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Continuous deep sedation

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https://www.readbyqxmd.com/read/29673342/medical-end-of-life-practices-in-swiss-cultural-regions-a-death-certificate-study
#1
Samia A Hurst, Ueli Zellweger, Georg Bosshard, Matthias Bopp
BACKGROUND: End-of-life decisions remain controversial. Switzerland, with three main languages shared with surrounding countries and legal suicide assistance, allows exploration of the effects of cultural differences on end-of-life practices within the same legal framework. METHODS: We conducted a death certificate study on a nationwide continuous random sample of Swiss residents. Using an internationally standardized tool, we sent 4998, 2965, and 1000 anonymous questionnaires to certifying physicians in the German-, French-, and Italian-speaking regions...
April 20, 2018: BMC Medicine
https://www.readbyqxmd.com/read/29649848/-palliative-sedation-despite-guidelines-a-difficult-process-of-decisions
#2
Martin Kamprad, Ute Helm
A distinction needs to be made between intermediate and continuous sedation as well as between minimal, moderate and deep sedation. To gain ethical acceptance it is crucial that for palliative sedation (PS) minimally required doses are administered to decrease suffering. Intermittent PS is used for decreasing physical symptoms, whereas deep continuous PS is used to minimize intolerable suffering or psychological symptoms. Precise medical indication and education of patient and relatives are pre-requirements to any PS...
April 2018: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29643623/effect-of-dexmedetomidine-infusion-on-hemodynamic-responses-in-microsurgery-of-larynx
#3
Shakuntala Basantwani, Mayuresh Patil, Balasaheb Govardhane, Jyoti Magar, Bharati Tendolkar
Background and Aims: Microlaryngeal surgery is a frequently performed ear, nose, and throat procedure used to diagnose and treat laryngeal disorders. Suspension laryngoscopy causes prolonged stimulation of the deep pressure receptors of the larynx leading to adverse circulatory responses and consequently cardiac complications. In this study, dexmedetomidine infusion was used to assess its effectiveness for attenuation of this hemodynamic stress response. Material and Methods: Sixty patients undergoing elective microlaryngeal surgery randomly received either dexmedetomidine 1 μg/kg over 10 min followed by continuous infusion of 0...
January 2018: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29578351/endoscopy-and-sedation-an-inseparable-binomial-for-the-gastroenterologist
#4
Javier Crespo, Álvaro Terán
The development of endoscopy and its increasing demand among the population have led to a growing need for propofol-based sedation techniques. Benefit is indisputable for both patients and endoscopists, but some aspects require considering the "who" and "how" of sedation as related to safety and health care costs. Propofol is first-choice in endoscopy for the European Society of Gastrointestinal Endoscopy because of its fast onset of action and short half-life, and many reports exist on its safety when used by gastroenterologists rather than anesthesiologists...
April 2018: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/29560568/continuous-deep-sedation-until-death-a-swiss-death-certificate-study
#5
Sarah Ziegler, Margareta Schmid, Matthias Bopp, Georg Bosshard, Milo Alan Puhan
BACKGROUND: In the last decade, the number of patients continuously deeply sedated until death increased up to fourfold. The reasons for this increase remain unclear. OBJECTIVE: To identify socio-demographic and clinical characteristics of sedated patients, and concurrent possibly life-shortening medical end-of-life decisions. DESIGN: Cross-sectional death certificate study in German-speaking Switzerland in 2001 and 2013. PARTICIPANTS: Non-sudden and expected deaths (2001: N = 2281, 2013: N = 2256) based on a random sample of death certificates and followed by an anonymous survey on end-of-life practices among attending physicians...
March 20, 2018: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/29548891/pressure-injury-progression-and-factors-associated-with-different-end-points-in-a-home-palliative-care-setting-a-retrospective-chart-review-study
#6
Marco Artico, Daniela D'Angelo, Michela Piredda, Tommasangelo Petitti, Luciano Lamarca, Maria Grazia De Marinis, Angelo Dante, Maura Lusignani, Maria Matarese
CONTEXT: Patients with advanced illnesses show the highest prevalence for pressure injuries. In the palliative care setting, the ultimate goal is injury healing, but equally important is wound maintenance, wound palliation (wound-related pain and symptom management), and primary and secondary wound prevention. OBJECTIVES: To describe the course of healing for pressure injuries in a home palliative care setting according to different end-points, and to explore patient and caregiver characteristics and specific care activities associated with their achievement...
March 13, 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29545985/the-effect-of-daily-sedation-weaning-application-on-morbidity-and-mortality-in-intensive-care-unit-patients
#7
Selcuk Kayir, Hulya Ulusoy, Guvenc Dogan
Background/aims Sedation is one of the most important components of intensive care unit (ICU) in patients who are mechanically ventilated at intensive care conditions. As a result of sedation and analgesia in the intensive care unit, the patient is to be awakened a comfortable and easy process. The aim of the study is to demonstrate the effects of day-time sedation interruptions in intensive care patients. Material and methods We made a retrospective review of 100 patients who were monitored, mechanically ventilated and treated at our intensive care unit between January 2008 and January 2013...
January 13, 2018: Curēus
https://www.readbyqxmd.com/read/29465247/viability-of-single-balloon-enteroscopy-performed-under-endoscopist-directed-sedation
#8
Leopoldo López Rosés, Beatriz Álvarez, Abel González Ramírez, Alina López Baz, Alexia Fernández López, Sara Alonso, Andrés Dacal, Eva Martí, Gino Albines, Julieta Fernández Molina, Ángel Lancho
INTRODUCTION: there is a lot of controversy with regard to who should be responsible for sedation during digestive endoscopy, particularly in advanced procedures that require deep sedation such as enteroscopy. The aim of this study was to evaluate the endoscopist-directed sedation viability during single balloon enteroscopy. MATERIAL AND METHOD: this was a prospective, observational study of a series of consecutive enteroscopies. The clinical staff included an endoscopist, scrub nurse and a nurse in charge of monitoring and sedative administration...
April 2018: Revista Española de Enfermedades Digestivas
https://www.readbyqxmd.com/read/29464512/feasibility-of-continuous-sedation-monitoring-in-critically-ill-intensive-care-unit-patients-using-the-neurosense-wav-cns-index
#9
Nicholas West, Paul B McBeth, Sonia M Brodie, Klaske van Heusden, Sarah Sunderland, Guy A Dumont, Donald E G Griesdale, J Mark Ansermino, Matthias Görges
Sedation in the intensive care unit (ICU) is challenging, as both over- and under-sedation are detrimental. Current methods of assessment, such as the Richmond Agitation Sedation Scale (RASS), are measured intermittently and rely on patients' behavioral response to stimulation, which may interrupt sleep/rest. A non-stimulating method for continuous sedation monitoring may be beneficial and allow more frequent assessment. Processed electroencephalography (EEG) monitors have not been routinely adopted in the ICU...
February 20, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29337804/the-association-between-ventilator-dyssynchrony-delivered-tidal-volume-and-sedation-using-a-novel-automated-ventilator-dyssynchrony-detection-algorithm
#10
Peter D Sottile, David Albers, Carrie Higgins, Jeffery Mckeehan, Marc M Moss
OBJECTIVE: Ventilator dyssynchrony is potentially harmful to patients with or at risk for the acute respiratory distress syndrome. Automated detection of ventilator dyssynchrony from ventilator waveforms has been difficult. It is unclear if certain types of ventilator dyssynchrony deliver large tidal volumes and whether levels of sedation alter the frequency of ventilator dyssynchrony. DESIGN: A prospective observational study. SETTING: A university medical ICU...
February 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29243169/efficacy-of-two-types-of-palliative-sedation-therapy-defined-using-intervention-protocols-proportional-vs-deep-sedation
#11
Kengo Imai, Tatsuya Morita, Naosuke Yokomichi, Masanori Mori, Akemi Shirado Naito, Hiroaki Tsukuura, Toshihiro Yamauchi, Takashi Kawaguchi, Kaori Fukuta, Satoshi Inoue
PURPOSE: This study investigated the effect of two types of palliative sedation defined using intervention protocols: proportional and deep sedation. METHODS: We retrospectively analyzed prospectively recorded data of consecutive cancer patients who received the continuous infusion of midazolam in a palliative care unit. Attending physicians chose the sedation protocol based on each patient's wish, symptom severity, prognosis, and refractoriness of suffering. The primary endpoint was a treatment goal achievement at 4 h: in proportional sedation, the achievement of symptom relief (Support Team Assessment Schedule (STAS) ≤ 1) and absence of agitation (modified Richmond Agitation-Sedation Scale (RASS) ≤ 0) and in deep sedation, the achievement of deep sedation (RASS ≤ - 4)...
December 14, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29233852/inhalation-sedation-in-subjects-with-ards-undergoing-continuous-lateral-rotational-therapy
#12
Andreas Meiser, Heinrich V Groesdonk, Sarah Bonnekessel, Thomas Volk, Hagen Bomberg
INTRODUCTION: Isoflurane has shown better sedation control and potential benefits in patients with ARDS compared to propofol or midazolam, but the practical use during continuous lateral rotational therapy remains unknown. We therefore compared isoflurane with propofol and midazolam regarding sedation depth (per the Richmond Agitation-Sedation Scale), opioid consumption, lung function, and hemodynamics in patients treated with continuous lateral rotational therapy. METHODS: 38 consecutive critically ill surgical subjects were retrospectively studied using a hospital database...
April 2018: Respiratory Care
https://www.readbyqxmd.com/read/29173079/what-influences-intentions-to-request-physician-assisted-euthanasia-or-continuous-deep-sedation
#13
Anne-Lore Scherrens, Marc Roelands, Lieve Van den Block, Benedicte Deforche, Luc Deliens, Joachim Cohen
The increasing prevalence of euthanasia in Belgium has been linked to changing attitudes. Using National health survey data (N = 9651), we investigated Belgian adults' intention to ask a physician for euthanasia or continuous deep sedation in the hypothetical scenario of a terminal illness and examined its connection to sociodemographic and health characteristics. Respectively, 38.3 and 25.8% could envisage asking for euthanasia and continuous deep sedation. Those with very bad to fair subjective health and with depression more likely had an intention to ask for euthanasia, which suggests need for attention in the evaluation of requests from specific patient groups...
November 27, 2017: Death Studies
https://www.readbyqxmd.com/read/29118101/japanese-physicians-experiences-of-terminally-ill-patients-voluntarily-stopping-eating-and-drinking-a-national-survey
#14
Takuya Shinjo, Tatsuya Morita, Daisuke Kiuchi, Masayuki Ikenaga, Hirofumi Abo, Sayaka Maeda, Satoru Tsuneto, Yoshiyuki Kizawa
OBJECTIVES: Voluntarily stopping eating and drinking (VSED) could be regarded as a patients' own non-treatment decision that hastens death, which involves patients voluntarily forgoing food and liquid until death. The aims of this study were to investigate the experience of home hospice physicians and palliative care specialists who care for patients during VSED in Japan, and their opinions on continuous deep sedation (CDS) as a means to relieve patient symptoms during VSED. METHODS: 219 home hospice physicians and 695 palliative care specialists across Japan were surveyed by mail questionnaire in 2016...
November 8, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/29102388/-end-of-life-debate-citizen-s-point-of-view-about-deep-and-continuous-sedation
#15
J Toporski, T Jonveaux-Rivasseau, C Lamouille-Chevalier
INTRODUCTION: Sedation in palliative care meets a precise definition and corresponds to a medical practice. We assessed the comprehension of this practice by the French population. METHOD: In 2015, citizen expressed their views on the Claeys-Leonetti bill by means of a consultative forum made available on the Internet site of the National Assembly. The content of the messages filed, regarding the right to deep and continuous sedation until death was analyzed using the ALCESTE textual data analysis software, supplemented by a thematic analysis in order to identify the perception that Internet users had of this practice...
December 2017: La Revue de Médecine Interne
https://www.readbyqxmd.com/read/29056584/the-french-exception-the-right-to-continuous-deep-sedation-at-the-end-of-life
#16
Ruth Horn
In 2016, a law came into force in France granting terminally ill patients the right to continuous deep sedation (CDS) until death. This right was proposed as an alternative to euthanasia and presented as the 'French response' to problems at the end of life. The law draws a distinction between CDS and euthanasia and other forms of sympton control at the end of life. France is the first country in the world to legislate on CDS . This short report describes the particular context and underlying social values that led to this piece of legislation, and explores its meaning in the wider French context...
March 2018: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29056564/a-nationwide-survey-about-palliative-sedation-involving-japanese-palliative-care-specialists-intentions-and-key-factors-used-to-determine-sedation-as-proportionally-appropriate
#17
Jun Hamano, Tatsuya Morita, Masayuki Ikenaga, Hirofumi Abo, Yoshiyuki Kizawa, Satoru Tunetou
CONTEXT: Although there has long been debate about physicians' intentions and what physicians consider to be proportionally appropriate when performing palliative sedation, few large studies have been performed. OBJECTIVES: To identify physicians' intentions when starting continuous deep sedation and to clarify what factors determine whether physicians regard sedation as proportionally appropriate in relation to expected survival, the patients' wishes, and refractoriness...
March 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28983787/morally-relevant-similarities-and-differences-between-assisted-dying-practices-in-paradigm-and-non-paradigm-circumstances-could-they-inform-regulatory-decisions
#18
Jeffrey Kirby
There has been contentious debate over the years about whether there are morally relevant similarities and differences between the three practices of continuous deep sedation until death, physician-assisted suicide, and voluntary euthanasia. Surprisingly little academic attention has been paid to a comparison of the uses of these practices in the two types of circumstances in which they are typically performed. A comparative domains of ethics analysis methodological approach is used in the paper to compare 1) the use of the three practices in paradigm circumstances, and 2) the use of the practices in paradigm circumstances to their use in non-paradigm circumstances...
December 2017: Journal of Bioethical Inquiry
https://www.readbyqxmd.com/read/28974283/is-mesocardia-with-left-sided-caval-vein-draining-to-coronary-sinus-a-contraindication-for-a-percutaneous-pulmonary-valve-implantation-a-case-description
#19
Marinos Kantzis, Christoph M Happel, Nikolaus A Haas
Introduction Although the right jugular vein approach for percutaneous pulmonary valve implantation is well described, there are no reports that describe a percutaneous pulmonary valve implantation through a left superior caval vein to coronary sinus pathway. Case A 14-year-old female with tetralogy of Fallot, mesocardia, left superior caval vein draining into the coronary sinus, and hemiazygos continuation of the inferior caval vein underwent ventricular septal defect closure, with homograft insertion from the right ventricle to the pulmonary artery, patch augmentation of the left pulmonary artery, and creation of an atrial communication...
February 2018: Cardiology in the Young
https://www.readbyqxmd.com/read/28765755/airway-support-using-a-pediatric-intubation-tube-in-adult-patients-with-atrial-fibrillation-a-simple-and-unique-method-to-prevent-heart-movement-during-catheter-ablation-under-continuous-deep-sedation
#20
Masateru Takigawa, Atsushi Takahashi, Taishi Kuwahara, Kenji Okubo, Emiko Nakashima, Yuji Watari, Kazuya Yamao, Jun Nakajima, Yasuaki Tanaka, Katsumasa Takagi, Shigeki Kimura, Hiroyuki Hikita, Kenzo Hirao, Mitsuaki Isobe
BACKGROUND: The present study aimed to elucidate the safety and effectiveness of a noble and unique airway management technique in which a pediatric intubation tube is used in adult patients with atrial fibrillation (AF) undergoing catheter ablation (CA) under continuous deep sedation. METHODS: In total, 246 consecutive patients with AF (mean age, 65±10 years; 60 women) underwent CA under dexmedetomidine-based continuous deep sedation. A 4-mm pediatric intubation tube guided by a 10-French intratracheal suction tube was inserted smoothly, and the tip of the tube was located at the base of the epiglottis...
August 2017: Journal of Arrhythmia
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