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Procedural sedation elderly

Yaron Arbel, Nevena Zivkovic, Dhruven Mehta, Sam Radhakrishnan, Stephen E Fremes, Effat Rezaei, Asim N Cheema, Sami Al-Nasser, Ariel Finkelstein, Harindra C Wijeysundera
BACKGROUND: Most patients undergoing Transcatheter aortic valve implantation (TAVR) are elderly with significant co-morbidities and there is limited information available regarding factors that influence length of stay (LOS) post-procedure. The aim of this study was to identify the patient, and procedural factors that affect post-TAVR LOS using a contemporary multinational registry. METHODS: We conducted a retrospective cohort study, with patients recruited from three high volume tertiary institutions...
May 26, 2017: BMC Cardiovascular Disorders
Pamela Lovett, Victoria Gómez, David O Hodge, Beth Ladlie
PURPOSE: Despite current literature, data on the most effective sedation and best patient outcomes are insufficient for providing recovery time recommendations for elderly patients undergoing colonoscopy with sedation. We sought to identify the best sedation practice for shorter recovery times. Therefore, a study was conducted to examine recovery times among patients older than 65 years undergoing elective colonoscopy with intravenous sedation with either propofol or the combination of midazolam/fentanyl...
June 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
Wei He, Rong-Rong Huang, Qing-Yu Shi, Xian-Bao Liu, Jian-An Wang, Min Yan
OBJECTIVE: Transcatheter aortic valve implantation (TAVI) is a minimally invasive therapy for elderly patients with severe aortic valve stenosis who were refused surgical aortic valve replacement because of the high perioperative risk. Traditionally, this procedure has been done under general anesthesia, but more recently local anesthesia and sedation have become popular. This research assessed the effectiveness of transfemoral TAVI under bispectral index (BIS)-guided sedation. METHODS: In this single-center retrospective control analysis, clinical data, including demographic characteristics, echocardiography, periprocedural data, and main complications, were collected and assessed in 113 patients undergoing TAVI through the femoral artery under general anesthesia (GA group, n=36) and under BIS-guided sedation (SED group, n=77)...
2017: Journal of Zhejiang University. Science. B
Su Jung Han, Tae Hoon Lee, Sang-Heum Park, Young Sin Cho, Yun Nah Lee, Yunho Jung, Hyun Jong Choi, Il-Kwun Chung, Sang-Woo Cha, Jong Ho Moon, Young Deok Cho, Sun-Joo Kim
BACKGROUND AND AIM: As society ages, the need for endoscopic retrograde cholangiopancreatography (ERCP) is increasing. This prospective comparative study evaluated the safety and efficacy of midazolam- versus propofol-based sedations by non-anesthesiologists during therapeutic ERCP in patients over 80 years of age. METHODS: A total of 100 patients over 80 years of age who required therapeutic ERCP were enrolled and randomly received midazolam + fentanyl (MF group) or propofol + fentanyl (PF group) sedation...
May 2017: Digestive Endoscopy: Official Journal of the Japan Gastroenterological Endoscopy Society
A P De Silva, M A Niriella, Y Nandamuni, S D Nanayakkara, K R P Perera, S K Kodisinghe, K C E Subasinghe, A Pathmeswaran, H J de Silva
Background and study aims: Colonoscopy can cause anxiety and discomfort in patients. Sedation and analgesia as premedication can lead to complications in the elderly and those with comorbidities. This has led to an interest in the use of audio-visual distraction during the colonoscopy. We compared the effects of audio (AD) versus visual distraction (VD) in reducing discomfort and the need for sedation during colonoscopy. Patients and methods: Consecutive patients undergoing colonoscopy were randomized into three groups: one group was allowed to listen to the music of their choice (AD), the second group was allowed to watch a movie of their choice (VD), and the third group was not allowed either distraction during colonoscopy and acted as a control (C)...
November 2016: Endoscopy International Open
Mark R Borgaonkar, David Pace, Muna Lougheed, Curtis Marcoux, Bradley Evans, Nikita Hickey, Meghan O'Leary, Jerry McGrath
In 2012 the Canadian Association of Gastroenterology published 19 indicators of safety compromise. We studied the incidence of these indicators by reviewing all colonoscopies performed in St. John's, NL, between January 1, 2012, and June 30, 2012. Results. A total of 3235 colonoscopies were included. Adverse events are as follows. Medication-related includes use of reversal agents 0.1%, hypoxia 9.9%, hypotension 15.4%, and hypertension 0.9%. No patients required CPR or experienced allergic reactions or laryngospasm/bronchospasm...
2016: Canadian Journal of Gastroenterology & Hepatology
Helge Servatius, Thormen Höfeler, Boris A Hoffmann, Arian Sultan, Jakob Lüker, Benjamin Schäffer, Stephan Willems, Daniel Steven
AIMS: Propofol sedation has been shown to be safe for atrial fibrillation ablation and internal cardioverter-defibrillator implantation but its use for catheter ablation (CA) of ventricular tachycardia (VT) has yet to be evaluated. Here, we tested the hypothesis that VT ablation can be performed using propofol sedation administered by trained nurses under a cardiologist's supervision. METHODS AND RESULTS: Data of 205 procedures (157 patients, 1.3 procedures/patient) undergoing CA for sustained VT under propofol sedation were analysed...
August 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
David R Holmes, Rick A Nishimura, Frederick L Grover, Ralph G Brindis, John D Carroll, Fred H Edwards, Eric D Peterson, John S Rumsfeld, David M Shahian, Vinod H Thourani, E Murat Tuzcu, Sreekanth Vemulapalli, Kathleen Hewitt, Joan Michaels, Susan Fitzgerald, Michael J Mack
BACKGROUND: The Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry has been a joint initiative of the STS and the ACC in concert with multiple stakeholders. The TVT Registry has important information regarding patient selection, delivery of care, science, education, and research in the field of structural valvular heart disease. OBJECTIVES: This report provides an overview on current U.S. TVT practice and trends...
February 2016: Annals of Thoracic Surgery
Michael R J Sury, James H MacG Palmer, Tim M Cook, Jaideep J Pandit
The National Health Service anaesthesia annual activity (2013) was recently reported by the Fifth National Audit Program of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland. Within a large dataset were 620 dental cases. Here, we describe this data subset. The estimated annual dental caseload was 111,600:60% were children (< 16 y), 38.5% adults (16 - 65y) and 1.5% the elderly (> 65y). Almost all were elective day procedures (97%) and ASA 1 or 2 patients (95%)...
January 2016: SAAD Digest
Alberto Zangrillo, Patrizio Mazzone, Carmine D Votta, Nicola Villari, Paolo Della Bella, Fabrizio Monaco
PURPOSE: Left atrial appendage (LAA) closure is an interventional procedure increasingly used to prevent stroke in patients with permanent atrial fibrillation and contraindications to anticoagulation therapy. As this procedure requires a relatively immobile patient and performance of continuous and prolonged transesophageal echocardiography (TEE), it is usually performed under general anesthesia. In this case series, we describe the feasibility of prolonged TEE for percutaneous LAA closure using a new noninvasive ventilation device that can avoid the need for endotracheal intubation and general anesthesia...
August 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Aarno Dietz, Marion Wüstefeld, Minna Niskanen, Heikki Löppönen
OBJECTIVE: Although cochlear implantation is a relatively safe procedure, there is some reticence to subject elderly people, especially those with significant comorbidity, to the risks of general anesthesia. The purpose of the study was to explore the feasibility of cochlear implant surgery under local anesthesia and sedation in elderly people. STUDY DESIGN: Case report study (Clinical Capsule Report). SETTING: Single tertiary academic referral center...
June 2016: Otology & Neurotology
Wen-fei Tan, Er-ya Miao, Feng Jin, Hong Ma, Huang-wei Lu
BACKGROUND AND OBJECTIVES: Supplementation of spinal anesthesia with various sedatives is a standard protocol to alleviate patient anxiety associated with the surgical procedure. We hypothesized that, compared with dexmedetomidine, midazolam might have a subtle influence on sleep quality after surgery following elective transurethral prostatic resection (TURP) in elderly male patients. METHODS: A randomized, double-blind, controlled trial was conducted at the First Hospital of China Medical University from July 2014 to January 2015...
May 2016: Regional Anesthesia and Pain Medicine
Jung Min Lee, Soo Kyung Lee, Sang Jun Lee, Woon Suk Hwang, Sung Wook Jang, Eun Young Park
OBJECTIVES: This clinical trial is registered at (NCT02476981)This randomized, prospective double-blind study compared remifentanil with dexmedetomidine for monitored anaesthesia care during minimally invasive corrections of vertebral compression fractures (vertebroplasty or kyphoplasty). METHODS: Patients > 65 years of age with American Society of Anesthesiologists (ASA) classification I-III, scheduled for vertebroplasty or kyphoplasty under monitored anaesthesia care, received remifentanil (i...
April 2016: Journal of International Medical Research
Cesar J Garcia, Oscar A Lopez, Sameer Islam, Mohamed Othman, Yi Jia, Zuber D Mulla, Marc J Zuckerman
BACKGROUND: The use of gastrointestinal endoscopy in geriatric patients is rising as an increasing proportion of the population is reaching an advanced age. Most studies of endoscopic retrograde cholangiopancreatography (ERCP) in the elderly have been done in tertiary care or referral centers. METHODS: We analyzed the clinical and endoscopic data on all ERCPs in patients aged 65 years and older in a retrospective review of medical records of patients at the county hospitals in El Paso and Lubbock, Texas between 2004 and 2008...
January 2016: American Journal of the Medical Sciences
Anna Maria Grion, Umberto Gallo, Daniel Dumitru Tinjala, Julia Daragjati, Michele Loreggian, Giovanna Cardaci, Arduino Mangoni, Alberto Pilotto
BACKGROUND: Potentially inappropriate prescriptions (PIPs), associated with adverse drug reactions, hospitalization, and wasteful healthcare spending, are common in elderly patients with comorbidities and multiple drugs. OBJECTIVE: Our objective was to develop and validate a new tool to reduce PIPs in a hospitalized geriatric population. METHODS: This was an observational cohort study of two cohorts (development [n = 100 subjects] and validation [n = 449 subjects]) of consecutive patients aged ≥65 years admitted to geriatric wards from April to December 2012...
April 2016: Drugs & Aging
David R Holmes, Rick A Nishimura, Frederick L Grover, Ralph G Brindis, John D Carroll, Fred H Edwards, Eric D Peterson, John S Rumsfeld, David M Shahian, Vinod H Thourani, E Murat Tuzcu, Sreekanth Vemulapalli, Kathleen Hewitt, Joan Michaels, Susan Fitzgerald, Michael J Mack
BACKGROUND: The Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry has been a joint initiative of the STS and the ACC in concert with multiple stakeholders. The TVT Registry has important information regarding patient selection, delivery of care, science, education, and research in the field of structural valvular heart disease. OBJECTIVES: This report provides an overview on current U.S. TVT practice and trends...
December 29, 2015: Journal of the American College of Cardiology
Ki-Ho Ko, In-Jung Jun, Sangseok Lee, Yunhee Lim, Byunghoon Yoo, Kye-Min Kim
BACKGROUND: During sedation with dexmedetomidine, a dose adjustment may be needed based on the invasiveness of the procedure, the patient's general condition, and their age. We aim here to determine the effective dose (ED) of dexmedetomidine to induce an adequate depth of sedation in elderly patients undergoing spinal anesthesia. METHODS: In this study, 47 patients aged 65 years or older, American Society of Anesthesiologists physical status I or II, undergoing spinal anesthesia were included...
December 2015: Korean Journal of Anesthesiology
Chong-Sun Khoi, Jen-Jeng Wong, Hao-Chin Wang, Cheng-Wei Lu, Tzu-Yu Lin
OBJECTIVE: Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used for diagnostic and therapeutic purposes. Most of the patients may feel pain, anxiety, and discomfort during this procedure, so conscious sedation is usually used during ERCP. General anesthesia would be considered if conscious sedation fails to achieve the requirement of the endoscopists. Several studies showed that propofol-based sedation could provide a better recovery profile. However, propofol has a narrow therapeutic window and complications may occur beyond this window...
December 2015: Acta Anaesthesiologica Taiwanica: Official Journal of the Taiwan Society of Anesthesiologists
N Patrick Mayr, Jonathan Michel, Sabine Bleiziffer, Peter Tassani, Klaus Martin
Transfemoral transcatheter aortic valve implantation (TAVI) is nowadays a routine therapy for elderly patients with severe aortic stenosis (AS) and high perioperative risk. With growing experience, further development of the devices, and the expansion to "intermediate-risk" patients, there is increasing interest in performing this procedure under conscious sedation (TAVI-S) rather than the previously favoured approach of general anesthesia (TAVI-GA). The proposed benefits of TAVI-S include; reduced procedure time, shorter intensive care unit (ICU) length of stay, reduced need for intraprocedural vasopressor support, and the potential to perform the procedure without the direct presence of an anesthetist for cost-saving reasons...
September 2015: Journal of Thoracic Disease
Gay Sammons, William Ritchey
Elderly patients who require surgical interventions often have multiple comorbidities that complicate their intraoperative and postoperative care. Surgical team members should consider all potential problems that elderly patients may experience and base perioperative care on their assessment. This article discusses the use of the transversus abdominis plane (TAP) block in elderly patients undergoing surgical procedures to relieve pain and reduce the use of narcotics or sedatives during the immediate and extended postoperative recovery period...
November 2015: AORN Journal
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