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Moderate sedation

Santiago Mencía, Alba Palacios, Miriam García, Ana M Llorente, Olga Ordóñez, Blanca Toledo, Jesús López-Herce
OBJECTIVES: To analyze the effectiveness of inhaled sevoflurane in critically ill children with challenging sedation. DESIGN: Prospective case series. SETTING: Two PICUs of university hospitals in Spain. INTERVENTIONS: Prospective observational study and exploratory investigation conducted in two PICUs in Madrid, Spain, over a 6-year period. Children treated with inhaled sevoflurane due to difficult sedation were included...
March 19, 2018: Pediatric Critical Care Medicine
Douglas Lobb, Alix Clarke, Hollis Lai
Background: The purpose of this study is to investigate the effects of administration order when a sedative drug (midazolam) and an opioid analgesic drug (fentanyl) is applied for moderate intravenous (IV) sedation in dentistry. Methods: A retrospective chart review was conducted in one dental clinic during its transition from a midazolam-first to a fentanyl-first protocol for dental procedures requiring moderate IV sedation. Physiological parameters, drug administration times, patient recovery times, drug dosages, and patient recall and satisfaction were investigated for differences...
February 2018: Journal of Dental Anesthesia and Pain Medicine
Shayne P Bisetto, Cristiano F Melo, Adriano B Carregaro
OBJECTIVE: To evaluate dexmedetomidine, midazolam and dexmedetomidine-midazolam for sedation and antinociception in tegus. STUDY DESIGN: Prospective, crossover, randomized, blinded study. ANIMALS: Six healthy tegus (Salvator merianae) weighing 1.6±0.3 kg. METHODS: Tegus were administered intramuscularly saline (0.5 mL; CON), dexmedetomidine (0.2 mg kg-1 ; DX), midazolam (1 mg kg-1 ; MZ) and dexmedetomidine-midazolam (same doses; DM)...
January 17, 2018: Veterinary Anaesthesia and Analgesia
Tennessee D Park, Joshua M Enyart, Terrence E Goyke, Marna Rayl Greenberg
A 23-year-old man was transported to a trauma center after injuring himself while snowboarding. He presented with bilateral shoulder pain and associated deformity to both shoulders. His exam was otherwise unremarkable, and his x-rays confirmed bilateral shoulder dislocations. Cunningham and external rotation without sedation and analgesia techniques were unsuccessful even with local anesthesia to the joint. Subsequent bilateral reduction was successful with moderate sedation using the Milch technique. Simultaneous anterior bilateral shoulder dislocations are rare and providers may need to adjust their techniques to accommodate this unusual presentation...
February 2018: Radiology Case Reports
Juan A López-Rodríguez, Alina Rigabert, M Nieves Gómez Llano, Gabriel Rubio
OBJECTIVE: The aim of this study is to estimate risky-drug use patterns of consumption of primary care patients. DESIGN: Multicentric descriptive cross-sectional study. SETTING: five primary health care centers of the South of Madrid. PARTICIPANTS: all patients between 16-100 year-old consulting with their family physician. MEASUREMENTS: Spanish-validated World Health Organization ASSIST test was use to screen risky drug use in primary care...
March 15, 2018: Atencion Primaria
Ramón E Ruiz-Curiel, Ydaly Bonilla H, Alberto Baptista, Manuel Bronstein
OBJECTIVES: propofol is a rapid acting hypnotic that is becoming the drug of choice for sedation in digestive endoscopy worldwide. There is some controversy with regard to the use of propofol by physicians who are not anesthesiologists. We present our experience of the administration of propofol by endoscopist and nursing personnel. METHODS: this was a retrospective study of sedation in endoscopy. Propofol was exclusively used and administered by the endoscopist who performed the procedure and the nursing staff...
March 15, 2018: Revista Española de Enfermedades Digestivas
Emanuele Rondonotti, Cristiano Spada, Samuel Adler, Andrea May, Edward J Despott, Anastasios Koulaouzidis, Simon Panter, Dirk Domagk, Ignacio Fernandez-Urien, Gabriel Rahmi, Maria Elena Riccioni, Jeanin E van Hooft, Cesare Hassan, Marco Pennazio
SMALL-BOWEL CAPSULE ENDOSCOPY (SBCE): 1: ESGE recommends that prior to SBCE patients ingest a purgative (2 L of polyethylene glycol [PEG]) for better visualization.Strong recommendation, high quality evidence.However, the optimal timing for taking purgatives is yet to be established. 2: ESGE recommends that SBCE should be performed as an outpatient procedure if possible, since completion rates are higher in outpatients than in inpatients.Strong recommendation, moderate quality evidence...
March 14, 2018: Endoscopy
Kiffer G Card, Nathan J Lachowsky, Heather L Armstrong, Zishan Cui, Lu Wang, Paul Sereda, Jody Jollimore, Thomas L Patterson, Trevor Corneil, Robert S Hogg, Eric A Roth, David M Moore
INTRODUCTION: Among gay, bisexual, and other men who have sex with men (GBM), collinearity between polysubstance use and mental health concerns has obscured their combined effects on HIV risk with multivariable results often highlighting only one or the other. METHODS: We used mediation and moderation analyses to examine the effects of polysubstance use and depressive symptoms on high-risk sex (i.e., condomless anal sex with serodiscordant/unknown status partner) in a sample of sexually-active GBM, aged ≥16 years, recruited in Metro Vancouver using respondent driven sampling...
March 6, 2018: Addictive Behaviors
Oliver G Bosch, Fabrizio Esposito, Dario Dornbierer, Michael M Havranek, Robin von Rotz, Michael Kometer, Philipp Staempfli, Boris B Quednow, Erich Seifritz
According to the triple network hypothesis the brain is equipped with three core neurocognitive networks: the default mode (DMN), the salience (SN), and the central executive (CEN) network. Moreover, the so called dorsal nexus, has met growing interest as it is a hub region connecting these three networks. Assessment of resting-state functional connectivity (rsFC) of these networks enables the elucidation of drug-induced brain alterations. Gamma-hydroxybutyrate (GHB) is a GHB/GABA-B receptor agonist that induces a paradoxical state of mixed stimulation and sedation at moderate doses, which makes it a valuable tool to investigate neural signatures of subjective drug effects...
March 7, 2018: NeuroImage
Jessica E McDonald, Amy M Knollinger
PURPOSE: To evaluate the use of hyaluronic acid (HA) subdermal filler in canines and felines for entropion. METHODS: Complete ophthalmologic examination was performed by a board-certified veterinary ophthalmologist or ABVO-approved resident. Each case was characterized as primary, secondary, spastic or cicatricial entropion. HA subdermal filler, specifically Restylane® and Restylane Silk® , were utilized in dogs and cats, respectively. Subdermal injection was performed 1-2 mm from the eyelid margin in the affected area until normal eyelid conformation was achieved...
March 9, 2018: Veterinary Ophthalmology
Figen Govsa, Mehmet Asim Ozer, Huseyin Biceroglu, Asli Beril Karakas, Sedat Cagli, Cenk Eraslan, Ahmet Kemal Alagoz
BACKGROUND: Transarticular screw fixation has fatal complications such as vertebral artery (VA), carotid artery and spinal cord injuries. The landmarks for deciding the entry point for C1 lateral mass screws were clarified by using life-size three dimensional (3D) patient specific spine models. METHODS: This study included a total of 10 patients with C1 fractures. Dual CT scan data from C1 pre and post screwing of them were modified into 3D patient specific life-size cervical spine models...
March 3, 2018: World Neurosurgery
Ana Luisa Hernandez-Perez, Ana Gabriela Gallardo-Hernandez, German Ordoñez-Espinosa, Beatriz Martinez-Carrillo, Manuel Gerardo Bermudez-Ochoa, Cristina Revilla-Monsalve, Jose Antonio Sanchez-Lopez, Guillemo Saturno-Chiu, Ronald Leder
OBJECTIVE: A previous multidisciplinary pilot study based on computer simulations for the geriatric population showed that a dose of 0.5 mg/kg/h of propofol could sedate patients older than 65 for pacemaker implantation. The present study validates that the pacemaker implantation can be done in the elderly using 0.5-1 mg/kg/h of propofol with hemodynamic stability. METHODS: 66 patients from 65 to 88 years old scheduled for pacemaker implantation were randomly assigned one of three doses of propofol...
February 21, 2018: Aging Clinical and Experimental Research
Gajal Lakhe, Krishna Murari Adhikari, Kiran Khatri, Anil Maharjan, Akriti Bajracharya, Himdip Khanal
INTRODUCTION: Shivering is an unpleasant experience after spinal anesthesia. We conducted this study to evaluate the efficacy of ondansetron, ketamine and tramadol for prevention of shivering. METHODS: In this randomized controlled study, 120 patients aged 18-65 years of American Society of Anesthesiologist (ASA) physical status I and II undergoing various surgical procedures were included and allocated alternately to one of the 4 groups; Normal saline (Group1), Ondansetron 4mg (Group2), Ketamine 0...
October 2017: JNMA; Journal of the Nepal Medical Association
Thomas Grimmsmann, Markus Harden, Thomas Fiß, Wolfgang Himmel
BACKGROUND AND OBJECTIVES: Hospitalisation influences drug therapy in ambulatory care and this influence is generally negatively perceived. The few studies that have explored changes in benzodiazepine or sleep medication use as a function of hospitalisation failed to precisely determine the hospital's role in initiating, continuing and discontinuing these drugs on a valid basis. The aim of the study was to ascertain the overall influence of hospitalisation on the prescription of benzodiazepines and Z-drugs in outpatient care with a special focus on the role of different hospital departments and drug classes...
February 14, 2018: Swiss Medical Weekly
Céline Gélinas, Mélanie Bérubé, Annie Chevrier, Brenda T Pun, E Wesley Ely, Yoanna Skrobik, Juliana Barr
BACKGROUND: Delirium is highly prevalent in critically ill patients. Its detection with valid tools is crucial. OBJECTIVE: To analyze the development and psychometric properties of delirium assessment tools for critically ill adults. METHODS: Databases were searched to identify relevant studies. Inclusion criteria were English language, publication before January 2015, 30 or more patients, and patient population of critically ill adults (>18 years old)...
February 2018: Critical Care Nurse
Gunther Hempel, Philipp Simon, Peter Salz, Hermann Wrigge
Acute and chronic respiratory failures require immediate diagnosis and preferably individualized ventilation therapy. If possible, non-invasive ventilation should be considered to avoid complications of invasive mechanical ventilation. Especially in patients with ARDS and moderate to severe cases, non-invasive ventilation may not be suitable and should not be used uncritically.Invasive mechanical ventilation parameters should be adjusted individually. In the future, additional parameters such as transpulmonary pressure, monitoring of regional ventilation using electrical impedance tomography could help to individualize ventilator settings...
February 2018: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Oleg Mironov, Arash Jaberi, Robert Beecroft, John R Kachura
PURPOSE: To assess the safety and efficacy of percutaneous thermal ablation for the treatment of hepatocellular adenomas. MATERIALS AND METHODS: This is an ethics board-approved, single-arm, retrospective, cohort study of patients with pathologically proven hepatocellular adenomas treated with percutaneous thermal ablation at a tertiary referral center from 1999 to 2016. Demographic, procedural, and outcome data were collected and summarized with appropriate measures of central tendency and dispersion...
February 7, 2018: Cardiovascular and Interventional Radiology
Rebecca H Allen, Rameet Singh
Satisfactory pain control for women undergoing surgical abortion is important for patient comfort and satisfaction. Clinicians ought to be aware of the safety and efficacy of different pain control regimens. This document will focus on nonpharmacologic modalities to reduce pain and pharmacologic interventions up to the level of minimal sedation. For surgical abortion without intravenous medications, a multimodal approach to pain control may combine a dedicated emotional-support person, visual or auditory distraction, administration of local anesthesia to the cervix with buffered lidocaine, and a preoperative nonsteroidal anti-inflammatory drug...
January 30, 2018: Contraception
Meriem Bensalah, Malcolm Donaldson, Yamina Aribi, Malek Iabassen, Lyes Cherfi, Mustapha Nebbal, Meriem Medjaher, ElMehdi Haffaf, Benaissa Abdennebi, Mustapha Guenane, Adel Djermane, Zahra Kemali, Samia OuldKablia
BACKGROUND: Biochemical diagnosis of adrenal insufficiency (AI) is difficult in the context of traumatic brain injury (TBI) AIM: to assess the frequency and predictive factors of AI in victims of TBI from Algiers. METHODS: Between November 2009 and December 2013, TBI victims had a single 8-9 a.m. serum cortisol measurement during the acute post injury period (0-7 days). AI was defined according to basal cortisol levels of 83, 276 and 414 nmol/L. Variables studied were TBI severity according to Glasgow coma scale, duration of intubation and coma, pupillary status, hypotension, anemia, brain imaging findings, diabetes insipidus and medication...
February 5, 2018: Clinical Endocrinology
Joseph J Ruzbarsky, Elizabeth B Gausden, Elan M Goldwyn, Isaac P Lowenwirt, Vitaly Kotlyar
Background: Early surgical intervention for hip fractures in the elderly has proven efficacious. However, surgical delays commonly occur in this patient population due to comorbid conditions that put these patients at a high risk for hypotension-related complications of general or neuraxial anesthesia or anticoagulants that delay the safe use of neuraxial anesthesia. Questions/Purposes: The questions/purposes of this study are (1) to investigate if a fascia iliaca block in conjunction with light to moderate sedation could provide adequate analgesia throughout open surgery for intertrochanteric hip fractures (AO/OTA 31-1) without requiring conversion to general anesthesia with airway support and (2) to assess its perioperative complication profile...
February 2018: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
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