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Conscious sedation

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https://www.readbyqxmd.com/read/29145742/improving-mechanical-thrombectomy-time-metrics-in-the-angiography-suite-stroke-cart-parallel-workflows-and-conscious-sedation
#1
Fabio Settecase, David B McCoy, Robert Darflinger, Matthew D Alexander, Daniel L Cooke, Christopher F Dowd, Steven W Hetts, Randall T Higashida, Van V Halbach, Matthew R Amans
Purpose Earlier reperfusion of large-vessel occlusion (LVO) stroke improves functional outcomes. We hypothesize that use of a stroke cart in the angiography suite, containing all commonly used procedural equipment in a mechanical thrombectomy, combined with parallel staff workflows, and use of conscious sedation when possible, improve mechanical thrombectomy time metrics. Methods We identified 47 consecutive LVO patients who underwent mechanical thrombectomy at our center, retrospectively and prospectively from implementation of these three workflow changes (19 pre- and 28 post-)...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29137967/procedural-and-thirty-day-outcomes-following-transfemoral-implantation-of-the-fully-repositionable-and-retrievable-lotus-valve-without-routine-pre-dilatation-in-a-consecutive-patient-cohort-a-single-centre-experience
#2
Neil Ruparelia, Katharine Thomas, James D Newton, Kate Grebenik, Amar Keiralla, George Krasopoulos, Rana Sayeed, Adrian P Banning, Rajesh K Kharbanda
BACKGROUND / PURPOSE: The Lotus valve (Boston Scientific, Natick, MA, USA) is a contemporary transcatheter aortic valve implantation (TAVI) device that is fully repositionable and retrievable to aid implantation and optimise procedural results. The ability to implant the device without routine pre-dilatation is another possible advantage reducing associated risks and procedure times. The aim of this study is to report procedural and 30-day outcomes following TAVI in a consecutive patient group presenting with severe symptomatic aortic stenosis with the Lotus valve system without routine pre-dilatation...
November 4, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/29131286/conscious-sedation-for-transcatheter-implantation-of-atrial-septal-occluders-with-the-2d-and-3d-transesophageal-echocardiography-guidance-the-feasibility-and-safety-study
#3
Piotr Lipiec, Dawid Miśkowiec, Jan Z Peruga, Michał Plewka, Ewa Szymczyk, Paulina Wejner-Mik, Karolina Kupczyńska, Jarosław D Kasprzak
BACKGROUND: General anesthesia may have negative impact on patients mortality and morbidity, as well as overall procedure costs in atrial septal occluders (ASO) implantation. AIM: We sought to evaluate the safety, efficacy and feasibility of conscious sedation for transcatheter implantation of ASO. METHODS: 122 patients (pts) referred for transcatheter implantation of ASO were included. Mean patients' age was 51±15 years, 43 patients were male (35%)...
November 13, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/29130583/endoscopic-retrograde-cholangio-pancreatography-in-the-management-of-biliary-complications-after-paediatric-liver-transplantation
#4
Sivaramakrishnan Venkatesh Karthik, Seng-Hock Quak, Marion M Aw
BACKGROUND: The published paediatric experience with Endoscopic retrograde cholangio-pancreatography (ERCP) in the diagnosis and management of biliary complications following liver transplantation (LT) is limited. AIMS: We describe our experience with ERCP in the management of children following LT who presented with biliary complications, over a 20 year period (1995-2014). METHODS: The retrospectively reviewed data is summarized descriptively...
November 11, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
https://www.readbyqxmd.com/read/29121298/human-neural-correlates-of-sevoflurane-induced-unconsciousness
#5
B J A Palanca, M S Avidan, G A Mashour
Sevoflurane, a volatile anaesthetic agent well-tolerated for inhalation induction, provides a useful opportunity to elucidate the processes whereby halogenated ethers disrupt consciousness and cognition. Multiple molecular targets of sevoflurane have been identified, complementing imaging and electrophysiologic markers for the mechanistically obscure progression from wakefulness to unconsciousness. Recent investigations have more precisely detailed scalp EEG activity during this transition, with practical clinical implications...
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29121293/brain-functional-connectivity-differentiates-dexmedetomidine-from-propofol-and-natural-sleep
#6
P Guldenmund, A Vanhaudenhuyse, R D Sanders, J Sleigh, M A Bruno, A Demertzi, M A Bahri, O Jaquet, J Sanfilippo, K Baquero, M Boly, J F Brichant, S Laureys, V Bonhomme
Background: We used functional connectivity measures from brain resting state functional magnetic resonance imaging to identify human neural correlates of sedation with dexmedetomidine or propofol and their similarities with natural sleep. Methods: Connectivity within the resting state networks that are proposed to sustain consciousness generation was compared between deep non-rapid-eye-movement (N3) sleep, dexmedetomidine sedation, and propofol sedation in volunteers who became unresponsive to verbal command...
October 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29121108/spatio-temporal-dynamics-of-multimodal-eeg-fnirs-signals-in-the-loss-and-recovery-of-consciousness-under-sedation-using-midazolam-and-propofol
#7
Seul-Ki Yeom, Dong-Ok Won, Seong In Chi, Kwang-Suk Seo, Hyun Jeong Kim, Klaus-Robert Müller, Seong-Whan Lee
On sedation motivated by the clinical needs for safety and reliability, recent studies have attempted to identify brain-specific signatures for tracking patient transition into and out of consciousness, but the differences in neurophysiological effects between 1) the sedative types and 2) the presence/absence of surgical stimulations still remain unclear. Here we used multimodal electroencephalography-functional near-infrared spectroscopy (EEG-fNIRS) measurements to observe electrical and hemodynamic responses during sedation simultaneously...
2017: PloS One
https://www.readbyqxmd.com/read/29118800/septoplasty-scepter-balloon-angioplasty-for-vasospasm-after-aneurysmal-subarachnoid-hemorrhage
#8
Bradley A Gross, Daniel A Tonetti, Gregory M Weiner, David M Panczykowski, William J Ares, Cynthia L Kenmuir, Ashutosh P Jadhav, Tudor G Jovin, Brian T Jankowitz
Introduction: Balloon angioplasty can be a requisite approach for the treatment of symptomatic and/or severe vasospasm. Dual-lumen microcatheter balloons have multiple potential advantages for this indication including accommodating a 0.014-inch wire and the potential to deliver superselective vasodilators directly via the microcatheter prior to angioplasty. Methods: The authors reviewed a 3-year institutional experience with the Scepter XC balloon (Microvention, Tustin, CA, USA) in the treatment of postaneurysmal subarachnoid hemorrhage vasospasm, focusing on treatment methods, angiographic, and clinical results...
October 2017: Interventional Neurology
https://www.readbyqxmd.com/read/29117722/endoscopic-ultrasound-guided-pancreatic-fluid-collections-transmural-drainage-outcomes-in-100-consecutive-cases-of-pseudocysts-and-walled-off-necrosis-a-single-centre-experience-from-the-united-kingdom
#9
Chander Shekhar, Ben Maher, Colm Forde, Brinder Singh Mahon
BACKGROUND AND AIM: Endoscopic ultrasound-guided drainage is a minimally invasive first-line modality for the drainage of pancreatic fluid collection (PFC) resulting in a shorter hospital stay and less morbidity compared with surgical cystogastrostomy. Our aim is to evaluate potential differences in the outcomes of endoscopic ultrasound (EUS) guided transmural drainage (EUS-TD) drainage of pancreatic pseudocyst (PP) and walled-off necrosis (WON). METHOD: We retrospectively reviewed 100 consecutive EUS-guided drainages of PFC utilising EUS reports; clinical notes and imaging with follow-up (FU) to 12 months...
November 9, 2017: Scandinavian Journal of Gastroenterology
https://www.readbyqxmd.com/read/29109652/conscious-sedation-in-a-psychiatric-patient-a-challenge
#10
Priyanka Sethi, Pradeep Bhatia, Deepak Choudhary, Shilpi Verma
No abstract text is available yet for this article.
July 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29101954/anesthesia-in-the-electrophysiology-laboratory
#11
REVIEW
Jeff E Mandel, William G Stevenson, David S Frankel
The electrophysiology suite is a foreign location to many anesthesiologists. The initial experience was with shorter procedures under conscious sedation, and the value of greater tailoring of the sedation/anesthesia by anesthesiologists was not perceived until practice patterns had already been established. Although better control of ventilation with general anesthesia may be expected, suppression of arrhythmias, blunting of the hemodynamic adaptation to induced arrhythmias, and interference by muscle relaxants with identification of the phrenic nerve may be seen...
December 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/29101936/propofol-frenzy-clinical-spectrum-in-3-patients
#12
Diego Z Carvalho, Ryan A Townley, Christopher M Burkle, Alejandro A Rabinstein, Eelco F M Wijdicks
Postsedation neuroexcitation is sometimes attributed to intravenous injection of the sedative-hypnotic drug propofol. The movements associated with these events have strongly suggested convulsive activity, but they rarely have been comprehensively evaluated. We present video recordings of 3 healthy young patients who underwent elective surgery under conscious sedation and emerged from sedation with transient but repetitive violent motor activity and impaired consciousness. These manifestations required considerable mobilization of multiple health care workers to protect the patient from inflicting harm...
November 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29098683/effect-of-sufentanil-on-bispectral-index-in-the-elderly
#13
T de Valence, N Elia, C Czarnetzki, L Dumont, M R Tramèr, C Lysakowski
We examined the impact of adding sufentanil during anaesthesia induction with propofol on bispectral index values in elderly patients (≥ 65 years). Patients were randomly assigned to receive a target-controlled sufentanil infusion (effect-site concentration of 0.3 ng.ml(-1) ) or matching placebo, followed by a target-controlled propofol induction (initial effect-site concentration of 0.5 μg.ml(-1) ; step-wise increase of 0.5 μg.ml(-1) ) until loss of consciousness defined as an Observer's Assessment of Alertness/Sedation score < 2...
November 3, 2017: Anaesthesia
https://www.readbyqxmd.com/read/29096029/safety-and-efficacy-of-minimalist-approach-in-transfemoral-transcatheter-aortic-valve-replacement-insights-from-the-optimized-transcatheter-valvular-intervention-transcatheter-aortic-valve-implantation-ocean-tavi-registry
#14
Soh Hosoba, Masanori Yamamoto, Kayoko Shioda, Mitsuru Sago, Yutaka Koyama, Tetsuro Shimura, Ai Kagase, Norio Tada, Toru Naganuma, Motoharu Araki, Futoshi Yamanaka, Shinichi Shirai, Yusuke Watanabe, Kentaro Hayashida
OBJECTIVES: Favourable results have been reported for monitored anaesthesia care that includes local anaesthesia and conscious sedation [minimalist approach (MA)] for transfemoral transcatheter aortic valve replacement (TAVR). However, the efficacy of MA is still controversial in Japan. We describe our experience from a Japanese multicentre registry. METHODS: Between October 2013 and April 2016, 1215 consecutive Japanese patients with symptomatic, severe aortic stenosis undergoing TAVR with self-expandable or balloon-expandable valves were prospectively included in the Optimized transCathEter vAlvular intervention-Transcatheter Aortic Valve Implantation (OCEAN-TAVI) registry...
October 31, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29089921/the-neurological-wake-up-test-a-role-in-neurocritical-care-monitoring-of-traumatic-brain-injury-patients
#15
REVIEW
Niklas Marklund
The most fundamental clinical monitoring tool in traumatic brain injury (TBI) patients is the repeated clinical examination. In the severe TBI patient treated by continuous sedation in a neurocritical care (NCC) unit, sedation interruption is required to enable a clinical evaluation (named the neurological wake-up test; NWT) assessing the level of consciousness, pupillary diameter and reactivity to light, and presence of focal neurological deficits. There is a basic conflict regarding the NWT in the NCC setting; can the clinical information obtained by the NWT justify the risk of inducing a stress response in a severe TBI patient? Furthermore, in the presence of advanced multimodal monitoring and neuroimaging, is the NWT necessary to identify important clinical alterations? In studies of severe TBI patients, the NWT was consistently shown to induce a stress reaction including brief increases in intracranial pressure (ICP) and changes in cerebral perfusion pressure (CPP)...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/29089457/predictors-of-good-outcome-after-endovascular-therapy-for-vertebrobasilar-occlusion-stroke
#16
Mehdi Bouslama, Diogo C Haussen, Amin Aghaebrahim, Jonathan A Grossberg, Gregory Walker, Srikant Rangaraju, Anat Horev, Michael R Frankel, Raul G Nogueira, Tudor G Jovin, Ashutosh P Jadhav
BACKGROUND AND PURPOSE: Endovascular therapy is increasingly used in acute ischemic stroke treatment and is now considered the gold standard approach for selected patient populations. Prior studies have demonstrated that eventual patient outcomes depend on both patient-specific factors and procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome in acute posterior circulation large vessel occlusion strokes treated with endovascular therapy...
October 31, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29083986/effect-of-general-anesthesia-versus-conscious-sedation-for-stroke-thrombectomy-on-angiographic-workflow-in-a-randomized-trial-a-post-hoc-analysis-of-the-siesta-trial
#17
Johannes A R Pfaff, Silvia Schönenberger, Simon Nagel, Peter A Ringleb, Werner Hacke, Martin Bendszus, Julian Bösel, Markus Alfred Möhlenbruch
Purpose To investigate whether the sedation mode (ie, conscious sedation [CS] vs general anesthesia [GA]) affects the angiographic workflow applied for treatment of endovascular stroke in a post hoc analysis of a recent randomized controlled trial, Sedation versus Intubation for Endovascular Stroke Treatment (SIESTA). Materials and Methods SIESTA was an institutional review board-approved, single-center, prospective, randomized, parallel-group, open-label treatment trial with a blinded end-point evaluation to compare GA with CS for treatment of endovascular stroke in 73 and 77 patients, respectively...
October 30, 2017: Radiology
https://www.readbyqxmd.com/read/29072063/conscious-sedation-during-cryoballoon-ablation-of-atrial-fibrillation-the-feasibility-and-safety-study
#18
Dawid Miśkowiec, Jarosław D Kasprzak, Paulina Wejner-Mik, Ewa Szymczyk, Haval D Qawoq, Paweł Życiński, Tomasz Wcisło, Piotr Pagórek, Karolina Kupczyńska, Piotr Lipiec
BACKGROUND: Cryoballoon ablation for atrial fibrillation (cryoAF) is relatively simple, cost-effective and easy procedure. However, general anesthesia during this procedure may have negative impact on patients mortality and morbidity, as well as procedure costs. AIM: We sought to assess the feasibility and safety of conscious sedation during cryoAF. METHODS: Patients (pts) with paroxysmal or persistent, drug-refractory AF who underwent a first procedure of cryoAF were included in our single-center, retrospective study...
October 25, 2017: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/29060888/propofol-induced-sedation-diminishes-the-strength-of-frontal-parietal-occipital-eeg-network
#19
Dheeraj Rathee, Hubert Cecotti, Girijesh Prasad
The level of conscious experience can be effectively and reversibly altered by the administration of sedative agents. Several studies attempted to explore the variations in frontal-parietal network during propofol-induced sedation. However, contradictory outcomes warrant further investigations. In this study, we implemented the Neural Gas algorithm-based delay symbolic transfer entropy (NG-dSTE) for investigation of frontal-parietal-occipital (F-P-O) network using scalp EEG signals recorded during altered levels of consciousness...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/29060032/change-in-functional-networks-for-transitions-between-states-of-consciousness-during-midazolam-induced-sedation
#20
Minji Lee, Robert D Sanders, Seul-Ki Yeom, Dong-Ok Won, Hwi-Jae Kim, Bo-Ram Lee, Kwang-Suk Seo, Hyun Jeong Kim, Giulio Tononi, Seong-Whan Lee
How brain dynamics change across conscious states, including reliable signatures of the transitions between unconsciousness and consciousness, remains unclear. In this work, we addressed the changes in functional brain networks during self-titrated midazolam sedation using high-density electroencephalography (EEG) in ten subjects. We were particularly interested in the underlying network alterations, identified with graph theory, associated with transitions between states of consciousness. The weighted Phase Lag Index (wPLI) was used as the connectivity estimator between two signals...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
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