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Terminal sedation

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https://www.readbyqxmd.com/read/27935778/anesthesia-involvement-in-palliative-care
#1
Amanda C Faircloth
Palliative care teams require multidisciplinary support. While this is an emerging area in anesthesia practice, there are many avenues for certified registered nurse anesthetists (CRNAs) to share their unrivaled clinical knowledge. CRNAs may become involved with or consult on palliative sedation, medical management, interventional pain management, terminal wean/extubation, and organ donation. Additionally, CRNAs need to understand the unique needs of this patient population so that they can appropriately care for palliative care patients presenting to the operating room for palliative surgery...
January 2017: Annual Review of Nursing Research
https://www.readbyqxmd.com/read/27879954/comparison-of-terminal-extubation-and-terminal-weaning-as-mechanical-ventilation-withdrawal-in-icu-patients
#2
Damien Thellier, Pierre Y Delannoy, Olivier Robineau, Agnès Meybeck, Nicolas Boussekey, Arnaud Chiche, Olivier Leroy, Hugues Georges
BACKGROUND: Terminal extubation (TE) is applied in some intensive care unit (ICU) patients when a decision of withdrawal of mechanical ventilation is decided. Other units prefer terminal weaning (TW) with no removal of the endotracheal tube. We report our experience with these two procedures. METHODS: We conducted a retrospective study analyzing patients deceased in our ICU after a decision of life sustained therapy (LST) during the year 2013. TE was proposed to family members for patients presenting with two medical conditions: lack of vasoactive drugs (VAD) and SaO2 > 95% with a FIO2 < 50%...
November 23, 2016: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27845950/carbon-dioxide-insufflation-during-colonoscopy-in-inflammatory-bowel-disease-patients-a-double-blind-randomized-single-center-trial
#3
Přemysl Falt, Vít Šmajstrla, Petr Fojtík, Martin Hill, Ondřej Urban
OBJECTIVE: Bowel distension by insufflated air causes abdominal discomfort after colonoscopy. Carbon dioxide (CO2) instead of air insufflation during colonoscopy can reduce postprocedural discomfort in diagnostic and screening cases. Discomfort after colonoscopy and CO2 insufflation have never been studied in inflammatory bowel disease (IBD) patients, characterized by younger age, structural changes of the colon, and need for repeated and frequently uncomfortable colonoscopies. Our trial was designed to evaluate postprocedural discomfort associated with CO2 compared with air insufflation in unsedated or minimally sedated patients with known IBD...
November 11, 2016: European Journal of Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/27821105/interventions-and-decision-making-at-the-end-of-life-the-effect-of-establishing-the-terminal-illness-situation
#4
C Campos-Calderón, R Montoya-Juárez, C Hueso-Montoro, E Hernández-López, F Ojeda-Virto, M P García-Caro
BACKGROUND: Many 'routine' interventions performed in hospital rooms have repercussions for the comfort of the patient, and the decision to perform them should depend on whether the patient is identified as in a terminal phase. The aim of this study is to analyse the health interventions performed and decisions made in the last days of life in patients with advanced oncological and non-oncological illness to ascertain whether identifying the patient's terminal illness situation has any effect on these decisions...
November 7, 2016: BMC Palliative Care
https://www.readbyqxmd.com/read/27788524/insufficient-sedation-and-severe-side-effects-after-fast-administration-of-remifentanil-during-insure-in-preterm-newborns
#5
Ellen H M de Kort, Lidwien M Hanff, Daniella Roofthooft, Irwin K M Reiss, Sinno H P Simons
BACKGROUND: Neonatal intubation is stressful and should be performed with premedication. In the case of an INSURE (intubation/surfactant/extubation) procedure a short duration of action of the premedication used is needed to facilitate fast extubation. Given its pharmacological profile, remifentanil seems a suitable candidate. OBJECTIVES: The aim here was to evaluate the effect and side effects of remifentanil as a premedication for preterm neonates undergoing INSURE...
October 28, 2016: Neonatology
https://www.readbyqxmd.com/read/27776894/end-of-life-euthanasia-and-assisted-suicide-an-update-on-the-situation-in-france
#6
REVIEW
R Aubry
On February 2, 2016, the French parliament adopted legislation creating new rights for the terminally ill. The text modifies and reinforces the rights of patients to end-of-life care and strengthens the status of surrogate decision makers. Under the new regulations, advance directives become legally binding though not unenforceable. Two types of advance directives are distinguished depending on whether the person is suffering or not from a serious illness when drafting them. The attending physician must abide by the patient's advance directives except in three situations: there is a life-threatening emergency; the directives are manifestly inappropriate; the directives are not compatible with the patient's medical condition...
December 2016: Revue Neurologique
https://www.readbyqxmd.com/read/27743126/patient-satisfaction-after-endoscopic-submucosal-dissection-under-propofol-based-sedation-a-small-premedication-makes-all-the-difference
#7
Seokyung Shin, Chan Hyuk Park, Hyun Ju Kim, Sang Hun Park, Sang Kil Lee, Young Chul Yoo
BACKGROUND: Ideal sedation for endoscopic submucosal dissection (ESD) aims to satisfy both the endoscopist and patient. However, previous studies show that a satisfactory procedure for the endoscopist does not equal higher patient satisfaction. This study attempted to find a sedation protocol that is able to increase patient satisfaction during propofol-based sedation by adding low-dose midazolam as premedication. METHODS: Seventy-two adult patients were randomly allocated to receive either 0...
October 14, 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/27713005/deep-sedation-without-intubation-during-second-trimester-surgical-termination-in-an-inpatient-hospital-setting
#8
Abigail C Mancuso, Kelsey Lee, Ran Zhang, Elizabeth A Hoover, Colleen Stockdale, Abbey J Hardy-Fairbanks
OBJECTIVES: Safety of outpatient dilation and evacuations with intravenous (iv) sedation without intubation has been demonstrated, but there is a paucity of data on deep iv sedation on an inpatient second trimester surgical termination population. The purpose of this study is to evaluate complications of deep sedation with propofol without the use of intubation during second trimester surgical terminations in an inpatient teaching institution. STUDY DESIGN: A retrospective chart review of all obstetrical and anesthetic data from inpatient dilation and evacuations between gestational ages 15 0/7 and 24 0/7 during the years 2002 to 2015...
October 3, 2016: Contraception
https://www.readbyqxmd.com/read/27684802/the-optimal-dose-of-dexmedetomidine-added-to-an-sufentanil-based-analgesic-regimen-for-postoperative-pain-control-in-spine-surgery-a-probit-analysis-study
#9
Chun-Shan Dong, Yao Lu, Jun Zhang, Peng Sun, Jun-Ma Yu, Chao Wu, Qiang Lu
Postoperative spinal patients remain a challenge for provision of postoperative analgesia. Patient-controlled intravenous analgesia (PCIA) is a major method in reducing the severe pain after the surgery in our institution, but some adverse effects prevent the use of adequate dosage opioids.This study was determined using the probit analysis to investigate the optimal dose of dexmedetomidine (DEX) infusion for postoperative analgesia combined with sufentanil (SUF) in spine surgery.The dose of DEX needed to produce satisfactory analgesia conditions following combination of 3...
September 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27673357/sedation-by-propofol-for-painful-care-procedures-at-the-end-of-life-a-pilot-study-propopal-1
#10
Jean François Ciais, Flora Tremellat, Maud Castelli-Prieto, Caroline Jestin
BACKGROUND: At the end of life, patients may feel refractory pain during care procedures although they receive appropriate analgesia. They can benefit from a short-term sedation. Propofol is used for procedural sedation in emergency or reanimation departments. It may be adapted in a palliative care unit. OBJECTIVE: The main objective was to verify whether propofol could allow us to administer care without causing major pain to patients with refractory pain at the end of life...
September 27, 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27636926/-efficacy-of-kolofort-for-the-treatment-of-patients-with-irritable-bowel-syndrome
#11
V V Tsukanov, O S Rzhavicheva, A V Vasyutin, O V Dunaevskaya, Yu L Tonkikh, E P Bronnikova
AIM: to determine the efficacy and safety of Kolofort in the treatment of patients with irritable bowel syndrome (IBS). SUBJECTS AND METHODS: 52 patients (16 men and 36 women) aged 26 to 59 years were examined over 4 months to rule out organic disease. The diagnosis of IBS was established on the basis of the Rome III diagnostic criteria (2006). Seven patients were diagnosed as having IBS with a preponderance of constipation; 3 had IBS with a preponderance of diarrhea, and 42 had mixed IBS...
2016: Terapevticheskiĭ Arkhiv
https://www.readbyqxmd.com/read/27636909/nonoperative-treatment-of-type-iia-supracondylar-humerus-fractures-comparing-2-modalities
#12
Lauren Roberts, Jason Strelzow, Emily K Schaeffer, Christopher W Reilly, Kishore Mulpuri
BACKGROUND: Although the recommended treatment for Gartland types I and III supracondylar humeral fractures is well-established, the optimal treatment for type II fractures without rotational malalignment remains controversial, involving circumferential casting or closed reduction and pinning. Our institution uses pronated flexion-taping for Gartland type IIA fractures. This theoretically removes external pressure secondary to circumferential casting, potentially decreasing risks of compartment syndrome and mitigating loss of reduction with extension while maintaining optimal flexion position for reduction...
September 15, 2016: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/27634712/the-value-and-disvalue-of-consciousness
#13
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
https://www.readbyqxmd.com/read/27595264/sedation-for-bronchoscopy-and-complications-in-obese-patients
#14
Irtaza Khan, Arjun B Chatterjee, Christina R Bellinger, Edward Haponik
BACKGROUND: Bronchoscopy is a safe and minimally invasive diagnostic tool, but no studies have reported prospectively on sedation and outcomes in patients with objectively defined obesity. OBJECTIVES: The purpose of the study is to determine if obese patients require more sedation or had more procedural complications during bronchoscopy under moderate sedation than non-obese patients. METHODS: We evaluated complications and sedation requirements in non-obese versus obese patients, defined by multiple criteria including body mass index (BMI), neck circumference, abdominal height, and Mallampati scores...
2016: Respiration; International Review of Thoracic Diseases
https://www.readbyqxmd.com/read/27591413/cnidilide-an-alkylphthalide-isolated-from-the-roots-of-cnidium-officinale-suppresses-lps-induced-no-pge2-il-1%C3%AE-il-6-and-tnf-%C3%AE-production-by-ap-1-and-nf-%C3%AE%C2%BAb-inactivation-in-raw-264-7-macrophages
#15
Woo-Seok Lee, Ji-Sun Shin, Dae Sik Jang, Kyung-Tae Lee
Cnidilide, an alkyl phthalide isolated from the rhizome of Cnidium officinale, has been reported to possess antispasmodic and sedative effects. However, the anti-inflammatory capacity and molecular mechanism of cnidilide have not been studied to date. In the present study, we investigated the inhibitory effects of cnidilide on LPS-induced pro-inflammatory mediators and the underlying molecular mechanisms in RAW 264.7 macrophages. Our results indicated that cnidilide potently inhibits inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) expression at the protein and mRNA levels and their promoter activities, causing attendant decreases in the production of nitric oxide (NO) and prostaglandin E2 (PGE2)...
August 31, 2016: International Immunopharmacology
https://www.readbyqxmd.com/read/27566793/french-laypeople-s-and-health-professionals-views-on-the-acceptability-of-terminal-sedation
#16
Julie Mazoyer, María Teresa Muñoz Sastre, Paul Clay Sorum, Etienne Mullet
AIM: To study the views on the acceptability of terminal sedation (TS) of laypeople and health professionals in France. METHOD: In November 2013-June 2015, 223 laypeople and 53 health professionals (21 physicians and 32) judged the acceptability of TS in 48 realistic scenarios composed of all combinations of four factors: (a) the patients' life expectancy, (b) their request for sedation, (c) the decision-making process and (d) the type of sedation. In all scenarios, the patients were women with a terminal illness suffering from intractable pain and receiving the best possible care...
October 2016: Journal of Medical Ethics
https://www.readbyqxmd.com/read/27559256/patients-with-end-stage-interstitial-lung-disease-may-have-more-problems-with-dyspnea-than-end-stage-lung-cancer-patients
#17
Ryo Matsunuma, Hazuki Takato, Yoshihiro Takeda, Satoshi Watanabe, Yuko Waseda, Shinya Murakami, Yukimitsu Kawaura, Kazuo Kasahara
INTRODUCTION: Patients with end-stage interstitial  lung disease (ILD) do not appear to receive adequate palliative care despite apparent suffering before death. The aim of this study was to evaluate their signs, symptoms, and treatment received before death. METHODS: Patients with ILD and lung cancer (LC) who were hospitalized and died in our hospital were enrolled retrospectively. Signs and symptoms and treatments at 7 days, 3 days, and 1 day before death were evaluated and compared between the two groups of patients...
July 2016: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/27501853/pilot-trial-of-intravenous-lipid-emulsion-treatment-for-severe-nifedipine-induced-shock
#18
Christine M Murphy, Cliff Williams, Michael E Quinn, Brian Nicholson, Thomas Shoe, Michael C Beuhler, William P Kerns
Animal studies and human case reports show promise in using lipid rescue to treat refractory calcium channel antagonist toxicity. However, the majority of research and clinical experience has focused on non-dihydropyridine agents. Thus, we sought to investigate the value of lipid emulsion (ILE) therapy for dihydropyridine-induced shock. This IACUC-approved study utilized seven swine that were sedated with alpha-chloralose, mechanically ventilated, and instrumented for drug delivery and hemodynamic measures...
December 2016: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/27473996/blood-concentrations-of-remifentanil-during-and-after-infusion-in-horses-anesthetized-with-isoflurane-and-dexmedetomidine
#19
Perrine Benmansour, Jennifer Billinsky, Tanya Duke-Novakovski, Jane Alcorn
OBJECTIVE: To determine blood remifentanil concentration in isoflurane-anesthetized horses during and after a 1h remifentanil and dexmedetomidine infusion. STUDY DESIGN: Prospective study. ANIMALS: Six adult mixed breed horses with (mean±SD) bodyweight of 507±61kg and 14±4years of age. METHODS: Following sedation with xylazine IV, anesthesia was induced with ketamine IV mixed with diazepam IV. Anesthesia was maintained with isoflurane in oxygen...
August 2016: Research in Veterinary Science
https://www.readbyqxmd.com/read/27387971/randomized-trial-of-intranasal-fentanyl-versus-intravenous-morphine-for-abscess-incision-and-drainage
#20
Daniel B Fenster, Peter S Dayan, John Babineau, Linda Aponte-Patel, Daniel S Tsze
OBJECTIVES: Abscess incision and drainage (I&D) are painful and distressing procedures in children. Intranasal (IN) fentanyl is an effective analgesic for reducing symptomatic pain associated with fractures and burns but has not been studied for reducing procedural pain during abscess I&D. Our objective was to compare the analgesic efficacy of IN fentanyl with intravenous (IV) morphine for abscess I&D in children. METHODS: We performed a randomized noninferiority trial in children aged 4 to 18 years undergoing abscess I&D in a pediatric emergency department...
July 12, 2016: Pediatric Emergency Care
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