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Procedural sedation

Aravindhan Veerapandiyan, Ria Pal, Stephen D'Ambrosio, Iris Young, Katy Eichinger, Erin Collins, Per-Lennart Westesson, Jennifer Kwon, Emma Ciafaloni
OBJECTIVE: To report our experience delivering intrathecal nusinersen through cervical puncture in patients with spinal muscular atrophy (SMA) with no lumbar access. BACKGROUND: SMA is a neuromuscular disorder characterized by profound muscle weakness, atrophy, and paralysis due to degeneration of the anterior horn cells. Nusinersen, the first Food and Drug Administration-approved treatment for SMA, is administered intrathecally via lumbar puncture; however, many patients with SMA have scoliosis or solid spinal fusion with hardware that makes lumbar access impossible...
July 13, 2018: Neurology
Bünyamin Gürbulak, Muhammed Zübeyr Üçüncü, Erkan Yardımcı, Ebru Kırlı, Filiz Tüzüner
Introduction: Esophagogastroduodenoscopy (EGD) is a diagnostic method used in the investigation of upper gastrointestinal system diseases. A high level of anxiety of patients who undergo EGD increases the duration of the procedure and the sedation and analgesic requirements. Sedation is used to increase patient comfort and tolerance by reducing the anxiety and pain associated with endoscopic procedures. Aim: In this study, the effect of anxiety scores on medication doses was investigated in patients who underwent EGD under sedation...
June 2018: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
Katarzyna Kotfis, Małgorzata Zegan-Barańska, Marta Strzelbicka, Krzysztof Safranow, Maciej Żukowski, E Wesley Ely
Introduction: Pain in the critically ill affects nearly 50% of patients. In patients unable to self-report pain, behavioural scales are used. The aim of this study was to validate the Polish version of the Critical Care Pain Observation Tool (CPOT). Material and methods: The prospective observational cohort study included patients observed during non-nociceptive and nociceptive procedures, at rest, during the intervention, and 15 min after each intervention. Assessments included self-report by patients and CPOT assessment carried out by two blinded observers...
June 2018: Archives of Medical Science: AMS
Alberto Bolletta, Luca Andrea Dessy, Luca Fiorot, Alessio Tronci, Antonio Rusciani, Pedro Ciudad, Emilio Trignano
BACKGROUND: Tumescent local anesthesia (TLA) consists of infiltration of saline solution with lidocaine and epinephrine into the tissues to obtain regional anesthesia and vasoconstriction. The use of TLA in augmentation mammoplasty has been described for sub-glandular positioning. We describe a modified TLA technique for primary sub-muscular breast augmentation reporting our experience during the past 7 years. METHODS: From 2010 to 2017, 300 patients underwent bilateral primary sub-muscular breast augmentation under TLA and conscious sedation...
July 11, 2018: Aesthetic Plastic Surgery
Alexander Kulikov, Andrey Lubnin
PURPOSE OF REVIEW: The current review reports on current trends in the anesthetic management of awake craniotomy, including preoperative preparation, sedation schemes, pain management, and prevention of intraoperative complications. RECENT FINDINGS: Both approaches for anesthesia for awake craniotomy, asleep-awake-asleep and monitored anesthesia care (MAC), have shown equal efficacy for performing intraoperative brain mapping. Choice of the appropriate scheme is currently based mainly on the preferences of the particular anesthesiologist...
July 9, 2018: Current Opinion in Anaesthesiology
Hamit Yildiz
Targeted temperature management (therapeutic hypothermia) is a treatment method used to prevent potential complications that can develop in relation to the increased temperature in the brain as a result of cardiac arrest. Due to costs and various health policies there is no comprehensive study in the world that has been able to guide the relevant literature on therapeutic hypothermia. We have presented a 25-year-old female patient in our study who developed cardiac arrest after the administration of propofol for sedation before undergoing a diagnostic upper gastroscopy procedure and received a successful therapeutic hypothermia therapy following a resuscitation of 19 minutes...
July 11, 2018: Therapeutic Hypothermia and Temperature Management
Ricardo Jorge Dinis-Oliveira
Propofol is an intravenous short-acting anesthetic widely used to induce and maintain general anesthesia and to provide procedural sedation. The potential for propofol dependency and abuse has been recognized, and several cases of accidental overdose and suicide have emerged, mostly among the health professionals. Different studies have demonstrated an unpredictable interindividual variability of propofol pharmacokinetics and pharmacodynamics with forensic and clinical adverse relevant outcomes (e.g., pronounced respiratory and cardiac depression), namely, due to polymorphisms in the UDP-glucuronosyltransferase and cytochrome P450 isoforms and drugs administered concurrently...
2018: BioMed Research International
Tareq Abu-Izneid, Abdur Rauf, Syed Uzair Ali Shah, Abdul Wadood, Mohamed I S Abdelhady, Priymenko Nathalie, Domange Céline, Nashwa Mansour, Seema Patel
Background: Hypochaeris radicata (flatweed) from the family Asteraceae is a medicinal plant found in Europe, Middle East, and India. In folkloric medication, it is used to heal jaundice, dyspepsia, constipation, rheumatism, and hypoglycemia as well as renal problems. Leaves and roots of the plant have antioxidant and antibacterial properties. The plant is a rich source of pharmacologically active phytochemicals; however, it is explored scantily. The objective of the current study was to identify the chemical composition and investigate the in vivo biological potency of crude extracts of this plant...
2018: BioMed Research International
Garrido-Abad Pablo, Sinués-Ojas Bryan, Conde-Caturla Pablo, García-Martín Luis, Fernández-Arjona Manuel
OBJECTIVE: To describe micro-ureteroscopy, a novel minimally invasive approach for treating distal ureteral lithiasis. MATERIAL AND METHODS: Seven female patients with distal ureteral stones ≤ 10 mm were operated by microureteroscopy. The micro-ureteroscope consist on a 4.85 Fr (16-gauge) sheath, a 0.9 mm diameter flexible optic system and a 3-arm luer-lock adapter to connect the sheath and insert the optics. Patients are placed in lithotomy position. Under sedative anesthesia and antimicrobial coverage we performed micro-ureteroscopy in patients with distal ureteral stones, describing key steps and perioperative and postoperative outcomes...
July 7, 2018: Urology
Elisa C Walsh, Johanna M Lee, Kristina Terzakis, David W Zhou, Sara Burns, Timothy M Buie, Paul G Firth, Erik S Shank, Timothy T Houle, Emery N Brown, Patrick L Purdon
Patients with autism spectrum disorder (ASD) often require sedation or general anesthesia. ASD is thought to arise from deficits in GABAergic signaling leading to abnormal neurodevelopment. We sought to investigate differences in how ASD patients respond to the GABAergic drug propofol by comparing the propofol-induced electroencephalogram (EEG) of ASD and neurotypical (NT) patients. This investigation was a prospective observational study. Continuous 4-channel frontal EEG was recorded during routine anesthetic care of patients undergoing endoscopic procedures between July 1, 2014 and May 1, 2016...
2018: Frontiers in Systems Neuroscience
Muammer Altok, Bumyang Kim, Bina B Patel, Ya-Chen Tina Shih, John F Ward, Stephen E McRae, Brian F Chapin, Louis L Pisters, Curtis A Pettaway, Jeri Kim, Huseyin C Demirel, John W Davis
BACKGROUND: The cornerstone of prostate cancer diagnosis remains the transrectal ultrasound-guided biopsy (TRUS-BX), which most frequently occurs in the office setting under local anesthesia. However, there are now other techniques of prostate biopsy aimed at improving outcomes such as patient comfort, significant cancer detection, and infectious complications. The purpose of the present study is to compare the cost and efficacy outcomes of five different approaches. METHODS: We compared the comprehensive costs of a random sample size of 20-30 cases from each of the following: (1) local anesthesia TRUS-BX (reference), (2) sedation TRUS-BX, (3) general anesthesia transperineal template biopsy (TP), (4) sedation MRI-TRUS fusion biopsy (FB), and (5) sedation in-bore MRI biopsy (IB-MRI)...
July 9, 2018: Prostate Cancer and Prostatic Diseases
Raja J Selvaraj, Subhash Dukiya, Ajith Ananthakrishna Pillai, Santhosh Satheesh, Jayaraman Balachander
Aims: Sedation is not consistently used during electrophysiology procedures because of concerns regarding effects on tachycardia inducibility. We designed this study to assess the effect of conscious sedation on tachycardia inducibility and patient comfort during supraventricular tachycardia ablation. Methods and results: Patients with narrow QRS tachycardia and no pre-excitation undergoing an electrophysiology study were randomly assigned to sedation or placebo group...
July 5, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Kaitlin McGinn, S Noelle Davis, Elizabeth Terrry, Jon Simmons, Sidney Brevard
Current guidelines on the management of pain, agitation, and delirium in the intensive care unit (ICU) recommend a non-benzodiazepine (BDZ)-based approach to sedation. Management of agitation can be challenging in multitrauma patients but is imperative to facilitate patient recovery. Given the current guideline recommendations, a protocol to eliminate BDZ administration and maintain light levels of sedation was adopted in our ICU. The purpose of this analysis was to demonstrate that it is feasible to safely eliminate BDZ administration in a trauma ICU...
June 1, 2018: American Surgeon
Sophia Koutsogiannaki, Hui Zha, Koichi Yuki
Volatile anesthetics are often administered to patients with sepsis for procedural anesthesia or sedation in intensive care units. Sepsis still carries significant morbidities and mortalities, and organ injuries pose major complications. Early liver dysfunction is associated with poor outcome mainly as a result of overwhelming neutrophil recruitment. Leukocyte function-associated antigen-1 (LFA-1) and macrophage-1 antigen (Mac-1) are major adhesion molecules on neutrophils and involved in neutrophil recruitment...
2018: Translational Perioperative and Pain Medicine
I F Herrmann, M Gadebusch Bondio, D Domagk, M Strahl, C Arens
BACKGROUND: Anterograde transnasal flexible endoscopy of the pharynx, larynx, and proximal trachea without sedation has been established since the 1990s. Retroflexed endoscopic functional analysis has recently been introduced. OBJECTIVES: Adding retroflexed functional endoscopy from the oral cavity up to the duodenum to anterograde diagnostics allows the precise demonstration of how different factors interact in a complex way, e. g., in case of dysphagia or pathological reflux...
July 2018: HNO
A Silvers, A Licina, L Jolevska
There is an increasing number of specialties performing office-based procedures, with many different providers practising in this field. Office Based Anaesthesia Solutions is a private enterprise designed to be a high-quality general anaesthesia and sedation service delivering care across 18 dental practices in Victoria. We undertook a criterion-based audit of our practice standards and outcomes. Following ethics approval, we retrospectively reviewed consecutive patients managed by our service between March 2014 and July 2017...
July 2018: Anaesthesia and Intensive Care
Andrea Paulson, Christina K Zigler, Amy Houtrow, David Pruitt
BACKGROUND: Intramuscular botulinum toxin injections are utilized for treatment of focal spasticity in children, particularly in those with a diagnosis of cerebral palsy. There are a variety of techniques used when performing botulinum toxin injections without clear standards for pediatric providers. OBJECTIVE: To describe current practice techniques for botulinum toxin injections among pediatric physiatrists. DESIGN: Cross sectional survey using RedCap Software...
June 29, 2018: PM & R: the Journal of Injury, Function, and Rehabilitation
Hakan Akelma, Ebru Tarikçi Kiliç, Fikret Salik, Ayhan Kaydu
Objectives: To compare the effects of ketamine-fentanyl (KF) and ketamine-midazolam (KM) combinations on hemodynamic parameters, recovery properties, pain, and side effects in pediatric patients undergoing extracorporeal shock wave lithotripsy (ESWL) procedure. Methodology: In this double-blinded, randomized trial, 60 pediatric patients aged between 1 and 13 years with American Society of Anesthesiologists physical status Classes I and II, who scheduled for ESWL procedure, were included in the study...
April 2018: Anesthesia, Essays and Researches
Anita Kumari, Arvinder Pal Singh, Jyoti Vidhan, Ruchi Gupta, Jonny Dhawan, Jasleen Kaur
Background and Aims: Ambulatory surgery is continually evolving specialty in the majority of surgical procedures. Dexmedetomidine and midazolam are newer adjuvants for sedation and reducing the dose of anesthetic agents. The aim of this study was to compare the sedative and propofol-sparing effect of dexmedetomidine and midazolam in minor gynecological day care surgeries. Observer's Assessment of Activity and Sedation, dose of additional propofol, Aldrete and street fitness score were studied as primary outcomes...
April 2018: Anesthesia, Essays and Researches
Gilbert H L Tang, Syed Zaid, Isaac George, Omar K Khalique, Yigal Abramowitz, Yoshio Maeno, Raj R Makkar, Hasan Jilaihawi, Norihiko Kamioka, Vinod H Thourani, Vasilis Babaliaros, John G Webb, Nay M Htun, Adrian Attinger-Toller, Hasan Ahmad, Ryan Kaple, Kapil Sharma, Joseph A Kozina, Tsuyoshi Kaneko, Pinak Shah, Sameer A Hirji, Nimesh D Desai, Saif Anwaruddin, Dinesh Jagasia, Howard C Herrmann, Sukhdeep S Basra, Molly A Szerlip, Michael J Mack, Moses Mathur, Christina W Tan, Creighton W Don, Rahul Sharma, Sameer Gafoor, Ming Zhang, Samir R Kapadia, Stephanie L Mick, Amar Krishnaswamy, Nicholas Amoroso, Arash Salemi, S Chiu Wong, Annapoorna S Kini, Josep Rodes-Cabau, Martin B Leon, Susheel K Kodali
OBJECTIVES: The aim of this study was to determine factors affecting paravalvular leak (PVL) in transcatheter aortic valve replacement (TAVR) with the Edwards SAPIEN 3 (S3) valve in extremely large annuli. BACKGROUND: The largest recommended annular area for the 29-mm S3 is 683 mm2 . However, experience with S3 TAVR in annuli >683 mm2 has not been widely reported. METHODS: From December 2013 to July 2017, 74 patients across 16 centers with mean area 721 ± 38 mm2 (range: 684 to 852 mm2 ) underwent S3 TAVR...
June 26, 2018: JACC. Cardiovascular Interventions
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