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Agitation sedation

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https://www.readbyqxmd.com/read/29153301/does-neurofunction-monitoring-enhance-nursing-confidence-and-comfort
#1
Holly Ware, Sonja E Stutzman, Lori McGarry, Jenna Bland, DaiWai M Olson
Despite advances in the science of sedation and pain assessment, few studies have examined the impact of various assessment tools on nursing confidence. This study examines how bispextral index monitoring impacts nursing confidence in the assessment and comfort in medication administration based on that assessment. In this prospective observational Quality Improvement project, nurses using bispectral index (BIS) and the Richmond Agitation Sedation Scale (RASS) were randomly selected to complete a self-assessment survey intended to measure their personal confidence and comfort regarding care they were providing for a specific patient on the day the survey was completed...
November 15, 2017: Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses
https://www.readbyqxmd.com/read/29151416/-short-term-deep-sedation-strategy-in-patients-with-spontaneous-intracerebral-hemorrhage-a-randomized-controlled-trial
#2
Zhuheng Wang, Chunzhi Shi, Liping Sun, Qinghua Guo, Wei Qiao, Guanhua Zhou
OBJECTIVE: To evaluate the efficacy and safety of short-term deep sedation strategy in patients with spontaneous intracerebral hemorrhage (ICH) after surgery. METHODS: A perspective, randomized, parallel-group study was conducted. Adult patients with spontaneous ICH and undergoing craniotomy admitted to Daxing Teaching Hospital of Capital Medical University from December 2015 to November 2016 were enrolled. The patients who received surgery were randomly divided into a short-term deep sedation and a slight and middle sedation group...
November 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29150713/efficacy-of-silexan-in-subthreshold-anxiety-meta-analysis-of-randomised-placebo-controlled-trials
#3
Hans-Jürgen Möller, Hans-Peter Volz, Angelika Dienel, Sandra Schläfke, Siegfried Kasper
Subthreshold psychiatric disorders do not fully meet the diagnostic criteria of syndromal disorders but may be associated with comparable disability. To investigate the anxiolytic effect of Silexan, an active substance from lavender oil for oral administration, in patients with subthreshold anxiety, a meta-analysis that included all published trials with Silexan in this indication was performed. Three randomised, placebo-controlled trials in subthreshold anxiety disorders (anxiety disorder not otherwise specified, restlessness and agitation, mixed anxiety and depressive disorder) were included...
November 17, 2017: European Archives of Psychiatry and Clinical Neuroscience
https://www.readbyqxmd.com/read/29136716/-the-impact-of-goal-directed-analgesia-on-mechanical-ventilated-patients-s-outcomes-in-intensive-care-unit-a-clinical-observational-study
#4
Q D Li, X Y Wan, Y L Zhang, S W Li, L L Han, W W Li, H Y Shi
To investigate the impact of goal directed analgesia on the outcome of patients with mechanical ventilation in intensive care unit.A total of 126 patients who needed mechanical ventilation were recruited.With a method of before and after paired comparison, they were divided into two group: (1) analgesia with empirical administration or control group; (2) goal directed analgesia based on critical-care pain observation tool (CPOT). Compared with the control group, after goal directed analgesia was applied, the consumption of midazolam significantly dropped from (368...
November 1, 2017: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/29136301/ketamine-for-the-acute-management-of-excited-delirium-and-agitation-in-the-prehospital-setting
#5
Kyle A Weant, Lauren M Linder, Clint A Ross
BACKGROUND: Traditional first-line therapy in the prehospital setting for the acutely agitated patient includes an antipsychotic in combination with a benzodiazepine. Recently, interest has grown regarding the use of ketamine in the prehospital setting as an attempt to overcome the limitations of the traditional medications and provide a more safe and effective therapy. This review provides an overview of the pharmacology of ketamine, evaluates the literature regarding ketamine use for prehospital agitation, and proposes an algorithm that may be used within the prehospital setting...
November 14, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29135112/symptom-triggered-alcohol-vapor-inhalation-for-postoperative-alcohol-withdrawal-syndrome-in-patients-with-gastroesophageal-carcinoma
#6
Fengwei Kong, Miao Zhang, Heng Wang, Dong Liu, Ying Wu, Ning Chai, Wenbin Wu
PURPOSE: The purpose of this study was to investigate the feasibility and efficacy of alcohol vapor inhalation during fasting time for cancer patients with alcohol withdrawal symptoms (AWS) after surgery. METHODS: The data of 51 patients after esophagectomy or gastrectomy for gastroesophageal carcinoma in two hospitals from January 2011 to December 2016 was retrospectively analyzed. These patients were diagnosed with AWS with Clinic Institute Alcohol Withdrawal Syndrome Scale (CIWA-Ar) score ≥ 9 in two hospitals during fasting time from January 2011 to December 2016, and they were accordingly divided into alcohol vapor group (n=25) and diazepam group (n=26)...
September 2017: Journal of B.U.ON.: Official Journal of the Balkan Union of Oncology
https://www.readbyqxmd.com/read/29110954/effect-of-motor-subtypes-of-delirium-in-the-intensive-care-unit-on-fast-track-failure-after-cardiac-surgery
#7
Anna Lee, Jing Lan Mu, Chun Hung Chiu, Tony Gin, Malcolm John Underwood, Gavin Matthew Joynt
OBJECTIVE: The purpose of the study was to evaluate the association between motor subtypes of postoperative delirium in the intensive care unit and fast-track failure (a composite outcome of prolonged stay in the intensive care unit >48 hours, intensive care unit readmission, and 30-day mortality) after cardiac surgery. METHODS: This was a secondary analysis of a prospective cohort study of 600 consecutive adults undergoing cardiac surgery at a university hospital in Hong Kong (July 2013 to July 2015)...
September 30, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29109752/management-of-exaggerated-gag-reflex-in-dental-patients-using-intravenous-sedation-with-dexmedetomidine
#8
Aleksei P Reshetnikov, Anton A Kasatkin, Aleksandr L Urakov, Dmitrii Y Baimurzin
Pharmacological sedation is one of the effective ways of prevention of gag reflex development in patients experiencing anxiety and fright before dental treatment. We are reporting a case where we could successfully eliminate exaggerated gag reflex (intravenous [IV] Gagging Severity Index) in a dental patient using IV sedation with dexmedetomidine. IV administration of dexmedetomidine provided elimination of gag reflex at a depth of sedation for the patient with the Richmond Agitation-Sedation Scale score of -2 and -1...
September 2017: Dental Research Journal
https://www.readbyqxmd.com/read/29045280/sedation-practice-in-extracorporeal-membrane-oxygenation-treated-patients-with-acute-respiratory-distress-syndrome-a-retrospective-study
#9
Julian deBacker, Erik Tamberg, Laveena Munshi, Lisa Burry, Eddy Fan, Sangeeta Mehta
Our objective was to characterize sedation management in adult patients with severe respiratory distress syndrome (ARDS) treated with venovenous extracorporeal membrane oxygenation (VV-ECMO). We conducted a retrospective chart review of these patients treated at Toronto General Hospital between January 2012 and October 2015. Medications administered (sedative, analgesic, paralytic, and antipsychotic), sedation depth (Sedation Agitation Scale [SAS] score) delirium assessments, and mobilization were recorded daily...
October 18, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/29044304/delirium-in-a-latin-american-intensive-care-unit-a-prospective-cohort-study-of-mechanically-ventilated-patients
#10
Patricia Mesa, Ignacio José Previgliano, Sonia Altez, Silvina Favretto, María Orellano, Cinthya Lecor, Ana Soca, Ely Wesley
OBJECTIVE: To establish the prevalence of delirium in a general intensive care unit and to identify associated factors, clinical expression and the influence on outcomes. METHODS: This was a prospective cohort study in a medical surgical intensive care unit. The Richmond Agitation-Sedation Scale and Confusion Assessment Method for the Intensive Care Unit were used daily to identify delirium in mechanically ventilated patients. RESULTS: In this series, delirium prevalence was 80% (N = 184 delirious patients out of 230 patients)...
July 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/29033344/a-prospective-study-of-ketamine-as-primary-therapy-for-prehospital-profound-agitation
#11
Jon B Cole, Lauren R Klein, Paul C Nystrom, Johanna C Moore, Brian E Driver, Brandon J Fryza, Justin Harrington, Jeffrey D Ho
OBJECTIVE: We investigated the effectiveness of ketamine as a primary therapy for prehospital profound agitation. METHODS: This was a prospective observational study of patients receiving 5mg/kg of intramuscular ketamine for profound agitation, defined as a score of +4 on the Altered Mental Status Scale (AMSS), a validated ordinal scale of agitation from -4 (unresponsive) to +4 (most agitated). The primary outcome was time to adequate sedation (AMSS<+1). Secondary outcomes included need for additional sedatives, intubation frequency, complications associated with ketamine, and mortality...
October 7, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29023898/impact-of-ketamine-use-on-adjunctive-analgesic-and-sedative-medications-in-critically-ill-trauma-patients
#12
Kaitlin A Pruskowski, Kelly Harbourt, Mehrnaz Pajoumand, Sai-Ho Jason Chui, H Neal Reynolds
BACKGROUND: Ketamine may be used to manage pain and agitation that is refractory to "traditional" agents such as fentanyl, propofol, benzodiazepines, and dexmedetomidine; however, literature describing the use of ketamine continuous infusions for this purpose in critically ill trauma patients is limited. OBJECTIVES: The primary objective of this study was to determine the impact of the initiation of a ketamine continuous infusion on sedative and analgesic use in critically ill trauma patients...
October 10, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29021727/analgesia-sedation-and-arousal-status-in-burn-patients-the-gap-between-recommendations-and-current-practices
#13
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/28975307/effect-of-lorazepam-with-haloperidol-vs-haloperidol-alone-on-agitated-delirium-in-patients-with-advanced-cancer-receiving-palliative-care-a-randomized-clinical-trial
#14
RANDOMIZED CONTROLLED TRIAL
David Hui, Susan Frisbee-Hume, Annie Wilson, Seyedeh S Dibaj, Thuc Nguyen, Maxine De La Cruz, Paul Walker, Donna S Zhukovsky, Marvin Delgado-Guay, Marieberta Vidal, Daniel Epner, Akhila Reddy, Kimerson Tanco, Janet Williams, Stacy Hall, Diane Liu, Kenneth Hess, Sapna Amin, William Breitbart, Eduardo Bruera
Importance: The use of benzodiazepines to control agitation in delirium in the last days of life is controversial. Objective: To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer. Design, Setting, and Participants: Single-center, double-blind, parallel-group, randomized clinical trial conducted at an acute palliative care unit at MD Anderson Cancer Center, Texas, enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from February 11, 2014, to June 30, 2016, with data collection completed in October 2016...
September 19, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28973626/delirium-in-older-persons-advances-in-diagnosis-and-treatment
#15
REVIEW
Esther S Oh, Tamara G Fong, Tammy T Hshieh, Sharon K Inouye
Importance: Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual's function and quality of life, as well as broad societal effects with substantial health care costs. Objective: To summarize the current state of the art in diagnosis and treatment of delirium and to highlight critical areas for future research to advance the field...
September 26, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28962135/postoperative-benefits-of-dexmedetomidine-combined-with-flurbiprofen-axetil-after-thyroid-surgery
#16
Xing-Dui Ma, Bei-Ping Li, De-Ling Wang, Wen-Sheng Yang
The present study determined the effect of dexmedetomidine (Dex) combined with flurbiprofen axetil (FA) on analgesia, immune response, and preservation of cognitive function in patients subjected to general anesthesia. We recruited 100 patients with thyroid surgery and randomly divided them into four groups: Dex (D), FA (F), Dex combined with FA (DF), and saline control (C). The extubation and recovery times for Groups D and DF were significantly longer than for Groups F and C. After extubation, the heart rate and mean arterial pressure for Groups F, D, and DF were significantly lower than for Group C, and data for Group DF was significantly lower than for Group F...
September 2017: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28949804/can-dexmedetomidine-influence-recovery-profiles-from-general-anesthesia-in-nasal-surgery
#17
Ho Seok Lee, Ho Young Yoon, Ho Jun Jin, Se Hwan Hwang
Objectives Dexmedetomidine has sympatholytic, sedative, anesthetic, and analgesic effects, as well as vasoconstrictive effects, which may help prevent hypotension under general anesthesia. This meta-analysis aimed to perform a systematic review of the literature and investigate the effect of dexmedetomidine on perioperative morbidity following nasal surgery and its adverse effects. Data Sources MEDLINE, SCOPUS, and the Cochrane database. Review Methods Two authors independently searched the databases from their inception to March 2017...
September 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28934894/factors-associated-with-unplanned-extubation-in-children-a-case-control-study
#18
Paulo Sérgio Lucas da Silva, Marcelo Cunio Machado Fonseca
PURPOSE: Although several studies assess unplanned extubation (UE) in children, few have addressed determinants of UE and factors associated with reintubation in a case-controlled manner. We aimed to identify the risk factors and outcomes associated with UE in a pediatric intensive care unit. METHODS: Cases of UE were randomly matched with control patients at a ratio of 1:4 for age, severity of illness, and admission diagnosis. For cases and controls, we also collected data associated with UE events, reintubation, and outcomes...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28927578/the-critical-care-pain-observation-tool-is-reliable-in-non-agitated-but-not-in-agitated-intubated-patients
#19
Hoda Chookalayia, Mehdi Heidarzadeh, Mohammad Hassanpour-Darghah, Masoomeh Aghamohammadi-Kalkhoran, Mansoreh Karimollahi
OBJECTIVE: The Critical-Care Pain. OBSERVATION: Tool is one of the instruments developed to assess pain in patients who are unable to communicate verbally. The study aimed to survey the psychometric properties of Critical-Care Pain. OBSERVATION: Tool in four groups of non-verbal patients according to their Richmond Agitation Sedation Score (RASS). STUDY DESIGN AND METHODOLOGY: 65 critically ill patients (medical, surgical, trauma) were assessed using the critical care pain observation tool on six occasions (before, during and after nociceptive and non-nociceptive procedures)...
September 15, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28914247/assessment-of-hypoxia-sedation-level-and-adverse-events-occurring-during-inhalation-sedation-using-preadjusted-mix-of-30-nitrous-oxide-70-oxygen
#20
P V Samir, Srinivas Namineni, P Sarada
PURPOSE: To assess the efficacy of nitrous oxide (N2O)-oxygen (O2) inhalation sedation by rapid induction technique using preadjusted mix of 30% N2O and 70% O2 in children. MATERIALS AND METHODS: Sixty children with a treatment plan which included pulp therapy were recruited for the study. Children categorized 3 and 4 of Frankl behavior rating scale and American Society of Anesthesiologists health status I and II were included for the study. Children were distributed into study group (Group-I) and control group (Group-II) by fishbowl randomization...
October 2017: Journal of the Indian Society of Pedodontics and Preventive Dentistry
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