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Continuous deep sedation

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https://www.readbyqxmd.com/read/28482856/the-impact-of-the-inpatient-practice-of-continuous-deep-sedation-until-death-on-healthcare-professionals-emotional-well-being-a-systematic-review
#1
Sarah Ziegler, Hannes Merker, Margareta Schmid, Milo A Puhan
BACKGROUND: The practice of continuous deep sedation is a challenging clinical intervention with demanding clinical and ethical decision-making. Though current research indicates that healthcare professionals' involvement in such decisions is associated with emotional stress, little is known about sedation-related emotional burden. This study aims to systematically review the evidence on the impact of the inpatient practice of continuous deep sedation until death on healthcare professionals' emotional well-being...
May 8, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28469535/association-between-deep-sedation-from-continuous-intravenous-sedatives-and-extubation-failures-in-mechanically-ventilated-patients-in-the-pediatric-intensive-care-unit
#2
Jennifer M Schultheis, Travis S Heath, David A Turner
OBJECTIVE: The primary objective of this study was to determine whether an association exists between deep sedation from continuous infusion sedatives and extubation failures in mechanically ventilated children. Secondary outcomes evaluated risk factors associated with deep sedation. METHODS: This was a retrospective cohort study conducted between January 1, 2009, and October 31, 2012, in the pediatric intensive care unit (PICU) at Duke Children's Hospital. Patients were included in the study if they had been admitted to the PICU, had been mechanically ventilated for ≥48 hours, and had received at least one continuous infusion benzodiazepine and/or opioid infusion for ≥24 hours...
March 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/28442954/evaluation-of-efficacy-of-dexmedetomidine-versus-propofol-for-sedation-in-children-undergoing-magnetic-resonance-imaging
#3
Kirti Kamal, Unnati Asthana, Teena Bansal, Jagdish Dureja, Geeta Ahlawat, Saloni Kapoor
BACKGROUND: A deep level of sedation is required for magnetic resonance imaging (MRI) in children to ensure optimum image quality. The present study was conducted to evaluate the efficacy and safety of dexmedetomidine versus propofol for sedation in children undergoing MRI. MATERIALS AND METHODS: A total of sixty children aged 2-10 years, having physical status 1 or 2 according to the American Society of Anesthesiologists, undergoing MRI were included in the study...
April 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28441231/patient-specific-classification-of-icu-sedation-levels-from-heart-rate-variability
#4
Sunil B Nagaraj, Siddharth Biswal, Emily J Boyle, David W Zhou, Lauren M McClain, Ednan K Bajwa, Sadeq A Quraishi, Akeju Oluwaseun, Riccardo Barbieri, Patrick L Purdon, M Brandon Westover
OBJECTIVE: To develop a personalizable algorithm to discriminate between sedation levels in ICU patients based on heart rate variability. DESIGN: Multicenter, pilot study. SETTING: Several ICUs at Massachusetts General Hospital, Boston, MA. PATIENTS: We gathered 21,912 hours of routine electrocardiogram recordings from a heterogenous group of 70 adult ICU patients. All patients included in the study were mechanically ventilated and were receiving sedatives...
April 22, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28417889/monitoring-for-the-oral-and-maxillofacial-surgeon
#5
REVIEW
Robert C Bosack
Parenteral medications are titrated in the oral and maxillofacial surgery office to achieve moderate sedation, deep sedation, or general anesthesia while continuously maintaining spontaneous ventilation with an open airway. After initial drug administration, the provider assesses and interprets both the level of anesthesia and the presence/severity of adverse side effects, both of which guide further drug titration, cessation, reversal, or medical management. This assessment is called monitoring, which guides the conduct of anesthesia delivery and becomes the essence of this art...
May 2017: Oral and Maxillofacial Surgery Clinics of North America
https://www.readbyqxmd.com/read/28385584/a-study-of-the-clinical-utility-of-a-20-minute-secretin-stimulated-endoscopic-pancreas-function-test-and-performance-according-to-clinical-variables
#6
Luis F Lara, Morihito Takita, James S Burdick, Daniel C DeMarco, Ronnie R Pimentel, Tolga Erim, Marlon F Levy
BACKGROUND AND AIMS: Direct pancreas juice testing of bicarbonate, lipase, or trypsin after stimulation by secretin or cholecystokinin is used to determine exocrine function, a surrogate for diagnosing chronic pancreatitis (CP). Endoscopic pancreas function tests (ePFTs), where a peak bicarbonate concentration (PBC) ≥80 mEq/L in pancreas juice is considered normal, are now used more frequently. In this ePFT, aspirates start 35 minutes after secretin administration because pancreas output peaks 30 minutes after secretagogue administration...
April 3, 2017: Gastrointestinal Endoscopy
https://www.readbyqxmd.com/read/28370856/validation-of-adapted-dartmouth-operative-conditions-scale-for-sedation-during-pediatric-esophagogastroduodenoscopy
#7
Vanmathi Chandran, Barath Jagadisan, Barani Ganth
AIMS: Pediatric esophagogastroduodenoscopy requires deep sedation as it involves stimulation of the airway. Frequency of adverse events is higher with esophagogastroduodenoscopy. Hence, monitoring needs sedation scales like the Dartmouth Operative Condition Scale that identifies safe states of sedation. This study aims at validating the Adapted Dartmouth Operative Condition Scale for sedation rating by pediatricians during pediatric esophagogastroduodenoscopy. METHODS: Items in the Dartmouth Operating Conditions Scale were adapted for pediatric esophagogastroduodenoscopy...
June 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28287357/a-review-of-agents-for-palliative-sedation-continuous-deep-sedation-pharmacology-and-practical-applications
#8
John Bodnar
Continuous deep sedation at the end of life is a specific form of palliative sedation requiring a care plan that essentially places and maintains the patient in an unresponsive state because their symptoms are refractory to any other interventions. Because this application is uncommon, many providers may lack practical experience in this specialized area and resources they can access are outdated, nonspecific, and/or not comprehensive. The purpose of this review is to provide an evidence- and experience-based reference that specifically addresses those medications and regimens and their practical applications for this very narrow, but vital, aspect of hospice care...
March 2017: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/28285382/impact-of-deep-sedation-on-the-electrophysiological-behavior-of-pulmonary-vein-and-non-pv-firing-during-catheter-ablation-for-atrial-fibrillation
#9
Ryohsuke Narui, Seiichiro Matsuo, Ryota Isogai, Kenichi Tokutake, Kenichi Yokoyama, Mika Kato, Keiichi Ito, Shin-Ichi Tanigawa, Seigo Yamashita, Michifumi Tokuda, Keiichi Inada, Kenri Shibayama, Satoru Miyanaga, Kenichi Sugimoto, Michihiro Yoshimura, Teiichi Yamane
PURPOSE: Catheter ablation for atrial fibrillation is performed with and without deep sedation, which could affect the arrhythmogenic activity during the procedure. We investigated the impact of sedation on electrophysiological properties in patients with AF who underwent catheter ablation. METHODS: This study consisted of 255 consecutive patients with atrial fibrillation (229 males, persistent: 105 patients) who underwent a single-catheter ablation procedure. The patients were divided into the following two groups according to the depth of sedation during the procedure: group M (mild sedation with flunitrazepam in 138 patients) and group D (deep sedation with propofol in 117 patients)...
March 11, 2017: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
https://www.readbyqxmd.com/read/28134411/-deep-continuous-palliative-sedation-in-the-opinion-adopted-by-the-italian-national-bioethics-committee-deep-palliative-sedation
#10
Fabio Cembrani
The Author examines the recent opinion delivered by the Italian National Committee for Bioethics on deep palliative sedation. In particular, it examines its strengths and ample shade that show its ideology, once again, in contrast with the right of every human being to die with dignity.
November 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
https://www.readbyqxmd.com/read/28116457/-drug-induced-sedation-endoscopy-quo-vadis-review-and-outlook
#11
M Herzog, J T Maurer
BACKGROUND: Drug-induced sedation endoscopy (DISE) is a diagnostic procedure which allows evaluation of the collapsibility of the upper airway. According to expert opinion, it is possible to imitate nocturnal collapsibility and perform a realistic investigation of the site of obstruction and vibration. This should enable sufficient and precise therapeutic advice to be given solely on the basis of clinical assessment. OBJECTIVE: The current publication critically evaluates the present state of development of DISE and its potential indications...
January 23, 2017: HNO
https://www.readbyqxmd.com/read/28109272/opinions-about-the-new-law-on-end-of-life-issues-in-a-sample-of-french-patients-receiving-palliative-care
#12
MULTICENTER STUDY
Augustin Boulanger, Théo Chabal, Marie Fichaux, Mireille Destandau, Jean Marc La Piana, Pascal Auquier, Karine Baumstarck, Sébastien Salas
BACKGROUND: In February 2nd 2016, the French government enacted the Claeys-Leonetti law that forbade euthanasia and established the right to deep and continuous sedation for end-of-life patients. Moreover, the law also obliges clinicians to abide by any advance directives regarding treatment and investigation, except in cases where they are "obviously inappropriate" in a given medical situation, or in cases of emergency, in order to allow medical staff to take time to assess the patient's situation...
January 21, 2017: BMC Palliative Care
https://www.readbyqxmd.com/read/28105111/effect-of-rocuronium-on-the-bispectral-index-under-anesthesia-and-tracheal-intubation
#13
Hui Yue, Jinyu Han, Ling Liu, Kaiyuan Wang, Jincheng Li
The aim of the present study was to investigate the effect of various doses of rocuronium on bispectral index (BIS) responses to propofol induction and tracheal intubation, as well as the role of the non-depolarization muscle relaxant rocuronium on the depth of sedation. A total of 72 patients (American Society of Anesthesiologists physical status I-II) were anaesthetized with propofol using a target-controlled infusion, and randomly divided into two sedation level groups (n=36). The patients were divided into 2 groups according to the BIS value: A normal sedation group (group 1), with a stable BIS value at 40-60, and a deep sedation group (group 2), with a BIS value <20 or with burst suppression...
December 2016: Experimental and Therapeutic Medicine
https://www.readbyqxmd.com/read/28074297/-delirium-analgesia-and-sedation-in-intensive-care-medicine-development-of-a-protocol-based-management-approach
#14
A Wolf, R Mörgeli, A Müller, B Weiss, C Spies
Intensive care treatment has long-term consequences that are often not immediately apparent to the health care providers. The combination of muscle weakness, cognitive damage, and psychological disorders is comprised under the term post-intensive care syndrome (PICS). Analgesia and sedation protocols, as well as nonpharmacological preventive and therapeutic approaches, are effective tools for avoiding complications and improving long-term survival. The principle of "early goal-directed therapy" is fundamental...
February 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28063863/correlation-between-observational-scales-of-sedation-and-comfort-and-bispectral-index-scores
#15
Michael Barbato, Greg Barclay, Jan Potter, Wilf Yeo, Joseph Chung
CONTEXT: When palliative care patients enter the phase of unconsciousness preceding death, it is standard practice to initiate or continue a subcutaneous infusion of an opioid plus or minus a sedative. The doses are determined somewhat empirically and adjustments are based on clinical assessment and observational measures of sedation and comfort. Following reports that these observational measures could be misleading, this study assesses their validity by comparing them with an objective measure of sedation, the Bispectral Index Score (BIS)...
January 5, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28006887/palliative-sedation-the-position-statement-of-the-italian-national-committee-for-bioethics
#16
Luciano Orsi, Giuseppe R Gristina
In January 2016 the Italian National Bioethics Committee (NBC) published a position statement entitled Deep and continuous palliative sedation in the imminence of death, related to the use of sedation and analgesia for relief from pain and psychological distress in dying patients. In this statement the Committee points out the clinical and ethical appropriateness of palliative sedation as a therapeutic procedure. As a result, today palliative sedation has to be considered useful, scientifically safe and reliable, and acknowledged as an integral part of good clinical practice...
May 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/27920697/end-of-life-practices-in-france-under-the-claeys-leonetti-law-report-of-three-cases-in-the-oncology-unit
#17
Alexandre de Nonneville, Anthony Marin, Theo Chabal, Veronique Tuzzolino, Marie Fichaux, Sebastien Salas
On February 2, 2016, the French government enacted the Claeys-Leonetti law introducing the right to deep and continuous sedation and forbade euthanasia for end-of-life patients. This article reports the first descriptions of this kind of intervention at the final stage of life of 3 patients and highlights the need of patient-centered goals and the importance of close collaboration between the patient, family, and medical and paramedical team to achieve a higher quality of final palliative care.
September 2016: Case Reports in Oncology
https://www.readbyqxmd.com/read/27776894/end-of-life-euthanasia-and-assisted-suicide-an-update-on-the-situation-in-france
#18
REVIEW
R Aubry
On February 2, 2016, the French parliament adopted legislation creating new rights for the terminally ill. The text modifies and reinforces the rights of patients to end-of-life care and strengthens the status of surrogate decision makers. Under the new regulations, advance directives become legally binding though not unenforceable. Two types of advance directives are distinguished depending on whether the person is suffering or not from a serious illness when drafting them. The attending physician must abide by the patient's advance directives except in three situations: there is a life-threatening emergency; the directives are manifestly inappropriate; the directives are not compatible with the patient's medical condition...
December 2016: Revue Neurologique
https://www.readbyqxmd.com/read/27759115/kinetics-of-ventilation-induced-changes-in-diaphragmatic-metabolism-by-bilateral-phrenic-pacing-in-a-piglet-model
#19
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
https://www.readbyqxmd.com/read/27755068/clinical-practice-guidelines-for-sustained-neuromuscular-blockade-in-the-adult-critically-ill-patient
#20
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
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