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Conscious sedation

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https://www.readbyqxmd.com/read/29792239/screening-for-delirium-with-the-intensive-care-delirium-screening-checklist-icdsc-symptom-profile-and-utility-of-individual-items-in-the-identification-of-delirium-dependent-on-the-level-of-sedation
#1
Soenke Boettger, Rafael Meyer, André Richter, Susana Franco Fernandez, Alain Rudiger, Maria Schubert, Josef Jenewein, David Garcia Nuñez
OBJECTIVE: The importance of the proper identification of delirium, with its high incidence and adversities in the intensive care setting, has been widely recognized. One common screening instrument is the Intensive Care Delirium Screening Checklist (ICDSC); however, the symptom profile and key features of delirium dependent on the level of sedation have not yet been evaluated. METHOD: In this prospective cohort study, the ICDSC was evaluated versus the Diagnostic and Statistical Manual, 4th edition, text revision, diagnosis of delirium set as standard with respect to the symptom profile, and correct identification of delirium...
May 24, 2018: Palliative & Supportive Care
https://www.readbyqxmd.com/read/29789778/conscious-sedation-versus-general-anesthesia-for-patients-with-acute-ischemic-stroke-undergoing-endovascular-therapy-a-systematic-review-and-meta-analysis
#2
REVIEW
Ren Jing, Hui-Jun Dai, Fei Lin, Wan-Yun Ge, Ling-Hui Pan
The aim of this study is to compare the effect of conscious sedation (CS) with general anesthesia (GA) on clinical outcomes in patients with acute ischemic stroke (AIS) undergoing endovascular therapy (EVT). MEDLINE, EMBASE, and Cochrane Central Registers of Controlled Trials (from inception to July 2017) were searched for reports on CS and GA of AIS undergoing EVT. Two reviewers assessed the eligibility of the identified studies and extracted data. Data were analyzed using the fixed-effects model, and the sources of heterogeneity were explored by sensitive analysis...
2018: BioMed Research International
https://www.readbyqxmd.com/read/29788370/large-traumatic-skull-base-internal-carotid-artery-pseudoaneurysm-managed-with-endovascular-flow-diversion-2-dimensional-operative-video
#3
Gary Rajah, Richard Justin Garling, Leonardo Rangel-Castilla
We present a case of a traumatic skull base internal carotid artery (ICA) pseudoaneurysm treated with endovascular flow diversion stenting. The patient was a 27-year-old male who was involved in a motorcycle accident suffering multiple traumatic injuries including a large skull base fracture that extended through the carotid canal. Computed tomography angiography revealed a 2-cm right ICA pseudoaneurysm. Once the patient was stable, a digital subtraction angiography demonstrated enlargement of the pseudoaneurysm...
May 18, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29772269/a-new-method-for-determining-levels-of-sedation-in-dogs-a-pilot-study-with-propofol-and-a-novel-neuroactive-steroid-anesthetic
#4
B L Youngblood, Y Ueyama, W W Muir, G M Belfort, R H Hammond, J Dai, F G Salituro, A J Robichaud, J J Doherty
BACKGROUND: Different levels of consciousness are required in order to perform different medical procedures. Sedation scales established to objectively define various levels of sedation in humans have not been thoroughly characterized in non-human species. Postural changes in rats or dogs are useful as gross measures of sedation but are inadequate for quantitative assessment since graded levels of sedation are difficult to delineate and obscured by movement abnormalities. NEW METHOD: A new canine sedation scoring (CSS) method was developed based on the modified observer's assessment of alertness and sedation score (MOAA/S) used in humans...
May 14, 2018: Journal of Neuroscience Methods
https://www.readbyqxmd.com/read/29764750/patient-oriented-optimal-depth-of-conscious-sedation-using-midazolam-during-flexible-bronchoscopy-a-prospective-open-labeled-single-arm-trial
#5
Yuichiro Takeda, Hibiki Udagawa, Shinji Nakamichi, Yasuto Yoneshima, Motoyasu Iikura, Satoshi Hirano, Go Naka, Haruhito Sugiyama
BACKGROUND: The British Thoracic Society guidelines for diagnostic flexible bronchoscopy (FB) in adults recommend that intravenous sedation should be offered to patients undergoing bronchoscopy. However, it is difficult to determine the adequate depth of sedation for each patient because of inter-individual variability. METHODS: This prospective, open-label, single-arm study was conducted in patients undergoing routine bronchus examination with FB. All patients underwent FB under local anesthesia and conscious sedation, with initial administration of 0...
May 6, 2018: Respiratory Investigation
https://www.readbyqxmd.com/read/29763924/absence-of-complications-after-endoscopic-mucosal-biopsy
#6
Brian Johnson, Marc D Basson
BACKGROUND: There is no clarity with regard to the occurrence of serious complications from EGD-driven mucosal biopsy. This is important for considering both clinically indicated procedures and mucosal sampling for research. METHODS: We sought to quantify rates of serious complications from esophagogastroduodenoscopy (EGD) with biopsy. We studied 13,233 patients undergoing outpatient EGD with biopsy over 5 years in 2 North Dakota community hospitals, based on the reasoning that serious complications would cause hospitalization within 30 days...
May 15, 2018: Digestive Diseases
https://www.readbyqxmd.com/read/29761478/pain-relief-for-women-undergoing-oocyte-retrieval-for-assisted-reproduction
#7
REVIEW
Irene Kwan, Rui Wang, Emily Pearce, Siladitya Bhattacharya
BACKGROUND: Various methods of conscious sedation and analgesia (CSA) have been used during oocyte retrieval for assisted reproduction. The choice of agent has been influenced by the quality of sedation and analgesia and by concerns about possible detrimental effects on reproductive outcomes. OBJECTIVES: To assess the effectiveness and safety of different methods of conscious sedation and analgesia for pain relief and pregnancy outcomes in women undergoing transvaginal oocyte retrieval...
May 15, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29760857/retrospective-chart-review-of-synthetic-cannabinoid-intoxication-with-toxicologic-analysis
#8
Payal Sud, Miles Gordon, Laura Tortora, Matthew Stripp, Damon Borg, Adam Berman
Introduction: Use of synthetic cannabinoids (SC) has recently emerged as a new drug epidemic. Our emergency departments (EDs) received a surge of SC users presenting with lethargy and bradycardia, contrasting prior reports of SC-induced tachycardia and agitation. Our goal was to describe these novel presentations and characterize the compounds. Methods: We present a case series of patients with SC intoxication who presented to our toxicology service covering two tertiary care EDs between 2/11/2015 and 6/23/2015...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29757924/placebo-versus-low-dose-ketamine-infusion-in-addition-to-remifentanil-target-controlled-infusion-for-conscious-sedation-during-oocyte-retrieval-a-prospective-double-blinded-randomised-controlled-trial
#9
Hélène I Morue, Shalini Raj-Lawrence, Sarah Saxena, Anne Delbaere, Edgard Engelman, Luc A Barvais
BACKGROUND: Currently, there is no gold standard for monitored anaesthesia care during oocyte retrieval. OBJECTIVE: In our institution, the standard is a conscious sedation technique using a target-controlled infusion (TCI) of remifentanil, titrated to maintain a visual analogue pain score less than 30 mm. This protocol is well accepted by patients but is associated with frequent episodes of respiratory depression. The main objective of this study was to evaluate whether the addition of a continuous intravenous infusion of ketamine could reduce these episodes...
April 30, 2018: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/29755652/correlation-of-mdr1-gene-polymorphism-with-propofol-combined-with-remifentanil-anesthesia-in-pediatric-tonsillectomy
#10
YunLong Zhang, Yongpei Li, Hongfa Wang, Fang Cai, Sheliang Shen, Xiaopan Luo
The motive of this study was to investigate the interaction between polymorphisms in the MDR1 gene and anesthetic effects following pediatric tonsillectomy. In total, 240 children undergoing tonsillectomy with preoperative propofol-remifentanil anesthesia were selected. Genomic DNA was extracted from the peripheral blood of children after operation, and the MDR1 gene polymorphisms of 2677 G>T/A, 1236 C>T and 3435 C>T were detected by direct sequencing. We tested mean arterial pressure, diastolic blood pressure, systolic blood pressure, and heart rate at several time-points: T0 (5 mins after the repose), T1 (0 min after tracheal intubation), T2 (5 mins after the tracheal intubation), T3 (0 min after the tonsillectomy), T4 (0 min after removal of the mouth-gag) and T5 (5 min after the extubation)...
April 17, 2018: Oncotarget
https://www.readbyqxmd.com/read/29753606/immunizations-under-sedation-at-a-paediatric-hospital-in-melbourne-australia-from-2012-2016
#11
Daryl R Cheng, Sonja Elia, Kirsten P Perrett
BACKGROUND: Sedation for immunizations is of particular importance in a subset of paediatric patients with anxiety disorders, needle phobia, developmental or behavioural disorders. The Royal Children's Hospital (RCH) Melbourne offers a unique immunization under sedation service for these patients. We aimed to evaluate the number and types of patients using inpatient sedation for immunizations, distraction and sedation techniques used, and outcomes of these procedures. METHODS: A medical record review was conducted on all patients who had immunization under sedation between January 2012 to December 2016 in the RCH Day Medical Unit (DMU)...
May 9, 2018: Vaccine
https://www.readbyqxmd.com/read/29740019/feasibility-and-safety-of-using-local-anaesthesia-with-conscious-sedation-during-complex-cardiac-implantable-electronic-device-procedures
#12
Elif Kaya, Hendrik Südkamp, Julia Lortz, Tienush Rassaf, Rolf Alexander Jánosi
We assessed the feasibility and safety of using local anaesthesia with conscious sedation as an alternative to general anaesthesia during complex and noncomplex cardiac implantable device procedures. We enrolled 279 consecutive patients who underwent cardiac device implantation/replacement at our tertiary/quaternary cardiac specialist hospital during a 17-month study period. Continuous combined intravenous conscious sedation with propofol and midazolam plus fentanyl and local anaesthesia were used for all procedures...
May 8, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29739917/magnetic-resonance-imaging-selection-for-endovascular-stroke-therapy-workflow-in-the-goliath-trial
#13
Claus Z Simonsen, Albert J Yoo, Mads Rasmussen, Kristina E Sørensen, Thabele Leslie-Mazwi, Grethe Andersen, Leif H Sørensen
BACKGROUND AND PURPOSE: The GOLIATH trial (General or Local Anesthesia in Intra-Arterial Therapy) compared infarct growth and outcome in patients undergoing endovascular therapy under either general anesthesia or conscious sedation. Magnetic resonance imaging was performed before and after the procedure to study infarct growth. In this post hoc analysis of GOLIATH, we aimed to characterize the workflow of patients undergoing magnetic resonance imaging selection before endovascular therapy...
May 8, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29737490/regional-entropy-of-functional-imaging-signals-varies-differently-in-sensory-and-cognitive-systems-during-propofol-modulated-loss-and-return-of-behavioral-responsiveness
#14
Xiaolin Liu, Kathryn K Lauer, B Douglas Ward, Christopher J Roberts, Suyan Liu, Suneeta Gollapudy, Robert Rohloff, William Gross, Zhan Xu, Shanshan Chen, Lubin Wang, Zheng Yang, Shi-Jiang Li, Jeffrey R Binder, Anthony G Hudetz
The level and richness of consciousness depend on information integration in the brain. Altered interregional functional interactions may indicate disrupted information integration during anesthetic-induced unconsciousness. How anesthetics modulate the amount of information in various brain regions has received less attention. Here, we propose a novel approach to quantify regional information content in the brain by the entropy of the principal components of regional blood oxygen-dependent imaging signals during graded propofol sedation...
May 8, 2018: Brain Imaging and Behavior
https://www.readbyqxmd.com/read/29720440/association-of-blood-pressure-with-short-and-long-term-functional-outcome-after-stroke-thrombectomy-post-hoc-analysis-of-the-siesta-trial
#15
Silvia Schönenberger, Lorenz Uhlmann, Matthias Ungerer, Johannes Pfaff, Simon Nagel, Christina Klose, Martin Bendszus, Wolfgang Wick, Peter A Ringleb, Meinhard Kieser, Markus A Möhlenbruch, Julian Bösel
BACKGROUND AND PURPOSE: Outcome after mechanical thrombectomy for ischemic stroke may be influenced by blood pressure (BP). This study aims to assess the association of BP changes during general anesthesia versus conscious sedation with functional outcome after mechanical thrombectomy. METHODS: SIESTA (Sedation vs Intubation for Endovascular Stroke Treatment) was a monocentric randomized trial of general anesthesia versus conscious sedation during mechanical thrombectomy involving BP target protocols...
May 2, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29718148/transcatheter-aortic-valve-implantation-current-status-and-future-perspectives
#16
T J Cahill, M Chen, K Hayashida, A Latib, T Modine, N Piazza, S Redwood, L Søndergaard, B D Prendergast
In the 16 years since the first pioneering procedure, transcatheter aortic valve implantation (TAVI) has come of age and become a routine strategy for aortic valve replacement, increasingly performed under conscious sedation via transfemoral access. Simplification of the procedure, accumulation of clinical experience, and improvements in valve design and delivery systems have led to a dramatic reduction in complication rates. These advances have allowed transition to lower risk populations, and outcome data from the PARTNER 2A and SURTAVI trials have established a clear evidence base for use in intermediate risk patients...
April 27, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29694305/the-use-of-local-anesthesia-to-perform-lower-limb-revascularization-in-the-fragile-patient-with-critical-limb-ischemia
#17
N Kontopodis, A Papaioannou, E Tavlas, G Papadopoulos, S Lioudaki, K Tzirakis, C V Ioannou
Patients with critical limb ischemia are usually compromised, frequently making administration of general or regional anesthesia problematic. We treated 3 fragile patients presenting contraindications to undertake traditional anesthetic techniques for lower limb revascularization, in whom local anesthesia with conscious sedation was used to complete the operation. An axillo-bifemoral, a unilateral axillo-femoral and a femoro-femoral bypass were performed. Procedure was uneventful in all three cases despite the coexistence of specific surgical challenges (distal anastomosis at the profunda in two cases, redo surgery and scarred groin in the third)...
March 2018: Il Giornale di Chirurgia
https://www.readbyqxmd.com/read/29687438/sleep-in-critically-ill-mechanically-ventilated-patients-with-severe-sepsis-or-copd
#18
Y Boyko, P Jennum, H Oerding, J T Lauridsen, M Nikolic, P Toft
BACKGROUND: The standard method for scoring polysomnographic (PSG) sleep is insufficient in the intensive care unit (ICU). A modified classification has been proposed, but has not been tested in specific groups of ICU patients. We aimed firstly to (1) use the modified classification to describe sleep in two groups of ICU patients: a severe sepsis group and a chronic obstructive pulmonary disease (COPD) group, and (2) to compare sleep stage distribution in the groups; secondly to compare the PSG findings with nurses' sleep evaluation...
April 23, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29683964/outcomes-of-anesthesia-selection-in-endovascular-treatment-of-acute-ischemic-stroke
#19
Yuming Peng, Youxuan Wu, Xiaochuan Huo, Peng Wu, Yang Zhou, Jiaxin Li, Fa Liang, Xiaoyuan Liu, Yuesong Pan, Zhongrong Miao, Ruquan Han
BACKGROUND: The association between anesthesia type and outcomes in patients with acute ischemic stroke undergoing endovascular treatment (EVT) remains a subject of ongoing debate. METHODS: This prospective nonrandomized controlled trial included 149 consecutive patients with acute anterior circulation stroke who underwent EVT. The primary outcome was functional independence assessed by the modified Rankin Scale (mRS) after 3 months. RESULTS: A total of 105 (70...
April 20, 2018: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/29675060/utility-and-safety-of-endobronchial-ultrasound-guided-transbronchial-needle-aspiration-in-patients-with-mediastinal-and-hilar-lymphadenopathy-western-region-experience
#20
Ahmed A Aljohaney
AIMS: The aim of the study was to evaluate the clinical utility and safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with mediastinal and hilar lymphadenopathy and to explicitly describe the utility of this procedure in patient's outcome. METHODS: A retrospective review and analysis was conducted on 52 patients with mediastinal or hilar lymphadenopathy who underwent EBUS-TBNA from June 2012 to June 2016. All the patients were evaluated by computed tomography (CT) chest with contrast before EBUS examination...
April 2018: Annals of Thoracic Medicine
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