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Conscious Sedation in the field

Joshua Pound, P Richard Verbeek, Sheldon Cheskes
BACKGROUND: High quality cardiopulmonary resuscitation (CPR) has produced a relatively new phenomenon of consciousness in patients with vital signs absent. Further research is necessary to produce a viable treatment strategy during and post resuscitation. OBJECTIVE: To provide a case study done by paramedics in the field illustrating the need for sedation in a patient whose presentation was consistent with CPR induced consciousness. Resuscitative challenges are provided as well as potential future treatment options to minimize harm to both patients and prehospital providers...
October 28, 2016: Prehospital Emergency Care
Anthony G Hudetz, Xiping Liu, Siveshigan Pillay, Melanie Boly, Giulio Tononi
Consciousness is thought to scale with brain complexity, and it may be diminished in anesthesia. Lempel-Ziv complexity (LZC) of field potentials has been shown to be a promising measure of the level of consciousness in anesthetized human subjects, neurological patients, and across the sleep-wake states in rats. Whether this relationship holds for intrinsic networks obtained by functional brain imaging has not been tested. To fill this gap of knowledge, we estimated LZC from large-scale dynamic analysis of functional magnetic resonance images (fMRI) in conscious sedated and unconscious anesthetized rats...
August 15, 2016: Neuroscience Letters
Xiaotan Dai, Pingping Song, Baijiang Zhang
Tracheal intubation general anesthesia technique is widely used in video-assisted thoracic surgery (VATS) because it can improve the safety of VATS, but the complications of tracheal intubation can not be avoided. How to develop a "minimally invasive" surgery (including micro anesthesia) has become a hot topic in the field of minimally invasive surgery. Along with the progress of the anesthesia management technology and the risk management in the operation, the technology of non-intubated anesthesia was successfully applied to VATS, namely using local anesthesia to maintain patients intraoperative independent ventilation and intraoperative only mild sedation or fully conscious state of implementation of thoracoscope surgery, therefore is also called awake VATS...
May 20, 2016: Zhongguo Fei Ai za Zhi, Chinese Journal of Lung Cancer
Michael J Parkes, Stuart Green, Andrea M Stevens, Sophia Parveen, Rebecca Stephens, Thomas H Clutton-Brock
OBJECTIVE: Variability in the breathing pattern of patients with cancer during radiotherapy requires mitigation, including enlargement of the planned treatment field, treatment gating and breathing guidance interventions. Here, we provide the first demonstration of how easy it is to mechanically ventilate patients with breast cancer while fully conscious and without sedation, and we quantify the resulting reduction in the variability of breathing. METHODS: 15 patients were trained for mechanical ventilation...
June 2016: British Journal of Radiology
Pietro Fusaroli, Marta Serrani, Andrea Lisotti, Maria Cristina D'Ercole, Liza Ceroni, Giancarlo Caletti
BACKGROUND AND OBJECTIVES: Failures of endoscopic ultrasound (EUS) imaging of the head of the pancreas (HOP) and the common bile duct (CBD) have been reported in up to 50% of patients with status postsurgery (e.g., Billroth II and Roux-en-Y). This is attributable to inability to intubate the afferent limb or the duodenum. Recently, a forward-view (FV) echoendoscope has become available. The frontal endoscopic and ultrasound field of view theoretically allow easier manipulation throughout the gastrointestinal tract compared to the traditional echoendoscopes...
October 2015: Endoscopic Ultrasound
Meenu Chadha, Mayank Kulshrestha, Alok Biyani
Bronchoscopy as an investigation or therapeutic procedure demands anaesthesiologist to act accordingly. The present review will take the reader from rigid to fibreoptic flexible bronchoscopy. These procedures are now done as day care procedures in the operation theatre or in critical care units. Advantages and limitations of both rigid and flexible bronchoscopy are analysed. Recently, conscious sedation has come up as the commonly used anaesthetic technique for simple bronchoscopic procedures. However, general anaesthesia still remains a standard technique for more complex procedures...
September 2015: Indian Journal of Anaesthesia
A Devasya, M Sarpangala
UNLABELLED: Dexmedetomidine is a central α-2 agonist, similar to Clonidine, but 8 times more specific for the central α-2 receptor which causes sedation with minimal depression of respiration, making it safe for sedation during procedures. It is widely used in the field of medicine for many procedures especially premedication, awake intubation, and sedation of patients in intensive care units and pediatric procedural sedation. OBJECTIVE: To do a systematic review of the pharmacology, pharmacodynamics, as well as the usage of newer sedative drug- Dexmedetomidine in dentistry...
2015: Journal of Clinical Pediatric Dentistry
Gail Ter Haar
High intensity focused ultrasound (HIFU) is rapidly gaining clinical acceptance as a technique capable of providing non-invasive heating and ablation for a wide range of applications. Usually requiring only a single session, treatments are often conducted as day case procedures, with the patient either fully conscious, lightly sedated or under light general anesthesia. HIFU scores over other thermal ablation techniques because of the lack of necessity for the transcutaneous insertion of probes into the target tissue...
2016: Advances in Experimental Medicine and Biology
Kyung Soo Hong, Eun Young Choi, Dong-Ah Park, Jinkyeong Park
Moderate sedatives have been increasingly used to improve patient comfort during flexible bronchoscopy (FB). However, routine use of moderate sedation during FB is controversial because its efficacy and safety are not well established. This study aims to evaluate the efficacy and safety of moderate sedation during FB. A search was made of Medline, EMBASE, and the Cochrane Library to May 2014. Randomized controlled trials (RCTs) and quasi-RCTs were included. The main analysis was designed to examine the efficacy of moderate sedation during FB in sedation than no-sedation...
October 2015: Medicine (Baltimore)
N Mittal, A Goyal, K Jain, K Gauba
Despite the voluminous literature addressing the safety and efficacy of various sedative agents in the pediatric dental setting, the quality literature to form evidence based pediatric dental sedation practice is not available. Our search through PUBMED showed that during 1985-2012, a total of 184 original research papers on pediatric dental sedation were reported, and midazolam clearly dominated with 88 trials on this agent. Despite these large numbers of papers, Cochrane Review was able to pool a weak evidence in favor of midazolam...
2015: Journal of Clinical Pediatric Dentistry
Chandan J Das, Vinit Baliyan, Sanjay Sharma
Advances in imaging technology, especially in the last two decades, have led to a paradigm shift in the field of image-guided interventions in urology. While the traditional biopsy and drainage techniques are firmly established, image-based stone management and endovascular management of hematuria have evolved further. Ablative techniques for renal and prostate cancer and prostate artery embolization for benign prostatic hypertrophy have evolved into viable alternative treatments. Many urologic diseases that were earlier treated surgically are now effectively managed using minimally invasive image-guided techniques, often on a day care basis using only local anesthesia or conscious sedation...
July 2015: Indian Journal of Urology: IJU: Journal of the Urological Society of India
Daniela Casoni, Claudia Spadavecchia, Beat Wampfler, Wolfgang Thormann, Olivier L Levionnois
BACKGROUND: Intravenous anaesthetic drugs are the primary means for producing general anaesthesia in equine practice. The ideal drug for intravenous anaesthesia has high reliability and pharmacokinetic properties indicating short elimination and lack of accumulation when administered for prolonged periods. Induction of general anaesthesia with racemic ketamine preceded by profound sedation has already an established place in the equine field anaesthesia. Due to potential advantages over racemic ketamine, S-ketamine has been employed in horses to induce general anaesthesia, but its optimal dose remains under investigation...
2015: Acta Veterinaria Scandinavica
Moustafa A Moustafa, Doaa M Emara, Mohamed R Nouh
INTRODUCTION: Propofol and midazolam are widely used for pediatric magnetic resonance imaging (MRI) sedation. Increasing depth of sedation may be associated with airway obstruction. A neck collar supporting the mandible and maintaining the head in slight extension may be beneficial in maintaining airway patency. AIM OF THE STUDY: Primary aim: To assess upper airway size with and without a neck collar during pediatric MRI sedation with propofol-midazolam. Secondary aim: To evaluate complications encountered during the procedure...
April 2015: Paediatric Anaesthesia
Sivasankaran Balaratnasingam
OBJECTIVE: Clinicians dealing with referrals under the Mental Health Act in rural and remote parts of Australia face the difficult task of providing safe sedation whilst transferring the patient to an appropriate authorized facility. This paper reviews the efforts to overcome these challenges in the remote north-west of Australia. METHODS: Senior medical staff undertook a review of sedation practice in the region. A search was made of the medical literature to determine whether evidence based treatment may exist elsewhere and this information was used in conjunction with consensus opinion to devise a new guideline...
December 2014: Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists
Yasmeen N Daud, Douglas W Carlson
Pediatric sedation is an evolving field performed by an extensive list of specialties. Well-defined sedation systems within pediatric facilities are paramount to providing consistent, safe sedation. Pediatric sedation providers should be trained in the principles and practice of sedation, which include patient selection, pre-sedation assessment to determine risks during sedation, selection of optimal sedation medication, monitoring requirements, and post-sedation care. Training, credentialing, and continuing sedation education must be incorporated into sedation systems to verify and monitor the practice of safe sedation...
August 2014: Pediatric Clinics of North America
Aloka Samantaray
BACKGROUND AND AIM: Central venous catheter (CVC) insertion induces pain and discomfort to a conscious patient despite application of a local anaesthetic (LA) field block and this pain can be greatly lessened by using additional analgesics. The aim of this study was to evaluate the efficacy of dexmedetomidine along with LA field infiltration in controlling pain and discomfort associated with CVC insertion. METHODS: A prospective, randomised, double-blind, placebo-controlled trial of 54 patients scheduled for planned CVC insertion was undertaken...
May 2014: Indian Journal of Anaesthesia
D Orbegozo Cortes, C Santacruz, K Donadello, L Nobile, F S Taccone
BACKGROUND: Fluid therapy is widely used in critically ill patients to restore effective intravascular volume and improve organ perfusion. Recent studies have questioned the administration of colloid-based solutions, especially if containing hydroxyethyl starch (HES), in different ICU populations; however, there is still uncertainty on the use of colloids as initial fluid therapy for early resuscitation. METHODS: The aim of this study was to investigate the effect of two different resuscitation fluid strategies on the mortality of patients with shock...
August 2014: Minerva Anestesiologica
Andrea De Vito, Marina Carrasco Llatas, Agnoletti Vanni, Marcello Bosi, Alberto Braghiroli, Aldo Campanini, Nico de Vries, Evert Hamans, Winfried Hohenhorst, Bhik T Kotecha, Joachim Maurer, Filippo Montevecchi, Ottavio Piccin, Giovanni Sorrenti, Olivier M Vanderveken, Claudio Vicini
BACKGROUND: Although drug-induced sedation endoscopy (DISE) represents the most widespread diagnostic tool for upper airway endoscopic evaluation of snoring and obstructive sleep apnea hypopnea syndrome (OSAHS), many controversies exist about how to perform the sedation, the indications for DISE, and how to report DISE findings. The present position paper reports on a consensus as proposed by a group of European experts in the field of DISE after discussion during a recent dedicated meeting...
September 2014: Sleep & Breathing, Schlaf & Atmung
Hao Jia, Oleg M Pustovyy, Paul Waggoner, Ronald J Beyers, John Schumacher, Chester Wildey, Jay Barrett, Edward Morrison, Nouha Salibi, Thomas S Denney, Vitaly J Vodyanoy, Gopikrishna Deshpande
We depend upon the olfactory abilities of dogs for critical tasks such as detecting bombs, landmines, other hazardous chemicals and illicit substances. Hence, a mechanistic understanding of the olfactory system in dogs is of great scientific interest. Previous studies explored this aspect at the cellular and behavior levels; however, the cognitive-level neural substrates linking them have never been explored. This is critical given the fact that behavior is driven by filtered sensory representations in higher order cognitive areas rather than the raw odor maps of the olfactory bulb...
2014: PloS One
Robert A Avery, Eugene I Hwang, Hiroshi Ishikawa, Maria T Acosta, Kelly A Hutcheson, Domiciano Santos, Dina J Zand, Lindsay B Kilburn, Kenneth N Rosenbaum, Brian R Rood, Joel S Schuman, Roger J Packer
IMPORTANCE: Monitoring young children with optic pathway gliomas (OPGs) for visual deterioration can be difficult owing to age-related noncompliance. Optical coherence tomography (OCT) measures of retinal nerve fiber layer (RNFL) thickness have been proposed as a surrogate marker of vision but this technique is also limited by patient cooperation. OBJECTIVE: To determine whether measures of circumpapillary RNFL thickness, acquired with handheld OCT (HH-OCT) during sedation, can differentiate between young children with and without vision loss from OPGs...
March 2014: JAMA Ophthalmology
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