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Sample records for care mac sedation

  1. Sedation in neurological intensive care unit

    Directory of Open Access Journals (Sweden)

    Birinder S Paul

    2013-01-01

    Full Text Available Analgesia and sedation has been widely used in intensive care units where iatrogenic discomfort often complicates patient management. In neurological patients maximal comfort without diminishing patient responsiveness is desirable. In these patients successful management of sedation and analgesia incorporates a patient based approach that includes detection and management of predisposing and causative factors, including delirium, monitoring using sedation scales, proper medication selection, emphasis on analgesia based drugs and incorporation of protocols or algorithms. So, to optimize care clinician should be familiar with the pharmacokinetic and pharmacodynamic variables that can affect the safety and efficacy of analgesics and sedatives.

  2. Monitored Anaesthesia Care (MAC in antalgic surgery

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    Giovanni Maria Pisanu

    2011-09-01

    Full Text Available The use of surgical techniques for pain relief in the treatment of chronic-persistent pain unresponsive to drug therapy is experiencing a growing spread application in algology. These techniques have set themselves the goal of removing the pain after treatment. Therefore, not always, percutaneous or open procedures are carried out with due precaution necessary to alleviate the patient discomfort and suffering during the surgical intervention. We present our personal experience in the use of this technique Monitored Anaesthesia Care (MAC for patients undergoing surgical treatment of pain management at our Regional Center of Pain Management.

  3. Comfort and patient-centred care without excessive sedation

    DEFF Research Database (Denmark)

    Vincent, Jean-Louis; Shehabi, Yahya; Walsh, Timothy S;

    2016-01-01

    and Delirium guidelines, is conveyed in the mnemonic eCASH-early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as the default presumption for intensive care unit (ICU) patients in the absence of recognised medical...

  4. Sedation with dexmedetomidine in the intensive care setting

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    Gerlach AT

    2011-11-01

    Full Text Available Anthony T Gerlach, Claire V Murphy The Ohio State University Medical Center, Ohio State University, Columbus, OH, USA Abstract: Dexmedetomidine is an α-2 agonist that produces sedation and analgesia without compromising the respiratory drive. Use of dexmedetomidine as a sedative in the critically ill is associated with fewer opioid requirements compared with propofol and a similar time at goal sedation compared with benzodiazepines. Dexmedetomidine may produce negative hemodynamic effects including lower mean heart rates and potentially more bradycardia than other sedatives used in the critically ill. Recent studies have demonstrated that dexmedetomidine is safe at higher dosages, but more studies are needed to determine whether the efficacy of dexmedetomidine is dose dependent. In addition, further research is required to define dexmedetomidine's role in the care of delirious critically ill patients, as many, but not all, studies have indicated favorable outcomes. Keywords: dexmedetomidine, sedation, critical care

  5. Combination of Midazolam and Butorphanol for Sedation for Tympanoplasty under Monitored Anaesthesia Care

    OpenAIRE

    2016-01-01

    Background: Tympanoplasty is routinely done under local anaesthesia with sedation due to various advantages. Systemic analgesics and sedatives are generally given to improve the patient comfort. Aim & Objectives: To determine the effectiveness of combination of midazolam and butorphanol for sedation and to assess the sedation technique using midazolam and butorphanol for tympanoplasty under monitored anaesthesia care. Material and Methods: One hundred patients sched...

  6. The use of dexmedetomidine in intensive care sedation

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    Massimo Antonelli

    2013-05-01

    Full Text Available The goals and recommendations for ICU (Intensive Care Unit patients’ sedation and analgesia should be to have adequately sedated patients who are calm and arousal, so that they can guarantee a proper evaluation and an adequate control of pain. This way, it is also possible to perform their neurological evaluation, preserving intellectual faculties and helping them in actively participating to their care. Dexmedetomidine is a selective alpha-2 receptor agonist, member of theraputical cathegory: “other hypnotics and sedatives” (ATC: N05CM18. Dexmedetomidine is recommended for the sedation of adult ICU patients who need a sedation level not deeper than arousal in response to verbal stimulation (corresponding to Richmond Agitation-Sedation Scale 0 to -3. After the EMA approval, some European government authorities have elaborated HTA on dexmedetomidine, based on clinical evidence derived from Prodex and Midex trials. Dexmedetomidine resulted to be as effective as propofol and midazolam in maintaining the target depth of sedation in ICU patients. The mean duration of mechanical ventilation with dexmedetomidine was numerically shorter than with propofol and significantly shorter than with midazolam. The resulting favourable economic profile of dexmedetomidine supported the clinical use in ICU. Dexmedetomidine seems to provide clinical benefits due to the reduction of mechanical ventilation and ventilator weaning duration. Within the present review, an economic analysis of costs associated to the use of dexmedetomidine was therefore performed also in the Italian care setting. Thus, four different analyses were carried out based on the quantification of the total number of days in ICU, the time spent on mechanical ventilation, the weighted average number of days with mechanical ventilation or not and TISS points (Therapeutic Intervention Scoring System. Despite the incremental cost for drug therapy associated with dexmedetomidine, a reduction of

  7. Comfort and patient-centred care without excessive sedation

    DEFF Research Database (Denmark)

    Vincent, Jean-Louis; Shehabi, Yahya; Walsh, Timothy S

    2016-01-01

    and Delirium guidelines, is conveyed in the mnemonic eCASH-early Comfort using Analgesia, minimal Sedatives and maximal Humane care. eCASH aims to establish optimal patient comfort with minimal sedation as the default presumption for intensive care unit (ICU) patients in the absence of recognised medical...... contribute to the larger aims of eCASH by facilitating promotion of sleep, early mobilization strategies and improved communication of patients with staff and relatives, all of which may be expected to assist rehabilitation and avoid isolation, confusion and possible long-term psychological complications...... of an ICU stay. eCASH represents a new paradigm for patient-centred care in the ICU. Some organizational challenges to the implementation of eCASH are identified....

  8. Assessment of Sedation and Analgesia in Mechanically Ventilated Patients in Intensive Care Unit

    OpenAIRE

    2008-01-01

    Post traumatic stress resulting from an intensive care unit(ICU) stay may be prevented by adequate level of sedation and analgesia. Aims of the study were reviewing the current practices of sedation and analgesia in our ICU setup and to assess level of sedation and analgesia to know the requirement of sedative and analgesics in mechani-cally ventilated ICU patients. This prospective observational study was conducted on 50 consecutive mechanically ventilated patients in ICU over a period of 6 ...

  9. The Comparison of Ramsay and Richmond Scales for Intensive Care Unit Sedation, the Consistency Between Doctors and Nurses

    OpenAIRE

    2015-01-01

    Objective: Daily interruption and monitoring of sedation in intensive care unit (ICU) patients, especially in patients on mechanical ventilation, with the help of sedation scales is recommended for titration of sedative drugs. For this purpose, scales such as Richmond agitation-sedation scale (RASS) and the Ramsay sedation scale (RSS) are commonly used. Although these scales definitively describe sedation levels, perceptions and scores can differ among practitioners. The aim of this prospecti...

  10. Volatile Anesthetics. Is a New Player Emerging in Critical Care Sedation?

    Science.gov (United States)

    Jerath, Angela; Parotto, Matteo; Wasowicz, Marcin; Ferguson, Niall D

    2016-06-01

    Volatile anesthetic agent use in the intensive care unit, aided by technological advances, has become more accessible to critical care physicians. With increasing concern over adverse patient consequences associated with our current sedation practice, there is growing interest to find non-benzodiazepine-based alternative sedatives. Research has demonstrated that volatile-based sedation may provide superior awakening and extubation times in comparison with current intravenous sedation agents (propofol and benzodiazepines). Volatile agents may possess important end-organ protective properties mediated via cytoprotective and antiinflammatory mechanisms. However, like all sedatives, volatile agents are capable of deeply sedating patients, which can have respiratory depressant effects and reduce patient mobility. This review seeks to critically appraise current volatile use in critical care medicine including current research, technical consideration of their use, contraindications, areas of controversy, and proposed future research topics.

  11. Sedation versus no sedation

    DEFF Research Database (Denmark)

    Laerkner, Eva; Stroem, Thomas; Toft, Palle

    2017-01-01

    BACKGROUND: Currently there is a trend towards less or no use of sedation of mechanically ventilated patients. Still, little is known about how different sedation strategies affect relatives' satisfaction with the Intensive Care Unit (ICU). AIM: To explore if there was a difference in relatives......' personal reactions and the degree of satisfaction with information, communication, surroundings, care and treatment in the ICU between relatives of patients who receive no sedation compared with relatives of patients receiving sedation during mechanical ventilation in the ICU. METHOD: A survey study using...... in relatives' personal reactions or in the degree of satisfaction with information, communication, care and treatment in the ICU between relatives of patients in the two groups. Relatives of patients treated with no sedation felt more bothered by disturbances in the surroundings compared with relatives...

  12. Sedation in palliative care – a critical analysis of 7 years experience

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    Andres Inge

    2003-05-01

    Full Text Available Abstract Background The administration of sedatives in terminally ill patients becomes an increasingly feasible medical option in end-of-life care. However, sedation for intractable distress has raised considerable medical and ethical concerns. In our study we provide a critical analysis of seven years experience with the application of sedation in the final phase of life in our palliative care unit. Methods Medical records of 548 patients, who died in the Palliative Care Unit of GK Havelhoehe between 1995–2002, were retrospectively analysed with regard to sedation in the last 48 hrs of life. The parameters of investigation included indication, choice and kind of sedation, prevalence of intolerable symptoms, patients' requests for sedation, state of consciousness and communication abilities during sedation. Critical evaluation included a comparison of the period between 1995–1999 and 2000–2002. Results 14.6% (n = 80 of the patients in palliative care had sedation given by the intravenous route in the last 48 hrs of their life according to internal guidelines. The annual frequency to apply sedation increased continuously from 7% in 1995 to 19% in 2002. Main indications shifted from refractory control of physical symptoms (dyspnoea, gastrointestinal, pain, bleeding and agitated delirium to more psychological distress (panic-stricken fear, severe depression, refractory insomnia and other forms of affective decompensation. Patients' and relatives' requests for sedation in the final phase were significantly more frequent during the period 2000–2002. Conclusion Sedation in the terminal or final phase of life plays an increasing role in the management of intractable physical and psychological distress. Ethical concerns are raised by patients' requests and needs on the one hand, and the physicians' self-understanding on the other hand. Hence, ethically acceptable criteria and guidelines for the decision making are needed with special regard to

  13. Tracheotomy does not affect reducing sedation requirements of patients in intensive care – a retrospective study

    OpenAIRE

    Veelo, Denise P; Dongelmans, Dave A; Binnekade, Jan M; Korevaar, Johanna C; Vroom, Margreeth B; Schultz, Marcus J

    2006-01-01

    Introduction Translaryngeal intubated and ventilated patients often need sedation to treat anxiety, agitation and/or pain. Current opinion is that tracheotomy reduces sedation requirements. We determined sedation needs before and after tracheotomy of intubated and mechanically ventilated patients. Methods We performed a retrospective analysis of the use of morphine, midazolam and propofol in patients before and after tracheotomy. Results Of 1,788 patients admitted to our intensive care unit d...

  14. [Analgesia, sedation and delir – Treatment of patients in the neuro intensive care unit].

    Science.gov (United States)

    Jungk, Christine

    2015-11-01

    Analgesia and sedation of patients in the neuro intensive care unit, in particular in case of intracranial hypertension, remains a challenge even today. A goal for analgesia and sedation should be set for each individual patient (RASS -5 in case of intracranial hypertension) and should be re-evaluated repeatedly based on standardized scores (RASS plus EEG monitoring where appropriate, NCS). There are no sufficient evidence-based sedation algorithms in this patient cohort. Remifentanil, sufentanil and fentanyl have been proven safe and effective for continuous application; however, bolus application should be avoided. (S-)Ketamin can be considered safe when mechanical ventilation and sedation with GABA receptor agonists are applied. Propofol and benzodiazepines are equally safe and effective with shorter wake up times for propofol. The use of barbitarutes is restricted to intractable intracranial hypertension or status epilepicus. Evidence for alpha-2-adrenoceptoragonists and inhalative sedation is poor and requires further research.

  15. Combination of Midazolam and Butorphanol for Sedation for Tympanoplasty under Monitored Anaesthesia Care

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    Vinay Dhakate

    2016-01-01

    Full Text Available Background: Tympanoplasty is routinely done under local anaesthesia with sedation due to various advantages. Systemic analgesics and sedatives are generally given to improve the patient comfort. Aim & Objectives: To determine the effectiveness of combination of midazolam and butorphanol for sedation and to assess the sedation technique using midazolam and butorphanol for tympanoplasty under monitored anaesthesia care. Material and Methods: One hundred patients scheduled for tympanoplasty under local anaesthesia were given bolus doses of intravenous midazolam 0.03 mg/kg and butorphanol 0.03 mg/kg followed by midazolam infusion at 0.01 mg/kg/hr. If required, additional bolus doses of 0.01 mg/kg of both midazolam and butorphanol were given to achieve desired sedation and analgesia. The total dosage of midazolam and butorphanol, vital parameters, sedation score using Ramsay sedation score, pain score and surgeon satisfaction score using Numeric rating scale were recorded. Results: Ninety nine patients underwent tympanoplasty satisfactorily with sedation technique. Only one patient needed conversion to general anaesthesia. The mean duration of surgery was 92.7±8.16 minutes. The total midazolam and butorphanol dosages were 2.45±0.233 mg and 1.65±0.179 mg respectively. The desired Ramsay Sedation Score (RSS of 3 and pain score Numerical Rating Scale (NRS = 2.82±0.72 were achieved within 4-8 minutes. No side effects of excessive sedation were observed. Conclusion: Combined use of midazolam and butorphanol in low doses produces adequate sedation for tympanoplasty under local anaesthesia without serious adverse effects.

  16. Assessment of Sedation and Analgesia in Mechanically Ventilated Patients in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Udita Naithani

    2008-01-01

    Full Text Available Post traumatic stress resulting from an intensive care unit(ICU stay may be prevented by adequate level of sedation and analgesia. Aims of the study were reviewing the current practices of sedation and analgesia in our ICU setup and to assess level of sedation and analgesia to know the requirement of sedative and analgesics in mechani-cally ventilated ICU patients. This prospective observational study was conducted on 50 consecutive mechanically ventilated patients in ICU over a period of 6 months. Patient′s sedation level was assessed by Ramsay Sedation Scale (RSS = 1 : Agitated; 2,3 : Comfortable; 4,5,6 : Sedated and pain intensity by Behavioural Pain Scale (BPS = 3 :No pain, to 16 : Maximum pain. BPS, mean arterial pressure(MAP and heart rate(HR were assessed before and after painful stimulus (tracheal suction. Although no patient had received sedative and analgesics, mean Ramsay score was 3.52±1.92 with 30% patients categorized as ′agitated′, 12% as ′comfortable′ and 58% as ′sedated′ because of depressed consciousness level. Mean BPS at rest was 4.30±1.28 revealing background pain that further increased to 6.18±1.88 after painful stimulus. There was significant rise in HR (10.30%, MAP (7.56% and BPS (40.86% after painful stimulus, P< 0.0001. The correlation between BPS and Ramsay Score was negative and significant (P< 0.01. We conclude that there should be regular definition of the appropriate level of sedation and analgesia as well as monitoring of the desired level, using sedation and pain scales as a part of the total care for mechanically ventilated patients.

  17. Consensus guidelines on analgesia and sedation in dying intensive care unit patients

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    Lemieux-Charles Louise

    2002-08-01

    Full Text Available Abstract Background Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. Methods Using the Delphi technique, panelists rated levels of agreement with statements describing how analgesics and sedatives should be given to dying ICU patients and how palliative care should be distinguished from euthanasia. Participants were drawn from 3 panels: 1 Canadian Academic Adult Intensive Care Fellowship program directors and Intensive Care division chiefs (N = 9; 2 Deputy chief provincial coroners (N = 5; 3 Validation panel of Intensivists attending the Canadian Critical Care Trials Group meeting (N = 12. Results After three Delphi rounds, consensus was achieved on 16 statements encompassing the role of palliative care in the intensive care unit, the management of pain and suffering, current areas of controversy, and ways of improving palliative care in the ICU. Conclusion Consensus guidelines were developed to guide the administration of analgesics and sedatives to dying ICU patients and to help distinguish palliative care from euthanasia.

  18. COMPARISON OF DEXMEDETOMIDINE WITH FENTANYL FOR SEDATION IN TYMPANOPLASTY (ENT SURGERIES DONE UNDER MONITORED ANAESTHESIA CARE

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    Illendula

    2016-02-01

    Full Text Available INTRODUCTION Monitored anaesthesia care involves administering a combination of drugs for anxiolytic, hypnotic, amnestic and analgesic effect. Ideally it should result in less physiological disturbance and allow for more rapid recovery than general anaesthesia. It typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and analgesic drugs which is a common practice during various ENT surgical procedures. AIM OF STUDY Is to “Compare Dexmedetomidine with Fentanyl for sedation in tympanoplasty (ENT Surgeries”. The objective of the study is to evaluate the efficacy of dexmedetomidine and fentanyl as an appropriate sedative drug for Monitored Anaesthesia Care in Tympanoplasty (ENT surgeries METHODS & MATERIALS A total of 60 patients are being recruited into this study with regards to assess, Pain, Discomfort, Sedation, Peripheral Oxygen Saturation (SPO2 & Systolic Blood Pressure (SBP, Diastolic blood pressure (DBP, Mean arterial blood pressure(MAP & Heart rate This study was undertaken at Govt. ENT Hospital Hyderabad. Sixty (60 patients undergoing Tympanoplasty surgery were taken for study. Thus the study contains 30 patients in Dexmedetomidine group-(Group D and 30 patients in Fentanyl group (Group F RESULT Dexmedetomidine provides less discomfort, better sedation, and analgesia when compared with fentanyl under monitored anaesthesia care (Conscious sedation. However, the risk of adverse effects requires monitoring for ready intervention. It provides a unique type of sedation, “conscious sedation” in which patients appear to be sleepy but are easily arousable, cooperative and communicative when stimulated. It is sedative and analgesic agent, with opioid-sparing properties and minimal respiratory depression.

  19. Sedative load of medications prescribed for older people with dementia in care homes

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    Stevenson Elizabeth

    2011-09-01

    Full Text Available Abstract Background The objective of this study was to determine the sedative load and use of sedative and psychotropic medications among older people with dementia living in (residential care homes. Methods Medication data were collected at baseline and at two further time-points for eligible residents of six care homes participating in the EVIDEM-End Of Life (EOL study for whom medication administration records were available. Regular medications were classified using the Anatomical Therapeutic Chemical classification system and individual sedative loads were calculated using a previously published model. Results At baseline, medication administration records were reviewed for 115 residents; medication records were reviewed for 112 and 105 residents at time-points 2 and 3 respectively. Approximately one-third of residents were not taking any medications with sedative properties at each time-point, while a significant proportion of residents had a low sedative load score of 1 or 2 (54.8%, 59.0% and 57.1% at baseline and time-points 2 and 3 respectively. More than 10% of residents had a high sedative load score (≥ 3 at baseline (12.2%, and this increased to 14.3% at time-points 2 and 3. Approximately two-thirds of residents (66.9% regularly used one or more psychotropic medication(s. Antidepressants, predominantly selective serotonin re-uptake inhibitors (SSRIs, were most frequently used, while antipsychotics, hypnotics and anxiolytics were less routinely administered. The prevalence of antipsychotic use among residents was 19.0%, lower than has been previously reported for nursing home residents. Throughout the duration of the study, administration of medications recognised as having prominent sedative adverse effects and/or containing sedative components outweighed the regular use of primary sedatives. Conclusions Sedative load scores were similar throughout the study period for residents with dementia in each of the care homes. Scores were

  20. Nurses' experiences of caring for critically ill, non-sedated, mechanically ventilated patients in the Intensive Care Unit

    DEFF Research Database (Denmark)

    Laerkner, Eva; Egerod, Ingrid; Hansen, Helle Ploug

    2015-01-01

    OBJECTIVE: The objective was to explore nurses' experiences of caring for non-sedated, critically ill patients requiring mechanical ventilation. DESIGN AND SETTING: The study had a qualitative explorative design and was based on 13 months of fieldwork in two intensive care units in Denmark where...... a protocol of no sedation is implemented. Data were generated during participant observation in practice and by interviews with 16 nurses. Data were analysed using thematic interpretive description. FINDINGS: An overall theme emerged: "Demanding, yet rewarding". The demanding aspects of caring for more awake...... closeness. CONCLUSION: Despite the complexity of care, nurses preferred to care for more awake rather than sedated patients and appreciated caring for just one patient at a time. The importance of close collaboration between nurses and doctors to ensure patient comfort during mechanical ventilation...

  1. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients.

    Science.gov (United States)

    Sessler, Curtis N; Gosnell, Mark S; Grap, Mary Jo; Brophy, Gretchen M; O'Neal, Pam V; Keane, Kimberly A; Tesoro, Eljim P; Elswick, R K

    2002-11-15

    Sedative medications are widely used in intensive care unit (ICU) patients. Structured assessment of sedation and agitation is useful to titrate sedative medications and to evaluate agitated behavior, yet existing sedation scales have limitations. We measured inter-rater reliability and validity of a new 10-level (+4 "combative" to -5 "unarousable") scale, the Richmond Agitation-Sedation Scale (RASS), in two phases. In phase 1, we demonstrated excellent (r = 0.956, lower 90% confidence limit = 0.948; kappa = 0.73, 95% confidence interval = 0.71, 0.75) inter-rater reliability among five investigators (two physicians, two nurses, and one pharmacist) in adult ICU patient encounters (n = 192). Robust inter-rater reliability (r = 0.922-0.983) (kappa = 0.64-0.82) was demonstrated for patients from medical, surgical, cardiac surgery, coronary, and neuroscience ICUs, patients with and without mechanical ventilation, and patients with and without sedative medications. In validity testing, RASS correlated highly (r = 0.93) with a visual analog scale anchored by "combative" and "unresponsive," including all patient subgroups (r = 0.84-0.98). In the second phase, after implementation of RASS in our medical ICU, inter-rater reliability between a nurse educator and 27 RASS-trained bedside nurses in 101 patient encounters was high (r = 0.964, lower 90% confidence limit = 0.950; kappa = 0.80, 95% confidence interval = 0.69, 0.90) and very good for all subgroups (r = 0.773-0.970, kappa = 0.66-0.89). Correlations between RASS and the Ramsay sedation scale (r = -0.78) and the Sedation Agitation Scale (r = 0.78) confirmed validity. Our nurses described RASS as logical, easy to administer, and readily recalled. RASS has high reliability and validity in medical and surgical, ventilated and nonventilated, and sedated and nonsedated adult ICU patients.

  2. Closed-loop control for cardiopulmonary management and intensive care unit sedation using digital imaging

    Science.gov (United States)

    Gholami, Behnood

    This dissertation introduces a new problem in the delivery of healthcare, which could result in lower cost and a higher quality of medical care as compared to the current healthcare practice. In particular, a framework is developed for sedation and cardiopulmonary management for patients in the intensive care unit. A method is introduced to automatically detect pain and agitation in nonverbal patients, specifically in sedated patients in the intensive care unit, using their facial expressions. Furthermore, deterministic as well as probabilistic expert systems are developed to suggest the appropriate drug dose based on patient sedation level. Patients in the intensive care unit who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. The need for sedation arises both from patient anxiety due to the loss of personal control and the unfamiliar and intrusive environment of the intensive care unit, and also due to pain or other variants of noxious stimuli. In this dissertation, we develop a rule-based expert system for cardiopulmonary management and intensive care unit sedation. Furthermore, we use probability theory to quantify uncertainty and to extend the proposed rule-based expert system to deal with more realistic situations. Pain assessment in patients who are unable to verbally communicate is a challenging problem. The fundamental limitations in pain assessment stem from subjective assessment criteria, rather than quantifiable, measurable data. The relevance vector machine (RVM) classification technique is a Bayesian extension of the support vector machine (SVM) algorithm which achieves comparable performance to SVM while providing posterior probabilities for class memberships and a sparser model. In this dissertation, we use the RVM classification technique to distinguish pain from non-pain as well as assess pain intensity levels. We also correlate our results with the pain intensity

  3. Evaluating and monitoring analgesia and sedation in the intensive care unit.

    Science.gov (United States)

    Sessler, Curtis N; Grap, Mary Jo; Ramsay, Michael Ae

    2008-01-01

    Management of analgesia and sedation in the intensive care unit requires evaluation and monitoring of key parameters in order to detect and quantify pain and agitation, and to quantify sedation. The routine use of subjective scales for pain, agitation, and sedation promotes more effective management, including patient-focused titration of medications to specific end-points. The need for frequent measurement reflects the dynamic nature of pain, agitation, and sedation, which change constantly in critically ill patients. Further, close monitoring promotes repeated evaluation of response to therapy, thus helping to avoid over-sedation and to eliminate pain and agitation. Pain assessment tools include self-report (often using a numeric pain scale) for communicative patients and pain scales that incorporate observed behaviors and physiologic measures for noncommunicative patients. Some of these tools have undergone validity testing but more work is needed. Sedation-agitation scales can be used to identify and quantify agitation, and to grade the depth of sedation. Some scales incorporate a step-wise assessment of response to increasingly noxious stimuli and a brief assessment of cognition to define levels of consciousness; these tools can often be quickly performed and easily recalled. Many of the sedation-agitation scales have been extensively tested for inter-rater reliability and validated against a variety of parameters. Objective measurement of indicators of consciousness and brain function, such as with processed electroencephalography signals, holds considerable promise, but has not achieved widespread implementation. Further clarification of the roles of these tools, particularly within the context of patient safety, is needed, as is further technology development to eliminate artifacts and investigation to demonstrate added value.

  4. Tracheotomy does not affect reducing sedation requirements of patients in intensive care – a retrospective study

    Science.gov (United States)

    Veelo, Denise P; Dongelmans, Dave A; Binnekade, Jan M; Korevaar, Johanna C; Vroom, Margreeth B; Schultz, Marcus J

    2006-01-01

    Introduction Translaryngeal intubated and ventilated patients often need sedation to treat anxiety, agitation and/or pain. Current opinion is that tracheotomy reduces sedation requirements. We determined sedation needs before and after tracheotomy of intubated and mechanically ventilated patients. Methods We performed a retrospective analysis of the use of morphine, midazolam and propofol in patients before and after tracheotomy. Results Of 1,788 patients admitted to our intensive care unit during the study period, 129 (7%) were tracheotomized. After the exclusion of patients who received a tracheotomy before or at the day of admittance, 117 patients were left for analysis. The daily dose (DD; the amount of sedatives for each day) divided by the mean daily dose (MDD; the mean amount of sedatives per day for the study period) in the week before and the week after tracheotomy was 1.07 ± 0.93 DD/MDD versus 0.30 ± 0.65 for morphine, 0.84 ± 1.03 versus 0.11 ± 0.46 for midazolam, and 0.62 ± 1.05 versus 0.15 ± 0.45 for propofol (p < 0.01). However, when we focused on a shorter time interval (two days before and after tracheotomy), there were no differences in prescribed doses of morphine and midazolam. Studying the course in DD/MDD from seven days before the placement of tracheotomy, we found a significant decline in dosage. From day -7 to day -1, morphine dosage (DD/MDD) declined by 3.34 (95% confidence interval -1.61 to -6.24), midazolam dosage by 2.95 (-1.49 to -5.29) and propofol dosage by 1.05 (-0.41 to -2.01). After tracheotomy, no further decrease in DD/MDD was observed and the dosage remained stable for all sedatives. Patients in the non-surgical and acute surgical groups received higher dosages of midazolam than patients in the elective surgical group. Time until tracheotomy did not influence sedation requirements. In addition, there was no significant difference in sedation between different patient groups. Conclusion In our intensive care unit, sedation

  5. Use of propofol and other nonbenzodiazepine sedatives in the intensive care unit.

    Science.gov (United States)

    Angelini, G; Ketzler, J T; Coursin, D B

    2001-10-01

    Sedatives continue to be used on a routine basis in critically ill patients. Although many agents are available and some approach an ideal, none are perfect. Patients require continuous reassessment of their pain and need for sedation. Pathophysiologic abnormalities that cause agitation, confusion, or delirium must be identified and treated before unilateral administration of potent sedative agents that may mask potentially lethal insufficiencies. The routine use of standardized and validated sedation scales and monitors is needed. It is hoped that reliable objective monitors of patients' level of consciousness and comfort will be forthcoming. Each sedative agent discussed in this article seems to have a place in the ICU pharmacologic armamentarium to ensure the safe and comfortable delivery of care. Etomidate is an attractive agent for short-term use to provide the rapid onset and offset of sedation in critically ill patients who are at risk for hemodynamic instability but seem to need sedation or anesthesia to perform a procedure or manipulate the airway. Ketamine administered through intramuscular injection or intravenous infusion provides quick, intense analgesia and anesthesia and allows patients to tolerate limited but painful procedures. The risk/benefit ratio associated with the use of this neuroleptic agent must be weighed carefully. Ketamine is contraindicated in patients who lack normal intracranial compliance or who have significant myocardial ischemia. Barbiturates are reserved mainly to induce coma in patients at risk for severe CNS ischemia, which frequently is associated with refractory intracranial hypertension, or in patients with status epilepticus. When administered in high doses, these drugs have prolonged sedative and depressant effects. Judicious hemodynamic monitoring is required when barbiturate coma is induced. Haloperidol is indicated in the treatment of delirium. Patients should be monitored for extrapyramidal side effects and, when they

  6. Sedation and analgesia in the pediatric intensive care unit.

    Science.gov (United States)

    Tobias, Joseph D

    2005-08-01

    Various clinical situations may arise in the PICU that necessitate the use of sedation, analgesia, or both. Although there is a large clinical experience with midazolam in the PICU population and it remains the most commonly used benzodiazepine in this setting, lorazepam may provide an effective alternative, with a longer half-life and more predictable pharmacokinetics without the concern of active metabolites. However, there are limited reports regarding its use in the PICU population, and concerns exist regarding the potential for toxicity related to its diluent, propylene glycol. Although the synthetic opioid fentanyl frequently is chosen for use in the PICU setting because of its hemodynamic stability, preliminary data suggest morphine may have a slower development of tolerance and may cause fewer withdrawal symptoms than fentanyl. Morphine's safety profile includes long-term follow-up studies that have demonstrated no adverse central nervous system developmental effects from its use in neonates and infants. In the critically ill infant at risk following surgery for congenital heart disease, clinical experience supports the use of the synthetic opioids, given their ability to modulate PVR and prevent pulmonary hypertensive crisis. Alternatives to the benzodiazepines and opioids include ketamine, pentobarbital, or dexmedetomidine. Ketamine may be useful for patients with hemodynamic instability or airway reactivity. There are limited reports regarding the use of pentobarbital in the PICU, with one study raising concerns of a high incidence of adverse effects associated with its use. Propofol has gained great favor in the adult population as a means of providing deep sedation while allowing for rapid awakening; however, its routine use is not recommended because of its potential association with "propofol infusion syndrome." As the pediatric experience increases, it appears that there will be a role for newer agents such as dexmedetomidine.

  7. Relative reliability of the auditory evoked potential and Bispectral Index for monitoring sedation level in surgical intensive care patients.

    Science.gov (United States)

    Lu, C-H; Ou-Yang, H-Y; Man, K-M; Hsiao, P-C; Ho, S-T; Wong, C-S; Liaw, W-J

    2008-07-01

    Sedation is an important adjunct therapy for patients in the intensive care unit. The objective of the present study was to observe correlation between an established subjective measure, the Ramsay Sedation Scale, and two objective tools for monitoring critically ill patients: the Bispectral Index (BIS) and auditory evoked potential. Ninety patients undergoing major surgery scheduled for postoperative mechanical ventilation and continuous sedation with propofol and fentanyl were selected. Electrodes for determining BIS and auditory evoked potential were placed on the foreheads of all patients according to manufacturer's specifications at least six hours after patients' arrival at the intensive care unit. Ramsay Sedation Scale, BIS, signal quality index, composite A-line autoregressive index (AAI) and electromyographic activities were recorded every five minutes for 30 minutes. BIS and AAI showed good correlation amongst readings (r(s)=0.697, P Ramsay Sedation Scale (BIS, tau=-0.689; AAI, tau=-0.621; P Ramsay Sedation Scale. However, the BIS and auditory evoked potential monitors do not perform adequately as a substitute in the assessment of sedated intensive care unit patients. These monitors could be used as part of an integrated approach for the evaluation of those patients especially when the subjective scales do not work well in the setting of neuromuscular blockade or may not be sufficiently sensitive to evaluate very deep sedation.

  8. Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis

    Science.gov (United States)

    Zhang, Zhongheng; Chen, Kun; Ni, Hongying; Zhang, Xiaoling; Fan, Haozhe

    2017-01-01

    Sedatives are commonly used for mechanically ventilated patients in intensive care units (ICU). However, a variety of sedatives are available and their efficacy and safety have been compared in numerous trials with inconsistent results. To resolve uncertainties regarding usefulness of these sedatives, we performed a systematic review and network meta-analysis. Randomized controlled trials comparing sedatives in mechanically ventilated ICU patients were included. Graph-theoretical methods were employed for network meta-analysis. A total of 51 citations comprising 52 RCTs were included in our analysis. Dexmedetomidine showed shorter MV duration than lorazepam (mean difference (MD): 68.7; 95% CI: 18.2–119.3 hours), midazolam (MD: 10.2; 95% CI: 7.7–12.7 hours) and propofol (MD: 3.4; 95% CI: 0.9–5.9 hours). Compared with dexmedetomidine, midazolam was associated with significantly increased risk of delirium (OR: 2.47; 95% CI: 1.17–5.19). Our study shows that dexmedetomidine has potential benefits in reducing duration of MV and lowering the risk of delirium. PMID:28322337

  9. Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit

    Directory of Open Access Journals (Sweden)

    Emiliana Motta

    Full Text Available Summary Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU, in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols. Objective: Literature review on the main aspects of analgesia and sedation, abstinence syndrome, and delirium in the pediatric intensive care unit, in order to show the importance of the use of protocols on the management of critically ill patients. Method: Articles published in the past 16 years on PubMed, Lilacs, and the Cochrane Library, with the terms analgesia, sedation, abstinence syndrome, mild sedation, daily interruption, and intensive care unit. Results: Seventy-six articles considered relevant were selected to describe the importance of using a protocol of sedation and analgesia. They recommended mild sedation and the use of assessment scales, daily interruptions, and spontaneous breathing test. These measures shorten the time of mechanical ventilation, as well as length of hospital stay, and help to control abstinence and delirium, without increasing the risk of morbidity and morbidity. Conclusion: Despite the lack of controlled and randomized clinical trials in the pediatric setting, the use of protocols, optimizing mild sedation, leads to decreased morbidity.

  10. Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia

    Science.gov (United States)

    Soh, Tze Ling Gwendoline Beatrice; Krishna, Lalit Kumar Radha; Sim, Shin Wei; Yee, Alethea Chung Peng

    2016-01-01

    Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively ‘dead’. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma’s position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death. PMID:27211055

  11. Clinical Decision Support and Closed-Loop Control for Cardiopulmonary Management and Intensive Care Unit Sedation Using Expert Systems.

    Science.gov (United States)

    Gholami, Behnood; Bailey, James M; Haddad, Wassim M; Tannenbaum, Allen R

    2012-03-01

    Patients in the intensive care unit (ICU) who require mechanical ventilation due to acute respiratory failure also frequently require the administration of sedative agents. The need for sedation arises both from patient anxiety due to the loss of personal control and the unfamiliar and intrusive environment of the ICU, and also due to pain or other variants of noxious stimuli. While physicians select the agent(s) used for sedation and cardiovascular function, the actual administration of these agents is the responsibility of the nursing staff. If clinical decision support systems and closed-loop control systems could be developed for critical care monitoring and lifesaving interventions as well as the administration of sedation and cardiopulmonary management, the ICU nurse could be released from the intense monitoring of sedation, allowing her/him to focus on other critical tasks. One particularly attractive strategy is to utilize the knowledge and experience of skilled clinicians, capturing explicitly the rules expert clinicians use to decide on how to titrate drug doses depending on the level of sedation. In this paper, we extend the deterministic rule-based expert system for cardiopulmonary management and ICU sedation framework presented in [1] to a stochastic setting by using probability theory to quantify uncertainty and hence deal with more realistic clinical situations.

  12. Danish national sedation strategy. Targeted therapy of discomfort associated with critical illness. Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM)

    DEFF Research Database (Denmark)

    Fonsmark, Lise; Hein, Lars; Nibroe, Helle;

    2015-01-01

    Sedation of critically ill patients undergoing mechanical ventilation should be minimized or completely avoided. Only in selected situations is sedation indicated as first line therapy (increased intracranial pressure or therapeutic hypothermia). The critical care physicians primary objective sho...

  13. Delirium and Sedation in the Intensive Care Unit (ICU): survey of behaviors and attitudes of 1,384 healthcare professionals

    Science.gov (United States)

    Patel, RP; Gambrell, M; Speroff, T; Scott, TA; Pun, BT; Okahashi, J; Strength, C; Pandharipande, P; Girard, TD; Burgess, H; Dittus, RS; Bernard, GR; Ely, EW

    2013-01-01

    Objective A 2001 survey found that most healthcare professionals considered ICU delirium as a serious problem, but only 16% used a validated delirium screening tool. Our objective was to assess beliefs and practices regarding ICU delirium and sedation management. Design and Setting Between October 2006 and May 2007, a survey was distributed to ICU practitioners in 41 North American hospitals, 7 international critical care meetings and courses, and the American Thoracic Society email database Study Participants A convenience sample of 1,384 health care professionals including 970 physicians, 322 nurses, 23 respiratory care practitioners, 26 pharmacists, 18 nurse practitioners and physicians’ assistants, and 25 others. Results A majority [59% (766/1300)] estimated that over 1 in 4 adult mechanically ventilated patients experience delirium. Over half [59% (774/1302)] screen for delirium, with 33% of those respondents (258/774) using a specific screening tool. A majority of respondents use a sedation protocol, but 29% (396/1355) still do not. A majority (76%, 990/1309) has a written policy on spontaneous awakening trials (SATs), but the minority of respondents (44%, 446/1019) practice SATs on more than half of ICU days. Conclusions Delirium is considered a serious problem by a majority of healthcare professionals, and the percent of practitioners using a specific screening tool has increased since the last published survey data. While most respondents have adopted specific sedation protocols and have an approved approach to stopping sedation daily, few report even modest compliance with daily cessation of sedation. PMID:19237884

  14. The Comparison of Ramsay and Richmond Scales for Intensive Care Unit Sedation, the Consistency Between Doctors and Nurses

    Directory of Open Access Journals (Sweden)

    Aslı Hepkarşı

    2015-12-01

    Full Text Available Objective: Daily interruption and monitoring of sedation in intensive care unit (ICU patients, especially in patients on mechanical ventilation, with the help of sedation scales is recommended for titration of sedative drugs. For this purpose, scales such as Richmond agitation-sedation scale (RASS and the Ramsay sedation scale (RSS are commonly used. Although these scales definitively describe sedation levels, perceptions and scores can differ among practitioners. The aim of this prospective observational study was to evaluate these subjective assessments and the consistency between nurses, residents and specialists, and to evaluate the degree of ease of these scales. Material and Method: After ethic committee approval, a single-center prospective observational study was planned; 128 adult patients, who were conscious, and had no motor and sensory defects, were included in the study. Each patient was evaluated with the RASS and RSS scales by nurses, residents and specialists simultaneously and the scores and ease of scale were recorded in such a way which did not allow the participants to see each other. Data was analyzed by the medical informatics and statistics department of the university and the Weighted Kappa values between practitioners were measured. Results: A total of 482 observations were made from the 128 patients included in the study. Practitioners evaluated both sedation scales simultaneously. Upon comparison of the practitioners’ scale values, the consistency between the matching observation numbers showed a Weighted Kappa value between 0.71-0.77, which was found to be statistically significant and the consistency between participants was classified as “good”. The degree of ease of application for both scales was found to be “very easy”. Conclusion: This study reveals a correlation between RASS and RSS scores between practitioners with different educational levels. The implementation of both scales was found

  15. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care--short version.

    OpenAIRE

    Kleinschmidt, Stefan; Koppert, Wolfgang; Kessler, Paul; Huth, Ralf; Hartl, Wolfgang; Haase, Ulrike; Garten, Lars; Engelmann, Lothar; Eichler, Ingolf; Eggers, Verena; Dictus, Christine; Dall, Peter; Bürkle, Hartmut; Biniek, Rolf; Bäsell, Katrin

    2010-01-01

    Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2nd Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to hav...

  16. Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists.

    Directory of Open Access Journals (Sweden)

    Alawi Luetz

    Full Text Available Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1 and 868 patients (part 2 were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%. In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524 and approved by the ethical committee.

  17. Pediatric Sedation: A Global Challenge

    Directory of Open Access Journals (Sweden)

    David Gozal

    2010-01-01

    Full Text Available Pediatric sedation is a challenge which spans all continents and has grown to encompass specialties outside of anesthesia, radiology and emergency medicine. All sedatives are not universally available and local and national regulations often limit the sedation practice to specific agents and those with specific credentials. Some specialties have established certification and credentials for sedation delivery whereas most have not. Some of the relevant sedation guidelines and recommendations of specialty organizations worldwide will be explored. The challenge facing sedation care providers moving forward in the 21st century will be to determine how to apply the local, regional and national guidelines to the individual sedation practices. A greater challenge, perhaps impossible, will be to determine whether the sedation community can come together worldwide to develop standards, guidelines and recommendations for safe sedation practice.

  18. Addressing Palliative Sedation during Expert Consultation: A Descriptive Analysis of the Practice of Dutch Palliative Care Consultation Teams.

    Directory of Open Access Journals (Sweden)

    Patrick Hoek

    Full Text Available Since palliative sedation is considered a complex intervention, consultation teams are increasingly established to support general practice. This study aims to offer insight into the frequency and characteristics of expert consultations regarding palliative sedation.We performed a retrospective analysis of a longitudinal database. This database contained all patient-related consultations by Dutch Palliative Care Consultation teams, that were requested between 2004 and 2011. We described the frequency and characteristics of these consultations, in particular of the subgroup of consultations in which palliative sedation was addressed (i.e. PSa consultations. We used multivariate regression analysis to explore consultation characteristics associated with a higher likelihood of PSa consultations.Of the 44,443 initial consultations, most were requested by general practitioners (73% and most concerned patients with cancer (86%. Palliative sedation was addressed in 18.1% of all consultations. Palliative sedation was relatively more often discussed during consultations for patients with a neurologic disease (OR 1.79; 95% CI: 1.51-2.12 or COPD (OR 1.39; 95% CI: 1.15-1.69 than for patients with cancer. We observed a higher likelihood of PSa consultations if the following topics were also addressed during consultation: dyspnoea (OR 1.30; 95% CI: 1.22-1.40, agitation/delirium (OR 1.57; 95% CI: 1.47-1.68, exhaustion (OR 2.89; 95% CI: 2.61-3.20, euthanasia-related questions (OR 2.65; 95% CI: 2.37-2.96 or existential issues (OR 1.55; 95% CI: 1.31-1.83.In conclusion, PSa consultations accounted for almost one-fifth of all expert consultations and were associated with several case-related characteristics. These characteristics may help clinicians in identifying patients at risk for a more complex disease trajectory at the end of life.

  19. Current practices of mobilization, analgesia, relaxants and sedation in Indian ICUs: A survey conducted by the Indian Society of Critical Care Medicine

    Directory of Open Access Journals (Sweden)

    Rajesh Chawla

    2014-01-01

    Full Text Available Background and Aim: Use of sedation, analgesia and neuromuscular blocking agents is widely practiced in Intensive Care Units (ICUs. Our aim is to study the current practice patterns related to mobilization, analgesia, relaxants and sedation (MARS to help in standardizing best practices in these areas in the ICU. Materials and Methods: A web-based nationwide survey involving physicians of the Indian Society of Critical Care Medicine (ISCCM and the Indian Society of Anesthesiologists (ISA was carried out. A questionnaire included questions on demographics, assessment scales for delirium, sedation and pain, as also the pharmacological agents and the practice methods. Results: Most ICUs function in a semi-closed model. Midazolam (94.99% and Fentanyl (47.04% were the most common sedative and analgesic agents used, respectively. Vecuronium was the preferred neuromuscular agent. Monitoring of sedation, analgesia and delirium in the ICU. Ramsay′s Sedation Scale (56.1% and Visual Analogue Scale (48.07% were the preferred sedation and pain scales, respectively. CAM (Confusion Assessment Method-ICU was the most preferred method of delirium assessment. Haloperidol was the most commonly used agent for delirium. Majority of the respondents were aware of the benefit of early mobilization, but lack of support staff and safety concerns were the main obstacles to its implementation. Conclusion: The results of the survey suggest that compliance with existing guidelines is low. Benzodiazepines still remain the predominant ICU sedative. The recommended practice of giving analgesia before sedation is almost non-existent. Delirium remains an underrecognized entity. Monitoring of sedation levels, analgesia and delirium is low and validated and recommended scales for the same are rarely used. Although awareness of the benefits of early mobilization are high, the implementation is low.

  20. Application of sedation in pediatric intensive care unit%镇静在儿科重症监护病房的应用

    Institute of Scientific and Technical Information of China (English)

    房军臣

    2012-01-01

    镇静在危重患儿的治疗过程中已越来越受到重视,也普遍应用于临床.各种镇静药物及其使用方法、镇静水平的评估、镇静风险的防治等都有不同的文献报道.目前苯二氮(革)类是镇静的主要药物,咪达唑仑静脉维持是常用的镇静方法,Rasmay评分、舒适量表评分和脑电双频指数常用于评价镇静水平,良好的镇静评估和心电呼吸监护是防治镇静风险的关键.%Sedation has been paid more and more attention in the treatment of critically ill children,and applied in clinical commonly.There are different reports in the literature about all kinds of sedation drug and method of use,Ramesay,prevention and control of the sedation risk.At present,benzodiazepines are the main sedation drug and constant intravenous infusion of midazolam is the commonly used method of sedation.Rasmay,Comfort scale and bispectral index are used in assessing sedation commonly.Sedation assessment and Ecg respiratory care is the key to prevent and control sedation risk.

  1. Update on dexmedetomidine: use in nonintubated patients requiring sedation for surgical procedures

    Directory of Open Access Journals (Sweden)

    Mohanad Shukry

    2010-03-01

    Full Text Available Mohanad Shukry, Jeffrey A MillerUniversity of Oklahoma Health Sciences Center, Department of Anesthesiology, Children’s Hospital of Oklahoma, Oklahoma City, OK, USAAbstract: Dexmedetomidine was introduced two decades ago as a sedative and supplement to sedation in the intensive care unit for patients whose trachea was intubated. However, since that time dexmedetomidine has been commonly used as a sedative and hypnotic for patients undergoing procedures without the need for tracheal intubation. This review focuses on the application of dexmedetomidine as a sedative and/or total anesthetic in patients undergoing procedures without the need for tracheal intubation. Dexmedetomidine was used for sedation in monitored anesthesia care (MAC, airway procedures including fiberoptic bronchoscopy, dental procedures, ophthalmological procedures, head and neck procedures, neurosurgery, and vascular surgery. Additionally, dexmedetomidine was used for the sedation of pediatric patients undergoing different type of procedures such as cardiac catheterization and magnetic resonance imaging. Dexmedetomidine loading dose ranged from 0.5 to 5 μg kg-1, and infusion dose ranged from 0.2 to 10 μg kg-1 h-1. Dexmedetomidine was administered in conjunction with local anesthesia and/or other sedatives. Ketamine was administered with dexmedetomidine and opposed its bradycardiac effects. Dexmedetomidine may by useful in patients needing sedation without tracheal intubation. The literature suggests potential use of dexmedetomidine solely or as an adjunctive agent to other sedation agents. Dexmedetomidine was especially useful when spontaneous breathing was essential such as in procedures on the airway, or when sudden awakening from sedation was required such as for cooperative clinical examination during craniotomies.Keywords: dexmedetomidine, sedation, nonintubated patients

  2. Development, dissemination and implementation of a sedation and analgesic guideline in a pediatric intensive care unit...it takes creativity and collaboration.

    Science.gov (United States)

    Thomas, Margot; Dhanani, Sonny; Irwin, Danica; Writer, Hilary; Doherty, Dermot

    2010-01-01

    Sedation and analgesia are administered to critically ill children to provide comfort and pain relief, decrease anxiety and to promote patient safety in relation to life-saving treatments. A comprehensive practice guideline focused on ways to implement evidence-based sedation and analgesia practices was developed, disseminated and implemented by an interprofessional team in the pediatric intensive care unit (PICU) at the Children's Hospital of Eastern Ontario (CHEO) in Ottawa, Canada. The goals of this quality of care initiative were to (1) reduce inconsistent practices, (2) improve patient outcomes related to comfort, and (3) enhance collaboration among health care team members caring for critically ill children. An evidence-based sedation and analgesia management (SAM) guideline for critically ill, intubated and ventilated infants and children was developed over a six-month period by a team composed of PICU physicians, pharmacists and nurses. The quality of patient care initiative focused on consistent use of (a) validated sedation and analgesia assessment tools, (b) a goal-directed approach by identifying daily therapeutic target scores and titrating interventions accordingly, and (c) non-pharmacologic, pharmacologic and adjunctive measures. The authors describe their experience in the development, dissemination and implementation of an interprofessional guideline directed at improving sedation and analgesia and patient safety in the PICU. Tools developed to support the practice change, challenges and lessons learned are shared.

  3. Sedation practice in Nordic and non-Nordic ICUs

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Albarran, John W.; Ring, Mette;

    2013-01-01

    A trend towards lighter sedation has been evident in many intensive care units (ICUs). The aims of the survey were to describe sedation practice in European ICUs and to compare sedation practice in Nordic and non-Nordic countries....

  4. Mac Bible

    CERN Document Server

    Spivey, Dwight

    2009-01-01

    This essential guide answers all your questions on using a Macintosh computer, whether you?re unpacking your very first Mac after switching from a PC or upgrading from an older Mac. You?ll walk through all pre-installed Mac applications, including using Mac OS X, browsing the Web using Safari, downloading music from the iTunes store, troubleshooting Mac-specific problems, organizing photos in iPhoto, organizing calendars in iCal, editing digital video in iMovie, and more.

  5. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version

    OpenAIRE

    DAS-Taskforce 2015; Baron, Ralf; Binder, Andreas; Biniek, Rolf; Braune, Stephan; Buerkle, Hartmut; Dall, Peter; Demirakca, Sueha; Eckardt, Rahel; Eggers, Verena; Eichler, Ingolf; Fietze, Ingo; Freys, Stephan; Fründ, Andreas; Garten, Lars

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the "Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care". Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from th...

  6. The perspectives of clinical staff and bereaved informal care-givers on the use of continuous sedation until death for cancer patients: The study protocol of the UNBIASED study

    Directory of Open Access Journals (Sweden)

    van der Heide Agnes

    2011-03-01

    Full Text Available Abstract Background A significant minority of dying people experience refractory symptoms or extreme distress unresponsive to conventional therapies. In such circumstances, sedation may be used to decrease or remove consciousness until death occurs. This practice is described in a variety of ways, including: 'palliative sedation', 'terminal sedation', 'continuous deep sedation until death', 'proportionate sedation' or 'palliative sedation to unconsciousness'. Surveys show large unexplained variation in incidence of sedation at the end of life across countries and care settings and there are ethical concerns about the use, intentions, risks and significance of the practice in palliative care. There are also questions about how to explain international variation in the use of the practice. This protocol relates to the UNBIASED study (UK Netherlands Belgium International Sedation Study, which comprises three linked studies with separate funding sources in the UK, Belgium and the Netherlands. The aims of the study are to explore decision-making surrounding the application of continuous sedation until death in contemporary clinical practice, and to understand the experiences of clinical staff and decedents' informal care-givers of the use of continuous sedation until death and their perceptions of its contribution to the dying process. The UNBIASED study is part of the European Association for Palliative Care Research Network. Methods/Design To realize the study aims, a two-phase study has been designed. The study settings include: the domestic home, hospital and expert palliative care sites. Phase 1 consists of: a focus groups with health care staff and bereaved informal care-givers; and b a preliminary case notes review to study the range of sedation therapy provided at the end of life to cancer patients who died within a 12 week period. Phase 2 employs qualitative methods to develop 30 patient-centred case studies in each country. These involve

  7. MacBook for dummies

    CERN Document Server

    Chambers , Mark L

    2014-01-01

    Make friends with your MacBook the fun and easy way! Ultra-light, ultra-fast, and ultra-powerful, the MacBook is the coolest laptop in town, and longtime Mac guru Mark L. Chambers is just the guy to help you get to know your MacBook in no time. Take a closer look at the latest features, get the lowdown on OS X, unleash your creative forces with iLife, take care of business with the iWork applications, and sync it all with iCloud with the expert advice in this bestselling MacBook guide. Whether this is your first MacBook or your first laptop, period, you''ll learn to navigate the Mac desktop, c

  8. The application of monitored anesthesia care (MAC) in vitreoretinal surgery%监护麻醉管理在眼科玻璃体视网膜手术中的应用

    Institute of Scientific and Technical Information of China (English)

    孙建娣; 任传路

    2011-01-01

    Objective To evaluate the application of monitored anesthesia care ( MAC ) in vitreoretinal surgery. Methods Monitored anesthesia care ( MAC ) with midazolam, fentanyl and propofol was performed in 60 ASA Ⅰ orⅡ patients in vitreoretinal surgery. With regular monitoring of SpO2 , RR, BP and ECG , sedation depth was made in accordance with Ramsay scores by the incidence of RR < 8 bpm lasting over 60 sec or SpO2 < 90% lasting over 30 sec or HR <50 bpm or body movement response. Postoperative symptoms as nausea and vomiting in patients were recorded and their satisfaction after surgery was also assessed. Results During MAC management procedure, BP remained stable, the incidence rates of HR<50 bpm, RR < 8 bpm lasting over 60 sec and SpO2 < 90% lasting over 30 sec were 1.7%( 1/60 ), 3.3%( 2/60 ) and 5% ( 3/60 ) respectively. Body movement occurred in 6 patients during the process of surgery, and 2 female patients had symptoms of postoperative nausea and vomiting. Postoperative satisfaction scores were ( 2.4 ± 0. 6 ) min. Conclusion MAC with midazolam, fentanyl and propofol can be safely and effectively used in vitreoretinal surgery with high satisfaction of patients by lightening or relieving anxiety and fearful pain and other nociceptive stimulus in patients.%目的 探讨监护麻醉管理(MAC)在眼科玻璃体视网膜手术中的应用.方法 60例美国麻醉师协会(ASA)分级Ⅰ、Ⅱ级眼科玻璃体视网膜手术患者使用咪达唑仑、芬太尼、丙泊酚行MAC,术中所有患者中常规作血氧饱和度(SpO2)、呼吸、无创血压和心电图监测,行镇静深度评分,工具为睡眠障碍镇静评分标准(Ramsay评分);记录SpO2<90%超过30 s 、呼吸频率(RR)<8 bpm超过60 s、血压(BP)<80/50 mmHg、心率(HR)<50 bpm的发生率以及术中的体动反应,观察围麻醉期恶心、呕吐发生率,术后患者满意度评估.结果 MAC过程中BP平稳,HR<50 bpm超过30 s发生率为1.7%(1/60),RR低于8 bpm超过60 s的发生率为3

  9. The Impact of High Versus Low Sedation Dosing Strategy on Cognitive Dysfunction in Survivors of Intensive Care Units: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Porhomayon Jahan

    2015-06-01

    Full Text Available Background: The practice of low vs. high sedation dosing strategy may impact the cognitive and mental health function in the intensive care unit (ICU. We aim to demonstrate that high sedation strategy will result in change of mental health function in ICU patients. Methods: We performed a systemic search and meta-analysis of medical databases in MEDLINE(from 1966 to March 2013 and EMBASE (from 1980 to March 2013, as well as the Cochrane Library using the MESH terms "Intensive Care Unit," and "Mental Health, for assessing the impact of sedation on posttraumatic stress disorder (PTSD or anxiety/depression and deliriumin the mix ICU setting including cardiac surgery patients. A total of 1216 patients were includedin the final analysis.Results: We included 11 studies in the final analysis and concluded that high dose sedationstrategy resulted in higher incidence of cognitive dysfunction with P value of 0.009. Theresult for subgroup of delirium showed P = 0.11 and PTSD/depression or anxiety of P = 0.001,Heterogeneity I2 was 64%. Overall analysis was statistically significant with a P value of 0.002.Conclusion: High sedation dosing strategy will negatively affect cognitive function in criticallyill patients. Large randomized trials are needed to address cognitive dysfunction in subgroup of patients with delirium.

  10. Improving patient care through the prism of psychology: application of Maslow's hierarchy to sedation, delirium, and early mobility in the intensive care unit.

    Science.gov (United States)

    Jackson, James C; Santoro, Michael J; Ely, Taylor M; Boehm, Leanne; Kiehl, Amy L; Anderson, Lindsay S; Ely, E Wesley

    2014-06-01

    The intensive care unit (ICU) is not only a place where lives are saved; it is also a site of harm and iatrogenic injury for millions of people treated in this setting globally every year. Increasingly, hospitals admit only the sickest patients, and although the overall number of hospital beds remains stable in the United States, the percentage of that total devoted to ICU beds is rising. These 2 realities engender a demographic imperative to address patient safety in the critical care setting. This article addresses the medical community's resistance to adopting a culture of safety in critical care with regard to issues surrounding sedation, delirium, and early mobility. Although there is currently much research and quality improvement in this area, most of what we know from these data and published guidelines has not become reality in the day-to-day management of ICU patients. This article is not intended to provide a comprehensive review of the literature but rather a framework to rethink our currently outdated culture of critical care by employing Maslow's hierarchy of needs, along with a few novel analogies. Application of Maslow's hierarchy will help propel health care professionals toward comprehensive care of the whole person not merely for survival but toward restoration of pre-illness function of mind, body, and spirit.

  11. Sedation in the ICU

    DEFF Research Database (Denmark)

    Strøm, Thomas

    2012-01-01

    Standard treatment of critically ill patients undergoing mechanical ventilation is continuous sedation. This standard treatment to all patients has been greatly challenged over the last decade. At the general intensive care department at Odense University hospital the standard treatment has been ...

  12. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care – short version

    Directory of Open Access Journals (Sweden)

    Kleinschmidt, Stefan

    2010-02-01

    Full Text Available Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2nd Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%.Between 2006–2009, the existing guidelines from the DGAI (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin were developed into 3rd Generation Guidelines for the securing and optimization of quality of analgesia, sedation and delirium management in the intensive care unit (ICU. In collaboration with another 10 professional societies, the literature has been reviewed using the criteria of the Oxford Center of Evidence Based Medicine. Using data from 671 reference works, text, diagrams and recommendations were drawn up. In the recommendations, Grade “A” (very strong recommendation, Grade “B” (strong recommendation and Grade “0” (open recommendation were agreed.As a result of this process we now have an interdisciplinary and consensus-based set of 3rd Generation Guidelines that take into account all critically illness patient populations.The use of protocols for analgesia, sedation and treatment of delirium are repeatedly demonstrated. These guidelines offer treatment recommendations for the ICU team. The implementation of scores and protocols into routine ICU practice is necessary for their success.

  13. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care – short version

    Science.gov (United States)

    Martin, Jörg; Heymann, Anja; Bäsell, Katrin; Baron, Ralf; Biniek, Rolf; Bürkle, Hartmut; Dall, Peter; Dictus, Christine; Eggers, Verena; Eichler, Ingolf; Engelmann, Lothar; Garten, Lars; Hartl, Wolfgang; Haase, Ulrike; Huth, Ralf; Kessler, Paul; Kleinschmidt, Stefan; Koppert, Wolfgang; Kretz, Franz-Josef; Laubenthal, Heinz; Marggraf, Guenter; Meiser, Andreas; Neugebauer, Edmund; Neuhaus, Ulrike; Putensen, Christian; Quintel, Michael; Reske, Alexander; Roth, Bernard; Scholz, Jens; Schröder, Stefan; Schreiter, Dierk; Schüttler, Jürgen; Schwarzmann, Gerhard; Stingele, Robert; Tonner, Peter; Tränkle, Philip; Treede, Rolf Detlef; Trupkovic, Tomislav; Tryba, Michael; Wappler, Frank; Waydhas, Christian; Spies, Claudia

    2010-01-01

    Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2nd Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%). Between 2006–2009, the existing guidelines from the DGAI (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin) and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) were developed into 3rd Generation Guidelines for the securing and optimization of quality of analgesia, sedation and delirium management in the intensive care unit (ICU). In collaboration with another 10 professional societies, the literature has been reviewed using the criteria of the Oxford Center of Evidence Based Medicine. Using data from 671 reference works, text, diagrams and recommendations were drawn up. In the recommendations, Grade “A” (very strong recommendation), Grade “B” (strong recommendation) and Grade “0” (open recommendation) were agreed. As a result of this process we now have an interdisciplinary and consensus-based set of 3rd Generation Guidelines that take into account all critically illness patient populations. The use of protocols for analgesia, sedation and treatment of delirium are repeatedly demonstrated. These guidelines offer treatment recommendations for the ICU team. The implementation of scores and protocols into routine ICU practice is necessary for their success. PMID:20200655

  14. Towards computerizing intensive care sedation guidelines: design of a rule-based architecture for automated execution of clinical guidelines

    Directory of Open Access Journals (Sweden)

    Kerckhove Wannes

    2010-01-01

    Full Text Available Abstract Background Computerized ICUs rely on software services to convey the medical condition of their patients as well as assisting the staff in taking treatment decisions. Such services are useful for following clinical guidelines quickly and accurately. However, the development of services is often time-consuming and error-prone. Consequently, many care-related activities are still conducted based on manually constructed guidelines. These are often ambiguous, which leads to unnecessary variations in treatments and costs. The goal of this paper is to present a semi-automatic verification and translation framework capable of turning manually constructed diagrams into ready-to-use programs. This framework combines the strengths of the manual and service-oriented approaches while decreasing their disadvantages. The aim is to close the gap in communication between the IT and the medical domain. This leads to a less time-consuming and error-prone development phase and a shorter clinical evaluation phase. Methods A framework is proposed that semi-automatically translates a clinical guideline, expressed as an XML-based flow chart, into a Drools Rule Flow by employing semantic technologies such as ontologies and SWRL. An overview of the architecture is given and all the technology choices are thoroughly motivated. Finally, it is shown how this framework can be integrated into a service-oriented architecture (SOA. Results The applicability of the Drools Rule language to express clinical guidelines is evaluated by translating an example guideline, namely the sedation protocol used for the anaesthetization of patients, to a Drools Rule Flow and executing and deploying this Rule-based application as a part of a SOA. The results show that the performance of Drools is comparable to other technologies such as Web Services and increases with the number of decision nodes present in the Rule Flow. Most delays are introduced by loading the Rule Flows

  15. Impact of different sedation protocols and perioperative procedures on patients admitted to the intensive care unit after maxillofacial tumor surgery of the lower jaw: A retrospective study.

    Science.gov (United States)

    Lebherz-Eichinger, Diana; Tudor, Bianca; Krenn, Claus G; Roth, Georg A; Seemann, Rudolf

    2016-04-01

    Maxillofacial tumor surgery often necessitates prolonged invasive ventilation to prevent blockage of the respiratory tract. To tolerate ventilation, continuously administered sedatives are recommended. Half-time of sedative or analgesic medication is an important characteristic by which narcotic drugs are chosen, due to the fact that weaning period increases with half-time. The aim of our study was to investigate whether a change in sedation regimen would affect the length of invasive ventilation or intensive care unit stay and medical costs. Additionally, the impact of various surgical procedures was analyzed. Data of 157 patients after mandibular surgery were retrospectively analyzed over 5 years in count regression models. Of those patients, 84 received a sedation regimen with sufentanil and midazolam and 73 with remifentanil and propofol. The impact of the surgical procedures (tracheostomy, tumor resection, neck dissection and length of operation) and the patient age and sex were analyzed with respect to length of ventilation and ICU days. Cost savings were calculated. Our data show that patients receiving remifentanil/propofol had fewer ventilation days (2.5 ± 2.5 versus 6.1 ± 4.6 days, P < 0.001) and were discharged earlier from the intensive care unit than patients receiving sufentanil/midazolam (5.1 ± 3.8 versus 9.2 ± 6.2 days, P < 0.001), leading to calculated cost savings of about 8000 Euro per patient. Length of operation negatively influenced length of ICU stay (P < 0.001). In conclusion, short-acting drugs such as remifentanil/propofol, as well as tracheostoma and shortened surgery duration may reduce the postoperative need for invasive ventilation and length of intensive care unit stay.

  16. Sedation assessment using the Ramsay scale.

    Science.gov (United States)

    Dawson, Rachel; von Fintel, Nicholas; Nairn, Stuart

    2010-06-01

    Patients undergoing sedation in emergency departments (EDs) must be monitored carefully to ensure that, when they are being transferred to different departments, they are safe and that information about them is accurate. However, sedation scoring, for which several tools are available, should not be confused with assessment of consciousness, which is undertaken using the Glasgow Coma Scale. This article considers the validity and reliability of sedation scoring tools, and discusses how ED staff can choose and integrate them into patient care pathways.

  17. ICU病人镇静治疗的护理对策%Nursing strategy of sedative therapy to intensive care units patients

    Institute of Scientific and Technical Information of China (English)

    罗杨; 洪蝶玫; 黄嘉佳

    2009-01-01

    To explore the nursing strategy of sedative therapy to intensive care units (ICU) patients. The clinical nursing of 197 ICU patients treated with midazolam or propofol were retrospectively summarized and analyzed, whose Sedation Scale scores were 1. After the treatment all indexes of 197 patients in respiration and circulation systerm were obviously improved. 197 patients had more compliance to the treatment and without unexpected extubation, endotracheal tube falling off and the comphcations such as bad memory and dyssemnia. The synthesis measures such as closely observing pafient's condition, enhancing clinical monitoring, promptly modulating the doses of sedatives and dealing with drug adverse reaction, carefully completing the whole mental nursing were the key points of ensuring safe sedative treating and less complications to ICU patients.%探讨ICU病人应用镇静治疗的护理对策.对2006年9月至2007年9月197例Ramsay评分标准1分的ICU病人应用咪唑安定或丙泊酚镇静治疗的临床护理行回顾性总结和分析.197例病人应用镇静治疗后呼吸和循环系统各项指标明显改善,病人能更好地配合治疗,无意外拔管和导管脱落,无不良记忆及睡眠障碍等并发症发生.严密观察病情、加强临床监护、及时调整镇静药物的剂量和处理药物不良反应、细致做好全程心理护理等综合措施,是保证ICU病人镇静治疗安全、减少并发症发生的关键.

  18. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015 – short version

    Directory of Open Access Journals (Sweden)

    DAS-Taskforce 2015

    2015-11-01

    Full Text Available In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine, twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM in conjunction with Society of Critical Care Medicine (SCCM and American Society of Health-System Pharmacists (ASHP from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation, Grade “B” (recommendation and Grade “0” (open recommendation. The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine.

  19. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version

    Science.gov (United States)

    Baron, Ralf; Binder, Andreas; Biniek, Rolf; Braune, Stephan; Buerkle, Hartmut; Dall, Peter; Demirakca, Sueha; Eckardt, Rahel; Eggers, Verena; Eichler, Ingolf; Fietze, Ingo; Freys, Stephan; Fründ, Andreas; Garten, Lars; Gohrbandt, Bernhard; Harth, Irene; Hartl, Wolfgang; Heppner, Hans-Jürgen; Horter, Johannes; Huth, Ralf; Janssens, Uwe; Jungk, Christine; Kaeuper, Kristin Maria; Kessler, Paul; Kleinschmidt, Stefan; Kochanek, Matthias; Kumpf, Matthias; Meiser, Andreas; Mueller, Anika; Orth, Maritta; Putensen, Christian; Roth, Bernd; Schaefer, Michael; Schaefers, Rainhild; Schellongowski, Peter; Schindler, Monika; Schmitt, Reinhard; Scholz, Jens; Schroeder, Stefan; Schwarzmann, Gerhard; Spies, Claudia; Stingele, Robert; Tonner, Peter; Trieschmann, Uwe; Tryba, Michael; Wappler, Frank; Waydhas, Christian; Weiss, Bjoern; Weisshaar, Guido

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation), Grade “B” (recommendation) and Grade “0” (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine. PMID:26609286

  20. Bispectral index monitoring in the management of sedation in an intensive care unit patient with locked-in syndrome.

    Science.gov (United States)

    Quraishi, Sadeq A; Blosser, Sandralee A; Cherry, Robert A

    2011-11-01

    Locked-in syndrome is an extremely rare neurological state caused by injury of the ventral pons. The syndrome is characterized by quadriplegia and anarthria with concomitant preservation of cortical function. When a reversible underlying pathological abnormality is identified and managed aggressively, meaningful recovery is possible. Because patients retain consciousness throughout their illness, a dependable method for titrating sedation may improve their quality of life. The case presented suggests that bispectral index monitoring may be a cost-effective and reliable method for managing sedation in patients with locked-in syndrome.

  1. Conscious Sedation Procedures Using Intravenous Midazolam for Dental Care in Patients with Different Cognitive Profiles: A Prospective Study of Effectiveness and Safety

    Science.gov (United States)

    Collado, Valérie; Faulks, Denise; Nicolas, Emmanuel; Hennequin, Martine

    2013-01-01

    The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N2O/O2 was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N2O/O2), were shown to be safe and effective in patients with intellectual disability when administered by dentists. PMID:23940729

  2. Conscious sedation procedures using intravenous midazolam for dental care in patients with different cognitive profiles: a prospective study of effectiveness and safety.

    Directory of Open Access Journals (Sweden)

    Valérie Collado

    Full Text Available The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID compared to dentally anxious patients (DA. Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale, and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS. 50% N₂O/O₂ was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test. Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test. Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test. Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions and were less often relaxed after induction (58.9% ID vs. 90.3% DA and during dental treatment (39.5% ID vs. 59.7% DA (p<0.001, Fisher exact test than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N₂O/O₂, were shown to be safe and effective in patients with intellectual disability when administered by dentists.

  3. Conscious sedation procedures using intravenous midazolam for dental care in patients with different cognitive profiles: a prospective study of effectiveness and safety.

    Science.gov (United States)

    Collado, Valérie; Faulks, Denise; Nicolas, Emmanuel; Hennequin, Martine

    2013-01-01

    The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N₂O/O₂ was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N₂O/O₂), were shown to be safe and effective in patients with intellectual disability when administered by dentists.

  4. Sedation and monitoring for gastrointestinal endoscopy.

    Science.gov (United States)

    Amornyotin, Somchai

    2013-02-16

    The safe sedation of patients for diagnostic or therapeutic procedures requires a combination of properly trained physicians and suitable facilities. Additionally, appropriate selection and preparation of patients, suitable sedative technique, application of drugs, adequate monitoring, and proper recovery of patients is essential. The goal of procedural sedation is the safe and effective control of pain and anxiety as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation practices for gastrointestinal endoscopy (GIE) vary widely. The majority of GIE patients are ambulatory cases. Most of this procedure requires a short time. So, short acting, rapid onset drugs with little adverse effects and improved safety profiles are commonly used. The present review focuses on commonly used regimens and monitoring practices in GIE sedation. This article is to discuss the decision making process used to determine appropriate pre-sedation assessment, monitoring, drug selection, dose of sedative agents, sedation endpoint and post-sedation care. It also reviews the current status of sedation and monitoring for GIE procedures in Thailand.

  5. Sedation-related complications in gastrointestinal endoscopy.

    Science.gov (United States)

    Amornyotin, Somchai

    2013-11-16

    Sedation practices for gastrointestinal endoscopic (GIE) procedures vary widely in different countries depending on health system regulations and local circumstances. The goal of procedural sedation is the safe and effective control of pain and anxiety, as well as to provide an appropriate degree of memory loss or decreased awareness. Sedation-related complications in gastrointestinal endoscopy, once occurred, can lead to significant morbidity and occasional mortality in patients. The risk factors of these complications include the type, dose and mode of administration of sedative agents, as well as the patient's age and underlying medical diseases. Complications attributed to moderate and deep sedation levels are more often associated with cardiovascular and respiratory systems. However, sedation-related complications during GIE procedures are commonly transient and of a mild degree. The risk for these complications while providing any level of sedation is greatest when caring for patients already medically compromised. Significant unwanted complications can generally be prevented by careful pre-procedure assessment and preparation, appropriate monitoring and support, as well as post-procedure management. Additionally, physicians must be prepared to manage these complications. This article will review sedation-related complications during moderate and deep sedation for GIE procedures and also address their appropriate management.

  6. The progress of light sedation for critically ill adult patients in intensive care unit%重症加强治疗病房成人患者浅镇静治疗进展

    Institute of Scientific and Technical Information of China (English)

    李双玲; 王东信; 杨拔贤

    2016-01-01

    The latest advance of sedation for critically ill adult patients in intensive care unit (ICU) was reviewed in order to provide certain clinical information for the ICU physicians about sedation. Guidelines, clinical research, Meta-analysis, and reviews in recent years were collected using electronic data base. Discussions included: ① the definition of light sedation, and its effects on clinical outcome, stress, sleep and delirium; ② light sedation strategies included: the target population, the target sedation strategy and daily sedation interruption, clinical assessment and monitoring of sedation, selection of sedative drugs, light sedation extenuation; ③ light sedation strategies and pain, agitation, delirium control bundles; ④ the problems and prospects of light sedation. Light sedation is the main principle of currently ICU sedation strategy in critically ill adult patients. Goal-directed light sedation should be considered as a routine therapy in most clinical situation, and its goal should be achieved as early as possible in the early stage of sedation. Routine use of benzodiazepines should be avoided, especially in patients with or at a risk of delirium. Prevention and treatment of agitation with a combination of non-pharmacologic or pharmacologic methods; ICU specification rules for pain, agitation and delirium prevention and treatment should be made. Light sedation is the main ICU sedation strategy in adult patients now, but must be individualized for each patient.%对重症加强治疗病房(ICU)成人患者镇静方面的最新进展进行综述,强调浅镇静策略是目前ICU危重患者镇静的主要治疗原则,其主要内容包括:①目标导向的浅镇静应常规化,尽可能在镇静早期即达标;②应摒弃常规使用苯二氮类药物,尤其对有谵妄风险或已经有谵妄的患者;③联合药物或非药物的有效方法预防和治疗躁动;④制定纳入疼痛、躁动和谵

  7. Perspectives on the Role of Fospropofol in the Monitored Anesthesia Care Setting

    Directory of Open Access Journals (Sweden)

    Joseph V. Pergolizzi

    2011-01-01

    Full Text Available Monitored anesthesia care (MAC is a safe, effective, and appropriate form of anesthesia for many minor surgical procedures. The proliferation of outpatient procedures has heightened interest in MAC sedation agents. Among the most commonly used MAC sedation agents today are benzodiazepines, including midazolam, and propofol. Recently approved in the United States is fospropofol, a prodrug of propofol which hydrolyzes in the body by alkaline phosphatase to liberate propofol. Propofol liberated from fospropofol has unique pharmacological properties, but recently retracted pharmacokinetic (PK and pharmacodynamic (PD evaluations make it difficult to formulate clear conclusions with respect to fospropofol's PK/PD properties. In safety and efficacy clinical studies, fospropofol demonstrated dose-dependent sedation with good rates of success at doses of 6.5 mg/kg along with good levels of patient and physician acceptance. Fospropofol has been associated with less pain at injection site than propofol. The most commonly reported side effects with fospropofol are paresthesia and pruritus. Fospropofol is a promising new sedation agent that appears to be well suited for MAC sedation, but further studies are needed to better understand its PK/PD properties as well its appropriate clinical role in outpatient procedures.

  8. Palliative sedation versus euthanasia: an ethical assessment.

    Science.gov (United States)

    ten Have, Henk; Welie, Jos V M

    2014-01-01

    The aim of this article was to review the ethical debate concerning palliative sedation. Although recent guidelines articulate the differences between palliative sedation and euthanasia, the ethical controversies remain. The dominant view is that euthanasia and palliative sedation are morally distinct practices. However, ambiguous moral experiences and considerable practice variation call this view into question. When heterogeneous sedative practices are all labeled as palliative sedation, there is the risk that palliative sedation is expanded to include practices that are actually intended to bring about the patients' death. This troublesome expansion is fostered by an expansive use of the concept of intention such that this decisive ethical concept is no longer restricted to signify the aim in guiding the action. In this article, it is argued that intention should be used in a restricted way. The significance of intention is related to other ethical parameters to demarcate the practice of palliative sedation: terminality, refractory symptoms, proportionality, and separation from other end-of-life decisions. These additional parameters, although not without ethical and practical problems, together formulate a framework to ethically distinguish a more narrowly defined practice of palliative sedation from practices that are tantamount to euthanasia. Finally, the article raises the question as to what impact palliative sedation might have on the practice of palliative care itself. The increasing interest in palliative sedation may reemphasize characteristics of health care that initially encouraged the emergence of palliative care in the first place: the focus on therapy rather than care, the physical dimension rather than the whole person, the individual rather than the community, and the primacy of intervention rather than receptiveness and presence.

  9. Clinical study of midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Xing Lu; Jun Li; Tong Li; Jie Zhang; Zhi-Bo Li; Xin-Jing Gao; Lei Xu

    2016-01-01

    Purpose:To evaluate midazolam sequential with dexmedetomidine for agitated patients undergoing weaning to implement light sedation in ICU.Methods:This randomized,prospective study was conducted in Tianjin Third Central Hospital,China.Using a sealed-envelope method,the patients were randomly divided into 2 groups (40 patients per group).Each patient of group A received an initial loading dose of midazolam at 0.3-3 mg/kg·h 24 h before extubation,followed by an infusion of dexmedetomidine at a rate of 0.2-1 μg/kg·h until extubation.Each patient of group B received midazolam at a dose of 0.3-3 mg/kg·h until extubation.The dose of sedation was regulated according to RASS sedative scores maintaining in the range of-2-1.All patients were continuously monitored for 60 min after extubation.During the course,heart rate (HR),mean artery pressure (MAP),extubation time,adverse reactions,ICU stay,and hospital stay were observed and recorded continuously at the following time points:24 h before extubation (T1),12 h before extubation (T2),extubation (T3),30 min after extubation (T4),60 min after extubation (T5).Results:Both groups reached the goal of sedation needed for ICU patients.Dexmedetomidine was associated with a significant increase in extubation quality compared with midazolam,reflected in the prevalence of delirium after extubation (20% (8/40) vs 45% (18/40)),respectively (p =0.017).There were no clinically significant decreases in HR and MAP after infusing dexmedetomidine or midazolam.In the group A,HR was not significantly increased after extubation;however,in the group B,HR was significantly increased compared with the preextubation values (p < 0.05).HR was significantly higher in the group B compared with the group A at 30 and 60 main after extubation (both,p < 0.05).Compared with preextubation values,MAP was significantly increased at extubation in the group B (p < 0.05) and MAP was significantly higher at T3,T4,T5 in the group B than group A (p < 0

  10. Windows for Intel Macs

    CERN Document Server

    Ogasawara, Todd

    2008-01-01

    Even the most devoted Mac OS X user may need to use Windows XP, or may just be curious about XP and its applications. This Short Cut is a concise guide for OS X users who need to quickly get comfortable and become productive with Windows XP basics on their Macs. It covers: Security Networking ApplicationsMac users can easily install and use Windows thanks to Boot Camp and Parallels Desktop for Mac. Boot Camp lets an Intel-based Mac install and boot Windows XP on its own hard drive partition. Parallels Desktop for Mac uses virtualization technology to run Windows XP (or other operating systems

  11. Macs for dummies

    CERN Document Server

    Baig, Edward C

    2014-01-01

    Get the most out of your Mac with this comprehensive guide Macs For Dummies, 13th Edition is the ultimate guide to your Mac, fully updated to include information about the latest updates. The book walks you through troubleshooting, syncing mobile devices, integrating Windows, and more, so you can take advantage of everything Macs have to offer. Whether you're a new user, a recent convert, or you just want to get the most out of your Mac, this book puts all the information you need in one place. Discover what makes Macs superior computing machines. Learn the basics, from mastering the Dock and

  12. Level of Discomfort Decreases After the Administration of Continuous Palliative Sedation: A Prospective Multicenter Study in Hospices and Palliative Care Units

    NARCIS (Netherlands)

    Deijck, R.H.P.D. van; Hasselaar, J.G.J.; Verhagen, S.; Vissers, K.C.P.; Koopmans, R.T.C.M.

    2016-01-01

    CONTEXT: A gold standard or validated tool for monitoring the level of discomfort during continuous palliative sedation (CPS) is lacking. Therefore, little is known about the course of discomfort in sedated patients, the efficacy of CPS, and the determinants of discomfort during CPS. OBJECTIVES: To

  13. Dexmedetomidine ameliorates monitored anaesthesia care

    Directory of Open Access Journals (Sweden)

    Priyamvada Gupta

    2014-01-01

    Full Text Available Background and Aims: Monitored anaesthesia care (MAC is meant for procedures under local anaesthesia. Various drugs have been used for this purpose. The recently introduced alpha2 agonist, dexmedetomidine provides "conscious sedation" with adequate analgesia and minimal respiratory depression. Hence, the safety and efficacy of two doses of dexmedetomidine for sedation and analgesia were evaluated. Methods: A total of 90 patients were distributed in three groups of 30 each: Dexmedetomidine 0.5 μg/kg (DL, dexmedetomidine 1.0 μg/kg (DH and normal saline (C. The initial loading dose was followed by maintenance infusion of 0.2-0.7 μg/kg/h of dexmedetomidine or equivalent volume of saline. Study drug was started at least 15 min before placement of local anaesthesia. Drugs were titrated to a target level of sedation (=3 on Ramsay sedation scale [RSS]. Midazolam 0.02 mg/kg for RSS < 3 and fentanyl 0.5 μg/kg were supplemented as required. The statistical analysis was performed using Chi-square test and mean and anova analysis. Results: In groups DL and DH fewer patients required supplemental midazolam, 56.7% (17/30 and 40% (12/30, compared with control, where 86.7% (26/30needed midazolam supplements. P = 0.000. Both groups DL and DH required significantly less fentanyl (84.8 and 83.9 μg versus control (144.2 μg. There was significantly increased ease of achieving and maintaining targeted sedation and analgesia in both dexmedetomidine groups when compared with placebo (P = 0.001. Adverse events observed with dexmedetomidine were bradycardia and hypotension. Conclusions: Dexmedetomidine in the doses studied was considered safe and effective sedative and analgesic for patients undergoing procedures under MAC.

  14. Enterprise Mac administrators guide

    CERN Document Server

    Smith, William

    2015-01-01

    IT departments everywhere will be integrating Macs and Mac OS X into their IT infrastructure and this book will tell them how to do it. It will serve as an authoritative, useful and frequently referenced book on Mac OS X administration.

  15. Danish national sedation strategy. Targeted therapy of discomfort associated with critical illness. Danish Society of Intensive Care Medicine (DSIT) and the Danish Society of Anesthesiology and Intensive Care Medicine (DASAIM)

    DEFF Research Database (Denmark)

    Fonsmark, Lise; Hein, Lars; Nibroe, Helle;

    2015-01-01

    should be to focus on the reversible causes of agitation, such as: pain, anxiety, delirium, dyspnea, withdrawal symptoms, sleep or gastrointestinal symptoms. If sedation is used a validated sedation scale is recommended. On a daily basis sedation should be interrupted and only restarted after a thorough...

  16. Sedation for pediatric endoscopy.

    Science.gov (United States)

    Lee, Myung Chul

    2014-03-01

    It is more difficult to achieve cooperation when conducting endoscopy in pediatric patients than adults. As a result, the sedation for a comfortable procedure is more important in pediatric patients. The sedation, however, often involves risks and side effects, and their prediction and prevention should be sought in advance. Physicians should familiarize themselves to the relevant guidelines in order to make appropriate decisions and actions regarding the preparation of the sedation, patient monitoring during endoscopy, patient recovery, and hospital discharge. Furthermore, they have to understand the characteristics of the pediatric patients and different types of endoscopy. The purpose of this article is to discuss the details of sedation in pediatric endoscopy.

  17. Sedation for Esophagogastroduodenal Endoscopy

    Directory of Open Access Journals (Sweden)

    Tayfun Aydin

    2011-05-01

    Full Text Available Different anesthetic techniques and drugs can be used for esophagogastroduedonal endoscopy. However, the scientists are still searching for appropriate drugs and protocols for sedation during esophagogastroduedonal endoscopy. The aim of this review is to discuss the topics related with sedation and esophagogastroduedonal endoscopy in the light of literature. Today standard procedure for diagnostic esophagogastroduedonal endoscopy usually consists of topical pharyngeal anesthesia, minimal sedation or anxiolysis, which may be complemented with analgesia when needed. When a prolonged, complex, or particularly troublesome or painful examination is foreseen, deeper sedation with multiple drugs and in closed observation of a staff may be required.

  18. Benzodiazepines: Sedation and Agitation.

    Science.gov (United States)

    Gallagher, Catherine

    2016-01-01

    Dental anxiety is common and frequently poses a barrier to necessary dental treatment. The increasing availability of conscious sedation in dental practice has made treatment much more accessible for anxious patients. At present, benzodiazepines are the most commonly used drugs in sedation practice and provide a pleasant experience for most, but not all, patients. An understanding of the mechanism of action of benzodiazepines should inform our practice and deepen our understanding of why and how sedation may fail. CPD/CLINICAL RELEVANCE: As an increasing number of dentists provide sedation for their patients an update on benzodiazepines is timely.

  19. 咪达唑仑用于重症监护患者镇静的效果评价%Efficacy Evaluation of Midazolam for Sedation in Intensive Care Patients

    Institute of Scientific and Technical Information of China (English)

    娄林娟

    2013-01-01

    目的 观察咪达唑仑在重症监护患者中的镇静效果.方法 选择2010年1月至2011年12月收治的重症监护患者100例,给予药物镇静治疗,将患者随机分成两组,各50例.对照组给予异丙酚镇静治疗,治疗组给予咪达唑仑镇静治疗,观察两组患者镇静起效时间、达到满意深度时间、苏醒时间及镇静前后与镇静期间心率、平均动脉压、脉搏氧饱和度变化.结果 治疗组镇静起效时间、达到满意深度时间、苏醒时间与对照组相比,差异有统计学意义(P<0.05);治疗组心率、平均动脉压、脉搏氧饱和度变化小于对照组,差异有统计学意义(P<0.05).结论 咪达唑仑对重症监护患者有较好的镇静效果,对心血管及呼吸循环抑制轻微,是重症监护患者理想的镇静剂.%Objective To investigate the sedative effect of midazolam for intensive care patients. Methods A hundred cases intensive care patients in our hospital from 2010 to 2011 were gaven the drug sedation, these patients were randomly divided into two groups, each group had 50 cases, the control group was given propofol sedation, the treatment group were gaven the microphone to midazolam sedation, the sedation onset time, satisfactory depth of time, recovery time, and calm before and after the sedation during the heart rate, mean arterial blood pressure, pulse oxygen saturation of two groups of patients were observed. Results The sedation onset time, achieve satisfactory depth of time, wake time difference of treatment group was statistically significant (P < 0. 05) compared with control group; the heart rate, mean arterial blood pressure, pulse oxygen saturation of treatment group was less than the control group, the difference had statistically significant ( P < 0. 05). Conclusion The microphone midazolam sedation in intensive care patients have a better effect, a slight inhibition on cardiovascular, respiratory and circulatory, it s ideal sedative for intensive

  20. Sedation protocols versus daily sedation interruption: a systematic review and meta-analysis

    Science.gov (United States)

    Nassar Junior, Antonio Paulo; Park, Marcelo

    2016-01-01

    Objective The aim of this study was to systematically review studies that compared a mild target sedation protocol with daily sedation interruption and to perform a meta-analysis with the data presented in these studies. Methods We searched Medline, Scopus and Web of Science databases to identify randomized clinical trials comparing sedation protocols with daily sedation interruption in critically ill patients requiring mechanical ventilation. The primary outcome was mortality in the intensive care unit. Results Seven studies were included, with a total of 892 patients. Mortality in the intensive care unit did not differ between the sedation protocol and daily sedation interruption groups (odds ratio [OR] = 0.81; 95% confidence interval [CI] 0.60 - 1.10; I2 = 0%). Hospital mortality, duration of mechanical ventilation, intensive care unit and hospital length of stay did not differ between the groups either. Sedation protocols were associated with an increase in the number of days free of mechanical ventilation (mean difference = 6.70 days; 95%CI 1.09 - 12.31 days; I2 = 87.2%) and a shorter duration of hospital length of stay (mean difference = -5.05 days, 95%CI -9.98 - -0.11 days; I2 = 69%). There were no differences in regard to accidental extubation, extubation failure and the occurrence of delirium. Conclusion Sedation protocols and daily sedation interruption do not appear to differ in regard to the majority of analyzed outcomes. The only differences found were small and had a high degree of heterogeneity. PMID:28099642

  1. Anxiolytics, sedatives and hypnotics

    NARCIS (Netherlands)

    Absalom, Anthony; Adapa, R. M.

    2007-01-01

    Anxiolytics and sedatives are used in current anaesthetic practice for anxiolysis before surgery and as adjuvants during anaesthesia. The safety profile of these agents depends on their pharmacokinetic and pharmacodynamic profiles, patient comorbidity and the experience of the clinician. Sedative dr

  2. Bispectral index as a predictor of sedation depth during isoflurane or midazolam sedation in ICU patients.

    Science.gov (United States)

    Sackey, P V; Radell, P J; Granath, F; Martling, C R

    2007-06-01

    Bispectral index (BIS) is used for monitoring anaesthetic depth with inhaled anaesthetic agents in the operating room but has not been evaluated as a monitor of sedation depth in the intensive care unit (ICU) setting with these agents. If BIS could predict sedation depth in ICU patients, patient disturbances could be reduced and oversedation avoided. Twenty ventilator-dependent ICU patients aged 27 to 80 years were randomised to sedation with isoflurane via the AnaConDa or intravenous midazolam. BIS (A-2000 XP, version 3.12), electromyogram activity (EMG) and Signal Quality Index were measured continuously. Hourly clinical evaluation of sedation depth according to Bloomsbury Sedation Score (Bloomsbury) was performed. The median BIS value during a 10-minute interval prior to the clinical evaluation at the bedside was compared with Bloomsbury. Nurses performing the clinical sedation scoring were blinded to the BIS values. End-tidal isoflurane concentration was measured and compared with Bloomsbury. Correlation was poor between BIS and Bloomsbury in both groups (Spearman's rho 0.012 in the isoflurane group and -0.057 in the midazolam group). Strong correlation was found between BIS and EMG (Spearman's rho 0.74). Significant correlation was found between end-tidal isoflurane concentration and Bloomsbury (Spearman's rho 0.47). In conclusion, BIS XP does not reliably predict sedation depth as measured by clinical evaluation in non-paralysed ICU patients sedated with isoflurane or midazolam. EMG contributes significantly to BIS values in isoflurane or midazolam sedated, non-paralysed ICU patients. End-tidal isoflurane concentration appeared to be a better indicator of clinical sedation depth than BIS.

  3. Prolonged infusion of sedatives and analgesics in adult intensive care patients: A systematic review of pharmacokinetic data reporting and quality of evidence.

    Science.gov (United States)

    Tse, Andrew H W; Ling, Lowell; Joynt, Gavin M; Lee, Anna

    2017-03-01

    Although pharmacokinetic (PK) data for prolonged sedative and analgesic agents in intensive care unit (ICU) has been described, the number of publications in this important area appear relatively few, and PK data presented is not comprehensive. Known pathophysiological changes in critically ill patients result in altered drug PK when compared with non-critically ill patients. ClinPK Statement was recently developed to promote consistent reporting in PK studies, however, its applicability to ICU specific PK studies is unclear. In this systematic review, we assessed the overall ClinPK Statement compliance rate, determined the factors affecting compliance rate, graded the level of PK evidence and assessed the applicability of the ClinPK Statement to future ICU PK studies. Of the 33 included studies (n=2016), 22 (67%) were low evidence quality descriptive studies (Level 4). Included studies had a median compliance rate of 80% (IQR 66% to 86%) against the ClinPK Statement. Overall pooled compliance rate (78%, 95% CI 73% to 83%) was stable across time (P=0.38), with higher compliance rates found in studies fitting three compartments models (88%, P<0.01), two compartments models (83%, P<0.01) and one compartment models (77%, P=0.17) than studies fitting noncompartmental or unspecified models (69%) (P<0.01). Data unique to the interpretation of PK data in critically ill patients, such as illness severity (48%), organ dysfunction (36%) and renal replacement therapy use (32%), were infrequently reported. Discrepancy between the general compliance rate with ClinPK Statement and the under-reporting of ICU specific parameters suggests that the applicability of the ClinPK Statement to ICU PK studies may be limited in its current form.

  4. Mac at Work

    CERN Document Server

    Sparks, David

    2011-01-01

    Bridge the gap between using a Mac at home and at the office. Now that you love your Mac at home, you want to use one at the office without missing a beat of productivity or professionalism. This unique guide shows you how.  You'll find best Mac business practices for handling word processing, spreadsheet and presentation creation, task and project management, and graphics. The book also explores topics such as hardware maintenance, how to synchronize with multiple computers, data backup, and communication with Windows networks.: Covers the nuts and bolts of using a Mac at work, including sync

  5. Intention, procedure, outcome and personhood in palliative sedation and euthanasia.

    Science.gov (United States)

    Materstvedt, Lars Johan

    2012-03-01

    Palliative sedation at the end of life has become an important last-resort treatment strategy for managing refractory symptoms as well as a topic of controversy within palliative care. Furthermore, palliative sedation is prominent in the public debate about the possible legalisation of voluntary assisted dying (physician-assisted suicide and euthanasia). This article attempts to demonstrate that palliative sedation is fundamentally different from euthanasia when it comes to intention, procedure, outcome and the status of the person. Nonetheless, palliative sedation in its most radical form of terminal deep sedation parallels euthanasia in one respect: both end the experience of suffering. However, only the latter intentionally ends life and also has this as its goal. There is the danger that deep sedation could bring death forward in time due to particular side effects of the treatment. Still that would, if it happens, not be intended, and accordingly is defensible in view of the doctrine of double effect.

  6. A protocol of no sedation for critically ill patients receiving mechanical ventilation

    DEFF Research Database (Denmark)

    Strøm, Thomas; Martinussen, Torben; Toft, Palle

    2010-01-01

    BACKGROUND: Standard treatment of critically ill patients undergoing mechanical ventilation is continuous sedation. Daily interruption of sedation has a beneficial effect, and in the general intesive care unit of Odense University Hospital, Denmark, standard practice is a protocol of no sedation....

  7. Enterprise Mac Security Mac OS X Snow Leopard Security

    CERN Document Server

    Edge, Stephen Charles; Hunter, Beau; Sullivan, Gene; LeBlanc, Dee-Ann

    2010-01-01

    A common misconception in the Mac community is that Mac's operating system is more secure than others. While this might be true in certain cases, security on the Mac is still a crucial issue. When sharing is enabled or remote control applications are installed, Mac OS X faces a variety of security threats. Enterprise Mac Security: Mac OS X Snow Leopard is a definitive, expert-driven update of the popular, slash-dotted first edition and was written in part as a companion to the SANS Institute course for Mac OS X. It contains detailed Mac OS X security information, and walkthroughs on securing s

  8. Ethical Analysis of Analgesia and Sedation Therapy in Intensive Care Unit%ICU镇痛镇静治疗的伦理学分析

    Institute of Scientific and Technical Information of China (English)

    李国民

    2016-01-01

    镇痛镇静是危重病人治疗的必要措施。实施镇痛镇静治疗时,应当尊重病人及家属的知情同意权。在病人利益最大化原则和生命权优先的前提下,优化镇痛镇静治疗方案,避免不良作用和并发症发生。同时注意保护病人隐私,加强医护协作,推行由医师制定方案并指导护士主导实施的镇痛镇静管理模式。%Analgesia and sedation is the necessary measure in critically ill patients. For implementation of an-algesia and sedation treatment, we should respect the patients′ and family members′rights to be informed. Under the premiseof profit maximization and priority to life,we should optimize the analgesic and sedative treatment, and avoid the adverse effects and complications as far as possible. At the same time, we should pay attention to protec-ting patients′privacy and strengthening the cooperation of physicians and nurses. Analgesia sedation management mode formulated and guided by physicians and nurses-led should be promoted.

  9. Long term psychological effects of a no sedation protocol in critically ill Patients

    DEFF Research Database (Denmark)

    Stroem, Thomas; Stylsvig, Mette; Toft, Palle

    2011-01-01

    was to test whether a strategy of no sedation alters long-term psychological outcome compared with a standard strategy with sedation. METHODS: During intensive care stay 140 patients requiring mechanical ventilation were randomized to either no sedation or sedation with daily interruption of sedation......ABSTRACT: INTRODUCTION: A protocol of no sedation has been shown to reduce the time patients receive mechanical ventilation and reduce intensive care and total hospital length of stay. The long term psychological effects of this strategy have not yet been described. The purpose of the study...... applied to critically ill patients undergoing mechanical ventilation does not increase the risk of long term psychological sequelae after intensive care compared to standard treatment with sedation....

  10. A study of patient attitudes towards fasting prior to intravenous sedation for dental treatment in a dental hospital department.

    LENUS (Irish Health Repository)

    McKenna, Gerald

    2010-01-01

    Intravenous sedation is the most commonly used method of sedation for the provision of adult dental care. However, disparity exists in pre-operative fasting times in use for patients throughout the United Kingdom.

  11. [New technical developments for inhaled sedation].

    Science.gov (United States)

    Meiser, A; Bomberg, H; Volk, T; Groesdonk, H V

    2017-01-31

    The circle system has been in use for more than 100 years, whereas the first clinical application of an anaesthetic reflector was reported just 15 years ago. In the circle system, all breathing gas is rebreathed after carbon dioxide absorption. A reflector, on the other hand, with the breathing gas flowing to and fro, specifically retains the anaesthetic during expiration and resupplies it during the next inspiration. A high reflection efficiency (number of molecules resupplied/number of molecules exhaled, RE 80-90%) decreases consumption. In analogy to the fresh gas flow of a circle system, pulmonary clearance ((1-RE) × minute ventilation) defines the opposition between consumption and control of the concentration.It was not until reflection systems became available that volatile anaesthetics were used routinely in some intensive care units. Their advantages, such as easy handling, and better ventilatory capabilities of intensive care versus anaesthesia ventilators, were basic preconditions for this. Apart from AnaConDa™ (Sedana Medical, Uppsala, Sweden), the new MIRUS™ system (Pall Medical, Dreieich, Germany) represents a second, more sophisticated commercially available system.Organ protective effects, excellent control of sedation, and dose-dependent deep sedation while preserving spontaneous breathing with hardly any accumulation or induction of tolerance, make volatile anaesthetics an interesting alternative, especially for patients needing deep sedation or when intravenous drugs are no longer efficacious.But obviously, the outcome is most important. We know that deep intravenous sedation increases mortality, whereas inhalational sedation could prove beneficial. We now need prospective clinical trials examining mortality, but also the psychological outcome of those most critically ill patients sedated by inhalation or intravenously.

  12. Conscious sedation: A dying practice?

    OpenAIRE

    Manickam, Palaniappan; Kanaan, Ziad; Zakaria, Khalid

    2013-01-01

    Sedation practices vary according to countries with different health system regulations, the procedures done, and local circumstances. Interestingly, differences in the setting in which the practice of gastroenterology and endoscopy takes place (university-based vs academic practice) as well as other systematic practice differences influence the attitude of endoscopists concerning sedation practices. Conscious sedation using midazolam and opioids is the current standard method of sedation in ...

  13. [Sedation in pediatric digestive endoscopy].

    Science.gov (United States)

    Montanari, F; Viola, L; Amarri, S

    2001-01-01

    Sedation for children doing diagnostic or operative pediatric gastrointestinal endoscopy (PE) procedures is performed differently over the world and no consensus is yet agreed on the best paediatric endoscopy sedation (PES). Some centres do not use any sedation, especially in infants, most centre use some form of sedation: conscious sedation, deep sedation and general anaesthesia. We review sedation drugs and describe our centre protocol on 188 consecutive PE: oral premedication with flunitrazepam (0.05 mg/kg/dose) at least 30 min before procedure, petidine (1 mg/kg) followed by increasing boluses of midazolam (0.05 mg/kg up to a maximal 0.2 mg/kg or 5 mg) were given i.v. to obtain a conscious sedation. All PE could be performed and ended safely, PES resulted satisfactory in approximately 65% of patient having conscious sedation. SaO2 Endoscopy and sedation was always performed by the PE team in the immediate vicinity of anaesthesiologists at work. PE can be safely performed with conscious sedation. Basic and advanced resuscitation skills are needed for the PE team who wish to perform both endoscopic and sedation procedures.

  14. ICU机械通气患者镇静效果观察与护理%Sedative effect of patients with mechanical ventilation in ICU and nursing care

    Institute of Scientific and Technical Information of China (English)

    叶玲; 赵金花

    2014-01-01

    Objective To explore the sedative effect of propofol, midazolam for ICU patients with mechanical ventilation and the nursing experience.Methods Totals of 120 patients of ICU from June 2012 to December 2012 were randomly selected and divided into experiment group ( n =60 ) and control group ( n=60), experiment group were given propofol injection sedation, control group were given midazolam sedation, using Ramsay sedation score, compared two groups of patients the onset time of drug, recovery time after stopping drug, medicine adverse reaction and vital signs changes.Results In experiment group, the onset time was (23 ±8)s, the recovery time is (22 ±6)min, patients in control group were (48 ±9)s, (58 ±12)mins, and the differences between two groups were statistically significant (t =3.12,5.67,respectively;P<0.05).After sedation, heart rate (74 ±11) times/min, and breath (15 ±3) times/min of experiment group were slower than that of control group, and the difference was statistically significant (P<0.05).Conclusions Propofol sedation effect is good, and can fast acting, while it has a great influencing on the heart rate.%目的:探讨丙泊酚、咪达唑仑应用于机械通气患者镇静的疗效及护理体会。方法随机选择ICU机械通气患者120例,采用随机数字表法分为试验组与对照组,每组60例,试验组给予丙泊酚注射液镇静,对照组给予咪达唑仑镇静,采用Ramsay镇静评分比较两组患者用药后起效时间及停药后苏醒时间,比较两组用药后不良反应及生命体征变化。结果试验组患者起效时间、苏醒时间分别为(23±8)s,(22±6)min,对照组患者分别为(48±9)s,(58±12)min,两组比较差异有统计学意义(t值分别为3.12,5.67;P<0.05)。试验组患者镇静后心率(74±11)次/min,呼吸(15±3)次/min,较对照组出现减慢现象,差异有统计学意义(t值分别为-5.28,-4.17;P<0

  15. 脑电双频指数在儿科ICU镇静监测的临床应用价值%Sedation assessment by using bispectral index in the pediatric intensive care unit

    Institute of Scientific and Technical Information of China (English)

    滕国良; 姚军; 龚小慧; 张宇鸣

    2009-01-01

    目的 探讨脑电双频指数(BIS)在儿科ICU危重患儿镇静深度监测中的应用价值.方法 前瞻性收集我院PICU的42例6个月~13岁的危重患儿,以咪唑安定持续静脉滴注镇静治疗,在应用镇静剂后的10个时间段以Ramsay评分评价镇静深度的同时进行BIS监测,分析BIS与Ramsay评分在儿童危重症镇静评估的相关性及影响因素.结果 42例危重症患儿中共采集420对BIS与Ramsay对照数据,并做Spearman等级相关分析,BIS与Ramsay评分呈明显负相关(r=-0.8879,P0.05);BIS范围在55~80之间为危重症患儿合适的镇静分值.结论 BIS与Ramsay评分在危重症镇静深度评估中具有较好相关性.BIS监测具有操作简单、省时、连续性好等优点,可作为PICU患儿镇静深度判断的客观指标.%Objective To evaluate the applicability of bispectral index (BIS) in assessing sedation in pediatric intensive care unit. Methods Patients in pediatric ICU,aged six months to thirteen years and requi-ring sedation were given midazolam as sedative drug. The Ramsay score was assessed by physicians after mi-dazolam was given at ten time interval and these data were compared with the blinded BIS score. Results A total of 42 children were included in the study,420 valid paired observation of BIS values and Ramsay score were performed. According to Spearman's scale analysis, the correlation coefficient between BIS value and Ramsay score was -0.887 9 (P0.05). Conclusion BIS values cor-relate fairly well with the Ramsay scores in PICU patient. With the advantages such as simpleness, time-sav-ing,continuity and etc,BIS monitoring is a good objective tool for judging sedation depth of PICU patients.

  16. Narcotrend指导重症呼吸科患者使用右美托咪定的相关性研究%Correlation study of Narcotrend to guide dexmedetomidine sedation in intensive care unit of respiratory

    Institute of Scientific and Technical Information of China (English)

    王润丰; 朱永忠; 杜成; 夏梦; 庞加磊; 王研

    2015-01-01

    目的:探讨使用Narcotrend指导重症呼吸科患者使用右美托咪定镇静的个体化相关性研究,以达到降低药物副作用的目的。方法选取54例重症呼吸科患者,随机分为两组,给予右美托咪定镇静治疗,实验组以NTI值( Narcotrend检测仪根据镇静患者脑电信号量化形成的0~100的数值,用以客观反映镇静深度)75~85为目标调节泵速。对照组将Narcotrend监测仪显示屏幕反转,专人记录NTI数值,以镇静/警觉( OAA/S)评分3~4级为目标值调节泵速。分别记录生命体征,镇静深度,动脉血气变化情况,比较两组间上述指标差异。结果两组间比较,同一时间段NTI及OAA/S评分变化一致,差异无统计学意义( P>0.05)。结论 Narcotrend能准确有效显示重症呼吸科患者使用右美托咪定的镇静深度,且数据客观连续,为重症呼吸科患者镇静,提供新的依据。%Objective To explore the application value of Narcotrend in guiding the use of dexmedetomidine sedation in intensive care unit of respiratory. Methods 54 patients in respiratory IC were randomly divided into the experimental group and the control group. All patients were given dexmedetomidine sedation. The experimental group adjusted the dexmedetomidine dose to achieve NTI values 75~85 ( narcotrend detector displaying 0~100 according to EEG of patients to reflect the depth of sedation) , and the control group adjusted the dexmedetomidine dose to a-chieve OAA/S score 3~4 scale. The vital signs, degree of sedation and blood gas changes were recorded and comp-ered between the two groups. Results NTI and OAA/S score had no statistically significant difference between the two groups at the same time. Conclusion Narcotrend can accurately and effectively reflect the degree of sedation of patients in respiratory ICU, and the data are objective and continuous, which can provide a new means to guide seda-tion.

  17. Conscious sedation: a dying practice?

    Science.gov (United States)

    Manickam, Palaniappan; Kanaan, Ziad; Zakaria, Khalid

    2013-07-28

    Sedation practices vary according to countries with different health system regulations, the procedures done, and local circumstances. Interestingly, differences in the setting in which the practice of gastroenterology and endoscopy takes place (university-based vs academic practice) as well as other systematic practice differences influence the attitude of endoscopists concerning sedation practices. Conscious sedation using midazolam and opioids is the current standard method of sedation in diagnostic and therapeutic endoscopy. Interestingly, propofol is a commonly preferred sedation method by endoscopists due to higher satisfaction rates along with its short half-life and thus lower risk of hepatic encephalopathy. On the other hand, midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam. The administration of sedation under the supervision of a properly trained endoscopist could become the standard practice and the urgent development of an updated international consensus regarding the use of sedative agents like propofol is needed.

  18. Sedation regimens for gastrointestinal endoscopy.

    Science.gov (United States)

    Moon, Sung-Hoon

    2014-03-01

    Sedation allows patients to tolerate unpleasant endoscopic procedures by relieving anxiety, discomfort, or pain. It also reduces a patient's risk of physical injury during endoscopic procedures, while providing the endoscopist with an adequate setting for a detailed examination. Sedation is therefore considered by many endoscopists to be an essential component of gastrointestinal endoscopy. Endoscopic sedation by nonanesthesiologists is a worldwide practice and has been proven effective and safe. Moderate sedation/analgesia is generally accepted as an appropriate target for sedation by nonanesthesiologists. This focused review describes the general principles of endoscopic sedation, the detailed pharmacology of sedatives and analgesics (focused on midazolam, propofol, meperidine, and fentanyl), and the multiple regimens available for use in actual practice.

  19. Training and Competency in Sedation Practice in Gastrointestinal Endoscopy.

    Science.gov (United States)

    Da, Ben; Buxbaum, James

    2016-07-01

    The practice of endoscopic sedation requires a thorough understanding of preprocedural assessment, sedation pharmacology, intraprocedure monitoring, adverse event management, and postprocedural care. The training process has become increasingly standardized and entails knowledge and practice-based components. The use of propofol in particular requires a higher level of structured training owing to its narrow therapeutic window. Simulation has increased opportunities for practice-based training in a controlled environment. After completion of training, the endoscopist must demonstrate competence in theoretical understanding and technical ability to administer sedation. Although individual institutions have certification processes, there is a lack of validated, standardized methods to confirm competence.

  20. [Sedation and analgesia assessment tools in ICU patients].

    Science.gov (United States)

    Thuong, M

    2008-01-01

    Sedative and analgesic treatment administered to critically ill patients need to be regularly assessed to ensure that predefinite goals are well achieved as the risk of complications of oversedation is minimized. In most of the cases, which are lightly sedation patients, the goal to reach is a calm, cooperative and painless patient, adapted to the ventilator. Recently, eight new bedside scoring systems to monitor sedation have been developed and mainly tested for reliability and validity. The choice of a sedation scale measuring level of consciousness, could be made between the Ramsay sedation scale, the Richmond Agitation Sedation scale (RASS) and the Adaptation to The Intensive Care Environment scale-ATICE. The Behavioral Pain Scale (BPS) is a behavioral pain scale. Two of them have been tested with strong evidence of their clinimetric properties: ATICE, RASS. The nurses'preference for a convenient tool could be defined by the level of reliability, the level of clarity, the variety of sedation and agitation states represented user friendliness and speed. In fine, the choice between a simple scale easy to use and a well-defined and complex scale has to be discussed and determined in each unit. Actually, randomized controlled studies are needed to assess the potential superiority of one scale compared with others scales, including evaluation of the reliability and the compliance to the scale. The usefulness of the BIS in ICU for patients lightly sedated is limited, mainly because of EMG artefact, when subjective scales are more appropriated in this situation. On the other hand, subjective scales are insensitive to detect oversedation in patients requiring deep sedation. The contribution of the BIS in deeply sedation patients, patients under neuromuscular blockade or barbiturates has to be proved. Pharmacoeconomics studies are lacking.

  1. [Administration of intravenous sedation with midazolam by dentists is unsafe].

    Science.gov (United States)

    Broers, D L M; Plat, J; de Jongh, A; Zuidgeest, T G M; Blom, H C C M; Kraaijenhagen, A E; Pieterse, C M; Bildt, M M

    2015-03-01

    In the December issue of the Nederlands Tijdschrift voor Tandheelkunde (Dutch Journal of Dentistry) in 2014, an article was devoted to the use of light sedation with midazolam by dentists. A number of dentists who are active in the area of Special Dentistry (anxiety management, care of the disabled) and a anesthesiologist offer a response to the article and argue that the administration of intravenous sedation with midazolam by dentists is unsafe.

  2. The MAC framework: redefining MAC protocols for wireless sensor networks

    NARCIS (Netherlands)

    Parker, T.; Halkes, G.; Bezemer, M.; Langendoen, K.

    2010-01-01

    Most current WSN MAC protocol implementations have multiple tasks to perform—deciding on correct timing, sending of packets, sending of acknowledgements, etc. However, as much of this is common to all MAC protocols, there is duplication of functionality, which leads to larger MAC protocol code size

  3. Recent results from MAC

    Energy Technology Data Exchange (ETDEWEB)

    MAC Collaboration

    1982-05-01

    Some preliminary results from the MAC detector at PEP are presented. These include measurements of the angular distribution of ..gamma gamma.., ..mu mu.. and tau tau final states, a determination of the tau lifetime, a measurement of R, and a presentation of the inclusive muon p/sub perpendicular/ distribution for hadronic events.

  4. Macs For Seniors For Dummies

    CERN Document Server

    Chambers, Mark L

    2012-01-01

    You're never too old to fall in love—with your Mac! You took a while, but you are now the proud owner of your first Mac computer. Macs For Seniors For Dummies is just for you. This friendly, accessible guide walks you through choosing a Mac and learning how to use it. You'll find yourself falling head over heels for your Mac in no time. Macs For Seniors For Dummies introduces you to all the basics that you need to know: turning the Mac on and getting connected; using the keyboard and mouse; working with files and folders; navigate around the Mac desktop and OS X Lion; setting up an Inter

  5. Current sedation and monitoring practice for colonoscopy: an International Observational Study (EPAGE)

    DEFF Research Database (Denmark)

    Froehlich, F; Harris, JK; Wietlisbach, V;

    2006-01-01

    in endoscopy centers internationally. PATIENTS AND METHODS: This observational study included consecutive patients referred for colonoscopy at 21 centers in 11 countries. Endoscopists reported sedation and monitoring practice, using a standard questionnaire for each patient. RESULTS: 6004 patients were......BACKGROUND AND STUDY AIMS: Sedation and monitoring practice during colonoscopy varies between centers and over time. Knowledge of current practice is needed to ensure quality of care and help focus future research. The objective of this study was to examine sedation and monitoring practice...... included in this study, of whom 53 % received conscious/moderate sedation during colonoscopy, 30 % received deep sedation, and 17 % received no sedation. Sedation agents most commonly used were midazolam (47 %) and opioids (33 %). Pulse oximetry was done during colonoscopy in 77 % of patients, blood...

  6. iMac pocket genius

    CERN Document Server

    Hart-Davis, Guy

    2010-01-01

    If you want to get the very most out of your iMac, put this savvy Portable Genius guide to work. Want to make the most of the new Magic Mouse and the latest iLife apps? Set up a wireless network using your iMac's AirPort card? Watch television on your iMac, or show iMac videos and movies on your television? You'll find cool and useful Genius tips, full-color screenshots, and pages of easy-to-access shortcuts and tools that will save you time and let you enjoy your iMac to the max.

  7. Monolithic MACS micro resonators

    Science.gov (United States)

    Lehmann-Horn, J. A.; Jacquinot, J.-F.; Ginefri, J. C.; Bonhomme, C.; Sakellariou, D.

    2016-10-01

    Magic Angle Coil Spinning (MACS) aids improving the intrinsically low NMR sensitivity of heterogeneous microscopic samples. We report on the design and testing of a new type of monolithic 2D MACS resonators to overcome known limitations of conventional micro coils. The resonators' conductors were printed on dielectric substrate and tuned without utilizing lumped element capacitors. Self-resonance conditions have been computed by a hybrid FEM-MoM technique. Preliminary results reported here indicate robust mechanical stability, reduced eddy currents heating and negligible susceptibility effects. The gain in B1 /√{ P } is in agreement with the NMR sensitivity enhancement according to the principle of reciprocity. A sensitivity enhancement larger than 3 has been achieved in a monolithic micro resonator inside a standard 4 mm rotor at 500 MHz. These 2D resonators could offer higher performance micro-detection and ease of use of heterogeneous microscopic substances such as biomedical samples, microscopic specimens and thin film materials.

  8. Blind Cognitive MAC Protocols

    CERN Document Server

    Mehanna, Omar; Gamal, Hesham El

    2008-01-01

    We consider the design of cognitive Medium Access Control (MAC) protocols enabling an unlicensed (secondary) transmitter-receiver pair to communicate over the idle periods of a set of licensed channels, i.e., the primary network. The objective is to maximize data throughput while maintaining the synchronization between secondary users and avoiding interference with licensed (primary) users. No statistical information about the primary traffic is assumed to be available a-priori to the secondary user. We investigate two distinct sensing scenarios. In the first, the secondary transmitter is capable of sensing all the primary channels, whereas it senses one channel only in the second scenario. In both cases, we propose MAC protocols that efficiently learn the statistics of the primary traffic online. Our simulation results demonstrate that the proposed blind protocols asymptotically achieve the throughput obtained when prior knowledge of primary traffic statistics is available.

  9. iMac portable genius

    CERN Document Server

    Hart-Davis, Guy

    2010-01-01

    The most up-to-date coverage on the latest iMac advice, tools, and shortcuts Cool and useful tips, full-color screenshots, and savvy advice show you how to get the most out of your iMac. Fully updated to cover the iMac's latest features and capabilities, this guide is packed with indispensible information on iLife '09 and Mac OS X Snow Leopard, and shows you how to customize your iMac in a way that it will work best for you.Explores all the bells and whistles of the iMac, including the new Magic Mouse, iLife apps such as iPhoto and iMovie, and Mac OS X Snow LeopardShows yo

  10. Macs For Dummies, Pocket Edition

    CERN Document Server

    Baig, Edward C

    2011-01-01

    The fun and easy way to make the most of your wonderful Mac. Simply Mac-nificent — all the cool things your Mac can do! This handy guide helps you figure out the nuts and bolts of your Mac. Navigate the Mac desktop, use the Safari Web browser to surf the Internet, e-mail photos to friends and family, create and print documents, rip audio CDs, and more. The fun begins right here!. Open the book and find: How to set up and configure your Mac; Tips for getting around on the Mac desktop; Steps for setting up an e-mail account and browsing the Internet; Details about the free programs that come wit

  11. iMac for dummies

    CERN Document Server

    Chambers, Mark L

    2014-01-01

    Do it all with your iMac and this bestselling For Dummies guide! You're still a little giddy from finally scoring your new iMac, and you can't wait to get started. Even if you're already in love with your iMac, it helps to have a little guidance to really get the most out of this ultimate all-in-one computer. This updated edition of iMac For Dummies is the ideal way to learn the iMac fundamentals from setting up and personalizing your machine to importing files, making FaceTime video calls, surfing the web, using your favorite programs and apps, and everything in between. Trusted Mac guru Mark

  12. Patient-ventilator asynchrony during daily interruption of sedation versus no sedation protocol

    OpenAIRE

    2012-01-01

    Introduction: Daily interruption of sedation could minimize the problem of sedatives accumulation. Nevertheless, whatever is the sedation strategy; sedation, particularly deep levels, has been associated with high frequency of patient-ventilator asynchrony. Extending these findings, one would expect that no sedation protocol could reduce the frequency of patient-ventilator asynchrony. Aim: To assess the effect of no sedation protocol compared with daily interruption of sedation on patient-ven...

  13. Monitored anaesthesia care – Comparison of nalbuphine/dexmedetomidine versus nalbuphine/propofol for middle ear surgeries: A double-blind randomised trial

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao Nallam

    2017-01-01

    Full Text Available Background and Aims: Middle ear surgeries (MESs are usually performed under sedation with local anaesthesia and can be well tolerated by the patient with minimal discomfort. In the present study, we compare the effect of nalbuphine/dexmedetomidine combination with nalbuphine/propofol on sedation and analgesia in monitored anaesthesia care. Methods: One hundred adult patients undergoing MESs under monitored anaesthesia care (MAC were randomly allocated into two groups. All patients in both groups received injection nalbuphine 50 μg/kg intravenously (IV. Group D received a bolus dose of injection dexmedetomidine 1 μg/kg IV over 10 min followed by an infusion started at 0.4 μg/kg/h IV. Group P received a bolus dose of injection propofol 0.75 mg/kg followed by an infusion started at 0.025 mg/kg/min IV. Sedation was titrated to Ramsay Sedation Score (RSS of 3. Patient's mean arterial pressure, heart rate, saturation peripheral pulse and need for intraoperative rescue sedation/analgesia were recorded and compared. The data analysis was carried out with Z test and Chi-square test. Results: Mean RSS was significantly more in Group D (4.24 ± 1.54 as compared to Group P (2.58 ± 0.95. Overall VAS score was also significantly less in Group D (3.5 ± 1.7 than in Group P (5.4 ± 1.8. In total, 16 patients (32% in Group D had hypotension whereas 7 patients (14% only in Group P had hypotension. Conclusion: Nalbuphine/dexmedetomidine combination is superior to nalbuphine/propofol in producing sedation and decreasing VAS in patients undergoing MESs under MAC. Better surgeon and patient satisfaction were observed with nalbuphine/dexmedetomidine. Haemodynamics need to be closely monitored.

  14. Evaluating and monitoring sedation, arousal, and agitation in the ICU.

    Science.gov (United States)

    Sessler, Curtis N; Riker, Richard R; Ramsay, Michael A

    2013-04-01

    Optimal management of patient comfort and sedative drug therapy for intensive care unit (ICU) patients includes establishing a goal of therapy-often defined by a desired level of consciousness, with titration of medications to achieve this target. An assessment of the level of consciousness is best performed using a simple tool, such as a sedation scale that relies on observation of the patient to assign a level of conscious that ranges from alert to unarousable. Many sedation scales incorporate observation of the patient's response to stimulation, which typically escalates from simply calling the patient's name to physical stimulation. Many such tools also incorporate an assessment of the presence and intensity of agitated behavior. Implementation of sedation scales has been associated with improved outcomes, and the frequent assessment of level of consciousness using a sedation scale is strongly recommended in clinical practice guidelines. Further, selection of a sedation scale that has been demonstrated to be valid and reliable in your patient population is endorsed. Objective measures of consciousness, such as devices that use processed electroencephalography, are less well established for routine ICU management and are recommended only for selected situations.

  15. Learn Excel 2011 for Mac

    CERN Document Server

    Hart-Davis, Guy

    2011-01-01

    Microsoft Excel 2011 for Mac OS X is a powerful application, but many of its most impressive features can be difficult to find. Learn Excel 2011 for Mac by Guy Hart-Davis is a practical, hands-on approach to learning all of the details of Excel 2011 in order to get work done efficiently on Mac OS X. From using formulas and functions to creating databases, from analyzing data to automating tasks, you'll learn everything you need to know to put this powerful application to use for a variety of tasks. What you'll learn * The secrets of the Excel for Mac interface! * How to create effective workbo

  16. [Nursing management of ventilation and sedation in patients suffering from septic shock].

    Science.gov (United States)

    Bridey, Céline; Mathieu, Soulène; Steiger, Magali; Trari, Vanessa; Lavoivre, Christine; Ducrocq, Nicolas; Levy, Bruno; Gérard, Alain; Augros, Johann

    2012-06-01

    A significant number of intubated, ventilated and sedated patients suffering from septic shock develop acute respiratory distress syndrome (ARDS). The supervision by a multidisciplinary team optimises both the management of ventilation and the sedation analgesia of the patient. The nursing supervision and care related to this pathology are specific.

  17. Physician reports of terminal sedation without hydration or nutrition for patients nearing death in the Netherlands

    NARCIS (Netherlands)

    A. van der Heide (Agnes); A.M. Vrakking (Astrid); B.D. Onwuteaka-Philipsen (Bregje); P.J. van der Maas (Paul); G. van der Wal (Gerrit); J.A.C. Rietjens (Judith)

    2004-01-01

    textabstractBACKGROUND: Terminal sedation in patients nearing death is an important issue related to end-of-life care. OBJECTIVE: To describe the practice of terminal sedation in the Netherlands. DESIGN: Face-to-face interviews. SETTING: The Netherlands. PARTICIPANTS: Nationwide st

  18. Sedation and Analgesia in Burn

    Directory of Open Access Journals (Sweden)

    Özkan Akıncı

    2011-07-01

    Full Text Available Burn injury is one of the most serious injuries that mankind may face. In addition to serious inflammation, excessive fluid loss, presence of hemodynamic instability due to intercurrent factors such as debridements, infections and organ failure, very different levels and intensities of pain, psychological problems such as traumatic stress disorder, depression, delirium at different levels that occur in patient with severe burn are the factors which make it difficult to provide the patient comfort. In addition to a mild to moderate level of baseline permanent pain in burn patients, which is due to tissue damage, there is procedural pain as well, which occurs by treatments such as grafting and dressings, that are severe, short-term burst style 'breakthrough' pain. Movement and tactile stimuli are also seen in burn injury as an effect to sensitize the peripheral and central nervous system. Even though many burn centers have established protocols to struggle with the pain, studies show that pain relief still inadequate in burn patients. Therefore, the treatment of burn pain and the prevention of possible emergence of future psychiatric problems suc as post-traumatic stress disorder, the sedative and anxiolytic agents should be used as a recommendation according to the needs and hemodynamic status of individual patient. (Journal of the Turkish Society Intensive Care 2011; 9 Suppl: 26-30

  19. Evaluation of adult outpatient magnetic resonance imaging sedation practices: are patients being sedated optimally?

    Energy Technology Data Exchange (ETDEWEB)

    Middelkamp, J.E. [Univ. of British Columbia Diagnostic Radiology Residency Program, Vancouver, British Columbia (Canada); Forster, B.B, E-mail: Bruce.Forster@vch.ca [Vancouver Hospital, Univ. of British Columbia site, Dept. of Radiology, Vancouver, British Columbia (Canada); Keogh, C. [Brooke Radiology, Burnaby, British Columbia (Canada); Lennox, P.; Mayson, K. [Vancouver Hospital, Dept. of Anesthesia, Vancouver, British Columbia (Canada)

    2009-10-15

    To evaluate the use of anxiolytics in adult outpatient magnetic resonance imaging (MRI) centres and to determine whether utilisation is optimal based on the pharmacology of the drugs used, who prescribes these drugs, and how patients are managed after administration. Identical paper and Web-based surveys were used to anonymously collect data about radiologists' use of anxiolytic agents for adult outpatient MRI examinations. The survey questions were about the type of facility, percentage of studies that require sedation, the drug used and route of administration, who orders the drug, timing of administration, patient monitoring during and observation after the study, use of a dedicated nurse for monitoring, and use of standard sedation and discharge protocols. The {chi}2 analysis for statistical association among variables was used. Eighty-five of 263 surveys were returned (32% response rate). The radiologist ordered the medication (53%) in slightly more facilities than the referring physician (44%) or the nurse. Forty percent of patients received medication 15-30 minutes before MRI, which is too early for peak effect of oral or sublingual drugs. Lorazepam was most commonly used (64% first choice). Facilities with standard sedation protocols (56%) were more likely to use midazolam than those without standard sedation protocols (17% vs 10%), to have a nurse for monitoring (P = .032), to have standard discharge criteria (P = .001), and to provide written information regarding adverse effects (P = .002). Many outpatients in MRI centres may be scanned before the peak effect of anxiolytics prescribed. A standard sedation protocol in such centres is associated with a more appropriate drug choice, as well as optimized monitoring and postprocedure care. (author)

  20. Guidelines: In-office use of conscious sedation in periodontics.

    Science.gov (United States)

    2001-07-01

    In this time of heightened awareness of periodontal diseases and the potential consequences of untreated disease, a deterrent in the delivery of periodontal care continues to be patient anxiety concerning treatment and the fear of pain. These guidelines are intended for periodontists in the in-office use of enteral, inhalation, and/or parenteral conscious sedation in the delivery of care. The definitions, educational guidelines, and policies presented in these guidelines are consistent with the most current American Dental Association (ADA) documents Guidelines for the Use of Conscious Sedation, Deep Sedation and General Anesthesia for Dentists and the Guidelines for Teaching the Comprehensive Control of Anxiety and Pain in Dentistry available from the American Dental Association, 211 E. Chicago Avenue, Chicago, IL 60611 or http://www.ada.org, and for Revisions to Anesthesia Care Standards Comprehensive Accreditation Manual for Ambulatory Care, effective January 1, 2001, Joint Commission on Accreditation of Health Care Organizations, available through http://www.jcaho.org/standard/anesamb.html. This paper replaces the former position paper entitled "Guidelines for the Use of Conscious Sedation in Periodontics."

  1. Reflexology: its effects on physiological anxiety signs and sedation needs.

    Science.gov (United States)

    Akin Korhan, Esra; Khorshid, Leyla; Uyar, Mehmet

    2014-01-01

    To investigate whether reflexology has an effect on the physiological signs of anxiety and level of sedation in patients receiving mechanically ventilated support, a single blinded, randomized controlled design with repeated measures was used in the intensive care unit of a university hospital in Turkey. Patients (n = 60) aged between 18 and 70 years and were hospitalized in the intensive care unit and receiving mechanically ventilated support. Participants were randomized to a control group or an intervention group. The latter received 30 minutes of reflexology therapy on their feet, hands, and ears for 5 days. Subjects had vital signs taken immediately before the intervention and at the 10th, 20th, and 30th minutes of the intervention. In the collection of the data, "American Association of Critical-Care Nurses Sedation Assessment Scale" was used. The reflexology therapy group had a significantly lower heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate than the control group. A statistically significant difference was found between the averages of the scores that the patients included in the experimental and control groups received from the agitation, anxiety, sleep, and patient-ventilator synchrony subscales of the American Association of Critical-Care Nurses Sedation Assessment Scale. Reflexology can serve as an effective method of decreasing the physiological signs of anxiety and the required level of sedation in patients receiving mechanically ventilated support. Nurses who have appropriate training and certification may include reflexology in routine care to reduce the physiological signs of anxiety of patients receiving mechanical ventilation.

  2. Ellen MacArthur

    Institute of Scientific and Technical Information of China (English)

    Teodora; Lazarova

    2006-01-01

    Just over a year since breaking the round theworld solo record on board her 75 foot trimaranB&O,Ellen MacArthur embarked on a newventure:the Asian Record Circuit 2006,incorpo-rating the ‘Tour Of China’,and bringing a differ-ent set of challenges into new territories.Wespoke to Ellen and her team during their recent(April)stopover in Oingdao.When did you start sailing and what inspiredyou(you grew up in Derbyshire,in the UK,quite far away from the water)?I was introduced to sailing by my Aunt Thea ona small sailing boat called Cabaret.We wentsailing along the east coast of EngLand andbefore I knew it,I was hooked on sailing.I wasso inspired that when I was at school,I saved

  3. iMac for dummies

    CERN Document Server

    Chambers, Mark L

    2012-01-01

    The bestselling guide to the ultimate all-in-one computer—now updated and revised throughout! If you're looking for speed, performance, and power, the iMac is the ultimate all-in-one computer. From its superior performance, powerful operating system, and amazing applications, the iMac is one awesome machine, and the fun, friendly, and approachable style of iMac For Dummies is an ideal way to get started with the basics. You'll learn the fundamentals of the iMac including setting up and customizing your iMac and the software that comes with it, importing files from your old computer, send

  4. Macs for seniors for dummies

    CERN Document Server

    Chambers, Mark L

    2009-01-01

    Over 50 and thinking about getting your first computer? A user-friendly Mac is a great choice, and Macs For Seniors For Dummies walks you through choosing one and learning to use it. You won't even need your grandchildren to help! Macs For Seniors For Dummies introduces you to all the basic things you may not have encountered before-how to use the keyboard and mouse, work with files and folders, navigate around the Mac OS X desktop, set up an Internet connection, and much more. You'll learn to:Choose the Mac that's right for you, set it up, run programs and manage files, and hook up a printerU

  5. Cardiac Dysrhythmias With Midazolam Sedation

    OpenAIRE

    Rodrigo, Chandra R.; Rosenquist, Jan B.; Cheng, Chun Ho

    1990-01-01

    A randomized cross-over study was made of 32 young healthy Hong Kong Chinese to compare the incidence and nature of dysrhythmias that occurred during third molar surgery done under local anesthesia, alone or supplemented with midazolam sedation. The incidence of dysrhythmias during surgery was not significantly different during the two procedures. However prior to surgery, 25% of the patients had dysrhythmias during sedation with midazolam. The majority of dysrhythmias were infrequent unifoca...

  6. Intranasal sedatives in pediatric dentistry

    OpenAIRE

    AlSarheed, Maha A

    2016-01-01

    Objectives: To identify the intranasal (IN) sedatives used to achieve conscious sedation during dental procedures amongst children. Methods: A literature review was conducted by identifying relevant studies through searches on Medline. Search included IN of midazolam, ketamine, sufentanil, dexmedetomidine, clonidine, haloperidol and loranzepam. Studies included were conducted amongst individuals below 18 years, published in English, and were not restricted by year. Exclusion criteria were art...

  7. Intranasal sedatives in pediatric dentistry

    Science.gov (United States)

    AlSarheed, Maha A.

    2016-01-01

    Objectives: To identify the intranasal (IN) sedatives used to achieve conscious sedation during dental procedures amongst children. Methods: A literature review was conducted by identifying relevant studies through searches on Medline. Search included IN of midazolam, ketamine, sufentanil, dexmedetomidine, clonidine, haloperidol and loranzepam. Studies included were conducted amongst individuals below 18 years, published in English, and were not restricted by year. Exclusion criteria were articles that did not focus on pediatric dentistry. Results: Twenty studies were included. The most commonly used sedatives were midazolam, followed by ketamine and sufentanil. Onset of action for IN midazolam was 5-15 minutes (min), however, IN ketamine was faster (mean 5.74 min), while both IN sufentanil (mean 20 min) and IN dexmedetomidine (mean 25 min) were slow in comparison. Midazolam was effective for modifying behavior in mild to moderately anxious children, however, for more invasive or prolonged procedures, stronger sedatives, such as IN ketamine, IN sufentanil were recommended. In addition, ketamine fared better in overall success rate (89%) when compared with IN midazolam (69%). Intranasal dexmedetomidine was only used as pre-medication amongst children. While its’ onset of action is longer when compared with IN midazolam, it produced deeper sedation at the time of separation from the parent and at the time of anesthesia induction. Conclusion: Intranasal midazolam, ketamine and sufentanil are effective and safe for conscious sedation, while intranasal midazolam, dexmedetomidine and sufentanil have proven to be effective premedications. PMID:27570849

  8. Sedation of Pediatric Patients in Magnetic Resonance Imaging

    Science.gov (United States)

    2000-01-03

    Nurse, Pediatric Flight 1989-1993 Neonatal Intensive Care Unit Wright-Patterson Air Force Base, Ohio Staff Nurse 1989 Medical/Surgical Unit...techniques have changed over the years. Twenty years ago male infants receiving a circumcision sucked on bourbon sponges for sedation, today regional

  9. Hypnotics and Sedatives

    Science.gov (United States)

    Kabra, Pokar M.; Koo, Howard Y.; Marton, Laurence J.

    In recent years, most large hospitals have observed a marked increase in the admission of patients suffering from drug overdose. Overdose of narcotic drugs, such as the opiates, represent less of a problem on a day-to-day basis than do overdoses of prescribed drugs, such as sedatives and hypnotics. Clinical signs and symptoms for a narcotic drug overdose are very distinct, and in the majority of cases can be easily recognized by the attending physicians without the help of a toxicology laboratory. Loomis (1) reported that the majority of fatal poisonings owed to one, or a combination, of four agents: barbiturates, carbon monoxide, ethyl alcohol, and salicylates. Berry (2) estimated that 5-5'-disubstituted barbiturates were the second commonest cause of fatal poisoning in England, and that the frequency of their use was increasing. Other nonbarbiturate hypnotics involved in coma-producing incidents include glutethimide (Doriden®), methyprylon (Noludar®), and meprobamate (3, 4). In the last five years, diazepam (Valium®) has become one of the leading misused drugs (5).

  10. Review of palliative sedation and its distinction from euthanasia and lethal injection.

    Science.gov (United States)

    Hahn, Michael P

    2012-01-01

    Palliative sedation evolved from within the practice of palliative medicine and has become adopted by other areas of medicine, such as within intensive care practice. Clinician's usually come across this practice for dying patients who are foregoing or having life support terminated. A number of intolerable and intractable symptom burdens can occur during the end of life period that may require the use of palliative sedation. Furthermore, when patients receive palliative sedation, the continued use of hydration and nutrition becomes an issue of consideration and there are contentious bioethical issues involved in using or withholding these life-sustaining provisions. A general understanding of biomedical ethics helps prevent abuse in the practice of palliative sedation. Various sedative drugs can be employed in the provision of palliative sedation that can produce any desired effect, from light sedation to complete unconsciousness. Although there are some similarities in the pharmacotherapy of palliative sedation, euthanasia, physician-assisted suicide, and lethal injection, there is a difference in how the drugs are administered with each practice. There are some published guidelines about how palliative sedation should be practiced, but currently there is not any universally accepted standard of practice.

  11. Gotcha! Macs lose their innocence

    CERN Multimedia

    Computer Security Team

    2012-01-01

    Still believe your Mac is secure because Microsoft PCs fall prey to viruses and worms but Macs don’t? Time to wake up! This year has seen the first major compromise of Macs worldwide*. How is yours doing?   The “Flashback” Trojan is affecting Apple’s own variant of Java and compromises Macs via so-called drive-by infections, i.e. when you visit an appropriately prepared (infected!) website - and this might not necessarily be a site with questionable contents, but could well be a popular, reputable one. Security Companies worldwide have been monitoring this particular Trojan for a while and have estimated that more than half a million Macs were compromised. Connected to a few central command and control servers, the compromised Macs were then supporting the malicious activity of the bad guys! Fortunately, the security companies have now been able to take over those command and control servers and stop their destructive drive. So, Mac users, face the f...

  12. Anxiety in Children Undergoing VCUG: Sedation or No Sedation?

    Directory of Open Access Journals (Sweden)

    David W. Herd

    2008-01-01

    Full Text Available Background. Voiding cystourethrograms are distressing for children and parents. Nonpharmacological methods reduce distress. Pharmacological interventions for VCUG focus on sedation as well as analgesia, anxiolysis, and amnesia. Sedation has cost, time, and safety issues. Which agents and route should we use? Are we sure that sedation does not influence the ability to diagnose vesicoureteric reflux? Methods. Literature search of Medline, EMBASE, and the Cochrane Database. Review of comparative studies found. Results. Seven comparative studies including two randomised controlled trials were reviewed. Midazolam given orally (0.5-0.6 mg/kg or intranasally (0.2 mg/kg is effective with no apparent effect on voiding dynamics. Insufficient evidence to recommend other sedating agents was found. Deeper sedating agents may interfere with voiding dynamics. Conclusion. Midazolam reduces the VCUG distress, causes amnesia, and does not appear to interfere with voiding dynamics. Midazolam combined with simple analgesia is an effective method to reduce distress to children undergoing VCUG.

  13. Java and Mac OS X

    CERN Document Server

    Davis, T Gene

    2010-01-01

    Learn the guidelines of integrating Java with native Mac OS X applications with this Devloper Reference book. Java is used to create nearly every type of application that exists and is one of the most required skills of employers seeking computer programmers. Java code and its libraries can be integrated with Mac OS X features, and this book shows you how to do just that. You'll learn to write Java programs on OS X and you'll even discover how to integrate them with the Cocoa APIs.: Shows how Java programs can be integrated with any Mac OS X feature, such as NSView widgets or screen savers; Re

  14. [Results of a national survey about the use of sedation scales in emergency prehospital medicine].

    Science.gov (United States)

    Belpomme, V; Devaud, M-L; Pariente, D; Ricard-Hibon, A; Mantz, J

    2009-04-01

    The primary goal of sedation in emergency prehospital care is to guarantee the security of the mechanically ventilated patients by optimising their adaptation to the respirator. If the French prehospital guidelines are well codified, their applicability in routine clinical practice seem to be rather empirical. The aim of this national survey was to evaluate the use of the clinical sedation scales by the prehospital physicians. This prospective and clinical practice survey was begun in January 2005. An anonymous questionnaire was sent to the physicians working in the 377 Mobile Intensive Care Unit of the 105 French Emergency Medical Service System. The total response rate from physicians was 28% (n=497). Only 29% of the physicians (n=145) declared to use a sedation scale for a mechanically ventilated patient. The Ramsay score was used in 97% of the cases (n=141).The principal reasons given by the physicians for not using the sedation scales were their ignorance in 57% of the cases (n=200) and the systematic choice of a deep sedation in 42% of the cases (n=147). For 18% of them (n=62), the use of sedation scores was considered too complicated. The final results show that the utilisation ratio of the sedation scores is very low in emergency prehospital medicine and suggest that an effort toward improving the use of sedation in prehospital emergency medicine is necessary.

  15. Validity, reliability and applicability of Portuguese versions of sedation-agitation scales among critically ill patients

    Directory of Open Access Journals (Sweden)

    Antonio Paulo Nassar Junior

    Full Text Available CONTEXT AND OBJECTIVE: Sedation scales are used to guide sedation protocols in intensive care units (ICUs. However, no sedation scale in Portuguese has ever been evaluated. The aim of this study was to evaluate the validity and reliability of Portuguese translations of four sedation-agitation scales, among critically ill patients: Glasgow Coma Score, Ramsay, Richmond Agitation-Sedation Scale (RASS and Sedation-Agitation Scale (SAS. DESIGN AND SETTING: Validation study in two mixed ICUs of a university hospital. METHODS: All scales were applied to 29 patients by four different critical care team members (nurse, physiotherapist, senior critical care physician and critical care resident. We tested each scale for interrater reliability and for validity, by correlations between them. Interrater agreement was measured using weighted kappa (k and correlations used Spearman's test. RESULTS: 136 observations were made on 29 patients. All scales had at least substantial agreement (weighted k 0.68-0.90. RASS (weighted k 0.82-0.87 and SAS (weighted k 0.83-0.90 had the best agreement. All scales had a good and significant correlation with each other. CONCLUSIONS: All scales demonstrated good interrater reliability and were comparable. RASS and SAS showed the best correlations and the best agreement results in all professional categories. All these characteristics make RASS and SAS good scales for use at the bedside, to evaluate sedation-agitation among critically ill patients in terms of validity, reliability and applicability.

  16. [Sedation using ketamine for pain procedures in Pediatric Oncology.].

    Science.gov (United States)

    Ricard, C; Tichit, R; Troncin, R; Bernard, F

    2009-09-01

    Procedural sedation and analgesia for children is widely practiced. Since 2005 to 2007, we evaluated the safety and efficacy of ketamine to control pain induced by diagnostic procedures in pediatric oncology patients. Eight hundred fifty procedures were carried out in 125 patients aged 2 to 16 years. We associated EMNO (inhaled equimolar mixture of nitrous oxide and oxygen), atropin (oral or rectal), midazolam (oral or rectal) and ketamin (intravenous). An anesthesiologist injected ketamin. Average dose of ketamine was 0.33 to 2 mg/kg depending on number and invasiveness of procedures. This method requires careful monitoring and proper precautions. With these conditions, no complication was observed. All patients were effectively sedated. These results indicate that ketamine - in association with EMNO, atropine and midazolam - is safe and effective in pain management induced by diagnostic procedures in pediatric oncology patients. The sedative regimen of intravenous ketamine has greatly reduced patient, family and practitioners anxiety for diagnostic and therapeutic procedures.

  17. No-sedation during mechanical ventilation

    DEFF Research Database (Denmark)

    Laerkner, Eva; Stroem, Thomas; Toft, Palle

    2016-01-01

    BACKGROUND: Evidence is growing that less or no-sedation is possible and beneficial for patients during mechanical ventilation. AIM: To investigate if there was a difference in patient consciousness and nursing workload comparing a group of patients receiving no-sedation with a group of sedated...... patients with daily wake up, and also to estimate economic consequences of a no-sedation strategy. DESIGN AND METHODS: Data were collected during a prospective trial of 140 mechanically ventilated patients randomized to either no-sedation or to sedation with daily wake up. From day 1 to 7 in the intensive...

  18. Fluctuations in sedation levels may contribute to delirium in ICU patients

    DEFF Research Database (Denmark)

    Svenningsen, H; Egerod, Ingrid Eugenie; Videbech, P;

    2013-01-01

    Delirium in patients admitted to the intensive care unit (ICU) is a serious complication potentially increasing morbidity and mortality. The aim of this study was to investigate the impact of fluctuating sedation levels on the incidence of delirium in ICU.......Delirium in patients admitted to the intensive care unit (ICU) is a serious complication potentially increasing morbidity and mortality. The aim of this study was to investigate the impact of fluctuating sedation levels on the incidence of delirium in ICU....

  19. MacBook portable genius

    CERN Document Server

    Miser, Brad

    2008-01-01

    The Genius is in. You don't have to be a genius to use a MacBook. But if you want to get the very most out of yours, put this savvy Portable Genius guide to work. Want to connect your MacBook to other Macs? Use Expose to its fullest potential? Troubleshoot? You'll find cool and useful Genius tips, insider secrets, full-color screenshots, and pages of easy-to-access shortcuts and tools that will save you loads of time and make your MacBook IQ soar. Portable GENIUS Fun, hip, and straightforward, the new Portable Genius series gives forward-thinking Apple users useful informat

  20. Mac mini真体验

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    2005年,Mac mini首次登场,众所周知,苹果的模具更换的并不频繁,在外貌没有大幅改变的情况下,迄今为止,Mac mini实际上已经更新了7代。最新的Mac mini的工业设计实际上延续了2008年开始的Unibody一体成型铝合金机身设计与其他Mac在外观上保持了一致的元素。更小的Mac mini看起来更加性感诱人,那么,你需要它么?

  1. Mac Programming for Absolute Beginners

    CERN Document Server

    Wang, Wallace

    2011-01-01

    Want to learn how to program on your Mac? Not sure where to begin? Best-selling author Wallace Wang will explain how to get started with Cocoa, Objective-C, and Xcode. Whether you are an experienced Windows coder moving to the Mac, or you are completely new to programming, you'll see how the basic design of a Mac OS X program works, how Objective-C differs from other languages you may have used, and how to use the Xcode development environment. Most importantly, you'll learn how to use elements of the Cocoa framework to create windows, store data, and respond to users in your own Mac programs.

  2. A Mac Protocol Implementation for Wireless Sensor Network

    Directory of Open Access Journals (Sweden)

    Jamila Bhar

    2015-01-01

    Full Text Available IEEE 802.15.4 is an important standard for Low Rate Wireless Personal Area Network (LRWPAN. The IEEE 802.15.4 presents a flexible MAC protocol that provides good efficiency for data transmission by adapting its parameters according to characteristics of different applications. In this research work, some restrictions of this standard are explained and an improvement of traffic efficiency by optimizing MAC layer is proposed. Implementation details for several blocks of communication system are carefully modeled. The protocol implementation is done using VHDL language. The analysis gives a full understanding of the behavior of the MAC protocol with regard to backoff delay, data loss probability, congestion probability, slot effectiveness, and traffic distribution for terminals. Two ideas are proposed and tested to improve efficiency of CSMA/CA mechanism for IEEE 802.15.4 MAC Layer. Primarily, we dynamically adjust the backoff exponent (BE according to queue level of each node. Secondly, we vary the number of consecutive clear channel assessment (CCA for packet transmission. We demonstrate also that slot compensation provided by the enhanced MAC protocol can greatly avoid unused slots. The results show the significant improvements expected by our approach among the IEEE 802.15.4 MAC standards. Synthesis results show also hardware performances of our proposed architecture.

  3. Apple MacBook Air

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    当乔布斯手持MacBook Air,放言“there is somthing in air”时,苹果教徒们的信仰再一次得到了“升华”。其实再为MacBook Air来写这样一段文字,多少显得有些多余。

  4. Use of opioids and sedatives at End-of-Life

    Directory of Open Access Journals (Sweden)

    Shin Wei Sim

    2014-01-01

    Full Text Available Despite their proven efficacy and safety, opioid and sedative use for palliation in patients afflicted with cancer in Singapore have been shown to be a fraction of that in other countries. This paper explores the various psychosocial and system-related factors that appear to propagate this conservative approach to care in what is largely a western-influenced care practice. A search for publications relating to sedative and opioid usage in Asia was performed on PubMed, Google, Google Scholar, World Health Organization, and Singapore′s government agency websites using search terms such as "opioids," "sedatives," "palliation," "end-of-life-care," "pain management," "palliative care," "cancer pain," "Asia," "Singapore," and "morphine." Findings were classified into three broad groups - system-related, physician-related, and patient-related factors. A cautious medico-legal climate, shortage of physicians trained in palliative care, and lack of instruments for symptom assessment of patients at the end of life contribute to system-related barriers. Physician-related barriers include delayed access to palliative care due to late referrals, knowledge deficits in non-palliative medicine physicians, and sub-optimal care provided by palliative physicians. Patients′ under-reporting of symptoms and fear of addiction, tolerance, and side effects of opioids and sedatives may lead to conservative opioid use in palliative care as well. System-related, physician-related, and patient-related factors play crucial roles in steering the management of palliative patients. Addressing and increasing the awareness of these factors may help ensure patients receive adequate relief and control of distressing symptoms.

  5. Fiverr MacGyver

    Science.gov (United States)

    Hut, Rolf; van de Giesen, Nick; Larson, Martha

    2014-05-01

    Crowdsourcing has become popular over the past years, also for scientific endeavors. There are many Citizen Science projects and crowdfunding platforms, such as Kickstarter, that are make helpful contributions to moving environmental science forward. An interesting underused source of useful crowd-derived contributions to research is the website Fiverr.com. On this platform, thousands of people, acting as small-scale freelance contractors, offer their skills in the form of services. The platform offers a chance for people to take a hobby, skill, or pastime and make it something more by reaching out to a wider audience and by receiving a payment in return for services. As is typical of other crowdsourcing platforms, the tasks are small and usually self contained. As the name Fiverr suggests, offers start at US5 to provide a particular service. Services offered range from graphic design, to messages sung or spoken with various styles or accents, to complete apps for Android or iPhone. Skill providers on the platform can accept a range of variation of definition in the tasks, some can be described in general terms, for others it is more appropriate to provide examples. Fiverr provides a central location for those offering skills and those needing services to find each other, it makes it possible to communicate and exchange files, to make payments, and it provides support for resolving disputes. In all cases, it is important to keep expectations aligned with the nature of the platform: quality can and will vary. Ultimately, the critical contribution of Fiverr is not to replace professional services or otherwise save money, but rather to provide access to a large group of people with specialized skills who are able to make a contribution on short notice. In the context of this session, it can be considered a pool of people with MacGyver skills lying in wait of a MacGyyer task to attack. There are many ways in which Fiverr tasks, which are called 'gigs', can be useful in

  6. Switching to a Mac portable genius

    CERN Document Server

    McFedries, Paul

    2011-01-01

    Switching from a PC to a Mac is a breeze with this book Anyone considering making the move to Mac from the Windows world will find this book smoothes the way. While Macs are famous for ease of use, there are fundamental differences in Mac and PC ways of thinking, plus there?s the hassle of moving files, calendars, and other essential data from one platform to another. This guide lays out all the information, explains basic Mac procedures for the newcomer, offers great tips on data-sharing (including running Windows applications on a Mac), and provides everything the new Mac user needs to move

  7. MacBook Teach Yourself VISUALLY

    CERN Document Server

    Miser, Brad

    2010-01-01

    Like the MacBook itself, Teach Yourself VISUALLY MacBook, Second Edition is designed to be visually appealing, while providing excellent functionality at the same time. By using this book, MacBook users will be empowered to do everyday tasks quickly and easily. From such basic steps as powering on or shutting down the MacBook, working on the Mac desktop with the Dashboard and its widgets to running Windows applications, Teach Yourself VISUALLY MacBook, Second Edition covers all the vital information and provides the help and support a reader needs—in many ways it's like having a Mac Genius at

  8. Switching to a Mac For Dummies

    CERN Document Server

    Reinhold, Arnold

    2011-01-01

    Learn how to make the switch from PC to Mac a completely smooth transition The number of Mac users continues to increase significantly each year. If you are one of those people and are eager but also anxious about making the switch, then fear not! This friendly guide skips the jargon to deliver you an easy-to-read, understandable introduction to the Macintosh computer. Computer guru Arnold Reinhold walks you through the Mac OS, user interface, and icons. You'll learn how to set up your Mac, move your files from your PC to your Mac, switch applications, get your Mac online, network your Mac, se

  9. Non-Parenteral Medications for Procedural Sedation in Children- A Narrative: Review Article.

    Science.gov (United States)

    Fallah, Razieh; Ferdosian, Farzad; Shajari, Ahmad

    2015-01-01

    Procedural sedation may be needed in many diagnostic and therapeutic procedures in children. To make pediatric procedural sedation as safe as possible, protocols should be developed by institutions. Response to sedation in children is highly variable, while some become deeply sedated after minimal doses, others may need much higher doses. Child developmental status, clinical circumstances and condition of patient should be considered and then pharmacologic and non-pharmacologic interventions for sedation be selected. Drug of choice and administration route depend on the condition of the child, type of procedure, and predicted pain degree. The drugs might be administered parenteral (intravenous or intramuscular) or non parenteral including oral, rectal, sublingual, aerosolized buccal and intranasal. The use of intravenous medication such propofol, ketamine, dexmedetomidine, or etomidate may be restricted in use by pediatric anesthesiologist or pediatric critical care specialists or pediatric emergency medicine specialists. In this review article we discuss on non-parenteral medications that can be used by non- anesthesiologist.

  10. Comparison of Intravenous Dexmedetomidine and Midazolam for Bispectral Index-Guided Sedation During Spinal Anesthesia.

    Science.gov (United States)

    Jo, Youn Yi; Lee, Dongchul; Jung, Wol Seon; Cho, Noo Ree; Kwak, Hyun Jeong

    2016-10-04

    BACKGROUND Despite the high frequency of hypotension during spinal anesthesia with proper sedation, no previous report has compared the hemodynamic effects of dexmedetomidine and midazolam sedation during spinal anesthesia. We compared the effects of bispectral index (BIS)-guided intravenous sedation using midazolam or dexmedetomidine on hemodynamics and recovery profiles in patients who underwent spinal anesthesia. MATERIAL AND METHODS One hundred and sixteen adult patients were randomly assigned to receive either midazolam (midazolam group; n=58) or dexmedetomidine (dexmedetomidine group; n=58) during spinal anesthesia. Systolic, diastolic, and mean arterial pressures; heart rates; peripheral oxygen saturations; and bispectral index scores were recorded during surgery, and Ramsay sedation scores and postanesthesia care unit (PACU) stay were monitored. RESULTS Hypotension occurred more frequently in the midazolam group (Pmidazolam sedation.

  11. Sedation and Analgesia in Mechanical Ventilation

    DEFF Research Database (Denmark)

    Strøm, Thomas; Toft, Palle

    2014-01-01

    Traditionally, critically ill patients undergoing mechanical ventilation (MV) have received sedation. Over the last decade, randomized controlled trials have questioned continued use of deep sedation. Evidence shows that a nurse-driven sedation protocol reduces length of MV compared with standard...

  12. Mac OS X Lion在Mac App Store上线

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    2011年7月20日,Apple宣布具有超过250种新功能的世界最先进操作系统的第八个重要版本Mac OS X Lion今天在Mac App StoreTM推出并可进行下载,价格为29.99美元。Lion的诸多超强功能包括:全新Multi-Touch手势;全系统支持全屏应用程序;

  13. P18.07PALLIATIVE SEDATION FOR BRAIN TUMOR PATIENTS AT THE END OF LIFE

    Science.gov (United States)

    Pace, A.; Villani, V.; Benincasa, D.; Di Pasquale, A.; Carapella, C.M.; Pompili, A.

    2014-01-01

    BACKGROUND: Therapeutic (or palliative) sedation in the context of palliative medicine is the monitored use of medications intended to induce a state of decreased or absent awareness (unconsciousness) in order to relieve the burden of otherwise intractable suffering in a manner that is ethically acceptable to the patient, family and health-care providers. There is a large debate about the use of palliative sedation, sometime defined as terminal sedation. There are very few data about the role of palliative sedation in brain tumor patients at the end of life. However, in brain tumor patients palliative sedation may be necessary in case of uncontrolled delirium, agitation, death rattle or refractory seizures. METHODS: We retrospectively analyzed the clinical records of patients assisted at home until death by the Regina Elena Cancer Institute Palliative Home Care for brain tumor patients. All patients died for brain tumor in the last 2 years (2012-2013) were included in this study. RESULTS: Out of 190 brain tumor patients assisted at home in 2012-2013, 108 died and were included in this study. All patients were affected by malignant glioma. Palliative sedation was utilized in 12 cases (11%). In 8 cases for the control of refractory seizures and in 4 cases for delirium. Given the lack of advanced directives and low competence of patients, the decision about sedation was discussed by the care team with caregivers and family members. Palliative sedation was started with midazolam 0.5-1 mg/hr and prolonged until symptoms' control. CONCLUSION: The use of palliative sedation is relatively frequent in the practice of a neuro-oncologic palliative team. The most frequent refractory symptoms in this population of patients were seizures and delirium. The process of end of life treatment decisions in neuro-oncology requires to be better defined.

  14. Dexmedetomidine for monitored anesthesia care in patients undergoing liberation procedure for multiple sclerosis: An observational study

    Directory of Open Access Journals (Sweden)

    Saurabh Anand

    2012-01-01

    Full Text Available Background: It has been postulated that Multiple sclerosis (MS stems from a narrowing in the veins that drain blood from the brain, known medically as chronic cerebrospinal venous insufficiency, or CCSVI. It has been proposed that balloon angioplasty should alleviate the symptoms of MS. This procedure is also known as "The Liberation Procedure." Accordingly, a clinical study was undertaken to determine the effects of dexmedetomidine in patients undergoing the liberation procedure. Aims: To assess the effectiveness of dexmedetomidine in providing adequate sedation and pain relief for patients undergoing the liberation procedure. Settings and design: A prospective, nonrandomized observational study of 60 consecutive adult patients undergoing the liberation procedure under monitored anesthesia care (MAC who will receive dexmedetomidine as an anesthetic agent. Methods: A total of 60 adult patients were enrolled in the study. Dexmedetomidine was administered to all patients in a loading dose of 1 mcg/kg, which was followed by a maintenance dose of 0.2-0.5 mcg/kg/h. The evaluation of quality of sedation was based on Ramsay Sedation and the quality of analgesia was assessed using the visual analog scale. The following parameters were measured continuously: heart rate, mean arterial pressure and hemoglobin oxygen saturation. Patients were asked to answer the question, "How would you rate your experience with the sedation you have received during surgery?" using a seven-point Likert-like verbal rating scale. Statistical analysis: Repeated measurements were analyzed by repeated measures ANOVA for HR and BP. Results: Most of our patients were satisfied with their sedation. In most of the patients, MAP and HR dropped after the bolus dose of dexmedetomidine, and the drop was statistically significant. Conclusions: Dexmedetomidine can be used as a sole sedative agent in patients undergoing the liberation procedure.

  15. Nonmedical use of sedative-hypnotics and opiates among rural and urban women with protective orders.

    Science.gov (United States)

    Cole, Jennifer; Logan, T K

    2010-07-01

    The purpose of this study was to examine the prevalence and risk factors for lifetime nonmedical use of sedative-hypnotics and opiates among a sample of rural and urban women with recent partner violence victimization (n=756). Nearly one third of the sample (32.8%) reported ever using illicit sedative-hypnotics or opiates. Nonmedical use of sedative-hypnotics and opiates was significantly associated with lifetime cumulative exposure to interpersonal victimization, rural Appalachian residency, past-year use of other substances and other substance-related problems, and lifetime unmet health care needs. Findings have implications for substance abuse prevention and treatment and victim advocacy programs.

  16. Office 2011 for Mac For Dummies

    CERN Document Server

    LeVitus, Bob

    2011-01-01

    Get started with Office 2011 for Mac and discover the creative possibilitiesThe leading suite of productivity software for the Mac, Microsoft Office helps users complete common business tasks, including word processing, e-mail, presentations, financial analysis, and much more. Office 2011 for Mac For Dummies is the perfect companion for Microsoft Office for Mac users upgrading to the newest version, new computer users, and those who may have switched from the Windows version of Office. Written by one of the most popular gurus in the Mac community, Bob "Dr. Mac" LeVitus, the book explains every

  17. The perspectives of clinical staff and bereaved informal care-givers on the use of continuous sedation until death for cancer patients: The study protocol of the UNBIASED study

    NARCIS (Netherlands)

    J. Seymour (Jane); J.A.C. Rietjens (Judith); J. Brown (Jayne); A. van der Heide (Agnes); S. Sterckx (Sigrid); L. Deliens (Luc)

    2011-01-01

    textabstractBackground: A significant minority of dying people experience refractory symptoms or extreme distress unresponsive to conventional therapies. In such circumstances, sedation may be used to decrease or remove consciousness until death occurs. This practice is described in a variety of way

  18. Comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation

    Directory of Open Access Journals (Sweden)

    Werther Brunow de Carvalho

    1999-09-01

    Full Text Available CONTEXT: A high number of hospitalized children do not receive adequate sedation due to inadequate evaluation and use of such agents. With the increase in knowledge of sedation and analgesia in recent years, concern has also risen, such that it is now not acceptable that incorrect evaluations of the state of children's pain and anxiety are made. OBJECTIVE: A comparison between the Comfort and Hartwig sedation scales in pediatric patients undergoing mechanical lung ventilation. DESIGN: Prospective cohort study. SETTING: A pediatric intensive care unit with three beds at an urban teaching hospital. PATIENTS: Thirty simultaneous and independent observations were conducted by specialists on 18 patients studied. DIAGNOSTIC TEST: Comfort and Hartwig scales were applied, after 3 minutes of observation. MAIN MEASUREMENTS: Agreement rate (kappa. RESULTS: On the Comfort scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 20.28 (SD 2.78, 27.5 (SD 0.70, and 15.1 (SD 1.10, respectively, whereas on the Hartwig scale, the averages for adequately sedated, insufficiently sedated, and over-sedated were 16.35 (SD 0.77, 20.85 (SD 1.57, and 13.0 (SD 0.89, respectively. The observed agreement rate was 63% (p = 0.006 and the expected agreement rate was 44% with a Kappa coefficient of 0.345238 (z = 2.49. CONCLUSIONS: In our study there was no statistically significant difference whether the more complex Comfort scale was applied (8 physiological and behavioral parameters or the less complex Hartwig scale (5 behavioral parameters was applied to assess the sedation of mechanically ventilated pediatric patients.

  19. Interest of 50% nitrous oxide and oxygen premix sedation in gerodontology

    Science.gov (United States)

    Nicolas, Emmanuel; Lassauzay, Claire

    2009-01-01

    Elderly patients presenting cardiovascular, respiratory, or neurological disorders require a specific dental care approach, especially patients presenting Alzheimer’s disease. Sedative procedures can prevent dental care-induced stress, even when there is effective pain control, but they have to be adapted to accommodate age-induced physiological modifications, age-related pathologies, and the concomitant treatments. In many situations, routine sedative prescriptions for dental care, such as benzodiazepine or antihistaminics, are not recommended for these patients. Nitrous oxide inhalation together with a specific behavioral threshold is currently the only sedative procedure adapted to cognitively-impaired elderly patients. Nitrous oxide is able to curb stress and its cardiovascular consequences, improve oxygenation, and optimize cooperation during dental care, making not only rehabilitation treatments but also routine dental care a viable option. PMID:19503768

  20. Interest of 50% nitrous oxide and oxygen premix sedation in gerodontology.

    Science.gov (United States)

    Nicolas, Emmanuel; Lassauzay, Claire

    2009-01-01

    Elderly patients presenting cardiovascular, respiratory, or neurological disorders require a specific dental care approach, especially patients presenting Alzheimer's disease. Sedative procedures can prevent dental care-induced stress, even when there is effective pain control, but they have to be adapted to accommodate age-induced physiological modifications, age-related pathologies, and the concomitant treatments. In many situations, routine sedative prescriptions for dental care, such as benzodiazepine or antihistaminics, are not recommended for these patients. Nitrous oxide inhalation together with a specific behavioral threshold is currently the only sedative procedure adapted to cognitively-impaired elderly patients. Nitrous oxide is able to curb stress and its cardiovascular consequences, improve oxygenation, and optimize cooperation during dental care, making not only rehabilitation treatments but also routine dental care a viable option.

  1. Local Anesthesia Combined With Sedation Compared With General Anesthesia for Ambulatory Operative Hysteroscopy

    DEFF Research Database (Denmark)

    Brix, Lone Dragnes; Thillemann, Theis Muncholm; Nikolajsen, Lone

    2016-01-01

    anesthesia combined with sedation (group LA + S; n = 76) or general anesthesia (group GA; n = 77). Primary outcome was the worst pain intensity score in the postanesthesia care unit (PACU) rated by the patients on a numerical rating scale. FINDING: Data from 144 patients were available for analysis (LA + S...... was shorter (P anesthesia with sedation can be recommended as a first choice anesthetic technique for operative ambulatory hysteroscopy....

  2. Trends in Continuous Deep Sedation until Death between 2007 and 2013: A Repeated Nationwide Survey.

    Directory of Open Access Journals (Sweden)

    Lenzo Robijn

    Full Text Available 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.Population-based death certificate study in 2007 and 2013 in Flanders, Belgium. Reporting physicians received questionnaires about medical practices preceding the patient's death. Patient characteristics, clinical characteristics (drugs used, duration, artificial nutrition/hydration, intention and consent, and palliative care training of attending physician were recorded. We posed the following question regarding continuous deep sedation: 'Was the patient continuously and deeply sedated or kept in a coma until death by the use of one or more drugs'.After the initial rise of continuous deep sedation to 14.5% in 2007 (95%CI 13.1%-15.9%, its use decreased to 12.0% in 2013 (95%CI 10.9%-13.2%. Compared with 2007, in 2013 opioids were less often used as sole drug and the decision to use continuous deep sedation was more often preceded by patient request. Compared to non-experts, palliative care experts more often used benzodiazepines and less often opioids, withheld artificial nutrition/hydration more often and performed sedation more often after a request from or with the consent of the patient or family.Worldwide, this study is the first to show a decrease in the prevalence of continuous deep sedation. Despite positive changes in performance and decision-making towards more compliance with due care requirements, there is still room for improvement in the use of recommended drugs and in the involvement of patients and relatives in the

  3. Entropy correlates with Richmond Agitation Sedation Scale in mechanically ventilated critically ill patients.

    Science.gov (United States)

    Sharma, Ankur; Singh, Preet Mohinder; Trikha, Anjan; Rewari, Vimi; Chandralekha

    2014-04-01

    Sedation is routinely used in intensive care units. However due to absence of objective scoring systems like Bispectral Index and entropy our ability to regulate the degree of sedation is limited. This deficiency is further highlighted by the fact that agitation scores used in intensive care units (ICU) have no role in paralyzed patients. The present study compares entropy as a sedation scoring modality with Richmond Agitation Sedation Scale (RASS) in mechanically ventilated, critically ill patients in an ICU. Twenty-seven, mechanically ventilated, critically ill patients of either sex, 16-65 years of age, were studied over a period of 24 h. They received a standard sedation regimen consisting of a bolus dose of propofol 0.5 mg/kg and fentanyl 1 lg/kg followed by infusions of propofol and fentanyl ranging from 1.5 to 5 mg/kg/h and 0.5 to 2.0 lg/kg/h, respectively. Clinically relevant values of RASS for optimal ICU sedation (between 0 and -3) in non-paralyzed patients were compared to corresponding entropy values, to find if any significant correlation exists between the two. These entropy measurements were obtained using the Datex-Ohmeda-M-EntropyTM module. This module is presently not approved by Food and Drug Administration (FDA) for monitoring sedation in ICU. A total of 527 readings were obtained. There was a statistically significant correlation between the state entropy (SE) and RASS [Spearman's rho/rs = 0.334, p\\0.0001]; response entropy (RE) and RASS [Spearman's rho/rs = 0.341, p\\0.0001]). For adequate sedation as judged by a RASS value of 0 to -3, the mean SE was 57.86 ± 16.50 and RE was 67.75 ± 15.65. The present study illustrates that entropy correlates with RASS (between scores 0 and -3) when assessing the level of sedation in mechanically ventilated critically ill patients.

  4. The Evaluation of Efficacy and Safety Of Given Dexmedetomidine Sedation for Mechanical Ventilation in Intensive Care Medicine%右美托咪定镇静用于重症医学机械通气的效果及安全性评价

    Institute of Scientific and Technical Information of China (English)

    王丹

    2014-01-01

    Objective To analyze the right sedative dexmedetomidine for sedation in mechanical y ventilated patients in critical care medicine and to evaluate its safety. Methods 50 cases treated in our hospital critical y il mechanical y ventilated ICU patients were randomly divided into two groups of control and experimental groups. Selection of the control group of patients in the conventional mechanical ventilation during midazolam sedation, the experimental group selection right dexmedetomidine sedative,calming effect two groups were compared, and the recovery time after stopping ventilation time and other indicators. Results The results of the two methods is quite calm, there was no significant difference; but after discontinuation of patients in the experimental group and ventilation recovery time was significantly shorter than the control group,P<0.05,statistically significant. Conclusion Right dexmedetomidine for sedation in mechanically ventilated patients with severe medical obvious calming effect, and can shorten the patient's recovery time and ventilation.%目的:分析右美托咪啶镇静对于重症医学机械通气患者的镇静效果并评价其安全性。方法将我院治疗的50例重症机械通气患者随机分为两组对照组和实验组。对照组患者在机械通气过程中选用常规的咪达唑仑镇静,实验组选用右美托咪啶镇静,比较两组患者的镇静效果、停药后苏醒时间及通气时间等指标。结果两种方法的镇静效果相当,无显著性差异;但实验组患者的停药后苏醒时间及通气时间均明显短于对照组,P<0.05,具有统计学意义。结论右美托咪啶镇静对于重症医学机械通气患者有明显的镇静效果,并可缩短患者的苏醒时间及通气时间。

  5. Palliative sedation in advanced cancer patients: Does it shorten survival time? - A systematic review

    Directory of Open Access Journals (Sweden)

    B Barathi

    2013-01-01

    Full Text Available Background: Patients with advanced cancer often suffer from multiple refractory symptoms in the terminal phase of their life. Palliative sedation is one of the few ways to relieve this refractory suffering. Objectives: This systematic review investigated the effect of palliative sedation on survival time in terminally ill cancer patients. Materials and Methods: Six electronic databases were searched for both prospective and retrospective studies which evaluated the effect of palliative sedation on survival time. Only those studies which had a comparison group that did not receive palliative sedation were selected for the review. Abstracts of all retrieved studies were screened to include the most relevant studies and only studies which met inclusion criteria were selected. References of all retrieved studies were also screened for relevant studies. Selected studies were assessed for quality and data extraction was done using the structured data extraction form. Results: Eleven studies including four prospective and seven retrospective studies were identified. Mean survival time (MST was measured as the time from last admission until death. A careful analysis of the results of all the 11 studies indicated that MST of sedated and non-sedated group was not statistically different in any of the studies. Conclusion: This systematic review supports the fact that palliative sedation does not shorten survival in terminally ill cancer patients. However, this conclusion needs to be taken with consideration of the methodology, study design, and the population studied of the included studies in this review.

  6. Sedation in gastrointestinal endoscopy: current issues.

    Science.gov (United States)

    Triantafillidis, John K; Merikas, Emmanuel; Nikolakis, Dimitrios; Papalois, Apostolos E

    2013-01-28

    Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate (conscious) sedation. Moderate sedation, using midazolam and an opioid, is the standard method of sedation, although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation. Moreover, the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and, consequently, its low risk of inducing hepatic encephalopathy. In the future, propofol could become the preferred sedation agent, especially for routine colonoscopy. Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam. Among opioids, pethidine and fentanyl are the most popular. A number of other substances have been tested in several clinical trials with promising results. Among them, newer opioids, such as remifentanil, enable a faster recovery. The controversy regarding the administration of sedation by an endoscopist or an experienced nurse, as well as the optimal staffing of endoscopy units, continues to be a matter of discussion. Safe sedation in special clinical circumstances, such as in the cases of obese, pregnant, and elderly individuals, as well as patients with chronic lung, renal or liver disease, requires modification of the dose of the drugs used for sedation. In the great majority of patients, sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide. In this review, an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature.

  7. Our Sedation Experience on Mentally Retarded Patients

    OpenAIRE

    Metin Alkan

    2014-01-01

    Aim: The majority of dental treatments can be performed under local anesthesia. However, sedation or general anesthesia are often required for mentally retarded patients presenting a lack of cooperation. The aim of this study was to retrospectively evaluate the outcomes of mentally retarded patients treated under sedation. Material and Method: The records of the 214 mentally retarded patients that were treated under sedation between 2010-2012 were retrospectively evaluated. The retrospective ...

  8. Switching to a Mac For Dummies

    CERN Document Server

    Reinhold, Arnold

    2007-01-01

    Thinking of making the switch from your PC to a Mac? Congratulations! You're in for a great, virus-free ride. And Switching to Mac For Dummies makes it smoother than you ever imagined. From buying the Mac that's right for you to transferring your files to breaking your old Windows habits and learning to do things the (much easier) Mac way, it makes the whole process practically effortless. Whether you've been using Windows XP, Vista, or even Linux, you'll find simple, straightforward ways to make your transition go smoothly. That will leave you plenty of time to get familiar with Mac'

  9. Cognitive MAC designs for OSA networks

    CERN Document Server

    Derakhshani, Mahsa

    2014-01-01

    This SpringerBrief presents recent advances in the cognitive MAC designs for opportunistic spectrum access (OSA) networks. It covers the basic MAC functionalities and MAC enhancements of IEEE 802.11. Later chapters discuss the existing MAC protocols for OSA and classify them based on characteristic features. The authors provide new research in adaptive carrier sensing-based MAC designs tailored for OSA, which optimize spectrum utilization and ensure a peaceful coexistence of licensed and unlicensed systems. Analytically devised via optimization and game-theoretic approaches, these adaptive M

  10. Switching to the Mac The Missing Manual

    CERN Document Server

    Pogue, David

    2010-01-01

    Is Windows giving you pause? Ready to make the leap to the Mac instead? There has never been a better time to switch from Windows to Mac, and this incomparable guide will help you make a smooth transition. New York Times columnist and Missing Manuals creator David Pogue gets you past three challenges: transferring your stuff, assembling Mac programs so you can do what you did with Windows, and learning your way around Mac OS X. Learning to use a Mac is not a piece of cake, but once you do, the rewards are oh-so-much better. No viruses, worms, or spyware. No questionable firewalls, inefficien

  11. Mac OS X Lion Server For Dummies

    CERN Document Server

    Rizzo, John

    2011-01-01

    The perfect guide to help administrators set up Apple's Mac OS X Lion Server With the overwhelming popularity of the iPhone and iPad, more Macs are appearing in corporate settings. The newest version of Mac Server is the ideal way to administer a Mac network. This friendly guide explains to both Windows and Mac administrators how to set up and configure the server, including services such as iCal Server, Podcast Producer, Wiki Server, Spotlight Server, iChat Server, File Sharing, Mail Services, and support for iPhone and iPad. It explains how to secure, administer, and troubleshoot the networ

  12. Take Control of Maintaining Your Mac

    CERN Document Server

    Kissell, Joe

    2009-01-01

    Keep your Mac running smoothly with our easy maintenance program! Regular maintenance is necessary to avoid problems and to ensure your Mac runs at peak performance, but it's hard to know what to do and when to do it. Best-selling author Joe Kissell has now applied his commonsense approach to the task of maintaining your Mac, whether you use Tiger or Leopard! Learn how to start on the right foot; what you should do daily, weekly, monthly, and yearly; and how to prepare for Mac OS X updates. Joe even explains how to monitor your Mac's health and debunks common panaceas. Read this book to lea

  13. Preprocedural Assessment for Sedation in Gastrointestinal Endoscopy.

    Science.gov (United States)

    Tetzlaff, John E; Maurer, Walter G

    2016-07-01

    The role of the anesthesia service in sedation for gastrointestinal endoscopy (GIE) has been steadily increasing. The goals of preprocedural assessment are determined by the specific details of the procedure, the issues related to the illness that requires the endoscopy, comorbidities, the goals for sedation, and the risk of complications from the sedation and the endoscopic procedure. Rather than consider these issues as separate entities, they should be considered as part of a continuum of preparation for GIE. This is told from the perspective of an anesthesiologist who regularly participates in the full range of sedation for GIE.

  14. Comparative study between dexmedetomidine/nalbuphine and midazolam/nalbuphine in monitored anesthesia care during ear surgery

    Directory of Open Access Journals (Sweden)

    Mahmoud Hassan Mohamed

    2014-01-01

    Conclusion: We concluded that the combination of dexmedetomidine/nalbuphine is a better alternative to midazolam/nalbuphine in MAC since it provides analgesia, amnesia and sedation with better intraoperative and postoperative patient satisfaction with better surgical field exposure.

  15. The use of propofol as a sedative agent in gastrointestinal endoscopy: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Daorong Wang

    Full Text Available OBJECTIVES: To assess the efficacy and safety of propofol sedation for gastrointestinal endoscopy, we conducted a meta-analysis of randomized controlled trials (RCTs comparing propofol with traditional sedative agents. METHODS: RCTs comparing the effects of propofol and traditional sedative agents during gastrointestinal endoscopy were found on MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE. Cardiopulmonary complications (i.e., hypoxia, hypotension, arrhythmia, and apnea and sedation profiles were assessed. RESULTS: Twenty-two original RCTs investigating a total of 1,798 patients, of whom 912 received propofol only and 886 received traditional sedative agents only, met the inclusion criteria. Propofol use was associated with shorter recovery (13 studies, 1,165 patients; WMD -19.75; 95% CI -27.65, 11.86 and discharge times (seven studies, 471 patients; WMD -29.48; 95% CI -44.13, -14.83, higher post-anesthesia recovery scores (four studies, 503 patients; WMD 2.03; 95% CI 1.59, 2.46, better sedation (nine studies, 592 patients; OR 4.78; 95% CI 2.56, 8.93, and greater patient cooperation (six studies, 709 patients; WMD 1.27; 95% CI 0.53, 2.02, as well as more local pain on injection (six studies, 547 patients; OR 10.19; 95% CI 3.93, 26.39. Effects of propofol on cardiopulmonary complications, procedure duration, amnesia, pain during endoscopy, and patient satisfaction were not found to be significantly different from those of traditional sedative agents. CONCLUSIONS: Propofol is safe and effective for gastrointestinal endoscopy procedures and is associated with shorter recovery and discharge periods, higher post-anesthesia recovery scores, better sedation, and greater patient cooperation than traditional sedation, without an increase in cardiopulmonary complications. Care should be taken when extrapolating our results to specific practice settings and high-risk patient subgroups.

  16. Nurse-administered propofol sedation for endoscopy

    DEFF Research Database (Denmark)

    Jensen, J T; Vilmann, P; Horsted, T;

    2011-01-01

    The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program.......The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program....

  17. Epileptic fits under intravenous midazolam sedation.

    Science.gov (United States)

    Robb, N D

    1996-09-07

    A case is presented of a patient who suffered from recurrent epileptic fits while being treated under intravenous sedation with midazolam. Those using sedation are advised to beware of the patient who gives a history of fits being provoked in the dental environment.

  18. Sedation in the ICU Less is more

    DEFF Research Database (Denmark)

    Strom, T.

    2012-01-01

    . The intervention group received only bolus doses of morphine or haloperidol if delirium was suspected. The control group received standard infusion of sedatives to RAMSAY 3-4 and sedatives were interrupted on a daily basis. Both groups received morphine as intravenous bolus doses (2.5 to 5 mg). The primary outcome...

  19. Cultural changes in ICU sedation management

    DEFF Research Database (Denmark)

    Egerod, Ingrid

    2009-01-01

    The aim of this study was to explore physicians' views and perceptions of sedation, and offer a new approach to the understanding of issues of sedation. I used a qualitative, descriptive, and explorative multicenter design. Data were generated by seven key-informant interviews using a semistructu...

  20. Cardiovascular, Antinociceptive and Sedative Effects of Medetomidine Infusion in Sevoflurane Anesthesia in Puppies

    Directory of Open Access Journals (Sweden)

    J Morgaz*, JM Domínguez, R Navarrete, JA Fernández-Sarmiento, P Muñoz-Rascón, RJ Gómez-Villamandos and MM Granados

    2013-07-01

    Full Text Available The objective of this study was to determine the effect of a constant rate infusion of medetomidine in the cortical brain activity and hemodynamic parameters in sevoflurane anesthetized puppies. Six puppies of the age of two weeks old were included in the study and were anaesthetized three times with sevoflurane. On the first anesthesia, each dog’s minimum alveolar concentration (MAC for sevoflurane was determined by the use of the tail clamp method. On the second anesthesia (sevoflurane, the puppies were anesthetized at each of five multiples of their individual’s MAC, 0.75, 1, 1.25, 1.5 and 1.75 MAC, and bispectral index and cardiorespiratory parameters were registered. On the third anesthesia (sevoflurane+ medetomidine, puppies were anesthetized at each of five multiples of their individual’s MAC, and medetomidine (5 µg/kg+2µg/kg/h was administered. Mild cardiovascular depression was observed in sevoflurane+medetomidine in comparison with sevoflurane. Cortical and antinociceptive effects were not observed with medetomidine infusion although a mature EEG response to noxious stimulation would not have developed in puppies. Central alpha-2 adrenoreceptors would be immature in puppies during the first two weeks of life, and for this reason, medetomidine would not produce sedative and analgesic effects in young puppies. More studies have to be performed to support this statement.

  1. Our Sedation Experience on Mentally Retarded Patients

    Directory of Open Access Journals (Sweden)

    Metin Alkan

    2014-03-01

    Full Text Available Aim: The majority of dental treatments can be performed under local anesthesia. However, sedation or general anesthesia are often required for mentally retarded patients presenting a lack of cooperation. The aim of this study was to retrospectively evaluate the outcomes of mentally retarded patients treated under sedation. Material and Method: The records of the 214 mentally retarded patients that were treated under sedation between 2010-2012 were retrospectively evaluated. The retrospective data included demographic variables, duriation of anesthesia, anti-epileptic drugs used, level of sedation, anesthetic agents, the type of dental treatment and adverse events during and after sedation. Results: In this study the mean age of patients was 22,49±9,54. The female/male ratio was 109/105. The number of ASA I, II, III patients were 43, 157 and 14 respectively. 16.8% of the patiens (n=36 was on one anti-epileptic drug regimen, while 29.9% of the patiens (n=54 was on more than one anti-epileptic drug regimen. The sedation levels were determined as minimal sedation (6.5%, n=14, moderate sedation (35%, n=75 and deep sedation (58.4%, n=125 respectively. The midazolam-ketamine combination was the most preferred anesthetic regimen (41.1%, n=88. Single dental extraction was the most performed dental treatment (58.4%, n=125. Postoperative nausea and vomiting was encountered in 3.7% of patients (n=8. Respiratuar depression occurred in 2 patients. Two patients developed bronchospasm, while one patient developed postoperative agitation, deep bradycardia and allergic reaction respectively. Discussion: We are of the opinion that sedation can be performed safely by choosing the appropriate drug and method without depressing respiration and reflexes.

  2. Prescribing patterns of the four most commonly used sedatives in endoscopic examination in Korea: propofol, midazolam, diazepam, and lorazepam.

    Science.gov (United States)

    Shin, Ju-Young; Lee, Shin Haeng; Shin, Sun Mi; Kim, Mi Hee; Park, Sung Geon; Park, Byung-Joo

    2015-04-01

    As the sedative use increases due to the effectiveness and relatively safe profile, the abuse potential is also increasing. This study was conducted to examine the usage of four sedative agents in endoscopic examination and to compare the propofol use with the other three sedatives. Using National Health Insurance claims data from 2008 to 2012, we identified the number of cases of conscious sedation during endoscopy using one or more of the following agents: propofol, midazolam, diazepam, and lorazepam. The general characteristics of patients and medical service providers were analyzed, and the regional and annual distributions of frequency of use were compared. We also identified patient cases with excessive number of endoscopic examinations. Among the total of 3,156,231 sedatives users, midazolam was the most commonly used agent (n=2,845,250, 90.1%). However, the largest increase in patient number, which increased from 11,410 in 2008 to 28,170 in 2012, was observed with propofol. While the majority of patients received an annual endoscopy, we identified several suspected abuse cases of patients receiving endoscopies repetitively as many as 114 times in five years. The rise of sedative use in endoscopic examinations and several patient cases of repeated sedative administration suggest a potential risk for abuse. Medical service providers should be cautious when using sedatives and carefully review each patient's medical history prior to the procedure.

  3. Mac OS X Tiger for Unix Geeks

    CERN Document Server

    Jepson, Brian

    2005-01-01

    If you're one of the many Unix developers drawn to Mac OS X for its Unix core, you'll find yourself in surprisingly unfamiliar territory. Unix and Mac OS X are kissing cousins, but there are enough pitfalls and minefields in going from one to another that even a Unix guru can stumble, and most guides to Mac OS X are written for Mac aficionados. For a Unix developer, approaching Tiger from the Mac side is a bit like learning Russian by reading the Russian side of a Russian-English dictionary. Fortunately, O'Reilly has been the Unix authority for over 25 years, and in Mac OS X Tiger for Unix Gee

  4. Web Development with the Mac

    CERN Document Server

    Vegh, Aaron

    2010-01-01

    Learn Web development the Apple way and build a business. With a focus on both coding and creative development, this in-depth guide thoroughly covers what you need to know to build winning websites for clients — from what it takes to bring a business online to how to make your site interactive to how to run a freelance web business. In between, you'll master the technical tools of the trade — such as HTML, CSS, JavaScript, PHP, and Ruby on Rails — and learn how to create beautiful interfaces using Photoshop . This book covers everything a fledgling web developer working on a Mac needs to launc

  5. Teach yourself visually Mac Mini

    CERN Document Server

    Hart-Davis, Guy

    2012-01-01

    The perfect how-to guide for visual learners Apple?s Mac Mini packs a powerful punch is in a small package, including both HDMI and Thunderbolt ports plus the acclaimed OS X. But if you want to get the very most from all this power and versatility, be sure to get this practical visual guide. With full-color, step-by-step instructions as well as screenshots and illustrations on every page, it clearly shows you how to accomplish tasks rather than burying you in pages of text. Discover helpful visuals and how-tos on the OS, hardware specs, Launchpad, the App Store, multimedia capabilities (such

  6. A Phase IIIb, randomized, double-blind, placebo-controlled, multicenter study evaluating the safety and efficacy of dexmedetomidine for sedation during awake fiberoptic intubation.

    Science.gov (United States)

    Bergese, Sergio D; Candiotti, Keith A; Bokesch, Paula M; Zura, Andrew; Wisemandle, Wayne; Bekker, Alex Y

    2010-01-01

    GABA-mediated sedatives have respiratory depressant properties that may be detrimental in patients with difficult airways. In this randomized, double-blind, multicenter, Phase IIIb Food and Drug Administration study, safety and efficacy of dexmedetomidine compared with placebo were evaluated as the primary sedative for awake fiberoptic intubation (AFOI). Patients were randomized to receive dexmedetomidine or saline. Patients were sedated with dexmedetomidine or rescue midazolam to achieve targeted sedation (Ramsay Sedation Scale ≥ 2) before topicalization and throughout AFOI. Primary efficacy endpoint was percentage of patients requiring rescue midazolam; secondary efficacy endpoints were total dose of rescue midazolam, percentage requiring additional rescue nonmidazolam medications, anesthesiologist's assessment of ease of subject care, and patient recall and satisfaction 24 hours postoperatively. Less rescue midazolam was required to maintain Ramsay Sedation Scale ≥2 (47.3% vs. 86.0%, P sedated with midazolam. Patients and anesthesiologists showed favorable satisfaction responses in both groups. Adverse events and patient recall were similar in both groups. Dexmedetomidine is effective as the primary sedative in patients undergoing AFOI. Some patients may require small supplemental doses of midazolam, in addition to dexmedetomidine, to achieve sufficient sedation for AFOI. Dexmedetomidine provides another AFOI option for sedation of patients with difficult airways.

  7. Review on sedation for gastrointestinal tract endoscopy in children by non-anesthesiologists

    Science.gov (United States)

    Orel, Rok; Brecelj, Jernej; Dias, Jorge Amil; Romano, Claudio; Barros, Fernanda; Thomson, Mike; Vandenplas, Yvan

    2015-01-01

    AIM: To present evidence and formulate recommendations for sedation in pediatric gastrointestinal (GI) endoscopy by non-anesthesiologists. METHODS: The databases MEDLINE, Cochrane and EMBASE were searched for the following keywords “endoscopy, GI”, “endoscopy, digestive system” AND “sedation”, “conscious sedation”, “moderate sedation”, “deep sedation” and “hypnotics and sedatives” for publications in English restricted to the pediatric age. We searched additional information published between January 2011 and January 2014. Searches for (upper) GI endoscopy sedation in pediatrics and sedation guidelines by non-anesthesiologists for the adult population were performed. RESULTS: From the available studies three sedation protocols are highlighted. Propofol, which seems to offer the best balance between efficacy and safety is rarely used by non-anesthesiologists mainly because of legal restrictions. Ketamine and a combination of a benzodiazepine and an opioid are more frequently used. Data regarding other sedatives, anesthetics and adjuvant medications used for pediatric GI endoscopy are also presented. CONCLUSION: General anesthesia by a multidisciplinary team led by an anesthesiologist is preferred. The creation of sedation teams led by non-anesthesiologists and a careful selection of anesthetic drugs may offer an alternative, but should be in line with national legislation and institutional regulations. PMID:26240691

  8. Analysis of 3gpp-MAC and two-key 3gpp-MAC

    DEFF Research Database (Denmark)

    Knudsen, Lars Ramkilde; Mitchell, C.J.

    2003-01-01

    Forgery and key-recovery attacks are described on the 3gpp-MAC scheme, proposed for inclusion in the 3gpp specification. Three main classes of attack are given, all of which operate whether or not truncation is applied to the MAC value. Attacks in the first class use a large number of 'chosen MACs......', those in the second class use a large number of 'known MACs', and those in the third class require a large number of MAC verifications, but very few known MACS and no chosen MACS. The first class yields both forgery and key-recovery attacks, whereas the second and third classes are key-recovery attacks...... only. Both single-key and two-key variants of 3gpp-MAC are considered; the forgery attacks are relevant to both variants, whereas the key-recovery attacks are only relevant to the two-key variant....

  9. Take control of troubleshooting your Mac

    CERN Document Server

    Kissell, Joe

    2009-01-01

    Learn how to solve any Mac problem with Joe Kissell's expert advice! We may love our Macs, but they can still suffer significant problems. In this essential guide from best-selling author Joe Kissell, you'll learn 17 basic troubleshooting procedures and how to solve 9 common problems, along with an easy-to-follow way to troubleshoot novel problems. Whether your Mac won't turn on, experiences kernel panics repeatedly, or is glacially slow, this book has the calm, friendly advice you need to find a solution. Following in the footsteps of his critically acclaimed books Take Control of Mac OS X

  10. Mac protocols for cyber-physical systems

    CERN Document Server

    Xia, Feng

    2015-01-01

    This book provides a literature review of various wireless MAC protocols and techniques for achieving real-time and reliable communications in the context of cyber-physical systems (CPS). The evaluation analysis of IEEE 802.15.4 for CPS therein will give insights into configuration and optimization of critical design parameters of MAC protocols. In addition, this book also presents the design and evaluation of an adaptive MAC protocol for medical CPS, which exemplifies how to facilitate real-time and reliable communications in CPS by exploiting IEEE 802.15.4 based MAC protocols. This book wil

  11. Teach yourself visually MacBook Pro

    CERN Document Server

    Hart-Davis, Guy

    2014-01-01

    Clear instructions to help visual learners get started with their MacBook Pro Covering all the essential information you need to get up to speed with your MacBook Pro, this new edition provides you with the most up-to-date information on performing everyday tasks quickly and easily. From basics such as powering on or shutting down the MacBook Pro to more advanced tasks such as running Windows applications, this visual guide provides the help and support you need to confidently use your MacBook Pro to its full potential.Empowers you to perform everyday tasks quickly and easilyCovers new hardwa

  12. Macs all-in-one for dummies

    CERN Document Server

    Hutsko, Joe

    2014-01-01

    Your all-in-one guide to unleashing your Mac's full potential It's a Mac world out there. But if you haven't read the instruction manual, you may be neglecting some of your computer's coolest features. Turn to Macs All-in-One For Dummies' jam-packed guide to access the incredible tools within your computer. With this fully updated reference, you will learn how to use Launchpad and Mission Control; protect your Mac; back up and restore data with Time Machine; sync across devices in iCloud; import, organize, and share photos; direct in iMovie; compose in GarageBand; and so much more. The possi

  13. Take control the Mac OS X lexicon

    CERN Document Server

    Zardetto, Sharon

    2009-01-01

    This ebook explains a little bit of everything; in fact, it's The Mac OS X (and then some) Lexicon because it's never just you and your Mac. It's you and your Mac and the Web, and your email, and that article you just read that threw 17 new acronyms at you or assumed that you knew all sorts of networking terms. Or it's you and your Mac and Finder features you've never touched, such as burn folders, smart folders, or proxy icons, and that mysterious Services submenu. This book is a great guide for Macintosh users everywhere who have trouble keeping up with the latest jargon, fo

  14. Interest of 50% nitrous oxide and oxygen premix sedation in gerodontology

    Directory of Open Access Journals (Sweden)

    Emmanuel Nicolas

    2008-12-01

    Full Text Available Emmanuel Nicolas1,2, Claire Lassauzay1,21CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; 2Université Clermont 1, EA 3847, Faculty of Dentistry, 63000 Clermont-Ferrand, FranceAbstract: Elderly patients presenting cardiovascular, respiratory, or neurological disorders require a specific dental care approach, especially patients presenting Alzheimer’s disease. Sedative procedures can prevent dental care-induced stress, even when there is effective pain control, but they have to be adapted to accommodate age-induced physiological modifications, age-related pathologies, and the concomitant treatments. In many situations, routine sedative prescriptions for dental care, such as benzodiazepine or antihistaminics, are not recommended for these patients. Nitrous oxide inhalation together with a specific behavioral threshold is currently the only sedative procedure adapted to cognitively-impaired elderly patients. Nitrous oxide is able to curb stress and its cardiovascular consequences, improve oxygenation, and optimize cooperation during dental care, making not only rehabilitation treatments but also routine dental care a viable option.Keywords: nitrous oxide, oxygen, premix, sedation, gerodontology, dental care

  15. Sedation for pediatric radiological procedures: analysis of potential causes of sedation failure and paradoxical reactions

    Energy Technology Data Exchange (ETDEWEB)

    Karian, V.E.; Burrows, P.E.; Connor, L. [Dept. of Radiology, Children' s Hospital, Boston, MA (United States); Zurakowski, D. [Dept. of Biostatistics, Children' s Hospital, Boston, MA (United States); Mason, K.P. [Dept. of Anesthesiology, Children' s Hospital, Boston, MA (United States)

    1999-11-01

    Background. Sedation for diagnostic imaging and interventional radiologic procedures in pediatrics has greatly increased over the past decade. With appropriate patient selection and monitoring, serious adverse effects are infrequent, but failure to sedate and paradoxical reactions do occur. Objective. The purpose of this study was to determine, among patients undergoing sedation for radiologic procedures, the incidence of sedation failure and paradoxical reaction to pentobarbital and to identify potentially correctable causes. Materials and methods. Records of 1665 patients who were sedated in the radiology department from 1 November 1997 to 1 July 1998 were reviewed. Patients failing sedation or experiencing paradoxical reaction were compared with respect to sex, age group, diagnosis, scan type, time of day, NPO status, use of IV contrast and type of sedation agent using the Fisher exact test, Pearson chi-square, analysis of variance (ANOVA), the Student t-test, and logistic regression. Results. Data analysis revealed a sedation failure rate of 1 % and paradoxical reaction rate of 1.2 %. Stepwise multiple logistic regression revealed that the only significant independent multivariate predictor of failure was the need for the administration of a combination of pentobarbital, fentanyl, and midazolam IV. Conclusion. The low rate of sedation failure and paradoxical reactions to pentobarbital was near optimal and probably cannot be improved with the currently available sedatives. (orig.)

  16. Moral differences in deep continuous palliative sedation and euthanasia.

    Science.gov (United States)

    Juth, Niklas; Lindblad, Anna; Lynöe, Niels; Sjöstrand, Manne; Helgesson, Gert

    2013-06-01

    In palliative care there is much debate about which end of life treatment strategies are legitimate and which are not. Some writers argue that there is an important moral dividing-line between palliative sedation and euthanasia, making the first acceptable and the latter not. We have questioned this. In a recent article, Lars Johan Materstvedt has argued that we are wrong on two accounts: first, that we fail to account properly for the moral difference between continuous deep palliative sedation at the end of life and euthanasia, and, second, that we fail to account properly for the difference between permanent loss of consciousness and death. Regarding the first objection, we argue that Materstvedt misses the point: we agree that there is a difference in terms of intentions between continuous deep palliative sedation and euthanasia, but we question whether this conceptual difference makes up for a moral difference. Materstvedt fails to show that it does. Regarding the second objection, we argue that if nothing else is at stake than the value of the patient's life, permanent unconsciousness and death are morally indifferent.

  17. 咪达唑仑复合异丙酚镇静对ICU机械通气患者谵妄的影响%Effect of sedation with midazolam combined with propofol on delirium in mechanically ventilated patients in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    傅小云; 胡杰; 苏德; 高飞; 杨学忠; 喻田

    2015-01-01

    目的 评价咪达唑仑复合异丙酚镇静对ICU机械通气患者谵妄的影响.方法 选择需行镇静镇痛气管插管、呼吸机辅助呼吸的ICU患者522例,年龄28~ 64岁,体重41~ 82 kg,性别不限,根据治疗期间的镇静方法分为2组:咪达唑仑镇静组(M组,n=240)和咪达唑仑+异丙酚镇静组(MP组,n=232).M组和MP组静脉输注咪达唑仑0.03 ~ 0.17 mg/min镇静,静脉输注舒芬太尼0.07~ 0.14 μg/min镇痛.MP组当循环稳定、压力支持8~ 10 cmH2O、潮气量>400 ml、通气频率<25次/min、吸入氧浓度<45%时,改为静脉输注异丙酚0.8~ 2.0 mg/min镇静,镇静时间12~24 h.机械通气期间维持Richmond躁动-镇静量表评分-1 ~-2分.记录谵妄的发生情况和持续时间,并根据Richmond躁动-镇静量表评分将其分为兴奋型、抑制型和混合型,记录不同类型谵妄的发生情况和持续时间.结果 2组谵妄发生率和持续时间比较差异无统计学意义(P>0.05).与M组比较,MP组兴奋型谵妄发生率降低(P<0.05),抑制型和混合型谵妄的发生率、不同类型谵妄持续时间差异无统计学意义(P>0.05).结论 咪达唑仑复合异丙酚可降低ICU机械通气患者兴奋型谵妄的发生,但不能缩短谵妄持续时间.%Objective To evaluate the effect of sedation with midazolam combined with propofol on delirium in mechanically ventilated patients in the intensive care unit (ICU).Methods Five hundred and twenty-two patients who required sedation and analgesia,endotracheal intubation and mechanical ventilation used to assist respiration,aged 28-64 yr,weighing 41-82 kg,were randomized into 2 groups according to the sedation protocols during therapy:sedation with midazolam group (group M,n =240) and sedation with midazolam + propofol group (group MP,n=232).In M and MP groups,sedation was induced with midazolam infusion 0.03-0.17 mg/min,and analgesia was induced with sufentanil infusion 0.07-0.14 μg/min.In group MP

  18. Short Report. Audit of Conscious Sedation Provision in a Salaried Dental Service.

    Science.gov (United States)

    Jones, Stephen G

    2016-01-01

    Clinical audit is a tool that may be used to improve the quality of care and outcomes for patients in a health care setting as well as a mechanism for clinicians to reflect on their performance. The audit described in this short report involved the collection and analysis of data related to the administration of 1,756 conscious sedations, categorised as standard techniques, by clinicians employed by an NHS Trust-based dental service during the year 2014. Data collected included gender, age and medical status of subject, the type of care delivered, the dose of drug administered and the quality of the achieved sedation and any sedation-related complications. This was the first time that a service-wide clinical audit had been undertaken with the objective of determining the safety and effectiveness of this aspect of care provision. Evaluation of the analysed data supported the perceived view that such care was being delivered satisfactorily. This on-going audit will collect data during year 2016 on the abandonment of clinical sessions, in which successful sedation had been achieved, due to the failure to obtain adequate local anaesthesia.

  19. A MAC Mode for Lightweight Block Ciphers

    DEFF Research Database (Denmark)

    Luykx, Atul; Preneel, Bart; Tischhauser, Elmar Wolfgang;

    2016-01-01

    , but also allows high-performance parallel implementations. We highlight this in a comprehensive implementation study, instantiating LightMAC with PRESENT and the AES. Moreover, LightMAC allows flexible trade-offs between rate and maximum message length. Unlike PMAC and its many derivatives, Light...

  20. VLA-MAC: A Variable Load Adaptive MAC Protocol for Wireless Sensor Networks

    Science.gov (United States)

    Yao, Guoliang; Liu, Hao; Chen, Hao; Shi, Longxin

    This letter presents VLA-MAC, a novel adaptive MAC protocol for wireless sensor networks that can achieve high energy efficiency and low latency in variable load conditions. In VLA-MAC, traffic load is measured online and utilized for adaptive adjustment. VLA-MAC transmits packets via a burst style to alleviate packets accumulation problem and achieve low latency in high load condition. Furthermore, it also saves obvious energy by removing unnecessary listen period in low load condition. Unlike current approach, VLA-MAC does not need to adjust duty-cycle according to load online. Simulation results based on ns-2 show the performance improvements of our protocol.

  1. Guidance for commissioning NHS England dental conscious sedation services: a framework tool.

    Science.gov (United States)

    Howlett, Paul

    2014-01-01

    Conscious sedation is an integral part of modern day dental care and should be delivered through a high quality, effective and evidence-based approach. Commissioning of NHS dental services in England is currently under review by NHS England and the National Dental Commissioning Group. This group has identified the management of vulnerable people including anxious patients, as one of its priorities. The Society for the Advancement of Anaesthesia in Dentistry (SAAD) believes this provides an opportunity to influence the commissioning of NHS conscious sedation services. With this aim in mind,"Guidance for Commissioning NHS England Dental Conscious Sedation Services: A Framework Tool" was developed. This guidance proposes a common approach to the organisation of NHS dental conscious sedation services in England, advocating the provision of Tier 1 and Tier 2 services in all regions. Its ethos is a"hub and spoke" model of service delivery with patient assessment delivered by experienced and well trained dental sedationists at its core. In line with the recent Francis Report fundamental standards for all aspects of dental conscious sedation practice are outlined, supported by a robust and predictable quality assurance process. This work has been shared with key stakeholders in NHS England including the Chief Dental Officer and the Head of Primary Care Commissioning.

  2. Changes to the bispectral index and regional cerebral blood flow in a sedative state, caused by midazolam administration

    OpenAIRE

    池田, 淳子; イケダ, ジュンコ; Junko, IKEDA

    2006-01-01

    Psychosedation, as used in the field of dentistry, is intended to provide trouble-free dental care while maintaining a proper level of sedation. One drug used in psychosedation is midazolam, which is known to have a strong amnestic effect. In the current research, I sought to clarify whether the bispectral index (BIS) using EEC analysis can be used for assessment of optimal sedation in psychosedation, and what effects midazolam has on the cerebrum's mechanism of memory. The subjects were 17 h...

  3. Sedation and analgesia in gastrointestinal endoscopy: What’s new?

    Institute of Scientific and Technical Information of China (English)

    Lorella; Fanti; Pier; Alberto; Testoni

    2010-01-01

    Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures.The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated.Providing an adequate regimen of sedation/analgesia might be considered an art,influencing several aspects of endoscopic procedures: the quality of the examination,the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation.The properties of a model sedative agent for endosc...

  4. Sedation and analgesia in gastrointestinal endoscopy: What’s new?

    OpenAIRE

    Fanti, Lorella; Testoni, Pier Alberto

    2010-01-01

    Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures. The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated. Providing an adequate regimen of sedation/analgesia might be considered an art, influencing several aspects of endoscopic procedures: the quality of the examination, the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation. The properties of a model sedat...

  5. The Significance of Sedation Control in Patients Receiving Mechanical Ventilation

    OpenAIRE

    2012-01-01

    Background Adequate assessment and control of sedation play crucial roles in the proper performance of mechanical ventilation. Methods A total of 30 patients with various pulmonary diseases were prospectively enrolled. The study population was randomized into two groups. The sedation assessment group (SAG) received active protocol-based control of sedation, and in the empiric control group (ECG), the sedation levels were empirically adjusted. Subsequently, daily interruption of sedation (DIS)...

  6. Ketamine Sedation in Gastrointestinal Endoscopy in Children

    Directory of Open Access Journals (Sweden)

    Ayman E. Eskander

    2016-07-01

    CONCLUSION: Ketamine sedation found to be safe for paediatric gastrointestinal endoscopy in Egyptian children without co-morbidities. Transient Hypoxia (13% may occur but easily reversed by nasal oxygen therapy.

  7. Pediatric oral conscious sedation: changes to come.

    Science.gov (United States)

    Malamed, S F; Reggiardo, P

    1999-11-01

    Recent media attention has focused the public's attention on issues surrounding pediatric oral conscious sedation. Under a law passed in 1998 and taking affect on Jan. 1, 2000, California dentists will be subject to certification and procedural provisions designed to ensure the educational qualification of the provider and the standards under which the procedure is performed. This article discusses the history of concern and regulation regarding sedation of children in the dental office.

  8. 右美托咪定用于重症监护病房正颌外科术后留置气管插管患者的镇静%Dexmedetomidine for sedation during intubation period in postoperative patients receiving orthognathic surgery in intensive care unit

    Institute of Scientific and Technical Information of China (English)

    方舒东; 朱也森; 徐辉; 姜虹

    2012-01-01

    AIM To study the effectiveness and safety of dexmedetomidine for sedation during intubation period in postoperative patients receiving orthognathic surgery admitted to intensive care unit (ICU). METHODS Forty post-operative patients undergoing orthognathic surgery with tracheal intubation in ICU were enrolled and randomized into 2 groups to receive either midazolam or dexmedetomidine. The dexmedetomidine group starting dose was 0.4μg·kg-1·h-1 without a loading dose and adjusted 0.2 to 0.7 μg ·kg·h-1. The midazolam group starting dose was 0.1 mg·kg-1·h-1 and adjusted 0.05 to 0.2 mg·kg·h-1, the dose of sedation was regulated by Ramsay Sedation Score (RSS) maintain 2 to 4 sedative score. During the course, RSS, heart rate (HR) , blood pressure, respiratory rate ( RR) and pulse oxygen saturation ( SpO2) were observed and registered continuously. The amount of the drug, and incidence of adverse reactions, such as hypotension, bradycardia, delirium, etc. were recorded in two groups. RESULTS The expected sedative scores were obtained in all patients in two groups. The HR and mean arterial blood pressures ( MAP) showed no significantly different between two groups before sedation (P > 0.05). The HR in the dexmedetomidine group at 1, 2, 3, 4, 6, 8, 12 and 16 h were lower compared with those in the midazolam group ( P < 0.05) . The MAP in the dexmedetomidine group at 1, 2, 3, and 4 h were lower than those in the midazolam group (P < 0.05) .The times of dose adjustment needed were significantly lower in the dexmedetomidine group ( 2 patients with 1 adjustment each) than those in the midazolam group ( 3 patients with 1 adjustment, 4 patients with 2 adjustments). Atropine was administered to 2 patients in the dexmedetomidine group because of bradycardia. No serious adverse reactions occurred in both groups. CONCLUSION Dexmedetomidine 0.4 μg · kg-1 · h-1 is effective sedatives for post-operative patients undergoing orthognathic surgery with tracheal intubation in

  9. Guidelines for sedation in gastroenterological endoscopy.

    Science.gov (United States)

    Obara, Katsutoshi; Haruma, Ken; Irisawa, Atsushi; Kaise, Mitsuru; Gotoda, Takuji; Sugiyama, Masanori; Tanabe, Satoshi; Horiuchi, Akira; Fujita, Naotaka; Ozaki, Makoto; Yoshida, Masahiro; Matsui, Toshiyuki; Ichinose, Masao; Kaminishi, Michio

    2015-05-01

    Recently, the need for sedation in gastrointestinal endoscopy has been increasing. However, the National Health Insurance Drug Price list in Japan does not include any drug specifically used for the sedation. Although benzodiazepines are the main medication, their use in cases of gastrointestinal endoscopy has not been approved. This has led the Japan Gastrointestinal Endoscopy Society to develop the first set of guidelines for sedation in gastrointestinal endoscopy on the basis of evidence-based medicine in collaboration with the Japanese Society for Anesthesiologists. The present guidelines comprise 14 statements, five of which were judged to be valid on the highest evidence level and three on the second highest level. The guidelines are not intended to strongly recommend the use of sedation for gastrointestinal endoscopy, but rather to indicate the policy as to the choice of appropriate procedures when such sedation is deemed necessary. In clinical practice, the final decision as to the use of sedation should be made by physicians considering patient willingness and physical condition.

  10. The patient experience of intensive care

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Bergbom, Ingegerd; Lindahl, Berit

    2015-01-01

    countries have been particularly close to goals of lighter or no sedation and a more humane approach to intensive care. OBJECTIVES: The aim of our study was to systematically review and reinterpret newer Nordic studies of the patient experience of intensive care to obtain a contemporary description of human......: Nordic intensive care units. PARTICIPANTS: Patients in Nordic intensive care units. METHODS: We performed a literature search of qualitative studies of the patient experience of intensive care based on Nordic publications in 2000-2013. We searched the following databases: PubMed, CINAHL, Scopus, and Psyc......BACKGROUND: Sedation practices in the intensive care unit have evolved from deep sedation and paralysis toward lighter sedation and better pain management. The new paradigm of sedation has enabled early mobilization and optimized mechanical ventilator weaning. Intensive care units in the Nordic...

  11. Comparison between intranasal and intravenous midazolam sedation (with or without patient control) in a dental phobia clinic.

    Science.gov (United States)

    Kaufman, E; Davidson, E; Sheinkman, Z; Magora, F

    1994-08-01

    Two new modes of sedation; patient-controlled sedation (PCS) and intranasal sedation (INS) were compared with the traditional bolus intravenous sedation (BIVS) while delivering dental care to apprehensive patients in a specialized dental fear clinic. Effective sedation was evaluated in a randomized, prospective study in 42 ASA 1 and 2 patients, in a factorial design. Eighteen patients were sedated with .5% midazolam INS. Ten patients received intravenous PCS via a patient-controlled analgesia pump containing midazolam, and 14 patients received intermittent intravenous boluses of 1 mg midazolam given as needed (BIVS). Appropriate local anesthetic nerve blocks with 2% lidocaine with 1:100,000 epinephrine, and supplementary inhalation of nitrous oxide and oxygen via a nasal mask, were also given to all patients in the study. The dosage requirement with PCS was higher than that found with INS or BIVS. However, PCS produced some anxiety reduction when compared with INS and BIVS. It also reduced interfering movements during treatment more effectively than the other sedation modes. No complications were detected in any of the patients and they were able to leave the clinic within 1 hour after completion of treatment.

  12. Bispectral index monitoring for conscious sedation in intervention: better, safer, faster

    Energy Technology Data Exchange (ETDEWEB)

    Bell, J.K.; Laasch, H.-U.; Wilbraham, L.; England, R.E.; Morris, J.A.; Martin, D.F. E-mail: derrick.martin@smtr.nhs.uk

    2004-12-01

    AIM: The aim of this study was to compare subjective (Ramsay sedation score, RSS) with objective electroencephalogram-based bispectral index (BIS) assessment, and to validate the appropriate BIS range for measurement of conscious sedation in interventional procedures. MATERIALS AND METHODS: One hundred patients undergoing sedo-analgesia (midazolam and fentanyl) for interventional gastrointestinal procedures were divided into two groups. In group A (n=30) sedation was guided by the RSS with the operator blinded to the BIS recording. In group B (n=70) the operator titrated intravenous sedation to maintain an optimal BIS, predetermined from the results in group A. Recovery time, procedure duration, physiological parameters and unplanned events were recorded in both groups. RESULTS: There was a significant correlation between the BIS and RSS (p<0.001). BIS values of 87.2 and 80.9 corresponded to an RSS of 3 and 4, respectively. The optimal BIS level was defined as 80-85. Fifty-seven point five percent of readings were within this range in group B compared with 26.5% in group A (p<0.001). Sedation approaching general anaesthesia (BIS<60) occurred in 5.5% of patients in group A but not in group B. Mean recovery time, duration of procedure, midazolam and fentanyl doses were significantly reduced in group B. Unplanned events were reduced from 27 to 17%, but this was not statistically significant (p=0.29). CONCLUSION: BIS monitoring enables more effective titration of sedatives to maintain a suitable level of consciousness, whilst reducing procedure time. The BIS offers an objective, safe and reliable measure of sedation, without disturbing either patient or operator. BIS monitoring raises the standard of patient care, and in our view, should be used to augment standard assessment.

  13. Comparison of sedation strategies for critically ill patients

    DEFF Research Database (Denmark)

    Hutton, Brian; Burry, Lisa D; Kanji, Salmaan

    2016-01-01

    BACKGROUND: Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug...... of interest include duration of mechanical ventilation, time to first extubation, ICU and hospital length of stay, re-intubation, tracheostomy, mortality, total sedative and opioid exposure, health-related quality of life, and adverse events. To inform our NMA, we will first conduct conventional pair......-wise meta-analyses using random-effects models. Where appropriate, we will perform Bayesian NMA using WinBUGS software. DISCUSSION: There are multiple strategies to optimize sedation for mechanically ventilated patients. Current ICU guidelines recommend protocolized sedation or daily sedation interruption...

  14. Comparison of CSMA based MAC protocols of wireless sensor networks

    CERN Document Server

    singh, Himanshu

    2012-01-01

    Energy conservation has been an important area of interest in Wireless Sensor networks (WSNs). Medium Access Control (MAC) protocols play an important role in energy conservation. In this paper, we describe CSMA based MAC protocols for WSN and analyze the simulation results of these protocols. We implemented S-MAC, T-MAC, B-MAC, B-MAC+, X-MAC, DMAC and Wise-MAC in TOSSIM, a simulator which unlike other simulators simulates the same code running on real hardware. Previous surveys mainly focused on the classification of MAC protocols according to the techniques being used or problem dealt with and presented a theoretical evaluation of protocols. This paper presents the comparative study of CSMA based protocols for WSNs, showing which MAC protocol is suitable in a particular environment and supports the arguments with the simulation results. The comparative study can be used to find the best suited MAC protocol for wireless sensor networks in different environments.

  15. Wireless sensors networks MAC protocols analysis

    CERN Document Server

    Chaari, Lamia

    2010-01-01

    Wireless sensors networks performance are strictly related to the medium access mechanism. An effective one, require non-conventional paradigms for protocol design due to several constraints. An adequate equilibrium between communication improvement and data processing capabilities must be accomplished. To achieve low power operation, several MAC protocols already proposed for WSN. The aim of this paper is to survey and to analyze the most energy efficient MAC protocol in order to categorize them and to compare their performances. Furthermore we have implemented some of WSN MAC protocol under OMNET++ with the purpose to evaluate their performances.

  16. Learn Office 2011 for Mac OS X

    CERN Document Server

    Hart-Davis, Guy

    2011-01-01

    Office for Mac remains the leading productivity suite for Mac, with Apple's iWork and the free OpenOffice.org trailing far behind. And now it's being updated with a cleaner interface and more compatibility with Exchange and SharePoint. Learn Office 2011 for Mac OS X offers a practical, hands-on approach to using Office 2011 applications to create and edit documents and get work done efficiently. You'll learn how to customize Office, design, create, and share documents, manipulate data in a spreadsheet, and create lively presentations. You'll also discover how to organize your email, contacts,

  17. Beginning Mac OS X Snow Leopard programming

    CERN Document Server

    Trent, Michael

    2010-01-01

    Michael Trent is a technical reviewer for numerous books and magazine articles and the coauthor of Beginning Mac OS X Programming with Drew McCormack. Drew McCormack is an experienced computational scientist, founder of the ""The Mental Faculty""-an independent company developing software for the Mac and iPhone-and the coauthor of Beginning Mac OS X Programming with Michael Trent. Wrox Beginning guides are crafted to make learning programming languages and technologies easier than you think, providing a structured, tutorial format that will guide you through all the techniques involved.

  18. Mac OS X Lion portable genius

    CERN Document Server

    Spivey, Dwight

    2012-01-01

    Two e-books, Mac OS X Lion Portable Genius and MacBook Pro Portable Genius, Third Edition, bundled in one package Books in the Portable Genius series provide readers with the most accessible, useful information possible, including plenty of tips and techniques for the most-used features in a product or software. These e-books will show you what you may not find out by just working with your MacBook Pro and OS X Lion. Genius icons present smart or innovative ways to do something, saving time and hassle. Easy-to-find information gives you the essentials plus insightful tips on how to navigate

  19. Office 2008 for Mac for dummies

    CERN Document Server

    LeVitus, Bob

    2013-01-01

    Office 2008 for Mac is here, with great new enhancements to all your favorite office productivity tools. Who better than "Dr. Mac, "Bob LeVitus, to show you how to load and use them all? From choosing the best version for your needs to managing your life with your online calendar, Office 2008 For Mac For Dummies covers what you need to know. It compares the Student/Teacher Edition, Standard Edition, and Professional Edition, then walks you through installing your preferred version and keeping it up to date. You'll find out all the things you can do with Word, Excel, PowerPoint, and Entourage,

  20. Mac OS X for Unix Geeks (Leopard)

    CERN Document Server

    Rothman, Ernest E; Rosen, Rich

    2009-01-01

    If you've been lured to Mac OS X because of its Unix roots, this invaluable book serves as a bridge between Apple's Darwin OS and the more traditional Unix systems. The new edition offers a complete tour of Mac OS X's Unix shell for Leopard and Tiger, and helps you find the facilities that replace or correspond to standard Unix utilities. Learn how to compile code, link to libraries, and port Unix software to Mac OS X and much more with this concise guide.

  1. Descriptions by General Practitioners and Nurses of Their Collaboration in Continuous Sedation Until Death at Home: In-Depth Qualitative Interviews in Three European Countries

    NARCIS (Netherlands)

    L. Anquinet (Livia); J.A.C. Rietjens (Judith); N. Mathers (Nigel); J. Seymour (Jane); A. van der Heide (Agnes); L. Deliens (Luc)

    2014-01-01

    textabstractContext: One palliative care approach that is increasingly being used at home for relieving intolerable suffering in terminally ill patients is continuous sedation until death. Its provision requires a multidisciplinary team approach, with adequate collaboration and communication. Howeve

  2. MAC Layer Hurdles in BSNs

    CERN Document Server

    Ullah, Sana; Choi, Young-Woo; Lee, Hyung-Soo; Kwak, Kyung Sup

    2009-01-01

    The last few decades have seen considerable research progress in microelectronics and integrated circuits, system-on-chip design, wireless communication, and sensor technology. This progress has enabled the seamless integration of autonomous wireless sensor nodes around a human body to create a Body Sensor Network (BSN). The development of a proactive and ambulatory BSN induces a number of enormous issues and challenges. This paper presents the technical hurdles during the design and implementation of a low-power Medium Access Control (MAC) protocol for in-body and on-body sensor networks. We analyze the performance of IEEE 802.15.4 protocol for the on-body sensor network. We also provide a comprehensive insight into the heterogeneous characteristics of the in-body sensor network. A low-power technique called Pattern-Based Wake-up Table is proposed to handle the normal traffic in a BSN. The proposed technique provides a reliable solution towards low-power communication in the in-body sensor network.

  3. Review on sedation for gastrointestinal tract endoscopy inchildren by non-anesthesiologists

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    AIM To present evidence and formulate recommendationsfor sedation in pediatric gastrointestinal (GI)endoscopy by non-anesthesiologists.METHODS: The databases MEDLINE, Cochrane andEMBASE were searched for the following keywords"endoscopy, GI", "endoscopy, digestive system" AND"sedation", "conscious sedation", "moderate sedation","deep sedation" and "hypnotics and sedatives" forpublications in English restricted to the pediatric age.We searched additional information published between January 2011 and January 2014. Searches for (upper) GIendoscopy sedation in pediatrics and sedation guidelinesby non-anesthesiologists for the adult population wereperformed.RESULTS: From the available studies three sedationprotocols are highlighted. Propofol, which seems tooffer the best balance between efficacy and safety israrely used by non-anesthesiologists mainly becauseof legal restrictions. Ketamine and a combination ofa benzodiazepine and an opioid are more frequentlyused. Data regarding other sedatives, anesthetics andadjuvant medications used for pediatric GI endoscopyare also presented.CONCLUSION: General anesthesia by a multidisciplinaryteam led by an anesthesiologist is preferred. The creationof sedation teams led by non-anesthesiologists anda careful selection of anesthetic drugs may offer analternative, but should be in l

  4. Sedation and Monitoring in the Pediatric Patient during Gastrointestinal Endoscopy.

    Science.gov (United States)

    Chung, Hyun Kee; Lightdale, Jenifer R

    2016-07-01

    Sedation is a fundamental component of pediatric gastrointestinal procedures. The 2 main types of sedation for pediatric endoscopy remain general anesthesia and procedural sedation. Although anesthesiologist-administered sedation protocols are more common, there is no ideal regimen for endoscopy in children. This article discusses specific levels of sedation for endoscopy as well as various regimens that can be used to achieve each. Risks and considerations that may be specific to performing gastrointestinal procedures in children are reviewed. Finally, potential future directions for sedation and monitoring that may change the practice of pediatric gastroenterology and ultimately patient outcomes are examined.

  5. H-MAC: A Hybrid MAC Protocol for Wireless Sensor Networks

    CERN Document Server

    Mehta, S; 10.5121/ijcnc.2010.2208

    2010-01-01

    In this paper, we propose a hybrid medium access control protocol (H-MAC) for wireless sensor networks. It is based on the IEEE 802.11's power saving mechanism (PSM) and slotted aloha, and utilizes multiple slots dynamically to improve performance. Existing MAC protocols for sensor networks reduce energy consumptions by introducing variation in an active/sleep mechanism. But they may not provide energy efficiency in varying traffic conditions as well as they did not address Quality of Service (QoS) issues. H-MAC, the propose MAC protocol maintains energy efficiency as well as QoS issues like latency, throughput, and channel utilization. Our numerical results show that H-MAC has significant improvements in QoS parameters than the existing MAC protocols for sensor networks while consuming comparable amount of energy.

  6. CR-MAC: A multichannel MAC protocol for cognitive radio ad hoc networks

    CERN Document Server

    Kamruzzaman, S M

    2010-01-01

    This paper proposes a cross-layer based cognitive radio multichannel medium access control (MAC) protocol with TDMA, which integrate the spectrum sensing at physical (PHY) layer and the packet scheduling at MAC layer, for the ad hoc wireless networks. The IEEE 802.11 standard allows for the use of multiple channels available at the PHY layer, but its MAC protocol is designed only for a single channel. A single channel MAC protocol does not work well in a multichannel environment, because of the multichannel hidden terminal problem. Our proposed protocol enables secondary users (SUs) to utilize multiple channels by switching channels dynamically, thus increasing network throughput. In our proposed protocol, each SU is equipped with only one spectrum agile transceiver, but solves the multichannel hidden terminal problem using temporal synchronization. The proposed cognitive radio MAC (CR-MAC) protocol allows SUs to identify and use the unused frequency spectrum in a way that constrains the level of interference...

  7. Sedation for pediatric diagnostic imaging: use of pediatric and nursing resources as an alternative to a radiology department sedation team

    Energy Technology Data Exchange (ETDEWEB)

    Ruess, Lynne [Department of Radiology, Tripler Army Medical Center, Honolulu, HI (United States); Uniformed Services University of the Health Scsiences, Bethesda, MD (United States); O' Connor, Stephen C. [Department of Radiology, Tripler Army Medical Center, Honolulu, HI (United States); Mikita, Cecilia P. [Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI (United States); Creamer, Kevin M. [Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI (United States)

    2002-07-01

    Objective. To develop a pathway to provide safe, effective, and efficient sedation for pediatric diagnostic imaging studies using non-radiology personnel. Materials and methods. A multidisciplinary team considered manpower and training requirements and national sedation standards before designing a sedation pathway, which included scheduling, pre-sedation history and physical, medication protocols, and monitoring. Oral and IV medication protocols were developed based on patient age and weight. Sedation delays were defined as >15 min (IV) or >30 min (PO) from start of sedation to start of imaging. A sedation failure resulted in an incomplete diagnostic imaging study. Failure rates of 124 sedations before and 388 sedations after the pathway were compared.Results. The sedation failure rate for 7 months prior to pathway initiation was 15% (19/124). In the first 25 months after pathway initiation, failures were significantly reduced to 1.5% (6/388) (P<0.0001). Three (50%) of the six failures after pathway initiation were long examinations (>55 min). Deviation from the recommended medication protocol accounted for most of the 115 delays. Only minor adverse events were seen (12/388, 3.1%).Conclusion. Implementing a pediatric sedation pathway significantly decreases the sedation failure rate. Pediatric residents and nurses can safely, effectively and efficiently sedate pediatric patients for routine diagnostic imaging procedures without the need for a radiology department sedation team in a department with a small-to-moderate volume of pediatric patients. (orig.)

  8. Learn Mac OS X Snow Leopard

    CERN Document Server

    Meyers, Scott

    2009-01-01

    You're smart and savvy, but also busy. This comprehensive guide to Apple's Mac OS X 10.6, Snow Leopard, gives you everything you need to know to live a happy, productive Mac life. Learn Mac OS X Snow Leopard will have you up and connected lickity split. With a minimum of overhead and a maximum of useful information, you'll cover a lot of ground in the time it takes other books to get you plugged in. If this isn't your first experience with Mac OS X, skip right to the "What's New in Snow Leopard" sections. You may also find yourself using this book as a quick refresher course or a way

  9. Ketamine-propofol sedation in circumcision

    Directory of Open Access Journals (Sweden)

    Handan Gulec

    2015-10-01

    Full Text Available ABSTRACTBACKGROUND AND OBJECTIVE: To compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation.METHODS: 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05 mg/kg + ketamine 3 mg/kg + atropine 0.02 mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II.RESULTS: In the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p > 0.050. Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20th min, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p < 0.050.CONCLUSION: Propofol-ketamine (Ketofol provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.

  10. Macintosh Troubleshooting Pocket Guide for Mac OS

    CERN Document Server

    Lerner, David; Corporation, Tekserve

    2009-01-01

    The Macintosh Troubleshooting Pocket Guide covers the most common user hardware and software trouble. It's not just a book for Mac OS X (although it includes tips for OS X and Jaguar), it's for anyone who owns a Mac of any type-- there are software tips going back as far as OS 6. This slim guide distills the answers to the urgent questions that Tekserve's employee's answer every week into a handy guide that fits in your back pocket or alongside your keyboard.

  11. Enhanced Sleep Mode MAC Control for EPON

    DEFF Research Database (Denmark)

    Yan, Ying; Dittmann, Lars

    2011-01-01

    This paper introduces sleep mode operations for EPON. New MAC control functions are proposed to schedule sleep periods. Traffic profiles are considered to optimize energy efficiency and network performances. Simulation results are analyzed in OPNET modeler.......This paper introduces sleep mode operations for EPON. New MAC control functions are proposed to schedule sleep periods. Traffic profiles are considered to optimize energy efficiency and network performances. Simulation results are analyzed in OPNET modeler....

  12. General Anesthetic Versus Light Sedation: Effect on Pediatric Endoscopy Wait Times

    Directory of Open Access Journals (Sweden)

    Christine Edwards

    2013-01-01

    Full Text Available BACKGROUND: Wait times are an important measure of health care system effectiveness. There are no studies describing wait times in pediatric gastroenterology for either outpatient visits or endoscopy. Pediatric endoscopy is performed under light sedation or general anesthesia. The latter is hypothesized to be associated with a longer wait time due to practical limits on access to anesthesia in the Canadian health care system.

  13. Interest of 50% nitrous oxide and oxygen premix sedation in gerodontology

    OpenAIRE

    Nicolas, Emmanuel

    2008-01-01

    Emmanuel Nicolas1,2, Claire Lassauzay1,21CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; 2Université Clermont 1, EA 3847, Faculty of Dentistry, 63000 Clermont-Ferrand, FranceAbstract: Elderly patients presenting cardiovascular, respiratory, or neurological disorders require a specific dental care approach, especially patients presenting Alzheimer’s disease. Sedative procedures can prevent dental care-induced stress, even when there is effective pain cont...

  14. 42 CFR 423.2130 - Effect of the MAC's decision.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Effect of the MAC's decision. 423.2130 Section 423... (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2130 Effect of the MAC's decision. The MAC's decision is final and...

  15. 42 CFR 423.2126 - Case remanded by the MAC.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Case remanded by the MAC. 423.2126 Section 423.2126... (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2126 Case remanded by the MAC. (a) When the MAC may remand a case to the...

  16. 42 CFR 405.1130 - Effect of the MAC's decision.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Effect of the MAC's decision. 405.1130 Section 405....1130 Effect of the MAC's decision. The MAC's decision is final and binding on all parties unless a Federal district court issues a decision modifying the MAC's decision or the decision is revised as...

  17. 42 CFR 423.1974 - Medicare Appeals Council (MAC) review.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Medicare Appeals Council (MAC) review. 423.1974..., MAC review, and Judicial Review § 423.1974 Medicare Appeals Council (MAC) review. An enrollee who is dissatisfied with an ALJ hearing decision may request that the MAC review the ALJ's decision or dismissal...

  18. 42 CFR 423.2120 - Filing briefs with the MAC.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Filing briefs with the MAC. 423.2120 Section 423... (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2120 Filing briefs with the MAC. Upon request, the MAC will give...

  19. 42 CFR 423.2118 - Obtaining evidence from the MAC.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Obtaining evidence from the MAC. 423.2118 Section..., MAC review, and Judicial Review § 423.2118 Obtaining evidence from the MAC. An enrollee may request... the costs of providing these items. If an enrollee requests evidence from the MAC and an...

  20. 42 CFR 405.1120 - Filing briefs with the MAC.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Filing briefs with the MAC. 405.1120 Section 405....1120 Filing briefs with the MAC. Upon request, the MAC will give the party requesting review, as well... ending with the date the brief is received by the MAC will not be counted toward the...

  1. Molecular determinants responsible for sedative and non-sedative properties of histamine H₁-receptor antagonists.

    Science.gov (United States)

    Uesawa, Yoshihiro; Hishinuma, Shigeru; Shoji, Masaru

    2014-01-01

    There is argument whether non-sedative properties of histamine H1-receptor antagonists (antihistamines) are determined by their active extrusions from the brain via P-glycoprotein or their restricted penetration through the blood-brain barrier. We have reported that sedative and non-sedative antihistamines can be well discriminated by measuring changes in their binding to H1 receptors upon receptor internalization in intact cells, which depends on their membrane-penetrating ability. In this study, molecular determinants responsible for sedative and non-sedative properties of antihistamines were evaluated by quantitative structure-activity relationship (QSAR) analyses. Multiple regression analyses were applied to construct a QSAR model, taking internalization-mediated changes in the binding of antihistamines as objective variables and their structural descriptors as explanatory variables. The multiple regression model was successfully constructed with two explanatory variables, i.e., lipophilicity of the compounds at physiological pH (logD) and mean information content on the distance degree equality (IDDE) (r(2) = 0.753). The constructed model discriminated between sedative and non-sedative antihistamines with 94% accuracy for external validation. These results suggest that logD and IDDE concerning lipophilicity and molecular shapes of compounds, respectively, predominantly determine the membrane-penetrating ability of antihistamines for their side effects on the central nervous system.

  2. The use of sedation in the radiology department

    Energy Technology Data Exchange (ETDEWEB)

    Patatas, K. [Radiology Academy, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds (United Kingdom); St James University Hospital, Leeds (United Kingdom)], E-mail: kpatatas@hotmail.com; Koukkoulli, A. [St James University Hospital, Leeds (United Kingdom)

    2009-07-15

    The use of intravenous sedation and analgesia in patients undergoing interventional diagnostic and therapeutic procedures is increasing. Sedation by non-anaesthetists is considered to be safe, provided that they have received adequate training and have the necessary equipment, facilities, and personnel. This article aims to increase awareness of the safe use of sedative drugs in radiology and provide a practical guideline for minimal and moderate sedation.

  3. Quality Assurance in the Endoscopy Suite: Sedation and Monitoring.

    Science.gov (United States)

    Harris, Zachary P; Liu, Julia; Saltzman, John R

    2016-07-01

    Recent development and expansion of endoscopy units has necessitated similar progress in the quality assurance of procedure sedation and monitoring. The large number of endoscopic procedures performed annually underlies the need for standardized quality initiatives focused on mitigating patient risk before, during, and immediately after endoscopic sedation, as well as improving procedure outcomes and patient satisfaction. Specific standards are needed for newer sedation modalities, including propofol administration. This article reviews the current guidelines and literature concerning quality assurance and endoscopic procedure sedation.

  4. An assessment of computer-assisted personalized sedation : a sedation delivery system to administer propofol for gastrointestinal endoscopy

    NARCIS (Netherlands)

    Pambianco, Daniel J.; Whitten, Christopher J.; Moerman, Annelies; Struys, Michel M.; Martin, James F.

    2008-01-01

    Background: Demand for colonoscopy and EGD procedures is increasing. Impediments to performing these examinations persist, Patients perceive these procedures as unpleasant and painful. The use of suboptimal sedatives results in inefficiency in endoscopy practices. Improving sedation methods utilizin

  5. Neural correlates of successful semantic processing during propofol sedation

    NARCIS (Netherlands)

    Adapa, Ram M.; Davis, Matthew H.; Stamatakis, Emmanuel A.; Absalom, Anthony R.; Menon, David K.

    2014-01-01

    Sedation has a graded effect on brain responses to auditory stimuli: perceptual processing persists at sedation levels that attenuate more complex processing. We used fMRI in healthy volunteers sedated with propofol to assess changes in neural responses to spoken stimuli. Volunteers were scanned awa

  6. The use of Midazolam as an Intranasal Sedative in Dentistry.

    Science.gov (United States)

    Greaves, Anwen

    2016-01-01

    The administration of midazolam intranasally exploits the unique structure of the nasopharynx thus ensuring rapid delivery to the systemic circulation (The Nose - Brain Pathway). The absorption of midazolam nasally is influenced by the volume and concentration of midazolam, its physicochemical properties and the characteristics of the nasal mucosa. Delivering midazolam intranasally is non-titratable. The level of conscious sedation may be equivalent to that achieved by intravenous routes but is approached in a less controlled manner. Randomised Control trials using intranasal sedation in children have shown the technique to be safe and effective in secondary care for dental procedures at concentrations varying from 0.2 mg/kg to 0.5 mg/kg. A combined technique of intranasal midazolam (to facilitate cannulation) and intravenous midazolam is used for adults with moderate to severe learning disabilities. This has revolutionised dental treatment for this group of patients as treatment under General Anaesthesia (GA) may be avoided. Intranasal delivery of midazolam is emerging as a significant tool in our dental armamentarium for the treatment of anxious children, phobic adult patients and patients with learning disabilities.

  7. SA-MAC:Self-Stabilizing Adaptive MAC Protocol for Wireless Sensor Networks

    Institute of Scientific and Technical Information of China (English)

    波澄; 韩君泽; 李向阳; 王昱; 肖波

    2014-01-01

    A common method of prolonging the lifetime of wireless sensor networks is to use low power duty cycling protocol. Existing protocols consist of two categories: sender-initiated and receiver-initiated. In this paper, we present SA-MAC, a self-stabilizing adaptive MAC protocol for wireless sensor networks. SA-MAC dynamically adjusts the transmission time-slot, waking up time-slot, and packet detection pattern according to current network working condition, such as packet length and wake-up patterns of neighboring nodes. In the long run, every sensor node will find its own transmission phase so that the network will enter a stable stage when the network load and qualities are static. We conduct extensive experiments to evaluate the energy consumption, packet reception rate of SA-MAC in real sensor networking systems. Our results indicate that SA-MAC outperforms other existing protocols.

  8. Monitoring sedation for bronchoscopy in mechanically ventilated patients by using the Ramsay sedation scale versus auditory-evoked potentials

    OpenAIRE

    2014-01-01

    Background Appropriate sedation benefits patients by reducing the stress response, but it requires an appropriate method of assessment to adjust the dosage of sedatives. The aim of this study was to compare the difference in the sedation of mechanically ventilated patients undergoing flexible bronchoscopy (FB) monitored by auditory-evoked potentials (AEPs) or the Ramsay sedation scale (RSS). Methods In a prospective, randomized, controlled study, all patients who underwent FB with propofol se...

  9. Implantable body sensor network MAC protocols using wake-up radio - Evaluation in animal tissue

    NARCIS (Netherlands)

    Ramachandran, V.R.K.; Zwaag, van der Berend Jan; Meratnia, Nirvana; Havinga, Paul

    2015-01-01

    Applications of implantable sensor networks in the health-care industry have increased tremendously over the last decade. There are different types of medium access control (MAC) protocols that are designed for implantable body sensor networks, using different physical layer technologies such as nar

  10. Midazolam sedates Passeriformes for field sampling but affects multiple venous blood analytes

    Directory of Open Access Journals (Sweden)

    Heatley JJ

    2015-01-01

    Full Text Available J Jill Heatley,1 Jennifer Cary,2,3 Lyndsey Kingsley,1 Hughes Beaufrere,4 Karen E Russell,5 Gary Voelker2,3 1Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, 2Department of Wildlife and Fisheries Sciences, 3Texas A&M Biodiversity Research and Teaching Collections, Texas A&M University, College Station, TX, USA; 4Health Sciences Centre, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada; 5Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, College Station, TX, USA Abstract: Feasibility and effect of midazolam administration on blood analytes and for sedation of Passeriformes being collected in a larger study of genetic biodiversity was assessed. Midazolam (5.6±2.7 mg/kg was administered intranasally prior to sampling, euthanasia, and specimen preparation of 104 passerine birds. Each bird was assessed for sedation score and then multiple analytes were determined from jugular blood samples using the i-STAT® point of care analyzer at “bird side”. Most birds were acceptably sedated, sedation became more pronounced as midazolam dose increased, and only a single bird died. Electrolyte concentrations and venous blood gas analytes were affected by midazolam administration while blood pH, packed cell volume, hemoglobin, and calculated hematocrit were not. Intranasal midazolam gives adequate sedation and is safe for short-term use in free-living Passeriformes. Based on venous blood analyte data, sedation of Passeriformes prior to handling appears to reduce stress but also produces venous blood gas differences consistent with hypoventilation relative to birds which were not given midazolam. Further study is recommended to investigate midazolam's continued use in free-living avian species. Studies should include safety, reversal and recovery, effect upon additional endogenous analytes, and compatibility with studies of ecology and toxicology

  11. [Midazolam sedation in the general dental practice].

    Science.gov (United States)

    Bertens, J; Abraham-Inpijn, L; Meuwissen, P J

    1994-03-01

    The general dental practitioner is occasionally confronted with patients who, on the basis of psychological--and often somatic--criteria, are difficult to treat. Medicinal sedation in combination with anxiety reduction may be deemed appropriate for such patients. In the Netherlands inhalation sedation by means of a combination of oxygen and nitrous oxide is generally used. The limitations and disadvantages of this method have directed attention towards sedation by means of midazolam, a quick-acting benzodiazepine. In view of the complications which may accompany the administration of midazolam, the general practitioner working alone or in a group practice is advised against using midazolam sedation. Such use should be reserved for a dentist working in a hospital setting, who is able to consult with a physician regarding the advisability of administering midazolam. Even then, the safety of the patient requires that the practitioners have a proper insight into the physical state of the patient, work according to a protocol and in accordance with clearly defined responsibilities, and provide adequate accommodation during and after treatment.

  12. Nitrous oxide sedation and sexual phenomena.

    Science.gov (United States)

    Jastak, J T; Malamed, S F

    1980-07-01

    Nine cases of sexual phenomena that occurred with use of nitrous oxide and oxygen sedation are described. Dentists involved routinely used concentrations of nitrous oxide greater than 50% and did not have assistants in the room during dental procedures. Recommendations on the concentrations of nitrous oxide and the presence of an assistant are made.

  13. Palliative sedation : not just normal medical practice. Ethical reflections on the Royal Dutch Medical Association's guideline on palliative sedation

    NARCIS (Netherlands)

    Janssens, Rien; van Delden, Johannes J. M.; Widdershoven, Guy A. M.

    2012-01-01

    The main premise of the Royal Dutch Medical Association's (RDMA) guideline on palliative sedation is that palliative sedation, contrary to euthanasia, is normal medical practice. Although we do not deny the ethical distinctions between euthanasia and palliative sedation, we will critically analyse t

  14. Maintenance time of sedative effects after an intravenous infusion of diazepam:A guide for endoscopy using diazepam

    Institute of Scientific and Technical Information of China (English)

    Takahisa Furuta; Mutsuhiro Ikuma; Akira Hishida; Kyoichi Ohashi; Mitsushige Sugimoto; Akiko Nakamura; Naohito Shirai; Shingen Misaka; Shinya Uchida; Hiroshi Watanabe; Takashi Ishizaki

    2008-01-01

    AIM:To examine whether the sedative effects assessed by psychomotor tests would depend on the cytochrome P450(CYP)2C19 genotypes after an infusion regimen of diazepam commonly used for gastrointestinal endoscopy in Japan.METHODS:Fifteen healthy Japanese volunteers consisting of three different CYP2C19 genotype groups underwent a critical flicker fusion test,an eye movement analysis and a postural sway test as a test for physical sedative effects,and a visual analog scale(VAS)symptom assessment method as a test for mental sedative effects during the 336 h period after the intravenous infusion of diazepam(5 mg).RESULTS:The physical sedative effects assessed by the critical flicker test continued for 1h(t values of 5 min,30 min and 60 min later:4.35,5.00 and 3.19,respectively)and those by the moving radial area of a postural sway test continued for 3h(t values of 5 h,30 h,60 min and 3 h later:-4.05,-3.42,-2.17 and -2.58,respectively),which changed significantly compared with the baseline level before infusion(P<0.05).On the other hand,the mental sedative effects by the VAS method improved within 1 h.The CYP2C19 genotype-dependent differences in the postinfusion sedative effects were not observed in any of the four psychomotor function tests.CONCLUSION:With the psychomotor tests,the objective sedative effects of diazepam continued for 1 h to 3 h irrespective of CYP2C19 genotype status and the subjective sedative symptoms improved within 1 h.Up to 3 h of clinical care appears to be required after the infusion of diazepam,although patients feel subjectively improved.(C)2008 The W3G Press,All rights reserved.

  15. Mac OS X Snow Leopard试用

    Institute of Scientific and Technical Information of China (English)

    大大

    2009-01-01

    苹果新一代操作系统Mac OS X 10.6 Snow Leopard(雪豹)于8月底上市。根据NPD集团的统计数据,该系统在美国市场前两周的销售非常喜人,是2007年Mac OS X 10.5 Leopard上市销量的2倍以上,是2005年的Mac OS X 10.4 Tiger操作系统的售量的4倍。假如你也对升级价格仅需88元雪豹系统感兴趣,就让我们从一起升级安装开始,体验它独特的魅力。

  16. MacSelfService online tutorial

    CERN Document Server

    CERN. Geneva

    2016-01-01

    Mac Self-Service is a functionality within the Mac Desktop Service built and maintained to empower CERN users by giving them easy access to applications and configurations through the Self-Service application. This tutorial (text attached to the event page) explains how to install Mac Self-Service and how to use it to install applications and printers. Content owner: Vincent Nicolas Bippus Presenter: Pedro Augusto de Freitas Batista Tell us what you think via e-learning.support at cern.ch More tutorials in the e-learning collection of the CERN Document Server (CDS) https://cds.cern.ch/collection/E-learning%20modules?ln=en All info about the CERN rapid e-learning project is linked from http://twiki.cern.ch/ELearning  

  17. Patient-directed music therapy reduces anxiety and sedation exposure in mechanically-ventilated patients: a research critique.

    Science.gov (United States)

    Gullick, Janice G; Kwan, Xiu Xian

    2015-05-01

    This research appraisal, guided by the CASP Randomised Controlled Trial Checklist, critiques a randomised, controlled trial of patient-directed music therapy compared to either noise-cancelling headphones or usual care. This study recruited 373 alert, mechanically-ventilated patients across five intensive care units in the United States. The Music Assessment Tool, administered by a music therapist, facilitated music selection by participants in the intervention group. Anxiety was measured using the VAS-A scale. Sedation exposure was measured by both sedation frequency and by sedation intensity using a daily sedation intensity score. Context for the data was supported by an environmental scan form recording unit activity and by written comments from nurses about the patient's responses to the protocol. Patient-directed music therapy allowed a significant reduction in sedation frequency compared to noise-cancelling headphones and usual care participants. Patient-directed music therapy led to significantly lower anxiety and sedation intensity compared to usual care, but not compared to noise-cancelling headphones. This is a robust study with clear aims and a detailed description of research methods and follow-up. While no participants were lost to follow-up, not all were included in the analysis: 37% did not have the minimum of two anxiety assessments for comparison and 23% were not included in sedation analysis. While some participants utilised the intervention or active control for many hours-per-day, half the music therapy participants listened for 12min or less per day and half of the noise-cancelling headphone participants did not appear to use them. While the results suggest that patient-directed music therapy and noise-cancelling headphones may be useful and cost-effective interventions that lead to an overall improvement in anxiety and sedation exposure, these may appeal to a subset of ICU patients. The self-directed use of music therapy and noise

  18. Comparison of sevoflurane with isoflurane for rapid mask induction in midazolam and butorphanol-sedated dogs.

    Science.gov (United States)

    Mutoh, T; Kojima, K; Takao, K; Nishimura, R; Sasaki, N

    2001-05-01

    Rapid mask induction can be a useful induction technique for veterinary patients, although it is often accompanied by exaggerated excitement responses in unpremedicated animals (Mutoh et al.: Jpn. J. Vet. Anesth. Surg. 26, 109-116; J. Vet. Med. Sci. 57, 1007-1013; J. Vet. Med. Sci. 57, 1121-1124; 1995). The aim of this study was to compare sevoflurane with isoflurane for rapid mask induction in six dogs sedated by a combination of midazolam (0.1 mg/kg) and butorphanol (0.2 mg/kg). Induction with sevoflurane (5%, 2.4 minimum alveolar concentration [MAC]) in O2 resulted in shorter time to loss of the palpebral reflex, negative tail clamp response, and successful intubation than with isoflurane (3%, 2.4 MAC) in O2. There were no changes in heart rate or mean arterial blood pressure during induction with sevoflurane, whereas an increase in heart rate was observed in dogs induced with isoflurane. A decrease in respiratory rate compared with the pre-induction rate was observed during induction, and associated mild respiratory acidosis, characterized by an increase in arterial PCO2, was measured at the end of the induction period in both induction groups. None of the animals had episodes of induction-related complications. These results suggest that both sevoflurane and isoflurane produce a smooth onset of induction in midazolam and butorphanol-sedated dogs. Sevoflurane is a more suitable for rapid mask induction than isoflurane since it provides faster induction associated with a lower blood/gas partition coefficient.

  19. Use of sevoflurane inhalation sedation for outpatient third molar surgery.

    Science.gov (United States)

    Ganzberg, S; Weaver, J; Beck, F M; McCaffrey, G

    1999-01-01

    This study attempted to determine if sevoflurane in oxygen inhaled via a nasal hood as a sole sedative agent would provide an appropriate level of deep sedation for outpatient third molar surgery. Twenty-four patients scheduled for third molar removal were randomly assigned to receive either nasal hood inhalation sevoflurane or an intravenous deep sedation using midazolam and fentanyl followed by a propofol infusion. In addition to measuring patient, surgeon, and dentist anesthesiologist subjective satisfaction with the technique, physiological parameters, amnesia, and psychomotor recovery were also assessed. No statistically significant difference was found between the sevoflurane and midazolam-fentanyl-propofol sedative groups in physiological parameters, degree of amnesia, reported quality of sedation, or patient willingness to again undergo a similar deep sedation. A trend toward earlier recovery in the sevoflurane group was identified. Sevoflurane can be successfully employed as a deep sedative rather than a general anesthetic for extraction of third molars in healthy subjects.

  20. Mac OS X Snow Leopard pocket guide

    CERN Document Server

    Seiblod, Chris

    2009-01-01

    Whether you're new to the Mac or a longtime user, this handy book is the quickest way to get up to speed on Snow Leopard. Packed with concise information in an easy-to-read format, Mac OS X Snow Leopard Pocket Guide covers what you need to know and is an ideal resource for problem-solving on the fly. This book goes right to the heart of Snow Leopard, with details on system preferences, built-in applications, and utilities. You'll also find configuration tips, keyboard shortcuts, guides for troubleshooting, lots of step-by-step instructions, and more. Learn about new features and changes s

  1. MacBook Pro Portable Genius

    CERN Document Server

    Miser, Brad

    2012-01-01

    Discover loads of tips and techniques for the newest MacBook Pro You're already ahead of the game with a MacBook Pro. Now you can get even more out the popular Apple notebook with the new edition of this handy, compact book. Crammed with savvy insights and tips on key tools and shortcuts, this book will help you increase your productivity and keep your Apple digital lifestyle on track. From desktop sharing and wireless networking to running Windows applications, this book avoids fluff, doesn't skimp on the essentials, saves you time and hassle, and shows you what you most want to know. Include

  2. An Evaluation of Intranasal Sufentanil and Dexmedetomidine for Pediatric Dental Sedation

    Directory of Open Access Journals (Sweden)

    James M. Hitt

    2014-03-01

    Full Text Available Conscious or moderate sedation is routinely used to facilitate the dental care of the pre- or un-cooperative child. Dexmedetomidine (DEX has little respiratory depressant effect, possibly making it a safer option when used as an adjunct to either opioids or benzodiazepines. Unlike intranasal (IN midazolam, IN application of DEX and sufentanil (SUF does not appear to cause much discomfort. Further, although DEX lacks respiratory depressive effects, it is an α2-agonist that can cause hypotension and bradycardia when given in high doses or during prolonged periods of administration. The aim of this feasibility study was to prospectively assess IN DEX/SUF as a potential sedation regimen for pediatric dental procedures. After IRB approval and informed consent, children (aged 3–7 years; n = 20 from our dental clinic were recruited. All patients received 2 μg/kg (max 40 μg of IN DEX 45 min before the procedure, followed 30 min later by 1 μg/kg (max 20 μg of IN SUF. An independent observer rated the effects of sedation using the Ohio State University Behavior Rating Scale (OSUBRS and University of Michigan Sedation Scale (UMSS. The dentist and the parent also assessed the efficacy of sedation. Dental procedures were well tolerated and none were aborted. The mean OSUBRS procedure score was 2.1, the UMSS procedure score was 1.6, and all scores returned to baseline after the procedure. The average dentist rated quality of sedation was 7.6 across the 20 subjects. After discharge, parents reported one child with prolonged drowsiness and one child who vomited at home. The use of IN DEX supplemented with IN SUF provided both an effective and tolerable form of moderate sedation. Although onset and recovery are slower than with oral (PO midazolam and transmucosal fentanyl, the quality of the sedation may be better with less risk of respiratory depression. Results from this preliminary study showed no major complications from IN delivery of these agents.

  3. MAC2: A Multi-Hop Adaptive MAC Protocol with Packet Concatenation for Wireless Sensor Networks

    Science.gov (United States)

    Nguyen, Kien; Meis, Ulrich; Ji, Yusheng

    Wireless sensor network MAC protocols switch radios off periodically, employing the so-called duty cycle mechanism, in order to conserve battery power that would otherwise be wasted by energy-costly idle listening. In order to minimize the various negative side-effects of the original scheme, especially on latency and throughput, various improvements have been proposed. In this paper, we introduce a new MAC protocol called MAC2(Multi-hop Adaptive with packet Concatenation-MAC) which combines three promising techniques into one protocol. Firstly, the idea to forward packets over multiple hops within one operational cycle as initially introduced in RMAC. Secondly, an adaptive method that adjusts the listening period according to traffic load minimizing idle listening. Thirdly, a packet concatenation scheme that not only increases throughput but also reduces power consumption that would otherwise be incurred by additional control packets. Furthermore, MAC2 incorporates the idea of scheduling data transmissions with minimum latency, thereby performing packet concatenation together with the multi-hop transmission mechanism in a most efficient way. We evaluated MAC2 using the prominent network simulator ns-2 and the results show that our protocol can outperform DW-MAC — a state of the art protocol both in terms of energy efficiency and throughput.

  4. The MacNew Heart Disease health-related quality of life instrument: A summary

    Directory of Open Access Journals (Sweden)

    Guyatt Gordon

    2004-01-01

    Full Text Available Abstract Background The measurement of health, the effects of disease, and the impact of health care include not only an indication of changes in disease frequency and severity but also an estimate of patients' perception of health status before and after treatment. One of the more important developments in health care in the past decade may be the recognition that the patient's perspective is as legitimate and valid as the clinician's in monitoring health care outcomes. This has lead to the development of instruments to quantify the patients' perception of their health status before and after treatment. Methods We review evidence supporting the measurement properties of the MacNew Heart Disease Health-related Quality of Life [MacNew] Questionnaire which was designed to evaluate how daily activities and physical, emotional, and social functioning are affected by coronary heart disease and its treatment. Results Reliability was demonstrated by using internal consistency and the intraclass correlation coefficients for the three domains in the Dutch, English, Farsi, German, and Spanish versions of the MacNew. With internal consistency and intraclass correlation coefficients =>0.73, reliability is high. Validity of the MacNew was examined with factor analysis and three core underlying factors, physical, emotional, and social, were identified, explaining 63.0 – 66.5% of the observed variance and replicated in the translations with psychometric data. Construct validity of the MacNew was further demonstrated by extensive substantiation of the logical relationships, defined a priori, between items and other comparison tools. The MacNew is responsive and sensitive to changes in HRQL following various interventions for patients with heart disease with 11 of 13 effect size statistics >0.80. Taking an average of 10 minutes or less to complete, the respondent-burden for the MacNew is low and its acceptability is demonstrated by response rates of over 90

  5. MacIntyre, Managerialism and Universities

    Science.gov (United States)

    Stolz, Steven A.

    2017-01-01

    MacIntyre's earlier work and concern with social science enquiry not only exposes its limits, but also provides an insight into how its knowledge claims have been put to ideological use. He maintains that the institutional embodiment of these ideological ideas is the bureaucratic manager who has had a negative role to play in social structures…

  6. Results from the MAC Vertex chamber

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, H.N.

    1987-05-01

    The design, construction, and performance characteristics of a high precision gaseous drift chamber made of thin walled proportional tubes are described. The device achieved an average spatial resolution of 45 ..mu..m in use for physics analysis with the MAC detector. The B-lifetime result obtained with this chamber is discussed.

  7. AH-MAC: Adaptive Hierarchical MAC Protocol for Low-Rate Wireless Sensor Network Applications

    Directory of Open Access Journals (Sweden)

    Adnan Ismail Al-Sulaifanie

    2017-01-01

    Full Text Available This paper proposes an adaptive hierarchical MAC protocol (AH-MAC with cross-layer optimization for low-rate and large-scale wireless sensor networks. The main goal of the proposed protocol is to combine the strengths of LEACH and IEEE 802.15.4 while offsetting their weaknesses. The predetermined cluster heads are supported with an energy harvesting circuit, while the normal nodes are battery-operated. To prolong the network’s operational lifetime, the proposed protocol transfers most of the network’s activities to the cluster heads while minimizing the node’s activity. Some of the main features of this protocol include energy efficiency, self-configurability, scalability, and self-healing. The simulation results showed great improvement of the AH-MAC over LEACH protocol in terms of energy consumption and throughput. AH-MAC consumes eight times less energy while improving throughput via acknowledgment support.

  8. CA-MAC: A Novel MAC Protocol to Alleviate Congestion in Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    WU, J.

    2013-11-01

    Full Text Available Even if the traffic pattern is known and the network topology is simple, a strong congestion can take place in wireless sensor networks (WSNs due to the data gathering effect and the duty-cycle operation. In this paper, we propose a novel medium access control (MAC protocol to alleviate the congestion, which is referred to as the congestion alleviation-MAC (CA-MAC. It adopts an adaptive contention window (ACW, which allows the nodes with more buffered packets to transmit with a higher probability, as well as an intelligent burst packet transmission when the congested nodes seize the channel. Simulations are performed in NS-2, and results show that the proposed CA-MAC protocol achieves a good performance in terms of the packet delivery ratio (PDR, power consumption, throughput, and average latency.

  9. Exposure histories of lunar meteorites: ALHA81005, MAC88104, MAC88105, and Y791197

    Energy Technology Data Exchange (ETDEWEB)

    Nishiizumi, K.; Arnold, J.R. (Univ. of California, San Diego, (United States)); Klein, J.; Fink, D.; Middleton, R. (Univ. of Pennsylvania, Philadelphia (United States)); Kubik, P.W.; Sharma, P.; Elmore, D. (Univ. of Rochester, NY (United States)); Reedy, R.C. (Los Alamos National Lab., NM (United States))

    1991-11-01

    The cosmogenic radionuclides {sup 41}Ca, {sup 36}Cl, {sup 26}Al, and {sup 10}Be in the Allan Hills 81005, MacAlpine Hills 88104, MacAlpine Hills 88105,and Yamato 791197 meteorites were measured by accelerator mass spectrometry (AMS). {sup 53}Mn in Allan Hills 81005 and Yamato 791197 was measured by activation. These four lunar meteorites experienced similar histories. They were ejected from near the surface of the Moon ranging in depth down to 400 g/cm{sup 2} and had very short transition times (less than 0.1 Ma) from the Moon to the Earth. A comparison of the cosmogenic nuclide concentrations in MacAlpine Hills 88104 and MacAlpine Hills 88105 clearly indicates that they are a pair from the same fall.

  10. Sedative-Hypnotics and Human Performance.

    Science.gov (United States)

    1981-06-01

    clobazam , diazepam , and lorazepam (drugs not marketed as sedative- hypnotics), the overall percent decrement is 30.9% and the order of sensitivity remains...medicine. Because of the widespread use of the benzodiazepines as anti-anxiety drugs, Kleinknecht & Donaldson (1975) reviewed the effects of diazepam on...cognitive and psychomotor performance, while, in an earlier review, McNalr (1973) included meprobamate in addition to the benzodiazepines, diazepam and

  11. 42 CFR 405.1126 - Case remanded by the MAC.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Case remanded by the MAC. 405.1126 Section 405.1126....1126 Case remanded by the MAC. (a) When the MAC may remand a case. Except as specified in § 405.1122(c), the MAC may remand a case in which additional evidence is needed or additional action by the ALJ...

  12. Midazolam sedation for percutaneous liver biopsy.

    Science.gov (United States)

    Alexander, J A; Smith, B J

    1993-12-01

    Control of patient respiration is needed to safely perform percutaneous liver biopsy (PLB) and may be adversely affected by sedation. The purpose of this study was to evaluate the safety of PLB with intravenous midazolam and to evaluate patient acceptance of PLB with and without sedation. Two hundred seventeen consecutive patients underwent 301 percutaneous liver biopsies. One hundred fifty-one of the biopsies were done after the patients were sedated with intravenous midazolam immediately before the biopsy. The last 61 patients were questioned after the biopsy to evaluate the discomfort of the procedure, their memory of the procedure, and their willingness to undergo another PLB. The major complication rate was similar in the midazolam-treated (0.7%) and untreated (0.7%) groups. The midazolam-treated patients had a numerically lower mean pain score (1.5 +/- 0.4 vs 4.0 +/- 0.7) (mean +/- SEM) (P = 0.07) and significantly lower mean memory score (4.8 +/- 0.7 vs 9.9 +/- 0.1) (P < 0.01) than the untreated patients. The treated and untreated groups had similar mean willingness for repeat PLB scores (9.3 +/- 0.3 vs 9.1 +/- 0.6). We conclude that: (1) there is no increased risk of PLB with midazolam and (2) patients have less memory of the procedure with midazolam.

  13. Medetomidine-midazolam sedation in sheep.

    Science.gov (United States)

    Raekallio, M; Tulamo, R M; Valtamo, T

    1998-01-01

    Seven sheep were sedated 3 times: with medetomidine (15 micrograms kg-1), with midazolam (0.1 mg kg-1) and with a combination of the drugs. All drugs were administered intravenously. Heart and respiratory rates were measured. Arterial blood samples were collected, and PaO2, PaCO2, pH, haemoglobin concentration and saturation, and base excess were determined. Systolic and mean arterial pressures were recorded before and after the treatment with medetomidine-midazolam. Midazolam increased the time of recumbency induced by medetomidine. After administration of midazolam alone, 4 of the 7 sheep were sedated and the other 3 were excited. Heart rate decreased after both medetomidine and medetomidine-midazolam. One sheep suffered a cardiac arrest after medetomidine-midazolam injection, and it required resuscitation. PaO2 and haemoglobin oxygen saturation decreased after medetomidine, and medetomidine-midazolam caused a marked hypoxaemia. PaCO2 increased after medetomidine, both alone and combined with midazolam, but arterial pH was within the reference values after all drug administrations. Systolic and mean arterial pressures decreased after medetomidine-midazolam. This study indicates that though in sheep midazolam potentiates the sedative effect of medetomidine, the combination of medetomidine and midazolam also reduces the in PaO2 and haemoglobin oxygen saturation more than medetomidine alone. The results indicate that a medetomidine-midazolam combination is unsafe for sheep at the doses studied.

  14. Reduction in standard MAC and MAC for intubation after clonidine premedication in children.

    Science.gov (United States)

    Inomata, S; Kihara, S; Yaguchi, Y; Baba, Y; Kohda, Y; Toyooka, H

    2000-11-01

    We examined the relative effects of different doses of oral clonidine on the MAC for endotracheal intubation (MACEI) and the MAC for skin incision (MAC) in children. We studied 90 children (15 in each group) (age range 2-8 yr, weight 10-27 kg, height 89-124 cm) who received one of three preanaesthetic medications: placebo (control), oral clonidine 2 micrograms kg-1, or oral clonidine 4 micrograms kg-1 100 min before anaesthesia. Anaesthesia was induced and maintained with sevoflurane in oxygen and air without i.v. anesthetics and neuromuscular relaxants. The end-tidal sevoflurane concentration was kept constant for > or = 15 min before tracheal intubation or skin incision. MACs were determined using Dixon's 'up-and-down method'. Mean (SD) MACEIs of sevoflurane were 2.9 (0.1)%, 2.5 (0.1)% and 1.9 (0.1)% (P clonidine 2 micrograms kg-1 and clonidine 4 micrograms kg-1 groups. The MACEIs and MACs decreased dose-dependently. The MACEI/MAC ratio (1.4) was not affected by clonidine.

  15. CR-MAC: A Multichannel MAC Protocol for Cognitive Radio AD HOC Networks

    Directory of Open Access Journals (Sweden)

    S. M. Kamruzzaman

    2010-09-01

    Full Text Available This paper proposes a cross-layer based cognitive radio multichannel medium access control (MACprotocol with TDMA, which integrate the spectrum sensing at physical (PHY layer and the packetscheduling at MAC layer, for the ad hoc wireless networks. The IEEE 802.11 standard allows for the useof multiple channels available at the PHY layer, but its MAC protocol is designed only for a singlechannel. A single channel MAC protocol does not work well in a multichannel environment, because ofthe multichannel hidden terminal problem. Our proposed protocol enables secondary users (SUs toutilize multiple channels by switching channels dynamically, thus increasing network throughput. In ourproposed protocol, each SU is equipped with only one spectrum agile transceiver, but solves themultichannel hidden terminal problem using temporal synchronization. The proposed cognitive radioMAC (CR-MAC protocol allows SUs to identify and use the unused frequency spectrum in a way thatconstrains the level of interference to the primary users (PUs. Our scheme improves network throughputsignificantly, especially when the network is highly congested. The simulation results show that ourproposed CR-MAC protocol successfully exploits multiple channels and significantly improves networkperformance by using the licensed spectrum band opportunistically and protects PUs from interference,even in hidden terminal situations.

  16. 42 CFR 405.1128 - Action of the MAC.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Action of the MAC. 405.1128 Section 405.1128 Public... the MAC. (a) After it has reviewed all the evidence in the administrative record and any additional evidence received, subject to the limitations on MAC consideration of additional evidence in §...

  17. 42 CFR 405.1118 - Obtaining evidence from the MAC.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Obtaining evidence from the MAC. 405.1118 Section... Council Review § 405.1118 Obtaining evidence from the MAC. A party may request and receive a copy of all... these items. If a party requests evidence from the MAC and an opportunity to comment on that...

  18. 42 CFR 423.2128 - Action of the MAC.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Action of the MAC. 423.2128 Section 423.2128 Public...) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2128 Action of the MAC. (a) After it has reviewed all the evidence in...

  19. 42 CFR 422.608 - Medicare Appeals Council (MAC) review.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Medicare Appeals Council (MAC) review. 422.608... and Appeals § 422.608 Medicare Appeals Council (MAC) review. Any party to the hearing, including the MA organization, who is dissatisfied with the ALJ hearing decision, may request that the MAC...

  20. MAC 700 Wash高亮度灯具

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    马田最新推出的MAC 700 Wash高亮度灯具继承了MAC系列的传统优点.具有与MAC 700 Profile相同的强大功能、模组桔构和出色设计,是MAC 700 Profile的“最佳搭档”。

  1. Sedation versus general anaesthesia in paediatric patients undergoing chest CT

    Energy Technology Data Exchange (ETDEWEB)

    Lam, W.W.M.; So, N.M.C.; Metreweli, C. [Chinese Univ. of Hong Kong, Dept. of Diagnostic Radiology and Organ Imaging (China); Chen, P.P. [Chinese Univ. of Hong Kong, Anaesthesiology and Intensive Care (China)

    1998-05-01

    Objective: CT of the chest in paediatric patients often requires sedation or general anaesthesia to minimize motion artefacts. Both sedation and general anaesthesia are associated with atelectasis which obscures the underlying pulmonary pathology. We conducted a prospective study to compare these two methods with respect to degree of motion artefacts and extent of atelectasis. Material and Methods: Nineteen patients undergoing 22 chest CT examinations were randomly selected for either sedation or general anaesthesia. The total area of atelectasis and the degree of motion artefacts were measured. Results: The mean percentage of atelectasis was 6.67% for general anaesthesia and 0.01% for sedation (p=0.01). There was no significant difference in the quality of the images between the sedation patients and the general anaesthesia patients. Conclusion: Whenever the clinical condition permits it, sedation rather than general anaesthesia should be given to paediatric patients undergoing chest CT. (orig.).

  2. Techniques to administer oral, inhalational, and IV sedation in dentistry

    Directory of Open Access Journals (Sweden)

    Diana Krystyna Harbuz

    2016-02-01

    Full Text Available Background Sedation in dentistry is a controversial topic given the variety of opinions regarding its safe practice. Aims This article evaluates the various techniques used to administer sedation in dentistry and specific methods practiced to form a recommendation for clinicians. Methods An extensive literature search was performed using PubMed, Medline, Google Scholar, Google, and local library resources. Results Most of the literature revealed a consensus that light sedation on low-risk American Society of Anesthesiologists (ASA groups, that is ASA I, and possibly II, is the safest method for sedation in a dental outpatient setting. Conclusion Formal training is essential to achieve the safe practice of sedation in dentistry or medicine. The appropriate setting for sedation should be determined as there is an increased risk outside the hospital setting. Patients should be adequately assessed and medication titrated appropriately, based on individual requirements.

  3. Use of sevoflurane inhalation sedation for outpatient third molar surgery.

    OpenAIRE

    Ganzberg, S.; Weaver, J.; Beck, F. M.; McCaffrey, G

    1999-01-01

    This study attempted to determine if sevoflurane in oxygen inhaled via a nasal hood as a sole sedative agent would provide an appropriate level of deep sedation for outpatient third molar surgery. Twenty-four patients scheduled for third molar removal were randomly assigned to receive either nasal hood inhalation sevoflurane or an intravenous deep sedation using midazolam and fentanyl followed by a propofol infusion. In addition to measuring patient, surgeon, and dentist anesthesiologist subj...

  4. Augmenting sedation with hypnosis in drug-dependent patients.

    OpenAIRE

    Lu, D. P.; Lu, G. P.; Hersh, E. V.

    1995-01-01

    The successful use of conscious sedation in patients physically dependent on centrally acting drugs is problematic for the dental anesthesiologist because of the concomitant development of tolerance to standard sedative agents. Dosage requirements necessary to adequately sedate these patients are often higher than recommended and carry an increased risk of drug overdose. The following report summarizes our experience with 18 drug-dependent patients in whom hypnosis was employed in conjunction...

  5. Prehospital Use of IM Ketamine for Sedation of Violent and Agitated Patients

    Directory of Open Access Journals (Sweden)

    Kenneth A. Scheppke

    2014-11-01

    Full Text Available Introduction: Violent and agitated patients pose a serious challenge for emergency medical services (EMS personnel. Rapid control of these patients is paramount to successful prehospital evaluation and also for the safety of both the patient and crew. Sedation is often required for these patients, but the ideal choice of medication is not clear. The objective is to demonstrate that ketamine, given as a single intramuscular injection for violent and agitated patients, including those with suspected excited delirium syndrome (ExDS, is both safe and effective during the prehospital phase of care, and allows for the rapid sedation and control of this difficult patient population. Methods: We reviewed paramedic run sheets from five different catchment areas in suburban Florida communities. We identified 52 patients as having been given intramuscular ketamine 4mg/kg IM, following a specific protocol devised by the EMS medical director of these jurisdictions, to treat agitated and violent patients, including a subset of which would be expected to suffer from ExDS. Twenty-six of 52 patients were also given parenteral midazolam after medical control was obtained to prevent emergence reactions associated with ketamine. Results: Review of records demonstrated that almost all patients (50/52 were rapidly sedated and in all but three patients no negative side effects were noted during the prehospital care. All patients were subsequently transported to the hospital before ketamine effects wore off. Conclusion: Ketamine may be safely and effectively used by trained paramedics following a specific protocol. The drug provides excellent efficacy and few clinically significant side effects in the prehospital phase of care, making it an attractive choice in those situations requiring rapid and safe sedation especially without intravenous access. [West J Emerg Med. 2014;15(7:–0.

  6. Isolation and characterisation of human gingival margin-derived STRO-1/MACS1 and MACS2 cell populations

    Institute of Scientific and Technical Information of China (English)

    Karim M Fawzy El-Sayed; Sebastian Paris; Christian Graetz; Neemat Kassem; Mohamed Mekhemar; Hendrick Ungefroren; Fred Fandrich; Christof Dorfer

    2015-01-01

    Recently, gingival margin-derived stem/progenitor cells isolated via STRO-1/magnetic activated cell sorting (MACS) showed remarkable periodontal regenerative potential in vivo. As a second-stage investigation, the present study’s aim was to perform in vitro characterisation and comparison of the stem/progenitor cell characteristics of sorted STRO-1-positive (MACS1) and STRO-1-negative (MACS2) cell populations from the human free gingival margin. Cells were isolated from the free gingiva using a minimally invasive technique and were magnetically sorted using anti-STRO-1 antibodies. Subsequently, the MACS1 and MACS2 cell fractions were characterized by flow cytometry for expression of CD14, CD34, CD45, CD73, CD90, CD105, CD146/MUC18 and STRO-1. Colony-forming unit (CFU) and multilineage differentiation potential were assayed for both cell fractions. Mineralisation marker expression was examined using real-time polymerase chain reaction (PCR). MACS1 and MACS2 cell fractions showed plastic adherence. MACS1 cells, in contrast to MACS2 cells, showed all of the predefined mesenchymal stem/progenitor cell characteristics and a significantly higher number of CFUs (P,0.01). More than 95%of MACS1 cells expressed CD105, CD90 and CD73;lacked the haematopoietic markers CD45, CD34 and CD14, and expressed STRO-1 and CD146/MUC18. MACS2 cells showed a different surface marker expression profile, with almost no expression of CD14 or STRO-1, and more than 95%of these cells expressed CD73, CD90 and CD146/MUC18, as well as the haematopoietic markers CD34 and CD45 and CD105. MACS1 cells could be differentiated along osteoblastic, adipocytic and chondroblastic lineages. In contrast, MACS2 cells demonstrated slight osteogenic potential. Unstimulated MACS1 cells showed significantly higher expression of collagen I (P,0.05) and collagen III (P,0.01), whereas MACS2 cells demonstrated higher expression of osteonectin (P,0.05;Mann–Whitney). The present study is the first to compare gingival

  7. MacBook All-in-One For Dummies

    CERN Document Server

    Chambers, Mark L

    2011-01-01

    Get comfortable and confident with your MacBook! Combining the fun-but-straightforward content of nine minibooks, this new edition of MacBook All-in-One For Dummies delivers helpful coverage of the rich features and essential tools you need to know to use the MacBook to its fullest potential. You'll learn an array of MacBook basics while veteran author Mark Chambers walks you through setting up your MacBook, running programs, finding files with Finder, searching with Spotlight, keeping track with Address Book, enjoying music with iTunes, creating cool multimedia projects with iLife, and more.

  8. Periodic cardiovascular and ventilatory activity during midazolam sedation.

    Science.gov (United States)

    Galletly, D C; Williams, T B; Robinson, B J

    1996-04-01

    We have examined the effects of sedation with midazolam 0.1 mg kg-1 and reversal with flumazenil 0.5 mg on beat-to-beat heart rate (HR) variability (HRV), systolic arterial pressure (SAP), finger photoplethysmograph amplitude (PLA) and impedence pneumography in eight volunteers. With the onset of sedation there was a small decrease in SAP and increase in HR (ns). Spectral analysis of the HR time series showed reductions in the proportion of power in the high (> 0.15 Hz) frequency "ventilatory" band consistent with midazolam causing vagolysis. During sedation, low frequency (midazolam sedation were reversed by administration of flumazenil.

  9. Fospropofol disodium injection for the sedation of patients undergoing colonoscopy.

    Science.gov (United States)

    Levitzky, Benjamin E; Vargo, John J

    2008-08-01

    Sedation plays a central role in making colonoscopy tolerable for patients and feasible for the endoscopist to perform. The array of agents used for endoscopic sedation continues to evolve. Fospropofol (FP), a prodrug of propofol with a slower pharmacokinetic profile, is currently under evaluation for use during endoscopic procedures. Preliminary data suggests that FP dosed at 6.5 mg/kg is well tolerated by most patients with perineal paresthesias being the most commonly experienced adverse effect. This article will examine the current literature on the use of FP for the sedation of patients undergoing colonoscopy, highlighting the pharmacokinetics, pharmacodynamics, risks, and common adverse events associated with the novel sedative/hypnotic.

  10. Earth tides in MacDonald's model

    CERN Document Server

    Ferraz-Mello, S

    2013-01-01

    We expand the equations used in MacDonald's 1964 theory and Fourier analyze the tidal variations of the height at one point on the Earth surface, and also the tidal potential at such point. It is shown that no intrinsic law is relating the lag of the tide components to their frequencies. In other words, no simple rheology is being intrinsically fixed by MacDonald's equations. The same is true of the modification proposed by Singer(1968). At variance with these two cases, the modification proposed by Williams and Efroimsky (2012) fix the standard Darwin rheology in which the lags are proportional to the frequencies and their model is, in this sense, equivalent to Mignard's 1979 formulation of Darwin's theory.

  11. Modeling MAC layer for powerline communications networks

    Science.gov (United States)

    Hrasnica, Halid; Haidine, Abdelfatteh

    2001-02-01

    The usage of electrical power distribution networks for voice and data transmission, called Powerline Communications, becomes nowadays more and more attractive, particularly in the telecommunication access area. The most important reasons for that are the deregulation of the telecommunication market and a fact that the access networks are still property of former monopolistic companies. In this work, first we analyze a PLC network and system structure as well as a disturbance scenario in powerline networks. After that, we define a logical structure of the powerline MAC layer and propose the reservation MAC protocols for the usage in the PLC network which provides collision free data transmission. This makes possible better network utilization and realization of QoS guarantees which can make PLC networks competitive to other access technologies.

  12. MacBook Pro portable genius

    CERN Document Server

    Gruman, Galen

    2013-01-01

    Learn the skills, tools and shortcuts you need in order to make the most of your MacBook Pro This easy-to-use, compact guide skips the fluff and gets right to the essentials so that you can maximize all the latest features of the MacBook Pro. Packed with savvy insights and tips on key tools and shortcuts, this handy book aims to help you increase your productivity and save you time and hassle. From desktop sharing and wireless networking to running Windows applications and more, this book shows you what you want to know. Includes the latest version of OS X, iCloud, FaceTime, and moreCovers al

  13. Patient-controlled sedation with propofol/remifentanil versus propofol/alfentanil for patients undergoing outpatient colonoscopy, a randomized, controlled double-blind study

    Directory of Open Access Journals (Sweden)

    Sherif S Sultan

    2014-01-01

    Full Text Available Context: Many techniques are used for sedation of colonoscopies. Patient-controlled sedation (PCS is utilizing many drugs or drug combinations. Aims: The aim of this study is to compare the safety and feasibility of propofol/remifentanil versus propofol/alfentanil given to sedate patients undergoing outpatient colonoscopies through a patient-controlled technique. Settings and Design: Controlled randomized and double-blind study. Materials and Methods: A total of 80 patients were randomly divided into two groups; PA group received a combination of propofol/alfentanil and PR group received propofol/remifentanil combination. Patients were monitored for heart rate (HR, blood pressure (BP, oxygen saturation, and Ramsay sedation scale (RSS. Times of the following events were recorded; initiation of sedation, insertion and removal of the colonoscope, recovery and discharge. Five intervals were calculated; time to sedation, procedure time, postprocedure time, procedure room time, and postanesthesia care unit (PACU time. Endoscopist and patient satisfaction scores were obtained. Statistical Analysis Used: Unpaired Student′s t-test was used to compare between the two groups. Paired Student′s t-test was used to compare baseline readings with readings after 30 min of sedation in the same group when needed. Results: Both groups showed slowing of the HR and decrease in mean arterial BP. HR and mean arterial BP were significantly lower 5 and 10 min after initiation of sedation in PR group when compared with PA group. Both HR and mean arterial BP returned to presedation readings 30 min after initiation of sedation in PR group but not in PA group. No differences between the two groups concerning oxygen saturation, RSS, endoscopist and patient satisfaction scores. Postprocedure and PACU times were significantly prolonged in PA group. Conclusion: PCS with either remifentanil/propofol or alfentanil/propofol for patients undergoing outpatient colonoscopy is safe

  14. Performance Analysis of MAC Layer Protocols in Wireless Sensor Network

    Directory of Open Access Journals (Sweden)

    Hameeza Ahmed

    2014-10-01

    Full Text Available Media Access Control (MAC layer protocols have a critical role in making a typical Wireless Sensor Network (WSN more reliable and efficient. Choice of MAC layer protocol and other factors including number of nodes, mobility, traffic rate and playground size dictates the performance of a particular WSN. In this paper, the performance of an experimental WSN is evaluated using different MAC layer protocols. In this experiment, a WSN is created using OMNeT++ MiXiM network simulator and its performance in terms of packet delivery ratio and mean latency is evaluated. The simulation results show that IEEE 802.11 MAC layer protocol performs better than CSMA, B-MAC and IEEE 802.15.4 MAC layer protocols. In the considered scenario, IEEE 802.15.4 is ranked second in performance, followed by CSMA and B-MAC.

  15. Physicians' and pharmacists' attitudes toward the use of sedation at the end of life: influence of prognosis and type of suffering.

    Science.gov (United States)

    Blondeau, Danielle; Roy, Louis; Dumont, Serge; Godin, Gaston; Martineau, Isabelle

    2005-01-01

    End-of-life sedation remains a controversial and ill-defined clinical practice; its applications vary considerably. With this in mind, a study was conducted using a 2 x 2 experimental design. The variables experimented with were prognosis (short- or long-term) and type of suffering (physical or existential). The goal was to study the influence of the two independent variables on attitude toward sedation. Four clinical vignettes were completed by 124 clinicians, doctors, and pharmacists working in different palliative care environments in the Province of Quebec. The results indicate that the type of suffering influences a subject's attitude to end-of-life sedation. Thus, when a patient was suffering physically, the respondents were significantly in favour of sedation, whereas they were not in favour of this practice if the suffering was existential. Lastly, it is clear that health professionals are uncomfortable when confronted with their patients' existential suffering. This is an issue worth exploring in future studies.

  16. 关于Mac OS X Lion

    Institute of Scientific and Technical Information of China (English)

    饭桶

    2011-01-01

    Lion是Mac OS X操作系统的第七个版本,第一个版本是2001年发布的Cheetah(猎豹).或许很多Windows用户会认为,Lion不过是一次升级,主版本仍然是Mac OSX.那么我不介意稍微解释一下:Mac OS X对应的层次是Windows,Cheetah或者Lion相当于XP,或者7.因此即使从软件工程的角度看,Lion也是一个全新的操作系统.由于重新编译了核心,Lion的安装文件只有3.6GB大小,比上一代(Snow Leopard)减少了近一半的体积,这种比旧版本体积更小的新操作系统在历史上可不多见.

  17. Power Saving MAC Protocols for WSNs and Optimization of S-MAC Protocol

    Directory of Open Access Journals (Sweden)

    Simarpreet Kaur

    2012-11-01

    Full Text Available Low power MAC protocols have received a lot of consideration in the last few years because of their influence on the lifetime of wireless sensor networks. Since, sensors typically operate on batteries, replacement of which is often difficult. A lot of work has been done to minimize the energy expenditure and prolong the sensor lifetime through energy efficient designs, across layers. Meanwhile, the sensor network should be able to maintain a certain throughput in order to fulfill the QoS requirements of the end user, and to ensure the constancy of the network. This paper introduces different types of MAC protocols used for WSNs and proposes S‐MAC, a Medium‐Access Control protocol designed for Wireless Sensor Networks. S‐MAC uses a few innovative techniques to reduce energy consumption and support selfconfiguration. A new protocol is suggested to improve the energy efficiency, latency and throughput of existing MAC protocol for WSNs. A modification of the protocol is then proposed to eliminate the need for some nodes to stay awake longer than the other nodes which improves the energy efficiency, latency and throughput and hence increases the life span of a wireless sensor network.

  18. Sedative medications outside the operating room and the pharmacology of sedatives

    DEFF Research Database (Denmark)

    Hansen, Tom G

    2015-01-01

    mention new drugs on the horizon. RECENT FINDINGS: There are many drugs available for procedural sedation; however, they all have drawbacks and shortcomings. Multiple adverse effects are associated with the use of these agents, hence monitoring is essential, and emergency equipment should be readily...

  19. SR-MAC: A Low Latency MAC Protocol for Multi-Packet Transmissions in Wireless Sensor Networks

    Institute of Scientific and Technical Information of China (English)

    Hong-Wei Tang; Jian-Nong Cao; Xue-Feng Liu; Cai-Xia Sun

    2013-01-01

    Event detection is one of the major applications of wireless sensor networks (WSNs).Most of existing medium access control (MAC) protocols are mainly optimized for the situation under which an event only generates one packet on a single sensor node.When an event generates multiple packets on a single node,the performance of these MAC protocols degrades rapidly.In this paper,we present a new synchronous duty-cycle MAC protocol called SR-MAC for the event detection applications in which multiple packets are generated on a single node.SR-MAC introduces a new scheduling mechanism that reserves few time slots during the SLEEP period for the nodes to transmit multiple packets.By this approach,SR-MAC can schedule multiple packets generated by an event on a single node to be forwarded over multiple hops in one operational cycle without collision.We use event delivery latency (EDL) and event delivery ratio (EDR) to measure the event detection capability of the SR-MAC protocol.Through detailed ns-2 simulation,the results show that SR-MAC can achieve lower EDL,higher EDR and higher network throughput with guaranteed energy efficiency compared with R-MAC,DW-MAC and PR-MAC.

  20. Nurse-administered propofol sedation for endoscopy

    DEFF Research Database (Denmark)

    Jensen, J T; Vilmann, P; Horsted, T

    2011-01-01

    of hypoxemia were documented in 1764 patients (4.4%), in 56/983 upper endoscopies (5.7%) and 22/754 lower endoscopies (2.9%) (P = 0.007). Assisted ventilation was necessary in 19 cases (1.1%) and anesthesiologic assistance was requested 10 times. Two patients required endotracheal intubation. A change in blood....... In the implementation phase, data from 1822 endoscopic procedures in 1764 patients were prospectively collected. All adverse events related to sedation were recorded (defined as oxygen saturation intubation, change in blood pressure > 20 mmHg). RESULTS: 78 cases...

  1. Moderate sedation for MRI in young children with autism

    Energy Technology Data Exchange (ETDEWEB)

    Ross, Allison Kinder [Duke University Medical Center, Division of Pediatric Anesthesia, Durham (United States); Hazlett, Heather Cody; Garrett, Nancy T. [University of North Carolina School of Medicine, Department of Psychiatry, Chapel Hill, NC (United States); Wilkerson, Christy [Duke University Medical Center, Department of Radiology, Durham, NC (United States); Piven, Joseph [University of North Carolina School of Medicine, Departments of Psychiatry and Pediatrics, Chapel Hill, NC (United States)

    2005-09-01

    Autism is a pervasive neurodevelopmental disorder. Because of the deficits associated with the condition, sedation of children with autism has been considered more challenging than sedation of other children. To test this hypothesis, we compared children with autism against clinical controls to determine differences in requirements for moderate sedation for MRI. Children ages 18-36 months with autism (group 1, n = 41) and children with no autistic behavior (group 2, n = 42) were sedated with a combination of pentobarbital and fentanyl per sedation service protocol. The sedation nurse was consistent for all patients, and all were sedated to achieve a Modified Ramsay Score of 4. Demographics and doses of sedatives were recorded and compared. There were no sedation failures in either group. Children in group 1 (autism) were significantly older than group 2 (32.02{+-}3.6 months vs 28.16{+-}6.7 months) and weighed significantly more (14.87{+-}2.1 kg vs 13.42{+-}2.2 kg). When compared on a per-kilogram basis, however, group 1 had a significantly lower fentanyl requirement than group 2 (1.25{+-}0.55 mcg/kg vs 1.57{+-}0.81 mcg/kg), but no significant difference was found in pentobarbital dosing between groups 1 and 2, respectively (4.92{+-}0.92 mg/kg vs 5.21{+-}1.6 mg/kg). Autistic children in this age range are not more difficult to sedate and do not require higher doses of sedative agents for noninvasive imaging studies. (orig.)

  2. W-MAC: a workload-aware MAC protocol for heterogeneous convergecast in wireless sensor networks.

    Science.gov (United States)

    Xia, Ming; Dong, Yabo; Lu, Dongming

    2011-01-01

    The power consumption and latency of existing MAC protocols for wireless sensor networks (WSNs) are high in heterogeneous convergecast, where each sensor node generates different amounts of data in one convergecast operation. To solve this problem, we present W-MAC, a workload-aware MAC protocol for heterogeneous convergecast in WSNs. A subtree-based iterative cascading scheduling mechanism and a workload-aware time slice allocation mechanism are proposed to minimize the power consumption of nodes, while offering a low data latency. In addition, an efficient schedule adjustment mechanism is provided for adapting to data traffic variation and network topology change. Analytical and simulation results show that the proposed protocol provides a significant energy saving and latency reduction in heterogeneous convergecast, and can effectively support data aggregation to further improve the performance.

  3. Notas sobre dois livros de MacIntyre Notes on two books by MacIntyre

    Directory of Open Access Journals (Sweden)

    Isabel Ribeiro de Oliveira

    2005-04-01

    Full Text Available Os conceitos centrais da teoria da justiça desenvolvida por Alasdair MacIntyre - prática, narrativa e tradição - ocupam o núcleo da análise feita acerca de dois de seus livros: Depois da Virtude e Justiça de Quem? Qual racionalidade?. O artigo considera a relação, em MacIntyre, entre ética e história, virtude e relativismo, bem como apresenta seu conceito do Eu, como corretivos à anomia contemporânea.The central concepts of MacIntyre's approach to justice - practice, narrative and tradition - constitute the main trust of the analysis of two of his books: After Virtue and Whose justice? Which rationality? The article elaborates on the relationship of ethics to history, of virtues to relativism as well as his conception of the self as correctives to the pervasive anomie in contemporary societies.

  4. Endoscopy: consensus on approving propofol sedation by nonanesthesiologists.

    Science.gov (United States)

    Riphaus, Andrea

    2010-04-01

    Propofol sedation by nonanesthesiologists is still a highly controversial issue despite the fact that numerous studies have approved this sedation regimen for gastrointestinal endoscopy. A new position statement from a collaboration of four different American gastroenterology and hepatology societies outlines the latest recommendations for nonanesthesiologist administration of propofol.

  5. Fospropofol disodium injection for the sedation of patients undergoing colonoscopy

    Directory of Open Access Journals (Sweden)

    Benjamin E Levitzky

    2008-09-01

    Full Text Available Benjamin E Levitzky1, John J Vargo21Department of Gastroenterology and Hepatology, 2Section of Therapeutic and Hepatobiliary Endoscopy, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USAAbstract: Sedation plays a central role in making colonoscopy tolerable for patients and feasible for the endoscopist to perform. The array of agents used for endoscopic sedation continues to evolve. Fospropofol (FP, a prodrug of propofol with a slower pharmacokinetic profi le, is currently under evaluation for use during endoscopic procedures. Preliminary data suggests that FP dosed at 6.5 mg/kg is well tolerated by most patients with perineal paresthesias being the most commonly experienced adverse effect. This article will examine the current literature on the use of FP for the sedation of patients undergoing colonoscopy, highlighting the pharmacokinetics, pharmacodynamics, risks, and common adverse events associated with the novel sedative/hypnotic.Keywords: fospropofol, Aquavan, propofol, sedation, colonoscopy

  6. Efficacy and safety of Dexmedetomidine and Midazolam for sedation in intensive care unit patients: a systematic review%右美托咪定和咪达唑仑用于ICU患者镇静效果的系统评价

    Institute of Scientific and Technical Information of China (English)

    薛锐; 夏中元; 周斌; 刘敏

    2012-01-01

    Objective To review the clinic efficacy and safety of Dexmedetomidine and Midazolam for sedation of the patients in intensive care unit (ICU). Methods Using the search terms "Dexmedetomidine or Midazolam, sedation, ICU", trials were collected through searches of PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), VIP, CNKI and WANFANG databases (from January 1, 1996 to March 31, 2012) for randomized controlled trials about the efficacy and safety of Dexmedetomidine and Midazolam. The included studies were evaluated with criteria and the extracted data were analyzed by RevMan 5.0.25. Results Ten studies involving 1 633 patients met the inclusion criteia. The results of meta-analyses showed that, ①efficacy indicator: compared with the Midazolam-treated patients, the Dexmedetomidine-treated patients had shorter the duration of mechanical ventilation [WMD = -1.90, 95%CI(-1.96, -1.83), P < 0.01] and shorter the length of ICU stay [WMD = -1.70, 95%CI (-1.79, -1.60), P < 0.01], while there were no statistical differences in the onset time of sedation and the awake time; ②safety indicator: the prevalence of delirium during treatment was lower in Dexmedetomidine-treated patients [RR = 0.29, 95%C7 (0.13, 0.62), P = 0.002], while there were no statistical differences in hypotension, incidences of braycardia and braycardia requiring treatment. Conclusion Dexmedetomidine can shorten the duration of mechanical ventilation, the length of ICU stay and reduce the incidences of delirium, which is beneficial for the outcome in ICU patients.%目的 比较右美托咪定和咪达唑仑用于重症医学科(ICU)患者镇静的有效性和安全性,为ICU患者合理镇静提供循证依据.方法 以右美托咪定或咪达唑仑、ICU、镇静为检索词,计算机检索PubMed、Embase、Cochrane 图书馆、VIP、CNKI、WANFANG 数据库,检索时限均为1996年1月1日~2012年3月31日,在按纳入和排除标准进行资料提取

  7. Sedation with a remifentanil infusion to facilitate rapid awakening and tracheal extubation in an infant with a potentially compromised airway

    Directory of Open Access Journals (Sweden)

    Naples J

    2016-10-01

    Full Text Available Jeffrey Naples,1,2 Mark W Hall,1,2 Joseph D Tobias,3,4 1Department of Pediatrics, The Ohio State University, 2Division of Pediatric Critical Care Medicine, Nationwide Children’s Hospital, 3Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, 4Department of Anesthesiology and Pain Medicine, The Ohio State University, Columbus, OH, USA Abstract: Sedation is generally required during endotracheal intubation and mechanical ventilation in infants and children. While there are many options for the provision of sedation, the most commonly used agents such as midazolam and fentanyl demonstrate a context-sensitive half-life, which may result in a prolonged effect when these agents are discontinued following a continuous infusion. We present a 20-month-old infant who required endotracheal intubation due to respiratory failure following seizures. At the referring hospital, multiple laryngoscopies were performed with the potential for airway trauma. To maximize rapid awakening and optimize respiratory function surrounding tracheal extubation, sedation was transitioned from fentanyl and midazolam to remifentanil for 18–24 hours prior to tracheal extubation. The unique pharmacokinetics of remifentanil are presented in this study, its use in this clinical scenario is discussed, and its potential applications in the pediatric intensive care unit setting are reviewed. Keywords: remifentanil, sedation, pediatric, airway, extubation

  8. Implementation of MAC by using Modified Vedic Multiplier

    OpenAIRE

    2013-01-01

    Multiplier Accumulator Unit (MAC) is a part of Digital Signal Processors. The speed of MAC depends on the speed of multiplier. So by using an efficient Vedic multiplier which excels in terms of speed, power and area, the performance of MAC can be increased. For this fast method of multiplication based on ancient Indian Vedic mathematics is proposed in this paper. Among various method of multiplication in Vedic mathematics, Urdhva Tiryagbhyam is used and the multiplication is for 32 X 32 bits....

  9. APC-MAC/TA: Adaptive Power Controlled MAC Protocol with Traffic Awareness for Wireless Sensor Networks

    Science.gov (United States)

    Woo, Seok; Kim, Kiseon

    In this paper, we propose an adaptive power controlled MAC protocol with a traffic-aware scheme specifically designed to reduce both energy and latency in wireless sensor networks. Typically, existing MAC protocols for sensor networks sacrifice latency performance for node energy efficiency. However, some sensor applications for emergencies require rather fast transmissions of sensed data, where we need to consider both energy and latency together. The proposed MAC protocol includes two novel ideas: one is a transmission power control scheme for improving latency in high traffic loads, and the other is a traffic-aware scheme to save more energy in low traffic loads. The transmission power control scheme increases channel utilization by mitigating interference between nodes, and the traffic-aware scheme allows nodes to sleep to reduce idle energy consumption when there are no traffic loads in a network. Simulation results show that the proposed protocol significantly reduces the latency as well as the energy consumption compared to the S-MAC protocol specifically for a large transmission power of nodes and low network traffic.

  10. Essential Mac OS X panther server administration integrating Mac OS X server into heterogeneous networks

    CERN Document Server

    Bartosh, Michael

    2004-01-01

    If you've ever wondered how to safely manipulate Mac OS X Panther Server's many underlying configuration files or needed to explain AFP permission mapping--this book's for you. From the command line to Apple's graphical tools, the book provides insight into this powerful server software. Topics covered include installation, deployment, server management, web application services, data gathering, and more

  11. Mac OS X Snow Leopard Server For Dummies

    CERN Document Server

    Rizzo, John

    2009-01-01

    Making Everything Easier!. Mac OS® X Snow Leopard Server for Dummies. Learn to::;. Set up and configure a Mac network with Snow Leopard Server;. Administer, secure, and troubleshoot the network;. Incorporate a Mac subnet into a Windows Active Directory® domain;. Take advantage of Unix® power and security. John Rizzo. Want to set up and administer a network even if you don't have an IT department? Read on!. Like everything Mac, Snow Leopard Server was designed to be easy to set up and use. Still, there are so many options and features that this book will save you heaps of time and effort. It wa

  12. Energy-efficient MAC protocols for Wireless Sensor Networks

    Institute of Scientific and Technical Information of China (English)

    Li De-liang; Peng Fei

    2009-01-01

    Designing energy-efficient Medium Access Control (MAC) protocols has a significant influence on the energy performance of wireless sensor network (WSN). In this paper we present a survey of the recent typical MAC protocols regarding energy efficiency for WSN. According to channel access policies, we classify these protocols into four categories: contention-based, TDMA-based, hybrid, and cross layer protocols, in which the advantages and disadvantages in each class of MAC protocols are discussed. Finally, we point out open research issues that need to carry on to achieve high energy efficiency for the design of MAC protocols in WSN.

  13. Study on intracellular trafficking of Mac-1 by direct visualization

    Institute of Scientific and Technical Information of China (English)

    YAN Ming; MAO Jifang; WEI Yi; ZHONG Jigen; YANG Shengsheng; XU Renbao

    2004-01-01

    Previously, we constructed DNA vectors containing cDNA of Mac-1 subunits (CD11b or CD18b) fused with fluorescence protein (FP). cDNA fragments and the DNA constructs were then transfected into CHO cells (as CHO-Mac-1-FP). The structure and function of Mac-1-FP obtained from the CHO-Mac-1-FP cells are nearly identical to that expressed in wild type leukocytes. In the present study, the intracellular trafficking of Mac-1 was visualized directly by monitoring the fluorescent intensities of YFP-CD18 and PE-conjugated monoclonal antibody against CD11b under a confocal microscope in CHO-Mac-1-FP cells. The results indicate that: (ⅰ) although Mac-1 was not detected in the cell membrane at resting state, it had been translocated and clustered into the cell membrane by 1 h and internalized 2 h after PMA stimulation, at which point the fluorescence intensity began to diminish gradually, probably due to partial degradation of Mac-1. The fluorescence of CD18 and CD11b reappeared on the cell membrane 1 h after re-treatment with PMA, suggesting the recycling of non-degraded Mac-1. (ⅱ) The adhesion rate of CHO-Mac-1-FP to magnetic beads coupled ICAM-1 increased within 4 h after their initial interaction, accompanied by the clustering of Mac-1-FP. After 8 h,the adhesion rate declined and fluorescence also decreased simultaneously. The pattern of change in fluorescence in CHO-Mac-1-FP cells elicited by ICAM-1 beads was similar to that elicited by PMA, suggesting that endocytosis and degradation of Mac-1 occurred after the interaction with ICAM-1. Thus, we conclude that the intracellular trafficking of Mac-1 after activation is associated with membrane translocation, endocytosis, degradation and recycling. These changes are in parallel with the adhesion of CHO-Mac-1-FP cells with ICAM-1, and may be involved in the adhesion and detachment of leukocytes. The detachment of leukocytes may be caused by endocytosis of Mac-1.

  14. An Energy Efficient Analysis of S-MAC And H-MAC Protocols for Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    P.T.Kalaivaani

    2013-04-01

    Full Text Available Wireless Sensor Networks (WSNs is an interesting topic to the researchers because of its variousapplications. The applications are health monitoring and environmental monitoring, Industrial ProcessMonitoring, Target detection, Target tracking, Energy Efficiency, Disaster Management and MilitarySecurity Systems. The wireless medium requires highly optimized medium Access Protocols to avoidinterferences. Limited resources have driven the research towards energy consumption of MACfunctionalities. Two Medium Access Control (MAC protocol performances are analyzed by using the MAClayer frame work for wireless sensor networks. In this paper an energy efficient analysis of S-MAC and HMACprotocols for wireless sensor networks is proposed with spatial correlation concept. Two MACprotocols such as Sensor MAC (S-MAC and Hybrid MAC (H-MAC protocols are proposed to analyze theperformance of Wireless Sensor Network using four different Parameters such as End to End delay, PacketDelivery Ratio, Packet Drop Rate and Energy Consumption. Performance analysis is carried out by usingthe simulation tool NS2.

  15. Cocktail sedation containing propofol versus conventional sedation for ERCP: a prospective, randomized controlled study

    Directory of Open Access Journals (Sweden)

    Angsuwatcharakon Phonthep

    2012-08-01

    Full Text Available Abstract Background ERCP practically requires moderate to deep sedation controlled by a combination of benzodiazepine and opiod. Propofol as a sole agent may cause oversedation. A combination (cocktail of infused propofol, meperidine, and midazolam can reduce the dosage of propofol and we hypothesized that it might decrease the risk of oversedation. We prospectively compare the efficacy, recovery time, patient satisfactory, and side effects between cocktail and conventional sedations in patients undergoing ERCP. Methods ERCP patients were randomized into 2 groups; the cocktail group (n = 103 and the controls (n = 102. For induction, a combination of 25 mg of meperidine and 2.5 mg of midazolam were administered in both groups. In the cocktail group, a bolus dose of propofol 1 mg/kg was administered and continuously infused. In the controls, 25 mg of meperidine or 2.5 mg/kg of midazolam were titrated to maintain the level of sedation. Results In the cocktail group, the average administration rate of propofol was 6.2 mg/kg/hr. In the control group; average weight base dosage of meperidine and midazolam were 1.03 mg/kg and 0.12 mg/kg, respectively. Recovery times and patients’ satisfaction scores in the cocktail and control groups were 9.67 minutes and 12.89 minutes (P = 0.045, 93.1and 87.6 (P P Conclusions Cocktail sedation containing propofol provides faster recovery time and better patients’ satisfaction for patients undergoing ERCP. However, mild degree of desaturation may still develop. Trial registration ClinicalTrials.gov, NCT01540084

  16. TreeMAC: Localized TDMA MAC protocol for real-time high-data-rate sensor networks

    Science.gov (United States)

    Song, W.-Z.; Huang, R.; Shirazi, B.; LaHusen, R.

    2009-01-01

    Earlier sensor network MAC protocols focus on energy conservation in low-duty cycle applications, while some recent applications involve real-time high-data-rate signals. This motivates us to design an innovative localized TDMA MAC protocol to achieve high throughput and low congestion in data collection sensor networks, besides energy conservation. TreeMAC divides a time cycle into frames and each frame into slots. A parent node determines the children's frame assignment based on their relative bandwidth demand, and each node calculates its own slot assignment based on its hop-count to the sink. This innovative 2-dimensional frame-slot assignment algorithm has the following nice theory properties. First, given any node, at any time slot, there is at most one active sender in its neighborhood (including itself). Second, the packet scheduling with TreeMAC is bufferless, which therefore minimizes the probability of network congestion. Third, the data throughput to the gateway is at least 1/3 of the optimum assuming reliable links. Our experiments on a 24-node testbed show that TreeMAC protocol significantly improves network throughput, fairness, and energy efficiency compared to TinyOS's default CSMA MAC protocol and a recent TDMA MAC protocol Funneling-MAC. Partial results of this paper were published in Song, Huang, Shirazi and Lahusen [W.-Z. Song, R. Huang, B. Shirazi, and R. Lahusen, TreeMAC: Localized TDMA MAC protocol for high-throughput and fairness in sensor networks, in: The 7th Annual IEEE International Conference on Pervasive Computing and Communications, PerCom, March 2009]. Our new contributions include analyses of the performance of TreeMAC from various aspects. We also present more implementation detail and evaluate TreeMAC from other aspects. ?? 2009 Elsevier B.V.

  17. Terahertz spectroscopic study of benzodiazepine sedative hypnotics

    Science.gov (United States)

    Deng, Fusheng; Shen, Jingling; Wang, Xianfeng

    2011-08-01

    Terahertz time domain spectroscopy (THz-TDS) is used to the pure active ingredient of three benzodiazepine sedative hypnotics with similar molecular structure. The absorption spectra of them are studied in the range of 0.2~2.6THz. Based on the experiment, the theoretical simulation results of diazepam, nitrazepam and clonazepam are got by the Gaussian03 package of DFT/B3LYP/6-31G* method in single-molecule models. The experimental results show that even if the molecular structure and medicine property of them are similar, the accurate identification of them can still be done with their characteristic absorption spectra. Theoretical simulation results are well consistent with the experimental results. It demonstrates that absorption peaks of them in THz range mainly come from intra-molecular forces and are less affected by the intermolecular interaction and crystal effects.ô

  18. Chloral hydrate sedation in radiology: retrospective audit of reduced dose

    Energy Technology Data Exchange (ETDEWEB)

    Bracken, Jennifer [Children' s University Hospital, Radiology Department, Dublin (Ireland); Royal Children' s Hospital, Department of Medical Imaging, Parkville, Victoria (Australia); Heaslip, Ingrid; Ryan, Stephanie [Children' s University Hospital, Radiology Department, Dublin (Ireland)

    2012-03-15

    Chloral hydrate (CH) is safe and effective for sedation of suitable children. The purpose of this study was to assess whether adequate sedation is achieved with reduced CH doses. We retrospectively recorded outpatient CH sedations over 1 year. We defined standard doses of CH as 50 mg/kg (infants) and 75 mg/kg (children >1 year). A reduced dose was defined as at least 20% lower than the standard dose. In total, 653 children received CH sedation (age, 1 month-3 years 10 months), 42% were given a reduced initial dose. Augmentation dose was required in 10.9% of all children, and in a higher proportion of children >1 year (15.7%) compared to infants (5.7%; P < 0.001). Sedation was successful in 96.7%, and more frequently successful in infants (98.3%) than children >1 year (95.3%; P = 0.03). A reduced initial dose had no negative effect on outcome (P = 0.19) or time to sedation. No significant complications were seen. We advocate sedation with reduced CH doses (40 mg/kg for infants; 60 mg/kg for children >1 year of age) for outpatient imaging procedures when the child is judged to be quiet or sleepy on arrival. (orig.)

  19. Surgeon-administered conscious sedation and local anesthesia for ambulatory anorectal surgery.

    Science.gov (United States)

    Hina, Miss; Hourigan, Jon S; Moore, Richard A; Stanley, J Daniel

    2014-01-01

    Anorectal procedures are often performed in an outpatient setting using a variety of anesthetic techniques. One technique that has not been well studied is surgeon-administered conscious sedation along with local anesthetic. The purpose of this study was to evaluate the use of this technique with emphasis on safety, efficacy, and patient satisfaction. Chart review was performed on 133 consecutive patients who had anorectal procedures at an outpatient surgery center. Additionally, 65 patients were enrolled prospectively and completed a satisfaction survey. Inclusively, charts of 198 patients who underwent outpatient anorectal surgery under conscious sedation and local anesthesia under the direction of a colorectal surgeon from 2004 through 2008 were reviewed. Parameters related to patient and procedural characteristics, safety, efficacy, and satisfaction were evaluated. Surgeon-administered sedation consisted of combined fentanyl and midazolam in 90 per cent. Eighty per cent of procedures were performed in the prone position and 23 per cent were in combination with an endoscopic procedure. Eighty-two per cent were classified as American Society of Anesthesiologists Grade 1 or 2. Transient mild hypoxemia or hypotension occurred in 4 and 3 per cent of the patients, respectively. Mean operative time was 29 minutes with a mean stay in the postanesthesia care unit of 37 minutes. There were no early major cardiac or respiratory complications. Ninety-seven per cent of the patients surveyed reported a high degree of satisfaction. Surgeon-administered conscious sedation with local anesthesia was well tolerated for outpatient anorectal surgeries. Additional studies are needed to confirm the safety and efficacy of this technique.

  20. 42 CFR 423.2122 - What evidence may be submitted to the MAC.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false What evidence may be submitted to the MAC. 423.2122..., MAC review, and Judicial Review § 423.2122 What evidence may be submitted to the MAC. (a) Appeal before the MAC on request for review of ALJ's decision. (1) If the MAC is reviewing an ALJ's...

  1. 42 CFR 405.1122 - What evidence may be submitted to the MAC.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false What evidence may be submitted to the MAC. 405.1122... Council Review § 405.1122 What evidence may be submitted to the MAC. (a) Appeal before the MAC on request for review of ALJ's decision. (1) If the MAC is reviewing an ALJ's decision, the MAC limits its...

  2. Are sedatives and hypnotics associated with increased suicide risk of suicide in the elderly?

    Directory of Open Access Journals (Sweden)

    Waern Margda

    2009-06-01

    Full Text Available Abstract Background While antidepressant-induced suicidality is a concern in younger age groups, there is mounting evidence that these drugs may reduce suicidality in the elderly. Regarding a possible association between other types of psychoactive drugs and suicide, results are inconclusive. Sedatives and hypnotics are widely prescribed to elderly persons with symptoms of depression, anxiety, and sleep disturbance. The aim of this case-control study was to determine whether specific types of psychoactive drugs were associated with suicide risk in late life, after controlling for appropriate indications. Methods The study area included the city of Gothenburg and two adjacent counties (total 65+ population 210 703 at the start of the study. A case controlled study of elderly (65+ suicides was performed and close informants for 85 suicide cases (46 men, 39 women mean age 75 years were interviewed by a psychiatrist. A population based comparison group (n = 153 was created and interviewed face-to-face. Primary care and psychiatric records were reviewed for both suicide cases and comparison subjects. All available information was used to determine past-month mental disorders in accordance with DSM-IV. Results Antidepressants, antipsychotics, sedatives and hypnotics were associated with increased suicide risk in the crude analysis. After adjustment for affective and anxiety disorders neither antidepressants in general nor SSRIs showed an association with suicide. Antipsychotics had no association with suicide after adjustment for psychotic disorders. Sedative treatment was associated with an almost fourteen-fold increase of suicide risk in the crude analyses and remained an independent risk factor for suicide even after adjustment for any DSM-IV disorder. Having a current prescription for a hypnotic was associated with a four-fold increase in suicide risk in the adjusted model. Conclusion Sedatives and hypnotics were both associated with increased

  3. Response to intravenous midazolam sedation in general dental practice.

    Science.gov (United States)

    Ellis, S

    1996-06-08

    The object of this study was to grade the response of patients undergoing a variety of dental procedures with the aid of intravenous midazolam sedation in general dental practice and to explore any relationships between the patients preoperative anxiety assessment and the clinician's assessment of co-operation whilst under sedation. One hundred consecutive patients aged between 18 and 58 years (mean 32 years; sd 10 years) and in ASA Class I or II were prospectively studied. Results showed that despite attempts to grade patient's behaviour it was not possible to reliably predict patient's responses under intravenous sedation. In addition to these findings, the great individual variation in sensitivity to midazolam was confirmed.

  4. Nurse administered propofol sedation for pulmonary endoscopies requires a specific protocol

    DEFF Research Database (Denmark)

    Jensen, Jeppe Thue; Banning, Anne-Marie; Clementsen, Paul;

    2012-01-01

    This study provides an evaluation and risk analysis of propofol sedation for endoscopic pulmonary procedures according to our unit's "gastroenterologic nurse-administered propofol sedation (NAPS) guideline".......This study provides an evaluation and risk analysis of propofol sedation for endoscopic pulmonary procedures according to our unit's "gastroenterologic nurse-administered propofol sedation (NAPS) guideline"....

  5. Using a learning needs assessment to identify knowledge deficits regarding procedural sedation for pediatric patients.

    Science.gov (United States)

    Jest, Anne D; Tonge, Andrea

    2011-12-01

    Procedural sedation is a cost-effective method of providing sedation and analgesia for patients undergoing diagnostic and therapeutic procedures. Sedation ranges on a continuum from minimal sedation to deep sedation, so procedural sedation can pose many risks for patients (eg, compromised airway, depressed respirations, hypotension). The unique variables inherent in the pediatric population and the associated risks of procedural sedation make it imperative that RNs be knowledgeable and competent in monitoring and managing these patients. Through the use of a learning needs assessment, perioperative resource nurses at a pediatric hospital in a large, southeast metropolitan area identified practice concerns associated with staff RNs' management of pediatric patients undergoing procedural sedation. As a result of these findings, the perioperative resource nurses are in the process of implementing annual sedation competency skills testing in a special procedures laboratory for all nurses who participate in sedation procedures.

  6. Influence of prior determination of baseline minimum alveolar concentration (MAC) of isoflurane on the effect of ketamine on MAC in dogs.

    Science.gov (United States)

    Gianotti, Giacomo; Valverde, Alexander; Johnson, Ron; Sinclair, Melissa; Gibson, Thomas; Dyson, Doris H

    2014-07-01

    The objective of this study was to determine if prior measurement of the minimum alveolar concentration (MAC) of isoflurane influences the effect of ketamine on the MAC of isoflurane in dogs. Eight mixed-breed dogs were studied on 2 occasions. Anesthesia was induced and maintained using isoflurane. In group 1 the effect of ketamine on isoflurane MAC was determined after initially finding the baseline isoflurane MAC. In group 2, the effect of ketamine on isoflurane MAC was determined without previous measure of the baseline isoflurane MAC. In both groups, MAC was determined again 30 min after stopping the CRI of ketamine. Plasma ketamine concentrations were measured during MAC determinations. In group 1, baseline MAC (mean ± SD: 1.18 ± 0.14%) was decreased by ketamine (0.88 ± 0.14%; P MAC after stopping ketamine was similar (1.09 ± 0.16%) to baseline MAC and higher than with ketamine (P MAC with ketamine (0.79 ± 0.11%) was also increased after stopping ketamine (1.10 ± 0.17%; P MAC values with ketamine were different between groups (P MAC determination. The MAC of isoflurane during the CRI of ketamine yielded different results when methods of same day (group-1) versus separate days (group-2) are used, despite similar plasma ketamine concentrations with both methods. However, because the magnitude of this difference was less than 10%, either method of determining MAC is deemed acceptable for research purposes.

  7. MAC of xenon and halothane in rhesus monkeys.

    Science.gov (United States)

    Whitehurst, S L; Nemoto, E M; Yao, L; Yonas, H

    1994-10-01

    Local cerebral blood flow (LCBF) maps produced by 33% xenon-enhanced computed tomographic scanning (Xe/CT LCBF) are useful in the clinical diagnosis and management of patients with cerebrovascular disorders. However, observations in humans that 25-35% xenon (Xe) inhalation increases cerebral blood flow (CBF) have raised concerns that Xe/CT LCBF measurements may be inaccurate and that Xe inhalation may be hazardous in patients with decreased intracranial compliance. In contrast, 33% Xe does not increase CBF in rhesus monkeys. To determine whether this interspecies difference in the effect of Xe on CBF correlates with an interspecies difference in the anesthetic potency of Xe, we measured the minimum alveolar concentration (MAC) of Xe preventing movement to a tail-clamp stimulus in rhesus monkeys. Using a standard protocol for the determination of MAC in animals, we first measured the MAC of halothane (n = 5), and then used a combination of halothane and Xe to measure the MAC of Xe (n = 7). The halothane MAC was 0.99 +/- 0.12% (M +/- SD), and the Xe MAC was 98 +/- 15%. These results suggest that the MAC of Xe in rhesus monkeys is higher than the reported human Xe MAC value of 71%. Thus the absence of an effect of 33% Xe on CBF in the rhesus monkey may be related to its lower anesthetic potency.

  8. Intel-Based Mac Computers Improve Teaching and Learning

    Science.gov (United States)

    Technology & Learning, 2007

    2007-01-01

    Today, Mac computers offer schools an easy and powerful way to engage students in learning, foster 21st century skills and leverage existing software assets. Innovative software and hardware built into the Mac allows students to demonstrate their individual strengths--empowering them to be creators of content, rather than just consumers. Judging…

  9. On the orthogonality of the MacDonald s functions

    Energy Technology Data Exchange (ETDEWEB)

    Passian, Ali [ORNL; Simpson, Henry [University of Tennessee, Knoxville (UTK); Koucheckian, Sherwin [University of South Florida, Tampa; Yakubovich, Semyon [University of Porto, Portugal

    2009-01-01

    A proof of an orthogonality relation for the MacDonald's functions with identical arguments but unequal complex lower indices is presented. The orthogonality is derived first via a heuristic approach based on the Mehler-Fock integral transform of the MacDonald's functions, and then proved rigorously using a polynomial approximation procedure.

  10. Steven MacCall: Winner of LJ's 2010 Teaching Award

    Science.gov (United States)

    Berry, John N., III

    2010-01-01

    This article profiles Steven L. MacCall, winner of "Library Journal's" 2010 Teaching Award. An associate professor at the School of Library and Information Studies (SLIS) at the University of Alabama, Tuscaloosa, MacCall was nominated by Kathie Popadin, known as "Kpop" to the members of her cohort in the online MLIS program at SLIS. Sixteen of…

  11. Multi-channel MAC Protocol in Cognitive Radio Networks

    Directory of Open Access Journals (Sweden)

    Yongli Sun

    2013-11-01

    Full Text Available Since cognitive wireless network (CRN has the characteristic of secondary use, it can enable the device to dynamically access available spectrum without interference to primary users (PUs, which can effectively alleviate contradiction between the lack of spectrum resources and the growing demand for wireless access. However, Medium Access Control (MAC protocol as CRN core components, can achieve competition access of the licensed spectrum and coordination control, which will maximize spectrum utilization efficiency and network throughput. The contribution of this survey is threefold. First, we analyze the characteristics of the existed multi- channel MAC protocol in CRN; Second, according to the different ways of spectrum access in CRNs, the multi-channel MAC protocols are classified into time-slotted based MAC protocol, control channel based MAC protocol and hybrid MAC protocol, and the paper emphatically analyzed the advantages and disadvantages of these multi-channel MAC protocols; Finally, the paper explores the difficulties and the challenges of multi-channel MAC protocols design in cognitive wireless network.

  12. Anaesthesia for procedures in the intensive care unit.

    Science.gov (United States)

    Chollet-Rivier, M; Chioléro, R L

    2001-08-01

    Taking in charge severely ill patients in the intensive care environment to manage complex procedures is a performance requiring highly specific knowledge. Close collaboration between anaesthetists and intensive care specialists is likely to improve the safety and quality of medical care. Three forms of anaesthetic care should be considered in clinical practice: sedation and analgesia; monitored anaesthetic care; and general anaesthesia or conduction block anaesthesia. Even in the field of sedation and analgesia, the anaesthesiologist can offer expertise on new anaesthetic techniques like: the most recent concepts of balanced anaesthesia in terms of pharmacokinetics and dynamics, favouring the use of short-acting agents and of sedative-opioid combinations. New modes of administration and monitoring intravenous anaesthesia have been developed, with potential application in the intensive care unit. These include the use of target-controlled administration of intravenous drugs, and of electroencephalographic signals to monitor the level of sedation.

  13. McCay ("Mac") Vernon (1928-2013).

    Science.gov (United States)

    Sherman, William A

    2014-09-01

    McCay ("Mac") Vernon, the founding and preeminent psychologist in the field of deafness. Mac was born at Walter Reed Hospital in Washington, DC, into a military family on October 14, 1928 and died on August 28, 2013, at the age of 84. Prior to Mac, research and clinical direction in the field were sparse. Mac became the icon for psychological services for deaf people, and his work extended into the education of deaf children, forensic and ethical practices with the deaf, and public understanding of deafness as a disability and of deaf persons as a psychosocial minority group. Mac will also be remembered for his sharp intellect, good humor, compassion, and advocacy for those who are misunderstood.

  14. A Sensing Error Aware MAC Protocol for Cognitive Radio Networks

    CERN Document Server

    Hu, Donglin

    2011-01-01

    Cognitive radios (CR) are intelligent radio devices that can sense the radio environment and adapt to changes in the radio environment. Spectrum sensing and spectrum access are the two key CR functions. In this paper, we present a spectrum sensing error aware MAC protocol for a CR network collocated with multiple primary networks. We explicitly consider both types of sensing errors in the CR MAC design, since such errors are inevitable for practical spectrum sensors and more important, such errors could have significant impact on the performance of the CR MAC protocol. Two spectrum sensing polices are presented, with which secondary users collaboratively sense the licensed channels. The sensing policies are then incorporated into p-Persistent CSMA to coordinate opportunistic spectrum access for CR network users. We present an analysis of the interference and throughput performance of the proposed CR MAC, and find the analysis highly accurate in our simulation studies. The proposed sensing error aware CR MAC p...

  15. A Pilot Study of Ketamine versus Midazolam/Fentanyl Sedation in Children Undergoing GI Endoscopy

    OpenAIRE

    Lightdale, Jenifer R; Mitchell, Paul D; Fredette, Meghan E.; Mahoney, Lisa B.; Zgleszewski, Steven E.; Lisa Scharff; Fox, Victor L

    2011-01-01

    Background. Ketamine sedation has been found superior by physician report to traditional sedation regimens for pediatric endoscopy. Goal. To objectively compare sedation with ketamine versus midazolam/fentanyl for children undergoing gastrointestinal endoscopy. Study. Patients received one of two regimens and were independently monitored using a standardized rating scale. Results. There were 2 episodes of laryngospasm during ketamine sedation. Univariate analyses showed patients sedated with ...

  16. Moderate and deep nurse-administered propofol sedation is safe

    DEFF Research Database (Denmark)

    Jensen, Jeppe Thue; Møller, Ann; Hornslet, Pernille;

    2015-01-01

    INTRODUCTION: Non-anaesthesiologist-administered propofol sedation (NAPS/NAAP) is increasingly used in many countries. Most regimens aim for light or moderate sedation. Little evidence on safety of deep NAPS sedation is available. The aim of this study was to explore the safety of intermittent deep...... dose was 331.6 mg (standard deviation = 179.4 mg). The overall rate of hypoxia was 3.2%, and the rate of hypotension was 3.1%. Assisted ventilation was needed in 0.5%. Age (p ... with a higher rate of adverse events. CONCLUSION: Safety during intermittent deep sedation with NAPS was good. Age, ASA class 3 and total propofol dose were correlated with a higher rate of adverse events. Patients aged 60 years or more needed more handling during adverse events. FUNDING: Arvid Nilsson...

  17. Alasdair MacIntyre, joven lector de Freud

    Directory of Open Access Journals (Sweden)

    Ramis Barceló, Rafael

    2010-06-01

    Full Text Available This article tries to show the reading of Freud that MacIntyre made from 1955 to 1970. For this purpose, it summarizes the ideas of MacIntyre in the intellectual context, mainly the use of philosophical ideas of Freud against the Enlightenment project. MacIntyre criticises Marxist interpreters and the mixing between Marx and Freud. MacIntyre uses the philosophical ideas of Freud for answering two problems on determinism: the links between determinism and reasons for action and determinism and Marxism. The main conclusion is that MacIntyre used Freud in his own advantage: as an ally in the criticism of the Enlightenment.

    Este artículo trata de mostrar la lectura que MacIntyre hizo de Freud desde 1955 hasta 1970. Con este fin, se resumen las ideas de MacIntyre en el contexto intelectual, principalmente el uso de las ideas filosóficas de Freud contra el proyecto de la Ilustración. MacIntyre critica a los intérpretes de Marx y a la mezcla entre Marx y Freud. MacIntyre usa las ideas filosóficas de Freud para contestar dos problemas sobre el determinismo: los vínculos entre el determinismo y las razones para la acción y el determinismo y el marxismo. La conclusión principal es que MacIntyre usó a Freud en su propio beneficio: como un aliado en la crítica de la Ilustración.

  18. Mitral flow propagation velocity in non-sedated healthy cats

    OpenAIRE

    SILVA, A.C.; R.A.L. Muzzi; G. Oberlender; L.A.L. Muzzi; M.R. Coelho; R.B. Nogueira

    2014-01-01

    Mitral flow propagation velocity (Vp) is an index used to evaluate the left ventricular diastolic function. Its influence on human and small animal cardiopathies has been studied; however there are few reports evaluating this variable in domestic felines. In addition, there is a lack of studies in non-sedated healthy cats. Therefore, the purpose of this study was to establish values for Vp and its correlation with other echocardiographic indexes in non-sedated healthy cats in order to provide...

  19. Fospropofol disodium injection for the sedation of patients undergoing colonoscopy

    OpenAIRE

    Levitzky, Benjamin E; Vargo, John J.

    2008-01-01

    Benjamin E Levitzky1, John J Vargo21Department of Gastroenterology and Hepatology, 2Section of Therapeutic and Hepatobiliary Endoscopy, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USAAbstract: Sedation plays a central role in making colonoscopy tolerable for patients and feasible for the endoscopist to perform. The array of agents used for endoscopic sedation continues to evolve. Fospropofol (FP), a prodrug of propofol with a slower pharmacokin...

  20. Aminophylline Fails to Reverse Conscious Sedation with Midazolam in Dentistry

    OpenAIRE

    Rodrigo, Chandra R.; Rosenquist, Jan B.

    1986-01-01

    A double blind, randomized crossover study investigated whether aminophylline reverses the conscious sedation with midazolam in dentistry to result in quicker clinical recovery than when midazolam is used alone. Twenty-five patients between 17-30 years of age (ASA Grade 1) were sedated with midazolam for bilateral third molar extractions, one side being operated on one visit. Aminophylline or normal saline was given at the end of the surgical procedure on one visit and the alternative during ...

  1. Balanced propofol sedation administered by nonanesthesiologists: The first Italian experience

    Science.gov (United States)

    Repici, Alessandro; Pagano, Nico; Hassan, Cesare; Carlino, Alessandra; Rando, Giacomo; Strangio, Giuseppe; Romeo, Fabio; Zullo, Angelo; Ferrara, Elisa; Vitetta, Eva; Ferreira, Daniel de Paula Pessoa; Danese, Silvio; Arosio, Massimo; Malesci, Alberto

    2011-01-01

    AIM: To assess the efficacy and safety of a balanced approach using midazolam in combination with propofol, administered by non-anesthesiologists, in a large series of diagnostic colonoscopies. METHODS: Consecutive patients undergoing diagnostic colonoscopy were sedated with a single dose of midazolam (0.05 mg/kg) and low-dose propofol (starter bolus of 0.5 mg/kg and repeated boluses of 10 to 20 mg). Induction time and deepest level of sedation, adverse and serious adverse events, as well as recovery times, were prospectively assessed. Cecal intubation and adenoma detection rates were also collected. RESULTS: Overall, 1593 eligible patients were included. The median dose of propofol administered was 70 mg (range: 40-120 mg), and the median dose of midazolam was 2.3 mg (range: 2-4 mg). Median induction time of sedation was 3 min (range: 1-4 min), and median recovery time was 23 min (range: 10-40 min). A moderate level of sedation was achieved in 1561 (98%) patients, whilst a deep sedation occurred in 32 (2%) cases. Transient oxygen desaturation requiring further oxygen supplementation occurred in 8 (0.46%; 95% CI: 0.2%-0.8%) patients. No serious adverse event was observed. Cecal intubation and adenoma detection rates were 93.5% and 23.4% (27.8% for male and 18.5% for female, subjects), respectively. CONCLUSION: A balanced sedation protocol provided a minimalization of the dose of propofol needed to target a moderate sedation for colonoscopy, resulting in a high safety profile for non-anesthesiologist propofol sedation. PMID:21987624

  2. Balanced propofol sedation administered by nonanesthesiologists: The first Italian experience

    Institute of Scientific and Technical Information of China (English)

    Alessandro Repici; Eva Vitetta; Daniel de Paula Pessoa Ferreira; Silvio Danese; Massimo Arosio; Alberto Malesci; Nico Pagano; Cesare Hassan; Alessandra Carlino; Giacomo Rando; Giuseppe Strangio; Fabio Romeo; Angelo Zullo; Elisa Ferrara

    2011-01-01

    AIM: To assess the efficacy and safety of a balanced approach using midazolam in combination with propofol, administered by non-anesthesiologists, in a large series of diagnostic colonoscopies.METHODS: Consecutive patients undergoing diagnostic colonoscopy were sedated with a single dose of midazolam (0.05 mg/kg) and low-dose propofol (starter bolus of 0.5 mg/kg and repeated boluses of 10 to 20 mg). Induction time and deepest level of sedation, adverse and serious adverse events, as well as recovery times, were prospectively assessed. Cecal intubation and adenoma detection rates were also collected.RESULTS: Overall, 1593 eligible patients were included. The median dose of propofol administered was 70 mg (range: 40-120 mg), and the median dose of midazolam was 2.3 mg (range: 2-4 mg). Median induction time of sedation was 3 min (range: 1-4 min), and median recovery time was 23 min (range: 10-40 min). A moderate level of sedation was achieved in 1561 (98%) patients, whilst a deep sedation occurred in 32 (2%) cases. Transient oxygen desaturation requiring further oxygen supplementation occurred in 8 (0.46%; 95% CI: 0.2%-0.8%) patients. No serious adverse event was observed. Cecal intubation and adenoma detection rates were 93.5% and 23.4% (27.8% for male and 18.5% for female, subjects), respectively.CONCLUSION: A balanced sedation protocol provided a minimalization of the dose of propofol needed to target a moderate sedation for colonoscopy, resulting in a high safety profile for non-anesthesiologist propofol sedation.

  3. TR-MAC: an energy-efficient MAC protocol exploiting transmitted reference modulation for wireless sensor networks

    NARCIS (Netherlands)

    Morshed, Sarwar; Heijenk, Geert

    2014-01-01

    The medium access control (MAC) protocol determines the energy consumption of a wireless sensor node by specifying the listening, transmitting or sleeping time. Therefore MAC protocols play an important role in minimizing the overall energy consumption in a typical wireless sensor network (WSN). Usi

  4. TreeMAC: Localized TDMA MAC protocol for real-time high-data-rate sensor networks

    Science.gov (United States)

    Song, W.-Z.; Huang, R.; Shirazi, B.; Husent, R.L.

    2009-01-01

    Earlier sensor network MAC protocols focus on energy conservation in low-duty cycle applications, while some recent applications involve real-time high-data-rate signals. This motivates us to design an innovative localized TDMA MAC protocol to achieve high throughput and low congestion in data collection sensor networks, besides energy conservation. TreeMAC divides a time cycle into frames and frame into slots. Parent determines children's frame assigmnent based on their relative bandwidth demand, and each node calculates its own slot assignment based on its hop-count to the sink. This innovative 2-dimensional frame-slot assignment algorithm has the following nice theory properties. Firstly, given any node, at any time slot, there is at most one active sender in its neighborhood (includ ing itself). Secondly, the packet scheduling with TreelMAC is bufferless, which therefore minimizes the probability of network congestion. Thirdly, the data throughput to gateway is at least 1/3 of the optimum assuming reliable links. Our experiments on a 24 node test bed demonstrate that TreeMAC protocol significantly improves network throughput and energy efficiency, by comparing to the TinyOS's default CSMA MAC protocol and a recent TDMA MAC protocol Funneling-MAC[8]. ?? 2009 IEEE.

  5. November 2012 critical care journal club

    Directory of Open Access Journals (Sweden)

    Raschke RA

    2012-12-01

    Full Text Available No abstract available. Article truncated at 150 words. Mehta S, Burry L, Cook D, Fergusson D, et al. Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol. JAMA 2012;308:1985-92. PDFThis study was a multi-center, randomized controlled trial that compared protocolized sedation with protocolized sedation plus daily sedation interruption. The protocol used to titrate benzodiazepine and opioid infusions incorporated a validated scale (Sedation-agitation Scale (SAS or Richmond Agitation Sedation Scale (RASS in order to maintain a comfortable but arousable state. Four hundred and thirty mechanically ventilated, critically ill patients were recruited from medical and surgical ICUs in 16 institutions in North America. The study showed no benefit in the group that underwent daily sedation interruption - length of intubation was 7 days, length of ICU stay was 10 days and length of hospital stay was 20 days in both groups. There was no significant difference in the incidence of delirium (53 vs. ...

  6. Performing bone marrow biopsies with or without sedation: a comparison.

    Science.gov (United States)

    Giannoutsos, I; Grech, H; Maboreke, T; Morgenstern, G

    2004-06-01

    Although intravenous sedation (ISED) in addition to a local anaesthetic (LA) is commonly used in the performance of a bone marrow aspirate and trephine (BMAT), it is not clear under what circumstances and in which way sedation may be most beneficial. In this study, information was gathered using a questionnaire, from 112 patients shortly after undergoing BMAT; the duration of the procedures and the length of the biopsy cores were measured and any complications noted. Most patients (68%) chose to receive LA only, and almost all (74/76) were happy with their decision. Patients who received sedation gave lower pain scores than patients receiving LA only (1 vs. 3) and were found to have lower levels of apprehension at the thought of having a repeat procedure. Patients having a repeat BMAT showed a slightly increased preference for having sedation compared with patients who were undergoing it for the first time. There is some concern that guidelines regarding the use of ISED for procedures other than BMAT are not always adhered to, and current practice may be best revealed by a large-scale audit of sedation practice for the performance of BMAT. Patients should be given the choice of having ISED if the appropriate resources are available, but in most cases the additional small risk of receiving sedation can be avoided.

  7. Propofol for Anesthesia and Postoperative Sedation Resulted in Fewer Inflammatory Responses than Sevoflurane Anesthesia and Midazolam Sedation after Thoracoabdominal Esophagectomy.

    Science.gov (United States)

    Nakanuno, Ryuichi; Yasuda, Toshimichi; Hamada, Hiroshi; Yoshikawa, Hiroshi; Nakamura, Ryuji; Saeki, Noboru; Kawamoto, Masashi

    2015-09-01

    Responses to surgical stress can be modulated by anesthetics. We prospectively compared the effects of two different anesthetic/sedative techniques on the peak postoperative bladder temperature (BT) and the postoperative C-reactive protein (CRP) level. Twenty patients who were scheduled to undergo elective thoracoabdominal esophagectomy were allocated to receive either propofol anesthesia followed by propofol sedation (PP group, n = 10) or sevoflurane anesthesia followed by midazolam sedation (SM group, n = 10). In each case, the patient's peak bladder temperature was measured on the morning after surgery, and their serum CRP levels were assessed on postoperative days (POD) 1, 2, and 3. The patients' postoperative clinical courses were also evaluated. The peak postoperative BT (degrees C) (37.6 ± 0.4 vs. 38.2 ± 0.6, respectively; p midazolam sedation.

  8. Using continuous sedation until death for cancer patients: A qualitative interview study of physicians' and nurses' practice in three European countries

    NARCIS (Netherlands)

    J. Seymour (Jane); J.A.C. Rietjens (Judith); S.M. Bruinsma (Sophie); L. Deliens (Luc); S. Sterckx (Sigrid); F. Mortier (Freddy); J. Brown (Jayne); N. Mathers (Nigel); A. van der Heide (Agnes)

    2015-01-01

    textabstractBackground: Extensive debate surrounds the practice of continuous sedation until death to control refractory symptoms in terminal cancer care. We examined reported practice of United Kingdom, Belgian and Dutch physicians and nurses. Methods: Qualitative case studies using interviews. Set

  9. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals

    NARCIS (Netherlands)

    J. Harris (Julia); A.-S. Ramelet (Anne-Sylvie); M. van Dijk (Monique); P. Pokorna (Pavla); J.M. Wielenga (Joke); L.N. Tume (Lyvonne); D. Tibboel (Dick); E. Ista (Erwin)

    2016-01-01

    textabstractBackground: This position statement provides clinical recommendations for the assessment of pain, level of sedation, iatrogenic withdrawal syndrome and delirium in critically ill infants and children. Admission to a neonatal or paediatric intensive care unit (NICU, PICU) exposes a child

  10. Multichannel MAC Layer In Mobile Ad—Hoc Network

    Science.gov (United States)

    Logesh, K.; Rao, Samba Siva

    2010-11-01

    This paper we presented the design objectives and technical challenges in Multichannel MAC protocols in Mobile Ad-hoc Network. In IEEE 802.11 a/b/g standards allow use of multiple channels, only a single channel is popularly used, due to the lack of efficient protocols that enable use of Multiple Channels. Even though complex environments in ad hoc networks require a combined control of physical (PHY) and medium access control (MAC) layers resources in order to optimize performance. And also we discuss the characteristics of cross-layer frame and give a multichannel MAC approach.

  11. MacRuby Ruby and Cocoa on OS X

    CERN Document Server

    Aimonetti, Matt

    2011-01-01

    Want to build native Mac OS X applications with a sleek, developer-friendly alternative to Objective-C? MacRuby is an ideal choice. This in-depth guide shows you how Apple's implementation of Ruby gives you access to all the features available to Objective-C programmers. You'll get clear, detailed explanations of MacRuby, including quick programming techniques such as prototyping. Perfect for programmers at any level, this book is packed with code samples and complete project examples. If you use Ruby, you can tap your skills to take advantage of Interface Builder, Cocoa libraries, the Objec

  12. Handling Deafness Problem of Scheduled Multi-Channel Polling MACs

    Science.gov (United States)

    Jiang, Fulong; Liu, Hao; Shi, Longxing

    Combining scheduled channel polling with channel diversity is a promising way for a MAC protocol to achieve high energy efficiency and performance under both light and heavy traffic conditions. However, the deafness problem may cancel out the benefit of channel diversity. In this paper, we first investigate the deafness problem of scheduled multi-channel polling MACs with experiments. Then we propose and evaluate two schemes to handle the deafness problem. Our experiment shows that deafness is a significant reason for performance degradation in scheduled multi-channel polling MACs. A proper scheme should be chosen depending on the traffic pattern and the design objective.

  13. Cooperative energy harvesting-adaptive MAC protocol for WBANs.

    Science.gov (United States)

    Esteves, Volker; Antonopoulos, Angelos; Kartsakli, Elli; Puig-Vidal, Manel; Miribel-Català, Pere; Verikoukis, Christos

    2015-05-28

    In this paper, we introduce a cooperative medium access control (MAC) protocol, named cooperative energy harvesting (CEH)-MAC, that adapts its operation to the energy harvesting (EH) conditions in wireless body area networks (WBANs). In particular, the proposed protocol exploits the EH information in order to set an idle time that allows the relay nodes to charge their batteries and complete the cooperation phase successfully. Extensive simulations have shown that CEH-MAC significantly improves the network performance in terms of throughput, delay and energy efficiency compared to the cooperative operation of the baseline IEEE 802.15.6 standard.

  14. Strategies for Optimal MAC Parameters Tuning in IEEE 802.15.6 Wearable Wireless Sensor Networks.

    Science.gov (United States)

    Alam, Muhammad Mahtab; Ben Hamida, Elyes

    2015-09-01

    Wireless body area networks (WBAN) has penetrated immensely in revolutionizing the classical heath-care system. Recently, number of WBAN applications has emerged which introduce potential limits to existing solutions. In particular, IEEE 802.15.6 standard has provided great flexibility, provisions and capabilities to deal emerging applications. In this paper, we investigate the application-specific throughput analysis by fine-tuning the physical (PHY) and medium access control (MAC) parameters of the IEEE 802.15.6 standard. Based on PHY characterizations in narrow band, at the MAC layer, carrier sense multiple access collision avoidance (CSMA/CA) and scheduled access protocols are extensively analyzed. It is concluded that, IEEE 802.15.6 standard can satisfy most of the WBANs applications throughput requirements by maximum achieving 680 Kbps. However, those emerging applications which require high quality audio or video transmissions, standard is not able to meet their constraints. Moreover, delay, energy efficiency and successful packet reception are considered as key performance metrics for comparing the MAC protocols. CSMA/CA protocol provides the best results to meet the delay constraints of medical and non-medical WBAN applications. Whereas, the scheduled access approach, performs very well both in energy efficiency and packet reception ratio.

  15. +Psychometric evaluation of the MacDQoL individualised measure of the impact of macular degeneration on quality of life

    Directory of Open Access Journals (Sweden)

    ffytche Timothy

    2005-04-01

    Full Text Available Abstract Background The MacDQoL is an individualised measure of the impact of macular degeneration (MD on quality of life (QoL. There is preliminary evidence of its psychometric properties and sensitivity to severity of MD. The aim of this study was to carry out further psychometric evaluation with a larger sample and investigate the measure's sensitivity to MD severity. Methods Patients with MD (n = 156: 99 women, 57 men, mean age 79 ± 13 years, recruited from eye clinics (one NHS, one private completed the MacDQoL by telephone interview and later underwent a clinic vision assessment including near and distance visual acuity (VA, comfortable near VA, contrast sensitivity, colour recognition, recovery from glare and presence or absence of distortion or scotoma in the central 10° of the visual field. Results The completion rate for the MacDQoL items was 99.8%. Of the 26 items, three were dropped from the measure due to redundancy. A fourth was retained in the questionnaire but excluded when computing the scale score. Principal components analysis and Cronbach's alpha (0.944 supported combining the remaining 22 items in a single scale. Lower MacDQoL scores, indicating more negative impact of MD on QoL, were associated with poorer distance VA (better eye r = -0.431 p Conclusion The MacDQoL 22-item scale has excellent internal consistency reliability and a single-factor structure. The measure is acceptable to respondents and the generic QoL item, MD-specific QoL item and average weighted impact score are related to several measures of vision. The MacDQoL demonstrates that MD has considerable negative impact on many aspects of QoL, particularly independence, leisure activities, dealing with personal affairs and mobility. The measure may be valuable for use in clinical trials and routine clinical care.

  16. The risks of using continuous deep palliative sedation within the context of euthanasia

    Directory of Open Access Journals (Sweden)

    Polaks R.

    2016-01-01

    Full Text Available Although palliative care is one of the main arguments among the opponents of euthanasia, the individual medical activities implemented within it are not always evaluated unequivocally. Considering that patient in such care centres arrives mainly at the last stages of the disease when intensive treatments are no longer able to help, to reduce discomfort and relieve pain caused by the disease, analgesic means can be used that can shorten the patient's life expectancy and cause death. Such undesirable consequences can be seen in the deep and continuous palliative sedation, which not only is the last resort for pain prevention process, but also is still quite debatable medical and legal doctrine, seeing in it a similarity to the so-called “easy death”, resulting in an unofficial name - “slow euthanasia”. It is therefore important to emphasize that deep and continuous palliative sedation is considered medically correct action only if its application is justified by the need to relieve the incurably ill person from the grievous pain and sufferings caused by the disease, not to cause death, and only when in certain clinical circumstances, it cannot be achieved by other means and methods. In all other cases, depending on the state fact matters, activities of a physician constitute either an active voluntary or non-voluntary euthanasia, which in most countries of the world is a subject to criminal sanctions.

  17. Infecting Windows, Linux & Mac in one go

    CERN Multimedia

    Computer Security Team

    2012-01-01

    Still love bashing on Windows as you believe it is an insecure operating system? Hold on a second! Just recently, a vulnerability has been published for Java 7.   It affects Windows/Linux PCs and Macs, Internet Explorer, Safari and Firefox. In fact, it affects all computers that have enabled the Java 7 plug-in in their browser (Java 6 and earlier is not affected). Once you visit a malicious website (and there are plenty already out in the wild), your computer is infected… That's "Game Over" for you.      And this is not the first time. For a while now, attackers have not been targeting the operating system itself, but rather aiming at vulnerabilities inherent in e.g. your Acrobat Reader, Adobe Flash or Java programmes. All these are standard plug-ins added into your favourite web browser which make your web-surfing comfortable (or impossible when you un-install them). A single compromised web-site, however, is sufficient to prob...

  18. Prior determination of baseline minimum alveolar concentration (MAC) of isoflurane does not influence the effect of ketamine on MAC in rabbits.

    Science.gov (United States)

    Gianotti, Giacomo; Valverde, Alexander; Sinclair, Melissa; Dyson, Doris H; Gibson, Thomas; Johnson, Ron

    2012-10-01

    The objective of this study was to compare the effect on the minimum alveolar concentration (MAC) of isoflurane when ketamine was administered either after or without prior determination of the baseline MAC of isoflurane in rabbits. Using a prospective randomized crossover study, 8 adult, female New Zealand rabbits were allocated to 2 treatment groups. Anesthesia was induced and maintained with isoflurane. Group 1 (same-day determination) had the MAC-sparing effect of ketamine [1 mg/kg bodyweight (BW) bolus followed by a constant rate infusion (CRI) of 40 μg/kg BW per min, given by intravenous (IV)], which was determined after the baseline MAC of isoflurane was determined beforehand. A third MAC determination was started 30 min after stopping the CRI. Group 2 (separate-day determination) had the MAC-sparing effect of ketamine determined without previous determination of the baseline MAC of isoflurane. A second MAC determination was started 30 min after stopping the CRI. In group 1, the MAC of isoflurane (2.15 ± 0.09%) was significantly decreased by ketamine (1.63 ± 0.07%). After stopping the CRI, the MAC was significantly less (2.04 ± 0.11%) than the baseline MAC of isoflurane and significantly greater than the MAC during the CRI. In group 2, ketamine decreased isoflurane MAC (1.53 ± 0.22%) and the MAC increased significantly (1.94 ± 0.25%) after stopping the CRI. Minimum alveolar concentration (MAC) values did not differ significantly between the groups either during ketamine administration or after stopping ketamine. Under the study conditions, prior determination of the baseline isoflurane MAC did not alter the effect of ketamine on MAC. Both methods of determining MAC seemed to be valid for research purposes.

  19. A COMPARITIVE STUDY TO EVALUATE EFICACY OF IV INFUSION OF DEXMEDETOMIDINE VERSUS IV INFUSION OF PROPOFOL FOR POST - OPERATIVE ICU SEDATION

    Directory of Open Access Journals (Sweden)

    Vindhya

    2014-12-01

    Full Text Available Patients requiring mechanical ventilation usually needs adequate sedation and analgesia to facilitate their care. Dexmedetomidine , a short - acting alpha - 2 - agonist , possesses anxiolytic , anesthetic , hypnotic , and analgesic properties. AIM : The objective of this study is to evaluate and compare the safety and efficacy of iv infusion of Dexmedetomidine with iv infusion of propofol for sedation in post - operative ICU patients. MATERIALS AND METHODS: Fifty patients who were ambulatory and who required the post - operative me chanical ventilation or post - operative sedation were enrolled , in which 25 patients received Dexmedetomidine and remaining 25 patients received propofol. All these patients were treated for the period of 8 to 24 h. STATISTICAL ANALYSIS USED: Data were anal yzed using Student's t - test and Chi - square test. The value of P < 0.05 was considered as statistically significant. RESULTS: Demographic data were comparable. Pulse rate , respiratory rate and blood pressure were comparable. Depth of sedation is similar. To maintain analgesia throughout the study period , patients receiving propofol infusions required significantly more analgesics than patients receiving Dexmedetomidine. CONCLUSIONS: Dexmedetomidine appears to be a safe and acceptable ICU sedative agent .

  20. Brainstem auditory-evoked responses with and without sedation in autism and Down's syndrome.

    Science.gov (United States)

    Sersen, E A; Heaney, G; Clausen, J; Belser, R; Rainbow, S

    1990-04-15

    Brainstem auditory-evoked responses (BAER) were obtained from 46 control, 16 Down's syndrome, and 48 autistic male subjects. Six Down's syndrome and 37 autistic subjects were tested with sedation. Sedated and unsedated Down's syndrome subjects displayed shorter absolute and interpeak latencies for early components of the BAER whereas the sedated autistic group showed longer latencies for the middle and late components. The prolongation of latencies in the sedated autistic group was unrelated to age or intellectual level. Although individuals requiring sedation may have a higher probability of neurological impairment, an effect of sedation on the BAER cannot be ruled out.

  1. Competition at the Wireless Sensor Network MAC Layer: Low Power Probing interfering with X-MAC

    Science.gov (United States)

    Zacharias, Sven; Newe, Thomas

    2011-08-01

    Wireless Sensor Networks (WSNs) combine sensors with computer networks and enable very dense, in-situ and live measurements of data over a large area. Since this emerging technology has the potential to be embedded almost everywhere for numberless applications, interference between different networks can become a serious issue. For most WSNs, it is assumed today that the network medium access is non-competitive. On the basis of X-MAC interfered by Low Power Probing, this paper shows the danger and the effects of different sensor networks communicating on a single wireless channel of the 2.4 GHz band, which is used by the IEEE 802.15.4 standard.

  2. Big Mac arvestab raha ostujõudu / Harli Uljas

    Index Scriptorium Estoniae

    Uljas, Harli

    2005-01-01

    The Economist võrdleb maailma valuutade suhestamiseks Big Mac'i burgeri hindu 120 riigis, kuna see meetod võimaldab saada ülevaate riikide elanikkonna tegelikust ostujõust. Tabel: Hamburgeri standard

  3. Aeronautical Mobile Airport Communications System (AeroMACS)

    Science.gov (United States)

    Budinger, James M.; Hall, Edward

    2011-01-01

    To help increase the capacity and efficiency of the nation s airports, a secure wideband wireless communications system is proposed for use on the airport surface. This paper provides an overview of the research and development process for the Aeronautical Mobile Airport Communications System (AeroMACS). AeroMACS is based on a specific commercial profile of the Institute of Electrical and Electronics Engineers (IEEE) 802.16 standard known as Wireless Worldwide Interoperability for Microwave Access or WiMAX (WiMax Forum). The paper includes background on the need for global interoperability in air/ground data communications, describes potential AeroMACS applications, addresses allocated frequency spectrum constraints, summarizes the international standardization process, and provides findings and recommendations from the world s first AeroMACS prototype implemented in Cleveland, Ohio, USA.

  4. MAC layer security issues in wireless mesh networks

    Science.gov (United States)

    Reddy, K. Ganesh; Thilagam, P. Santhi

    2016-03-01

    Wireless Mesh Networks (WMNs) have emerged as a promising technology for a broad range of applications due to their self-organizing, self-configuring and self-healing capability, in addition to their low cost and easy maintenance. Securing WMNs is more challenging and complex issue due to their inherent characteristics such as shared wireless medium, multi-hop and inter-network communication, highly dynamic network topology and decentralized architecture. These vulnerable features expose the WMNs to several types of attacks in MAC layer. The existing MAC layer standards and implementations are inadequate to secure these features and fail to provide comprehensive security solutions to protect both backbone and client mesh. Hence, there is a need for developing efficient, scalable and integrated security solutions for WMNs. In this paper, we classify the MAC layer attacks and analyze the existing countermeasures. Based on attacks classification and countermeasures analysis, we derive the research directions to enhance the MAC layer security for WMNs.

  5. Design and Implementation of an Efficient 64 bit MAC

    Directory of Open Access Journals (Sweden)

    Mohammad Shabber Hasan Khan

    2015-08-01

    Full Text Available The design of optimized 64 bit multiplier and accumulator (MAC unit is implemented in this paper. MAC unit plays major role in many of the digital signal processing (DSP applications. The MAC unit is designed with the combinations of multipliers and adders. In the proposed method MAC unit is implemented using Vedic multiplier and the adder is done with ripple carry adder .The components are reduced by implementing Vedic multiplier using the techniques of Vedic mathematics that have been modified to improve performance. a high speed processor depends significantly on the multiplier as it is one of the key hardware blocks in most digital signal processing systems as well as in general processors. The area is optimized effectively using Vedic multiplier .The total design implemented using Xilinx.

  6. Rating of new outlet structures for MacFarlane Reservoir

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Memorandum explaining the new work on the outlet structure at MacFarlane Reservoir. Flow measurements were taken at different staff gage elevations and this data is...

  7. After MacIntyre : Kaasaegsest vooruseetikast / Meego Remmel

    Index Scriptorium Estoniae

    Remmel, Meego

    2006-01-01

    Alasdair MacIntyre panus 20. sajandi eetikasse. Tema käsitlus vooruseetikast ja vooruseetilisest perspektiivist, mida on võimalik näha komplekselt, vaadeldes voorust, praktikat, narratiivi ja traditsiooni mõisteid

  8. Mac OS X : Tiger edition the missing manual

    CERN Document Server

    Pogue, David

    2005-01-01

    You can set your watch to it: As soon as Apple comes out with another version of Mac OS X, David Pogue hits the streets with another meticulous Missing Manual to cover it with a wealth of detail. The new Mac OS X 10.4, better known as Tiger, is faster than its predecessors, but nothing's too fast for Pogue and Mac OS X: The Missing Manual. There are many reasons why this is the most popular computer book of all time. With its hallmark objectivity, the Tiger Edition thoroughly explores the latest features to grace the Mac OS. Which ones work well and which do not? What should you look for? Th

  9. Use of Flumazenil to Provide Adequate Recovery Time Post-Midazolom Infusion in a General Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    MOJTABA MOJTAHEDZADEH

    1999-08-01

    Full Text Available Sedation permits patients to tolerate the various treatment modalities to which they are subjected. However it may sometimes cause prolonged sedation in critically ill patients. Flumazenil, a benzo¬diazepine antagonist, reverses midazolam-induced sedation and amnesia. We prospectively designed a double-blind randomized study to evaluate the effects of flumazenil on thirty (30 Iranian General Intensive Care Unit (ICU patients. They were requiring mechanical ventilation for more than 12 hours and they were sedated by midazolam infusions. Sedation levels were measured hourly during the infusion, at the end of the infusion, and at 5, 15, 30, 60, and 120 min after cessation of the mida¬zolam infusion. Reversal of sedation was observed in all patients who received flumazenil, and re-sedation occurred in seven of these patients. Reversal was not seen in any of the patients who receiv-ed placebo.

  10. Conscious Sedation for Endoscopic Retrograde Cholangiopancreatography: Dexmedetomidine Versus Midazolam

    Science.gov (United States)

    Kilic, Neslihan; Sahin, Sukran; Aksu, Hale; Yavascaoglu, Belgin; Gurbet, Alp; Turker, Gurkan; Kadioglu, Asli Guler

    2011-01-01

    Objective: Midazolam and dexmedetomidine, which are used for sedation during endoscopic retrograde cholangiopancreatography, were compared to evaluate the differences in efficacy, hemodynamics, and side effects. Materials and Methods: Fifty patients aged between 18 and 80 were randomly assigned to two groups according to American Society of Anesthesiologists (ASA) classification: Group M received midazolam with an initial bolus infusion of 0.04 mg/kg intravenously (i.v.), followed by additional doses of 0.5 mg i.v. midazolam, titrated to achieve a Ramsay sedation scale score of 3–4. Group D received dexmedetomidine with an initial bolus infusion of 1 mcg/kg/hr i.v. over 10 minutes, followed by a continuous infusion of 0.2–0.7 mcg/kg/hr, titrated to achieve an RSS of 3–4. A Mini Mental Status Examination (MMSE) was performed prior to sedation and in the recovery room once the Modified Aldrete Score (MAS) reached 9–10. Patient heart rates, arterial pressure and pain were evaluated. Results: Patients in Group D had lower heart rates at 20, 25, 30, 35 and 40 minutes following the initiation of sedation (p0.05). When patient and surgeon satisfaction was compared between the two groups, Group D showed higher surgeon satisfaction scores (p<0.05). Conclusion: The use of dexmedetomidine for conscious sedation during short, invasive procedures, such as endoscopic retrograde cholangiopancreatography, could be a superior alternative to the use of midazolam. PMID:25610153

  11. Reversal of midazolam sedation with flumazenil following conservative dentistry.

    Science.gov (United States)

    Davies, C A; Sealey, C M; Lawson, J I; Grant, I S

    1990-04-01

    The purpose of this double-blind randomized study was to assess recovery of mental function following reversal of midazolam-induced sedation with the specific antagonist flumazenil (R015-1788) or placebo following conservative dental procedures. Recovery was assessed using choice reaction time and critical flicker fusion threshold, both objective tests of psychomotor function; linear analogue sedation scores and simple memory tests. Assessments were repeated up to 3 h after administration of flumazenil or placebo to discover whether recovery was sustained or whether resedation occurred due to the short duration of action of flumazenil. Flumazenil in doses from 0.5 to 1.0 mg rapidly reversed the sedative and amnesic effects of a mean dose of 8.2 mg of midazolam without apparent evidence of subsequent resedation. Since recovery of mental function in the control group had ordinarily occurred 45 min after administration of placebo, routine reversal of midazolam sedation with flumazenil cannot be justified. Nevertheless, in cases of undue sedation persisting after dental treatment, flumazenil may be used with minimal risk of resedation occurring.

  12. Entonox as a sedative for bone marrow aspiration and biopsy.

    Science.gov (United States)

    Gudgin, E J; Besser, M W; Craig, J I O

    2008-02-01

    Bone marrow aspiration and biopsy can be a painful procedure. Sedation techniques may make this investigation more acceptable to patients, but have the potential to cause life-threatening complications, as well as requiring additional staff and equipment for safe administration. We assessed the use of Entonox, a 50 : 50 mix of nitrous oxide and oxygen, as a sedation and analgesic agent, and compared it to previous experience with the intravenous (i.v.) benzodiazepine midazolam. Patients' perception of pain, and both the operator and patient's views on the ease of the procedure and safety factors were recorded. Twenty-two patients who had previously required i.v. midazolam sedation (16), or who requested sedation (6) were studied. Fifteen of 16 (94%) found Entonox better or equal to midazolam, and only one patient (6%) found it worse. There were no serious adverse events due to Entonox. We have shown, in this small group of patients, that Entonox is an effective, safe alternative to intravenous midazolam for sedation during bone marrow biopsy, and is considered acceptable by both patients and staff. It has the major advantage that no additional staff or facilities are required for safe administration or monitoring the patient during or after the procedure.

  13. Prevalence and impact of alcohol and other drug use disorders on sedation and mechanical ventilation: a retrospective study

    Directory of Open Access Journals (Sweden)

    Jenvey Wendy I

    2007-03-01

    Full Text Available Abstract Background Experience suggests that patients with alcohol and other drug use disorders (AOD are commonly cared for in our intensive care units (ICU's and require more sedation. We sought to determine the impact of AOD on sedation requirement and mechanical ventilation (MV duration. Methods Retrospective review of randomly selected records of adult patients undergoing MV in the medical ICU. Diagnoses of AOD were identified using strict criteria in Diagnostic and Statistical Manual of Mental Disorders, and through review of medical records and toxicology results. Results Of the 70 MV patients reviewed, 27 had AOD (39%. Implicated substances were alcohol in 22 patients, cocaine in 5, heroin in 2, opioids in 2, marijuana in 2. There was no difference between AOD and non-AOD patients in age, race, or reason for MV, but patients with AOD were more likely to be male (21 versus 15, p Conclusion The prevalence of AOD among medical ICU patients undergoing MV is high. Patients with AOD receive higher doses of sedation than their non-AOD counterparts to achieve similar RASS scores but do not undergo longer duration of MV.

  14. Conformal holonomy in MacDowell-Mansouri gravity

    Energy Technology Data Exchange (ETDEWEB)

    Reid, James A., E-mail: j.a.reid@abdn.ac.uk [SUPA Department of Physics, University of Aberdeen, Aberdeen, AB24 3UE (United Kingdom); Wang, Charles H.-T., E-mail: c.wang@abdn.ac.uk [SUPA Department of Physics, University of Aberdeen, Aberdeen, AB24 3UE (United Kingdom); STFC Rutherford Appleton Laboratory, Chilton, Didcot, Oxon, OX11 0QX (United Kingdom)

    2014-03-15

    The MacDowell-Mansouri formulation of general relativity is based on a gauge theory whose gauge algebra depends on the sign of the cosmological constant. In this article, we show that the gauge algebra is uniquely determined by the conformal structure of spacetime itself. Specifically, we show that in vacuum: the spacetime conformal holonomy algebra coincides with the MacDowell-Mansouri gauge algebra for both signs of the cosmological constant, in both Lorentzian and Euclidean metric signatures.

  15. Some Problems of Alasdair MacIntyre’s "Emotivism Thesis"

    OpenAIRE

    2016-01-01

    In this article Alasdair MacIntyre’s thesis concerning emotivist use of moral utterances in contemporary liberal societies is analysed. One tries to show that it needs further clarification since at least three elements of MacIntyre’s argument seem to pose certain problems; these are: ‘discussion halt’ as the source of emotivism, comprehensive doctrines as premises of respective arguments in liberal debates and the problem of incommensurability. These three problematic eleme...

  16. 42 CFR 423.2062 - Applicability of policies not binding on the ALJ and MAC.

    Science.gov (United States)

    2010-10-01

    ... and MAC. 423.2062 Section 423.2062 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2062 Applicability of policies not binding on the ALJ and MAC. (a) ALJs and the MAC are not bound by CMS program guidance, such as...

  17. 42 CFR 423.2050 - Removal of a hearing request from an ALJ to the MAC.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Removal of a hearing request from an ALJ to the MAC..., ALJ Hearings, MAC review, and Judicial Review § 423.2050 Removal of a hearing request from an ALJ to the MAC. If a request for hearing is pending before an ALJ, the MAC may assume responsibility...

  18. 42 CFR 423.2110 - MAC reviews on its own motion.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false MAC reviews on its own motion. 423.2110 Section 423... (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2110 MAC reviews on its own motion. (a) General rule. The MAC may decide...

  19. 42 CFR 423.2102 - Request for MAC review when ALJ issues decision or dismissal.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Request for MAC review when ALJ issues decision or... Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2102 Request for MAC review when ALJ issues decision or dismissal. (a)(1) An enrollee to the ALJ hearing may request a MAC review if the enrollee...

  20. Efficacy of Chloral Hydrate-Hydroxyzine and Chloral Hydrate-Midazolam in Pediatric Magnetic Resonance Imaging Sedation

    Directory of Open Access Journals (Sweden)

    Razieh FALLAH

    2014-04-01

    implications of pharmacokinetics and pharmacodynamics of procedural sedation agents in children. Curr Opin Pediatr 2012;24:225-32.3. Mason KP, Prescilla R, Fontaine PJ, Zurakowski D. Pediatric CT sedation: comparison of dexmedetomidine and pentobarbital. AJR Am J Roentgenol 2011;196(2:W194-8.4. Schulte-Uentrop L, Goepfert MS. Anaesthesia or sedation for MRI in children. Curr Opin Anaesthesiol 2010;23(4:513-7.5. Freeman JM. The risks of sedation for electroencephalograms: data at last. Pediatrics 2001; 108(1:178.6. Cortellazzi P, Lamperti M, Minati L, Falcone C, Pantaleoni C, Caldiroli D. Sedation of neurologically impaired children undergoing MRI: a sequential approach. Paediatr Anaesth 2007;17(7:630-6.7. Haselkorn T, Whittemore AS, Udaltsova N, Friedman GD. Short-term chloral hydrate administration and cancer in humans. Drug Saf 2006; 29(1:67-77.8. Costa LR, Costa PS, Brasileiro SV, Bendo CB, Viegas CM, Paiva SM. Post-Discharge Adverse Events following Pediatric Sedation with High Doses of Oral Medication. J Pediatr 2012;160(5:807-13.9. da Costa LR, da Costa PS, Lima AR. A randomized double-blinded trial of chloral hydrate with or without hydroxyzine versus placebo for pediatric dental sedation. Braz Dent J 2007;18(4:334-40.10. Klein EJ, Brown JC, Kobayashi A, Osincup D, Seidel K. A randomized clinical trial comparing oral, aerosolized intranasal, and aerosolized buccal midazolam. Ann Emerg Med 2011;58(4:323-9.11. Johnson E, Briskie D, Majewski R, Edwards S, Reynolds P. The physiologic and behavioral effects of oral and intranasal midazolam in pediatric dental patients. Pediatr Dent 2010;32(3:229-38.12. Wetzel RC. Anesthesia, Perioperative Care, and Sedation. In: Kliegman RM, Stanton BF, Schor NF, St. Geme JW, Behrman RE, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders; 2011. p. 359-60.13. Cote CJ, Wilson S. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update

  1. Sedation and patient monitoring in vascular and interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    McDermott, V.G.M.; Chapman, M.E.; Gillespie, I. (Royal Infirmary, Edinburgh (United Kingdom))

    1993-08-01

    A postal survey of British and Irish interventional radiologists was carried out in 1991 to assess current practice with respect to sedation and monitoring of patients during angiography and interventional procedures. The response rate was 65%, 49% of patients are fasted prior to angiography and 68% prior to interventional procedures. Radiologists participate in obtaining consent in 60% of cases. Patients are often (50%) sedated for angiography and usually (62-94% depending on the procedure) sedated for interventional procedures. Nurses are present for most procedures, but are given the task of monitoring the patient's vital signs in only 49% of cases. Anaesthetists are present for less than 10% of interventional procedures. The findings indicate a wide variation in practice and a need to standardize practice at a uniform high level. (author).

  2. Registered nurse-administered sedation for gastrointestinalendoscopic procedure

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    The rising use of nonanesthesiologist-administeredsedation for gastrointestinal endoscopy has clinicalsignificances. Most endoscopic patients require someforms of sedation and/or anesthesia. The goals ofthis sedation are to guard the patient's safety, minimizephysical discomfort, to control behavior and todiminish psychological responses. Generally, moderatesedation for these procedures has been offered by thenon-anesthesiologist by using benzodiazepines and/oropioids. Anesthesiologists and non-anesthesiologistpersonnel will need to work together for these challengesand for safety of the patients. The sedationtraining courses including clinical skills and knowledgeare necessary for the registered nurses to facilitate thepatient safety and the successful procedure. However,appropriate patient selection and preparation, adequatemonitoring and regular training will ensure that the useof nurse-administered sedation is a feasible and safetechnique for gastrointestinal endoscopic procedures.

  3. Anaesthesia with sevoflurane in pigeons: minimal anaesthetic concentration (MAC) determination and investigation of cardiorespiratory variables at 1 MAC.

    Science.gov (United States)

    Botman, J; Gabriel, F; Dugdale, A H A; Vandeweerd, J-M

    2016-05-28

    The objective of the study was to determine the minimal anaesthetic concentration (MAC) of sevoflurane (SEVO) in pigeons and investigate the effects of 1 MAC SEVO anaesthesia on cardiovascular and respiratory variables compared with the awake state. This is a prospective, experimental study. Animals were seven healthy adult pigeons. After acclimatisation to handling, heart rate (HR), heart rhythm, respiratory rate (fR), end-expired carbon dioxide tension (PE'CO2), inspired CO2 tension, indirect systolic arterial blood pressure (SAP) and cloacal temperature were measured to determine baseline, 'awake' values. Pigeons were then anaesthetised with SEVO and MAC was determined by the 'bracketing' method. The same variables were monitored during a 40 minute period at 1.0 MAC SEVO for each bird. Mean MAC was 3.0±0.6 per cent for SEVO. During maintenance of anaesthesia at 1.0 MAC, SAP decreased significantly (P<0.001) without any significant change in HR. Although PE'CO2 increased significantly (P=0.001) despite an increase in fR, awake PE'CO2 values were unexpectedly low. Sinus arrhythmias were detected in two birds under SEVO anaesthesia. The times to tracheal intubation and to recovery were 2.5±0.7 and 6.4±1.7 minutes, respectively. Recovery was rapid and uneventful in all birds. In conclusion, SEVO is suitable for anaesthesia in pigeons.

  4. Learning Unix for Mac OS X Tiger Unlock the Power of Unix

    CERN Document Server

    Taylor, Dave

    2005-01-01

    Thoroughly revised and updated for Mac OS X Tiger, this new edition introduces Mac users to the Terminal application and shows you how to navigate the command interface, explore hundreds of Unix applications that come with the Mac, and, most importantly, how to take advantage of both the Mac and Unix interfaces. If you want to master the command-line, this gentle guide to using Unix on Mac OS X Tiger is well worth its cover price

  5. Documentation of competency on sedation for gastrointestinal endoscopy.

    Science.gov (United States)

    Bjorkman, David J

    2010-01-01

    There is general consensus in national and societal guidelines that training for sedation should be part of basic training for endoscopy. There is no clear consensus, however, on the structure of that training. More importantly, these same guidelines are often silent on the specific requirements to demonstrate competency for administration of sedation, ways to document that competency and measures to assure that competency is maintained. In the absence of data demonstrating improved outcomes with specific approaches, the process and principles in this paper are proposed as a starting point to be modified by future research and data.

  6. Upper airway obstruction during midazolam sedation: modification by nasal CPAP.

    Science.gov (United States)

    Nozaki-Taguchi, N; Isono, S; Nishino, T; Numai, T; Taguchi, N

    1995-08-01

    We examined the depressant effect of midazolam on respiration in 21 healthy women undergoing lower abdominal surgery with spinal anaesthesia. Airway gas flow, airway pressure, and the sound of snoring were recorded together with arterial oxygen saturation (SpO2). After spinal anaesthesia was established, subjects were deeply sedated with pentazocine 15 mg followed by incremental doses of midazolam 1 mg i.v. up to 0.1 mg.kg-1. When SpO2 decreased to midazolam sedation for spinal anaesthesia.

  7. [The effects of long-term sedation on intestinal function].

    Science.gov (United States)

    Zielmann, S; Grote, R

    1995-12-01

    Gastrointestinal integrity with intact function are of main importance in critically ill patients, and not only as a route of nutritional support. Drugs used for long-term sedation can lead to disordered gastrointestinal motility. In this study we compared the influence of different combinations of analgesics and sedatives on the intestinal function in mechanically ventilated, critically ill patients. METHODS. A total of 190 patients were evaluated retrospectively. All patients required controlled mechanical ventilation and deep sedation (Ramsay Score 5-6) for 7 days or more due to acute respiratory failure or elevated intracranial pressure. In none of these patients was enteric tube feeding contraindicated. Intact intestinal function was assumed when full enteric tube feeding was achieved on days 5 and 6 of the treatment period. Furthermore, other gastrointestinal motility disorders (e.g. constipation) had to be absent. In all patients the feeding tube was placed in the stomach by the nasogastric route. Corresponding to different combinations of analgesics and sedatives, the 190 patients were divided into 11 groups. The following combinations were used: group 1 (n = 20), fentanyl+flunitrazepam; group 2 (n = 20), fentanyl+midazolam; group 3 (n = 20), fentanyl+thiopentone; group 4 (n = 20) piritramide+midazolam; group 5 (n = 20), piritramide and continuous epidural administration of bupivacaine+midazolam; group 6 (n = 20), piritramide+gamma-aminobutyric acid (GABA); group 7 (n = 20), ketamine+midazolam; group 8 (n = 10), ketamin+methohexitone; group 9 (n = 20), ketamine+propofol; group 10 (n = 10), ketamine+midazolam and GABA; group 11 (n = 10), sufentail+midazolam and methohexitone. Patients in groups 3, 8, 9, 10, and 11 all had severe head injury and elevated intracranial pressure. Group 6 was made up exclusively of elderly patients (> 65 years) without head trauma. RESULTS. The patients in groups 1, 2, and 3 received fentanyl for analgesia and were completely fed

  8. 76 FR 68197 - Clinical Development Programs for Sedation Products; Public Workshop; Request for Comments

    Science.gov (United States)

    2011-11-03

    ... No. FDA-2010-N-0547] Clinical Development Programs for Sedation Products; Public Workshop; Request... development and use of sedation products in adult and pediatric age groups. FDA intends to take into account... development and use of sedation products in adult and pediatric age groups. In the notice, FDA invited...

  9. [Technology of nitrous oxide/oxygen inhalation sedation and its clinical application in pediatric dentistry].

    Science.gov (United States)

    Zhong, Tian; Hu, Daoyong

    2014-02-01

    Dental fear is a common problem in pediatric dentistry. Therefore, sedation for pediatric patients is an essential tool for anxiety management. Nitrous oxide/oxygen inhalation sedation is a safe, convenient, effective way to calm children. The review is about the technology of nitrous oxide/oxygen inhalation sedation and its clinical application in pediatric dentistry.

  10. [Optimal dose of midazolam as premedicant for combined spinal and epidural anesthesia with midazolam sedation].

    Science.gov (United States)

    Tabuchi, Y

    1992-04-01

    Sixty patients who underwent simple total hysterectomy under combined spinal and epidural anesthesia with midazolam sedation, were the subjects of a randomized double-blind comparison of intramuscular midazolam 4, 4.5 and 5 mg, and a dose determined by body weight as premedicants. Similar changes in arterial pressure and heart rate were observed. Furthermore sedation and the value of pulse oximetry on arrival were the same. Besides half the patients were amnesic during the procedure of regional approach. However the dose of premedicant was inversely correlated with the maintenance dose. The reduction of pulse oximetry reading on the induction was smaller, while the requirement of vasopressor occurred earlier following the larger dose of premedicant. In spite of the slower induction, the fall of pulse oximetry reading did not decrease. One hour after incision, the reduction of PaO2 was not dose related. In addition count of leucocyte and the level of blood glucose were unchanged. Premedicant determined by body weight was not correlated with the induction dose and amnesic effect. Our findings suggest midazolam 5 mg intramuscularly is the more preferable dose, but careful attention on arterial pressure is required.

  11. Manufacturing process of high quality phytopreparation on example of herbal sedative

    Directory of Open Access Journals (Sweden)

    Đorđević Sofija

    2013-01-01

    Full Text Available Introduction. Rational phytotherapy is a modern concept of using plant-originated drugs which has emerged from the need to improve phytotherapy in order to make the use of herbal remedies more efficient and safer. The aim of this study was to give the health-care workers more information on the manufacturing process of high quality phytopreparation following principles of Good Manufacturing Practice and Good Laboratory Practice on the example of herbal sedative, Odoval S® capsules. Material and Methods. This study was designed to reflect the production process of a high-quality and safe herbal remedy, starting from defining the formulation and the production procedure to the quality control of raw materials, characterization of the final product, and testing stability of active ingredients in the capsules. Results. Formulation of the phytopreparation, validation of the production process, quality control and stability testing, all together have resulted in the production of capsules with defined valeric acid content (1 mg valeric acid per capsule. Discussion. The preparation is recommended to relieve the symptoms caused by chronic stress (anxiety, irritability, fatigue, lack of concentration, heart palpitations and for mild insomnia. Conclusion. This paper presents the complete cycle of the production of a phytopreparation on the example of a new herbal sedative - Odoval S® capsules.

  12. Victor Bérard et la Macédoine

    Directory of Open Access Journals (Sweden)

    Ivan Savev

    2011-01-01

    Full Text Available Un helléniste convaincu, Victor Bérard, en vient, au début du XXe siècle à soutenir l’existence de « Macédoniens » et le slogan « la Macédoine aux Macédoniens”.Le Congrès de Berlin en 1878 avait laissé la Macédoine aux mains des Ottomans. La Grèce, la Serbie et la Bulgarie, parvenues à ses limites et prévoyant le retrait futur des Ottomans peaufinent les arguments linguistiques et historiques qui justifieront leurs revendications territoriales. Victor Bérard, un helléniste respecté et bon connaisseur de la région sud balkanique, effectue des enquêtes en Macédoine en 1896 et 1903 qu’il publie à Paris.Cette étude montre comment, dans le contexte de la propagande nationaliste des prétendants à la possession de la Macédoine, Victor Bérard en vient progressivement à affirmer qu’il existe une population autochtone, les Macédoniens. Il soutient leur programme pour la constitution d’une fédération ou confédération avec le slogan « la Macédoine aux Macédoniens » ce qui fait toute l’actualité de ses ouvrages.In 1878, the Congress of Berlin had left Macedonia in the hands of the Ottomans. Greece, Serbia and Bulgaria had reached its limits. Anticipating the Ottoman retreat, they polish language and historical arguments that will justify their territorial claims. Victor Bérard, a respected Hellenist and a good expert of the southern Balkans, is doing researches in Macedonia in 1896 and 1903. These will be later published in Paris.This study shows how, in the context of the nationalist propaganda build-up made by the candidates for the possession of Macedonia, Victor Bérard comes progressively to assert the existence of a native population: the Macedonians. He supports their program for the forming of a federation or confederation which slogan would be “Macedonia to Macedonians”. This makes his works very topical.

  13. The many faces of Mac-1 in autoimmune disease.

    Science.gov (United States)

    Rosetti, Florencia; Mayadas, Tanya N

    2016-01-01

    Mac-1 (CD11b/CD18) is a β2 integrin classically regarded as a pro-inflammatory molecule because of its ability to promote phagocyte cytotoxic functions and enhance the function of several effector molecules such as FcγR, uPAR, and CD14. Nevertheless, recent reports have revealed that Mac-1 also plays significant immunoregulatory roles, and genetic variants in ITGAM, the gene that encodes CD11b, confer risk for the autoimmune disease systemic lupus erythematosus (SLE). This has renewed interest in the physiological roles of this integrin and raised new questions on how its seemingly opposing biological functions may be regulated. Here, we provide an overview of the CD18 integrins and how their activation may be regulated as this may shed light on how the opposing roles of Mac-1 may be elicited. We then discuss studies that exemplify Mac-1's pro-inflammatory versus regulatory roles particularly in the context of IgG immune complex-mediated inflammation. This includes a detailed examination of molecular mechanisms that could explain the risk-conferring effect of rs1143679, a single nucleotide non-synonymous Mac-1 polymorphism associated with SLE.

  14. A national guideline for palliative sedation in the Netherlands

    NARCIS (Netherlands)

    Verkerk, Marian; van Wijlick, Eric; Legemaate, Johan; de Graeff, Alexander

    2007-01-01

    The first national guideline on palliative sedation in The Netherlands has been adopted by the General Board of the Royal Dutch Medical Association. By law, the physician is obliged to take this guideline into consideration. In this paper, we present the main principles of the guideline. Palliative

  15. Breast Surgery Using Thoracic Paravertebral Blockade and Sedation Alone

    Directory of Open Access Journals (Sweden)

    James Simpson

    2014-01-01

    Full Text Available Introduction. Thoracic paravertebral block (TPVB provides superior analgesia for breast surgery when used in conjunction with general anesthesia (GA. Although TPVB and GA are often combined, for some patients GA is either contraindicated or undesirable. We present a series of 28 patients who received a TPVB with sedation alone for breast cancer surgery. Methods. A target controlled infusion of propofol or remifentanil was used for conscious sedation. Ultrasound guided TPVB was performed at one, two, or three thoracic levels, using up to 30 mL of local anesthetic. If required, top-up local infiltration analgesia with prilocaine 0.5% was performed by the surgeon. Results. Most patients were elderly with significant comorbidities and had TPVB injections at just one level (54%. Patient choice and anxiety about GA were indications for TVPB in 9 patients (32%. Prilocaine top-up was required in four (14% cases and rescue opiate analgesia in six (21%. Conclusions. Based on our technique and the outcome of the 28 patients studied, TPVB with sedation and ultrasound guidance appears to be an effective and reliable form of anesthesia for breast surgery. TPVB with sedation is a useful anesthetic technique for patients in which GA is undesirable or poses an unacceptable risk.

  16. Nitrous Oxide-Oxygen Sedation: USAF Dental Guidelines.

    Science.gov (United States)

    1981-11-01

    prosthodontic tooth o rd ...r. 1-,t doA ,stry. Also, N20-0, sedation can be used a- . :., :> , ires -uch as periodontal scaling, orthodontic ad. ’ ci ... of...this demonstration and asked to use N 0 the next day when one of his teeth was to be extracted . Colton consented and the results were successful--Wells

  17. Sedation in gastrointestinal endoscopy: Where are we at in 2014?

    Science.gov (United States)

    Ferreira, Alexandre Oliveira; Cravo, Marília

    2015-02-16

    Gastrointestinal endoscopies are invasive and unpleasant procedures that are increasingly being used worldwide. The importance of high quality procedures (especially in colorectal cancer screening), the increasing patient awareness and the expectation of painless examination, increase the need for procedural sedation. The best single sedation agent for endoscopy is propofol which, due to its' pharmacokinetic/dynamic profile allows for a higher patient satisfaction and procedural quality and lower induction and recovery times, while maintaining the safety of traditional sedation. Propofol is an anesthetic agent when used in higher doses than those needed for endoscopy. Because of this important feature it may lead to cardiovascular and respiratory depression and, ultimately, to cardiac arrest and death. Fueled by this argument, concern over the safety of its administration by personnel without general anesthesia training has arisen. Propofol usage seems to be increasing but it's still underused. It is a safe alternative for simple endoscopic procedures in low risk patients even if administered by non-anesthesiologists. Evidence on propofol safety in complex procedures and high risk patients is less robust and in these cases, the presence of an anesthetist should be considered. We review the existing evidence on the topic and evaluate the regional differences on sedation practices.

  18. Disruption of cortical integration during midazolam-induced light sedation.

    Science.gov (United States)

    Liang, Peipeng; Zhang, Han; Xu, Yachao; Jia, Wenbin; Zang, Yufeng; Li, Kuncheng

    2015-11-01

    This work examines the effect of midazolam-induced light sedation on intrinsic functional connectivity of human brain, using a randomized, double-blind, placebo-controlled, cross-over, within-subject design. Fourteen healthy young subjects were enrolled and midazolam (0.03 mg/kg of the participant's body mass, to a maximum of 2.5 mg) or saline were administrated with an interval of one week. Resting-state fMRI was conducted before and after administration for each subject. We focus on two types of networks: sensory related lower-level functional networks and higher-order functions related ones. Independent component analysis (ICA) was used to identify these resting-state functional networks. We hypothesize that the sensory (visual, auditory, and sensorimotor) related networks will be intact under midazolam-induced light sedation while the higher-order (default mode, executive control, salience networks, etc.) networks will be functionally disconnected. It was found that the functional integrity of the lower-level networks was maintained, while that of the higher-level networks was significantly disrupted by light sedation. The within-network connectivity of the two types of networks was differently affected in terms of direction and extent. These findings provide direct evidence that higher-order cognitive functions including memory, attention, executive function, and language were impaired prior to lower-level sensory responses during sedation. Our result also lends support to the information integration model of consciousness.

  19. Does type of instrument influence colonoscopy performance and sedation practice?

    Institute of Scientific and Technical Information of China (English)

    Ramesh P Arasaradnam; Paul D Hurlstone

    2007-01-01

    @@ TO THE EDITOR In the UK, clear guidelines exist as to the expected levelof competence an individual endoscopist should achieve.This is of utmost importance given the variance inpractice among endoscopic departments as highlightedby the National Colonoscopy audit in 2002[1]. The auditedvariables included sedation practice, caecal completion andcomtlication rates, but not the Wpe of instrument used.

  20. Changes in resting neural connectivity during propofol sedation.

    Directory of Open Access Journals (Sweden)

    Emmanuel A Stamatakis

    Full Text Available The default mode network consists of a set of functionally connected brain regions (posterior cingulate, medial prefrontal cortex and bilateral parietal cortex maximally active in functional imaging studies under "no task" conditions. It has been argued that the posterior cingulate is important in consciousness/awareness, but previous investigations of resting interactions between the posterior cingulate cortex and other brain regions during sedation and anesthesia have produced inconsistent results.We examined the connectivity of the posterior cingulate at different levels of consciousness. "No task" fMRI (BOLD data were collected from healthy volunteers while awake and at low and moderate levels of sedation, induced by the anesthetic agent propofol. Our data show that connectivity of the posterior cingulate changes during sedation to include areas that are not traditionally considered to be part of the default mode network, such as the motor/somatosensory cortices, the anterior thalamic nuclei, and the reticular activating system.This neuroanatomical signature resembles that of non-REM sleep, and may be evidence for a system that reduces its discriminable states and switches into more stereotypic patterns of firing under sedation.

  1. Procedural sedation and analgesia for gastrointestinal endoscopy in infants and children: how, with what, and by whom?

    Science.gov (United States)

    Bartkowska-Śniatkowska, Alicja; Rosada-Kurasińska, Jowita; Zielińska, Marzena; Grześkowiak, Małgorzata; Bienert, Agnieszka; Jenkins, Ian A; Ignyś, Iwona

    2014-01-01

    Endoscopic procedures involving the gastrointestinal tract have been successfully developed in paediatric practice over the last two decades, improving both diagnosis and treatment in many children's gastrointestinal diseases. In this group of patients, experience and co-operation between paediatricians/endoscopists and paediatric anaesthesiologists should help to guarantee the quality and safety of a procedure and should additionally help to minimise the risk of adverse events which are greater the smaller the child is. This principle is more and more important especially since the announcement of the Helsinki Declaration on Patient Safety in Anaesthesiology in 2010, emphasising the role of anaesthesiology in promoting safe perioperative care. The Helsinki Declaration has been endorsed by all European anaesthesiology institutions as well as the World Health Organisation's 'Safe Surgery Saves Lives' initiative including the 'Surgical Safety Checklist'. Although most of these procedures could be performed by paediatricians under procedural sedation and analgesia, children with congenital defects and serious coexisting diseases (ASA ≥ III) as well as the usage of anaesthetics (e.g. propofol) must be managed by paediatric anaesthesiologists. We have reviewed the specific principles employed during qualification and performance of procedural sedation and analgesia for gastrointestinal endoscopy in paediatrics. We have also tried to answer the questions as to how, with what, and by whom, procedural sedation for gastrointestinal endoscopy in children should be performed.

  2. Comparison of Pharmacopuncture, Aquapuncture and Acepromazine for Sedation of Horses

    Directory of Open Access Journals (Sweden)

    Stelio P. L. Luna

    2008-01-01

    Full Text Available Pharmacopuncture, the injection of subclinical doses of drugs into acupoints reduces drug undesirable side effects, residues in animal consumption products and treatment costs in large animals. Acepromazine (Acp produces several undesirable effects, such as hypotension. Previous studies with the injection of 1/10 of Acp dose in dog acupoints showed its advantage for sedation, minimizing undesirable effects. Eight horses were randomly submitted to four different treatment protocols according to a Latin Square double-blind design: (i 0.1 ml kg−1 of saline subcutaneously injected at the cervical region, (ii 0.1 mg kg−1 of Acp injected subcutaneously at the cervical region, (iii 0.01 ml kg−1 of saline injected into GV1 acupoint (aquapuncture and (iv 0.01 mg kg−1 of Acp injected into GV1 acupoint (pharmacopuncture. Heart rate, respiratory rate, head height and degree of sedation were measured before and at 30, 60 and 90 min after treatments. Signs of sedation were observed in all treated groups at 30 min and only in 1/10Acp-GV1 at 60 min after the treatments. Only the group treated with 0.1 mg kg−1 of Acp s.c. had significantly lower values of head height at 30 min. Respiratory rate tended to reduce in all groups but was significantly lower only in horses treated with 0.1 mg kg−1 of Acp s.c. Heart rate remained unchanged in all groups. Acp-pharmacopuncture on GV1 in horses produced a mild sedation when compared with the conventional dose of Acp. More investigations are necessary to determine the optimal dosage of Acp-pharmacopuncture for sedation in horses.

  3. Flumazenil reversal of midazolam sedation in the elderly.

    Science.gov (United States)

    Katz, J A; Fragen, R J; Dunn, K L

    1991-01-01

    In a randomized, double-blind, placebo-controlled study, the efficacy of flumazenil in reversing the psychomotor, sedative, and amnestic effects of midazolam in elderly patients after surgery under regional anesthesia was examined. Thirty ASA I-III patients older than 63 years undergoing regional anesthesia with midazolam sedation were randomly assigned to receive either intravenous flumazenil (n = 19) or intravenous placebo (n = 11) after surgery. After assessments of sedation immediately postoperatively, 0.1 mg/ml flumazenil or placebo was given in 2-ml increments twice, a minute apart, and titrated in further 2-ml increments until patients were awake or until 10 ml had been given. Efficacy of reversal was determined using patient and observer assessments of sedation and simple psychomotor tests administered preoperatively and at five, 15, 30, 60, 120, and 180 minutes after test drug administration. Reversal of amnesia was tested by assessing recall of pictures shown at five, 15, 30, and 60 minutes after drug administration. Time profiles of digit substitution test and observer assessment of sedation data were significantly different between the flumazenil and placebo groups. For observer's assessment of sleep, significant differences were noted between flumazenil and placebo groups only at five, 15, and 30 minutes after test drug administration. A significant difference was noted between flumazenil and placebo patients in the ability to recall pictures shown five and 15 minutes after drug administration, but not pictures shown at 30 or 60 minutes. Within-group analysis demonstrated that loss of difference over time between flumazenil and placebo groups was the result of decreasing effect of both flumazenil and midazolam.

  4. Implementation of MAC by using Modified Vedic Multiplier

    Directory of Open Access Journals (Sweden)

    Sreelekshmi M. S.

    2013-09-01

    Full Text Available Multiplier Accumulator Unit (MAC is a part of Digital Signal Processors. The speed of MAC depends on the speed of multiplier. So by using an efficient Vedic multiplier which excels in terms of speed, power and area, the performance of MAC can be increased. For this fast method of multiplication based on ancient Indian Vedic mathematics is proposed in this paper. Among various method of multiplication in Vedic mathematics, Urdhva Tiryagbhyam is used and the multiplication is for 32 X 32 bits. Urdhva Tiryagbhyam is a general multiplication formula applicable to all cases of multiplication. Adder used is Carry Look Ahead adder. The proposed design shows improvement over carry save adder.

  5. Office for iPad and Mac for dummies

    CERN Document Server

    Weverka, Peter

    2015-01-01

    The easy way to work with Office on your iPad or Mac Are you a Mac user who isn't accustomed to working with Microsoft Office? Consider this friendly guide your go-to reference! Written in plain English and packed with easy-to-follow, step-by-step instructions, Office for iPad and Mac For Dummies walks you through every facet of Office, from installing the software and opening files to working with Word, Excel, PowerPoint, and Outlook-and beyond. Plus, you'll discover how to manage files, share content and collaborate online through social media, and find help when you need it. Two things a

  6. A Fair-Priority MAC design in Networked Control System

    Directory of Open Access Journals (Sweden)

    Hongjun Li

    2009-10-01

    Full Text Available Media Access Control (MAC protocols in Wireless Networked Control System (WNCS must minimize the radio energy costs in sensor nodes. Latency and throughput are also important design features for MAC protocols in the applications. But most of them cannot guarantee quality for real-time traffic. This paper studies the state of the art of current real-time MAC protocols, and then introduces a medium access control protocol and a improved protocol that provide multiple priority levels and hard real-time transmission. The channel is accessed by sensors according to their priorities. Sensors send frames in a round manner with same priority. The fairness between different priorities is provided. The channel access procedure is divided into two stages: broadcast period and transmission period. Simulation and experiment results indicate that our protocol provides high channel utilization and bounded delays for real-time communication and can be well applied in the many fields especially the dynamic wireless sensor networks.

  7. An Energy Efficient MAC Proto col for Linear WSNs

    Institute of Scientific and Technical Information of China (English)

    DAI Guoyong; MIAO Chunyu; YING Kezhen; WANG Kai; CHEN Qingzhang

    2015-01-01

    Wireless sensor networks (WSNs) have been employed as an ideal solution in many applications for data gathering in harsh environment. Energy consumption is a key issue in wireless sensor networks since nodes are often battery operated. Medium access control (MAC) pro-tocol plays an important role in energy efficiency in wire-less sensor networks because nodes’ access to the shared medium is coordinated by the MAC layer. An energy ef-ficient MAC protocol is designed for data gathering in linear wireless sensor networks. In order to enhance the performance, when a source node transmits data to the sink, proper relay nodes are selected for forwarding data according to the energy consumption factor and residual energy balance factor. Some simulation experiments are conducted and the results show that, the proposed proto-col provides better energy efficiency and long lifetime than the existing DMAC protocol.

  8. ETEEM- Extended Traffic Aware Energy Efficient MAC Scheme for WSNs

    Directory of Open Access Journals (Sweden)

    Younas Khan

    2016-11-01

    Full Text Available Idle listening issue arises when a sensor node listens to medium despite the absence of data which results in consumption of energy. ETEEM is a variant of Traffic Aware Energy Efficient MAC protocol (TEEM which focuses on energy optimization due to reduced idle listening time and much lesser overhead on energy sources. It uses a novel scheme for using idle listening time of sensor nodes. The nodes are only active for small amount of time and most of the time, will be in sleep mode when no data is available. ETEEM reduces energy at byte level and uses a smaller byte packet called FLAG replacing longer byte SYNC packets of S-MAC and SYNCrts of TEEM respectively. It also uses a single acknowledgement packet per data set hence reducing energy while reducing frequency of the acknowledgment frames sent. The performance of ETEEM is 70% better comparative to other under-consideration MAC protocols.

  9. Cognitive MAC Protocols for General Primary Network Models

    CERN Document Server

    Mehanna, Omar; Gamal, Hesham El

    2009-01-01

    We consider the design of cognitive Medium Access Control (MAC) protocols enabling a secondary (unlicensed) transmitter-receiver pair to communicate over the idle periods of a set of primary (licensed) channels. More specifically, we propose cognitive MAC protocols optimized for both slotted and un-slotted primary networks. For the slotted structure, the objective is to maximize the secondary throughput while maintaining synchronization between the secondary pair and not causing interference to the primary network. Our investigations differentiate between two sensing scenarios. In the first, the secondary transmitter is capable of sensing all the primary channels, whereas it senses only a subset of the primary channels in the second scenario. In both cases, we propose blind MAC protocols that efficiently learn the statistics of the primary traffic on-line and asymptotically achieve the throughput obtained when prior knowledge of primary traffic statistics is available. For the un-slotted structure, the object...

  10. Dolphin natures, human virtues: MacIntyre and ethical naturalism.

    Science.gov (United States)

    Glackin, Shane Nicholas

    2008-09-01

    Can biological facts explain human morality? Aristotelian 'virtue' ethics has traditionally assumed so. In recent years Alasdair MacIntyre has reintroduced a form of Aristotle's 'metaphysical biology' into his ethics. He argues that the ethological study of dependence and rationality in other species--dolphins in particular--sheds light on how those same traits in the typical lives of humans give rise to the moral virtues. However, some goal-oriented dolphin behaviour appears both dependent and rational in the precise manner which impresses MacIntyre, yet anything but ethically 'virtuous'. More damningly, dolphin ethologists consistently refuse to evaluate such behaviour in the manner MacIntyre claims is appropriate to moral judgement. In light of this, I argue that virtues--insofar as they name a biological or ethological category--do not name a morally significant one.

  11. SACRB-MAC: A High-Capacity MAC Protocol for Cognitive Radio Sensor Networks in Smart Grid.

    Science.gov (United States)

    Yang, Zhutian; Shi, Zhenguo; Jin, Chunlin

    2016-03-31

    The Cognitive Radio Sensor Network (CRSN) is considered as a viable solution to enhance various aspects of the electric power grid and to realize a smart grid. However, several challenges for CRSNs are generated due to the harsh wireless environment in a smart grid. As a result, throughput and reliability become critical issues. On the other hand, the spectrum aggregation technique is expected to play an important role in CRSNs in a smart grid. By using spectrum aggregation, the throughput of CRSNs can be improved efficiently, so as to address the unique challenges of CRSNs in a smart grid. In this regard, we proposed Spectrum Aggregation Cognitive Receiver-Based MAC (SACRB-MAC), which employs the spectrum aggregation technique to improve the throughput performance of CRSNs in a smart grid. Moreover, SACRB-MAC is a receiver-based MAC protocol, which can provide a good reliability performance. Analytical and simulation results demonstrate that SACRB-MAC is a promising solution for CRSNs in a smart grid.

  12. SACRB-MAC: A High-Capacity MAC Protocol for Cognitive Radio Sensor Networks in Smart Grid

    Directory of Open Access Journals (Sweden)

    Zhutian Yang

    2016-03-01

    Full Text Available The Cognitive Radio Sensor Network (CRSN is considered as a viable solution to enhance various aspects of the electric power grid and to realize a smart grid. However, several challenges for CRSNs are generated due to the harsh wireless environment in a smart grid. As a result, throughput and reliability become critical issues. On the other hand, the spectrum aggregation technique is expected to play an important role in CRSNs in a smart grid. By using spectrum aggregation, the throughput of CRSNs can be improved efficiently, so as to address the unique challenges of CRSNs in a smart grid. In this regard, we proposed Spectrum Aggregation Cognitive Receiver-Based MAC (SACRB-MAC, which employs the spectrum aggregation technique to improve the throughput performance of CRSNs in a smart grid. Moreover, SACRB-MAC is a receiver-based MAC protocol, which can provide a good reliability performance. Analytical and simulation results demonstrate that SACRB-MAC is a promising solution for CRSNs in a smart grid.

  13. A comparative study of dexmedetomidine vs midazolam for sedation and hemodynamic changes during tympanoplasty and modified radical mastoidectomy

    Directory of Open Access Journals (Sweden)

    Dhara A. Vyas

    2013-10-01

    Full Text Available Background: The benzodiazepine, Midazolam, has been used medication given for sedation in tympanoplasty and mastoidectomy because of a number of beneficial effects. However, Dexmedetomidine is a highly selective α2-adrenoceptor agonist is emerging as preferred choice now a day. The aim of the study is to compare hemodynamic stability and sedation under Dexmedetomidine vs Midazolam during tympanoplasty and modified radical mastoidectomy done under local anaesthesia. Methods: After obtaining ethics clearance from institution and written informed consent from patients, 50 patients of age group 15 to 50 years of ASA grade i & ii were selected and divided in to two groups: Group D: Inj. Dexmedetomidine 1µg/kg over 15min, followed by 0.5µg/kg/hr (n= 25. Group M: Inj. Midazolam 0.05 mg/kg i.v. slowly, followed by 0.01mg/kg/hr (n= 25. Arterial blood pressure, heart rate and sedation level were monitored. The surgeons and patients were asked to rate their satisfaction, using the Likert scale. Results: Sedation score difference between group Dand group M was not statistically significant. There was no statistically significant difference found in diastolic blood pressure of both the groups. There was a significant reduction in heart rate in group D as compared to group M. Surgeon’s satisfaction score and patient’s satisfaction score both were high in group D compare to group M. Conclusions: For monitored anaesthesia care in ENT surgeries performed under local anaesthesia, inj. Dexmedetomidine could be a better alternative over inj. Midazolam. [Int J Basic Clin Pharmacol 2013; 2(5.000: 562-566

  14. Vehicle Health Management Communications Requirements for AeroMACS

    Science.gov (United States)

    Kerczewski, Robert J.; Clements, Donna J.; Apaza, Rafael D.

    2012-01-01

    As the development of standards for the aeronautical mobile airport communications system (AeroMACS) progresses, the process of identifying and quantifying appropriate uses for the system is progressing. In addition to defining important elements of AeroMACS standards, indentifying the systems uses impacts AeroMACS bandwidth requirements. Although an initial 59 MHz spectrum allocation for AeroMACS was established in 2007, the allocation may be inadequate; studies have indicated that 100 MHz or more of spectrum may be required to support airport surface communications. Hence additional spectrum allocations have been proposed. Vehicle health management (VHM) systems, which can produce large volumes of vehicle health data, were not considered in the original bandwidth requirements analyses, and are therefore of interest in supporting proposals for additional AeroMACS spectrum. VHM systems are an emerging development in air vehicle safety, and preliminary estimates of the amount of data that will be produced and transmitted off an aircraft, both in flight and on the ground, have been prepared based on estimates of data produced by on-board vehicle health sensors and initial concepts of data processing approaches. This allowed an initial estimate of VHM data transmission requirements for the airport surface. More recently, vehicle-level systems designed to process and analyze VHM data and draw conclusions on the current state of vehicle health have been undergoing testing and evaluation. These systems make use of vehicle system data that is mostly different from VHM data considered previously for airport surface transmission, and produce processed system outputs that will be also need to be archived, thus generating additional data load for AeroMACS. This paper provides an analysis of airport surface data transmission requirements resulting from the vehicle level reasoning systems, within the context of overall VHM data requirements.

  15. Rand and MacIntyre on moral agency

    OpenAIRE

    Beadle, Ron

    2008-01-01

    This paper contrasts the work of Ayn Rand and Alasdair MacIntyre on moral agency. Both argue that moral agency requires the application of a consistent moral code across relationships with others and that such consistency is rarely evident in the modern social order. However, while MacIntyre holds this failure to be a defining feature of the modern social order, Rand holds this to be a failure of individuals and a marker of a wider cultural confusion. While Rand sees selfishness and capitalis...

  16. Link-layer jamming attacks on S-MAC

    OpenAIRE

    Law, Yee Wei; Hartel, Pieter; Hartog, den, D.N.; Havinga, Paul

    2005-01-01

    We argue that among denial-of-service (DoS) attacks, link-layer jamming is a more attractive option to attackers than radio jamming is. By exploiting the semantics of the link-layer protocol (aka MAC protocol), an attacker can achieve better efficiency than blindly jamming the radio signals alone. In this paper, we investigate some jamming attacks on S-MAC, the level of effectiveness and efficiency the attacks can potentially achieve, and a countermeasure that can be implemented against one o...

  17. Alasdair MacIntyre: relatividad conceptual, tomismo y liberalismo

    Directory of Open Access Journals (Sweden)

    Carlos Isler S.

    2011-01-01

    Full Text Available Influenciado por Thomas Kuhn, Alasdair MacIntyre presenta una teoría conceptualmente relativista sobre las tradiciones de investigación, la cual pretende no sólo describir la estructura de las distintas tradiciones, sino también encontrar un principioque permita resolver las disputas entre ellas. Se expone esta teoría y se analiza su compatibilidad con el tomismo, tradición a la que MacIntyre dice pertenecer, y con el liberalismo, tradición a la que critica con vigor.

  18. Efficacy and safety of deep sedation by non-anesthesiologists for cardiac MRI in children

    Energy Technology Data Exchange (ETDEWEB)

    Jain, Rini [University of Ottawa, Department of Pediatrics, Division of Emergency Medicine, Children' s Hospital of Eastern Ontario, Ottawa (Canada); Petrillo-Albarano, Toni; Stockwell, Jana A. [Emory University School of Medicine, Department of Pediatrics, Division of Critical Care Medicine, Atlanta, GA (United States); Children' s Sedation Services, Children' s Healthcare of Atlanta at Egleston, Atlanta, GA (United States); Parks, W.J. [Emory University School of Medicine, Department of Pediatrics, Division of Cardiology, Children' s Healthcare of Atlanta, Sibley Heart Center, Atlanta, GA (United States); Linzer, Jeffrey F. [Children' s Sedation Services, Children' s Healthcare of Atlanta at Egleston, Atlanta, GA (United States); Emory University School of Medicine, Department of Pediatrics, Division of Emergency Medicine, Atlanta, GA (United States)

    2013-03-15

    Cardiac MRI has become widespread to characterize cardiac lesions in children. No study has examined the role of deep sedation performed by non-anesthesiologists for this investigation. We hypothesized that deep sedation provided by non-anesthesiologists can be provided with a similar safety and efficacy profile to general anesthesia provided by anesthesiologists. This is a retrospective chart review of children who underwent cardiac MRI over a 5-year period. The following data were collected from the medical records: demographic data, cardiac lesion, American Society of Anesthesiologists (ASA) physical status, sedation type, provider, medications, sedation duration and adverse events or interventions. Image and sedation adequacy were recorded. Of 1,465 studies identified, 1,197 met inclusion criteria; 43 studies (3.6%) used general anesthesia, 506 (42.3%) had deep sedation and eight (0.7%) required anxiolysis only. The remaining 640 studies (53.5%) were performed without sedation. There were two complications in the general anesthesia group (4.7%) versus 17 in the deep sedation group (3.4%). Sedation was considered inadequate in 22 of the 506 deep sedation patients (4.3%). Adequate images were obtained in 95.3% of general anesthesia patients versus 86.6% of deep sedation patients. There was no difference in the incidence of adverse events or cardiac MRI image adequacy for children receiving general anesthesia by anesthesiologists versus deep sedation by non-anesthesiologists. In summary, this study demonstrates that an appropriately trained sedation provider can provide deep sedation for cardiac MRI without the need for general anesthesia in selected cases. (orig.)

  19. Effect of sedative-hypnotics, anesthetics and analgesics on sleep architecture in obstructive sleep apnea.

    Science.gov (United States)

    McEntire, Dan M; Kirkpatrick, Daniel R; Kerfeld, Mitchell J; Hambsch, Zakary J; Reisbig, Mark D; Agrawal, Devendra K; Youngblood, Charles F

    2014-11-01

    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. This article critically reviewed the literature relevant to preoperative screening for OSA, prevalence of OSA in surgical populations and changes in postoperative sleep architecture relevant to OSA patients. In particular, we addressed three questions in regard to the effects of sedative-hypnotics, anesthetics and analgesics on sleep architecture, the underlying mechanisms and the relevance to OSA. Indeed, these classes of drugs alter sleep architecture, which likely significantly contributes to abnormal postoperative sleep architecture, exacerbation of OSA and postoperative complications.

  20. Directional Medium Access Control (MAC Protocols in Wireless Ad Hoc and Sensor Networks: A Survey

    Directory of Open Access Journals (Sweden)

    David Tung Chong Wong

    2015-06-01

    Full Text Available This survey paper presents the state-of-the-art directional medium access control (MAC protocols in wireless ad hoc and sensor networks (WAHSNs. The key benefits of directional antennas over omni-directional antennas are longer communication range, less multipath interference, more spatial reuse, more secure communications, higher throughput and reduced latency. However, directional antennas lead to single-/multi-channel directional hidden/exposed terminals, deafness and neighborhood, head-of-line blocking, and MAC-layer capture which need to be overcome. Addressing these problems and benefits for directional antennas to MAC protocols leads to many classes of directional MAC protocols in WAHSNs. These classes of directional MAC protocols presented in this survey paper include single-channel, multi-channel, cooperative and cognitive directional MACs. Single-channel directional MAC protocols can be classified as contention-based or non-contention-based or hybrid-based, while multi-channel directional MAC protocols commonly use a common control channel for control packets/tones and one or more data channels for directional data transmissions. Cooperative directional MAC protocols improve throughput in WAHSNs via directional multi-rate/single-relay/multiple-relay/two frequency channels/polarization, while cognitive directional MAC protocols leverage on conventional directional MAC protocols with new twists to address dynamic spectrum access. All of these directional MAC protocols are the pillars for the design of future directional MAC protocols in WAHSNs.

  1. Comparison of sedation strategies for critically ill patients: a protocol for a systematic review incorporating network meta-analyses

    OpenAIRE

    Hutton, B.; Burry, Lisa D; Kanji, Salmaan; Mehta, Sangeeta; Guenette, Melanie; Martin, Claudio M.; Dean A Fergusson; Adhikari, Neill K.; Egerod, Ingrid; Williamson, David; Straus, Sharon; Moher, David; Ely, E. Wesley; Rose, Louise

    2016-01-01

    Background Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug pharmacokinetic limitations and minimize oversedation, thereby shortening the duration of mechanical ventilation. At present, it is unclear which strategy is most effective, as few have been directly comp...

  2. God, Sport Philosophy, Kinesiology: A MacIntyrean Examination

    Science.gov (United States)

    Twietmeyer, Gregg

    2015-01-01

    Sport philosophy is in crisis. This subdiscipline of kinesiology garners little to no respect and few tenure track lines in kinesiology departments. Why is this the case? Why isn't philosophy held in greater esteem? Is it possible that philosopher Alasdair MacIntyre's (2009) diagnosis found in "God, Philosophy, Universities" could…

  3. Beamforming in Ad Hoc Networks: MAC Design and Performance Modeling

    Directory of Open Access Journals (Sweden)

    Khalil Fakih

    2009-01-01

    Full Text Available We examine in this paper the benefits of beamforming techniques in ad hoc networks. We first devise a novel MAC paradigm for ad hoc networks when using these techniques in multipath fading environment. In such networks, the use of conventional directional antennas does not necessarily improve the system performance. On the other hand, the exploitation of the potential benefits of smart antenna systems and especially beamforming techniques needs a prior knowledge of the physical channel. Our proposition performs jointly channel estimation and radio resource sharing. We validate the fruitfulness of the proposed MAC and we evaluate the effects of the channel estimation on the network performance. We then present an accurate analytical model for the performance of IEEE 802.11 MAC protocol. We extend the latter model, by introducing the fading probability, to derive the saturation throughput for our proposed MAC when the simplest beamforming strategy is used in real multipath fading ad hoc networks. Finally, numerical results validate our proposition.

  4. Link-layer jamming attacks on S-MAC

    NARCIS (Netherlands)

    Law, Yee Wei; Hartel, Pieter; Hartog, den Jerry; Havinga, Paul

    2005-01-01

    We argue that among denial-of-service (DoS) attacks, link-layer jamming is a more attractive option to attackers than radio jamming is. By exploiting the semantics of the link-layer protocol (aka MAC protocol), an attacker can achieve better efficiency than blindly jamming the radio signals alone. W

  5. Roles of Mac-1 and glycoprotein IIb/IIIa integrins in leukocyte-platelet aggregate formation: stabilization by Mac-1 and inhibition by GpIIb/IIIa blockers.

    Science.gov (United States)

    Patko, Zsofia; Csaszar, Albert; Acsady, Gyorgy; Peter, Karlheinz; Schwarz, Meike

    2012-01-01

    Circulating platelet-leukocyte hetero-aggregates play an important role in acute cardiovascular events and hypersensitivity reactions. The association involves the receptor families of selectins and integrin. The objective of this study was to investigate the role of CD11b/CD18 integrin (Mac-1) in hetero-aggregate formation and search for a counter-receptor on platelets ready to interact with Mac-1. As a model of leukocytes, Mac-1 presenting Chinese hamster ovary (CHO) cells were used to evaluate the role of Mac-1 in hetero-aggregate formation. The amount of CHO cell-bound active and inactive platelets was measured by flow cytometry, while the counter-receptors on platelets were identified via using blocking antibodies. We observed significant platelet adhesion on Mac-1-bearing cells when platelet-rich plasma or activated platelets were present. Inactive platelets did not adhere to Mac-1-bearing cells. Addition of fibrinogen, a ligand of Mac-1 significantly increased platelet binding. CD40L was demonstrated to act similarly on Mac-1. Inhibition of platelet GpIIb/IIIa completely abolished CHO cell-platelet aggregation. In our study, we have shown for the first time that Mac-1 mediates the formation of hetero-aggregates without selectin tethering when Mac-1 ligands such as fibrinogen or CD40L are present and blockers of platelet GpIIb/IIIa are able to diminish this interaction.

  6. Pyrogen testing of lipid-based TPN using Mono Mac 6 monocyte cell line and DELFIA

    DEFF Research Database (Denmark)

    Moesby, Lise; Hansen, E W; Christensen, J D

    1997-01-01

    Measurement of lipopolysaccharide (LPS) induced interleukin-6 (IL-6) secretion in Mono Mac 6 cells.......Measurement of lipopolysaccharide (LPS) induced interleukin-6 (IL-6) secretion in Mono Mac 6 cells....

  7. Non-sedation versus sedation with a daily wake-up trial in critically ill patients receiving mechanical ventilation (NONSEDA Trial)

    DEFF Research Database (Denmark)

    Toft, Palle; Olsen, Hanne Tanghus; Jørgensen, Helene Korvenius;

    2014-01-01

    -sedation supplemented with pain management during mechanical ventilation.Control intervention is sedation with a daily wake-up trial.The primary outcome will be all cause mortality at 90 days after randomization. Secondary outcomes will be: days until death throughout the total observation period; coma- and delirium...

  8. The rise of empirical research in medical ethics: a MacIntyrean critique and proposal.

    Science.gov (United States)

    Lawrence, Ryan E; Curlin, Farr A

    2011-04-01

    Hume's is/ought distinction has long limited the role of empirical research in ethics, saying that data about what something is cannot yield conclusions about the way things ought to be. However, interest in empirical research in ethics has been growing despite this countervailing principle. We attribute some of this increased interest to a conceptual breakdown of the is/ought distinction. MacIntyre, in reviewing the history of the is/ought distinction, argues that is and ought are not strictly separate realms but exist in a close relationship that is clarified by adopting a teleological orientation. We propose that, instead of recovering a teleological orientation, society tends to generate its own goals via democratic methods like those described by Rousseau or adopt agnosticism about teleology such as described by Richard Rorty. In both latter scenarios, the distinction between is and ought is obscured, and the role for empirical research grows, but for controversial reasons. MacIntyre warns that the is/ought distinction should remain, but reminds ethicists to make careful arguments about when and why it is legitimate to move from is to ought.

  9. Comparison of Oral and Intravenous Diazepam Sedation for Periodontal Surgery

    OpenAIRE

    1987-01-01

    Intravenous and oral diazepam were evaluated as to their effectiveness in conscious sedation during two similar surgical episodes. Ten patients, six females and four males, from 30 to 60 years of age were included in the study. Patients received either 10 mg oral diazepam and saline intravenous injection or oral placebo and 10 mg intravenous (IV) diazepam at each trial. Half the patients received the oral diazepam first and the other half received the IV diazepam first. Patients were not info...

  10. Benzodiazepines for conscious sedation in the dental office

    OpenAIRE

    Theodoro Weissheimert; Alexandre da Silveira Gerzson; Henderson Eduarth Schwengber; Angelo Menuci Neto

    2016-01-01

    Conventional behavioral conditioning techniques are usually suf fi cient for management of patients with fear and anxiety during dental treatment. When such techniques do not produce the expected results, dental anxiety can be managed using drug-based treatments known as conscious sedation. Anxiety can complicate dental procedures because of effects such as increased blood pressure, hyperventilation, and fainting. Medications such as benzodiazepines can be used to avoid these complicat...

  11. Analysis for commonly prescribed non-sedating antihistamines

    Directory of Open Access Journals (Sweden)

    Michael E. El-Kommos

    2015-03-01

    Full Text Available A comprehensive review with 185 references for the analysis of commonly prescribed members of an important class of drugs, non-sedating antihistamines (NSAs, is presented. The review covers most of the methods described for the analysis of cetirizine (CTZ, ebastine (EBS, fexofenadine (FXD, ketotifen (KET and loratadine (LOR in pure forms, in different pharmaceutical dosage forms and in biological fluids. The review covers the period from 1991 till now.

  12. 42 CFR 405.1110 - MAC reviews on its own motion.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false MAC reviews on its own motion. 405.1110 Section 405....1110 MAC reviews on its own motion. (a) General rule. The MAC may decide on its own motion to review a decision or dismissal issued by an ALJ. CMS or any of its contractors may refer a case to the MAC for it...

  13. Minimum Alveolar Concentration for Blunting Adrenergic Responses (MAC-BAR) of Sevoflurane in Dogs

    OpenAIRE

    YAMASHITA, Kazuto; FURUKAWA, Erika; ITAMI, Takaharu; ISHIZUKA, Tomohito; TAMURA, Jun; MIYOSHI, Kenjirou

    2012-01-01

    It is well known that heart rate or arterial blood pressure may increase in response to surgical stimulation despite the absence of a purposeful movement. However, there is limited information regarding anesthetic requirement for blunting adrenergic response in dogs. This study was designed to compare the minimum alveolar concentrations of sevoflurane required to prevent autonomic response (MAC-BAR) and purposeful movement (MAC) in dogs. Sevoflurane MAC-BAR and MAC were determined in 5 beagle...

  14. Mitral flow propagation velocity in non-sedated healthy cats

    Directory of Open Access Journals (Sweden)

    A.C. Silva

    2014-02-01

    Full Text Available Mitral flow propagation velocity (Vp is an index used to evaluate the left ventricular diastolic function. Its influence on human and small animal cardiopathies has been studied; however there are few reports evaluating this variable in domestic felines. In addition, there is a lack of studies in non-sedated healthy cats. Therefore, the purpose of this study was to establish values for Vp and its correlation with other echocardiographic indexes in non-sedated healthy cats in order to provide new perspectives related to diastolic function in this species. Twenty-six clinically healthy cats were submitted to echocardiography to assess the animals' cardiac conditions. Variables such as age, heart rate (HR, body surface area (BSA, initial (E mitral and late (A mitral ventricular filling waves, isovolumic relaxation time (IVRT and E/IVRT relation were correlated to Vp. No proven relation between any of these variables and Vp was observed in this present study, except for HR and BSA. In the variability analysis, higher values were verified for inter-observer analysis. This study concludes that Vp proved to be an useful index for estimating left ventricular relaxation in non-sedated healthy domestic cats and provides reference ranges for this variable.

  15. Why are second-generation H1-antihistamines minimally sedating?

    Science.gov (United States)

    Hu, Yawen; Sieck, Deidra E; Hsu, Walter H

    2015-10-15

    H1-antihistamines are widely used in treating allergic disorders, e.g., conjunctivitis, urticaria, dermatitis and asthma. The first-generation H1-antihistamines have a much greater sedative effect than the second-generation H1-antihistamines. Researchers could not offer a satisfactory explanations until late 1990s when studies showed that second-generation H1-antihistamines were substrates of P-glycoprotein. P-glycoprotein, expressed in the blood-brain barrier, acts as an efflux pump to decrease the concentration of H1-antihistamines in the brain, which minimizes drug effects on the central nervous system and results in less sedation. P-glycoprotein is found in the apical side of the epithelium. It consists of transmembrane domains that bind substrates/drugs and nucleotide-binding domains that bind and hydrolyze ATP to generate energy for the drug efflux. This review mainly discusses interactions between P-glycoprotein and commonly used second-generation H1-antihistamines. In addition, it describes other possible determining factors of minimal sedating properties of second-generation H1-antihistamines.

  16. Colonoscopy ‘My Way’: Preparation, Anticoagulants, Antibiotics and Sedation

    Directory of Open Access Journals (Sweden)

    Jerome D Waye

    1999-01-01

    Full Text Available Colonoscopy was introduced in the 1960s. The facility with which this technique is performed has been enhanced by vast improvements in instrumentation. In spite of this, physician attitudes concerning colonoscopy have changed little over the past several decades. The diet for precolonoscopic preparation has not been altered for 30 years. Colonoscopists have a great reluctance to use a new preparation instead of the 4 L electrolyte solution, perhaps because this was such a significant advance in colonoscopic cleansing, its predecessor being castor oil and enemas. Physicians continue to be wary of the patient who is taking acetylsalicylic acid in the absence of any studies that show that this is detrimental for polypectomy. The management of the patient on warfarin anticoagulation remains a subject for debate. As for antibiotic prophylaxis, most endoscopy units do not have a standardized approach, although there are good guidelines that, if followed, should decrease the risk of infective endocarditis. Sedation for the endoscopic examination is usually administered by the colonoscopist, although anesthesiologists may, in some countries (and in some defined areas of the United States be the primary administrators of sedation and analgesia. The present article is a personal approach to the following issues: the preparation of the colon for an examination, current thoughts about anticoagulation and acetylsalicylic acid, antibiotic prophylaxis for colonoscopy and the technique for sedation out of the hospital.

  17. The Effect of Intravenous Dexmedetomidine on Spinal Block and Sedation

    Directory of Open Access Journals (Sweden)

    Abdurrahman Ekici

    2015-03-01

    Material and Methods: Our randomised, double-blind study was applied to ASA I-III, 18-75 years old 50 patients scheduled for transurethral surgery. The patients were divided into two groups and spinal anesthesia with 5% levobupivacaine 12.5 mg was administered to all patients. Intravenous dexmedetomidine was received 1 and micro;g/kg for loading dose before 0.5 and micro;g/kg/hour infusion to Group D (n=25. Saline infusion was given 1 and micro;g/kg for loading dose before 0.5 and micro;g/kg/hour infusion to Group S (n=25. Systolic, diastolic and mean arterial pressure, heart rate, peripheral oxygen saturation values, pain and sedation score, the level and duration of motor and sensorial block, recovery and patient comfort score and side effects were recorded. Results: Time to reach maximum block level and duration of spinal anesthesia were longer in Group D than Group S. Sedation scores were significantly higher in Group D than Group S intraoperatively (except 1th minute and postoperatively 10th and 15th minutes. The incidence of side effects, postoperative recovery and patient comfort values were similar between the groups. Conclusion: We found that dexmedetomidine prolongs duration of motor block, provides safe and effective sedation without increasing the incidence of side effect in the patients under spinal anesthesia. [Cukurova Med J 2015; 40(1.000: 55-62

  18. Dexmedetomidine versus Remifentanil for Sedation during Awake Fiberoptic Intubation

    Directory of Open Access Journals (Sweden)

    Davide Cattano

    2012-01-01

    Full Text Available This study compared remifentanil and dexmedetomidine as awake fiberoptic intubation (AFOI anesthetics. Thirty-four adult ASA I-III patients were enrolled in a double-blinded randomized pilot study to receive remifentanil (REM or dexmedetomidine (DEX for sedation during AFOI (nasal and oral. Thirty patients completed the study and received 2 mg midazolam IV and topical anesthesia. The REM group received a loading dose of 0.75 mcg/kg followed by an infusion of 0.075 mcg/kg/min. The DEX group received a loading dose of 0.4 mcg/kg followed by an infusion of 0.7 mcg/kg/hr. Time to sedation, number of intubation attempts, Ramsay sedation scale (RSS score, bispectral index (BIS, and memory recall were recorded. All thirty patients were successfully intubated by AFOI (22 oral intubations/8 nasal. First attempt success rate with AFOI was higher in the REM group than the DEX group, 72% and 38% (P=0.02, respectively. The DEX group took longer to attain RSS of ≥3 and to achieve BIS <80, as compared to the REM group. Postloading dose verbal recall was poorer in the DEX group. Dexmedetomidine seems a useful adjunct for patients undergoing AFOI but is dependent on dosage and time. Further studies in the use of dexmedetomidine for AFOI are warranted.

  19. MDS-Mac: a scheduled MAC for localization, time-synchronisation and communication in underwater acoustic networks

    NARCIS (Netherlands)

    Kleunen, van Wouter; Meratnia, Nirvana; Havinga, Paul J.M.

    2012-01-01

    In this paper we describe a design for an underwater MAC protocol which combines localization, time-synchronisation and communication. This protocol is designed for small-scale clustered networks in which all nodes are able to ommunicate with each other. We consider an integrated design of localizat

  20. CoR-MAC: Contention over Reservation MAC Protocol for Time-Critical Services in Wireless Body Area Sensor Networks.

    Science.gov (United States)

    Yu, Jeongseok; Park, Laihyuk; Park, Junho; Cho, Sungrae; Keum, Changsup

    2016-05-09

    Reserving time slots for urgent data, such as life-critical information, seems to be very attractive to guarantee their deadline requirements in wireless body area sensor networks (WBASNs). On the other hand, this reservation imposes a negative impact on performance for the utilization of a channel. This paper proposes a new channel access scheme referred to as the contention over reservation MAC (CoR-MAC) protocol for time-critical services in wireless body area sensor networks. CoR-MAC uses the dual reservation; if the reserved time slots are known to be vacant, other nodes can access the time slots by contention-based reservation to maximize the utilization of a channel and decrease the delay of the data. To measure the effectiveness of the proposed scheme against IEEE 802.15.4 and IEEE 802.15.6, we evaluated their performances with various performance indexes. The CoR-MAC showed 50% to 850% performance improvement in terms of the delay of urgent and time-critical data according to the number of nodes.

  1. 42 CFR 405.1050 - Removal of a hearing request from an ALJ to the MAC.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Removal of a hearing request from an ALJ to the MAC... Removal of a hearing request from an ALJ to the MAC. If a request for hearing is pending before an ALJ, the MAC may assume responsibility for holding a hearing by requesting that the ALJ send the...

  2. 42 CFR 405.1102 - Request for MAC review when ALJ issues decision or dismissal.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Request for MAC review when ALJ issues decision or...) Medicare Appeals Council Review § 405.1102 Request for MAC review when ALJ issues decision or dismissal. (a)(1) A party to the ALJ hearing may request a MAC review if the party files a written request for...

  3. 42 CFR 405.1108 - MAC actions when request for review or escalation is filed.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false MAC actions when request for review or escalation...) Medicare Appeals Council Review § 405.1108 MAC actions when request for review or escalation is filed. (a) Except as specified in paragraphs (c) and (d) of this section, when a party requests that the MAC...

  4. 42 CFR 423.2108 - MAC Actions when request for review is filed.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false MAC Actions when request for review is filed. 423... Hearings, MAC review, and Judicial Review § 423.2108 MAC Actions when request for review is filed. (a) General. Except as specified in paragraph (c) of this section, when an enrollee requests that the...

  5. Traffic-adaptive duty cycle adaptation in TR-MAC protocol for wireless sensor networks

    NARCIS (Netherlands)

    Morshed, Sarwar; Baratchi, Mitra; Heijenk, Geert

    2016-01-01

    The Medium Access Control (MAC) layer can influence the energy consumption of a wireless sensor network (WSN) to a significant level. TR-MAC is an energy-efficient preamble sampling based MAC protocol for low power WSNs suitable for low data rate and low duty cycle scenario. However, low data rate i

  6. Library Signage: Applications for the Apple Macintosh and MacPaint.

    Science.gov (United States)

    Diskin, Jill A.; FitzGerald, Patricia

    1984-01-01

    Describes specific applications of the Macintosh computer at Carnegie-Mellon University Libraries, where MacPaint was used as a flexible, easy to use, and powerful tool to produce informational, instructional, and promotional signage. Profiles of system hardware and software, an evaluation of the computer program MacPaint, and MacPaint signage…

  7. A Comparative Study on the Sedative Effect of Oral Midazolam and Oral Promethazine Medication in Lumbar Puncture

    Directory of Open Access Journals (Sweden)

    Hojjat DERAKHSHANFAR

    2013-06-01

    Dent 2002;26(2:161-4.16. Naziri F, Alijanpour E, Rabei SM, Seifi S, Mir M, Hosseinpour M, et al. Comparison of oral Midazolam with oral Promethazine on decreasing anxiety of children when separated from their parents before anesthesia. J Babol Univ Medl Sci  2007;9(4:29-32.17. Parkinson L, Hughes J, Gill A, Billingham I, Ratcliffe J, Choonara I. A randomized controlled trial of sedation in the critically ill. Paediatr Anaesth 1997;7(5: 405-10. 18. Crean P. Sedation and neuromuscular blockade in paediatric intensive care;practice in the United Kingdom and North America. Paediatr Anaesth 2004;14(6:439-42.19. Schmidt AP, Valinetti EA, Bandeira D, Bertacchi MF, Simões CM, Auler JO Jr. Effects of preanesthetic administration of midazolam, clonidine, or dexmedetomidine on postoperative pain and anxiety in children. Paediatr Anaesth 2007;17(7:667-74.20. Pfeil N, Uhlig U, Kostev K, Carius R, Schröder H, Kiess W, et al. Antiemetic edications in children with presumed infectious gastroenteritis--harmacoepidemiology in Europe and Northern America. J Pediatr 2008;153(5:659-62.

  8. Midazolam sedation to produce complete amnesia for bronchoscopy: 2 years' experience at a district general hospital.

    Science.gov (United States)

    Williams, T J; Bowie, P E

    1999-05-01

    Patients may find bronchoscopy without sedation unpleasant. There is some evidence that patient satisfaction correlates with amnesia for the procedure. For several years we have used doses of midazolam sufficient to put patients lightly asleep hoping to produce complete amnesia. We looked at practical aspects of this technique over a 2-year period. We studied 337 consecutive patients. They were 219 men and 118 women of mean age 63 +/- 12.4 (SD). Sixty-seven patients were aged 75 years or over and the eldest was 86. Sixty-three patients were already hospital inpatients but the remainder were seen as day cases. Midazolam was given by slow i.v. injection over several minutes until the patient was judged to be lightly asleep. Patients were given supplemental oxygen (3 l min-1) and monitored by ECG and pulse oximetry. A note was made of the time at which they awakened, defined as when nursing staff felt the patients were awake enough to have a cup of tea and toast. Patients were asked if they had any memory of the procedure both on awakening and when seen a few days later to discuss the results. The procedures were carried out in a well-staffed Day Case Unit with a recovery area. The mean dose of midazolam used was 10.8 mg (mean +/- SD = 0.16 +/- 0.095 mg kg-1). The midazolam was given over a median of 4 min (range 1-15 min). Patients took 59 +/- 45 min (mean +/- SD) to wake up. Twenty-eight patients were given flumazanil to reverse the sedation (11 for concern over bleeding following biopsies, three for desaturation during and three after procedure, four as they were frail, two as they were restless, two as they were hypotensive after procedure and three for miscellaneous reasons). Only nine patients could remember any part of the procedure. Incremental doses of midazolam given slowly until patients are lightly asleep almost invariably produce complete amnesia for bronchoscopy. This is a safe technique but patients need careful monitoring and may require reversal of

  9. Una lectura interpretativa de Tras la virtud, de Alasdair MacIntyre - An Interpretive Reading of After Virtue, by Alasdair MacIntyre

    Directory of Open Access Journals (Sweden)

    Fernando Fernández-Llebrez

    2010-12-01

    Full Text Available This article centers on the thought of Alasdair MacIntyre, whose most prominente work, After Virtue, is considered a classic of political science. In contrast with other reviews, this article will examine After Virtue within the broader context of MacIntyre’s thinking and publications. An overview of MacIntyre’s literary corpus and the evolution of his thinking will shed light on the volume examined and trace certain ideas that are characteristic of this Scottish political philosopher. Matters that remained unsettled in After Virtue have become over time more defined in MacIntyre’s thinking, such as the influence exerted upon him by Thomas Aquinas.

  10. The Superconvergence Phenomenon and Proof of the MAC Scheme for the Stokes Equations on Non-uniform Rectangular Meshes

    KAUST Repository

    Li, Jichun

    2014-12-02

    For decades, the widely used finite difference method on staggered grids, also known as the marker and cell (MAC) method, has been one of the simplest and most effective numerical schemes for solving the Stokes equations and Navier–Stokes equations. Its superconvergence on uniform meshes has been observed by Nicolaides (SIAM J Numer Anal 29(6):1579–1591, 1992), but the rigorous proof is never given. Its behavior on non-uniform grids is not well studied, since most publications only consider uniform grids. In this work, we develop the MAC scheme on non-uniform rectangular meshes, and for the first time we theoretically prove that the superconvergence phenomenon (i.e., second order convergence in the (Formula presented.) norm for both velocity and pressure) holds true for the MAC method on non-uniform rectangular meshes. With a careful and accurate analysis of various sources of errors, we observe that even though the local truncation errors are only first order in terms of mesh size, the global errors after summation are second order due to the amazing cancellation of local errors. This observation leads to the elegant superconvergence analysis even with non-uniform meshes. Numerical results are given to verify our theoretical analysis.

  11. Variables Influencing the Depth of Conscious Sedation in Plastic Surgery: A Prospective Study

    Science.gov (United States)

    Kim, Wonwoo; Park, Hyochun; Kim, Hoonnam

    2017-01-01

    Background Conscious sedation has been widely utilized in plastic surgery. However, inadequate research has been published evaluating adequate drug dosage and depth of sedation. In clinical practice, sedation is often inadequate or accompanied by complications when sedatives are administered according to body weight alone. The purpose of this study was to identify variables influencing the depth of sedation during conscious sedation for plastic surgery. Methods This prospective study evaluated 97 patients who underwent plastic surgical procedures under conscious sedation. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and glucose levels were measured. Midazolam and ketamine were administered intravenously according to a preset protocol. Bispectral index (BIS) recordings were obtained to evaluate the depth of sedation 4, 10, 15, and 20 minutes after midazolam administration. Associations between variables and the BIS were assessed using multiple regression analysis. Results Alcohol intake and female sex were positively associated with the mean BIS (P<0.01). Age was negatively associated with the mean BIS (P<0.01). Body mass index (P=0.263), creatinine clearance (P=0.832), smoking history (P=0.398), glucose (P=0.718), AST (P=0.729), and ALT (P=0.423) were not associated with the BIS. Conclusions Older patients tended to have a greater depth of sedation, whereas females and patients with greater alcohol intake had a shallower depth of sedation. Thus, precise dose adjustments of sedatives, accounting for not only weight but also age, sex, and alcohol consumption, are required to achieve safe, effective, and predictable conscious sedation. PMID:28194341

  12. Sedation-associated hiccups in adults undergoing gastrointestinal endoscopy and colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Chien Cheng Liu; Cheng Yuan Lu; Chih Fang Changchien; Ping Hsin Liu; Daw Shyong Perng

    2012-01-01

    AIM:To investigate whether the incidence of hiccups in patients undergoing esophagogastroduodenoscopy (EGD) or same-day bidirectional endoscopy (EGD and colonoscopy; BDE) with sedation is different from those without sedation in terms of quantity,duration and typical onset time.METHtODS:Consecutive patients scheduled for elective EGD or same-day BDE at the gastrointestinal endoscopy unit or the health examination center were allocated to two groups:EGD without sedation (Group A)and BDE with sedation (Group B).The use of sedation was based on the patients' request.Anesthesiologists participated in this study by administrating sedative drugs as usual.A single experienced gastroenterologist performed both the EGD and the colonoscopic examinations for all the patients.The incidence,duration and onset time of hiccups were measured in both groups.In addition,the association between clinical variables and hiccups were analyzed.RESULTS:A total of 435 patients were enrolled in the study.The incidences of hiccups in the patients with and without sedation were significantly different (20.5% and 5.1%,respectively).The use of sedation for patients undergoing endoscopy was still significantly associated with an increased risk of hiccups (adjusted odds ratio:8.79,P < 0.001) after adjustment.The incidence of hiccups in males under sedation was high (67.4%).The sedated patients who received 2 mg midazolam developed hiccups more frequently compared to those receiving 1 mg midazolam (P =0.0028).The patients with the diagnosis of gastroesophageal reflux disease (GERD) were prone to develop hiccups (P =0.018).CONCLUSION:Male patients undergoing EGD or BDE with sedation are significantly more likely to suffer from hiccups compared to those without sedation.Midazolam was significantly associated with an increased risk of hiccups.Furthermore,patients with GERD are prone to develop hiccups.

  13. Intravenous labetolol in treating hypertensive crisis following dexmedetomidine infusion for procedural sedation.

    Science.gov (United States)

    Muthiah, Thilaka; Moni, Amarnath; Mathews, Lailu; Balaji, Sudarshan

    2016-03-01

    Dexmedetomidine is widely used for procedural sedation because of its unique combination of sedation, analgesia, and anxiolysis with minimal respiratory depression. Transient hypertension has been reported during the use of dexmedetomidine which is usually benign and is taken over by the hypotensive response on continuing the infusion. We report a case of hypertensive crisis following dexmedetomidine infusion used for procedural sedation, necessitating discontinuation of the infusion and treatment of hypertension. The dilemmas involved in treating hypertension caused by dexmedetomidine are discussed.

  14. Distinguishing and Second-Preimage Attacks on CBC-Like MACs

    Science.gov (United States)

    Jia, Keting; Wang, Xiaoyun; Yuan, Zheng; Xu, Guangwu

    This paper first presents a new distinguishing attack on the CBC-MAC structure based on block ciphers in cipher block chaining (CBC) mode. This attack detects a CBC-like MAC from random functions. The second result of this paper is a second-preimage attack on the CBC-MAC, which is an extension of the attack of Brincat and Mitchell. The attack also covers MT-MAC, PMAC and MACs with three-key enciphered CBC mode. Instead of exhaustive search, both types of attacks are of birthday attack complexity.

  15. A Pilot Study of Ketamine versus Midazolam/Fentanyl Sedation in Children Undergoing GI Endoscopy

    Science.gov (United States)

    Lightdale, Jenifer R.; Mitchell, Paul D.; Fredette, Meghan E.; Mahoney, Lisa B.; Zgleszewski, Steven E.; Scharff, Lisa; Fox, Victor L.

    2011-01-01

    Background. Ketamine sedation has been found superior by physician report to traditional sedation regimens for pediatric endoscopy. Goal. To objectively compare sedation with ketamine versus midazolam/fentanyl for children undergoing gastrointestinal endoscopy. Study. Patients received one of two regimens and were independently monitored using a standardized rating scale. Results. There were 2 episodes of laryngospasm during ketamine sedation. Univariate analyses showed patients sedated with ketamine (n = 17) moved more (median 25% of procedure time versus 8%, P = .03) and required similar low levels of restraint (0.83% versus 0.25%, P = .4) as patients sedated with midazolam/fentanyl (n = 20). Age-adjusted analyses suggested that patients sedated with ketamine were comparably more quiet (P = .002). Conclusions. A pilot trial of ketamine at our institution was associated with episodes of laryngospasm. In addition, children sedated with ketamine moved and required restraint similarly to patients sedated with midazolam/fentanyl. Physician perceptions may be affected by the fact that children who received ketamine were less likely to vocalize distress. PMID:21760813

  16. A Pilot Study of Ketamine versus Midazolam/Fentanyl Sedation in Children Undergoing GI Endoscopy

    Directory of Open Access Journals (Sweden)

    Jenifer R. Lightdale

    2011-01-01

    Full Text Available Background. Ketamine sedation has been found superior by physician report to traditional sedation regimens for pediatric endoscopy. Goal. To objectively compare sedation with ketamine versus midazolam/fentanyl for children undergoing gastrointestinal endoscopy. Study. Patients received one of two regimens and were independently monitored using a standardized rating scale. Results. There were 2 episodes of laryngospasm during ketamine sedation. Univariate analyses showed patients sedated with ketamine (=17 moved more (median 25% of procedure time versus 8%, =.03 and required similar low levels of restraint (0.83% versus 0.25%, =.4 as patients sedated with midazolam/fentanyl (=20. Age-adjusted analyses suggested that patients sedated with ketamine were comparably more quiet (=.002. Conclusions. A pilot trial of ketamine at our institution was associated with episodes of laryngospasm. In addition, children sedated with ketamine moved and required restraint similarly to patients sedated with midazolam/fentanyl. Physician perceptions may be affected by the fact that children who received ketamine were less likely to vocalize distress.

  17. Comparison of oral Midazolam-Ketamine and Midazolam-Promethazine as sedative agents in pediatric dentistry

    Directory of Open Access Journals (Sweden)

    Mojtaba Vahid Golpayegani

    2012-01-01

    Conclusion: Under the current circumstances, Ketamine/Midazolam combination provided sufficient sedative effect in lower doses. However, Midazolam/Promethazine combination did not produce similar results.

  18. Propofol Affects Different Human Brain Regions Depending on Depth of Sedation

    Institute of Scientific and Technical Information of China (English)

    Xiang Quan; Tie-hu Ye; Si-fang Lin; Liang Zou; Shou-yuan Tian

    2015-01-01

    Objective To investigate the effect of propofol on brain regions at different sedation levels and the association between changes in brain region activity and loss of consciousness using blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) and bispectral index (BIS) monitoring. Methods Forty-eight participants were enrolled at Peking Union Medical College Hospital from October 2011 to March 2012 and randomly assigned to a mild or a deep sedation group using computer- generated random numbers. Preliminary tests were performed a week prior to scanning to determine target effect site concentrations based on BIS and concomitant Observer's Assessment of Alertness/Sedation scores while under propofol. Within one week of the preliminary tests where propofol dose-response was established, BOLD-fMRI was conducted to examine brain activation with the subject awake, and with propofol infusion at the sedation level. Results Mild propofol sedation inhibited left inferior parietal lobe activation. Deep sedation inhibited activation of the left insula, left superior temporal gyrus, and right middle temporal gyrus. Compared with mild sedation, deep propofol sedation inhibited activation of the left thalamus, precentral gyrus, anterior cingulate, and right basal nuclei. Conclusion Mild and deep propofol sedation are associated with inhibition of different brain regions, possibly explaining differences in the respective loss of consciousness processes.

  19. Prospective pilot trial of dexmedetomidine sedation for awake diagnostic flexible bronchoscopy.

    Science.gov (United States)

    Lee, Keat; Orme, Ruari; Williams, Daryl; Segal, Reny

    2010-10-01

    Dexmedetomidine has the favorable properties of sedation, sympatholysis, analgesia, and a low risk of apnea. These properties suggest that dexmedetomidine may be useful in procedural sedation. In view of this, we conducted a pilot trial to determine the feasibility of using dexmedetomidine as a sole agent for providing sedation during awake diagnostic flexible bronchoscopy. Patients presenting for awake diagnostic flexible bronchoscopy consented to participate in a trial of dexmedetomidine sedation for the procedure. In addition to local anesthetic topicalization of the airways, dexmedetomidine was infused at 0.5 μg/kg over 10 minutes followed by an infusion of 0.2 to 0.7 μg/kg/h titrating to a Ramsay Sedation Scale score of 3. Hemodynamic parameters (heart rate, blood pressure), oxygenation status (pulse oximetry), adverse events, use of rescue sedation, and patient and proceduralist satisfaction were recorded during the trial. Five of 9 recruited patients required rescue sedation to allow the procedure to proceed. Dexmedetomidine as a sole agent at an infusion of 0.5 μg/kg over 10 minutes followed by an infusion of 0.2 to 0.7 μg/kg/h is unable to provide adequate sedation for awake diagnostic flexible bronchoscopy without the need for rescue sedation in a large proportion of patients.

  20. Secure MAC for Wireless Sensor Networks through RBFNN

    Directory of Open Access Journals (Sweden)

    P.Sankara Rao

    2010-08-01

    Full Text Available This paper discusses an application of a neural network in wireless sensor network security. It presents a Radial Basic Function Neural Network based media access control protocol (MAC to secure a CSMA-based wireless sensor network against the denial-of-service attacks launched by adversaries. The Radial Basic Function Neural Network enhances the security of a WSN by constantly monitoring the parameters that exhibit unusual variations in case of an attack. The RBFN shuts down the MAC layer and the physical layer of the sensor node when the suspicion factor, the output of the MLP, exceeds a preset threshold level. The MLP-guarded secure WSN is implemented using the Prowler simulator. Simulation results show that the MLP helps in extending the lifetime of the WSN.

  1. Activity Modelling and Comparative Evaluation of WSN MAC Security Attacks

    DEFF Research Database (Denmark)

    Pawar, Pranav M.; Nielsen, Rasmus Hjorth; Prasad, Neeli R.

    2012-01-01

    and initiate security attacks that disturb the normal functioning of the network in a severe manner. Such attacks affect the performance of the network by increasing the energy consumption, by reducing throughput and by inducing long delays. Of all existing WSN attacks, MAC layer attacks are considered....... The second aim of the paper is to simulate these attacks on hybrid MAC mechanisms, which shows the performance degradation of aWSN under the considered attacks. The modelling and implementation of the security attacks give an actual view of the network which can be useful in further investigating secure......Applications of wireless sensor networks (WSNs) are growing tremendously in the domains of habitat, tele-health, industry monitoring, vehicular networks, home automation and agriculture. This trend is a strong motivation for malicious users to increase their focus on WSNs and to develop...

  2. On the Development of Low Power MAC Protocol for WBANs

    CERN Document Server

    Ullah, Sana; Kwak, Kyung Sup

    2009-01-01

    Current advances in wireless communication, microelectronics, semiconductor technologies, and intelligent sensors have contributed to the development of unobtrusive WBANs. These networks provide long term health monitoring of patients without any constraint in their normal activities. Traditional MAC protocols do not accommodate the assorted WBAN traffic requirements in a power efficient manner. In this paper, we present a brief discussion on the development process of a low power MAC protocol for WBANs. We observe the behavior of a beacon-enabled IEEE 802.15.4 for on-body sensor networks. We further propose a low power technique called traffic based wakeup mechanism for a WBAN that exploits the traffic patterns of the BAN Nodes to ensure power efficient and reliable communication.

  3. Magnetic activated cell sorting (MACS): utility in assisted reproduction.

    Science.gov (United States)

    Makker, Kartikeya; Agarwal, Ashok; Sharma, Rakesh K

    2008-07-01

    Assisted reproductive techniques (ART) have now been extensively incorporated in the management of infertile couples. But even after rapid methodological and technological advances the success rates of these procedures have been below expectations. This has led to development of many sperm preparation protocols to obtain an ideal semen sample for artificial reproduction. Sperm apoptosis has been heavily linked to failures in reproductive techniques. One of the earliest changes shown by apoptotic spermatozoa is externalization of phosphatidyl serine. Magnetic activated cell sorting (MACS) is a novel sperm preparation technique that separates apoptotic and non-apoptotic spermatozoa based on the expression of phosphatidylserine. This has led to the incorporation of MACS as a sperm preparation technique. The review highlights the principle and mechanism of this novel technique and enumerates its advantages as a sperm preparation technique. Its utility in ART as an efficient tool for sperm recovery and its application in cryopreservation of semen samples is also explained.

  4. LHC@home online tutorial for Mac users - recording

    CERN Document Server

    CERN. Geneva

    2016-01-01

    A step-by-step online tutorial about LHC@home for Mac users by Alexandre Racine. It contains detailed instructions on how-to-join this volunteer computing project.  There are 3 screen capture videos with the real installation process accelerated attached to the event page. This 5' video is linked from http://lhcathome.web.cern.ch/join-us Also from the CDS e-learning category.

  5. Mac OS X Server Snow Leopard 雪豹

    Institute of Scientific and Technical Information of China (English)

    王炳晨

    2010-01-01

    日前,苹果公司宣布推出Mac OSX Server Snow Leopard服务器系统。这是一个真正意义的全64位操作系统,为充分发挥多核心处理器和内存的性能而设计,且完全兼容32位应用程序。

  6. Remifentanil-Ketamine versus Fentanyl-Ketamine sedation in patients undergoing phacoemulsification with topical anesthesia: comparison of intraocular pressure changes and sedation quality

    Directory of Open Access Journals (Sweden)

    Bahram Soleymani

    2008-04-01

    Full Text Available BACKGROUND: Narcotics and sedatives can reduce intraocular pressure. This study was performed to evaluate the effect of remifentanil plus ketamine on intraocular pressure and sedation quality in comparison with fentanyl plus ketamine during and after operation in patients undergoing phacoemulsification with topical anesthesia.METHODS: Forty four patients were randomized into two groups to receive either a continuous infusion of remifentanil (0.2 µg/kg/min for 4 min and then 0.1 µg/kg/min: Group R, n=22 or bolus intravenous fentanyl (1.5 µg/kg: Group F, n=22 for sedation. Patients in both groups received low dose ketamine (0.15 mg/kg intravenously. Topical anesthesia was performed using tetracaine 0.5% eye drop in both eyes. Intraocular pressure was measured in non-operative eye before sedation (baseline, 2 minutes after sedation, before intraocular lens insertion, at the end of operation and 15 minutes after the end of operation using Schiötz tonometer. Sedation, cooperation, satisfaction and pain scores and also postoperative nausea and vomiting were recorded in all patients. Surgeon satisfaction scores were evaluated at the end of operation.RESULTS: The intraocular pressure did not differ significantly between the two groups throughout the study. The mean (SD intraocular pressures 2 minutes after sedation, before intraocular lens insertion, at the end of operation and 15 minutes after the end of operation in recovery room were all less than that of baseline in both groups, but the baseline value was decreased only significantly (P CONCLUSIONS: Combination of remifentanil infusion and intravenous ketamine did not offer any advantages over the combination of intravenous fentanyl and ketamine in order to prevent intraocular pressure rising during phacoemulsification. The lower incidence of postoperative nausea and vomiting and higher rate of appropriate sedation in fentanyl group suggested fentanyl as a more suitable medication for systemic

  7. On the Selection of MAC Optimised Routing Protocol for VANET

    Directory of Open Access Journals (Sweden)

    Kanu Priya

    2017-02-01

    Full Text Available In today‘s era of modernization, the concept of smart vehicles, smart cities and automated vehicles is trending day by day. VANET (Vehicular Adhoc Network has also been emerging as a potential applicant to enable these smart applications. Though VANET is very much similar to MANET (Mobile Adhoc Network but VANET has more severe challenges as compared to MANET due to hostile channel conditions and high degree of mobility. So lot of work related to MAC and Network Layer need attention from the network designers. In this paper MAC Layer has been optimised in terms of Queue Size by using QoS Parameters namely Packet Collision Rate, Packet Drop Rate, Throughput Rate and Broadcast Rate. In doing so, simulative investigations have been done to find out optimum queue size. For this purpose various routing protocols namely DSDV, AODV, ADV and GOD have been considered and optimum queue length for each of these have been obtained. Further the most efficient routing protocol has also been identified. Moreover this paper also compares the performance of most efficient Routing Protocols selected in terms of QoS parameters for different MAC Interfaces.

  8. 42 CFR 423.2140 - MAC Review of ALJ decision in a case remanded by a Federal District Court.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false MAC Review of ALJ decision in a case remanded by a... BENEFIT Reopening, ALJ Hearings, MAC review, and Judicial Review § 423.2140 MAC Review of ALJ decision in..., when a case is remanded by a Federal District Court for further consideration and the MAC remands...

  9. Sedative effect of hydroalcholic leaf extracts of Cnidoscolous acontifolius.

    Directory of Open Access Journals (Sweden)

    O A Adebiyi

    2012-03-01

    Full Text Available Summary: The Cnidoscolous acontifolius hydroalcholic leaf extract (CAHLE has been reported to possess potent biological effects on the central nervous system. The objectives of this study were to investigate the safety, sedative and hypnotic effects of CAHLE in mice. Swiss albino mice (18-22g were randomly allotted to three groups (n=5 each and treated with CAHLE (3.0 g/kg, 6.0 g/kg and 9.0 g/kg intraperitoneally. They were observed for signs of toxicity and mortality over a 72 hour period and subsequently for 14 days. Normal saline (10 mL/kg, diazepam (1 mg/kg and CAHLE at doses of 100 mg/kg, 200 mg/kg, 400 mg/kg, 800mg/kg and 1600 mg/kg were administered to a fresh batch of randomly allotted (7 groups of mice (n=5 per group respectively. For the pentobarbitone sleeping time test, sodium pentobarbitone (40 mg/kg was administered five minutes after the administration of CAHLE. Data analysis was by one factor analysis of variance (ANOVA followed by post hoc analysis using Student Newman Kuels multiple comparison tests. CAHLE showed signs of toxicity and lethality at 9.0g/kg. Furthermore, CAHLE produced statistically significant inhibition (p<0.05 of spontaneous motor activity and increased the onset and the duration of sleep at all dose levels compared to normal saline and diazepam treated groups. The study concluded CAHLE has sedative action, prolongs sleep and is safe in mice. Industrial Relevance: This study provides data on the safety as well as the efficacy of Cnidoscolous acontifolius in producing sedation and prolongation of sleep in animals. These data will be essential in the quest to isolate and develop potent therapeutic agents for the management of psychiatric and neurological disorders. The potency of CAHLE makes it an important candidate for further evaluation to isolate or identify important bioactive constituents that may serve as template for the development of new generation drugs for the management of insomnia that afflict a

  10. Moderate and deep nurse-administered propofol sedation is safe

    DEFF Research Database (Denmark)

    Jensen, Jeppe Thue; Møller, Ann; Hornslet, Pernille;

    2015-01-01

    as patients developing an adverse event (oxygen saturation 30% or a drop in systolic blood pressure of > 50 mmHg). The remaining patients served as controls. RESULTS: A total of 6,840 consecutive patients undergoing 7,364 procedures were included. The mean propofol...... with a higher rate of adverse events. CONCLUSION: Safety during intermittent deep sedation with NAPS was good. Age, ASA class 3 and total propofol dose were correlated with a higher rate of adverse events. Patients aged 60 years or more needed more handling during adverse events. FUNDING: Arvid Nilsson...

  11. Midazolam sedation for the reduction of Colles' fractures.

    Science.gov (United States)

    Grant, A; Hoddinott, C; Evans, R

    1993-08-01

    The treatment of Colles' fractures in the elderly comprises a heavy workload for both accident and orthopaedic departments. The initial management has important clinical and financial implications for patient and hospital. The demand is variable and the ability to respond must also be flexible. The choice of anaesthetic technique is therefore most important. In our experience, intravenous sedation with midazolam (a water soluble benzodiazepine) has proven to be safe and effective in providing good conditions for anatomical reduction of Colles' fractures on an outpatient basis.

  12. Flumazenil reversal of midazolam sedation for dental procedures.

    Science.gov (United States)

    el-Attar, A; Adu-Gyamfi, Y; Tawfique, K

    1992-06-01

    The efficacy of flumazenil in the reversal of midazolam sedation was assessed in double-blind placebo controlled study. Thirty patients undergoing oral surgical procedures were included. Flumazenil administration was followed by immediate rise of the CNS functions scores to almost the baseline awake values. Compared to control group, patients were significantly more oriented and had better comprehension up to 15 minutes, more alert for 30 minutes and had better memory function up to 60 minutes. Peripheral oxygen saturation was significantly higher up to 15 minutes. Flumazenil allows better utilization and higher turn over rate where space and nursing resources are scarce.

  13. Anesthetic strategy during endovascular therapy: General anesthesia or conscious sedation? (GOLIATH - General or Local Anesthesia in Intra Arterial Therapy) A single-center randomized trial

    DEFF Research Database (Denmark)

    Simonsen, Claus Z; Sørensen, Leif H; Juul, Niels

    2016-01-01

    RATIONALE: Endovascular therapy after acute ischemic stroke due to large vessel occlusion is now standard of care. There is equipoise as to what kind of anesthesia patients should receive during the procedure. Observational studies suggest that general anesthesia is associated with worse outcomes...... compared to conscious sedation. However, the findings may have been biased. Randomized clinical trials are needed to determine whether the choice of anesthesia may influence outcome. AIM AND HYPOTHESIS: The objective of GOLIATH (General or Local Anestesia in Intra Arterial Therapy) is to examine whether....... Patients with acute ischemic stroke, scheduled for endovascular therapy, are randomized to receive either general anesthesia or conscious sedation. STUDY OUTCOMES: The primary outcome measure is infarct growth after 48-72 h (determined by serial diffusion-weighted magnetic resonance imaging). Secondary...

  14. To die, to sleep: US physicians' religious and other objections to physician-assisted suicide, terminal sedation, and withdrawal of life support.

    Science.gov (United States)

    Curlin, Farr A; Nwodim, Chinyere; Vance, Jennifer L; Chin, Marshall H; Lantos, John D

    2008-01-01

    This study analyzes data from a national survey to estimate the proportion of physicians who currently object to physician-assisted suicide (PAS), terminal sedation (TS), and withdrawal of artificial life support (WLS), and to examine associations between such objections and physician ethnicity, religious characteristics, and experience caring for dying patients. Overall, 69% of the US physicians object to PAS, 18% to TS, and 5% to WLS. Highly religious physicians are more likely than those with low religiosity to object to both PAS (84% vs 55%, P physicians' religious characteristics, ethnicity, and experience caring for dying patients.

  15. To Die, to Sleep: US Physicians’ Religious and Other Objections to Physician-Assisted Suicide, Terminal Sedation, and Withdrawal of Life Support

    Science.gov (United States)

    Curlin, Farr A.; Nwodim, Chinyere; Vance, Jennifer L.; Chin, Marshall H.; Lantos, John D.

    2010-01-01

    This study analyzes data from a national survey to estimate the proportion of physicians who currently object to physician-assisted suicide (PAS), terminal sedation (TS), and withdrawal of artificial life support (WLS), and to examine associations between such objections and physician ethnicity, religious characteristics, and experience caring for dying patients. Overall, 69% of the US physicians object to PAS, 18% to TS, and 5% to WLS. Highly religious physicians are more likely than those with low religiosity to object to both PAS (84% vs 55%, P physicians’ religious characteristics, ethnicity, and experience caring for dying patients. PMID:18198363

  16. Fast Hugs with Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Nimet Şenoğlu

    2014-12-01

    Full Text Available Mnemonics are commonly used in medical procedures as cognitive aids to guide clinicians all over the world. The mnemonic ‘FAST HUG’ (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glycemic control was proposed almost ten years ago for patient care in intensive care units and have been commonly used worldwide. Beside this, new mnemonics were also determined for improving routine care of the critically ill patients. But none of this was accepted as much as “FAST HUGS”. In our clinical practice we delivered an another mnemonic as FAST HUGS with ICU (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, Stress ulcer prevention, and Glucose control, Water balance, Investigation and Results, Therapy, Hypo-hyper delirium, Invasive devices, Check the daily infection parameters, Use a checklist for checking some of the key aspects in the general care of intensive care patients. In this review we summarized these mnemonics.

  17. High efficacy with deep nurse-administered propofol sedation for advanced gastroenterologic endoscopic procedures

    DEFF Research Database (Denmark)

    Jensen, Jeppe Thue; Hornslet, Pernille; Konge, Lars;

    2016-01-01

    BACKGROUND AND STUDY AIMS: Whereas data on moderate nurse-administered propofol sedation (NAPS) efficacy and safety for standard endoscopy is abundant, few reports on the use of deep sedation by endoscopy nurses during advanced endoscopy, such as Endoscopic Retrograde Cholangiopancreatography (ER...

  18. Propofol vs traditional sedative agents for endoscopic retrograde cholangiopancreatography: A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Lu-Long Bo; Yu Bai; Jin-Jun Bian; Ping-Shan Wen; Jin-Bao Li; Xiao-Ming Deng

    2011-01-01

    AIM: To investigate the efficacy and safety of propofol sedation for endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Databases including PubMed, Embase, and the Cochrane Central Register of Controlled Trials updated as of October 2010 were searched. Main outcome measures were ERCP procedure duration, recovery time, incidence of hypotension and hypoxia. RESULTS: Six trials with a total of 663 patients were included. The pooled mean difference in ERCP procedure duration between the propofol and traditional sedative agents was -8.05 (95% CI: -16.74 to 0.63), with no significant difference between the groups. The pooled mean difference in the recovery time was -18.69 (95% CI: -25.44 to -11.93), which showed a significant reduction with use of propofol sedation. Compared with traditional sedative agents, the pooled OR with propofol sedation for ERCP causing hypotension or hypoxia was 1.69 (95% CI: 0.82-3.50) and 0.90 (95% CI: 0.55-1.49), respectively, which indicated no significant difference between the groups. CONCLUSION: Propofol sedation during ERCP leads to shorter recovery time without an increase of cardiopulmonary side effects. Propofol sedation can provide adequate sedation during ERCP.

  19. Efficacy Outcome Measures for Procedural Sedation Clinical Trials in Adults: An ACTTION Systematic Review.

    Science.gov (United States)

    Williams, Mark R; McKeown, Andrew; Dexter, Franklin; Miner, James R; Sessler, Daniel I; Vargo, John; Turk, Dennis C; Dworkin, Robert H

    2016-01-01

    Successful procedural sedation represents a spectrum of patient- and clinician-related goals. The absence of a gold-standard measure of the efficacy of procedural sedation has led to a variety of outcomes being used in clinical trials, with the consequent lack of consistency among measures, making comparisons among trials and meta-analyses challenging. We evaluated which existing measures have undergone psychometric analysis in a procedural sedation setting and whether the validity of any of these measures support their use across the range of procedures for which sedation is indicated. Numerous measures were found to have been used in clinical research on procedural sedation across a wide range of procedures. However, reliability and validity have been evaluated for only a limited number of sedation scales, observer-rated pain/discomfort scales, and satisfaction measures in only a few categories of procedures. Typically, studies only examined 1 or 2 aspects of scale validity. The results are likely unique to the specific clinical settings they were tested in. Certain scales, for example, those requiring motor stimulation, are unsuitable to evaluate sedation for procedures where movement is prohibited (e.g., magnetic resonance imaging scans). Further work is required to evaluate existing measures for procedures for which they were not developed. Depending on the outcomes of these efforts, it might ultimately be necessary to consider measures of sedation efficacy to be procedure specific.

  20. Effects of sedation on echocardiographic variables of left atrial and left ventricular function in healthy cats.

    Science.gov (United States)

    Ward, Jessica L; Schober, Karsten E; Fuentes, Virginia Luis; Bonagura, John D

    2012-10-01

    Although sedation is frequently used to facilitate patient compliance in feline echocardiography, the effects of sedative drugs on echocardiographic variables have been poorly documented. This study investigated the effects of two sedation protocols on echocardiographic indices in healthy cats, with special emphasis on the assessment of left atrial size and function, as well as left ventricular diastolic performance. Seven cats underwent echocardiography (transthoracic two-dimensional, spectral Doppler, color flow Doppler and tissue Doppler imaging) before and after sedation with both acepromazine (0.1 mg/kg IM) and butorphanol (0.25 mg/kg IM), or acepromazine (0.1 mg/kg IM), butorphanol (0.25 mg/kg IM) and ketamine (1.5 mg/kg IV). Heart rate increased significantly following acepromazine/butorphanol/ketamine (mean±SD of increase, 40±26 beats/min) and non-invasive systolic blood pressure decreased significantly following acepromazine/butorphanol (mean±SD of decrease, 12±19 mmHg). The majority of echocardiographic variables were not significantly different after sedation compared with baseline values. Both sedation protocols resulted in mildly decreased left ventricular end-diastolic dimension and mildly increased left ventricular end-diastolic wall thickness. This study therefore failed to demonstrate clinically meaningful effects of these sedation protocols on echocardiographic measurements, suggesting that sedation with acepromazine, butorphanol and/or ketamine can be used to facilitate echocardiography in healthy cats.

  1. Propofol-based sedation does not increase rate of perforation during colonoscopic procedur

    Directory of Open Access Journals (Sweden)

    Somchai Amornyotin

    2010-02-01

    Full Text Available Sedation-related colonoscopic perforation (CP has been under much debate. Our aim was to assess and compare the CP rate during colonoscopy by using sedation with or without propofol adjuvant. All patients who underwent colonoscopic procedure at the WGO Endoscopy Training Center, Siriraj Hospital, Thailand from March 2005 to October 2007 by using the intravenous sedation (IVS technique were analyzed. The primary outcome was the CP rate; the secondary outcomes were sedation-related complications and death during and immediately after the procedure. There were 6140 colonos-copies and 1532 flexible sigmoidoscopies during the study period, of which 6122 colonoscopic procedures were performed by using IVS. All of these procedures were categorized into two groups: group A, the IVS technique was propofol-based sedation and group B, the IVS technique was non-propofol-based sedation. After matching the indications of procedure, there were 2022 colonoscopies in group A and 512 colonoscopies in group B. Colonoscopic procedures were performed by staff endoscopists (10.8% or residents and fellows (89.2%. The characteristics of patients and sedative agents used in perforated patients in both groups were not significantly different. In group A, five patients (0.25% suffered from perforation and two of them died. In group B, one patient (0.20% had CP; the difference was not significant (P=0.829. Our data showed that colonoscopy under propofol-based sedation did not increase the perforation rate. Serious complications are uncommon.

  2. Propofol-Based Sedation Does Not Increase Rate of Complication during Percutaneous Endoscopic Gastrostomy Procedure

    Directory of Open Access Journals (Sweden)

    Somchai Amornyotin

    2011-01-01

    Full Text Available Objectives. To evaluate and compare the complication rate of sedation with or without propofol regimen for percutaneous endoscopic gastrostomy (PEG in a hospital in Thailand. Subjects and Methods. A total of 198 patients underwent PEG procedures by using intravenous sedation (IVS from Siriraj Hospital, Thailand from August 2006 to January 2009. The primary outcome variable was the overall complication rate. The secondary outcome variables were sedation and procedure related complications, and mortality rate. Results. After matching ASA physical status and indications of procedure, there were 92 PEG procedures in propofol based sedation group (A and 20 PEG procedures in non-propofol based sedation group (B. All sedation was given by residents or anesthetic nurses directly supervised by staff anesthesiologist in the endoscopy room. There were no significant differences in patients' characteristics, sedation time, indication, complications, anesthetic personnel and mortality rate between the two groups. All complications were easily treated, with no adverse sequelae. Mean dose of fentanyl and midazolam in group A was significantly lower than in group B. Conclusion. Propofol-based sedation does not increase rate of complication during PEG procedure. Additionally, IVS of PEG procedure is relatively safe and effective when performed by physicians in training. Serious complications are none.

  3. Sedative Drug Use among King Saud University Medical Students: A Cross-Sectional Sampling Study

    Directory of Open Access Journals (Sweden)

    Ahmed A. Al-Sayed

    2014-01-01

    Full Text Available Introduction. Medical students experience significant psychological stress and are therefore at higher risk of using sedatives. There are currently no studies describing the prevalence of sedative drug use among medical students in Saudi Arabia. The aim of this study was to evaluate the prevalence and factors associated with sedative drug use among medical students in Saudi Arabia. Materials and Methods. A cross-sectional convenience sampling study gathered data by anonymous questionnaire from students enrolled at the King Saud University College of Medicine in 2011. The questionnaires collected data regarding social and demographic variables, sleep patterns, and the use of stimulant and sedative drugs since enrollment. Sedatives were defined as any pharmaceutical preparations that induce sleep. Results and Discussion. Of the 729 students who returned questionnaires, 17.0% reported sedative drug use at some time since enrollment. Higher academic year, lower grade point average, regular exercise, fewer hours of sleep per day, poorer quality of sleep, and the presence of sleeping disorders were found to be significantly associated with sedative drug use. Conclusions. Further study is required to increase our understanding of sedative drug use patterns in this relatively high-risk group, as such understanding will help in the development of early intervention programs.

  4. Inappropriateness of using opioids for end-stage palliative sedation: a Dutch study.

    NARCIS (Netherlands)

    Reuzel, R.P.B.; Hasselaar, J.G.J.; Vissers, K.C.P.; Wilt, G.J. van der; Groenewoud, J.M.M.; Crul, B.J.P.

    2008-01-01

    To be able to distinguish end-stage palliative sedation from euthanasia without having to refer to intentions that are difficult to verify, physicians must be able to manage palliative sedation appropriately (i.e., see that death is not hastened as a result of disproportionate medication). In the pr

  5. The role of capnography in endoscopy patients undergoing nurse-administered propofol sedation

    DEFF Research Database (Denmark)

    Slagelse, Charlotte; Vilmann, Peter; Hornslet, Pernille;

    2013-01-01

    . The existing literature on capnography for endoscopy patients sedated with nurse-administered propofol sedation (NAPS) is limited. Can the addition of capnography to standard monitoring during endoscopy with NAPS reduce the number, duration, and level of hypoxia. Materials and methods. This study...

  6. Survey of anaesthetists' practice of sedation for gastrointestinal endoscopy.

    Science.gov (United States)

    Leslie, K; Allen, M L; Hessian, E; Lee, A Y-S

    2016-07-01

    We conducted a survey of Australian specialist anaesthetists about their practice of sedation for elective and emergency gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP), and colonoscopy. A 24-item survey was emailed to 1,000 anaesthetists in August 2015. Responses were received from 409 anaesthetists (response rate=41%) with responses from 395 anaesthetists analysed. Pulse oximetry and oxygen administration were routine for all procedures for all respondents. Blood pressure was routinely measured by most respondents during gastroscopy (elective=88%; emergency=97%), ERCP (elective=99%; emergency=99%) and colonoscopy (elective=91%; emergency=98%). The airway was routinely managed with jaw lift or oral or nasal airway by 99%, 76% and 97% of respondents during gastroscopy, ERCP and colonoscopy, whereas in emergency procedures endotracheal intubation was routine in 49%, 64% and 17% of procedures. Propofol was routinely administered by 99% of respondents for gastroscopy and 100% of respondents for ERCP and colonoscopy. A maximum depth of sedation in which patients were unresponsive to painful stimulation was targeted by the majority of respondents for all procedures except for elective gastroscopy. These results may be used to facilitate comparison of practice in Australia and overseas, and give an indication of compliance by Australian anaesthetists with the relevant Australian and New Zealand College of Anaesthetists guideline.

  7. Quality of life following third molar removal under conscious sedation

    Science.gov (United States)

    Sancho-Puchades, Manuel; Berini-Aytés, Leonardo; Gay-Escoda, Cosme

    2012-01-01

    Aim: The aim of this study was to assess quality of life (QoL) and degree of satisfaction among outpatients subjected to surgical extraction of all four third molars under conscious sedation. A second objective was to describe the evolution of self-reported pain measured in a visual analogue scale (VAS) in the 7 days after extraction. Study design: Fifty patients received a questionnaire assessing social isolation, working isolation, eating and speaking ability, diet modifications, sleep impairment, changes in physical appearance, discomfort at suture removal and overall satisfaction at days 4 and 7 after surgery. Pain was recorded by patients on a 100-mm pain visual analogue scale (VAS) every day after extraction until day 7. Results: Thirty-nine patients fulfilled correctly the questionnaire. Postoperative pain values suffered small fluctuations until day 5 (range: 23 to 33 mm in a 100-mm VAS), when dicreased significantly. A positive association was observed between difficult ranked surgeries and higher postoperative pain levels. The average number of days for which the patient stopped working was 4.9. Conclusion: The removal of all third molars in a single appointment causes an important deterioration of the patient’s QoL during the first postoperative week, especially due to local pain and eating discomfort. Key words:Third molar removal, quality of life, sedation. PMID:22926461

  8. Intranasal Midazolam Sedation in a Pediatric Emergency Dental Clinic.

    Science.gov (United States)

    Peerbhay, Fathima; Elsheikhomer, Ahmed Mahgoub

    2016-01-01

    The purpose of this study was to compare the effectiveness and recovery times of 0.3 and 0.5 mg/kg intranasal midazolam (INM) administered with a mucosal atomizer device (MAD) in a pediatric emergency dental hospital clinic. One hundred eighteen children aged from 4 to 6 years were randomly administered either 0.3 or 0.5 mg/kg INM via an MAD in a triple-blinded randomized controlled trial. Sedation was achieved to some degree in 100% of the sample. The pulse rate and oxygen saturation were within the normal range in 99% of the patients. A burning sensation was reported in 9% of children. The recovery time of the 0.5 mg/kg group was statistically longer than that of the 0.3 mg/kg group (16.5 vs 18.8 minutes) but the difference was not clinically significant. The findings of this study show that 0.3 or 0.5 mg/kg doses of INM resulted in safe and effective sedation. The 0.5 mg/kg dose was more effective than the 0.3 mg/kg dose in reducing anxiety.

  9. IV ATP potentiates midazolam sedation as assessed by bispectral index.

    Science.gov (United States)

    Sakurai, Satoru; Fukunaga, Atsuo; Ichinohe, Tatsuya; Kaneko, Yuzuru

    2014-01-01

    In this study, by measuring bispectral index (BIS), we tested the hypothesis that intravenous adenosine 5'-triphosphate (ATP) infusion would deepen the level of midazolam-induced sedation. Ten healthy volunteers underwent 2 experiments with at least 2 weeks' interval: immediately after intravenous bolus administration of midazolam (0.04 mg/kg), they received continuous infusion of either ATP infusion (100 μg/kg/min) or placebo (saline) for 40 minutes in a double-blind, randomized, crossover manner. Changes in BIS values and responsiveness to verbal command as well as cardiorespiratory variables were observed throughout the study periods. Administration of midazolam alone reduced BIS value from control: 97 ± 1 to 68 ± 18 at 25 minutes, which was accompanied by significant cardiopulmonary depressant effects, while maintaining responsiveness to verbal command (consciousness) throughout the study period. Coadministration of ATP with midazolam further reduced BIS value to 51 ± 13, associated with complete loss of consciousness without adverse effect on the cardiorespiratory systems. We conclude that the addition of ATP infusion to midazolam significantly enhances midazolam sedation without disturbing cardiorespiratory functions.

  10. Nasotracheal intubation of a patient with restricted mouth opening using a McGrath MAC X-Blade and Magill forceps.

    Science.gov (United States)

    Arslan, Zehra İpek; Ozdal, P; Ozdamar, D; Agır, H; Solak, M

    2016-10-01

    We experienced a case of successful nasotracheal intubation using the X-Blade of the McGrath MAC in a 28-year-old woman with a 2.5-cm mouth opening. She had no teeth on the right side, her neck movement was limited, her mandibular protrusion was grade C, and her Mallampati could not be evaluated. Her tongue was fixed to the left wall during a previous surgery. We evaluated the awake glottic view using the McGrath MAC X-Blade and topical oral anesthesia. We obtained a Cormack-Lehane grade II view and then decided to administer general anesthesia. Intubation was attempted with a Macintosh laryngoscope, but we could not insert the scope deeply enough and there was no area in which to insert the Magill forceps or endotracheal tube. We then used the X-Blade 3 of the McGrath MAC and obtained a sufficient area in which to insert the tube and manipulate the Magill forceps. A laryngoscopic view was achieved in 7 s and nasotracheal intubation was performed in 16 s with a 7.0-mm spiral tube using the Magill forceps. McGrath MAC X-Blade can be used with the Magill forceps in patients with restricted mouth opening with careful patient selection, in experienced hands.

  11. Unconscious sedation/analgesia with propofol versus conscious sedation with fentanyl/midazolam for catheter ablation of atrial fibrillation: a prospective, randomized study

    Institute of Scientific and Technical Information of China (English)

    TANG Ri-bo; MA Chang-sheng; DONG Jian-zeng; ZHAO Wen-du; LIU Xing-peng; KANG Jun-ping; LONG De-yong; YU Rong-hui; HU Fu-li; LIU Xiao-hui

    2007-01-01

    @@ Catheter ablation of atrial fibrillation (AF) has been increased dramatically recently.1 However, it is an unpleasant procedure with intolerable pain without sedation. Propofol and fentanyl/midazolam have been widely used in painful clinical examination and cardiovascular procedures with established safety and efficacy.2,3 Propofol, alfentanyl and midazolam were administrated for catheter ablation in some electrophysiological labs for a less painful procedure.4However, there is few published work on the sedation regimen for catheter ablation of AF.

  12. Capnography and the Bispectral Index—Their Role in Pediatric Sedation: A Brief Review

    Directory of Open Access Journals (Sweden)

    Maria Sammartino

    2010-01-01

    Full Text Available Sedation in children is increasingly emerging as a minimally invasive technique that may be associated with local anaesthesia or diagnostic and therapeutic procedures which do not necessarily require general anaesthesia. Standard monitoring requirements are not sufficient to ensure an effective control of pulmonary ventilation and deep sedation. Capnography in pediatric sedation assesses the effect of different drugs on the occurrence of respiratory failure and records early indicators of respiratory impairment. The Bispectral index (BIS allows the reduction of dose requirements of anaesthetic drugs, the reduction in the time to extubation and eye opening, and the reduction in the time to discharge. In the field of pediatric sedation, capnography should be recommended to prevent respiratory complications, particularly in spontaneous ventilation. The use of the BIS index, however, needs further investigation due to a lack of evidence, especially in infants. In this paper, we will investigate the role of capnography and the BIS index in improving monitoring standards in pediatric sedation.

  13. Combined sedation with midazolam/propofol for gastrointestinal endoscopy in elderly patients

    Directory of Open Access Journals (Sweden)

    Schlief Hans-Eugen

    2010-01-01

    Full Text Available Abstract Background Although gastrointestinal endoscopy with sedation is increasingly performed in elderly patients, data on combined sedation with midazolam/propofol are very limited for this age group. Methods We retrospectively analyzed 454 endoscopic procedures in 347 hospitalized patients ≥ 70 years who had received combined sedation with midazolam/propofol. 513 endoscopic procedures in 397 hospitalized patients Results Elderly patients had a higher level of co-morbidity and needed lower mean propofol doses for sedation. We observed no major complication and no difference in the number of minor complications. The procedure-associated mortality was 0%; the 28-day mortality was significantly higher in the elderly (2.9% vs. 1.0%. Conclusions In this study on elderly patients with high level co-morbidity, a favourable safety profile was observed for a combined sedation with midazolam/propofol with a higher sensitivity to propofol in the elderly.

  14. Conscious midazolam sedation in third molar surgery--aspects of post-operative patient evaluation.

    Science.gov (United States)

    Bremerich, A; Hierl, T

    1995-09-01

    This study was conducted on 426 patients undergoing third molar surgery to evaluate their opinion on surgery and the follow-up period concerning postoperative behaviour, pain, and complaints. Two groups were formed as patients had to choose between local anaesthesia only or additional conscious sedation by means of intravenous midazolam (0.1 mg/kg). Women and younger patients preferred conscious sedation. Surgery was described as significantly less distressing by the sedated group. No difference in the evaluation of the follow-up period between both groups existed. Patients of the midazolam group took more analgesics, tended to stay longer in bed and reported on protracted cooling. Non-sedated persons older than 30 years complained about a slower decrease in postoperative pain. According to these findings, sensitive, cautious patients tend to prefer conscious sedation which is reflected in their behaviour. No relationship between the evaluation of surgery itself and the follow-up period could be found.

  15. Electrocardiographic, echocardiographic, and indirect blood pressure evaluation in dogs subjected to different sedation protocols

    Directory of Open Access Journals (Sweden)

    Helena Mondardo Cardoso

    Full Text Available ABSTRACT: The present study aimed to evaluate the effects of different sedation protocols on blood pressure and echocardiographic and electrocardiographic parameters in dogs. In total, 24 male mixed-breed dogs with a mean weight of 9.87±3.0kg were used.Animals were randomly divided into four groups (n=6, which were subjected to sedation using the following protocols: acepromazine (0.05mgkg-1 and butorphanol (0.3mgkg-1 (AB; acepromazine (0.05mgkg-1and methadone (0.5mgkg-1 (AM; acepromazine (0.03mgkg-1, methadone (0.5mgkg-1, and midazolam (0.3mgkg-1(MAM; and methadone only (0.5mgkg-1 (M. Indirect blood pressure (BP measurements and computerized electrocardiography (ECG and echocardiography (ECO were performed immediately before the application of the sedation protocol (baseline, and the same evaluations were repeated after 15 minutes. BP decreased in groups AB, MAM, and AM compared to baseline values. Electrocardiographic measurements showed decreased heart rates (HRs after sedation in all groups, and bradycardia was observed after sedation in two dogs from group M and one animal from group AM. The P-wave duration increased after sedation in groups AM and M. After sedation, no changes in cardiac dimensions were revealed byECO.Fractional shortening (FS decreased after sedation in the AM group, and dogs from group AB exhibited a smaller decrease in FS compared with the other groups. The cardiac index (CI was lower in groups AM and M than in the other groups. Animals from group AB were less resistant to examination and exhibited the most favorable sedation scores. It was concluded that the combination of acepromazine and butorphanol was the best sedation protocol for performing echocardiogram measurementsbecause dogs were less resistant to examinations and echocardiographic parameters of FS and CI remained stable.

  16. Feeding response of sport fish after electrical immobilization, chemical sedation, or both

    Science.gov (United States)

    Meinertz, Jeffery R.; Fredricks, Kim T.; Ambrose, Ryan D.; Jackan, Leanna M.; Wise, Jeremy K.

    2012-01-01

    Fishery managers frequently capture wild fish for a variety of fishery management activities. Though some activities can be accomplished without immobilizing the fish, others are accomplished more readily, humanely, and safely (for both the handler and the fish) when fish are immobilized by physical (e.g., electrical immobilization) or chemical sedation. A concern regarding the use of chemical sedatives is that chemical residues may remain in the fillet tissue after the fish recovers from sedation. If those residues are harmful to humans, there is some risk that a postsedated fish released to public waters may be caught and consumed by an angler. To characterize this risk, a series of four trials were conducted. Three trials assessed feeding activity after hatchery-reared fish were electrically immobilized, chemically sedated, or both, and one trial assessed the likelihood of an angler catching a wild fish that had been electrically immobilized and chemically sedated. Results from the first trial indicated that the feeding activity of laboratory habituated fish was variable among and within species after electrical immobilization, chemical sedation, or both. Results from the second trial indicated that the resumption of feeding activity was rapid after being mildly sedated for 45 min. Results from the third trial indicated that the feeding activity of outdoor, hatchery-reared fish was relatively aggressive after fish had been chemically sedated. Results from the fourth trial indicated that the probability of capturing wild fish in a more natural environment by angling after fish had been electrically immobilized and chemically sedated is not likely, i.e., in a group of five fish caught, 3 out of 100 times one would be a fish that had been sedated.

  17. TMAC: Timestamp-Ordered MAC Protocol for Wireless Mesh Networks

    KAUST Repository

    Nawab, Faisal

    2011-05-01

    Wireless Mesh Networks (WMNs) have emerged to meet a need for a self-organized and self-configured multi-hop wireless network infrastructure. Low cost infrastructure and ease of deployment have made WMNs an attractive technology for last mile access. However, 802.11 based WMNs are subject to serious fairness issues. With backlogged TCP traffic, nodes which are two or more hops away from the gateway are subject to starvation, while the one-hop away node saturates the channel with its own local traffic. We study the interactions of TCP and IEEE 802.11 MAC in WMNs to aid us in understanding and overcoming the unfairness problem. We propose a Markov chain to capture the behavior of TCP sessions, particularly the impact on network throughput performance due to the effect of queue utilization and packet relaying. A closed form solution is derived to numerically derive the throughput. Based on the developed model, we propose a distributed MAC protocol called Timestamp-ordered MAC (TMAC), aiming to alleviate the unfairness problem in WMNs via a manipulative per-node scheduling mechanism which takes advantage of the age of each packet as a priority metric. Simulation is conducted to validate our model and to illustrate the fairness characteristics of TMAC. Our results show that TMAC achieves excellent resource allocation fairness while maintaining above 90% of maximum link capacity in parking lot and large grid topologies. Our work illuminates the factors affecting TCP fairness in WMNs. Our theoretical and empirical findings can be used in future research to develop more fairness-aware protocols for WMNs.

  18. Design of High Speed Architecture of Parallel MAC Based On Radix-2 MBA

    Directory of Open Access Journals (Sweden)

    Syed Anwar Ahmed,

    2014-05-01

    Full Text Available The multiplier and multiplier-and-accumulator (MAC are the essential elements of the digital signal processing such as filtering, convolution, transformations and Inner products. Parallel MAC is frequently used in digital signal processing and video/graphics applications. Fast multipliers are essential parts of digital signal processing systems. The speed of multiply operation is of great importance in digital signal processing as well as in the general purpose processors today, especially since the media processing took off. The MAC provides high speed multiplication and multiplication with accumulative addition. This paper presents a combined process of multiplication and accumulation based on radix-4 & radix-8 booth encodings. In this Paper, we investigate the method of implementing the Parallel MAC with the smallest possible delay. Enhancing the speed of operation of the parallel MAC is a major design issue. This has been achieved by developing a CLA adder for parallel MAC.

  19. Proximate analysis of coal by Leco MAC-400

    Energy Technology Data Exchange (ETDEWEB)

    Wilson, S.T. (British Steel Corporation, London (UK). Ravenscraig Works)

    1988-01-01

    Discussion is presented of the use of the Leco Mac-400 Proximate Analyser at the Ravenscraig Steel Works, UK. It is used for the analysis of in-plant coals and the determination of ash in coke. The instrument does not meet the British Standard requirement for repeatability, so is not used for 'value in use' coal analysis. It has recently been overhauled, however, and will be re-evaluated to see if the overhaul has brought an improvement in performance. 6 figs., 7 tabs.

  20. Intelligent Cooperative MAC Protocol for Balancing Energy Consumption

    Science.gov (United States)

    Wu, S.; Liu, K.; Huang, B.; Liu, F.

    To extend the lifetime of wireless sensor networks, we proposed an intelligent balanced energy consumption cooperative MAC protocol (IBEC-CMAC) based on the multi-node cooperative transmission model. The protocol has priority to access high-quality channels for reducing energy consumption of each transmission. It can also balance the energy consumption among cooperative nodes by using high residual energy nodes instead of excessively consuming some node's energy. Simulation results show that IBEC-CMAC can obtain longer network lifetime and higher energy utilization than direct transmission.