Noninvasive pressure sedation

CONTEXT: Music is ubiquitous and found in all cultures; it elicits both physiological and psychological responses in its listener. It has been proven that music reduces perception of pain and dosages of anesthetics and sedatives used during surgery. AIMS: To study the effect spiritual music on perioperative anxiety and hemodynamic parameters in elderly patients undergoing procedures under spinal anesthesia. SETTINGS AND DESIGN: A prospective, randomized controlled study...

We retrospectively analyzed the data from patients admitted to the intensive care unit (ICU) of the Hospital of L'Aquila during the first and second waves of pandemic to identify pain related to COVID-19. Pain was evaluated by using the Numerical Rating Scale, and the assessment for neuropathic disturbances of pain was performed with von Frey's hair and Lindblom tests. Pain increased significantly during hospitalization (from 48% at hospital admission to 94.3% at ICU discharge). Female patients were affected by somatic pain in 32...

OBJECTIVE: To compare cardiopulmonary variables and blood gas analytes in guinea pigs (Cavia porcellus) during anesthesia with and without abdominal carbon dioxide (CO2 ) insufflation at intra-abdominal pressures (IAPs) 4 and 6 mmHg, with and without endotracheal intubation. STUDY DESIGN: Prospective experimental trial. ANIMALS: A total of six intact female Hartley guinea pigs. METHODS: A crossover study with sequence randomization for IAP and intubation status was used...

BACKGROUND: The desired depth of sedation during flexible bronchoscopy is one in which verbal contact is possible whenever necessary. Although it is common that the depth of sedation is assessed by validated instruments such as the modified observer's assessment of alertness and sedation (MOAA/S) score, the repeated stimulation associated with the assessment can affect the sedation. The bispectral index (BIS) has been widely used for general anesthesia due to its objective and noninvasive nature...

UNLABELLED: Pediatric ventilation liberation has limited evidence, likely resulting in wide practice variation. To inform future work, practice patterns must first be described. OBJECTIVES: Describe international pediatric ventilation liberation practices and regional practice variation. DESIGN SETTING AND PARTICIPANTS: International cross-sectional electronic survey. Nontrainee pediatric medical and cardiac critical care physicians. MAIN OUTCOMES AND MEASURES: Practices focusing on spontaneous breathing trial (SBT) eligibility, SBT practice, non-SBT extubation readiness bundle elements, and post-extubation respiratory support...

BACKGROUND: Pulse amplitude index (PAx), a descriptor of cerebrovascular reactivity, correlates the changes of the pulse amplitude of the intracranial pressure (ICP) waveform (AMP) with changes in mean arterial pressure (MAP). AMP relies on cerebrovascular compliance, which is modulated by the state of the cerebrovascular reactivity. PAx can aid in prognostication after acute brain injuries as a tool for the assessment of cerebral autoregulation and could potentially tailor individual management; however, invasive measurements are required for its calculation...

Objectives: There has been controversy over whether ketamine affects intracranial pressure (ICP) in children. Transcranial Doppler ultrasound (TCD) is a validated technique used to assess ICP changes noninvasively. Gosling pulsatility index (PI) directly correlates with ICP changes. The objective of this study was to quantify PI changes as a surrogate marker for ICP changes in previously healthy children receiving intravenous ketamine for procedural sedation. Methods: We performed a prospective, observational study of patients 5-18 years old who underwent sedation with intravenous ketamine as monotherapy...

Background: The intermittent measurement of blood pressure (BP) remains the standard of care during anesthesia or procedural sedation. To improve the early identification of hemodynamic compromise, various noninvasive BP devices have been developed which provide a continuous BP reading. The current study evaluates the accuracy of a novel continuous BP device, the NICCI system, in adolescents weighing 40 - 80 kg. Methods: During intraoperative anesthetic care, BP readings (systolic, diastolic, and mean) were captured from the arterial cannula and the NICCI device every second...

INTRODUCTION: COVID-19 is responsible of severe hypoxaemia and acute respiratory distress syndrome (ARDS). Prone positioning improves oxygenation and survival in sedated mechanically patients with ARDS not related to COVID-19. Awake prone positioning is a simple and safe technique which improves oxygenation in non-intubated COVID-19 patients. We hypothesised that early prone positioning in COVID-19 patients breathing spontaneously in medical wards could decrease the rates of intubation or need for noninvasive ventilation or death...

Background: Catheter ablation for atrial fibrillation (AF) or left atrial tachycardia is well established. To avoid body movement and pain, sedative and analgesic agents are used. Objective: The aim was to investigate safety of sedation/anti-pain protocol administered by electrophysiology (EP) staff. Methods: A total of 3211 consecutive patients (61% male) undergoing left atrial ablation for paroxysmal AF (37.1%), persistent AF (35.3%) or left atrial tachycardia (27...

IMPORTANCE: The optimal first-line mode of noninvasive respiratory support for acutely ill children is not known. OBJECTIVE: To evaluate the noninferiority of high-flow nasal cannula therapy (HFNC) as the first-line mode of noninvasive respiratory support for acute illness, compared with continuous positive airway pressure (CPAP), for time to liberation from all forms of respiratory support. DESIGN, SETTING, AND PARTICIPANTS: Pragmatic, multicenter, randomized noninferiority clinical trial conducted in 24 pediatric critical care units in the United Kingdom among 600 acutely ill children aged 0 to 15 years who were clinically assessed to require noninvasive respiratory support, recruited between August 2019 and November 2021, with last follow-up completed in March 2022...

Compared with invasive mechanical ventilation, noninvasive ventilation (NIV) improves patient comfort and neurocognitive function; and reduces the likelihood of nosocomial infections and the need for sedation. NIV can also be used perioperatively to prevent postoperative pulmonary complications. This current report describes a case of a 64-year-old female patient with chronic obstructive pulmonary disease and chronic respiratory failure that underwent spinal anaesthesia during surgery. She was sedated with propofol...

BACKGROUND: Hyperoxia is associated with increased morbidity and mortality in the intensive care unit. Classical noninvasive measurements of oxygen saturation with pulse oximeters are unable to detect hyperoxia. The Oxygen Reserve Index (ORI) is a continuous noninvasive parameter provided by a multi-wave pulse oximeter that can detect hyperoxia. Primary objective was to evaluate the diagnostic accuracy of the ORI for detecting arterial oxygen tension (PaO2 ) > 100 mmHg in neurocritical care patients...

Background: Moderate sedation is an integral part of dental care delivery. Target-controlled infusion (TCI) has the potential to improve patient safety and outcome. We compared the effects of using TCI to administer remifentanil/manual bolus midazolam with manual bolus fentanyl/midazolam administration on patient safety parameters, drug administration times, and patient recovery times. Methods: In this retrospective chart review, records of patients who underwent moderate intravenous sedation over 12 months in a private dental clinic were assessed...

OBJECTIVE: To evaluate agreement with central systemic arterial pressure of an oscillometer and two cuff widths placed on the thoracic or pelvic limbs. STUDY DESIGN: Prospective experimental study. ANIMALS: A group of nine New Zealand White rabbits weighing 3.5 ± 0.3 kg. METHODS: Rabbits were sedated with dexmedetomidine and midazolam, then anesthetized with ketamine and sevoflurane. The femoral artery was surgically exposed and a 20 gauge, 5 cm catheter inserted to measure systolic (SAP), mean (MAP) and diastolic (DAP) blood pressure at the iliac artery and caudal aorta junction...

Respiratory failure due to muscle spasms is a major sequela of tetanus. Spasms can be controlled with sedation and adjunctive treatment, albeit at the expense of respiratory drive and weakness. Invasive ventilation under deep sedation with intensive care unit admission is the best practice. Where invasive ventilation is unavailable and when patients decline intubation, the management of muscle spasms and respiratory failure is extremely limited with low survival rates. Herein, we present a case of severe tetanus in a 90-year-old female farmer who declined intubation and whose respiratory failure was managed with noninvasive positive pressure ventilation (NPPV) with a moderate dose of continuous benzodiazepine infusion against spasms...

BACKGROUND: Increased intraabdominal pressure, termed intraabdominal hypertension (IAH), is reported as an independent cause of morbidity and mortality in the human ICU but, until recently, has been rarely described in veterinary species outside of experimental models. Failure to identify severe IAH leads to organ dysfunction, termed abdominal compartment syndrome, and rapidly becomes fatal without therapeutic intervention. Although the veterinary community has been slow to address the concept of IAH and associated comorbidities, recent companion and large animal case series and experimental studies suggest IAH may also be common in veterinary species and correlates well with risk factors and grading systems already described in the human literature...

BACKGROUND: The utilization of noninvasive positive pressure ventilation (NPPV) is becoming more and more common, especially in patients with acute or chronic respiratory failure. The purpose of our study is to analyze the factors that influence the efficacy of NPPV in the treatment of respiratory failure caused by a variety of etiology. METHODS: From May 2011 to April 2020, patients treated with NPPV during hospitalization in the First Affiliated Hospital of Soochow University were enrolled...

OBJECTIVE: To compare the sedative and cardiopulmonary effects of intranasal (IN) and intramuscular (IM) administration of dexmedetomidine and midazolam combination in New Zealand White rabbits. STUDY DESIGN: A randomized, crossover experimental study. ANIMALS: A total of eight healthy New Zealand White rabbits, aged 6-12 months, weighing 3.1 ± 0.3 kg (mean ± standard deviation). METHODS: The animals were randomly assigned to administration of dexmedetomidine (0...

Patient-ventilator asynchrony is very common in newborns. Achieving synchrony is quite challenging because of small tidal volumes, high respiratory rates, and the presence of leaks. Leaks also cause unreliable monitoring of respiratory metrics. In addition, ventilator adjustment must take into account that infants have strong vagal reflexes and demonstrate central apnea and periodic breathing, with a high variability in breathing pattern. Neurally adjusted ventilatory assist (NAVA) is a mode of ventilation whereby the timing and amount of ventilatory assist is controlled by the patient's own neural respiratory drive...