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Sedation awareness

L X Quan, H X An, D X Wang
OBJECTIVE: To observe the effects of 0.4 μg/(kg×h) dose of dexmedetomidine on intra-operative wake-up test in children patients undergoing scoliosis surgery. METHODS: Sixty patients for posterior scoliosis correction (ASA I-II, aged 5-16 years) from March 2013 to April 2015 were enrolled in this prospective, double-blinded, randomized, placebo-controlled study, The patients were randomly classified into two groups to receive dexmedetomidine (group RD, n=30) or saline solution (group R, n=30)...
October 18, 2016: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Floriana Pinto, Gianni Biancofiore
BACKGROUND: The ABCDE (Awakening and Breathing coordination of daily sedation and ventilator removal trials; Choice of sedative or analgesic exposure; Delirium monitoring and management; and Early mobility and exercise) bundle is a multidisciplinary set of evidence-based practices for improving patient outcomes in the intensive care unit. Nurses are critical to all the bundle's requirements. Therefore, understanding their knowledge, attitudes, and perception of the different bundle's components might help for an easier implementation into everyday clinical practice...
November 2016: Dimensions of Critical Care Nursing: DCCN
Hélène Jumeau, Philippe Lechien, Florence Dupriez
Posterior carpometacarpal (CMC) dislocation is a rare condition. Treatment is usually surgical though no strict consensus can be found upon literature review. If diagnosed early and no associated fractures are found, CMC dislocation could benefit from conservative treatment comprising closed reduction and splint immobilisation. We report the case of a 26-year-old man diagnosed with a posterior dislocation of the third, fourth, and fifth CMC joints after a fall of 1.5 meters, treated by external reduction under procedural sedation and immobilisation with a cast for 6 weeks...
2016: Case Reports in Emergency Medicine
John R Richards, Erik G Laurin, Nabil Tabish, Richard A Lange
BACKGROUND: Topical cocaine is sometimes used for the treatment of epistaxis, as it has both potent anesthetic and vasoconstrictive properties. Cocaine has unpredictable cardiovascular effects, such as sudden hypertension, tachycardia, coronary arterial vasoconstriction, and dysrhythmia. CASE REPORT: We report a case of acute iatrogenic cardiovascular toxicity from the use of topical cocaine in a 56-year-old man presenting to the Emergency Department with profound epistaxis...
September 29, 2016: Journal of Emergency Medicine
Charlotte B Winder, Stephen J LeBlanc, Derek B Haley, Kerry D Lissemore, M Ann Godkin, Todd F Duffield
Disbudding and dehorning dairy calves is very common, despite the introduction of polled genetics to most dairy breeds. Appropriate pain-control practices for these procedures affect both calf welfare and public perception of the dairy industry. Previously published work has shown that North American dairy producers have not widely adopted use of these medications for disbudding or dehorning. However, since the last published work examining these practices in Canada, changes regarding awareness, availability, and future requirements for pain control have occurred in the industry...
September 21, 2016: Journal of Dairy Science
Michael K Essandoh, Andrew J Otey, Mahmoud Abdel-Rasoul, Erica J Stein, Katja R Turner, Nicholas C Joseph, Emile G Daoud
BACKGROUND: To date, general anesthesia has been suggested as the preferred approach for implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD). The purpose of this study was to assess the use of monitored anesthesia care (MAC) for S-ICD implantation. The goals were to assess adequate sedation and analgesia (efficacy endpoints) and major perioperative airway or hemodynamic compromise (safety endpoints). The authors hypothesized that MAC may provide adequate sedation and analgesia and no major perioperative airway or hemodynamic compromise during S-ICD implantation and multiple defibrillation threshold (DFT) testing...
October 2016: Journal of Cardiothoracic and Vascular Anesthesia
Walter Glannon
Consciousness defines us as persons. It allows us to have both pleasurable and painful experiences. I present four neurological conditions in the clinical setting to explore how consciousness can be beneficial or harmful to patients: intraoperative awareness, prolonged disorders of consciousness, locked-in syndrome, and the effects of narcotics and sedation on terminally ill patients. The ethical significance of consciousness for patients in these conditions depends on two factors: the content of one's experience and whether one can report this content to others...
October 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Zhihao Liu, Jiaqi Mi, Shuang Yang, Manman Zhao, Yan Li, Li Sheng
YZG-331 is a synthetic adenosine analogue which exhibits the sedative and hypnotic effects by binding to the adenosine receptor. The present study was designed to investigate the effects of P-glycoprotein (P-gp) on the intestine and brain distribution of YZG-331 in vitro and in vivo as well as related binding mechanisms. The activity of P-gp ATPase was both induced by YZG-331 and verapamil, a typical P-gp inhibitor, but affinity of YZG-331 for P-gp was lower than that of verapamil. The docking analyses further elucidated the binding relationship of YZG-331 and P-gp...
September 7, 2016: European Journal of Pharmacology
Aditya B Patel, Debora C Matthews, Edmond Ghiabi
OBJECTIVE: To document the profile of periodontists in private practice in Canada in terms of services provided and referral patterns. METHODS: An online survey consisted on 45 questions in 3 categories: demographics, referral patterns and periodontal procedures performed. The sampling frame consisted of all active members of the Canadian Academy of Periodontology (n= 280). Letters and email containing links to the online survey were used to invite participants and to send reminders to non-respondents on days 7, 21 and 49...
March 2016: Journal—Canadian Dental Association, Journal de L'Association Dentaire Canadienne
Abeer A Selim, E Wesley Ely
AIM AND OBJECTIVES: The aim of the present study was to survey ICUs health care professionals' awareness and practice related to delirium. BACKGROUND: Despite the current evidence revealing the risks linked to delirium and advances in practice guidelines promoting delirium assessment, health care professionals show little sensitivity towards delirium and evident training needs. DESIGN: The study had a cross sectional survey design. METHODS: A sample of 168 ICU health care professionals; including nurses and physicians completed a semi structured questionnaire to survey their awareness, screening and management of delirium in ICUs...
August 18, 2016: Journal of Clinical Nursing
Heloisa Sousa Gomes, Liliani Aires Candido Vieira, Paulo Sucasas Costa, Aline Carvalho Batista, Luciane Rezende Costa
BACKGROUND: Dental procedures may cause stress and increase the salivary cortisol levels. It is important to known if apparently simple procedures such as professional dental prophylaxis at low speed (DP) are stressful for children with dental behaviour management problems (DBMP) to help with behaviour guidance strategies. This longitudinal study aimed to evaluate if DP changes a physiological marker of stress (salivary cortisol) in children with DBMP who were referred to dental treatment under sedation...
2016: BMC Oral Health
Jin Woo Choi, Jin Deok Joo, Dae Woo Kim, Jang Hyeok In, So Young Kwon, Kwonhui Seo, Donggyu Han, Ga Young Cheon, Hong Soo Jung
We aimed to compare fentanyl, remifentanil and dexmedetomidine with respect to hemodynamic stability, postoperative pain control and achievement of sedation at the postanesthetic care unit (PACU). In this randomized double-blind study, 90 consecutive total laparoscopic hysterectomy patients scheduled for elective surgery were randomly assigned to receive fentanyl (1.0 μg/kg) over 1 minute followed by a 0.4 μg/kg/hr infusion (FK group, n = 30), or remifentanil (1.0 μg/kg) over 1 minute followed by a 0.08 μg/kg/min infusion (RK group, n = 30), or dexmedetomidine (1 μg/kg) over 10 minutes followed by a 0...
September 2016: Journal of Korean Medical Science
N N J J M van der Sluiszen, A Vermeeren, S Jongen, E L Theunissen, A C M van Oers, C J Van Leeuwen, A Maret, C Desforges, A Delarue, J G Ramaekers
OBJECTIVE: Previous studies demonstrated that mequitazine produces mild sedation after single doses. Its enantiomer, l-mequitazine, has a stronger potency for the H1 receptor. The aim of the current study was to assess the effects of l-mequitazine and mequitazine, alone and with alcohol, on driving. METHODS: Twenty-five healthy volunteers were treated with l-mequitazine 2.5, 5.0 and 10 mg, mequitazine 10 mg and placebo, alone and in combination with alcohol in a double-blind crossover design...
September 2016: Psychopharmacology
Thomas C Sauter, Wolf E Hautz, Simone Hostettler, Monika Brodmann-Maeder, Luca Martinolli, Beat Lehmann, Aristomenis K Exadaktylos, Dominik G Haider
BACKGROUND: Sedation is a procedure required for many interventions in the Emergency department (ED) such as reductions, surgical procedures or cardioversions. However, especially under emergency conditions with high risk patients and rapidly changing interdisciplinary and interprofessional teams, the procedure caries important risks. It is thus vital but difficult to implement a standard operating procedure for sedation procedures in any ED. Reports on both, implementation strategies as well as their success are currently lacking...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Jan Claassen, Angela Velazquez, Emma Meyers, Jens Witsch, M Cristina Falo, Soojin Park, Sachin Agarwal, J Michael Schmidt, Nicholas D Schiff, Jacobo D Sitt, Lionel Naccache, E Sander Connolly, Hans-Peter Frey
OBJECTIVE: Accurate behavioral assessments of consciousness carry tremendous significance in guiding management, but are extremely challenging in acutely brain-injured patients. We evaluated whether electroencephalography (EEG) and multimodality monitoring parameters may facilitate assessment of consciousness in patients with subarachnoid hemorrhage. METHODS: A retrospective analysis was performed of 83 consecutively treated adults with subarachnoid hemorrhage. All patients were initially comatose and had invasive brain monitoring placed...
October 2016: Annals of Neurology
Marie Muyldermans, Serge Jennes, Stuart Morrison, Olivier Soete, Pierre-Michel François, Elkana Keersebilck, Thomas Rose, Olivier Pantet
OBJECTIVE: To describe a case of partial nephrogenic diabetes insipidus in a burned patient after prolonged delivery of low inspired concentrations of sevoflurane via an Anesthetic Conserving Device. DATA SOURCES: Clinical observation. STUDY SELECTION: Case report. DATA EXTRACTION: Relevant clinical information. DATA SYNTHESIS: A 34-year-old man was admitted with burns covering 52% of his total body surface area...
July 13, 2016: Critical Care Medicine
Kenneth D Katz, Adam L Leonetti, Blake C Bailey, Ryan M Surmaitis, Eric R Eustice, Sherri Kacinko, Scott M Wheatley
Synthetic cannabinoid use has risen at alarming rates. This case series describes 11 patients exposed to the synthetic cannabinoid, MAB-CHMINACA who presented to an emergency department with life-threatening toxicity including obtundation, severe agitation, seizures and death. All patients required sedatives for agitation, nine required endotracheal intubation, three experienced seizures, and one developed hyperthermia. One developed anoxic brain injury, rhabdomyolysis and died. A significant number were pediatric patients...
May 2016: Western Journal of Emergency Medicine
Keisuke Kameda, Kazuhiro Watarai, Kenji Takahashi, Tomohisa Shoko, Masayoshi Koinuma, Goro Ikushima
Since 2012, Matsudo City Hospital has increased the number of pharmacists stationed in the ward on weekday mornings at the emergency care center, the intensive care unit (ICU) and the high care unit (HCU). Multidisciplinary joint meetings and joint conferences are conducted in the emergency care center, and patient and drug information is shared. A 20-year-old man was transferred to our hospital after a traffic accident. He was diagnosed with subarachnoid hemorrhage and brain contusion. He exhibited violent movement and intense restlessness...
2016: Yakugaku Zasshi: Journal of the Pharmaceutical Society of Japan
Danton Char, Chandra Ramamoorthy, Lisa Wise-Faberowski
As physicians and caregivers of children with congenital heart disease, we are aware of the increasing need for procedures requiring anesthesia. While these procedures may be ideal for medical and cardiac surgical management, the risks and benefits must be assessed carefully. There are well known risks of cardiovascular and respiratory complications from anesthesia and sedation and a potentially under-appreciated risk of neurocognitive dysfunction. Both animal and human studies support the detrimental effects of repeated anesthetic exposure on the developing brain...
May 2016: Congenital Heart Disease
L Bosch, T Villar, M Y Latorre, S Pacreu
Acute intermittent porphyria is an autosomal dominant disorder that results from a partial deficiency of porphobilinogen deaminase and that causes very severe symptoms. Attacks may be triggered by a series of drugs and by other factors that the anesthesiologist should be aware of in order to reduce morbidity and mortality. Our objective is to review anesthetic considerations in acute intermittent porphyria. We present the case of a patient diagnosed with acute intermittent porphyria who was scheduled for knee arthroscopy...
August 2016: Revista Española de Anestesiología y Reanimación
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