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Pain, agitation, delirium

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https://www.readbyqxmd.com/read/27930564/effects-of-intraoperative-dexmedetomidine-with-intravenous-anesthesia-on-postoperative-emergence-agitation-delirium-in-pediatric-patients-undergoing-tonsillectomy-with-or-without-adenoidectomy-a-consort-prospective-randomized-controlled-clinical-trial
#1
Jun-Li Cao, Yu-Ping Pei, Jing-Qiu Wei, Yue-Ying Zhang
Postoperative emergence agitation/delirium (POED) is a common complication in pediatric surgery patients, which increases the risk of developing postoperative airway obstruction and respiratory depression. This study aims to investigate the safety and efficacy of intraoperative infusion of dexmedetomidine (DEX) and its effects on POED in pediatric patients undergoing tonsillectomy with or without adenoidectomy.Sixty patients scheduled for tonsillectomy with or without adenoidectomy, aged 2 to 8 years, were randomly allocated into 2 groups (n = 30)...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27907964/critical-care-neurology-perspective-on-delirium
#2
Matthew B Maas, Andrew M Naidech
The evidence linking delirium to poor outcomes after critical illness is compelling, including higher mortality, prolonged mechanical ventilation, longer length of intensive care unit stay, and long-term cognitive impairments. The attitude toward delirium in the neurologic community is shifting away from viewing it as an unmodifiable, inevitable consequence of severe illness to treating it is as a neurologic emergency, akin to seizures or encephalitis. Delirium, like other manifestations of critical illness encephalopathy, is an organ dysfunction syndrome...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27901329/comparing-incidence-of-emergence-delirium-between-sevoflurane-and-desflurane-in-children-following-routine-otolaryngology-procedures
#3
Jeremy N Driscoll, Brian M Bender, Carlos A Archilla, Carol M Klim, J Hossain, George Mychaskiw, Julie L Wei
BACKGROUND: Emergence delirium (ED) is a state of aggressive agitation that can occur temporarily in the process of emerging from anesthesia in children exposed to volatile or intravenous anesthetics. Emergence delirium is typically assessed using the published and validated pediatric emergence delirium (PAED) scale. Due to some variation in properties between sevoflurane and desflurane for maintenance of anesthesia after standard sevoflurane induction, we designed a prospective study to examine potential differences in emergence behavior and incidence of ED in children undergoing elective ear-nose-throat (ENT) surgery...
November 30, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27861180/improving-hospital-survival-and-reducing-brain-dysfunction-at-seven-california-community-hospitals-implementing-pad-guidelines-via-the-abcdef-bundle-in-6-064-patients
#4
Mary Ann Barnes-Daly, Gary Phillips, E Wesley Ely
OBJECTIVES: To track compliance by an interprofessional team with the Awakening and Breathing Coordination, Choice of drugs, Delirium monitoring and management, Early mobility, and Family engagement (ABCDEF) bundle in implementing the Pain, Agitation, and Delirium guidelines. The aim was to study the association between ABCDEF bundle compliance and outcomes including hospital survival and delirium-free and coma-free days in community hospitals. DESIGN: A prospective cohort quality improvement initiative involving ICU patients...
November 17, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27850836/1200-outcomes-associated-with-implementation-of-a-pain-agitation-and-delirium-guideline-in-the-icu
#5
Christine Swartzman, Pamela Andrews, Richard Feibelman, Daleen Penoyer, Mary Sole
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27849239/importance-of-the-use-of-protocols-for-the-management-of-analgesia-and-sedation-in-pediatric-intensive-care-unit
#6
Emiliana Motta, Michele Luglio, Artur Figueiredo Delgado, Werther Brunow de Carvalho
Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols...
September 2016: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/27798810/emergence-delirium-in-pediatric-anesthesia
#7
REVIEW
Arthura D Moore, Doralina L Anghelescu
Emergence delirium (ED) is a complex of perceptual disturbances and psychomotor agitation that occurs most commonly in preschool-aged children in the early postanesthetic period. The incidence of ED varies between 10 and 80% in children and is perceived as a troublesome clinical situation by 42% of pediatric anesthesiologists. Although these events are often short lived, they increase the risk of self-injury and delayed discharge, require additional nursing staff and can increase medical care costs, all of which are causes for concern...
October 31, 2016: Paediatric Drugs
https://www.readbyqxmd.com/read/27684770/2-ce-test-hours-assessing-and-managing-pain-agitation-and-delirium-in-hospitalized-older-adults
#8
Emily Contrada
No abstract text is available yet for this article.
October 2016: American Journal of Nursing
https://www.readbyqxmd.com/read/27655159/ce-assessing-and-managing-pain-agitation-and-delirium-in-hospitalized-older-adults
#9
Tonja M Hartjes, Lauren Meece, Ann L Horgas
: In the acute care setting, pain, agitation, and delirium (PAD) often occur as interrelated parts of a syndrome rather than as separate entities. Because the three facets of PAD may be similar in presentation, it is often difficult for clinicians to recognize the syndrome and to assess and treat it. The challenge is particularly great in older patients, who are more likely than their younger counterparts to have such comorbid conditions as dementia, which may impair the ability to report pain, or age-related physiologic changes that may affect the metabolism and clearance of certain medications...
October 2016: American Journal of Nursing
https://www.readbyqxmd.com/read/27647465/neurological-assessment-with-validated-tools-in-general-icu-multicenter-randomized-before-and-after-pragmatic-study-to-evaluate-the-effectiveness-of-an-e-learning-platform-for-continuous-medical-education
#10
Giovanni Mistraletti, Michele Umbrello, Stefania Anania, Elisa Andrighi, Alessandra Di Carlo, Federica Martinetti, Serena Barello, Giovanni Sabbatini, Paolo Formenti, Tommaso Maraffi, Francesco Marrazzo, Alessandra Palo, Giacomo Bellani, Riccarda Russo, Silvia Francesconi, Federico Valdambrini, Marco Cigada, Francesca Riccardi, Egidio A Moja, Gaetano Iapichino
BACKGROUND: International guidelines recommend systematic assessment of pain, agitation/sedation and delirium with validated scales for all ICU patients. However, these evaluations are often not done. We have created an e-learning training platform for the continuous medical education, and assessed its efficacy in increasing the use of validated tools by all medical and nursing staff of the participating ICUs during their daily practice. METHODS: Multicenter, randomized, before and after study...
September 20, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27624508/acute-porphyria-presenting-as-major-trauma-case-report-and-literature-review
#11
Joel Norton, Christine Hymers, Penelope Stein, Joanne May Jenkins, Duncan Bew
BACKGROUND: Acute porphyria is historically known as "the little imitator" in reference to its reputation as a notoriously difficult diagnosis. Variegate porphyria is one of the four acute porphyrias, and can present with both blistering cutaneous lesions and acute neurovisceral attacks involving abdominal pain, neuropsychiatric features, neuropathy, hyponatremia, and a vast array of other nonspecific clinical features. CASE REPORT: A 40-year-old man presented to the Emergency Department (ED) as a major trauma call, having been found in an "acutely confused state" surrounded by broken glass...
November 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27229650/beyond-the-golden-hours-caring-for-septic-patients-after-the-initial-resuscitation
#12
REVIEW
Jean P Gelinas, Keith R Walley
Recognition and management of agitation, delirium, and pain are key areas. Reduced use of sedatives is an important measure that must be coupled with increased patient engagement, mobilization, and exercise. Use of low tidal volumes and low mean airway pressures during mechanical ventilation is helpful. A key hemodynamic principle following early aggressive volume resuscitation is subsequent careful assessment to avoid unnecessary additional volume administration and adverse consequences of frank volume overload...
June 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27215361/application-of-clinical-practice-guidelines-for-pain-agitation-and-delirium
#13
REVIEW
Anna Krupp, Michele C Balas
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...
June 2016: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/27163223/interprofessional-implementation-of-a-pain-sedation-guideline-on-a-trauma-intensive-care-unit
#14
Tara L Sacco, Brenton LaRiccia
Trauma patients experience pain and agitation during their hospitalization. Many complications have been noted both in the absence of symptom management and the in presence of oversedation/narcotization. To combat noted untoward effects of pain and sedation management, an interprofessional team convened to develop a pain and sedation guideline for use in a trauma intensive care unit. Guideline development began with a comprehensive review of the literature. With the input of unit stakeholders, a nurse-driven analgosedation guideline was implemented for a 6-month trial...
May 2016: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/27108084/analgosedation-improving-patient-outcomes-in-icu-sedation-and-pain-management
#15
Ryan Wiatrowski, Colleen Norton, David Giffen
Sedation practices in the critical care unit have been trending toward lighter sedation since the start of the new millennium, but patients continue to experience inadequate pain management and excessive sedation. This paper includes a brief examination of the problem of pain management in the ICU; trends in sedation practices, including light sedation and the daily interruption of sedation; and a literature review of analgosedation. While the analgosedation literature is relatively sparse, it offers a promising, patient-centered method for managing the triad of pain, agitation, and delirium, while reducing common complications associated with long-term ventilation...
June 2016: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/27103793/delirium-in-the-geriatric-unit-proton-pump-inhibitors-and-other-risk-factors
#16
Iwona Otremba, Krzysztof Wilczyński, Jan Szewieczek
BACKGROUND: Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies. OBJECTIVE: Evaluate specific factors for development of delirium in a geriatric ward setting. METHODS: Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission...
2016: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/27075762/comfort-and-patient-centred-care-without-excessive-sedation-the-ecash-concept
#17
REVIEW
Jean-Louis Vincent, Yahya Shehabi, Timothy S Walsh, Pratik P Pandharipande, Jonathan A Ball, Peter Spronk, Dan Longrois, Thomas Strøm, Giorgio Conti, Georg-Christian Funk, Rafael Badenes, Jean Mantz, Claudia Spies, Jukka Takala
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...
June 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27032484/-diagnosis-and-treatment-of-urea-cycle-disorders-in-adult-patients
#18
F Maillot, H Blasco, B Lioger, A Bigot, C Douillard
Urea cycle disorders (UCDs) are inborn errors of metabolism in which the clinical picture is mostly due to ammonia intoxication. UCD onset may be observed at any age. Acute decompensations of UCDs include neuro-psychiatric symptoms such as headache, confusion, convulsions, ataxia, agitation or delirium, as well as digestive symptoms, namely nausea and vomiting along with abdominal pain. Acute decompensations may lead to an irreversible coma in the absence of specific therapy. The first step is to measure promptly ammonemia in such patients, and start appropriate therapy on an emergency basis...
March 28, 2016: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/27002463/attitudes-toward-use-of-benzodiazepines-among-u-s-hospice-clinicians-survey-and-review-of-the-literature
#19
Andrew Kamell, Lauren Kelley Smith
BACKGROUND: Benzodiazepines are commonly used in inpatient hospices internationally. U.S. hospice clinician views toward benzodiazepines are unknown. OBJECTIVES: Study objectives were (1) to assess inpatient hospice clinician attitudes towards the benefits of benzodiazepines for various indications and (2) to compare these attitudes to current clinical recommendations and literature. METHODS: A survey was developed and distributed to hospices with inpatient units nationwide...
May 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/26956672/sickle-cell-crisis-complicated-by-synthetic-cannabinoid-abuse-a-case-report
#20
Crystal Y Zheng, Caterina P Minniti, Mark H Chaitowitz
We describe a case of delirium occurring in a hospitalized sickle cell patient. Following admission for a typical pain crisis, the patient continued to report unrelieved pain with marked agitation for several days, despite escalating doses of opioid analgesia, and ultimately required intubation following development of acute chest syndrome (ACS). After some delay, it was discovered that he had been using a synthetic cannabinoid (K2) which may have precipitated his pain crisis and, with hindsight, explained his prolonged period of delirium...
June 2016: Hemoglobin
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