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Analgesia sedation delirium

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https://www.readbyqxmd.com/read/29021727/analgesia-sedation-and-arousal-status-in-burn-patients-the-gap-between-recommendations-and-current-practices
#1
A Lavrentieva, N Depetris, I Rodini
Assessment and treatment of pain, agitation and delirium are integral parts of the management of critically ill patients. The purpose of this review is to describe how pain, delirium and agitation are managed in general intensive care units and in burn units, and to address whether management of these issues is compatible with internationally accepted recommendations. A substantial gap exists between the conception of the guidelines, clinical practice and physicians' statements regarding pain, sedation and delirium management...
June 30, 2017: Annals of Burns and Fire Disasters
https://www.readbyqxmd.com/read/28941538/sedation-analgesia-and-neuromuscular-blockade-in-pediatric-critical-care-overview-and-current-landscape
#2
REVIEW
Athena F Zuppa, Martha A Q Curley
Sedation is a mainstay of therapy for critically ill children. Although necessary in the care of the critically ill child, sedative drugs are associated with adverse effects, such as disruption of circadian rhythm, altered sleep, delirium, potential neurotoxicity, and immunosuppression. Optimal approaches to the sedation of the critically ill child should include identification of sedation targets and sedation interruptions, allowing for a more individualized approach to sedation. Further research is needed to better understand the relationship between critical illness and sedation pharmacokinetics and pharmacodynamics, the impact of sedation on immune function, and the genetic implications on drug disposition and response...
October 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/28869145/the-early-diagnosis-and-management-of-mixed-delirium-in-a-patient-placed-on-ecmo-and-with-difficult-sedation-a-case-report
#3
María Acevedo-Nuevo, Maria Teresa González-Gil, Miguel Ángel Romera-Ortega, Ignacio Latorre-Marco, Maria Dolores Rodríguez-Huerta
Delirium represents a serious problem that impacts the physical and cognitive prognosis of patients admitted to intensive care units and requires prompt diagnosis and management. This article describes the case and progress of a patient placed on Extracorporeal Membrane Oxygenation with difficult sedation criteria and an early diagnosis of mixed delirium. During the case report, we reflect on the pharmacological and non-pharmacological strategies employed to cope with delirium paying special attention to the non-use of physical restraint measures in order to preserve vital support devices (endotracheal tube or Extracorporeal Membrane Oxygenation cannula)...
August 28, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28863011/sedation-and-mobilization-during-venovenous-extracorporeal-membrane-oxygenation-for-acute-respiratory-failure-an-international-survey
#4
Jonathan D Marhong, Julian DeBacker, Julien Viau-Lapointe, Laveena Munshi, Lorenzo Del Sorbo, Lisa Burry, Eddy Fan, Sangeeta Mehta
OBJECTIVES: To characterize sedation, analgesia, delirium, and mobilization practices in patients supported with venovenous extracorporeal membrane oxygenation for severe acute respiratory failure. DESIGN: Cross-sectional electronic survey administered January 2016 to March 2016. SETTING: Three-hundred ninety-four extracorporeal membrane oxygenation centers registered with the Extracorporeal Life Support Organization. SUBJECTS: Extracorporeal membrane oxygenation medical directors and program coordinators...
November 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28851588/do-sedation-and-analgesia-contribute-to-long-term-cognitive-dysfunction-in-critical-care-survivors
#5
S Fernandez-Gonzalo, M Turon, C De Haro, J López-Aguilar, M Jodar, L Blanch
Deep sedation during stay in the Intensive Care Unit (ICU) may have deleterious effects upon the clinical and cognitive outcomes of critically ill patients undergoing mechanical ventilation. Over the last decade a vast body of literature has been generated regarding different sedation strategies, with the aim of reducing the levels of sedation in critically ill patients. There has also been a growing interest in acute brain dysfunction, or delirium, in the ICU. However, the effect of sedation during ICU stay upon long-term cognitive deficits in ICU survivors remains unclear...
August 26, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/28845902/persistence-of-delirium-after-cessation-of-sedatives-and-analgesics-and-impact-on-clinical-outcomes-in-critically-ill-patients
#6
Michael T Kenes, Joanna L Stollings, Li Wang, Timothy D Girard, E Wesley Ely, Pratik P Pandharipande
STUDY OBJECTIVE: As delirium is a common manifestation in critically ill patients and is associated with worse clinical outcomes, we sought to characterize the reversibility of delirium after discontinuation of sedation and to determine whether sedation-associated delirium that rapidly reverses impacts clinical outcomes. DESIGN: Post hoc subgroup analysis of prospectively collected data from a previously published study. PATIENTS: Seventy adults admitted to a medical intensive care unit (ICU) between March and July 2012 who required mechanical ventilation with continuous analgesia and/or sedation and underwent a spontaneous awakening trial (SAT)...
August 28, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28733841/analgosedation-of-adult-patients-with-elevated-intracranial-pressure-survey-of-current-clinical-practice-in-austria
#7
Guenther Herzer, Claudia Mirth, Udo M Illievich, Wolfgang G Voelckel, Helmut Trimmel
BACKGROUND: Analgesia and sedation are key items in intensive care. Recently published S3 guidelines specifically address treatment of patients with elevated intracranial pressure. METHODS: The Austrian Society of Anesthesiology, Resuscitation and Intensive Care Medicine carried out an online survey of neurointensive care units in Austria in order to evaluate the current state of practice in the areas of analgosedation and delirium management in this high-risk patient group...
July 21, 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28725244/optimal-perioperative-anesthesia-management-for-gynecologic-interstitial-brachytherapy
#8
Alison A Nielsen, Tehani A Liyanage, Gary S Leiserowitz, Jyoti Mayadev
PURPOSE: To propose an optimal perioperative pain management clinical care pathway for interstitial brachytherapy for gynecologic cancer based on our interdepartmental experience. MATERIAL AND METHODS: We conducted a retrospective review of 23 women who underwent 32 interstitial brachytherapy procedures for gynecological cancers, analyzing patient demographics, type of anesthetic, medications, postoperative pain scores, adverse events, and delays in discharge. We measured the association of postoperative nausea and/or vomiting (PONV) with hydromorphone use, and postoperative pain scores and total narcotic administration with type of anesthesia...
June 2017: Journal of Contemporary Brachytherapy
https://www.readbyqxmd.com/read/28572103/interprofessional-team-s-perception-of-care-delivery-after-implementation-of-a-pediatric-pain-and-sedation-protocol
#9
Sandra L Staveski, May Wu, Tiffany M Tesoro, Stephen J Roth, Michael J Cisco
BACKGROUND: Pain and agitation are common experiences of patients in pediatric cardiac intensive care units. Variability in assessments by health care providers, communication, and treatment of pain and agitation creates challenges in management of pain and sedation. OBJECTIVES: To develop guidelines for assessment and treatment of pain, agitation, and delirium in the pediatric cardiac intensive unit in an academic children's hospital and to document the effects of implementation of the guidelines on the interprofessional team's perception of care delivery and team function...
June 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28523268/the-sedative-effect-of-propranolol-on-critically-ill-patients-a-case-series
#10
Junji Shiotsuka, Andrew Steel, James Downar
INTRODUCTION: Recent studies have examined the effectiveness of alpha-2 adrenergic agonists for controlling delirium and agitation. Propranolol, a non-selective beta-adrenergic antagonist with good penetration of the blood-brain barrier, has not been investigated for this purpose. MATERIALS AND METHODS: We retrospectively reviewed the medical records of all patients who were prescribed propranolol in our Medical Surgical ICU from January 1, 2010, to December 31, 2013...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/28485318/a-national-multicenter-survey-on-management-of-pain-agitation-and-delirium-in-intensive-care-units-in-china
#11
Jing Wang, Zhi-Yong Peng, Wen-Hai Zhou, Bo Hu, Xin Rao, Jian-Guo Li
BACKGROUND: The management of pain, agitation, and delirium (PAD) in Intensive Care Unit (ICU) is beneficial for patients and makes it widely applied in clinical practice. Previous studies showed that the clinical practice of PAD in ICU was improving; yet relatively little information is available in China. This study aimed to investigate the practice of PAD in ICUs in China. METHODS: A multicenter, nationwide survey was conducted using a clinician-directed questionnaire from September 19 to December 18, 2016...
May 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/28383293/peripheral-nerve-block-as-a-supplement-to-light-or-deep-general-anesthesia-in-elderly-patients-receiving-total-hip-arthroplasty-a-prospective-randomized-study
#12
Bin Mei, Hanning Zha, Xiaolong Lu, Xinqi Cheng, Shishou Cheng, Xuesheng Liu, Yuanhai Li, Erwei Gu
BACKGROUND: Peripheral nerve block combined with general anesthesia is a preferable anesthesia method for elderly patients receiving hip arthroplasty. The depth of sedation may influence patient recovery. Therefore, we aimed to investigate the influence of peripheral nerve blockade and different intraoperative sedation levels on the short-term recovery of elderly patients receiving total hip arthroplasty. METHODS: Patients aged 65 years and older undergoing total hip arthroplasty were randomized into three groups: a general anesthesia without lumbosacral plexus block group, and two general anesthesia plus lumbosacral plexus block groups, each with a different level of sedation (light or deep)...
April 5, 2017: Clinical Journal of Pain
https://www.readbyqxmd.com/read/28375992/pain-agitation-and-delirium-guidelines-interprofessional-perspectives-to-translate-the-evidence
#13
Juliane Jablonski, Jaime Gray, Todd Miano, Gretchen Redline, Heather Teufel, Tara Collins, Jose Pascual-Lopez, Martha Sylvia, Niels D Martin
BACKGROUND: Societal guidelines exist for the management of pain, agitation, and delirium (PAD) in critically ill patients. This contemporary practice aims for a more awake and interactive patient. Institutions are challenged to translate the interrelated multivariable concepts of PAD into daily clinical practice and to demonstrate improvement in quality outcomes. An interdisciplinary goal-directed approach shows outcomes in high-acuity surgical critical care during the early stages of implementation...
May 2017: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/28358177/survey-on-monitoring-analgesia-and-sedation-in-the-italian-pediatric-intensive-care-units
#14
Benedicta Tabacco, Claudio Tacconi, Angela Amigoni
BACKGROUND: Admission in Pediatric Intensive Care Unit requires management and monitoring of analgesia and sedation, in order to reduce their adverse effects, and to prevent withdrawal syndrome and delirium. The aim of this study is to evaluate the management of analgesia and sedation in critically ill children admitted in the Italian Pediatric Intensive Care Units. METHODS: For this survey we have submitted a telematics questionnaire to 24 nursing co- ordinators of the Pediatric Intensive Care Units or Neonatal Intensive Care Units admitting critically ill children...
March 28, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28338180/influence-of-dexmedetomidine-to-cognitive-function-during-recovery-period-for-children-with-general-anesthesia
#15
RANDOMIZED CONTROLLED TRIAL
Z-M Jia, H-N Hao, M-L Huang, D-F Ma, X-L Jia, B Ma
OBJECTIVE: We studied the influence of Dexmedetomidine on cognitive function in children during the recovery period of general anesthesia. PATIENTS AND METHODS: Ninety-three children who underwent general anesthesia were selected and randomly divided into (1) the control group, (2) the dexmedetomidine group, and (3) the dezocine group. Fentanyl, propofol, and rocuronium were used in all patients to induce anesthesia, while sevoflurane inhalation and propofol were used to maintain anesthesia...
March 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28250481/comparison-of-oral-dexmedetomidine-versus-oral-midazolam-as-premedication-to-prevent-emergence-agitation-after-sevoflurane-anaesthesia-in-paediatric-patients
#16
M Kavya Prabhu, Sripada G Mehandale
BACKGROUND AND AIMS: Sevoflurane is the most often used inhalational agent in paediatric anaesthesia, but emergence agitation (EA) remains a major concern. Oral midazolam and parenteral dexmedetomidine are known to be effective in controlling EA. We attempted to elucidate whether oral dexmedetomidine is better than midazolam in controlling EA. METHODS: Prospective double-blinded study involving ninety patients aged 1-10 years, undergoing elective surgeries of <2 h of expected duration under sevoflurane general anaesthesia, randomised to receive either midazolam (Group A) or dexmedetomidine (Group B) as oral premedication was carried out to record level of sedation before induction, haemodynamic parameters and recovery time...
February 2017: Indian Journal of Anaesthesia
https://www.readbyqxmd.com/read/28224179/-erratum-to-delirium-analgesia-and-sedation-in-intensive-care-medicine
#17
A Wolf, R Mörgeli, A Müller, B Weiss, C Spies
No abstract text is available yet for this article.
March 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28190439/neurologic-complications-of-polytrauma
#18
R M Jha, L Shutter
Neurologic complications in polytrauma can be classified by etiology and clinical manifestations: neurovascular, delirium, and spinal or neuromuscular problems. Neurovascular complications include ischemic strokes, intracranial hemorrhage, or the development of traumatic arteriovenous fistulae. Delirium and encephalopathy have a reported incidence of 67-92% in mechanically ventilated polytrauma patients. Causes include sedation, analgesia/pain, medications, sleep deprivation, postoperative state, toxic ingestions, withdrawal syndromes, organ system dysfunction, electrolyte/metabolic abnormalities, and infections...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28152732/reducing-pain-agitation-and-delirium-to-optimize-outcomes-in-mechanically-ventilated-critically-ill-oncology-patients
#19
Dana Bullick, Sharon Barniak, Joanne McGovern, Trisha Patel, Jeffrey Hoag
233 Background: Greater than 60% of cancer patients experience chronic pain which is heightened in critical illness. Optimal pain assessment is challenging in the critically ill leading to under treatment due to sedation during mechanical ventilation (MV). The Society of Critical Care Medicine (SCCM) favors treating pain with intermittent boluses rather than continuous infusions; however,appropriate analgesic doses and means of titration are elusive leading to over sedation, prolonged ventilation, and delirium...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28074297/-delirium-analgesia-and-sedation-in-intensive-care-medicine-development-of-a-protocol-based-management-approach
#20
A Wolf, R Mörgeli, A Müller, B Weiss, C Spies
Intensive care treatment has long-term consequences that are often not immediately apparent to the health care providers. The combination of muscle weakness, cognitive damage, and psychological disorders is comprised under the term post-intensive care syndrome (PICS). Analgesia and sedation protocols, as well as nonpharmacological preventive and therapeutic approaches, are effective tools for avoiding complications and improving long-term survival. The principle of "early goal-directed therapy" is fundamental...
February 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
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