MacCurdy.

    PubMed

    Forrester, John

    2008-01-01

    Viewing the reception of psychoanalysis in Britain from Cambridge, the paper examines the intertwining histories of the post-War British Psychological Society and the founding of the British Psycho-Analytical Society, following the initiatives of the two principal psychological entrepreneurs of the era, Charles Myers and Ernest Jones, Reforms in Cambridge in which psychoanalysis played a significant part are analysed, including the foundation of a Clinic for Nervous Diseases and the establishment of a separate Department of Experimental Psychology. The career of J. T. MacCurdy, Jones's student and Lecturer in Psychopathology at Cambridge, is discussed.

  17. 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.

  18. 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

  19. Intensity and duration of amnesia from intravenous midazolam given for sedation.

    PubMed

    Hupp, J R; Becker, L E

    1988-01-01

    A clinical study was performed investigating the ability of intravenous midazolam to cause amnesia for visual, auditory and painful stimuli presented during surgical removal of third molars. Various stimuli were presented prior to and after administration of a sufficient quantity of midazolam to produce profound sedation. Recall was then tested immediately after, one day, and one week following the surgery. The study found that midazolam produces at least 20 minutes of profound amnesia for all stimuli in 93 +/- 6% of individuals. However, little correlation was found between the dose of midazolam and the duration of amnesia. Anesthesia literally means the loss of sensation. In the clinical dental situation, the principle sensation lost, when using either regional or general anesthesia, is pain perception. Although prevention of pain sensation is the primary reason patients request local anesthesia prior to invasive dental care, for many patients, control of pain only partially prepares them to receive dental care. These patients request the adjunctive use of sedation or general anesthesia, not for further pain control, but rather requiring periodontal or oral/maxillofacial surgery in which such factors as the sight and taste of blood, the noise of bone-cutting equipment, or the pressure placed on the jaws is not eliminated by local anesthetics. Although effective anxiolytic oral, inhalational, or parenteral agents have been available for several decades, patients still usually retain their memory of events occurring during their dental care, particularly anxiety-provoking events. This memory of the uncomfortable portions of dental care stimulates additional anxiety so that patients may procrastinate when dental care is necessary.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Demand in pediatric dentistry for sedation and general anesthesia by dentist anesthesiologists: a survey of directors of dentist anesthesiologist and pediatric dentistry residencies.

    PubMed

    Hicks, C Gray; Jones, James E; Saxen, Mark A; Maupome, Gerardo; Sanders, Brian J; Walker, Laquia A; Weddell, James A; Tomlin, Angela

    2012-01-01

    This study describes what training programs in pediatric dentistry and dental anesthesiology are doing to meet future needs for deep sedation/general anesthesia services required for pediatric dentistry. Residency directors from 10 dental anesthesiology training programs in North America and 79 directors from pediatric dentistry training programs in North America were asked to answer an 18-item and 22-item online survey, respectively, through an online survey tool. The response rate for the 10 anesthesiology training program directors was 9 of 10 or 90%. The response rate for the 79 pediatric dentistry training program directors was 46 of 79 or 58%. Thirty-seven percent of pediatric dentistry programs use clinic-based deep sedation/general anesthesia for dental treatment in addition to hospital-based deep sedation/general anesthesia. Eighty-eight percent of those programs use dentist anesthesiologists for administration of deep sedation/general anesthesia in a clinic-based setting. Pediatric dentistry residency directors perceive a future change in the need for deep sedation/general anesthesia services provided by dentist anesthesiologists to pediatric dentists: 64% anticipate an increase in need for dentist anesthesiologist services, while 36% anticipate no change. Dental anesthesiology directors compared to 2, 5, and 10 years ago have seen an increase in the requests for dentist anesthesiologist services by pediatric dentists reported by 56% of respondents (past 2 years), 63% of respondents (past 5 years), and 88% of respondents (past 10 years), respectively. Predicting the future need of dentist anesthesiologists is an uncertain task, but these results show pediatric dentistry directors and dental anesthesiology directors are considering the need, and they recognize a trend of increased need for dentist anesthesiologist services over the past decade.

  1. 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

  2. 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.

  3. SACRB-MAC: A High-Capacity MAC Protocol for Cognitive Radio Sensor Networks in Smart Grid.

    PubMed

    Yang, Zhutian; Shi, Zhenguo; Jin, Chunlin

    2016-01-01

    The Cognitive Radio Sensor Network (CRSN) is considered as a viable solution to enhance various aspects of the electric power grid and to realize a smart grid. However, several challenges for CRSNs are generated due to the harsh wireless environment in a smart grid. As a result, throughput and reliability become critical issues. On the other hand, the spectrum aggregation technique is expected to play an important role in CRSNs in a smart grid. By using spectrum aggregation, the throughput of CRSNs can be improved efficiently, so as to address the unique challenges of CRSNs in a smart grid. In this regard, we proposed Spectrum Aggregation Cognitive Receiver-Based MAC (SACRB-MAC), which employs the spectrum aggregation technique to improve the throughput performance of CRSNs in a smart grid. Moreover, SACRB-MAC is a receiver-based MAC protocol, which can provide a good reliability performance. Analytical and simulation results demonstrate that SACRB-MAC is a promising solution for CRSNs in a smart grid. PMID:27043573

  4. SACRB-MAC: A High-Capacity MAC Protocol for Cognitive Radio Sensor Networks in Smart Grid.

    PubMed

    Yang, Zhutian; Shi, Zhenguo; Jin, Chunlin

    2016-03-31

    The Cognitive Radio Sensor Network (CRSN) is considered as a viable solution to enhance various aspects of the electric power grid and to realize a smart grid. However, several challenges for CRSNs are generated due to the harsh wireless environment in a smart grid. As a result, throughput and reliability become critical issues. On the other hand, the spectrum aggregation technique is expected to play an important role in CRSNs in a smart grid. By using spectrum aggregation, the throughput of CRSNs can be improved efficiently, so as to address the unique challenges of CRSNs in a smart grid. In this regard, we proposed Spectrum Aggregation Cognitive Receiver-Based MAC (SACRB-MAC), which employs the spectrum aggregation technique to improve the throughput performance of CRSNs in a smart grid. Moreover, SACRB-MAC is a receiver-based MAC protocol, which can provide a good reliability performance. Analytical and simulation results demonstrate that SACRB-MAC is a promising solution for CRSNs in a smart grid.

  5. SACRB-MAC: A High-Capacity MAC Protocol for Cognitive Radio Sensor Networks in Smart Grid

    PubMed Central

    Yang, Zhutian; Shi, Zhenguo; Jin, Chunlin

    2016-01-01

    The Cognitive Radio Sensor Network (CRSN) is considered as a viable solution to enhance various aspects of the electric power grid and to realize a smart grid. However, several challenges for CRSNs are generated due to the harsh wireless environment in a smart grid. As a result, throughput and reliability become critical issues. On the other hand, the spectrum aggregation technique is expected to play an important role in CRSNs in a smart grid. By using spectrum aggregation, the throughput of CRSNs can be improved efficiently, so as to address the unique challenges of CRSNs in a smart grid. In this regard, we proposed Spectrum Aggregation Cognitive Receiver-Based MAC (SACRB-MAC), which employs the spectrum aggregation technique to improve the throughput performance of CRSNs in a smart grid. Moreover, SACRB-MAC is a receiver-based MAC protocol, which can provide a good reliability performance. Analytical and simulation results demonstrate that SACRB-MAC is a promising solution for CRSNs in a smart grid. PMID:27043573

  6. Vehicle Health Management Communications Requirements for AeroMACS

    NASA Technical Reports Server (NTRS)

    Kerczewski, Robert J.; Clements, Donna J.; Apaza, Rafael D.

    2012-01-01

    As the development of standards for the aeronautical mobile airport communications system (AeroMACS) progresses, the process of identifying and quantifying appropriate uses for the system is progressing. In addition to defining important elements of AeroMACS standards, indentifying the systems uses impacts AeroMACS bandwidth requirements. Although an initial 59 MHz spectrum allocation for AeroMACS was established in 2007, the allocation may be inadequate; studies have indicated that 100 MHz or more of spectrum may be required to support airport surface communications. Hence additional spectrum allocations have been proposed. Vehicle health management (VHM) systems, which can produce large volumes of vehicle health data, were not considered in the original bandwidth requirements analyses, and are therefore of interest in supporting proposals for additional AeroMACS spectrum. VHM systems are an emerging development in air vehicle safety, and preliminary estimates of the amount of data that will be produced and transmitted off an aircraft, both in flight and on the ground, have been prepared based on estimates of data produced by on-board vehicle health sensors and initial concepts of data processing approaches. This allowed an initial estimate of VHM data transmission requirements for the airport surface. More recently, vehicle-level systems designed to process and analyze VHM data and draw conclusions on the current state of vehicle health have been undergoing testing and evaluation. These systems make use of vehicle system data that is mostly different from VHM data considered previously for airport surface transmission, and produce processed system outputs that will be also need to be archived, thus generating additional data load for AeroMACS. This paper provides an analysis of airport surface data transmission requirements resulting from the vehicle level reasoning systems, within the context of overall VHM data requirements.

  7. [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.

  8. Data representations in PDP-10 MacLISP

    NASA Technical Reports Server (NTRS)

    Steele, G. L., Jr.

    1977-01-01

    The internal representations of the various MacLISP data types are presented and discussed. Certain implementation tradeoffs are considered. The ultimate decisions on these tradeoffs are discussed in the light of MacLISP's prime objective of being an efficient high-level language for the implementation of large systems such as MACSYMA. The basic strategy of garbage collection is outlined, with reference to the specific representations involved. Certain clever tricks are explained and justified. The address space crunch is explained and some alternative solutions explored.

  9. A Flexible CSMA based MAC Protocol for Software Defined Radios

    NASA Astrophysics Data System (ADS)

    Puschmann, André; Kalil, Mohamed A.; Mitschele-Thiel, Andreas

    2012-09-01

    In this article, we propose a flexible CSMA based MAC protocol which facilitates research and experimentation using software define radios. The modular architecture allows to employ the protocol on platforms with heterogeneous hardware capabilities and provides the freedom to exchange or adapt the spectrum sensing mechanism without modifying the MAC protocol internals. We discuss the architecture of the protocol and provide structural details of its main components. Furthermore, we present throughput measurements that have been obtained on an example system using host-based spectrum sensing.

  10. 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

  11. Anxiolytic, sedative, and hypnotic activities of aqueous extract of Morinda citrifolia fruit.

    PubMed

    Kannan, Sridharan; Manickam, Shanti; RajaMohammed, Meher Ali

    2014-04-01

    Morinda citrifolia (Indian mulberry or noni) fruit has been long used as a folk medicine for a wide range of health purposes as it is claimed to have analgesic, antiinflammatory, antioxidant, detoxifier, and cell-rejuvenator properties. A recent study has revealed central nervous system suppressant nature of its extract. Hence, the present study has evaluated the anxiolytic, sedative, and hypnotic effects of the aqueous extracts of Morinda citrifolia in rodents in comparison to diazepam. Anxiety was assessed by 'Isolation-induced aggression' model, sedation by 'Spontaneous locomotor activity using actophotometer' and hypnotic activity by 'Prolongation of ketamine-induced sleeping time'. Six male mice were used for each of the groups and postdose, all the six that received diazepam had shown an inhibition of aggression, whereas in the test group, five of six mice and none in the control group had shown an inhibition of aggression (P = 0.0007). Similarly, for the sedative activity, the total number of spontaneous locomotor activity at 30 min following drug administration was found to be 364.67 ± 10.74, 123.16 ± 8.33, and 196.67 ± 3.7, while at 60 min it was found to be 209 ± 12.98, 49 ± 5.78, and 92 ± 2.5 (mean ± SD) for the control, standard, and test groups of mice respectively (P < 0.001). Hypnotic activity was measured by prolongation of ketamine-induced sleeping time wherein the onset and duration of loss of righting reflex were compared among each group of mice. The time in minutes for the onset in control, standard, and test groups was 4.01 ± 0.22, 1.23 ± 0.05, and 2.23 ± 0.07, respectively. The duration of loss of righting reflex was 44.23 ± 0.59, 56.03 ± 1.34, and 50.57 ± 0.36, respectively. Both these were statistically significant (P < 0.001). However, more clinical studies are needed to assess the long-term effects of the extract in humans.

  12. Comparison of oral Midazolam-Ketamine and Midazolam-Promethazine as sedative agents in pediatric dentistry

    PubMed Central

    Golpayegani, Mojtaba Vahid; Dehghan, Fereshteh; Ansari, Ghassem; Shayeghi, Shahnaz

    2012-01-01

    Background: Investigation was designed to evaluate the behavioral changes in children receiving dental treatment while they have been administered combination of Midazolam/Ketamine or Midazolam/Promethazine. Materials and Methods: This was a randomized double blind clinical trial with cases being selected from those uncooperative children aged 2 to 6 years from those referred for treatment under general anesthesia. Anxiety score of all cases were recorded before any attempt using Frankel's anxiety scoring system with those in negative category being included. Cases with at least a pair of similar size cavities on similar teeth were selected with each tooth being randomly allocated for one sedative regimen group. To avoid sequence effect, half of the patients received one regimen at the first visit while the other half received the other regimen as the first. Each case served as control for him or herself to reduce influencing factors. Child's reaction was recorded before, during, and at the end of dental procedure. SO2 as well as Pulse rate were recorded as the most critical vital signs. Collected data were then analyzed using analysis of variance (ANOVA) and paired t-test. Results: Patients’ mean age was 3.5 years with 43% being male. Only 10% of the Ketamine/Midazolam group showed considerable amount of change in their behavior with a statistical significant difference being presented (P=0.029). Conclusion: Under the current circumstances, Ketamine/Midazolam combination provided sufficient sedative effect in lower doses. However, Midazolam/Promethazine combination did not produce similar results. PMID:22363361

  13. Determination of trimeprazine-facilitated sedation in children by hair analysis.

    PubMed

    Kintz, Pascal; Villain, Marion; Cirimele, Vincent

    2006-01-01

    Trimeprazine or alimemazine is largely used as an antipruritic agent, but it is also used for insomnia, cough, and oral premedication in pediatric day surgery. The first cases involving repetitive sedation linked to the use of trimeprazine as a drug-facilitated crime and subsequent impairment of two children are reported. Because of the long delay between the alleged crime and clinical examination, collection of blood or urine was of little value. This is the reason why the laboratory developed an original approach based on hair testing by liquid chromatography-tandem mass spectrometry. A strand of hair from each child was sampled about 2 months after the first suspicion of administration and was cut into small segments. After cutting into small pieces, 20 mg of hair was incubated overnight in a phosphate buffer (pH 8.4). The aqueous phase was extracted by 5 mL of a mixture of diethyl ether/methylene chloride (80:20) in presence of diazepam-d(5) used as the internal standard (IS). Hair extract was separated on a XTerra MS C18 column using a gradient of acetonitrile and formate buffer. Detection was based on two daughter ions: transitions m/z 299.3 to 299.0 and 100.0 and m/z 289.9 to 154.0 for trimeprazine and the IS, respectively. In the hair of the two subjects, trimeprazine was detected at concentrations in the range 23 to 339 pg/mg. The stepmother, who was the perpetrator in both cases, did not challenge the use of trimeprazine as a sedative drug.

  14. Onyx HD-500 embolization of intracranial aneurysms: modified technique using continuous balloon inflation under conscious sedation.

    PubMed

    Rahme, Ralph; Grande, Andrew; Jimenez, Lincoln; Abruzzo, Todd A; Ringer, Andrew J

    2014-08-01

    The conventional technique of intracranial aneurysm embolization using Onyx HD-500 (ev3 Neurovascular, Irvine, CA, USA) involves repetitive balloon inflation-deflation cycles under general anesthesia. By limiting parent artery occlusion to 5 minutes, this cyclic technique is thought to minimize cerebral ischemia. However, intermittent balloon deflation may lengthen procedure time and allow balloon migration, resulting in intimal injury or Onyx leakage. We report our experience using a modified technique of uninterrupted Onyx injection with continuous balloon occlusion under conscious sedation. All Onyx embolization procedures for unruptured aneurysms performed by the senior author (A.J.R.) between September 2008 and April 2010 were retrospectively reviewed. Demographic, clinical, angiographic, and procedural data were recorded. Twenty-four embolization procedures were performed in 21 patients with 23 aneurysms, including four recurrences. Twenty aneurysms (87%) involved the paraclinoid or proximal supraclinoid internal carotid artery. Size ranged from 2.5 to 24mm and neck diameter from 2 to 8mm. The modified technique was employed in 19 cases. All but one patient (94.4%) tolerated continuous balloon inflation. Complete occlusion was achieved in 20 aneurysms (83.3%) and subtotal occlusion in three (12.5%). Stable angiographic results were seen in 85%, 94%, 94%, and 100% of patients at 6, 12, 24, and 36months, respectively. There were no deaths. Permanent non-disabling neurological morbidity occurred in one patient (4.2%). Minor, transient, and/or angiographic complications were seen in three patients (12.5%), none related to the technique itself. Onyx embolization of unruptured intracranial aneurysms can be safely and effectively performed using continuous balloon inflation under conscious sedation.

  15. Nefopam, a Non-sedative Benzoxazocine Analgesic, Selectively Reduces the Shivering Threshold

    PubMed Central

    Alfonsi, Pascal; Adam, Frederic; Passard, Andrea; Guignard, Bruno; Sessler, Daniel I.; Chauvin, Marcel

    2005-01-01

    Background The analgesic nefopam does not compromise ventilation, is minimally sedating, and is effective as a treatment for postoperative shivering. We evaluated the effects of nefopam on the major thermoregulatory responses in humans: sweating, vasoconstriction, and shivering. Methods Nine volunteers were studied on three randomly assigned days: 1) control (Saline), 2) nefopam at a target plasma concentration of 35 ng/ml (Small Dose), and 3) nefopam at a target concentration of 70 ng/ml (Large Dose, ≈20 mg total). Each day, skin and core temperatures were increased to provoke sweating and then reduced to elicit peripheral vasoconstriction and shivering. We determined the thresholds (triggering core temperature at a designated skin temperature of 34°C) by mathematically compensating for changes in skin temperature using the established linear cutaneous contributions to control of each response. Results Nefopam did not significantly modify the slopes for sweating (0.0 ± 4.9°C·μg−1·ml; r2 = 0.73 ± 0.32) or vasoconstriction (−3.6 ± 5.0°C·μg−1·ml; r2=−0.47± 0.41). In contrast, nefopam significantly reduced the slope of shivering (−16.8 ± 9.3°C·μg−1·ml; r2 = 0.92 ± 0.06). Large-Dose nefopam thus reduced the shivering threshold by 0.9 ± 0.4°C (P<0.001) without any discernable effect on the sweating or vasoconstriction thresholds. Conclusions Most drugs with thermoregulatory actions — including anesthetics, sedatives, and opioids — synchronously reduce the vasoconstriction and shivering thresholds. Nefopam however reduced only the shivering threshold. This pattern has not previously been reported for a centrally acting drug. That pharmacologic modulation of vasoconstriction and shivering can be separated is of clinical and physiologic interest. PMID:14695722

  16. 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

  17. 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.

  18. 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

  19. 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

  20. 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

  1. 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

  2. Roles of Mac-1 and glycoprotein IIb/IIIa integrins in leukocyte-platelet aggregate formation: stabilization by Mac-1 and inhibition by GpIIb/IIIa blockers.

    PubMed

    Patko, Zsofia; Csaszar, Albert; Acsady, Gyorgy; Peter, Karlheinz; Schwarz, Meike

    2012-01-01

    Circulating platelet-leukocyte hetero-aggregates play an important role in acute cardiovascular events and hypersensitivity reactions. The association involves the receptor families of selectins and integrin. The objective of this study was to investigate the role of CD11b/CD18 integrin (Mac-1) in hetero-aggregate formation and search for a counter-receptor on platelets ready to interact with Mac-1. As a model of leukocytes, Mac-1 presenting Chinese hamster ovary (CHO) cells were used to evaluate the role of Mac-1 in hetero-aggregate formation. The amount of CHO cell-bound active and inactive platelets was measured by flow cytometry, while the counter-receptors on platelets were identified via using blocking antibodies. We observed significant platelet adhesion on Mac-1-bearing cells when platelet-rich plasma or activated platelets were present. Inactive platelets did not adhere to Mac-1-bearing cells. Addition of fibrinogen, a ligand of Mac-1 significantly increased platelet binding. CD40L was demonstrated to act similarly on Mac-1. Inhibition of platelet GpIIb/IIIa completely abolished CHO cell-platelet aggregation. In our study, we have shown for the first time that Mac-1 mediates the formation of hetero-aggregates without selectin tethering when Mac-1 ligands such as fibrinogen or CD40L are present and blockers of platelet GpIIb/IIIa are able to diminish this interaction.

  3. 12 CFR 615.5174 - Farmer Mac securities.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... securities. (2) Credit risk parameters including: (i) The quantities and types of Farmer Mac mortgage.... (d) Stress Test. You must perform stress tests on mortgage securities that are issued or guaranteed... fails a stress test, you must divest it as required by § 615.5143. Effective Date Note: At 77 FR...

  4. 12 CFR 615.5174 - Farmer Mac securities.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... securities. (2) Credit risk parameters including: (i) The quantities and types of Farmer Mac mortgage.... (d) Stress Test. You must perform stress tests on mortgage securities that are issued or guaranteed... fails a stress test, you must divest it as required by § 615.5143....

  5. The MacArthur Foundation in Nigeria: Report on Activities

    ERIC Educational Resources Information Center

    John D. and Catherine T. MacArthur Foundation, 2009

    2009-01-01

    In 2007, Nigeria passed an important milestone: one elected government passed power to another for the first time in the nation's history. Though imperfect, the poll demonstrated powerfully that Nigeria's representative democracy was not a transient phase between periods of military repression but a growing reality. For 20 years, the MacArthur…

  6. Modeling Woven Polymer Matrix Composites with MAC/GMC

    NASA Technical Reports Server (NTRS)

    Bednarcyk, Brett A.; Arnold, Steven M. (Technical Monitor)

    2000-01-01

    NASA's Micromechanics Analysis Code with Generalized Method of Cells (MAC/GMC) is used to predict the elastic properties of plain weave polymer matrix composites (PMCs). The traditional one step three-dimensional homogertization procedure that has been used in conjunction with MAC/GMC for modeling woven composites in the past is inaccurate due to the lack of shear coupling inherent to the model. However, by performing a two step homogenization procedure in which the woven composite repeating unit cell is homogenized independently in the through-thickness direction prior to homogenization in the plane of the weave, MAC/GMC can now accurately model woven PMCs. This two step procedure is outlined and implemented, and predictions are compared with results from the traditional one step approach and other models and experiments from the literature. Full coupling of this two step technique with MAC/ GMC will result in a widely applicable, efficient, and accurate tool for the design and analysis of woven composite materials and structures.

  7. God, Sport Philosophy, Kinesiology: A MacIntyrean Examination

    ERIC Educational Resources Information Center

    Twietmeyer, Gregg

    2015-01-01

    Sport philosophy is in crisis. This subdiscipline of kinesiology garners little to no respect and few tenure track lines in kinesiology departments. Why is this the case? Why isn't philosophy held in greater esteem? Is it possible that philosopher Alasdair MacIntyre's (2009) diagnosis found in "God, Philosophy, Universities" could…

  8. Proposal and Rationale for the Development of a Mac Lab.

    ERIC Educational Resources Information Center

    Bordner, Marsha

    At Clark State Community College (CSCC), in Ohio, faculty in the Commercial Art and English departments have investigated and debated the best uses for a Mac Lab. Computer needs for the Commercial Art Program were determined through visits to local businesses that produce art on a commercial level; to local secondary school commercial art…

  9. What if MacGyver Taught Physical Education?

    ERIC Educational Resources Information Center

    Marston, Rip; Leech, Trey

    2014-01-01

    In an era of rising childhood obesity rates, many physical educators find themselves with declining financial resources. Similar to how MacGyver had to do when he was in a bind on his self-titled television show, physical educators need to think creatively when providing equipment for use by their students. The problem that has been identified is:…

  10. MacMahon's conjecture on symmetric plane partitions

    PubMed Central

    Andrews, George E.

    1977-01-01

    In 1898, P. A. MacMahon conjectured that the generating function for symmetric plane partitions with at most s rows and each part at most j has an especially simple closed form. An outline of the proof of this conjecture is given here. PMID:16592386

  11. MacDowell-Mansouri gravity and Cartan geometry

    NASA Astrophysics Data System (ADS)

    Wise, Derek K.

    2010-08-01

    The geometric content of the MacDowell-Mansouri formulation of general relativity is best understood in terms of Cartan geometry. In particular, Cartan geometry gives clear geometric meaning to the MacDowell-Mansouri trick of combining the Levi-Civita connection and coframe field, or soldering form, into a single physical field. The Cartan perspective allows us to view physical spacetime as tangentially approximated by an arbitrary homogeneous 'model spacetime', including not only the flat Minkowski model, as is implicitly used in standard general relativity, but also de Sitter, anti-de Sitter or other models. A 'Cartan connection' gives a prescription for parallel transport from one 'tangent model spacetime' to another, along any path, giving a natural interpretation of the MacDowell-Mansouri connection as 'rolling' the model spacetime along physical spacetime. I explain Cartan geometry, and 'Cartan gauge theory', in which the gauge field is replaced by a Cartan connection. In particular, I discuss MacDowell-Mansouri gravity, as well as its more recent reformulation in terms of BF theory, in the context of Cartan connections.

  12. Integrated, Kerberized Login on MacOS X

    NASA Technical Reports Server (NTRS)

    Hotz, Henry B.

    2006-01-01

    Context for this information. MacOS X login process and available hooks. Authorization Services configuration. Authorization Services plug-in s. Kerberos plug-in s. Other bugs and recommendations. Authorization Services Called by loginwindow, screen saver and fast user switching. It calls Directory Services, Login Hook, and Login Items (System Preferences).

  13. 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.

  14. 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

  15. 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…

  16. 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

  17. 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...

  18. 42 CFR 405.1110 - MAC reviews on its own motion.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false MAC reviews on its own motion. 405.1110 Section 405....1110 MAC reviews on its own motion. (a) General rule. The MAC may decide on its own motion to review a decision or dismissal issued by an ALJ. CMS or any of its contractors may refer a case to the MAC for it...

  19. Photocopy of drawing (original drawing of MacDill Field in possession ...

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

    Photocopy of drawing (original drawing of MacDill Field in possession of MacDill Air Force Base, Civil Engineering, Tampa, Florida; 1952 architectural drawings by Strategic Air Command, MacDill Air Force Base) BASE LAYOUT, 1952 - MacDill Air Force Base, Bounded by City of Tampa North, Tampa Bay South, Old Tampa Bay West, & Hillsborough Bay East, Tampa, Hillsborough County, FL

  20. [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.

  1. [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

  2. 42 CFR 423.2108 - MAC Actions when request for review is filed.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false MAC Actions when request for review is filed. 423... Hearings, MAC review, and Judicial Review § 423.2108 MAC Actions when request for review is filed. (a) General. Except as specified in paragraph (c) of this section, when an enrollee requests that the...

  3. 33 CFR 165.768 - Security Zone; MacDill Air Force Base, Tampa Bay, FL.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Security Zone; MacDill Air Force....768 Security Zone; MacDill Air Force Base, Tampa Bay, FL. (a) Location. The following area is a... title. All waters within Tampa Bay, Florida in the vicinity of MacDill Air Force Base,...

  4. 42 CFR 405.1108 - MAC actions when request for review or escalation is filed.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false MAC actions when request for review or escalation...) Medicare Appeals Council Review § 405.1108 MAC actions when request for review or escalation is filed. (a) Except as specified in paragraphs (c) and (d) of this section, when a party requests that the MAC...

  5. 78 FR 65541 - Federal Agricultural Mortgage Corporation Funding and Fiscal Affairs; Farmer Mac Liquidity...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-01

    ... 75 FR 27951 (May 19, 2010). \\12\\ See 76 FR 71798 supra. By a letter dated April 17, 2013, Farmer Mac... detail in the proposed rule imposes the FCA's business judgments on Farmer Mac's board. \\22\\ See 76 FR... change, pending the adoption of final liquidity rules for Farmer Mac. See 77 FR 66375, supra at...

  6. 42 CFR 405.1102 - Request for MAC review when ALJ issues decision or dismissal.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Request for MAC review when ALJ issues decision or...) Medicare Appeals Council Review § 405.1102 Request for MAC review when ALJ issues decision or dismissal. (a)(1) A party to the ALJ hearing may request a MAC review if the party files a written request for...

  7. 75 FR 69154 - Land Release for Long Island MacArthur Airport

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-10

    ... Federal Aviation Administration Land Release for Long Island MacArthur Airport AGENCY: Federal Aviation... requesting public comment on the Long Island MacArthur Airport (ISP), Ronkonkoma, New York, notice of...-aeronautical development. The parcel is located on the northeast corner of the Long Island MacArthur...

  8. 42 CFR 405.1050 - Removal of a hearing request from an ALJ to the MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Removal of a hearing request from an ALJ to the MAC... Removal of a hearing request from an ALJ to the MAC. If a request for hearing is pending before an ALJ, the MAC may assume responsibility for holding a hearing by requesting that the ALJ send the...

  9. Factor Structure and Validity of the MacArthur Competence Assessment Tool--Criminal Adjudication

    ERIC Educational Resources Information Center

    Zapf, Patricia A.; Skeem, Jennifer L.; Golding, Stephen L.

    2005-01-01

    Examination of the available literature regarding the development of the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA) reveals 2 theoretical factor structures on which the MacCAT-CA was based: one in which 3 lower-order constructs are proposed (understanding, reasoning, appreciation) and one in which 2 higher-order…

  10. Library Signage: Applications for the Apple Macintosh and MacPaint.

    ERIC Educational Resources Information Center

    Diskin, Jill A.; FitzGerald, Patricia

    1984-01-01

    Describes specific applications of the Macintosh computer at Carnegie-Mellon University Libraries, where MacPaint was used as a flexible, easy to use, and powerful tool to produce informational, instructional, and promotional signage. Profiles of system hardware and software, an evaluation of the computer program MacPaint, and MacPaint signage…

  11. 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.

  12. 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.

  13. CoR-MAC: Contention over Reservation MAC Protocol for Time-Critical Services in Wireless Body Area Sensor Networks.

    PubMed

    Yu, Jeongseok; Park, Laihyuk; Park, Junho; Cho, Sungrae; Keum, Changsup

    2016-05-09

    Reserving time slots for urgent data, such as life-critical information, seems to be very attractive to guarantee their deadline requirements in wireless body area sensor networks (WBASNs). On the other hand, this reservation imposes a negative impact on performance for the utilization of a channel. This paper proposes a new channel access scheme referred to as the contention over reservation MAC (CoR-MAC) protocol for time-critical services in wireless body area sensor networks. CoR-MAC uses the dual reservation; if the reserved time slots are known to be vacant, other nodes can access the time slots by contention-based reservation to maximize the utilization of a channel and decrease the delay of the data. To measure the effectiveness of the proposed scheme against IEEE 802.15.4 and IEEE 802.15.6, we evaluated their performances with various performance indexes. The CoR-MAC showed 50% to 850% performance improvement in terms of the delay of urgent and time-critical data according to the number of nodes.

  14. CoR-MAC: Contention over Reservation MAC Protocol for Time-Critical Services in Wireless Body Area Sensor Networks.

    PubMed

    Yu, Jeongseok; Park, Laihyuk; Park, Junho; Cho, Sungrae; Keum, Changsup

    2016-01-01

    Reserving time slots for urgent data, such as life-critical information, seems to be very attractive to guarantee their deadline requirements in wireless body area sensor networks (WBASNs). On the other hand, this reservation imposes a negative impact on performance for the utilization of a channel. This paper proposes a new channel access scheme referred to as the contention over reservation MAC (CoR-MAC) protocol for time-critical services in wireless body area sensor networks. CoR-MAC uses the dual reservation; if the reserved time slots are known to be vacant, other nodes can access the time slots by contention-based reservation to maximize the utilization of a channel and decrease the delay of the data. To measure the effectiveness of the proposed scheme against IEEE 802.15.4 and IEEE 802.15.6, we evaluated their performances with various performance indexes. The CoR-MAC showed 50% to 850% performance improvement in terms of the delay of urgent and time-critical data according to the number of nodes. PMID:27171085

  15. CoR-MAC: Contention over Reservation MAC Protocol for Time-Critical Services in Wireless Body Area Sensor Networks

    PubMed Central

    Yu, Jeongseok; Park, Laihyuk; Park, Junho; Cho, Sungrae; Keum, Changsup

    2016-01-01

    Reserving time slots for urgent data, such as life-critical information, seems to be very attractive to guarantee their deadline requirements in wireless body area sensor networks (WBASNs). On the other hand, this reservation imposes a negative impact on performance for the utilization of a channel. This paper proposes a new channel access scheme referred to as the contention over reservation MAC (CoR-MAC) protocol for time-critical services in wireless body area sensor networks. CoR-MAC uses the dual reservation; if the reserved time slots are known to be vacant, other nodes can access the time slots by contention-based reservation to maximize the utilization of a channel and decrease the delay of the data. To measure the effectiveness of the proposed scheme against IEEE 802.15.4 and IEEE 802.15.6, we evaluated their performances with various performance indexes. The CoR-MAC showed 50% to 850% performance improvement in terms of the delay of urgent and time-critical data according to the number of nodes. PMID:27171085

  16. MacMouse. Developing Preschool Readiness Concepts and Skills with HyperCard and MacRecorder.

    ERIC Educational Resources Information Center

    Fitterman, L. Jeffrey

    Through developments with the use of the "Apple Macintosh" computer, "HyperCard," and "MacRecorder," children in preschool handicapped programs are now capable of participating in appropriate computerized learning experiences. "HyperCard" allows educators to produce their own computerized instructional lessons with a software program that…

  17. 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

  18. Dental treatment for handicapped patients; sedation vs general anesthesia and update of dental treatment in patients with different diseases

    PubMed Central

    Corcuera-Flores, José R.; Delgado-Muñoz, José M.; Ruiz-Villandiego, José C.; Maura-Solivellas, Isabel

    2014-01-01

    Dental treatment on Handicapped Patients is often difficult because many people with a wide range of ages (from children to the elderly) with different pathologies that can affect the oral cavity and differ widely are included in this group. This situation creates some controversy, because according to pathology, each patient will be treated differently depending on collaboration, general health status, age or medication used to treat this pathologies. According to this situation we can opt for an outpatient treatment without any kind of previous medication, a treatment under conscious or deep sedation or a under general anesthesia treatment. With this systematic review is intended to help clarify in which cases patients should be treated under general anesthesia, sedation (conscious or deep) or outpatient clinic without any medication, as well as clarify what kind of treatments can be carried in private dental clinics and which should be carried out in a hospital. It will also discuss the most common diseases among this group of patients and the special care to be taken for their dental treatment. Key words:Hospital dentistry, handicapped patient. PMID:24121922

  19. MacB ABC transporter is a dimer whose ATPase activity and macrolide-binding capacity are regulated by the membrane fusion protein MacA.

    PubMed

    Lin, Hong Ting; Bavro, Vassiliy N; Barrera, Nelson P; Frankish, Helen M; Velamakanni, Saroj; van Veen, Hendrik W; Robinson, Carol V; Borges-Walmsley, M Inês; Walmsley, Adrian R

    2009-01-01

    Gram-negative bacteria utilize specialized machinery to translocate drugs and protein toxins across the inner and outer membranes, consisting of a tripartite complex composed of an inner membrane secondary or primary active transporter (IMP), a periplasmic membrane fusion protein, and an outer membrane channel. We have investigated the assembly and function of the MacAB/TolC system that confers resistance to macrolides in Escherichia coli. The membrane fusion protein MacA not only stabilizes the tripartite assembly by interacting with both the inner membrane protein MacB and the outer membrane protein TolC, but also has a role in regulating the function of MacB, apparently increasing its affinity for both erythromycin and ATP. Analysis of the kinetic behavior of ATP hydrolysis indicated that MacA promotes and stabilizes the ATP-binding form of the MacB transporter. For the first time, we have established unambiguously the dimeric nature of a noncanonic ABC transporter, MacB that has an N-terminal nucleotide binding domain, by means of nondissociating mass spectrometry, analytical ultracentrifugation, and atomic force microscopy. Structural studies of ABC transporters indicate that ATP is bound between a pair of nucleotide binding domains to stabilize a conformation in which the substrate-binding site is outward-facing. Consequently, our data suggest that in the presence of ATP the same conformation of MacB is promoted and stabilized by MacA. Thus, MacA would facilitate the delivery of drugs by MacB to TolC by enhancing the binding of drugs to it and inducing a conformation of MacB that is primed and competent for binding TolC. Our structural studies are an important first step in understanding how the tripartite complex is assembled.

  20. MacB ABC transporter is a dimer whose ATPase activity and macrolide-binding capacity are regulated by the membrane fusion protein MacA.

    PubMed

    Lin, Hong Ting; Bavro, Vassiliy N; Barrera, Nelson P; Frankish, Helen M; Velamakanni, Saroj; van Veen, Hendrik W; Robinson, Carol V; Borges-Walmsley, M Inês; Walmsley, Adrian R

    2009-01-01

    Gram-negative bacteria utilize specialized machinery to translocate drugs and protein toxins across the inner and outer membranes, consisting of a tripartite complex composed of an inner membrane secondary or primary active transporter (IMP), a periplasmic membrane fusion protein, and an outer membrane channel. We have investigated the assembly and function of the MacAB/TolC system that confers resistance to macrolides in Escherichia coli. The membrane fusion protein MacA not only stabilizes the tripartite assembly by interacting with both the inner membrane protein MacB and the outer membrane protein TolC, but also has a role in regulating the function of MacB, apparently increasing its affinity for both erythromycin and ATP. Analysis of the kinetic behavior of ATP hydrolysis indicated that MacA promotes and stabilizes the ATP-binding form of the MacB transporter. For the first time, we have established unambiguously the dimeric nature of a noncanonic ABC transporter, MacB that has an N-terminal nucleotide binding domain, by means of nondissociating mass spectrometry, analytical ultracentrifugation, and atomic force microscopy. Structural studies of ABC transporters indicate that ATP is bound between a pair of nucleotide binding domains to stabilize a conformation in which the substrate-binding site is outward-facing. Consequently, our data suggest that in the presence of ATP the same conformation of MacB is promoted and stabilized by MacA. Thus, MacA would facilitate the delivery of drugs by MacB to TolC by enhancing the binding of drugs to it and inducing a conformation of MacB that is primed and competent for binding TolC. Our structural studies are an important first step in understanding how the tripartite complex is assembled. PMID:18955484

  1. MacB ABC Transporter Is a Dimer Whose ATPase Activity and Macrolide-binding Capacity Are Regulated by the Membrane Fusion Protein MacA*S⃞

    PubMed Central

    Lin, Hong Ting; Bavro, Vassiliy N.; Barrera, Nelson P.; Frankish, Helen M.; Velamakanni, Saroj; van Veen, Hendrik W.; Robinson, Carol V.; Borges-Walmsley, M. Inês; Walmsley, Adrian R.

    2009-01-01

    Gram-negative bacteria utilize specialized machinery to translocate drugs and protein toxins across the inner and outer membranes, consisting of a tripartite complex composed of an inner membrane secondary or primary active transporter (IMP), a periplasmic membrane fusion protein, and an outer membrane channel. We have investigated the assembly and function of the MacAB/TolC system that confers resistance to macrolides in Escherichia coli. The membrane fusion protein MacA not only stabilizes the tripartite assembly by interacting with both the inner membrane protein MacB and the outer membrane protein TolC, but also has a role in regulating the function of MacB, apparently increasing its affinity for both erythromycin and ATP. Analysis of the kinetic behavior of ATP hydrolysis indicated that MacA promotes and stabilizes the ATP-binding form of the MacB transporter. For the first time, we have established unambiguously the dimeric nature of a noncanonic ABC transporter, MacB that has an N-terminal nucleotide binding domain, by means of nondissociating mass spectrometry, analytical ultracentrifugation, and atomic force microscopy. Structural studies of ABC transporters indicate that ATP is bound between a pair of nucleotide binding domains to stabilize a conformation in which the substrate-binding site is outward-facing. Consequently, our data suggest that in the presence of ATP the same conformation of MacB is promoted and stabilized by MacA. Thus, MacA would facilitate the delivery of drugs by MacB to TolC by enhancing the binding of drugs to it and inducing a conformation of MacB that is primed and competent for binding TolC. Our structural studies are an important first step in understanding how the tripartite complex is assembled. PMID:18955484

  2. 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

  3. [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)

  4. 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.

  5. 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.

  6. 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.

  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. 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

  9. A Rosenzweig-MacArthur (1963) Criterion for the Chemostat

    PubMed Central

    Cheng, Yuanji

    2016-01-01

    The Rosenzweig-MacArthur (1963) criterion is a graphical criterion that has been widely used for elucidating the local stability properties of the Gause (1934) type predator-prey systems. It has not been stated whether a similar criterion holds for models with explicit resource dynamics (Kooi et al. (1998)), like the chemostat model. In this paper we use the implicit function theorem and implicit derivatives for proving that a similar graphical criterion holds under chemostat conditions, too. PMID:27517080

  10. A Rosenzweig-MacArthur (1963) Criterion for the Chemostat.

    PubMed

    Lindström, Torsten; Cheng, Yuanji

    2016-01-01

    The Rosenzweig-MacArthur (1963) criterion is a graphical criterion that has been widely used for elucidating the local stability properties of the Gause (1934) type predator-prey systems. It has not been stated whether a similar criterion holds for models with explicit resource dynamics (Kooi et al. (1998)), like the chemostat model. In this paper we use the implicit function theorem and implicit derivatives for proving that a similar graphical criterion holds under chemostat conditions, too.

  11. Preliminary results on B-anti B mixing from MAC

    SciTech Connect

    Hurst, R.

    1987-05-01

    An excess of like-charge dimuons has been observed with the MAC detector in multihadron events produced in e e annihilation at s = 29 GeV. If this excess is attributed to B - anti B mixing, the corresponding value of the mixing parameter chi = GAMMA(B X)/GAMMA(B X) is chi = 0.21/sub -0.15//sup +0.25/ and chi > 0.02 at 90% C.L.

  12. 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.

  13. 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

  14. Micromechanics Analysis Code (MAC) User Guide: Version 1.0

    NASA Technical Reports Server (NTRS)

    Wilt, T. E.; Arnold, S. M.

    1994-01-01

    The ability to accurately predict the thermomechanical deformation response of advanced composite materials continues to play an important role in the development of these strategic materials. Analytical models that predict the effective behavior of composites are used not only by engineers performing structural analysis of large-scale composite components but also by material scientists in developing new material systems. For an analytical model to fulfill these two distinct functions it must be based on a micromechanics approach which utilizes physically based deformation and life constitutive models and allows one to generate the average (macro) response of a composite material given the properties of the individual constituents and their geometric arrangement. Here the user guide for the recently developed, computationally efficient and comprehensive micromechanics analysis code, MAC, who's predictive capability rests entirely upon the fully analytical generalized method of cells, GMC, micromechanics model is described. MAC is a versatile form of research software that 'drives' the double or triple ply periodic micromechanics constitutive models based upon GMC. MAC enhances the basic capabilities of GMC by providing a modular framework wherein (1) various thermal, mechanical (stress or strain control), and thermomechanical load histories can be imposed; (2) different integration algorithms may be selected; (3) a variety of constituent constitutive models may be utilized and/or implemented; and (4) a variety of fiber architectures may be easily accessed through their corresponding representative volume elements.

  15. Micromechanics Analysis Code (MAC). User Guide: Version 2.0

    NASA Technical Reports Server (NTRS)

    Wilt, T. E.; Arnold, S. M.

    1996-01-01

    The ability to accurately predict the thermomechanical deformation response of advanced composite materials continues to play an important role in the development of these strategic materials. Analytical models that predict the effective behavior of composites are used not only by engineers performing structural analysis of large-scale composite components but also by material scientists in developing new material systems. For an analytical model to fulfill these two distinct functions it must be based on a micromechanics approach which utilizes physically based deformation and life constitutive models and allows one to generate the average (macro) response of a composite material given the properties of the individual constituents and their geometric arrangement. Here the user guide for the recently developed, computationally efficient and comprehensive micromechanics analysis code's (MAC) who's predictive capability rests entirely upon the fully analytical generalized method of cells (GMC), micromechanics model is described. MAC is a versatile form of research software that 'drives' the double or triply periodic micromechanics constitutive models based upon GMC. MAC enhances the basic capabilities of GMC by providing a modular framework wherein (1) various thermal, mechanical (stress or strain control) and thermomechanical load histories can be imposed, (2) different integration algorithms may be selected, (3) a variety of constituent constitutive models may be utilized and/or implemented, and (4) a variety of fiber and laminate architectures may be easily accessed through their corresponding representative volume elements.

  16. 42 CFR 423.2116 - Effect of dismissal of request for MAC review or request for hearing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Effect of dismissal of request for MAC review or... BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2116 Effect of dismissal of request for MAC review or request for hearing. The dismissal of a request for MAC review or denial of...

  17. 42 CFR 423.2140 - MAC Review of ALJ decision in a case remanded by a Federal District Court.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false MAC Review of ALJ decision in a case remanded by a... BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2140 MAC Review of ALJ decision in..., when a case is remanded by a Federal District Court for further consideration and the MAC remands...

  18. Audiovisual distraction as a useful adjunct to epidural anesthesia and sedation for prolonged lower limb microvascular orthoplastic surgery.

    PubMed

    Athanassoglou, Vassilis; Wallis, Anna; Galitzine, Svetlana

    2015-11-01

    Lower limb orthopedic operations are frequently performed under regional anesthesia, which allows avoidance of potential side effects and complications of general anesthesia and sedation. Often though, patients feel anxious about being awake during operations. To decrease intraoperative anxiety, we use multimedia equipment consisting of a tablet device, noise-canceling headphones, and a makeshift frame, where patients can listen to music, watch movies, or occupy themselves in numerous ways. These techniques have been extensively studies in minimally invasive, short, or minor procedures but not in prolonged orthoplastic operations. We report 2 cases where audiovisual distraction was successfully applied to 9.5-hour procedures, proved to be a very useful adjunct to epidural anesthesia + sedation, and made an important contribution to positive patients' outcomes and overall patients' experience with regional anesthesia for complex limb reconstructive surgery. In the era when not only patients' safety and clinical outcomes but also patients' positive experiences are of paramount importance, audiovisual distraction may provide a simple tool to help improve experience of appropriately informed patients undergoing suitable procedures under regional anesthesia. The anesthetic technique received a very positive appraisal by both patients and encouraged us to study further the impact of modern audiovisual technology on anxiolysis for major surgery under regional anesthesia. The duration of surgery per se is not a contraindication to the use of audiovisual distraction. The absolute proviso of successful application of this technique to major surgery is effective regional anesthesia and good teamwork between the clinicians and the patients.

  19. MacA, a periplasmic membrane fusion protein of the macrolide transporter MacAB-TolC, binds lipopolysaccharide core specifically and with high affinity.

    PubMed

    Lu, Shuo; Zgurskaya, Helen I

    2013-11-01

    The Escherichia coli MacAB-TolC transporter has been implicated in efflux of macrolide antibiotics and secretion of enterotoxin STII. In this study, we found that purified MacA, a periplasmic membrane fusion protein, contains one tightly bound rough core lipopolysaccharide (R-LPS) molecule per MacA molecule. R-LPS was bound specifically to MacA protein with affinity exceeding that of polymyxin B. Sequence analyses showed that MacA contains two high-density clusters of positively charged amino acid residues located in the cytoplasmic N-terminal domain and the periplasmic C-terminal domain. Substitutions in the C-terminal cluster reducing the positive-charge density completely abolished binding of R-LPS. At the same time, these substitutions significantly reduced the functionality of MacA in the protection of E. coli against macrolides in vivo and in the in vitro MacB ATPase stimulation assays. Taken together, our results suggest that R-LPS or a similar glycolipid is a physiological substrate of MacAB-TolC. PMID:23974027

  20. 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

  1. 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.

  2. [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.

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. Mycobacterium avium complex (MAC) osteomyelitis and septic arthritis in an immunocompetent host.

    PubMed

    Jones, A R; Bartlett, J; McCormack, J G

    1995-01-01

    We describe a case of Mycobacterium avium complex (MAC) osteomyelitis and septic arthritis in an immunocompetent man. Infection was derived from a chainsaw injury sustained on the lateral aspect of the ankle 13 years earlier, and had spread through the bone, joint and soft tissue emerging at the medial aspect. This was successfully treated with surgical debridement, drainage, arthrodesis and 18 months of chemotherapy consisting of clarithromycin, rifampicin, ethambutol, and ciprofloxacin with an initial 2 weeks of amikacin. Infections with this organisms are generally associated with immunocompromised states, particularly advanced AIDS. However, our patient illustrates that atypical mycobacterial infections must also be considered in immunocompetent patients who have a prolonged clinical course and an appropriate potential source of infection.

  9. 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

  10. 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

  11. 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.

  12. 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

  13. Somatosensory evoked potentials can be recorded on the midline of the skull with subdermal electrodes in non-sedated rats elicited by magnetic stimulation of the tibial nerve.

    PubMed

    Zhang, Shu-Xin; Huang, Fengfa; Gates, Mary; Holmberg, Eric G

    2012-07-15

    Somatosensory evoked potentials (SSEPs) are a sensitive quantitative measure of conduction in somatosensory pathways of the central nervous system and are increasingly used in both clinical trials and animal experiments. SSEPs can be recorded in non-sedated rodents by magnetic stimulation (MS) of peripheral nerves. To overcome some disadvantages caused by using anesthesia and implanted recording electrodes, we used subdermal needle electrodes located on the midline of the skull to successfully record SSEPs in non-sedated rats, elicited by stimulating the tibial nerve with a magnetic stimulator. The wave form contains a typical P1 peak and N1 peak. Although there is a variation of P1 latency, N1 latency, and P1-N1 amplitude between right side and left side, it was not statistically significant. In addition, there is a significantly positive relationship between P1-N1 amplitude and MS strength, suggesting that the increase in magnetic stimulating strength resulted in the increase in P1-N1 amplitude. Results in the present study demonstrate that our modified method is a reliable and feasible paradigm for recording SSEPs in non-sedated rats. PMID:22579876

  14. Comparison of the applicability of rule-based and self-organizing fuzzy logic controllers for sedation control of intracranial pressure pattern in a neurosurgical intensive care unit.

    PubMed

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

    2006-08-01

    This paper assesses the controller performance of a self-organizing fuzzy logic controller (SOFLC) in comparison with a routine clinical rule-base controller (RBC) for sedation control of intracranial pressure (ICP) pattern. Eleven patients with severe head injury undergoing different neurosurgeries in a neurosurgical intensive care unit (NICU) were divided into two groups. In all cases the sedation control periods lasted 1 h and assessments of propofol infusion rates were made at a frequency of once per 30 s. In the control group of 10 cases selected from 5 patients, a RBC was used, and in the experimental group of 10 cases selected from 6 patients, a self-organizing fuzzy logic controller was used. A SOFLC was derived from a fuzzy logic controller and allowed to generate new rules via self-learning beyond the initial fuzzy rule-base obtained from experts (i.e., neurosurgeons). The performance of the controllers was analyzed using the ICP pattern of sedation for 1 h of control. The results show that a SOFLC can provide a more stable ICP pattern by administering more propofol and changing the rate of delivery more often when rule-base modifications have been considered.

  15. Standing sedation in African elephants (Loxodonta africana) using detomidine-butorphanol combinations.

    PubMed

    Neiffer, Donald L; Miller, Michele A; Weber, Martha; Stetter, Mark; Fontenot, Deidre K; Robbins, P K; Pye, Geoffrey W

    2005-06-01

    Standing sedation was provided for 14 clinical procedures in three African elephants (Loxodonta africana) managed by combined protected and modified-protected contact and trained through operant conditioning. An initial hand-injection of detomidine hydrochloride and butorphanol tartrate at a ratio of 1:1 on a microg:microg basis was administered intramuscularly, with a dosage range of 50-70 mg (12.9-19.7 microg/kg) for each drug. The initial injection resulted in adequate sedation for initiation and completion of eight procedures, whereas supplemental doses were required for the remaining procedures. The dosage range for the supplemental injections of each drug was 4.0-7.3 microg/kg. Initial effect was noted within 3.0-25 min (mean = 11.6 min, SD +/- 5.9 min), with maximal effect occurring at 25-30 min for those procedures not requiring supplementation. In all but one procedure, this effect was maintained until the end of the procedure, which ranged from 47 to 98 min (mean = 74.7 min, SD +/- 18.8 min). No cardiac or respiratory depression was appreciated. Recovery after administration of reversal agents was rapid and complete, ranging from 2 to 20 min (mean = 9.0 min, SD +/- 7.0 min). On the basis of the authors' experience, recommended dosage ranges for reversal agents would be intravenous yohimbine (73.4-98.5 microg/kg), intravenous naltrexone (48.9-98.5 microg/kg), and intramuscular naltrexone (73.4-98.5 microg/kg). Approximately one-third to one-half of the total naltrexone dose should be administered intravenously. Mild adverse side effects limited to the gastrointestinal tract were observed in association with five procedures including abdominal distention with or without transient anorexia. Administration of reversal agents, encouraging exercise and water consumption, and administration of flunixin meglumine were helpful in the resolution of signs. In addition to gastrointestinal signs, slight ataxia was observed before initiation of surgical stimulation

  16. Standing sedation in African elephants (Loxodonta africana) using detomidine-butorphanol combinations.

    PubMed

    Neiffer, Donald L; Miller, Michele A; Weber, Martha; Stetter, Mark; Fontenot, Deidre K; Robbins, P K; Pye, Geoffrey W

    2005-06-01

    Standing sedation was provided for 14 clinical procedures in three African elephants (Loxodonta africana) managed by combined protected and modified-protected contact and trained through operant conditioning. An initial hand-injection of detomidine hydrochloride and butorphanol tartrate at a ratio of 1:1 on a microg:microg basis was administered intramuscularly, with a dosage range of 50-70 mg (12.9-19.7 microg/kg) for each drug. The initial injection resulted in adequate sedation for initiation and completion of eight procedures, whereas supplemental doses were required for the remaining procedures. The dosage range for the supplemental injections of each drug was 4.0-7.3 microg/kg. Initial effect was noted within 3.0-25 min (mean = 11.6 min, SD +/- 5.9 min), with maximal effect occurring at 25-30 min for those procedures not requiring supplementation. In all but one procedure, this effect was maintained until the end of the procedure, which ranged from 47 to 98 min (mean = 74.7 min, SD +/- 18.8 min). No cardiac or respiratory depression was appreciated. Recovery after administration of reversal agents was rapid and complete, ranging from 2 to 20 min (mean = 9.0 min, SD +/- 7.0 min). On the basis of the authors' experience, recommended dosage ranges for reversal agents would be intravenous yohimbine (73.4-98.5 microg/kg), intravenous naltrexone (48.9-98.5 microg/kg), and intramuscular naltrexone (73.4-98.5 microg/kg). Approximately one-third to one-half of the total naltrexone dose should be administered intravenously. Mild adverse side effects limited to the gastrointestinal tract were observed in association with five procedures including abdominal distention with or without transient anorexia. Administration of reversal agents, encouraging exercise and water consumption, and administration of flunixin meglumine were helpful in the resolution of signs. In addition to gastrointestinal signs, slight ataxia was observed before initiation of surgical stimulation

  17. 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

  18. 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

  19. 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

  20. 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.

  1. The safety and efficacy of outpatient midazolam intravenous sedation for oral surgery with and without fentanyl.

    PubMed Central

    Milgrom, P.; Beirne, O. R.; Fiset, L.; Weinstein, P.; Tay, K. M.; Martin, M.

    1993-01-01

    This study examined midazolam and midazolam plus fentanyl in a placebo-controlled, double-blind clinical trial. It tested the hypothesis that combined drug therapy results in significantly poorer safety but no difference in efficacy compared to the single drug approach. Subjects were among 207 mildly anxious young adults having their third molars removed. Fentanyl had a significant depressant effect on respiration. Fifty of 79 (63%) subjects who received a midazolam-fentanyl combination became apneic, while only two of 78 (3%) who received midazolam alone were apneic (Fisher's Exact Test, P < 0.001). Two subjects (2.5%) in the combination group and none in the midazolam alone group had oxygen saturations drop below 90%. About twice as many subjects in the combination group had end-tidal carbon dioxide (EtCO2) levels greater than 25% above baseline. While these results are consistent with those for apnea, contingency analyses of the oxygen saturation and EtCO2 results were not statistically significant. Subjects in the combination group were more than four times as likely to have excellent versus good, fair, or poor sedation at a given level of intraoperative pain, and behavioral (movement and verbalization) but not cognitive measures of anxiety were attenuated. PMID:7645789

  2. State of the art: sedation concepts with volatile anesthetics in critically Ill patients.

    PubMed

    Soukup, Jens; Schärff, Katharina; Kubosch, Kristina; Pohl, Carsten; Bomplitz, Michael; Kompardt, Jesco

    2009-12-01

    The use of volatile anesthetics in the intensive care unit (ICU) has only been possible at great cost with the use of commercially available anesthesia systems. A new anesthetic-conserving device (AnaConDa) now facilitates, from a technical viewpoint, the routine use of volatile anesthetics in intensive care patients as part of prolonged sedation, using ICU ventilators. The volatile anesthetic is hereby applied continually via a syringe pump into a miniature vaporizer, which is integrated into the ventilator circuit in place of the usual respiratory filter. During expiration, the anesthetic exhaled by the patient enters the recirculation system, is predominantly stored in the active carbon layer of the anesthetic-conserving device, and redirected into the inspiratory air. At clinically relevant concentrations, more than 90% of the gas is recirculated in such a way. Aside from the possibility of using a central anesthetic gas scavenging system, the use of special passive residual gas filters, which can be connected to the expiratory outlet of the respirator machine, appears above all to be practical. The use of volatile anesthetics on the ICU could adopt a permanent position in various intensive care analgosedation concepts in future. It may be possible thereby to optimize the treatment process both in medical and economical terms. PMID:19327951

  3. 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

  4. Intelligent Cooperative MAC Protocol for Balancing Energy Consumption

    NASA Astrophysics Data System (ADS)

    Wu, S.; Liu, K.; Huang, B.; Liu, F.

    To extend the lifetime of wireless sensor networks, we proposed an intelligent balanced energy consumption cooperative MAC protocol (IBEC-CMAC) based on the multi-node cooperative transmission model. The protocol has priority to access high-quality channels for reducing energy consumption of each transmission. It can also balance the energy consumption among cooperative nodes by using high residual energy nodes instead of excessively consuming some node's energy. Simulation results show that IBEC-CMAC can obtain longer network lifetime and higher energy utilization than direct transmission.

  5. Mac configuration management at the Los Alamos National Laboratory

    SciTech Connect

    Marcus, Allan B

    2010-01-01

    The Los Alamos National Laboratory (LANL) had a need for central configuration management of non-Windows computers. LANL has three to five thousand Macs and an equal number of Linux based systems. The primary goal was to be able to inventory all non-windows systems and patch Mc OS X systems. LANL examined a number of commercial and open source solutions and ultimately selected Puppet. This paper will discuss why we chose Puppet, how we implemented it, and some lessons we learned along the way.

  6. MQ-MAC: a multi-constrained QoS-aware duty cycle MAC for heterogeneous traffic in wireless sensor networks.

    PubMed

    Monowar, Muhammad Mostafa; Rahman, Md Obaidur; Hong, Choong Seon; Lee, Sungwon

    2010-01-01

    Energy conservation is one of the striking research issues now-a-days for power constrained wireless sensor networks (WSNs) and hence, several duty-cycle based MAC protocols have been devised for WSNs in the last few years. However, assimilation of diverse applications with different QoS requirements (i.e., delay and reliability) within the same network also necessitates in devising a generic duty-cycle based MAC protocol that can achieve both the delay and reliability guarantee, termed as multi-constrained QoS, while preserving the energy efficiency. To address this, in this paper, we propose a Multi-constrained QoS-aware duty-cycle MAC for heterogeneous traffic in WSNs (MQ-MAC). MQ-MAC classifies the traffic based on their multi-constrained QoS demands. Through extensive simulation using ns-2 we evaluate the performance of MQ-MAC. MQ-MAC provides the desired delay and reliability guarantee according to the nature of the traffic classes as well as achieves energy efficiency.

  7. 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

  8. 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.

  9. 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

  10. Serum Mac-2 binding protein is a novel biomarker for chronic pancreatitis

    PubMed Central

    Maekawa, Tomohiro; Kamada, Yoshihiro; Ebisutani, Yusuke; Ueda, Makiko; Hata, Tomoki; Kawamoto, Koichi; Takamatsu, Shinji; Mizutani, Kayo; Shimomura, Mayuka; Sobajima, Tomoaki; Fujii, Hironobu; Nakayama, Kotarosumitomo; Nishino, Kimihiro; Yamada, Makoto; Kumada, Takashi; Ito, Toshifumi; Eguchi, Hidetoshi; Nagano, Hiroaki; Miyoshi, Eiji

    2016-01-01

    AIM: To determine the efficacy of Mac-2 binding protein (Mac-2bp) for diagnosis of chronic pancreatitis. METHODS: Fifty-nine healthy volunteers (HV), 162 patients with chronic pancreatitis (CP), and 94 patients with pancreatic ductal adenocarcinoma (PDAC) were enrolled in this study. We measured serum Mac-2bp using our developed enzyme-linked immunosorbent assay kit. Additional biochemical variables were measured using an automated analyzer (including aminotransferase, alanine aminotransferase, γ-glutamyltransferase, alkaline phosphatase, triglyceride, C-reactive protein, and amylase levels) or chemiluminescent enzyme immunoassay (carbohydrate antigen 19-9 and carcinoembryonic antigen). The ability of Mac-2bp to predict CP diagnosis accurately was assessed using receiver operating characteristic (ROC) analyses. RESULTS: Serum Mac-2bp levels were significantly increased in CP patients compared to HV (P < 0.0001) and PDAC patients (P < 0.0001). Area under the ROC curve values of Mac-2bp for the discrimination of CP from HV and PDAC were 0.727 and 0.784, respectively. Multivariate analyses demonstrated that serum Mac-2bp levels were independent determinants for CP diagnosis from HV and PDAC patients. Immunohistological staining showed that Mac-2bp was expressed faintly in the pancreas tissues of both CP and PDAC patients. Serum aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, alkaline phosphatase, and triglyceride levels were significantly higher in patients with CP or PDAC. Serum Mac-2bp levels were highly correlated with protein levels of alanine aminotransferase, γ-glutamyltransferase, and C-reactive protein, but not amylase, suggesting that the damaged liver produces Mac-2bp. CONCLUSION: Measurement of serum Mac-2bp may be a novel and useful biomarker for CP diagnosis as well as liver fibrosis in the general population. PMID:27158210

  11. 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

  12. Membrane attack complex (MAC)-mediated damage to spermatozoa: protection of the cells by the presence on their membranes of MAC inhibitory proteins.

    PubMed Central

    Rooney, I A; Davies, A; Morgan, B P

    1992-01-01

    Although antibody and complement are known to cause immobilization and killing of spermatozoa in vitro the components of the complement system mediating these effects remain undefined. Here we have examined the effects of the membrane attack complex (MAC) on spermatozoa and demonstrate that spermatotoxic effects are dependent on assembly of the complete MAC. We subsequently examined the presence and functional significance of the complement regulatory proteins decay accelerating factor (DAF), MAC-inhibiting protein (MIP) and CD59 antigen on spermatozoa. Both DAF and CD59 antigen were present on the membranes of these cells. Neutralization of CD59 antigen with specific antibodies increased the susceptibility of the cells to MAC-mediated damage, suggesting a role for this molecule in the protection of spermatozoa from complement-mediated damage in the female reproductive tract. Images Figure 2 Figure 4 PMID:1374057

  13. 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

  14. 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.

  15. 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.

  16. 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

  17. 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.

  18. 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

  19. 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

  20. 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

  1. 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

  2. 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

  3. Comparative study of MacCormack and TVD MacCormack schemes for three-dimensional separation at wing/body junctions in supersonic flows

    NASA Technical Reports Server (NTRS)

    Lakshmanan, Balakrishnan; Tiwari, Surendra N.

    1992-01-01

    A robust, discontinuity-resolving TVD MacCormack scheme containing no dependent parameters requiring adjustment is presently used to investigate the 3D separation of wing/body junction flows at supersonic speeds. Many production codes employing MacCormack schemes can be adapted to use this method. A numerical simulation of laminar supersonic junction flow is found to yield improved separation location predictions, as well as the axial velocity profiles in the separated flow region.

  4. THE EFFECT OF TEMPERATURE ON THE GROWTH OF MYCOBACTERIUM AVIUM COMPLEX (MAC) ORGANISMS

    EPA Science Inventory

    MAC organisms are able to grow, persist, and colonize in water distribution systems and may amplify in hospital hot water systems. This study examined the response of MAC organisms (M. avium, M. intracellulare, and MX) to a range of temperatures commonly associated with drinking...

  5. Self-Admitted Pretensions of Mac Users on a Predominantly PC University Campus

    ERIC Educational Resources Information Center

    Firmin, Michael W.; Wood, Whitney L. Muhlenkamp; Firmin, Ruth L.; Wood, Jordan C.

    2010-01-01

    The present qualitative research study addressed the overall research question of college students' pretention dynamics in the context of a university setting. Thirty-five Mac users were interviewed on a university campus that exclusively supports PC machines. Mac users shared four self-admitted pretensions related to using Macintosh computers.…

  6. Geochemistry and petrography of the MacAlpine Hills lunar meteorites

    NASA Technical Reports Server (NTRS)

    Lindstrom, Marilyn M.; Mckay, David S.; Wentworth, Susan J.; Martinez, Rene R.; Mittlefehldt, David W.; Wang, Ming-Sheng; Lipschutz, Michael E.

    1991-01-01

    MacAlpine Hills 88104 and 88105, anorthositic lunar meteorites recovered form the same area in Antartica, are characterized. Petrographic studies show that MAC88104/5 is a polymict breccia dominated by impact melt clasts. It is better classified as a fragmental breccia than a regolith breccia. The bulk composition is ferroan and highly aluminous (Al2O3-28 percent).

  7. Morphological evaluation of sperm from infertile men selected by magnetic activated cell sorting (MACS).

    PubMed

    Curti, Gianni; Skowronek, Fernanda; Vernochi, Rita; Rodriguez-Buzzi, Ana Laura; Rodriguez-Buzzi, Juan Carlos; Casanova, Gabriela; Sapiro, Rossana

    2014-12-01

    Electron microscopy analysis performed in five infertile human subjects after sperm selection by swim-up followed by magnetic activated cell sorting (MACS) demonstrated a decrease in the number of spermatozoa with characteristics compatible with cell death. However, no significant differences were found when the swim-up/MACS semen fraction was compared with swim-up fraction alone.

  8. A Meta-Analytic Review of the MacAndrew Alcoholism Scale.

    ERIC Educational Resources Information Center

    Cooper-Hakim, Amy; Viswesvaran, Chockalingam

    2002-01-01

    Using meta analysis, examined the predictive validity of scores on the MacAndrew Alcoholism Scale (C. MacAndrew, 1965). Compared results for 161 studies with results for 63 studies using cut scores. Discusses why the use of continuous measures rather than cut scores is recommended. (SLD)

  9. Subcellular localization and dynamics of Mac-1 (alpha m beta 2) in human neutrophils.

    PubMed Central

    Sengeløv, H; Kjeldsen, L; Diamond, M S; Springer, T A; Borregaard, N

    1993-01-01

    The subcellular localization of Mac-1 was determined in resting and stimulated human neutrophils after disruption by nitrogen cavitation and fractionation on two-layer Percoll density gradients. Light membranes were further separated by high voltage free flow electrophoresis. Mac-1 was determined by an ELISA with monoclonal antibodies that were specific for the alpha-chain (CD11b). In unstimulated neutrophils, 75% of Mac-1 colocalized with specific granules including gelatinase granules, 20% with secretory vesicles and the rest with plasma membranes. Stimulation with nanomolar concentrations of FMLP resulted in the translocation of Mac-1 from secretory vesicles to the plasma membrane, and only minimal translocation from specific granules and gelatinase granules. Stimulation with PMA or Ionomycin resulted in full translocation of Mac-1 from secretory vesicles and gelatinase granules to the plasma membrane, and partial translocation of Mac-1 from specific granules. These findings were corroborated by flow cytometry, which demonstrated a 6-10-fold increase in the surface membrane content of Mac-1 in response to stimulation with FMLP, granulocyte-macrophage colony stimulating factor, IL-8, leukotriene B4, platelet-activating factor, TNF-alpha, and zymosan-activated serum, and a 25-fold increase in response to Ionomycin. Thus, secretory vesicles constitute the most important reservoir of Mac-1 that is incorporated into the plasma membrane during stimulation with inflammatory mediators. PMID:8376598

  10. 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

  11. Reliable Multicast MAC Protocol for IEEE 802.11 Wireless LANs with Extended Service Range

    NASA Astrophysics Data System (ADS)

    Choi, Woo-Yong

    2011-11-01

    In this paper, we propose the efficient reliable multicast MAC protocol by which the AP (Access Point) can transmit reliably its multicast data frames to the recipients in the AP's one-hop or two-hop transmission range. The AP uses the STAs (Stations) that are directly associated with itself as the relays for the data delivery to the remote recipients that cannot be reached directly from itself. Based on the connectivity information among the recipients, the reliable multicast MAC protocol optimizes the number of the RAK (Request for ACK) frame transmissions in a reasonable computational time. Numerical examples show that our proposed MAC protocol significantly enhances the MAC performance compared with the BMMM (Batch Mode Multicast MAC) protocol that is extended to support the recipients that are in the AP's one-hop or two-hop transmission range in IEEE 802.11 wireless LANs.

  12. Opportunistic Pathogens Mycobacterium Avium Complex (MAC) and Legionella spp. Colonise Model Shower.

    PubMed

    Whiley, Harriet; Giglio, Steven; Bentham, Richard

    2015-07-24

    Legionella spp. and Mycobacterium avium complex (MAC) are opportunistic pathogens of public health concern. Hot water systems, including showers, have been identified as a potential source of infection. This paper describes the colonization of Legionella and MAC on the flexible tubing within a model potable shower system, utilizing thermostatic mixing and a flexible shower head. A MAC qPCR method of enumeration was also developed. MAC and Legionella spp. were detected within the biofilm at maximum concentrations of 7.0 × 104 and 2.0 × 103 copies/cm2 PVC tubing respectively. No significant changes were observed between sample of the flexible shower tubing that dried between uses and those that remained filled with water. This suggested the "unhooking" showerheads and allowing them to dry is not an effective method to reduce the risk of Legionella or MAC colonisation.

  13. Opportunistic Pathogens Mycobacterium Avium Complex (MAC) and Legionella spp. Colonise Model Shower.

    PubMed

    Whiley, Harriet; Giglio, Steven; Bentham, Richard

    2015-01-01

    Legionella spp. and Mycobacterium avium complex (MAC) are opportunistic pathogens of public health concern. Hot water systems, including showers, have been identified as a potential source of infection. This paper describes the colonization of Legionella and MAC on the flexible tubing within a model potable shower system, utilizing thermostatic mixing and a flexible shower head. A MAC qPCR method of enumeration was also developed. MAC and Legionella spp. were detected within the biofilm at maximum concentrations of 7.0 × 104 and 2.0 × 103 copies/cm2 PVC tubing respectively. No significant changes were observed between sample of the flexible shower tubing that dried between uses and those that remained filled with water. This suggested the "unhooking" showerheads and allowing them to dry is not an effective method to reduce the risk of Legionella or MAC colonisation. PMID:26213977

  14. Opportunistic Pathogens Mycobacterium Avium Complex (MAC) and Legionella spp. Colonise Model Shower

    PubMed Central

    Whiley, Harriet; Giglio, Steven; Bentham, Richard

    2015-01-01

    Legionella spp. and Mycobacterium avium complex (MAC) are opportunistic pathogens of public health concern. Hot water systems, including showers, have been identified as a potential source of infection. This paper describes the colonization of Legionella and MAC on the flexible tubing within a model potable shower system, utilizing thermostatic mixing and a flexible shower head. A MAC qPCR method of enumeration was also developed. MAC and Legionella spp. were detected within the biofilm at maximum concentrations of 7.0 × 104 and 2.0 × 103 copies/cm2 PVC tubing respectively. No significant changes were observed between sample of the flexible shower tubing that dried between uses and those that remained filled with water. This suggested the “unhooking” showerheads and allowing them to dry is not an effective method to reduce the risk of Legionella or MAC colonisation. PMID:26213977

  15. Interference Analysis Status and Plans for Aeronautical Mobile Airport Communications System (AeroMACS)

    NASA Technical Reports Server (NTRS)

    Kerczewski, Robert J.; Wilson, Jeffrey D.

    2010-01-01

    Interference issues related to the operation of an aeronautical mobile airport communications system (AeroMACS) in the C-Band (specifically 5091-5150 MHz) is being investigated. The issue of primary interest is co-channel interference from AeroMACS into mobile-satellite system (MSS) feeder uplinks. The effort is focusing on establishing practical limits on AeroMACS transmissions from airports so that the threshold of interference into MSS is not exceeded. The analyses are being performed with the software package Visualyse Professional, developed by Transfinite Systems Limited. Results with omni-directional antennas and plans to extend the models to represent AeroMACS more accurately will be presented. These models should enable realistic analyses of emerging AeroMACS designs to be developed from NASA Test Bed, RTCA 223, and European results.

  16. 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

  17. 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.

  18. [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

  19. 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.

  20. 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.

  1. 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.

  2. 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

  3. 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.

  4. 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

  5. [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.

  6. Response to MacNeilage and Davis and to Oller.

    PubMed

    Whalen, D H; Giulivi, Sara; Goldstein, Louis M; Nam, Hosung; Levitt, Andrea G

    2011-07-01

    The article by MacNeilage and Davis in this issue, entitled "In Defense of the 'Frames, then Content' (FC) Perspective on Speech Acquisition: A Response to Two Critiques" appears to assume that the only alternative to segment-level control is oscillation specifically of the jaw; however, other articulators could be oscillated by infants as well. This allows the preferred CV combinations to emerge without positing a level of segmental control in babbling. Their response does not address our modeling work, which, rather similarly to Davis's own modeling (Serkhane, Schwartz, Boë, Davis, & Matyear, 2007), shows little support for the Frame-then-Content (F/C) account. Our results show substantial support for the Articulatory Phonology (AP) one. A closer look at feeding in infants shows substantial control of the tongue and lips, casting further doubt on the foundation of the F/C account.

  7. Rocket measurements of electron density irregularities during MAC/SINE

    NASA Technical Reports Server (NTRS)

    Ulwick, J. C.

    1989-01-01

    Four Super Arcas rockets were launched at the Andoya Rocket Range, Norway, as part of the MAC/SINE campaign to measure electron density irregularities with high spatial resolution in the cold summer polar mesosphere. They were launched as part of two salvos: the turbulent/gravity wave salvo (3 rockets) and the EISCAT/SOUSY radar salvo (one rocket). In both salvos meteorological rockets, measuring temperature and winds, were also launched and the SOUSY radar, located near the launch site, measured mesospheric turbulence. Electron density irregularities and strong gradients were measured by the rocket probes in the region of most intense backscatter observed by the radar. The electron density profiles (8 to 4 on ascent and 4 on descent) show very different characteristics in the peak scattering region and show marked spatial and temporal variability. These data are intercompared and discussed.

  8. Mac-1 Regulates IL-13 Activity in Macrophages by Directly Interacting with IL-13Rα1.

    PubMed

    Cao, Chunzhang; Zhao, Juanjuan; Doughty, Emily K; Migliorini, Mary; Strickland, Dudley K; Kann, Maricel G; Zhang, Li

    2015-08-28

    Mac-1 exhibits a unique inhibitory activity toward IL-13-induced JAK/STAT activation and thereby regulates macrophage to foam cell transformation. However, the underlying molecular mechanism is unknown. In this study, we report the identification of IL-13Rα1, a component of the IL-13 receptor (IL-13R), as a novel ligand of integrin Mac-1, using a co-evolution-based algorithm. Biochemical analyses demonstrated that recombinant IL-13Rα1 binds Mac-1 in a purified system and supports Mac-1-mediated cell adhesion. Co-immunoprecipitation experiments revealed that endogenous Mac-1 forms a complex with IL-13Rα1 in solution, and confocal fluorescence microscopy demonstrated that these two receptors co-localize with each other on the surface of macrophages. Moreover, we found that genetic inactivation of Mac-1 promotes IL-13-induced JAK/STAT activation in macrophages, resulting in enhanced polarization along the alternative activation pathway. Importantly, we observed that Mac-1(-/-) macrophages exhibit increased expression of foam cell differentiation markers including 15-lipoxygenase and lectin-type oxidized LDL receptor-1 both in vitro and in vivo. Indeed, we found that Mac-1(-/-)LDLR(-/-) mice develop significantly more foam cells than control LDLR(-/-) mice, using an in vivo model of foam cell formation. Together, our data establish for the first time a molecular mechanism by which Mac-1 regulates the signaling activity of IL-13 in macrophages. This newly identified IL-13Rα1/Mac-1-dependent pathway may offer novel targets for therapeutic intervention in the future.

  9. 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

  10. 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

  11. 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

  12. 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.

  13. 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

  14. 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

  15. 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

  16. 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.

  17. Use of the mini-MAC scale in the evaluation of mental adjustment to cancer

    PubMed Central

    Marek, Ewelina; Deptała, Andrzej

    2015-01-01

    Aim of the study The objective of the study was to evaluate mental adjustment to cancer in patients diagnosed with an oncologic disease through identification of the coping strategies they had adopted. Material and methods Seventy-four patients of the Clinic of Oncology and Haematology at the Central Clinical Hospital (CSK) of the Ministry of Interior (MSW) in Warsaw were included in the study. The degree of adaptation to cancer was evaluated with the use of the mini-Mental Adjustment to Cancer (mini-MAC) scale. The individual subscales, i.e. fighting spirit, positive redefinition, helplessness-hopelessness, and anxious preoccupation, were collated with socio-demographic characteristics. Results Study findings indicate that: 1) tumour patients typically manifest behaviour that allows one to identify their adjustment to cancer; 2) in malignant tumour patients constructive behaviour prevails over destructive behaviour; 3) the helplessness-hopelessness response is more pronounced in men than women; 4) metastatic patients manifest stronger helplessness-hopelessness response than patients with locally limited tumours; 5) pensioners more often than people of working age adopt the helplessness-hopelessness strategy; and 6) patients with the shortest disease period manifest the strongest fighting spirit. Conclusions Cancer patients employ various strategies of coping with disease depending on socio-demographic factors. PMID:26793028

  18. 42 CFR 405.1062 - Applicability of local coverage determinations and other policies not binding on the ALJ and MAC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... other policies not binding on the ALJ and MAC. 405.1062 Section 405.1062 Public Health CENTERS FOR... of local coverage determinations and other policies not binding on the ALJ and MAC. (a) ALJs and the MAC are not bound by LCDs, LMRPs, or CMS program guidance, such as program memoranda and...

  19. 42 CFR 405.1116 - Effect of dismissal of request for MAC review or request for hearing.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Effect of dismissal of request for MAC review or...) Medicare Appeals Council Review § 405.1116 Effect of dismissal of request for MAC review or request for hearing. The dismissal of a request for MAC review or denial of a request for review of a dismissal...

  20. 42 CFR 405.1140 - MAC review of ALJ decision in a case remanded by a Federal district court.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false MAC review of ALJ decision in a case remanded by a...) Medicare Appeals Council Review § 405.1140 MAC review of ALJ decision in a case remanded by a Federal... district court for further consideration and the MAC remands the case to an ALJ, a decision...

  1. 78 FR 77450 - Fannie Mae and Freddie Mac Loan Purchase Limits: Request for Public Input on Implementation Issues

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-23

    ... AGENCY Fannie Mae and Freddie Mac Loan Purchase Limits: Request for Public Input on Implementation Issues... Home Loan Mortgage Corporation (Freddie Mac) (together, the Enterprises). Each Enterprise must set its... before FHFA decides whether and how to proceed with the planned reductions in Freddie Mac's and...

  2. 42 CFR 405.1104 - Request for MAC review when an ALJ does not issue a decision timely.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Request for MAC review when an ALJ does not issue a...) Medicare Appeals Council Review § 405.1104 Request for MAC review when an ALJ does not issue a decision... under § 405.1016 may request MAC review if— (1) The appellant files a written request with the ALJ...

  3. IgG Endopeptidase SeMac does not Inhibit Opsonophagocytosis of Streptococcus equi Subspecies equi by Horse Polymorphonuclear Leukocytes

    PubMed Central

    Liu, Mengyao; Lei, Benfang

    2010-01-01

    The secreted Mac protein made by group A Streptococcus (GAS) inhibits opsonophagocytosis of GAS by human polymorphonuclear leukocytes (PMNs). This protein also has the endopeptidase activity against human immunoglobulin G (IgG), and the Cys94, His262 and Asp284 are critical for the enzymatic activity. The horse pathogen Streptococcus equi subspecies equi produces a homologue of Mac (SeMac). SeMac was characterized to determine whether SeMac has IgG endopeptidase activity and inhibits opsonophagocytosis of S. equi by horse PMNs. The gene was cloned and recombinant SeMac was overexpressed in Escherichia coli and purified to homogeneity. Mice with experimental S. equi infection and horses with strangles caused by S. equi seroconverted to SeMac, indicating that SeMac is produced in vivo during infection. SeMac has endopeptidase activity against human IgG. However, the protein just cleaves a small fraction, which may be IgG1 only, of horse IgG. Replacement of Cys102 with Ser or His272 with Ala abolishes the enzymatic activity of SeMac, and the Asp294Ala mutation greatly decreases the enzymatic activity. SeMac does not inhibit opsonophagocytosis of S. equi by horse PMNs but opsonophagocytosis of GAS by human PMNs. Thus, SeMac is a cysteine endopeptidase with a limited activity against horse IgG and must have other function. PMID:20556207

  4. A Priority-Based Adaptive MAC Protocol for Wireless Body Area Networks.

    PubMed

    Bhandari, Sabin; Moh, Sangman

    2016-01-01

    In wireless body area networks (WBANs), various sensors and actuators are placed on/inside the human body and connected wirelessly. WBANs have specific requirements for healthcare and medical applications, hence, standard protocols like the IEEE 802.15.4 cannot fulfill all the requirements. Consequently, many medium access control (MAC) protocols, mostly derived from the IEEE 802.15.4 superframe structure, have been studied. Nevertheless, they do not support a differentiated quality of service (QoS) for the various forms of traffic coexisting in a WBAN. In particular, a QoS-aware MAC protocol is essential for WBANs operating in the unlicensed Industrial, Scientific, and Medical (ISM) bands, because different wireless services like Bluetooth, WiFi, and Zigbee may coexist there and cause severe interference. In this paper, we propose a priority-based adaptive MAC (PA-MAC) protocol for WBANs in unlicensed bands, which allocates time slots dynamically, based on the traffic priority. Further, multiple channels are effectively utilized to reduce access delays in a WBAN, in the presence of coexisting systems. Our performance evaluation results show that the proposed PA-MAC outperforms the IEEE 802.15.4 MAC and the conventional priority-based MAC in terms of the average transmission time, throughput, energy consumption, and data collision ratio. PMID:26999162

  5. A cross-layer duty cycle MAC protocol supporting a pipeline feature for wireless sensor networks.

    PubMed

    Tong, Fei; Xie, Rong; Shu, Lei; Kim, Young-Chon

    2011-01-01

    Although the conventional duty cycle MAC protocols for Wireless Sensor Networks (WSNs) such as RMAC perform well in terms of saving energy and reducing end-to-end delivery latency, they were designed independently and require an extra routing protocol in the network layer to provide path information for the MAC layer. In this paper, we propose a new cross-layer duty cycle MAC protocol with data forwarding supporting a pipeline feature (P-MAC) for WSNs. P-MAC first divides the whole network into many grades around the sink. Each node identifies its grade according to its logical hop distance to the sink and simultaneously establishes a sleep/wakeup schedule using the grade information. Those nodes in the same grade keep the same schedule, which is staggered with the schedule of the nodes in the adjacent grade. Then a variation of the RTS/CTS handshake mechanism is used to forward data continuously in a pipeline fashion from the higher grade to the lower grade nodes and finally to the sink. No extra routing overhead is needed, thus increasing the network scalability while maintaining the superiority of duty-cycling. The simulation results in OPNET show that P-MAC has better performance than S-MAC and RMAC in terms of packet delivery latency and energy efficiency.

  6. A Priority-Based Adaptive MAC Protocol for Wireless Body Area Networks.

    PubMed

    Bhandari, Sabin; Moh, Sangman

    2016-03-18

    In wireless body area networks (WBANs), various sensors and actuators are placed on/inside the human body and connected wirelessly. WBANs have specific requirements for healthcare and medical applications, hence, standard protocols like the IEEE 802.15.4 cannot fulfill all the requirements. Consequently, many medium access control (MAC) protocols, mostly derived from the IEEE 802.15.4 superframe structure, have been studied. Nevertheless, they do not support a differentiated quality of service (QoS) for the various forms of traffic coexisting in a WBAN. In particular, a QoS-aware MAC protocol is essential for WBANs operating in the unlicensed Industrial, Scientific, and Medical (ISM) bands, because different wireless services like Bluetooth, WiFi, and Zigbee may coexist there and cause severe interference. In this paper, we propose a priority-based adaptive MAC (PA-MAC) protocol for WBANs in unlicensed bands, which allocates time slots dynamically, based on the traffic priority. Further, multiple channels are effectively utilized to reduce access delays in a WBAN, in the presence of coexisting systems. Our performance evaluation results show that the proposed PA-MAC outperforms the IEEE 802.15.4 MAC and the conventional priority-based MAC in terms of the average transmission time, throughput, energy consumption, and data collision ratio.

  7. A Cross-Layer Duty Cycle MAC Protocol Supporting a Pipeline Feature for Wireless Sensor Networks

    PubMed Central

    Tong, Fei; Xie, Rong; Shu, Lei; Kim, Young-Chon

    2011-01-01

    Although the conventional duty cycle MAC protocols for Wireless Sensor Networks (WSNs) such as RMAC perform well in terms of saving energy and reducing end-to-end delivery latency, they were designed independently and require an extra routing protocol in the network layer to provide path information for the MAC layer. In this paper, we propose a new cross-layer duty cycle MAC protocol with data forwarding supporting a pipeline feature (P-MAC) for WSNs. P-MAC first divides the whole network into many grades around the sink. Each node identifies its grade according to its logical hop distance to the sink and simultaneously establishes a sleep/wakeup schedule using the grade information. Those nodes in the same grade keep the same schedule, which is staggered with the schedule of the nodes in the adjacent grade. Then a variation of the RTS/CTS handshake mechanism is used to forward data continuously in a pipeline fashion from the higher grade to the lower grade nodes and finally to the sink. No extra routing overhead is needed, thus increasing the network scalability while maintaining the superiority of duty-cycling. The simulation results in OPNET show that P-MAC has better performance than S-MAC and RMAC in terms of packet delivery latency and energy efficiency. PMID:22163895

  8. LFA-1 is sufficient in mediating neutrophil emigration in Mac-1-deficient mice.

    PubMed Central

    Lu, H; Smith, C W; Perrard, J; Bullard, D; Tang, L; Shappell, S B; Entman, M L; Beaudet, A L; Ballantyne, C M

    1997-01-01

    To better define the specific function of Mac-1 (CD11b) versus LFA-1 (CD11a) and the other CD11 integrins in vivo, we have disrupted murine CD11b by targeted homologous recombination in embryonic stem cells and generated mice which are homozygous for a mutation in CD11b. A null mutation was confirmed by Southern blotting, RNase protection assay, immunohistochemistry, and flow cytometry. Neutrophils isolated from mice deficient in Mac-1 were defective in adherence to keyhole limpet hemocyanin-coated glass, iC3b-mediated phagocytosis, and homotypic aggregation. When challenged by thioglycollate intraperitoneally, Mac-1-deficient mice had similar levels of neutrophil accumulation in the peritoneal cavity at 1, 2, and 4 h. Treatment with mAb to LFA-1 blocked 78% of neutrophil accumulation in Mac-1-deficient mice and 58% in wild-type mice. Neutrophil emigration into the peritoneal cavity 16 h after the implantation of fibrinogen-coated disks was not reduced in Mac-1-deficient mice whereas neutrophil adhesion to the fibrinogen-coated disks was reduced by > 90%. Neutrophils from Mac-1-deficient mice also showed reduced degranulation. Our results demonstrate that Mac-1 plays a critical role in mediating binding of neutrophils to fibrinogen and neutrophil degranulation, but is not necessary for effective neutrophil emigration, which is more dependent upon LFA-1. PMID:9077544

  9. A Priority-Based Adaptive MAC Protocol for Wireless Body Area Networks

    PubMed Central

    Bhandari, Sabin; Moh, Sangman

    2016-01-01

    In wireless body area networks (WBANs), various sensors and actuators are placed on/inside the human body and connected wirelessly. WBANs have specific requirements for healthcare and medical applications, hence, standard protocols like the IEEE 802.15.4 cannot fulfill all the requirements. Consequently, many medium access control (MAC) protocols, mostly derived from the IEEE 802.15.4 superframe structure, have been studied. Nevertheless, they do not support a differentiated quality of service (QoS) for the various forms of traffic coexisting in a WBAN. In particular, a QoS-aware MAC protocol is essential for WBANs operating in the unlicensed Industrial, Scientific, and Medical (ISM) bands, because different wireless services like Bluetooth, WiFi, and Zigbee may coexist there and cause severe interference. In this paper, we propose a priority-based adaptive MAC (PA-MAC) protocol for WBANs in unlicensed bands, which allocates time slots dynamically, based on the traffic priority. Further, multiple channels are effectively utilized to reduce access delays in a WBAN, in the presence of coexisting systems. Our performance evaluation results show that the proposed PA-MAC outperforms the IEEE 802.15.4 MAC and the conventional priority-based MAC in terms of the average transmission time, throughput, energy consumption, and data collision ratio. PMID:26999162

  10. 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

  11. Design and Implementation of Hybrid MAC-Based Robust Architecture for Wireless Sensor Network

    NASA Astrophysics Data System (ADS)

    Shon, Taeshik; Kim, Eui-Jik; in, Jeongsik; Park, Yongsuk

    In this letter, we propose an energy efficient hybrid architecture, the Hybrid MAC-based Robust Architecture (HMR), for wireless sensor networks focusing on MAC layer's scheduling and adaptive security suite as a security sub layer. A hybrid MAC layer with TDMA and CSMA scheduling is designed to prolong network life time, and the multi-channel TDMA based active/sleep scheduling is presented. We also present the security related functionalities needed to employ a flexible security suite to packets dynamically. Implementation and testbed of the proposed framework based on IEEE 802.15.4 are shown as well.

  12. An augmented MMS MACS for the Topex/Poseidon mission and beyond. [Modular Attitude Control Subsystem

    NASA Technical Reports Server (NTRS)

    Williams, R. J.; Dennehy, C. J.; Lee, D.; Welch, R. V.

    1990-01-01

    The augmented Modular Attitude Control Subsystem (MACS) is described, with emphasis on the significant hardware modifications that have been incorporated into the Landsat MMS (Multimission Modular Spacecraft) MACS design to satisfy the Topex/Poseidon mission attitude control and determination requirements. Particular attention is given to a modification consisting in the addition of an earth pointing safe hold mode utilizing yaw coarse sun sensors to provide a yaw-slew capability for maintaining adequate illumination of the solar array. The design utility of this augmented MACS module for future spacecraft applications is pointed out.

  13. 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...

  14. 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…

  15. 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.

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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.

  1. 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

  2. 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

  3. 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

  4. 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.

  5. 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

  6. 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

  7. 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

  8. 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.

  9. 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

  10. 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.

  11. Pliable Cognitive MAC for Heterogeneous Adaptive Cognitive Radio Sensor Networks.

    PubMed

    Al-Medhwahi, Mohammed; Hashim, Fazirulhisyam; Ali, Borhanuddin Mohd; Sali, Aduwati

    2016-01-01

    The rapid expansion of wireless monitoring and surveillance applications in several domains reinforces the trend of exploiting emerging technologies such as the cognitive radio. However, these technologies have to adjust their working concepts to consider the common characteristics of conventional wireless sensor networks (WSNs). The cognitive radio sensor network (CRSN), still an immature technology, has to deal with new networks that might have different types of data, traffic patterns, or quality of service (QoS) requirements. In this paper, we design and model a new cognitive radio-based medium access control (MAC) algorithm dealing with the heterogeneous nature of the developed networks in terms of either the traffic pattern or the required QoS for the node applications. The proposed algorithm decreases the consumed power on several fronts, provides satisfactory levels of latency and spectrum utilization with efficient scheduling, and manages the radio resources for various traffic conditions. An intensive performance evaluation is conducted to study the impact of key parameters such as the channel idle time length, node density, and the number of available channels. The performance evaluation of the proposed algorithm shows a better performance than the comparable protocols. Moreover, the results manifest that the proposed algorithm is suitable for real time monitoring applications. PMID:27257964

  12. MAC protocol for ad hoc networks using a genetic algorithm.

    PubMed

    Elizarraras, Omar; Panduro, Marco; Méndez, Aldo L; Reyna, Alberto

    2014-01-01

    The problem of obtaining the transmission rate in an ad hoc network consists in adjusting the power of each node to ensure the signal to interference ratio (SIR) and the energy required to transmit from one node to another is obtained at the same time. Therefore, an optimal transmission rate for each node in a medium access control (MAC) protocol based on CSMA-CDMA (carrier sense multiple access-code division multiple access) for ad hoc networks can be obtained using evolutionary optimization. This work proposes a genetic algorithm for the transmission rate election considering a perfect power control, and our proposition achieves improvement of 10% compared with the scheme that handles the handshaking phase to adjust the transmission rate. Furthermore, this paper proposes a genetic algorithm that solves the problem of power combining, interference, data rate, and energy ensuring the signal to interference ratio in an ad hoc network. The result of the proposed genetic algorithm has a better performance (15%) compared to the CSMA-CDMA protocol without optimizing. Therefore, we show by simulation the effectiveness of the proposed protocol in terms of the throughput.

  13. MAC Protocol for Ad Hoc Networks Using a Genetic Algorithm

    PubMed Central

    Elizarraras, Omar; Panduro, Marco; Méndez, Aldo L.

    2014-01-01

    The problem of obtaining the transmission rate in an ad hoc network consists in adjusting the power of each node to ensure the signal to interference ratio (SIR) and the energy required to transmit from one node to another is obtained at the same time. Therefore, an optimal transmission rate for each node in a medium access control (MAC) protocol based on CSMA-CDMA (carrier sense multiple access-code division multiple access) for ad hoc networks can be obtained using evolutionary optimization. This work proposes a genetic algorithm for the transmission rate election considering a perfect power control, and our proposition achieves improvement of 10% compared with the scheme that handles the handshaking phase to adjust the transmission rate. Furthermore, this paper proposes a genetic algorithm that solves the problem of power combining, interference, data rate, and energy ensuring the signal to interference ratio in an ad hoc network. The result of the proposed genetic algorithm has a better performance (15%) compared to the CSMA-CDMA protocol without optimizing. Therefore, we show by simulation the effectiveness of the proposed protocol in terms of the throughput. PMID:25140339

  14. MAC protocol for an ATM-based SuperPON

    NASA Astrophysics Data System (ADS)

    Angelopoulos, John D.; Koulouris, John; Fragoulopoulos, Stratos K.

    1996-11-01

    Developments in optical amplifiers and the tendency towards fewer and larger switching stages made feasible and desirable the concept of SuperPONs with a range of 100km. Up to 15000 residential customers can share the SuperPON on a TDMA basis lowering the cost of access to B-ISDN services. Tree PONs require a MAC protocol to arbitrate the access to upstream slots among the competing customer ATM cells in a dynamic and efficient way. The protocol presented in this work combines different access mechanisms according to service quality requirements. All bursty traffic is manipulated transparently using a reservation approach with closed loop control so as to handle the unpredictability of arrivals. In contrast, voice, N-ISDN and other delay sensitive services are provided with unsolicited access permits. In addition, composite cells offered quasi- synchronous permits are used to support STM legacy traffic without echo-cancellers. So, ABR traffic which is delay tolerant and more cost sensitive, can and should be concentrated with full exploitation of multiplexing gain prospects. The permit distribution algorithm focuses on cell spacing, control of CDV, almost jitter free access for synchronous traffic and efficiency for ABR traffic.

  15. A MAC Protocol to Support Monitoring of Underwater Spaces †

    PubMed Central

    Santos, Rodrigo; Orozco, Javier; Ochoa, Sergio F.; Meseguer, Roc; Eggly, Gabriel; Pistonesi, Marcelo F.

    2016-01-01

    Underwater sensor networks are becoming an important field of research, because of their everyday increasing application scope. Examples of their application areas are environmental and pollution monitoring (mainly oil spills), oceanographic data collection, support for submarine geolocalization, ocean sampling and early tsunamis alert. The challenge of performing underwater communications is well known, provided that radio signals are useless in this medium, and a wired solution is too expensive. Therefore, the sensors in these networks transmit their information using acoustic signals that propagate well under water. This data transmission type not only brings an opportunity, but also several challenges to the implementation of these networks, e.g., in terms of energy consumption, data transmission and signal interference. In order to help advance the knowledge in the design and implementation of these networks for monitoring underwater spaces, this paper proposes a MAC protocol for acoustic communications between the nodes, based on a self-organized time division multiple access mechanism. The proposal was evaluated using simulations of a real monitoring scenario, and the obtained results are highly encouraging. PMID:27355950

  16. MAC to VAX Connectivity: Heartrate Spectral Analysis System

    NASA Technical Reports Server (NTRS)

    Rahman, Hasan H.; Faruque, Monazer

    1993-01-01

    The heart rate Spectral Analysis System (SAS) acquires and analyzes, in real-time, the Space Shuttle onboard electrocardiograph (EKG) experiment signals, calculates the heartrate, and applies a Fast Fourier Transformation (FFT) to the heart rate. The system also calculates other statistical parameters such as the 'mean heart rate' over specific time period and heart rate histogram. This SAS is used by NASA Principal Investigators as a research tool to determine the effects of weightlessness on the human cardiovascular system. This is also used to determine if Lower Body Negative Pressure (LBNP) is an effective countermeasure to the orthostatic intolerance experienced by astronauts upon return to normal gravity. In microgravity, astronauts perform the LBNP experiment in the mid deck of the Space Shuttle. The experiment data are downlinked by the orbiter telemetry system, then processed and analyzed in real-time by the integrated Life Sciences Data Acquisition (LSDS) - Spectral Analysis System. The data system is integrated within the framework of two different computer systems, VAX and Macintosh (Mac), using the networking infrastructure to assist the investigators in further understanding the most complex machine on Earth--the human body.

  17. Pliable Cognitive MAC for Heterogeneous Adaptive Cognitive Radio Sensor Networks

    PubMed Central

    Ali, Borhanuddin Mohd; Sali, Aduwati

    2016-01-01

    The rapid expansion of wireless monitoring and surveillance applications in several domains reinforces the trend of exploiting emerging technologies such as the cognitive radio. However, these technologies have to adjust their working concepts to consider the common characteristics of conventional wireless sensor networks (WSNs). The cognitive radio sensor network (CRSN), still an immature technology, has to deal with new networks that might have different types of data, traffic patterns, or quality of service (QoS) requirements. In this paper, we design and model a new cognitive radio-based medium access control (MAC) algorithm dealing with the heterogeneous nature of the developed networks in terms of either the traffic pattern or the required QoS for the node applications. The proposed algorithm decreases the consumed power on several fronts, provides satisfactory levels of latency and spectrum utilization with efficient scheduling, and manages the radio resources for various traffic conditions. An intensive performance evaluation is conducted to study the impact of key parameters such as the channel idle time length, node density, and the number of available channels. The performance evaluation of the proposed algorithm shows a better performance than the comparable protocols. Moreover, the results manifest that the proposed algorithm is suitable for real time monitoring applications. PMID:27257964

  18. Pliable Cognitive MAC for Heterogeneous Adaptive Cognitive Radio Sensor Networks.

    PubMed

    Al-Medhwahi, Mohammed; Hashim, Fazirulhisyam; Ali, Borhanuddin Mohd; Sali, Aduwati

    2016-01-01

    The rapid expansion of wireless monitoring and surveillance applications in several domains reinforces the trend of exploiting emerging technologies such as the cognitive radio. However, these technologies have to adjust their working concepts to consider the common characteristics of conventional wireless sensor networks (WSNs). The cognitive radio sensor network (CRSN), still an immature technology, has to deal with new networks that might have different types of data, traffic patterns, or quality of service (QoS) requirements. In this paper, we design and model a new cognitive radio-based medium access control (MAC) algorithm dealing with the heterogeneous nature of the developed networks in terms of either the traffic pattern or the required QoS for the node applications. The proposed algorithm decreases the consumed power on several fronts, provides satisfactory levels of latency and spectrum utilization with efficient scheduling, and manages the radio resources for various traffic conditions. An intensive performance evaluation is conducted to study the impact of key parameters such as the channel idle time length, node density, and the number of available channels. The performance evaluation of the proposed algorithm shows a better performance than the comparable protocols. Moreover, the results manifest that the proposed algorithm is suitable for real time monitoring applications.

  19. A MAC Protocol to Support Monitoring of Underwater Spaces.

    PubMed

    Santos, Rodrigo; Orozco, Javier; Ochoa, Sergio F; Meseguer, Roc; Eggly, Gabriel; Pistonesi, Marcelo F

    2016-06-27

    Underwater sensor networks are becoming an important field of research, because of their everyday increasing application scope. Examples of their application areas are environmental and pollution monitoring (mainly oil spills), oceanographic data collection, support for submarine geolocalization, ocean sampling and early tsunamis alert. The challenge of performing underwater communications is well known, provided that radio signals are useless in this medium, and a wired solution is too expensive. Therefore, the sensors in these networks transmit their information using acoustic signals that propagate well under water. This data transmission type not only brings an opportunity, but also several challenges to the implementation of these networks, e.g., in terms of energy consumption, data transmission and signal interference. In order to help advance the knowledge in the design and implementation of these networks for monitoring underwater spaces, this paper proposes a MAC protocol for acoustic communications between the nodes, based on a self-organized time division multiple access mechanism. The proposal was evaluated using simulations of a real monitoring scenario, and the obtained results are highly encouraging.

  20. A MAC Protocol to Support Monitoring of Underwater Spaces.

    PubMed

    Santos, Rodrigo; Orozco, Javier; Ochoa, Sergio F; Meseguer, Roc; Eggly, Gabriel; Pistonesi, Marcelo F

    2016-01-01

    Underwater sensor networks are becoming an important field of research, because of their everyday increasing application scope. Examples of their application areas are environmental and pollution monitoring (mainly oil spills), oceanographic data collection, support for submarine geolocalization, ocean sampling and early tsunamis alert. The challenge of performing underwater communications is well known, provided that radio signals are useless in this medium, and a wired solution is too expensive. Therefore, the sensors in these networks transmit their information using acoustic signals that propagate well under water. This data transmission type not only brings an opportunity, but also several challenges to the implementation of these networks, e.g., in terms of energy consumption, data transmission and signal interference. In order to help advance the knowledge in the design and implementation of these networks for monitoring underwater spaces, this paper proposes a MAC protocol for acoustic communications between the nodes, based on a self-organized time division multiple access mechanism. The proposal was evaluated using simulations of a real monitoring scenario, and the obtained results are highly encouraging. PMID:27355950