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Eye care in sedated patients

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
Gaspard Montandon, Sharon L Cushing, Fiona Campbell, Evan J Propst, Richard L Horner, Indra Narang
BACKGROUND: Opioid analgesia is an essential component of perioperative care, but effective analgesia can be limited by excessive sedation and respiratory depression. The cortical signatures associated with sedation by opioids and the relationship between changes in cortical activity and respiratory function are not well understood. The objectives of this study were to identify the electroencephalogram signatures of sedation and respiratory changes induced by morphine in a pediatric population after elective surgery...
November 2016: Anesthesiology
Eun Hee Chun, Myeong Jae Han, Hee Jung Baik, Hahck Soo Park, Rack Kyung Chung, Jong In Han, Hun Jung Lee, Jong Hak Kim
BACKGROUND: Dexmedetomidine as a sole agent showed limited use for painful procedures due to its insufficient sedative/analgesic effect, pronounced hemodynamic instability and prolonged recovery. The aim of this study was to compare the effects of dexmedetomidine-ketamine (DK) versus dexmedetomidine-midazolam-fentanyl (DMF) combination on the quality of sedation/analgesia and recovery profiles for monitored anesthesia care (MAC). METHODS: Fifty six patients undergoing chemoport insertion were randomly assigned to group DK or DMF...
2016: BMC Anesthesiology
Alexander Olaussen, Matthew Shepherd, Ziad Nehme, Karen Smith, Paul A Jennings, Stephen Bernard, Biswadev Mitra
INTRODUCTION: Consciousness may occur during effective management of cardiac arrest and ranges from eye opening to interfering with rescuers' resuscitation attempts. Reported cases in the medical literature appear scant compared to anecdotal reports. The aim of this study was to evaluate health care providers' experience with consciousness during cardio-pulmonary resuscitation (CPR). METHODS: A cross-sectional survey of 100 experienced health care professionals, including doctors, nurses and paramedics...
July 28, 2016: Australasian Emergency Nursing Journal: AENJ
S Ayasrah
Despite advances in pain management, critically ill patients continue to have unacceptably high rates of uncontrolled pain. Using the Behavioural Pain Scale and physiological indicators of pain, this study examines pain levels in mechanically ventilated patients prior to and during routine nursing procedures. A prospective descriptive design was used to assess and describe care-related pain associated with nociceptive procedures (repositioning, endotracheal suctioning, and vascular punctures) and non-nociceptive procedures (mouth care, eye care and dressing change)...
July 2016: Anaesthesia and Intensive Care
Sezen Akkaya, Yelda Buyru Özkurt, Sibel Aksoy, Hatice Kübra Kökçen
The purpose of this study is to compare pain experience and cooperation between consecutive surgeries in patients undergoing phacoemulsification in both eyes, using sub-Tenon's local anesthesia without sedation. In this study, 268 patients with bilateral senile cataracts were recruited. All operations were performed without sedation, using a clear corneal phacoemulsification technique and sub-Tenon's local anesthesia, by one of four surgeons. The first surgery was performed on the eye with the higher grade cataract...
July 23, 2016: International Ophthalmology
Maria I Castillo, Marie Cooke, Bonnie Macfarlane, Leanne M Aitken
BACKGROUND: Anxiety is an unpleasant emotion that most intensive care patients experience. This emotion is an important issue in intensive care settings because of its prevalence, adverse effects and severity. Little is known about the factors associated with state and trait anxiety during critical illness. OBJECTIVES: To describe the patterns of state anxiety reported by intensive care patients, and identify factors associated with state and trait anxiety. DESIGN: Prospective observational cohort study...
August 2016: International Journal of Nursing Studies
Robert M Wolfe, Jonathan Pomerantz, Deborah E Miller, Rebecca Weiss-Coleman, Tony Solomonides
The incidence of obstructive sleep apnea (OSA) has reached epidemic proportions, and it is an often unrecognized cause of perioperative morbidity and mortality. Profound hypoxic injury from apnea during the postoperative period is often misdiagnosed as cardiac arrest due to other causes. Almost a quarter of patients entering a hospital for elective surgery have OSA, and >80% of these cases are undiagnosed at the time of surgery. The perioperative period puts patients at high risk of apneic episodes because of drug effects from sedatives, narcotics, and general anesthesia, as well as from the effects of postoperative rapid eye movement sleep changes and postoperative positioning in the hospital bed...
March 2016: Journal of the American Board of Family Medicine: JABFM
Ryan M Rivosecchi, Sandra L Kane-Gill, Sue Svec, Shauna Campbell, Pamela L Smithburger
PURPOSE: The purpose was to determine if the implementation of an evidence-based nonpharmacologic protocol reduced the percentage of time patients spent delirious in a medical intensive care unit (MICU) that already uses a sedation and mobility protocol. MATERIALS AND METHODS: This was a prospective, pre-post quality improvement project of MICU patients conducted from September 2013 to April 2014. Evidence-based effective nonpharmacologic interventions with nursing education were bundled into the project protocol: music, opening/closing of blinds, reorientation/cognitive stimulation, and eye/ear care...
February 2016: Journal of Critical Care
Abbas Ebadi, Yaser Saeid, Shahrbanoo Ashrafi, Zahra Taheri-Kharameh
BACKGROUND: Given the high prevalence of eye disorders in intensive care units, evaluating critical care nurses' competence in providing standard eye care is a matter of utmost importance. However, to the best of our knowledge, there is no valid questionnaire for measuring nurses' competence to undertake eye care. AIMS: The aim of this study was to develop and evaluate the psychometric properties of a questionnaire on nurses' clinical competence in providing eye care to patients hospitalized in intensive care units...
November 9, 2015: Nursing in Critical Care
Heather F Burnett, Rosemary Lambley, Stephanie K West, Wendy J Ungar, Kamiar Mireskandari
BACKGROUND/AIMS: The inability of some children to tolerate detailed eye examinations often necessitates general anaesthesia (GA). The objective was to assess the incremental cost effectiveness of paediatric eye examinations carried out in an outpatient sedation unit compared with GA. METHODS: An episode of care cost-effectiveness analysis was conducted from a societal perspective. Model inputs were based on a retrospective cross-over cohort of Canadian children aged <7 years who had both an examination under sedation (EUS) and examination under anaesthesia (EUA) within an 8-month period...
November 2015: British Journal of Ophthalmology
Isabela F Azevedo-Santos, Iura G N Alves, Daniel Badauê-Passos, Valter J Santana-Filho, Josimari M DeSantana
BACKGROUND AND PURPOSE: Pain assessment in Intensive Care Units (ICU) can be performed based on validated instruments as the Behavioral Pain Scale (BPS). Despite the existence of this clinical score, there is no Brazilian version of it to assess critically ill patients. This study aimed to translate the BPS into Brazilian Portuguese, verify its psychometric properties (reliability, validity, and responsiveness) and the correlation between pain measured and heart rate (HR), blood pressure (BP), Ramsay, and RASS scores...
April 2016: Pain Practice: the Official Journal of World Institute of Pain
Marita Ritmala-Castren, Irina Virtanen, Sanna Leivo, Kirsi-Maija Kaukonen, Helena Leino-Kilpi
This study aimed to describe the quality of sleep of non-intubated patients and the night-time nursing care activities in an intensive care unit. The study also aimed to evaluate the effect of nursing care activities on the quality of sleep. An overnight polysomnography was performed in 21 alert, non-intubated, non-sedated adult patients, and all nursing care activities that involved touching the patient were documented by the bedside nurse. The median (interquartile range) amount of sleep was 387 (170, 486) minutes...
September 2015: Nursing & Health Sciences
Michael D Seidman, Richard K Gurgel, Sandra Y Lin, Seth R Schwartz, Fuad M Baroody, James R Bonner, Douglas E Dawson, Mark S Dykewicz, Jesse M Hackell, Joseph K Han, Stacey L Ishman, Helene J Krouse, Sonya Malekzadeh, James Whit W Mims, Folashade S Omole, William D Reddy, Dana V Wallace, Sandra A Walsh, Barbara E Warren, Meghan N Wilson, Lorraine C Nnacheta
OBJECTIVE: Allergic rhinitis (AR) is one of the most common diseases affecting adults. It is the most common chronic disease in children in the United States today and the fifth most common chronic disease in the United States overall. AR is estimated to affect nearly 1 in every 6 Americans and generates $2 to $5 billion in direct health expenditures annually. It can impair quality of life and, through loss of work and school attendance, is responsible for as much as $2 to $4 billion in lost productivity annually...
February 2015: Otolaryngology—Head and Neck Surgery
Feisal A Adatia, Monique Munro, Imran Jivraj, Abdallah Ajani, Rosa Braga-Mele
PURPOSE: To examine the subjective patient experience after cataract surgery. SETTING: Single multisurgeon cataract facility. DESIGN: Prospective intraindividual observational study. METHODS: Patients completed a questionnaire immediately after cataract extraction performed in their second eye. All patients had second-eye surgery within 6 months of first-eye surgery. Cases longer than 30 minutes were excluded. RESULTS: Of the 292 patients who completed the questionnaire, 12 were excluded based on surgical time...
January 2015: Journal of Cataract and Refractive Surgery
Marieke de Vries, Gerhard Putter
CLINICAL CHALLENGES: Anaesthesia for dental and oral procedures in cats can be challenging and many factors need to be taken into consideration. Often it is older patients requiring these procedures and, while old age itself is not a contraindication for general anaesthesia, older patients tend to have limited homeostatic reserves and are, therefore, more prone to anaesthesia-induced insults of vital organs. Most sedative and anaesthetic agents have cardiovascular side effects, which may result in detrimental consequences in older patients in which organ reserves are likely reduced...
January 2015: Journal of Feline Medicine and Surgery
Shilpa Kuruvilla, Jayanthi Peter, Sarada David, Prasanna Samuel Premkumar, Kartik Ramakrishna, Lovely Thomas, Manuel Vedakumar, John Victor Peter
PURPOSE: Recent emphasis on eye care in intensive care unit (ICU) patients has translated to eye assessment being part of routine care. In this setting, we determined the incidence, risk factors, and resolution time of exposure keratopathy. METHODS: In this prospective cohort study, 301 patients were examined within 24 hours of ICU admission and subsequently daily by an ophthalmologist till death or discharge. Eyelid position, conjunctival and corneal changes, treatment, and outcome data were collected...
April 2015: Journal of Critical Care
Dan M McEntire, Daniel R Kirkpatrick, Mitchell J Kerfeld, Zakary J Hambsch, Mark D Reisbig, Devendra K Agrawal, Charles F Youngblood
The perioperative care of obstructive sleep apnea (OSA) patients is currently receiving much attention due to an increased risk for complications. It is established that postoperative changes in sleep architecture occur and this may have pathophysiological implications for OSA patients. Upper airway muscle activity decreases during rapid eye movement sleep (REMS). Severe OSA patients exhibit exaggerated chemoreceptor-driven ventilation during non-rapid eye movement sleep (NREMS), which leads to central and obstructive apnea...
November 2014: Expert Review of Clinical Pharmacology
Kyung Hoon Kim
Dexmedetomidine, an imidazoline compound, is a highly selective α2-adrenoceptor agonist with sympatholytic, sedative, amnestic, and analgesic properties. In order to minimize the patients' pain and anxiety during minimally invasive spine surgery (MISS) when compared to conventional surgery under general anesthesia, an adequate conscious sedation (CS) or monitored anesthetic care (MAC) should be provided. Commonly used intravenous sedatives and hypnotics, such as midazolam and propofol, are not suitable for operations in a prone position due to undesired respiratory depression...
October 2014: Korean Journal of Pain
Stephen L Thornton, Richard F Clark
Donepezil and memantine are commonly prescribed antidementia drugs. There is a paucity of literature concerning pediatric ingestions of these drugs. We describe a case of a 2-year-old child who developed encephalopathy after an unintentional ingestion of donepezil and memantine. A 2-year-old girl was found by her family members agitated and reporting visual hallucinations. In the emergency department, she became sedated and had rightward eye deviation. She was hospitalized and had extensive neurological and infectious disease testing that was unremarkable, except for an electroencephalogram, which showed a nonspecific encephalopathy...
September 2014: Pediatric Emergency Care
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