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Conscious sedation

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https://www.readbyqxmd.com/read/28431040/prospective-assessment-of-pain-and-comfort-in-chronic-pain-patients-undergoing-interventional-pain-management-procedures
#1
Thomas Simopoulos, Daniel Leffler, Sheila Barnett, Devon Campbell, Shu Jing Lian, Jatinder S Gill
Objective.:  Interventional pain management procedures have an important role in the management of chronic pain. The present study seeks to identify the proportion of patients who experience severe pain during pain procedures either with or without sedation. There is then an attempt to identify any association of high pain levels with factors such as age, gender, ethnicity, preprocedure pain level, procedure type, tobacco use, and baseline pharmaceuticals taken for both pain and/or mood disorder management...
April 18, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28422846/application-of-remifentanil-for-conscious-sedation-and-analgesia-in-short-term-ercp-and-est-surgery
#2
Guo-Qiang Sun, Bao-Feng Gao, Guan-Jun Li, Yun-Long Lei, Jie Li
This study aims to observe and evaluate the use of remifentanil in conscious sedation and analgesia for the safety and comfort of patients undergoing short-term endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST).Sixty-eight patients who underwent ERCP and EST were randomly divided into two groups: research group and control group. Patients in the research group were intravenously injected with remifentanil (80-2/3* age) for 1 to 2 minutes, combined with the intravenous injection of propofol (20-30 mg) during the course of treatment...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28416960/medical-thoracoscopy-in-pleural-disease-experience-from-a-one-center-study
#3
Soo Jung Kim, Sun Mi Choi, Jinwoo Lee, Chang-Hoon Lee, Sang-Min Lee, Jae-Joon Yim, Chul-Gyu Yoo, Young Whan Kim, Sung Koo Han, Young Sik Park
BACKGROUND: Medical thoracoscopy (MT) is a minimally invasive, endoscopic procedure for exploration of the pleural cavity under conscious sedation and local anesthesia. MT has been performed at the Seoul National University Hospital since February 2014. This paper summarizes the findings and outcomes of MT cases at this hospital. METHODS: Patients who had undergone MT were enrolled in the study. MT was performed by pulmonologists, using both rigid and semi-rigid thoracoscopes...
April 2017: Tuberculosis and Respiratory Diseases
https://www.readbyqxmd.com/read/28415931/comparison-of-dexmedetomidine-and-propofol-for-conscious-sedation-in-inguinal-hernia-repair-a-prospective-randomized-controlled-trial
#4
Hong-Mei Wang, Xiao-Yu Shi, Xia-Rong Qin, Jia-Li Zhou, Yan-Fei Xia
Objective The ideal agents for conscious sedation during ambulatory inguinal hernia repair are still unclear. We aimed to compare the analgesic, sedative, haemodynamic, and side effects of dexmedetomidine with those of propofol in combination with fentanyl for conscious sedation in patients undergoing inguinal hernia repair. Methods Eighty patients undergoing unilateral inguinal hernia repair were prospectively randomized to receive either dexmedetomidine (n = 40) or propofol (n = 40). Dexmedetomidine and propofol dosages were adjusted to maintain the targeted level of sedation...
April 2017: Journal of International Medical Research
https://www.readbyqxmd.com/read/28414657/death-by-propofol
#5
James H Diaz, Alan David Kaye
Since its introduction in 1986, propofol ( two, 6-diisopropylphenol) , an intravenous sedative-hypnotic agent, has been utilized for the induction and maintenance of general anesthesia and conscious sedation in over 80 percent of cases; largely replacing thiopental ( sodium pentothal) over a decade ago. Unrestricted as a controlled substance, propofol's abuse potential emerged quickly and was highlighted by the death of pop singer, Michael Jackson, in 2009. In order to assess the epidemiological features of fatal propofol abuse, a descriptive analysis of the scientific literature was conducted using Internet search engines...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28413268/novel-propofol-derivatives-and-implications-for-anesthesia-practice
#6
REVIEW
Aiden Y Feng, Alan D Kaye, Rachel J Kaye, Kumar Belani, Richard D Urman
Propofol (2,6-diisopropylphenol) is the most commonly used intravenous agent for induction of anesthesia. It is also used for maintenance of anesthesia and sedation in both Intensive Care Units and outpatient procedural settings. Its success in the clinical setting has been a result of its rapid onset, short duration of action, and minimal side effects despite disadvantages associated with its oil emulsion formulation. Early attempts to alter the standard emulsion or to develop new formulations with cyclodextrins and micelles to resolve issues with pain upon injection, the need for antimicrobial agents, and possible hyperlipidemia have mostly failed...
January 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/28402867/functional-connectivity-and-network-analysis-during-hypoactive-delirium-and-recovery-from-anesthesia
#7
Tianne Numan, Arjen J C Slooter, Arendina W van der Kooi, Annemieke M L Hoekman, Willem J L Suyker, Cornelis J Stam, Edwin van Dellen
OBJECTIVE: To gain insight in the underlying mechanism of reduced levels of consciousness due to hypoactive delirium versus recovery from anesthesia, we studied functional connectivity and network topology using electroencephalography (EEG). METHODS: EEG recordings were performed in age and sex-matched patients with hypoactive delirium (n=18), patients recovering from anesthesia (n=20), and non-delirious control patients (n=20), all after cardiac surgery. Functional and directed connectivity were studied with phase lag index and directed phase transfer entropy...
March 6, 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/28398941/the-season-of-hoverboards-a-case-series-of-fractures
#8
Chester J Donnally, Charles M Lawrie, Augustus J Rush, Avi C Baitner
OBJECTIVE: The aim of this study was to identify the types of pediatric orthopedic extremity fractures that are sustained as a result of hoverboard (self-balancing, self-propelling, 2-wheeled boards) use. METHODS: We performed a retrospective review of all orthopedic consultations from the emergency department at our institution from December 1 to 31, 2015. Data was collected on the injury mechanism, fracture location, management, and patient characteristics including sex, age, and hand dominance...
April 11, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28393775/conscious-sedation-for-balloon-mitral-valvotomy-a-comparison-of-fentanyl-versus-sufentanil
#9
Shailendra Deochandra Modak, Deepa G Kane
CONTEXT: Analgesia and sedation are required for the comfort of patient and the cardiologist during balloon mitral valvotomy. AIMS: In this study, efficacy of analgesia, sedation, and patient satisfaction with sufentanil was compared with fentanyl. SETTINGS AND DESIGN: Single-centered, prospective single-blind study of sixty patients. MATERIALS AND METHODS: Patients between 15 and 45 years of rheumatic mitral stenosis with valve area of 0...
April 2017: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/28393105/patients-with-primary-sclerosing-cholangitis-require-more-sedation-during-endoscopic-retrograde-cholangiography
#10
Carsten Keil, Lukas Aguirre Dávila, Theodor Framke, Henrike Lenzen, Michael P Manns, Tim O Lankisch, Torsten Voigtländer
Background and study aims Patients with primary sclerosing cholangitis (PSC) require repeated endoscopic retrograde cholangiography (ERC). Our aim was to evaluate whether patients with PSC require higher doses of sedation during ERC. Patients and methods We retrospectively analyzed all patients undergoing ERC from 2006 to 2013 who received conscious sedation with propofol and midazolam. The duration of the intervention and a potential progression of propofol consumption or intervention time by visit number were analyzed...
April 2017: Endoscopy International Open
https://www.readbyqxmd.com/read/28388992/long-term-outcomes-of-560-consecutive-patients-treated-with-transcatheter-aortic-valve-implantation-and-propensity-score-matched-analysis-of-early-versus-new-generation-valves
#11
Amos Levi, Uri Landes, Abid R Assali, Katia Orvin, Ram Sharony, Hanna Vaknin-Assa, Ashraf Hamdan, Yaron Shapira, Shmuel Schwartzenberg, Pablo Codner, Aviv A Shaul, Mordechai Vaturi, Ariel Gutstein, Alexander Sagie, Ran Kornowski
Transcatheter aortic valve implantation (TAVI) is an established treatment for severe aortic stenosis in patients at high or prohibitive surgical risk. Nevertheless, long-term clinical and echocardiographic data are still lacking. We carried out an analysis of 560 consecutive patients who underwent TAVI at our institution from 2008 to 2016 to evaluate temporal changes in TAVI characteristics, predictors of 1-year and long-term outcomes, and to compare the performance of the early- and new-generation valve systems...
March 16, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28385584/a-study-of-the-clinical-utility-of-a-20-minute-secretin-stimulated-endoscopic-pancreas-function-test-and-performance-according-to-clinical-variables
#12
Luis F Lara, Morihito Takita, James S Burdick, Daniel C DeMarco, Ronnie R Pimentel, Tolga Erim, Marlon F Levy
BACKGROUND & AIMS: Direct pancreas juice testing of bicarbonate, lipase, or trypsin after stimulation by secretin or cholecystokinin (CCK) is used to determine exocrine function, a surrogate for diagnosing chronic pancreatitis (CP). Endoscopic pancreas function tests (ePFT) where a peak bicarbonate concentration (PBC) ≥80 mEq/L in pancreas juice is considered normal are now used more frequently. In this ePFT aspirates start 35 minutes after secretin administration because pancreas output peaks 30 minutes after secretagogue administration...
April 3, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28379981/improved-costs-and-outcomes-with-conscious-sedation-vs-general-anesthesia-in-tavr-patients-time-to-wake-up
#13
William Toppen, Daniel Johansen, Sohail Sareh, Josue Fernandez, Nancy Satou, Komal D Patel, Murray Kwon, William Suh, Olcay Aksoy, Richard J Shemin, Peyman Benharash
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become a commonplace procedure for the treatment of aortic stenosis in higher risk surgical patients. With the high cost and steadily increasing number of patients receiving TAVR, emphasis has been placed on optimizing outcomes as well as resource utilization. Recently, studies have demonstrated the feasibility of conscious sedation in lieu of general anesthesia for TAVR. This study aimed to investigate the clinical as well as cost outcomes associated with conscious sedation in comparison to general anesthesia in TAVR...
2017: PloS One
https://www.readbyqxmd.com/read/28371158/the-effect-of-gabapentin-on-delayed-discharge-from-the-postanesthesia-care-unit-a-retrospective-analysis
#14
Naveed T Siddiqui, Amir Yousefzadeh, Maaz Yousuf, Dileep Kumar, Farah K Choudhry, Zeev Friedman
BACKGROUND: Enhanced recovery after surgery programs have incorporated gabapentin as part of a multimodal analgesia protocol. The preemptive use of gabapentin was found to be beneficial due to its opioid-sparing effect. However, excessive sedation and delayed discharge from postanesthesia recovery units are of concern. The aim of this study was to investigate whether preoperative gabapentin increased the length of stay in the recovery unit. METHODS: This retrospective cross-sectional study was carried out over a period of 2 months in the postanesthesia care unit (PACU) of a tertiary care hospital in Canada...
March 30, 2017: Pain Practice: the Official Journal of World Institute of Pain
https://www.readbyqxmd.com/read/28366157/-sedation-during-noninvasive-mechanical-ventilation
#15
Fatma Yıldırım, İskender Kara, Ebru Ortaç Ersoy
Noninvasive mechanical ventilation (NIMV) is an effective technique that can avert side effects and complications associated with endotracheal intubation. The tolerance of NIMV is crucial for its success. Mask intolerance because of pain or discomfort, or claustrophobia, may lead the patient to refuse ongoing NIMV prompting its discontinuation. After considering all factors known to improve adaptation of the patients to NIMV, the implementation of sedation-based strategy to rescue patients with poor cooperation and/or adaptation to NIMV is remaining attaractive to enlarge its rate of success...
September 2016: Tüberküloz Ve Toraks
https://www.readbyqxmd.com/read/28363809/vaginismus-treatment-clinical-trials-follow-up-241-patients
#16
Peter T Pacik, Simon Geletta
INTRODUCTION: Vaginismus is mostly unknown among clinicians and women. Vaginismus causes women to have fear, anxiety, and pain with penetration attempts. AIM: To present a large cohort of patients based on prior published studies approved by an institutional review board and the Food and Drug Administration using a comprehensive multimodal vaginismus treatment program to treat the physical and psychologic manifestations of women with vaginismus and to record successes, failures, and untoward effects of this treatment approach...
March 28, 2017: Sexual Medicine
https://www.readbyqxmd.com/read/28360352/intracranial-venous-pressures-under-conscious-sedation-and-general-anesthesia
#17
Daniel M S Raper, Thomas J Buell, Ching-Jen Chen, Dale Ding, Robert M Starke, Kenneth C Liu
INTRODUCTION: Venous outflow obstruction has been implicated in the pathophysiology of a subset of patients with idiopathic intracranial hypertension (IIH), and venous sinus stenting (VSS) has emerged as an effective treatment. However, the effect of anesthesia on venous sinus pressure measurements is unpredictable. A more thorough understanding of the effect of the level of anesthesia on intracranial venous pressures might help to better define patients who might benefit most from stent placement...
March 30, 2017: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/28341128/-a-bronchial-mucous-gland-adenoma-resected-by-endoscopic-procedure
#18
C Vergnenègre, J Hureaux, B Morvant, T Urban, T Jeanfaivre
INTRODUCTION: Surgical resection is usually performed for the treatment of endobronchial tumors. This case describes the use of endoscopic resection as an initial treatment, allowing to spare lung parenchyma. CASE REPORT: A patient was admitted to the emergency unit with right lower lobe pneumonia. A thoracic CT-scan and subsequent bronchoscopy revealed an intrabronchial tumor between the right main and intermediate bronchus. Biopsies were non-diagnostic and a PET-scanner did not find any abnormalities...
March 22, 2017: Revue des Maladies Respiratoires
https://www.readbyqxmd.com/read/28340389/minilaparotomy-without-general-anesthesia-for-the-treatment-of-sigmoid-volvulus-in-high-risk-patients-a-case-series-of-4-patients
#19
Ernesto L Enrique, Kareem A Hamdy
BACKGROUND: Sigmoid volvulus (SV) is a common cause of large bowel obstruction worldwide. Presenting symptoms can be nonspecific and varied amongst the elderly population, making medical and surgical management challenging. This population is at markedly increase risk of complications and mortality with surgery under general anesthesia. In this case series, we describe 4 cases of sigmoid volvulus in octogenarians. GOALS: To demonstrate that sigmoid colectomy under local anesthesia, with or without intravenous conscious sedation, is feasible and can be done safely and with a low rate of converting to a general anesthetic...
March 2, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28337480/intra-channel-stent-release-technique-for-fluoroless-endoscopic-ultrasound-guided-lumen-apposing-metal-stent-placement-changing-the-paradigm
#20
Andrea Anderloni, Fabia Attili, Silvia Carrara, Domenico Galasso, Milena Di Leo, Guido Costamagna, Alessandro Repici, Rastislav Kunda, Alberto Larghi
Background Recently, a novel lumen-apposing fully covered self-expanding metal stent (LA-FCSEMS) mounted on an electrocautery-enhanced delivery system has been developed to perform endoscopic ultrasound (EUS)-guided transluminal drainage. From early experience, however, release of the proximal flange of the stent has mostly been done using endoscopic view guidance to ensure proper positioning. Aim We describe a new technique that we have named the Intra-Channel Stent Release Technique (ICSRT) to perform stent placement under complete EUS control, without the use of either fluoroscopic or endoscopic views...
January 2017: Endoscopy International Open
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