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Continuous deep sedation

Thomas Breuer, Nima Hatam, Benjamin Grabiger, Gernot Marx, Bradley J Behnke, Joachim Weis, Ruedger Kopp, Ghislaine Gayan-Ramirez, Norbert Zoremba, Christian S Bruells
Perioperative necessity of deep sedation is inevitably associated with diaphragmatic inactivation. This study investigated 1) the feasibility of a new phrenic nerve stimulation method allowing early diaphragmatic activation even in deep sedation and, 2) metabolic changes within the diaphragm during mechanical ventilation compared to artificial activity. 12 piglets were separated into 2 groups. One group was mechanically ventilated for 12 hrs (CMV) and in the second group both phrenic nerves were stimulated via pacer wires inserted near the phrenic nerves to mimic spontaneous breathing (STIM)...
October 19, 2016: Scientific Reports
Michael J Murray, Heidi DeBlock, Brian Erstad, Anthony Gray, Judi Jacobi, Che Jordan, William McGee, Claire McManus, Maureen Meade, Sean Nix, Andrew Patterson, M Karen Sands, Richard Pino, Ann Tescher, Richard Arbour, Bram Rochwerg, Catherine Friederich Murray, Sangeeta Mehta
OBJECTIVE: To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient." DESIGN: A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines...
November 2016: Critical Care Medicine
Tatsuya Morita, Kengo Imai, Naosuke Yokomichi, Masanori Mori, Yoshiyuki Kizawa, Satoru Tsuneto
Continuous deep sedation until death (CDS) is a type of palliative sedation therapy, and it has recently become a focus of intense debate. Marked inconsistencies in intervention procedures (i.e., what is CDS?) and unstandardized descriptions of patient backgrounds lead to difficulty in comparing the results in the literature. The primary aim of this paper was to propose a conceptual framework to perform empirical studies on CDS. We propose the definition of CDS using the intervention protocol. As there are two types of CDS proposed in world-wide literature, we recommend to prepare two types of intervention protocol for CDS: "continuous deep sedation as a result of proportional sedation" (gradual CDS), and "continuous deep sedation to rapidly induce unconsciousness" (rapid CDS)...
October 13, 2016: Journal of Pain and Symptom Management
Emer J Hughes, Tobias Winchman, Francesco Padormo, Rui Teixeira, Julia Wurie, Maryanne Sharma, Matthew Fox, Jana Hutter, Lucilio Cordero-Grande, Anthony N Price, Joanna Allsop, Jose Bueno-Conde, Nora Tusor, Tomoki Arichi, A D Edwards, Mary A Rutherford, Serena J Counsell, Joseph V Hajnal
PURPOSE: The goal of the Developing Human Connectome Project is to acquire MRI in 1000 neonates to create a dynamic map of human brain connectivity during early development. High-quality imaging in this cohort without sedation presents a number of technical and practical challenges. METHODS: We designed a neonatal brain imaging system (NBIS) consisting of a dedicated 32-channel receive array coil and a positioning device that allows placement of the infant's head deep into the coil for maximum signal-to-noise ratio (SNR)...
September 19, 2016: Magnetic Resonance in Medicine: Official Journal of the Society of Magnetic Resonance in Medicine
Dagmar Kettemann, Andreas Funke, André Maier, Simone Rosseau, Robert Meyer, Susanne Spittel, Christoph Münch, Thomas Meyer
Non-invasive ventilation (NIV) or tracheotomy with invasive ventilation (TIV) are treatment options in ALS. However, a proportion of patients receiving long-term ventilation decide to have it withdrawn. The objective of this study was to analyse the clinical characteristics and palliative approaches in ALS patients withdrawing from long-term ventilation (WLTV). In a cohort study, two different palliative concepts in WLTV were studied: (1) augmented symptom control (ASC; sedation not intended) in patients with ventilator-free tolerance; (2) continuous deep sedation (CDS; sedation intended) in patients without ventilator-free tolerance...
August 18, 2016: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration
Mehmet Sedat Durmaz, Hakan Demirtaş, Salih Hattapoğlu, Taylan Kara, Cemil Göya, Mehmet Emin Adin
Cleft foot deformity, also known as ectrodactyly, is a rare congenital developmental defect of extremities caused by malformation in continuity of apical ectoderm. The syndrome typically involves malformation or absence of the central rays of the feet and is characterized by deformities like median deep clefts of distal extremities. Routine examination of feet during second-trimester ultrasound (US) may increase the detection rates of foot malformations. Many malformations can be diagnosed with 2-dimensional (2D) US, but 3-dimensional (3D) US also helps better understanding of the foot malformations...
2016: Medicina
Dapeng Hou, Beibei Liu, Juan Zhang, Qiushi Wang, Wei Zheng
BACKGROUND While mild and moderate sedation have been widely used to reduce sudden agitation in intracerebral hemorrhage (ICH) patients after surgery, agitation is still a frequent problem, which may cause postoperative blood pressure fluctuation. The present study aimed to evaluate the efficacy and safety of short-course deep sedation for the treatment of ICH after surgery. MATERIAL AND METHODS A total of 41 ICH patients who received surgery, including traditional craniotomy hematoma removal and decompressive craniectomy, were including in this non-randomized control study...
2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Chelsea L Tasaka, Jeremiah J Duby, Komal Pandya, Machelle D Wilson, Kimberly A Hardin
BACKGROUND: Patients receiving therapeutic paralysis may experience inadequate sedation due to intrinsic limitations of behavioral sedation assessment. Bispectral index (BIS™) provides an objective measure of sedation; however, the role of BIS™ is not well defined in intensive care unit (ICU) patients on neuromuscular blocking agents (NMBA). OBJECTIVE: The aim of this study was to delineate the relationship between BIS™ and level of sedation for critically ill patients during therapeutic paralysis...
June 2016: Drugs—Real World Outcomes
Arvind Palanisamy, Matthew B Friese, Emily Cotran, Ludde Moller, Justin D Boyd, Gregory Crosby, Deborah J Culley
Neurocognitive dysfunction is common in survivors of intensive care. Prolonged sedation has been implicated but the mechanisms are unclear. Neurogenesis continues into adulthood and is implicated in learning. The neural progenitor cells (NPC) that drive neurogenesis have receptors for the major classes of sedatives used clinically, suggesting that interruption of neurogenesis may partly contribute to cognitive decline in ICU survivors. Using an in vitro system, we tested the hypothesis that prolonged exposure to propofol concentration- and duration-dependently kills or markedly decreases the proliferation of NPCs...
2016: PloS One
Kasper Raus, Kenneth Chambaere, Sigrid Sterckx
BACKGROUND: Continuous deep sedation at the end of life is a practice that has been the topic of considerable ethical debate, for example surrounding its perceived similarity or dissimilarity with physician-assisted dying. The practice is generally considered to be legal as a form of symptom control, although this is mostly only assumed. France has passed an amendment to the Public Health Act that would grant certain terminally ill patients an explicit right to continuous deep sedation until they pass away...
2016: BMC Medical Ethics
Lenzo Robijn, Joachim Cohen, Judith Rietjens, Luc Deliens, Kenneth Chambaere
BACKGROUND: Continuous deep sedation until death is a highly debated medical practice, particularly regarding its potential to hasten death and its proper use in end-of-life care. A thorough analysis of important trends in this practice is needed to identify potentially problematic developments. This study aims to examine trends in the prevalence and practice characteristics of continuous deep sedation until death in Flanders, Belgium between 2007 and 2013, and to study variation on physicians' degree of palliative training...
2016: PloS One
Tsukasa Higuchi, Kazuhiro Shimada, Yoshiaki Cho, Kisei Minami, Kouichi Takeuchi, Akiyuki Sakamoto
Although the effectiveness of subarachnoid continuous drug infusion has been established in cancer pain management, its clinical use in children is rare. A 14-year-old girl with neurofibromatosis type I complained of right leg pain stemming from a growing tumor on her right buttock. Continuous and breakthrough right leg pain were unbearable, even at high doses of systemic opioids that caused severe constipation and deep sedation. Subsequent continuous infusion of bupivacaine and morphine through a subarachnoid catheter effectively relieved the girl's pain...
August 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
Hermanus Vaessen, Elisabeth Bruens, Johannes Knape
BACKGROUND AND STUDY AIM: The purpose of this study was to evaluate whether moderate-to-deep sedation with propofol and alfentanil can be administered safely by nonmedical sedation practitioners, and the outcomes of this practice in the Netherlands. We retrospectively analyzed the occurrence of sedation-related complications in patients undergoing gastrointestinal endoscopic procedures. PATIENTS AND METHODS: In this study, 597 adult patients consecutively underwent upper gastrointestinal endoscopic procedures...
May 2016: Endoscopy International Open
Robert Zittoun
Continuous sedation until death (CSUD) is a practice which has developed recently in several countries, appearing more acceptable than euthanasia and medically assisted suicide, since more close to a "natural death". The French parliament has just adopted a law which stipulates CSUD on request of the patient in a definite number of circumstances, especially in incurable diseases near to the terminal stage with suffering refractory to treatments. Thus France has adopted a unique international position for the end-of-life care...
July 2016: La Presse Médicale
Fotini Fligou, Panagiotis Kallidonis, Nicolaos Flaris, Abdulrahman Al-Aown, Iason Kyriazis, Marinos Vasilas, Vasilis Panagopoulos, Petros Perimenis, Evangelos Liatsikos, Theofanis Vrettos
INTRODUCTION: Evaluation of ketamine and propofol combination for the performance of photoselective vaporization of prostate (PVP). PATIENTS AND METHODS: Twenty-six patients undergoing PVP for benign prostatic hyperplasia were included in the study. Co-morbidities were present in 24 patients. Midazolam 2 mg intravenous was administered for the induction to anesthesia. Propofol (10 mg/ml) and ketamine (1 mg/ml) were administered with the use of two pumps. An initial bolus dose of 0...
April 2016: Urology Annals
Ruixia Song, Junyan Li, Chenming Dong, Jing Yang
OBJECTIVE: To compare the sedative effect and safety of dexmedetomidine and midazolam in the intensive care unit (ICU) patients undergoing ventilator bundle treatment. METHODS: A prospective single-blind randomized controlled trial (RCT) was conducted. Ninety patients receiving ICU ventilator-assisted therapy and ventilator bundle treatments for more than 3 days in the First Department of Critical Care Medicine of the Second Hospital of Lanzhou University from January 2013 to December 2014 were enrolled...
October 2015: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
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
Andrew J B Pisansky, Sascha S Beutler, Richard D Urman
PURPOSE OF REVIEW: There has been a significant increase in the number and types of procedures performed outside of the operating room with nonanesthesia providers administering sedation. This review describes current recommendations for training nonanesthesiologists involved in administering deep sedation, summarizes best practices and highlights select patient outcomes. RECENT FINDINGS: There are numerous guidelines and standards related to the administration of deep sedation...
August 2016: Current Opinion in Anaesthesiology
Bernard Devalois, Louis Puybasset
New French 2016' Act recognizes 3 new rights for patients at the end of their life: right to dead without futilities, right to have their wishes respected and right to be comfortable in all circumstances. Medical acts must not be continued in an unreasonable way. Futility is defined by useless, disproportionate or without another aim that an artificial life sustaining acts. For patients who cannot tell their wishes, a withdrawing or withholding decision of life sustaining treatments can be taken with a collegiate process...
April 2016: La Presse Médicale
Woo-Keun Kwon, Jong Hyun Kim, Ji-Hye Lee, Byung-Gun Lim, Il-ok Lee, Seong Beom Koh, Taek Hyun Kwon
OBJECTIVE: The preferred choice of anesthesia for deep brain stimulation (DBS) has been local anesthesia due to the need of patients' cooperation during the procedure, and concern on the interference of sedatives on microelectrode recording (MER) results. However, local anesthesia during the whole procedure may be impossible in some patients due to uncontrolled anxiety, fear, delirium or exhaustion. Therefore, sedative drugs have been used for DBS, but findings of MER during the procedures have not been reported in detail, especially in the globus pallidus internus (GPi)...
April 2016: Clinical Neurology and Neurosurgery
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