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Sample records for repetitive sedation linked

  1. Widespread Chromatin Accessibility at Repetitive Elements Links Stem Cells with Human Cancer

    Directory of Open Access Journals (Sweden)

    Nicholas C. Gomez

    2016-11-01

    Full Text Available Chromatin regulation is critical for differentiation and disease. However, features linking the chromatin environment of stem cells with disease remain largely unknown. We explored chromatin accessibility in embryonic and multipotent stem cells and unexpectedly identified widespread chromatin accessibility at repetitive elements. Integrating genomic and biochemical approaches, we demonstrate that these sites of increased accessibility are associated with well-positioned nucleosomes marked by distinct histone modifications. Differentiation is accompanied by chromatin remodeling at repetitive elements associated with altered expression of genes in relevant developmental pathways. Remarkably, we found that the chromatin environment of Ewing sarcoma, a mesenchymally derived tumor, is shared with primary mesenchymal stem cells (MSCs. Accessibility at repetitive elements in MSCs offers a permissive environment that is exploited by the critical oncogene responsible for this cancer. Our data demonstrate that stem cells harbor a unique chromatin landscape characterized by accessibility at repetitive elements, a feature associated with differentiation and oncogenesis.

  2. Investigating the work-family conflict and health link: Repetitive thought as a mechanism.

    Science.gov (United States)

    Davis, Kelly D; Gere, Judith; Sliwinski, Martin J

    2016-10-06

    Research is needed to investigate mechanisms linking work-family conflict to poor health in working adults. We took a novel approach to build on extant studies by testing a potential mechanism in these associations - repetitive thought. Data came from a sample of 203 partnered working adults. There were significant direct effects of work-family conflict with lower life satisfaction, positive affect, and perceived health as well as greater fatigue. As for total effects, work-family conflict was significantly associated with all health outcomes - life satisfaction, positive affect, negative affect, fatigue, perceived health, and chronic health conditions - in the expected directions through repetitive thought. This study provides support that repetitive thought is one potential mechanism of how work-family conflict can take a toll on psychological and physical health. Findings are discussed in relation to improving workplace policies to improve the health of working adults managing work-family conflict.

  3. 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...

  4. Widespread Chromatin Accessibility at Repetitive Elements Links Stem Cells with Human Cancer

    OpenAIRE

    Nicholas C. Gomez; Austin J. Hepperla; Raluca Dumitru; Jeremy M. Simon; Fang Fang; Ian J. Davis

    2016-01-01

    Chromatin regulation is critical for differentiation and disease. However, features linking the chromatin environment of stem cells with disease remain largely unknown. We explored chromatin accessibility in embryonic and multipotent stem cells and unexpectedly identified widespread chromatin accessibility at repetitive elements. Integrating genomic and biochemical approaches, we demonstrate that these sites of increased accessibility are associated with well-positioned nucleosomes marked by ...

  5. Identification of an O-linked repetitive glycan chain of the polar flagellum flagellin of Azospirillum brasilense Sp7.

    Science.gov (United States)

    Belyakov, Alexei Ye; Burygin, Gennady L; Arbatsky, Nikolai P; Shashkov, Alexander S; Selivanov, Nikolai Yu; Matora, Larisa Yu; Knirel, Yuriy A; Shchyogolev, Sergei Yu

    2012-11-01

    This is the first report to have identified an O-linked repetitive glycan in bacterial flagellin, a structural protein of the flagellum. Studies by sugar analysis, Smith degradation, (1)H and (13)C NMR spectroscopy, and mass spectrometry showed that the glycan chains of the polar flagellum flagellin of the plant-growth-promoting rhizobacterium Azospirillum brasilense Sp7 are represented by a polysaccharide with a molecular mass of 7.7 kDa, which has a branched tetrasaccharide repeating unit of the following structure:

  6. Chewed out: an experimental link between food material properties and repetitive loading of the masticatory apparatus in mammals

    Directory of Open Access Journals (Sweden)

    Matthew J. Ravosa

    2015-11-01

    Full Text Available Using a model organism (rabbits that resembles a number of mammalian herbivores in key aspects of its chewing behaviors, we examined how variation in dietary mechanical properties affects food breakdown during mastication. Such data have implications for understanding phenotypic variation in the mammalian feeding apparatus, particularly with respect to linking jaw form to diet-induced repetitive loading. Results indicate that chewing frequency (chews/s is independent of food properties, whereas chewing investment (chews/g and chewing duration(s, which are proportional to repetitive loading of the jaws, are positively related to food stiffness and toughness. In comparisons of displacement-limited and stress-limited fragmentation indices, which respectively characterize the intraoral breakdown of tough and stiff foods, increases in chewing investment and duration are linked solely to stiffness. This suggests that stiffer foods engender higher peak loads and increased cyclical loading. Our findings challenge conventional wisdom by demonstrating that toughness does not, by itself, underlie increases in cyclical loading and loading duration. Instead, tough foods may be associated with such jaw-loading patterns because they must be processed in greater volumes owing to their lower nutritive quality and for longer periods of time to increase oral exposure to salivary chemicals.

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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.

  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. 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 ...

  15. 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.

  16. 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.

  17. 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...

  18. Sedation: Is it getting easier'

    African Journals Online (AJOL)

    procedures, even painless ones, on pre-adolescent children and patients with cognitive ..... sets the scene for disaster via cardiac depression; predisposition to ... They are, like all sedation recipients, to be prepared in terms of investigation and ...

  19. 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...

  20. 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...

  1. 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

  2. Intranasal sedatives in pediatric dentistry.

    Science.gov (United States)

    AlSarheed, Maha A

    2016-09-01

    To identify the intranasal (IN) sedatives used to achieve conscious sedation during dental procedures amongst children. 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.  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. Intranasal midazolam, ketamine, and sufentanil are effective and safe for conscious sedation, while intranasal midazolam, dexmedetomidine, and sufentanil have proven to be effective premedications.

  3. Sedation of children for auditory brainstem response using ketamine-midazolam-atropine combination - a retrospective analysis.

    Science.gov (United States)

    Bocskai, Tímea; Németh, Adrienne; Bogár, Lajos; Pytel, József

    2013-12-01

    Authors investigated sedation quality in children for auditory brainstem response testing. Two-hundred and seventy-six sedation procedures were retrospectively analyzed using recorded data focusing on efficacy of sedation and complications. Intramuscular ketamine-midazolam-atropine combination was administered on sedation preceded by narcotic suppository as pre-medication. On using the combination vital parameters remained within normal range, the complication rate was minimal. Pulse rate, arterial blood pressure and pulse oxymetry readings were stable, hypoventilation developed in 4, apnoea in none of the cases, post-sedation agitation occurred in 3 and nausea and/or vomiting in 2 cases. Repeated administration of narcotic agent was necessary in a single case only. Our practice is suitable for the sedation assisting hearing examinations in children. It has no influence on the auditory brainstem testing, the conditions necessary for the test can be met entirely with minimal side-effects. Our practice provides a more lasting sedation time in children during the examination hence there is no need for the repetition of the narcotics.

  4. 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).

  5. 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.

  6. 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.

  7. [Use of sedation in the palliative care situation by respiratory physicians].

    Science.gov (United States)

    Grijol-Cariou, A-L; Goupil, F; Hubault, P; Jouanneau, J

    2014-01-01

    The prognosis of advanced stage chronic lung disease, including lung cancer, is often poor and associated with uncomfortable symptoms for the patient, especially in the end of life phase. In the case of intolerable symptoms, refractory to maximal treatment, sedation may then be considered. This is sometimes a source of confusion and difficulty for clinicians who need to know the official guidelines. The purpose of this study was to investigate the use of sedation by respiratory physicians, in order to understand their difficulties in these complex situations. The study was conducted using semi-structured, anonymous interviews of volunteers. The topics discussed included their definition of sedation, its indications, their possible difficulties or reluctance in using it, the information given to the patient and the traceability of the sedation prescription. All respiratory physicians agreed to participate in the study, indicating a major interest in this topic. No sedation decision is taken without careful consideration. The majority of physicians understand the difference between anxiolysis and sedation, most defining the latter as using a drug to sedate a patient faced with uncontrollable symptoms. All doctors refused to link sedation to euthanasia, although half expressed a feeling of causality between sedation and the patient's death - knowing that few consider the possibility of transient sedation. The main reluctance among doctors is in chronic respiratory insufficiency. Any decision concerning sedation should be discussed beforehand with the care team and the resident in charge of the patient, but not necessarily with another colleague. There is rarely evidence of this discussion in the medical records or of the information given to the patient and his family, thus increasing the difficulties of decision-making, especially at nights or weekends. The decision to start sedation is seen as difficult because it presupposes that a life-threatening short

  8. Repetitive maladaptive behavior: beyond repetition compulsion.

    Science.gov (United States)

    Bowins, Brad

    2010-09-01

    Maladaptive behavior that repeats, typically known as repetition compulsion, is one of the primary reasons that people seek psychotherapy. However, even with psychotherapeutic advances it continues to be extremely difficult to treat. Despite wishes and efforts to the contrary repetition compulsion does not actually achieve mastery, as evidenced by the problem rarely resolving without therapeutic intervention, and the difficulty involved in producing treatment gains. A new framework is proposed, whereby such behavior is divided into behavior of non-traumatic origin and traumatic origin with some overlap occurring. Repetitive maladaptive behavior of non-traumatic origin arises from an evolutionary-based process whereby patterns of behavior frequently displayed by caregivers and compatible with a child's temperament are acquired and repeated. It has a familiarity and ego-syntonic aspect that strongly motivates the person to retain the behavior. Repetitive maladaptive behavior of traumatic origin is characterized by defensive dissociation of the cognitive and emotional components of trauma, making it very difficult for the person to integrate the experience. The strong resistance of repetitive maladaptive behavior to change is based on the influence of both types on personality, and also factors specific to each. Psychotherapy, although very challenging at the best of times, can achieve the mastery wished and strived for, with the aid of several suggestions provided.

  9. 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.

  10. No-sedation during mechanical ventilation

    DEFF Research Database (Denmark)

    Laerkner, Eva; Stroem, Thomas; Toft, Palle

    2016-01-01

    care unit (ICU), patients were Richmond Agitation and Sedation Scale (RASS) scored, nursing workload was measured with the Nursing Care Recording System (NCR11) and nurse's self-assessment of workload was reported on a Numeric Rating Scale from 1 (low) to 10 (high). RESULTS: Patients from the no......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......-sedation group had a median RASS score of -0·029 compared with -2 in the sedated group (P nurses self-reported workload was the same in both groups (P = 0·085). Because...

  11. 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.

  12. 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 ...

  13. 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.

  14. Pediatric dental sedation: challenges and opportunities

    OpenAIRE

    Nelson TM; Xu Z.

    2015-01-01

    Travis M Nelson, Zheng Xu Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA Abstract: High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases th...

  15. Pediatric dental sedation: challenges and opportunities

    Directory of Open Access Journals (Sweden)

    Nelson TM

    2015-08-01

    Full Text Available Travis M Nelson, Zheng Xu Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA Abstract: High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a

  16. Grammatical Change through Repetition.

    Science.gov (United States)

    Arevart, Supot

    1989-01-01

    The effect of repetition on grammatical change in an unrehearsed talk is examined based on a case study of a single learner. It was found that repetition allows for accuracy monitoring in that errors committed in repeated contexts undergo correction. Implications for teaching are discussed. (23 references) (LB)

  17. The Negative Repetition Effect

    Science.gov (United States)

    Mulligan, Neil W.; Peterson, Daniel J.

    2013-01-01

    A fundamental property of human memory is that repetition enhances memory. Peterson and Mulligan (2012) recently documented a surprising "negative repetition effect," in which participants who studied a list of cue-target pairs twice recalled fewer targets than a group who studied the pairs only once. Words within a pair rhymed, and…

  18. Nurse-administered propofol sedation for endoscopy

    DEFF Research Database (Denmark)

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

    2011-01-01

    BACKGROUND AND STUDY AIMS: 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. PATIENTS AND METHODS: A structured training program was developed both for endosco...... for sedation, and can be used as basis for further comparison. NAPS for endoscopic procedures is safe when performed by personnel properly trained in airway handling and sedation with propofol, and has considerable advantages compared with conventional sedation for endoscopy....

  19. 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.

  20. 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.

  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. Roles of repetitive sequences

    Energy Technology Data Exchange (ETDEWEB)

    Bell, G.I.

    1991-12-31

    The DNA of higher eukaryotes contains many repetitive sequences. The study of repetitive sequences is important, not only because many have important biological function, but also because they provide information on genome organization, evolution and dynamics. In this paper, I will first discuss some generic effects that repetitive sequences will have upon genome dynamics and evolution. In particular, it will be shown that repetitive sequences foster recombination among, and turnover of, the elements of a genome. I will then consider some examples of repetitive sequences, notably minisatellite sequences and telomere sequences as examples of tandem repeats, without and with respectively known function, and Alu sequences as an example of interspersed repeats. Some other examples will also be considered in less detail.

  3. Roles of repetitive sequences

    Energy Technology Data Exchange (ETDEWEB)

    Bell, G.I.

    1991-12-31

    The DNA of higher eukaryotes contains many repetitive sequences. The study of repetitive sequences is important, not only because many have important biological function, but also because they provide information on genome organization, evolution and dynamics. In this paper, I will first discuss some generic effects that repetitive sequences will have upon genome dynamics and evolution. In particular, it will be shown that repetitive sequences foster recombination among, and turnover of, the elements of a genome. I will then consider some examples of repetitive sequences, notably minisatellite sequences and telomere sequences as examples of tandem repeats, without and with respectively known function, and Alu sequences as an example of interspersed repeats. Some other examples will also be considered in less detail.

  4. 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....

  5. 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....

  6. Evaluation of a local ICU sedation guideline on goal-directed administration of sedatives and analgesics

    Directory of Open Access Journals (Sweden)

    DeGrado JR

    2011-05-01

    Full Text Available Jeremy R DeGrado1, Kevin E Anger1, Paul M Szumita1, Carol D Pierce2, Anthony F Massaro31Department of Pharmacy, 2Department of Nursing, 3Department of Pulmonary Medicine, Brigham and Women's Hospital, Boston, MA, USAPurpose: Sedatives and analgesics are commonly used in mechanically ventilated patients in the intensive care unit. Sedation guidelines have been shown to improve sedation management as well as various patient outcomes. The main objective was to evaluate adherence to a sedation guideline with both sedative prescribing and documentation of Richmond Agitation-Sedation Scale (RASS scores.Methods: In a retrospective chart review, data was collected on 111 medical intensive care unit patients mechanically ventilated via endotracheal tube for 12 hours or greater at Brigham and Women's Hospital. Fifty-seven patients were evaluated pre-guideline implementation and 54 patients were evaluated post-guideline.Results: Significant increases were seen in the post-guideline group in goal-directed sedation with a patient-specific RASS goal in the sedation order: 21.3 vs 85.4% (P < 0.001, and mean number of sedation assessments per 24 hours using the RASS: 4.7 vs 11.4 (P < 0.001. Similarly, this group experienced a higher percentage of RASS scores at their sedation goal: 31.4 vs 44.1% (P < 0.001. No difference was seen in other clinical endpoints.Conclusion: Implementation and routine application of a hospital pain and sedation guideline was associated with significantly improved sedation metrics, such as goal-directed sedation, as well as frequency of sedation level assessment and documentation. An increase was observed in the time that post-guideline patients spent at or near their RASS goal.Keywords: sedation, agitation, guideline, RASS, mechanically ventilated, intensive care unit

  7. Should patients undergoing a bronchoscopy be sedated?

    Science.gov (United States)

    Gonzalez, R; De-La-Rosa-Ramirez, I; Maldonado-Hernandez, A; Dominguez-Cherit, G

    2003-04-01

    The techniques, drugs and depth of sedation for flexible fiberoptic bronchoscopy is controversial, and several reports consider that the routine use of sedation is not a prerequisite. We evaluate whether the addition of sedation with propofol improves patient tolerance, compared to local anesthesic of the airway only. Eighteen patients with pneumonia undergoing flexible fiberoptic bronchoscopy were included in a randomized, single blind, prospective controlled study. The non-sedation group received airway topical anesthesia, whereas the sedation group received topical anesthesia and intravenous sedation with propofol. The degree of pain, cough, sensation of asphyxiation, degree of amnesia, global tolerance and acceptance of another bronchoscopy in the future were noted. Changes in blood pressure, heart rate and saturation of oxygen by pulse oximetry were also evaluated. The patients in sedation group had less cough (P < 0.05), pain (P < 0.01) and sensation of asphyxiation (P < 0.001). Global tolerance to the procedure was significantly better in the group under sedation (P < 0.01). These patients had total amnesia to the procedure (P < 0.0001), thus is more probable that will accept another bronchoscopy in the future (P < 0.01). There was a significant rise in heart rate and blood pressure in the patients without sedation. There were no differences in oxygen saturation (P = 0.75). Our results show that if we administer propofol for sedation, in addition to local anesthesia of the airway, the tolerance to the procedure is much better. Also it appears that sedation with propofol is safe if we carefully select and monitor the patient.

  8. Pediatric dental sedation: challenges and opportunities.

    Science.gov (United States)

    Nelson, Travis M; Xu, Zheng

    2015-01-01

    High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of

  9. Repetition and Translation Shifts

    Directory of Open Access Journals (Sweden)

    Simon Zupan

    2006-06-01

    Full Text Available Repetition manifests itself in different ways and at different levels of the text. The first basic type of repetition involves complete recurrences; in which a particular textual feature repeats in its entirety. The second type involves partial recurrences; in which the second repetition of the same textual feature includes certain modifications to the first occurrence. In the article; repetitive patterns in Edgar Allan Poe’s short story “The Fall of the House of Usher” and its Slovene translation; “Konec Usherjeve hiše”; are compared. The author examines different kinds of repetitive patterns. Repetitions are compared at both the micro- and macrostructural levels. As detailed analyses have shown; considerable microstructural translation shifts occur in certain types of repetitive patterns. Since these are not only occasional; sporadic phenomena; but are of a relatively high frequency; they reduce the translated text’s potential for achieving some of the gothic effects. The macrostructural textual property particularly affected by these shifts is the narrator’s experience as described by the narrative; which suffers a reduction in intensity.

  10. Effect of an analgo-sedation protocol for neurointensive patients

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Jensen, Malene Brorson; Herling, Suzanne Forsyth

    2010-01-01

    Sedation protocols are needed for neurointensive patients. The aim of this pilot study was to describe sedation practice at a neurointensive care unit and to assess the feasibility and efficacy of a new sedation protocol. The primary outcomes were a shift from sedation-based to analgesia-based se......-based sedation and improved pain management. The secondary outcomes were a reduction in unplanned extubations and duration of sedation....

  11. 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...

  12. 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....

  13. 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.

  14. 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...

  15. Midazolam for sedation before procedures.

    Science.gov (United States)

    Conway, Aaron; Rolley, John; Sutherland, Joanna R

    2016-05-20

    Midazolam is used for sedation before diagnostic and therapeutic medical procedures. It is an imidazole benzodiazepine that has depressant effects on the central nervous system (CNS) with rapid onset of action and few adverse effects. The drug can be administered by several routes including oral, intravenous, intranasal and intramuscular. To determine the evidence on the effectiveness of midazolam for sedation when administered before a procedure (diagnostic or therapeutic). We searched the Cochrane Central Register of Controlled Trials (CENTRAL to January 2016), MEDLINE in Ovid (1966 to January 2016) and Ovid EMBASE (1980 to January 2016). We imposed no language restrictions. Randomized controlled trials in which midazolam, administered to participants of any age, by any route, at any dose or any time before any procedure (apart from dental procedures), was compared with placebo or other medications including sedatives and analgesics. Two authors extracted data and assessed risk of bias for each included study. We performed a separate analysis for each different drug comparison. We included 30 trials (2319 participants) of midazolam for gastrointestinal endoscopy (16 trials), bronchoscopy (3), diagnostic imaging (5), cardioversion (1), minor plastic surgery (1), lumbar puncture (1), suturing (2) and Kirschner wire removal (1). Comparisons were: intravenous diazepam (14), placebo (5) etomidate (1) fentanyl (1), flunitrazepam (1) and propofol (1); oral chloral hydrate (4), diazepam (2), diazepam and clonidine (1); ketamine (1) and placebo (3); and intranasal placebo (2). There was a high risk of bias due to inadequate reporting about randomization (75% of trials). Effect estimates were imprecise due to small sample sizes. None of the trials reported on allergic or anaphylactoid reactions. Intravenous midazolam versus diazepam (14 trials; 1069 participants)There was no difference in anxiety (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.39 to 1.62; 175

  16. Trialogue: Preparation, Repetition and...

    Science.gov (United States)

    Oberg, Antoinette; And Others

    1996-01-01

    This paper interrogates both curriculum theory and the limits and potentials of textual forms. A set of overlapping discourses (a trialogue) focuses on inquiring into the roles of obsession and repetition in creating deeply interpretive locations for understanding. (SM)

  17. 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.

  18. 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.

  19. Emergency physician-administered propofol sedation: a report on 25,433 sedations from the pediatric sedation research consortium.

    Science.gov (United States)

    Mallory, Michael D; Baxter, Amy L; Yanosky, Daniel J; Cravero, Joseph P

    2011-05-01

    We describe the adverse events observed in a large sample of children sedated with propofol by emergency physicians and identify patient and procedure characteristics predictive of more serious adverse events. We identified sedations performed by emergency physicians using propofol as the primary sedative, included in the Pediatric Sedation Research Consortium database from July 2004 to September 2008. We describe the characteristics of the patients, procedures, location, adjunctive medications, and adverse events. We use a multivariable logistic regression model to identify predictors of more serious adverse events. Of 25,433 propofol sedations performed by emergency physicians, most (76%) were performed in a radiology department. More serious adverse events occurred in 581 sedations (2.28%; 95% confidence interval 2.1% to 2.5%). There were 2 instances of aspiration, 1 unplanned intubation, and 1 cardiac arrest. Significant predictors of serious adverse events were weight less than or equal to 5 kg, American Society of Anesthesiologists classification greater than 2, adjunctive medications (benzodiazepines, ketamine, opioids, or anticholinergics), nonpainful procedures, and primary diagnoses of upper respiratory illness or prematurity. We observed a low adverse event prevalence in this largest series of propofol sedations by emergency physicians. Factors indicating greater risk of more serious adverse events are detailed. Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  20. Sedative Hypnotic Medication Use and the Risk of Motor Vehicle Crash.

    Science.gov (United States)

    Hansen, Ryan N; Boudreau, Denise M; Ebel, Beth E; Grossman, David C; Sullivan, Sean D

    2015-08-01

    We sought to estimate the association between sedative hypnotic use and motor vehicle crash risk. We conducted a new user cohort study of 409 171 adults in an integrated health care system. Health plan data were linked to driver license and collision records. Participants were aged 21 years or older, licensed to drive in Washington State, had at least 1 year of continuous enrollment between 2003 and 2008, and were followed until death, disenrollment, or study end. We used proportional hazards regression to estimate the risk of crash associated with 3 sedatives. We found 5.8% of patients received new sedative prescriptions, with 11 197 person-years of exposure. New users of sedatives were associated with an increased risk of crash relative to nonuse: temazepam hazard ratio (HR) = 1.27 (95% confidence interval [CI] = 0.85, 1.91), trazodone HR = 1.91 (95% CI = 1.62, 2.25), and zolpidem HR = 2.20 (95% CI = 1.64, 2.95). These risk estimates are equivalent to blood alcohol concentration levels between 0.06% and 0.11%. New use of sedative hypnotics is associated with increased motor vehicle crash risk. Clinicians initiating sedative hypnotic treatment should consider length of treatment and counseling on driving risk.

  1. 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.)

  2. Dexmedetomidine for sedation of cardiosurgical patients

    Directory of Open Access Journals (Sweden)

    И. А. Козлов

    2015-10-01

    Full Text Available The problem of sedation in cardiosurgical intensive care units has obvious scientific and practical relevance. Many current studies deal with the implementation of novel medications for sedation, some features of their pharmacodynamic effects in different clinical settings, with advantages and disadvantages of their use in cardiosurgical patients. Recent years have seen an increase in the number of publications on the 2-adrenoceptor agonist dexmedetomidine used for sedation after open-heart surgery. The paper reviews current publications on 2-adrenoceptor agonists used in anesthesiology, considers their physiology and the mechanism of sedative action of dexmedetomidine, its pharmacokinetics and pharmacodynamics. The experience in using dexmedetomidine sedation in clinical practice is discussed in detail, by analyzing the data of current multicenter randomized trials in which this drug was compared with other sedative medications (propofol, midazolam, lorazepam. Some aspects of clinical pharmacology of dexmedetomidine, such as its effect on the sympathoadrenal system, hemodynamics, and respiratory system are analyzed. The clinical value of different receptor-dependent effects of the drug and the specific features of its application in different situations are also discussed. The authors share their own experience on delirium treatment and non-invasive ventilation in patients who receive dexmedetomidine sedation after heart transplantation and cardiac surgery.

  3. Conscious Sedation: Emerging Trends in Pediatric Dentistry.

    Science.gov (United States)

    Attri, Joginder Pal; Sharan, Radhe; Makkar, Vega; Gupta, Kewal Krishan; Khetarpal, Ranjana; Kataria, Amar Parkash

    2017-01-01

    Dental fear and anxiety is a common problem in pediatric patients. There is considerable variation in techniques used to manage them. Various sedation techniques using many different anesthetic agents have gained considerable popularity over the past few years. Children are not little adults; they differ physically, psychologically, and emotionally. The purpose of this review is to survey recent trends and concerning issues in the rapidly changing field of pediatric sedation. We will study the topic from the perspective of an anesthesiologist. It will also provide information to practitioners on the practice of conscious sedation in dentistry and will also outline the route of administration, pharmacokinetics, and pharmacodynamics of various drugs used.

  4. [Palliative sedation for psycho-existential suffering].

    Science.gov (United States)

    Weichselbaumer, Eva; Weixler, Dietmar

    2014-05-01

    Sedation in palliative care is generally considered as an important therapy in terminally ill patients with refractory symptoms. However the sedation of patients with intractable psycho-existential suffering is still under discussion. This paper discusses the case of a 56-year-old patient in the final phase of carcinoma of the ovaries, who required palliative sedation for refractory, mainly psycho-existential suffering. It describes the course on our ward and the difficult process of decision-making. We discuss our approach based on literature.

  5. Sedation Monitoring and Management during Percutaneous Endoscopic Lumbar Discectomy

    Directory of Open Access Journals (Sweden)

    Menekse Oksar

    2016-01-01

    Full Text Available Percutaneous endoscopic laser discectomy (PELD is a painful intervention that requires deep sedation and analgesia. However, sedation should be light at some point because cooperation by the patient during the procedure is required for successful surgical treatment. Light sedation poses a problem for endotracheal intubation, while patients placed in the prone position during percutaneous endoscopic discectomy pose a problem for airway management. Therefore, under these conditions, sedation should be not deeper than required. Here we report the sedation management of three cases that underwent PELD, with a focus on deep and safe sedation that was monitored using bispectral index score and observer’s assessment of alertness/sedation score.

  6. Provision of deep procedural sedation by a pediatric sedation team at a freestanding imaging center.

    Science.gov (United States)

    Emrath, Elizabeth T; Stockwell, Jana A; McCracken, Courtney E; Simon, Harold K; Kamat, Pradip P

    2014-08-01

    Freestanding imaging centers are popular options for health care systems to offer services accessible to local communities. The provision of deep sedation at these centers could allow for flexibility in scheduling imaging for pediatric patients. Our Children's Sedation Services group, comprised of pediatric critical care medicine and pediatric emergency medicine physicians, has supplied such a service for 5 years. However, limited description of such off-site services exists. The site has resuscitation equipment and medications, yet limited staffing and no proximity to hospital support. To describe the experience of a cohort of pediatric patients undergoing sedation at a freestanding imaging center. A retrospective chart review of all sedations from January 2012 to December 2012. Study variables include general demographics, length of sedation, type of imaging, medications used, completion of imaging, adverse events based on those defined by the Pediatric Sedation Research Consortium database and need for transfer to a hospital for additional care. Six hundred fifty-four consecutive sedations were analyzed. Most patients were low acuity American Society of Anesthesiologists physical class ≤ 2 (91.8%). Mean sedation time was 55 min (SD ± 24). The overwhelming majority of patients (95.7%) were sedated for MRI, 3.8% for CT and Propofol was used in 98% of cases. Overall, 267 events requiring intervention occurred in 164 patient encounters (25.1%). However, after adjustment for changes from expected physiological response to the sedative, the rate of events was 10.2%. Seventy-five (11.5%) patients had desaturation requiring supplemental oxygen, nasopharyngeal tube or oral airway placement, continuous positive airway pressure or brief bag valve mask ventilation. Eleven (1.7%) had apnea requiring continuous positive airway pressure or bag valve mask ventilation briefly. One patient had bradycardia that resolved with nasopharyngeal tube placement and continuous positive

  7. Sedation with nitrous oxide compared with no sedation during catheterization for urologic imaging in children

    Energy Technology Data Exchange (ETDEWEB)

    Zier, Judith L. [Children' s Hospitals and Clinics of Minnesota, Pediatric Critical Care, Minneapolis, MN (United States); Children' s Respiratory and Critical Care Specialists, Minneapolis, MN (United States); Kvam, Kathryn A. [University of Michigan Medical School, Ann Arbor, MI (United States); Kurachek, Stephen C. [Children' s Hospitals and Clinics of Minnesota, Pediatric Critical Care, Minneapolis, MN (United States); Finkelstein, Marsha [Children' s Hospitals and Clinics of Minnesota, Center for Care Innovation and Research, Minneapolis, MN (United States)

    2007-07-15

    Various strategies to mitigate children's distress during voiding cystourethrography (VCUG) have been described. Sedation with nitrous oxide is comparable to that with oral midazolam for VCUG, but a side-by-side comparison of nitrous oxide sedation and routine care is lacking. The effects of sedation/analgesia using 70% nitrous oxide and routine care for VCUG and radionuclide cystography (RNC) were compared. A sample of 204 children 4-18 years of age scheduled for VCUG or RNC with sedation or routine care were enrolled in this prospective study. Nitrous oxide/oxygen (70%/30%) was administered during urethral catheterization to children in the sedated group. The outcomes recorded included observed distress using the Brief Behavioral Distress Score, self-reported pain, and time in department. The study included 204 patients (99 nonsedated, 105 sedated) with a median age of 6.3 years (range 4.0-15.2 years). Distress and pain scores were greater in nonsedated than in sedated patients (P < 0.001). Time in department was longer in the sedated group (90 min vs. 30 min); however, time from entry to catheterization in a non-imaging area accounted for most of the difference. There was no difference in radiologic imaging time. Sedation with nitrous oxide is effective in reducing distress and pain during catheterization for VCUG or RNC in children. (orig.)

  8. 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)...

  9. 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...

  10. 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...

  11. 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.

  12. 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.

  13. 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.

  14. 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

  15. Novel porcine repetitive elements

    Directory of Open Access Journals (Sweden)

    Nonneman Dan J

    2006-12-01

    Full Text Available Abstract Background Repetitive elements comprise ~45% of mammalian genomes and are increasingly known to impact genomic function by contributing to the genomic architecture, by direct regulation of gene expression and by affecting genomic size, diversity and evolution. The ubiquity and increasingly understood importance of repetitive elements contribute to the need to identify and annotate them. We set out to identify previously uncharacterized repetitive DNA in the porcine genome. Once found, we characterized the prevalence of these repeats in other mammals. Results We discovered 27 repetitive elements in 220 BACs covering 1% of the porcine genome (Comparative Vertebrate Sequencing Initiative; CVSI. These repeats varied in length from 55 to 1059 nucleotides. To estimate copy numbers, we went to an independent source of data, the BAC-end sequences (Wellcome Trust Sanger Institute, covering approximately 15% of the porcine genome. Copy numbers in BAC-ends were less than one hundred for 6 repeat elements, between 100 and 1000 for 16 and between 1,000 and 10,000 for 5. Several of the repeat elements were found in the bovine genome and we have identified two with orthologous sites, indicating that these elements were present in their common ancestor. None of the repeat elements were found in primate, rodent or dog genomes. We were unable to identify any of the replication machinery common to active transposable elements in these newly identified repeats. Conclusion The presence of both orthologous and non-orthologous sites indicates that some sites existed prior to speciation and some were generated later. The identification of low to moderate copy number repetitive DNA that is specific to artiodactyls will be critical in the assembly of livestock genomes and studies of comparative genomics.

  16. 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...

  17. The role of sedation tests in identifying sedative drug effects in healthy volunteers and their power to dissociate sedative-related impairments from memory dysfunctions.

    NARCIS (Netherlands)

    Wezenberg, E.; Sabbe, B.G.C.C.; Hulstijn, W.; Ruigt, G.S.F.; Verkes, R.J.

    2007-01-01

    The study investigated whether four specified drugs would show similar patterns on tests considered to measure sedation. In addition, their drug-effect patterns on sedation and memory performance were compared to determine whether the sedative effects could be differentiated from the memory

  18. 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.

  19. 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.

  20. 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.)

  1. Ketamine-propofol sedation in circumcision.

    Science.gov (United States)

    Gulec, Handan; Sahin, Saziye; Ozayar, Esra; Degerli, Semih; Bercin, Fatma; Ozdemir, Osman

    2015-01-01

    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. 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 0.05mg/kg+ketamine 3mg/kg+atropine 0.02mg/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. 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, 20thmin, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (pPropofol-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. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  2. 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.

  3. Repetitive Pediatric Anesthesia in a Non-Hospital Setting

    Energy Technology Data Exchange (ETDEWEB)

    Buchsbaum, Jeffrey C., E-mail: jbuchsba@iupui.edu [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana (United States); Indiana University Health Proton Therapy Center, Bloomington, Indiana (United States); McMullen, Kevin P.; Douglas, James G. [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana (United States); Indiana University Health Proton Therapy Center, Bloomington, Indiana (United States); Jackson, Jeffrey L.; Simoneaux, R. Victor; Hines, Matthew; Bratton, Jennifer; Kerstiens, John [Indiana University Health Proton Therapy Center, Bloomington, Indiana (United States); Johnstone, Peter A.S. [Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana (United States); Indiana University Health Proton Therapy Center, Bloomington, Indiana (United States)

    2013-04-01

    Purpose: Repetitive sedation/anesthesia (S/A) for children receiving fractionated radiation therapy requires induction and recovery daily for several weeks. In the vast majority of cases, this is accomplished in an academic center with direct access to pediatric faculty and facilities in case of an emergency. Proton radiation therapy centers are more frequently free-standing facilities at some distance from specialized pediatric care. This poses a potential dilemma in the case of children requiring anesthesia. Methods and Materials: The records of the Indiana University Health Proton Therapy Center were reviewed for patients requiring anesthesia during proton beam therapy (PBT) between June 1, 2008, and April 12, 2012. Results: A total of 138 children received daily anesthesia during this period. A median of 30 fractions (range, 1-49) was delivered over a median of 43 days (range, 1-74) for a total of 4045 sedation/anesthesia procedures. Three events (0.0074%) occurred, 1 fall from a gurney during anesthesia recovery and 2 aspiration events requiring emergency department evaluation. All 3 children did well. One aspiration patient needed admission to the hospital and mechanical ventilation support. The other patient returned the next day for treatment without issue. The patient who fell was not injured. No patient required cessation of therapy. Conclusions: This is the largest reported series of repetitive pediatric anesthesia in radiation therapy, and the only available data from the proton environment. Strict adherence to rigorous protocols and a well-trained team can safely deliver daily sedation/anesthesia in free-standing proton centers.

  4. 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.

  5. [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.

  6. Pediatric procedural sedation by a dedicated nonanesthesiology pediatric sedation service using propofol.

    Science.gov (United States)

    Patel, Kalpesh N; Simon, Harold K; Stockwell, Christina A; Stockwell, Jana A; DeGuzman, Michael A; Roerig, Pei-Ling; Rigby, Mark R

    2009-03-01

    To evaluate the success and dosing requirements of propofol in children for prolonged procedural sedation by a nonanesthesiology-based sedation service. The pediatric sedation service at this institution uses propofol as its preferred sedative, and the local guideline suggests using 3 mg/kg for induction and 5 mg kg(-1) h(-1) for maintenance sedation. Doses can be adjusted as needed to individualize successful sedation. A retrospective analysis of patients sedated for 30 minutes or longer was conducted. Patients were stratified into 4 cohorts based on age (7 years [n = 55]) and dosing patterns, success, and adverse effects were investigated. Two hundred forty-nine patients met the inclusion criteria. Mean age was 4.8 years (SD, 4.1). The mean induction dose was 3.2 mg/kg (range, 0.9-9.7), and the mean maintenance infusion was 5.2 mg kg(-1) h(-1) (range, 0.14-21.3). No differences were seen in the induction doses in the different age cohorts, yet the SD was largest in the youngest cohort compared to any other. Although no differences were seen in maintenance rates by age, the greatest SD for dosing was seen in the oldest cohort. For all ages, all sedations were successful (100%) and unanticipated adverse effects rare (propofol does not vary significantly with age, there is greater variability in induction dosage for those younger than 1 year and in maintenance dosing for those 7 years or older. The results and general dosing parameters may assist pediatric subspecialists in using propofol for prolonged procedural sedation.

  7. 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

  8. Sedation of infants and children outside of the operating room.

    Science.gov (United States)

    Tobias, Joseph D

    2015-08-01

    Although adults may be able to tolerate procedures without sedation, developmental and cognitive issues often mandate the use of sedation in infants and children. There has been a shift in the philosophy regarding sedation with an increasing recognition of the negative psychological and physiological aspects of inadequate sedation. The expansion of our technology continues to result in an increasing number of techniques, which require sedation outside of the operating room environment. These factors have contributed to an ever growing number of pediatric patients presenting themselves for procedural sedation. This chapter will discuss issues regarding the provision of anesthesia outside of the operating room for pediatric patients including current guidelines for patient assessment prior to procedural, monitoring during sedation, and a discussion of some of the more commonly utilized sedative and analgesic agents within the pediatric population.

  9. Attitude and Practices of Sedation amongst Critical Care Nurses ...

    African Journals Online (AJOL)

    Attitude and Practices of Sedation amongst Critical Care Nurses Working in a ... a standardized approach towards sedation management as very important. ... pharmacological agents (75%) had less than five years work experience in the ICU.

  10. 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.

  11. 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.

  12. MIMICRY, DIFFERENCE AND REPETITION

    Directory of Open Access Journals (Sweden)

    Marcelo Mendes de Souza

    2008-07-01

    Full Text Available This article addresses Homi K. Bhabha’s concept of mimicry in a broader context, other than that of cultural studies and post-colonial studies, bringing together other concepts, such as that of Gilles Deleuze in Difference and repetition, among other texts, and other names, such as Silviano Santiago, Jorge Luís Borges, Franz Kafka and Giorgio Agamben. As a partial conclusion, the article intends to oppose Bhabha’s freudian-marxist view to Five propositions on Psychoanalysis (1973, Gilles Deleuze’s text about Psychoanalysis published right after his book The Anti-Oedipus.

  13. 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

  14. Pediatric Gastrointestinal Endoscopic Sedation: A 2010 Nationwide Survey in Taiwan

    Directory of Open Access Journals (Sweden)

    Po-Hon Chen

    2012-06-01

    Conclusion: A majority of pediatric EGD in Taiwan was performed under sedation and applied more often to younger children. Endoscopists were more satisfied during EGD when practicing sedation. This survey should help formulate updated practice guidelines and policies regarding endoscopic sedation.

  15. 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

  16. 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...

  17. [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.

  18. 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.

  19. Effects of music on sedation depth and sedative use during pediatric dental procedures.

    Science.gov (United States)

    Ozkalayci, Ozlem; Araz, Coskun; Cehreli, Sevi Burcak; Tirali, Resmiye Ebru; Kayhan, Zeynep

    2016-11-01

    The study aimed to investigate the effects of listening to music or providing sound isolation on the depth of sedation and need for sedatives in pediatric dental patients. Prospective, randomized, and controlled study. Tertiary, university hospital. In total, 180 pediatric patients, American Society of Anesthesiologists physical status I and II, who were scheduled for dental procedures of tooth extraction, filling, amputation, and root treatment. Patients were categorized into 3 groups: music, isolation, and control. During the procedures, the patients in the music group listened to Vivaldi's The Four Seasons violin concertos by sound-isolating headphones, whereas the patients in the isolation group wore the headphones but did not listen to music. All patients were sedated by 0.1 mg/kg midazolam and 1 mg/kg propofol. During the procedure, an additional 0.5 mg/kg propofol was administered as required. Bispectral index was used for quantifying the depth of sedation, and total dosage of the propofol was used for sedative requirements. The patients' heart rates, oxygen saturations, and Observer's Assessment of Alertness and Sedation Scale and bispectral index scores, which were monitored during the operation, were similar among the groups. In terms of the amount of propofol used, the groups were similar. Prolonged postoperative recovery cases were found to be significantly frequent in the control group, according to the recovery duration measurements (P = .004). Listening to music or providing sound isolation during pediatric dental interventions did not alter the sedation level, amount of medication, and hemodynamic variables significantly. This result might be due to the deep sedation levels reached during the procedures. However, listening to music and providing sound isolation might have contributed in shortening the postoperative recovery duration of the patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. 牙科镇静技术的研究进展%Research progress on dental sedation

    Institute of Scientific and Technical Information of China (English)

    周猛; 谢蟪旭

    2011-01-01

    The development of sedation techniques has always been inextricably linked with the development of dentistry. Today, the most commonly used dental nitrous oxide sedation technique has been proved to be potential harmful to medical staff, thus new technology of dental sedation is needed. The literature of sedation in dentistry in the recent years focused on three main areas: Midazolam sedation, sedation with dexmedetomidine in dentistry and patient controlled sedation with propofol in dentistry. The aim of this review is to summarize the recent literature in this field and state the current sedation technique in dentistry.%镇静技术的发展一直与口腔科的发展密不可分,现今口腔科最常用的一氧化氮(笑氧)混合气体镇静技术对医务人员具有潜在的健康威胁,因此,口腔科医师正在寻找新的镇静药物来代替一氧化氮.近年来,口腔科镇静技术的进展集中在3个方面:咪达唑仑镇静技术、美托咪啶镇静技术和异丙酚自控镇静技术.本文总结了最近几年有关口腔科镇静技术的文献,对镇静技术在口腔科的应用现状和进展作一综述.

  1. 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

  2. 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

  3. A novel system for automated propofol sedation: hybrid sedation system (HSS).

    Science.gov (United States)

    Zaouter, Cedrick; Taddei, Riccardo; Wehbe, Mohamad; Arbeid, Erik; Cyr, Shantale; Giunta, Francesco; Hemmerling, Thomas M

    2017-04-01

    Closed-loop systems for propofol have been demonstrated to be safe and reliable for general anesthesia. However, no study has been conducted using a closed-loop system specifically designed for sedation in patients under spinal anesthesia. We developed an automatic anesthesia sedation system that allows for closed-loop delivery of propofol for sedation integrating a decision support system, called the hybrid sedation system (HSS). The objective of this study is to compare this system with standard practice. One hundred fifty patients were enrolled and randomly assigned to two groups: HSS-Group (N = 75), in which propofol was administered using a closed-loop system; Control Group (N = 75), in which propofol was delivered manually. The clinical performance of the propofol sedation control is defined as efficacy to maintain bispectral index (BIS) near 65. The clinical control was called 'Excellent', 'Good', 'Poor' and 'Inadequate' with BIS values within 10 %, from 11 to 20 %, 21 to 30 %, or greater than 30 % of the BIS target of 65, respectively. The controller performance was evaluated using Varvel's parameters. Data are presented as mean ± standard deviation, groups were compared using t test or Chi square test, P propofol sedation showed better maintenance of the target BIS value compared to manual administration.

  4. Repetition in Waiting for Godot

    Institute of Scientific and Technical Information of China (English)

    李想; 魏妍

    2015-01-01

    Waiting for Godot is one of the most famous plays written by Samuel Barclay Beckett, and also is the founding work of“Theatre of the Absurd”. In the drama, repetitive phenomena shed light on the whole construction considerably. All the charac-ters were helpless and unthinking. Their dialogues were simple, nonsense and repetitive. Two scenes were cyclical. Repetition was used subtly in order to express the theme of the play, showing mental crisis after depravation of WWII.

  5. Safety of propofol sedation for pediatric outpatient procedures.

    Science.gov (United States)

    Larsen, Reagan; Galloway, David; Wadera, Sheetal; Kjar, Dean; Hardy, David; Mirkes, Curtis; Wick, Lori; Pohl, John F

    2009-10-01

    Propofol sedation is used more frequently in pediatric procedures because of its ability to provide varying sedation levels. The authors evaluated all outpatient pediatric procedures using propofol sedation over a 6-year period. All sedation was provided by pediatric intensivists at a single institution. In all, 4716 procedures were recorded during the study period; 15% of procedures were associated with minor complications, whereas only 0.1% of procedures were associated with major complications. Significantly more major complications associated with propofol occurred during bronchoscopy (P = .001). Propofol administered by a pediatric intensivist is a safe sedation technique in the pediatric outpatient setting.

  6. 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.

  7. Understanding maximal repetitions in strings

    CERN Document Server

    Crochemore, Maxime

    2008-01-01

    The cornerstone of any algorithm computing all repetitions in a string of length n in O(n) time is the fact that the number of runs (or maximal repetitions) is O(n). We give a simple proof of this result. As a consequence of our approach, the stronger result concerning the linearity of the sum of exponents of all runs follows easily.

  8. 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

  9. Sedation and analgesia for gastrointestinal endoscopy in children

    Directory of Open Access Journals (Sweden)

    Jernej Brecelj

    2013-10-01

    Full Text Available Different sedation or anesthesia protocols are available to enable gastrointestinal endoscopic examinations in children. None is optimal. Sedation is organized according to the medical system, resources and the availability of personnel and medication (sedatives, anesthetics, analgesics. If anesthesiologist’s sedation teams for children are not available, strong evidence supports sedation safety and efficiency when it is performed by specially educated non-anesthesiologists and registered nurses. This review is a brief synthesis of main guidelines and position papers of procedural sedation in children and, when unavailable, in adults, who are eligible for pediatric gastrointestinal endoscopy sedation by non-anesthesiologist. Published data are supplemented by clinical experience and the findings of author’s research on ketamine sedation. Other established sedative combinations are benzodiazepine and opioid or propofol as a sole agent or in combination with analgesics. Special stress is given on a proper choice of the sedation protocol for specific examination or procedure in accordance with institution’s policy. Whole endoscopic team has to be engaged in the implementation of new evidence and continuous education to achieve the highest possible safety and quality standards.

  10. Perceptual Repetition Blindness Effects

    Science.gov (United States)

    Hochhaus, Larry; Johnston, James C.; Null, Cynthia H. (Technical Monitor)

    1994-01-01

    The phenomenon of repetition blindness (RB) may reveal a new limitation on human perceptual processing. Recently, however, researchers have attributed RB to post-perceptual processes such as memory retrieval and/or reporting biases. The standard rapid serial visual presentation (RSVP) paradigm used in most RB studies is, indeed, open to such objections. Here we investigate RB using a "single-frame" paradigm introduced by Johnston and Hale (1984) in which memory demands are minimal. Subjects made only a single judgement about whether one masked target word was the same or different than a post-target probe. Confidence ratings permitted use of signal detection methods to assess sensitivity and bias effects. In the critical condition for RB a precue of the post-target word was provided prior to the target stimulus (identity precue), so that the required judgement amounted to whether the target did or did not repeat the precue word. In control treatments, the precue was either an unrelated word or a dummy.

  11. 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.

  12. 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.

  13. Analgesia and sedation after pediatric cardiac surgery.

    Science.gov (United States)

    Wolf, Andrew R; Jackman, Lara

    2011-05-01

    In recent years, the importance of appropriate intra-operative anesthesia and analgesia during cardiac surgery has become recognized as a factor in postoperative recovery. This includes the early perioperative management of the neonate undergoing radical surgery and more recently the care surrounding fast-track and ultra fast-track surgery. However, outside these areas, relatively little attention has focused on postoperative sedation and analgesia within the pediatric intensive care unit (PICU). This reflects perceived priorities of the primary disease process over the supporting structure of PICU, with a generic approach to sedation and analgesia that can result in additional morbidities and delayed recovery. Management of the marginal patient requires optimisation of not only cardiac and other attendant pathophysiology, but also every aspect of supportive care. Individualized sedation and analgesia strategies, starting in the operating theater and continuing through to hospital discharge, need to be regarded as an important aspect of perioperative care, to speed the process of recovery. © 2010 Blackwell Publishing Ltd.

  14. Repetitive element hypermethylation in multiple sclerosis patients.

    Science.gov (United States)

    Neven, K Y; Piola, M; Angelici, L; Cortini, F; Fenoglio, C; Galimberti, D; Pesatori, A C; Scarpini, E; Bollati, V

    2016-06-18

    Multiple sclerosis (MS) is a complex disorder of the central nervous system whose cause is currently unknown. Evidence is increasing that DNA methylation alterations could be involved in inflammatory and neurodegenerative diseases and could contribute to MS pathogenesis. Repetitive elements Alu, LINE-1 and SAT-α, are widely known as estimators of global DNA methylation. We investigated Alu, LINE-1 and SAT-α methylation levels to evaluate their difference in a case-control setup and their role as a marker of disability. We obtained blood samples from 51 MS patients and 137 healthy volunteers matched by gender, age and smoking. Methylation was assessed using bisulfite-PCR-pyrosequencing. For all participants, medical history, physical and neurological examinations and screening laboratory tests were collected. All repetitive elements were hypermethylated in MS patients compared to healthy controls. A lower Expanded Disability Status Scale (EDSS) score was associated with a lower levels of LINE-1 methylation for 'EDSS = 1.0' and '1.5 ≤ EDSS ≤ 2.5' compared to an EDSS higher than 3, while Alu was associated with a higher level of methylation in these groups: 'EDSS = 1.0' and '1.5 ≤ EDSS ≤ 2.5'. MS patients exhibit an hypermethylation in repetitive elements compared to healthy controls. Alu and LINE-1 were associated with degree of EDSS score. Forthcoming studies focusing on epigenetics and the multifactorial pathogenetic mechanism of MS could elucidate these links further.

  15. Directed PCR-free engineering of highly repetitive DNA sequences

    Directory of Open Access Journals (Sweden)

    Preissler Steffen

    2011-09-01

    Full Text Available Abstract Background Highly repetitive nucleotide sequences are commonly found in nature e.g. in telomeres, microsatellite DNA, polyadenine (poly(A tails of eukaryotic messenger RNA as well as in several inherited human disorders linked to trinucleotide repeat expansions in the genome. Therefore, studying repetitive sequences is of biological, biotechnological and medical relevance. However, cloning of such repetitive DNA sequences is challenging because specific PCR-based amplification is hampered by the lack of unique primer binding sites resulting in unspecific products. Results For the PCR-free generation of repetitive DNA sequences we used antiparallel oligonucleotides flanked by restriction sites of Type IIS endonucleases. The arrangement of recognition sites allowed for stepwise and seamless elongation of repetitive sequences. This facilitated the assembly of repetitive DNA segments and open reading frames encoding polypeptides with periodic amino acid sequences of any desired length. By this strategy we cloned a series of polyglutamine encoding sequences as well as highly repetitive polyadenine tracts. Such repetitive sequences can be used for diverse biotechnological applications. As an example, the polyglutamine sequences were expressed as His6-SUMO fusion proteins in Escherichia coli cells to study their aggregation behavior in vitro. The His6-SUMO moiety enabled affinity purification of the polyglutamine proteins, increased their solubility, and allowed controlled induction of the aggregation process. We successfully purified the fusions proteins and provide an example for their applicability in filter retardation assays. Conclusion Our seamless cloning strategy is PCR-free and allows the directed and efficient generation of highly repetitive DNA sequences of defined lengths by simple standard cloning procedures.

  16. 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.

  17. 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.).

  18. 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.

  19. 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...

  20. 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...

  1. Complications of three deep sedation methods for magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Solina Tith

    2012-01-01

    Conclusions: DS with a pentobarbital technique was associated with decreased odds for complications when compared to a propofol-based technique or a pentobarbital technique requiring supplemental sedation.

  2. Terminal sedation and euthanasia: a comparison of clinical practices.

    Science.gov (United States)

    Rietjens, Judith A C; van Delden, Johannes J M; van der Heide, Agnes; Vrakking, Astrid M; Onwuteaka-Philipsen, Bregje D; van der Maas, Paul J; van der Wal, Gerrit

    2006-04-10

    An important issue in the debate about terminal sedation is the extent to which it differs from euthanasia. We studied clinical differences and similarities between both practices in the Netherlands. Personal interviews were held with a nationwide stratified sample of 410 physicians (response rate, 85%) about the most recent cases in which they used terminal sedation, defined as administering drugs to keep the patient continuously in deep sedation or coma until death without giving artificial nutrition or hydration (n = 211), or performed euthanasia, defined as administering a lethal drug at the request of a patient with the explicit intention to hasten death (n = 123). We compared characteristics of the patients, the decision-making process, and medical care of both practices. Terminal sedation and euthanasia both mostly concerned patients with cancer. Patients receiving terminal sedation were more often anxious (37%) and confused (24%) than patients receiving euthanasia (15% and 2%, respectively). Euthanasia requests were typically related to loss of dignity and a sense of suffering without improving, whereas requesting terminal sedation was more often related to severe pain. Physicians applying terminal sedation estimated that the patient's life had been shortened by more than 1 week in 27% of cases, compared with 73% in euthanasia cases. Terminal sedation and euthanasia both are often applied to address severe suffering in terminally ill patients. However, terminal sedation is typically used to address severe physical and psychological suffering in dying patients, whereas perceived loss of dignity during the last phase of life is a major problem for patients requesting euthanasia.

  3. Smart syringe pumps for drug infusion during dental intravenous sedation.

    Science.gov (United States)

    Seo, Kwang-Suk; Lee, Kiyoung

    2016-09-01

    Dentists often sedate patients in order to reduce their dental phobia and stress during dental treatment. Sedatives are administered through various routes such as oral, inhalation, and intravenous routes. Intravenous administration has the advantage of rapid onset of action, predictable duration of action, and easy titration. Typically, midazolam, propofol or dexmedetomidine are used as intravenous sedatives. Administration of these sedatives via infusion by using a syringe pump is more effective and successful than infusing them as a bolus. However, during intravenous infusion of sedatives or opioids using a syringe pump, fatal accidents may occur due to the clinician's carelessness. To prevent such risks, smart syringe pumps have been introduced clinically. They allow clinicians to perform effective sedation by using a computer to control the dose of the drug being infused. To ensure patient safety, various alarm features along with a drug library, which provides drug information and prevents excessive infusion by limiting the dose, have been added to smart pumps. In addition, programmed infusion systems and target-controlled infusion systems have also been developed to enable effective administration of sedatives. Patient-controlled infusion, which allows a patient to control his/her level of sedation through self-infusion, has also been developed. Safer and more successful sedation may be achieved by fully utilizing these new features of the smart pump.

  4. 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.

  5. 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.

  6. Effects of repetitive exposure to anesthetics and analgesics in the Tg2576 mouse Alzheimer's model.

    Science.gov (United States)

    Quiroga, Carolina; Chaparro, Rafael E; Karlnoski, Rachel; Erasso, Diana; Gordon, Marcia; Morgan, David; Bosco, Gerardo; Rubini, Alessandro; Parmagnani, Andrea; Paoli, Antonio; Mangar, Devanand; Camporesi, Enrico M

    2014-11-01

    The use of anesthetics and sedatives has been suggested to be a contributor to Alzheimer's disease neuropathogenesis. We wanted to address the in vivo relevance of those substances in the Tg2576 Alzheimer's mouse model. Tg7526 mice were anesthesia-sedated for 90 min once a week for 4 weeks. Y maze, Congo Red, and amyloid beta (Aβ) immunochemistry were performed. We did not find any significant change in the navigation behavior of the exposed mice compared to the controls. Significantly less deposition of Aβ in the CA1 area of the hippocampus and frontal cortex of mice exposed to isoflurane, propofol, diazepam, ketamine, and pentobarbital was observed. In the dentate gyrus, Aβ deposition was significantly greater in the group treated with pentobarbital. Congo Red staining evidenced significantly fewer fibrils in the cortex of mice exposed to diazepam, ketamine, or pentobarbital. The adopted repetitive exposure did not cause a significant detriment in Tg7526 mouse.

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

    DEFF Research Database (Denmark)

    Hansen, Tom G

    2015-01-01

    PURPOSE OF REVIEW: There is a growing medical demand for suitable sedatives and analgesics to support the ongoing progress in diagnostic procedures and imaging techniques. This review provides an update of the pharmacology of the most commonly used drugs used for these procedures and shortly...

  8. 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.)

  9. Spectral entropy for assessing the depth of propofol sedation.

    Science.gov (United States)

    Kwon, Mi-Young; Lee, Seung-Yun; Kim, Tae-Yop; Kim, Duk Kyung; Lee, Kyoung-Min; Woo, Nam-Sik; Chang, Young-Jae; Lee, Myung Ae

    2012-03-01

    For patients in the intensive care unit (ICU) or under monitored anesthetic care (MAC), the precise monitoring of sedation depth facilitates the optimization of dosage and prevents adverse complications from underor over-sedation. For this purpose, conventional subjective sedation scales, such as the Observer's Assessment of Alertness/Sedation (OAA/S) or the Ramsay scale, have been widely utilized. Current procedures frequently disturb the patient's comfort and compromise the already well-established sedation. Therefore, reliable objective sedation scales that do not cause disturbances would be beneficial. We aimed to determine whether spectral entropy can be used as a sedation monitor as well as determine its ability to discriminate all levels of propofol-induced sedation during gradual increments of propofol dosage. In 25 healthy volunteers undergoing general anesthesia, the values of response entropy (RE) and state entropy (SE) corresponding to each OAA/S (5 to 1) were determined. The scores were then analyzed during each 0.5 mcg/ml- incremental increase of a propofol dose. We observed a reduction of both RE and SE values that correlated with the OAA/S (correlation coefficient of 0.819 in RE-OAA/S and 0.753 in SE-OAA/S). The RE and SE values corresponding to awake (OAA/S score 5), light sedation (OAA/S 3-4) and deep sedation (OAA/S 1-2) displayed differences (P < 0.05). The results indicate that spectral entropy can be utilized as a reliable objective monitor to determine the depth of propofol-induced sedation.

  10. 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)

  11. Repetition in English Political Public Speaking

    Institute of Scientific and Technical Information of China (English)

    李红梅

    2010-01-01

    Repetition is frequently used in English political public speaking to make it easy to be remembered and powerful to move the feelings of the public. This paper is intended to analyze the functions of repetition and different levels of repetition to highlight the significance of repetition in English political public speaking and the ability of using it in practice.

  12. Effects of nurses' practice of a sedation protocol on sedation and consciousness levels of patients on mechanical ventilation.

    Science.gov (United States)

    Abdar, Mohammad Esmaeili; Rafiei, Hossein; Abbaszade, Abbas; Hosseinrezaei, Hakimeh; Abdar, Zahra Esmaeili; Delaram, Masoumeh; Ahmadinejad, Mehdi

    2013-09-01

    Providing high-quality care in the intensive care units (ICUs) is a major goal of every medical system. Nurses play a crucial role in achieving this goal. One of the most important responsibilities of nurses is sedation and pain control of patients. The present study tried to assess the effect of nurses' practice of a sedation protocol on sedation and consciousness levels and the doses of sedatives and analgesics in the ICU patients. This clinical trial was conducted on 132 ICU patients on mechanical ventilation. The patients were randomly allocated to two groups. While the control group received the ICU's routine care, the intervention group was sedated by ICU nurses based on Jacob's modified sedation protocol. The subjects' sedation and consciousness levels were evaluated by the Richmond Agitation Sedation Scale (RASS) and the Glasgow Coma Scale (GCS), respectively. Doses of administered midazolam and morphine were also recorded. The mean RASS score of the intervention group was closer to the ideal range (-1 to +1), compared to the control group (-0.95 ± 0.3 vs. -1.88 ± 0.4). Consciousness level of the control group was lower than that of the intervention group (8.4 ± 0.4 vs. 8.8 ± 0.4). Finally, higher doses of midazolam and morphine were administered in the control group than in the intervention group. As nurses are in constant contact with the ICU patients, their practice of a sedation protocol can result in better sedation and pain control in the patients and reduce the administered doses of sedatives and analgesics.

  13. 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.

  14. 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...

  15. Sedation with dexmedetomidine in the intensive care setting

    Directory of Open Access Journals (Sweden)

    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

  16. 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

  17. [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.

  18. Varianish: Jamming with Pattern Repetition

    Directory of Open Access Journals (Sweden)

    Jort Band

    2014-10-01

    Full Text Available In music, patterns and pattern repetition are often regarded as a machine-like task, indeed often delegated to drum Machines and sequencers. Nevertheless, human players add subtle differences and variations to repeated patterns that are musically interesting and often unique. Especially when looking at minimal music, pattern repetitions create hypnotic effects and the human mind blends out the actual pattern to focus on variation and tiny differences over time. Varianish is a musical instrument that aims at turning this phenomenon into a new musical experience for musician and audience: Musical pattern repetitions are found in live music and Varianish generates additional (musical output accordingly that adds substantially to the overall musical expression. Apart from the theory behind the pattern finding and matching and the conceptual design, a demonstrator implementation of Varianish is presented and evaluated.

  19. REPETITIVE CLUSTER-TILTED ALGEBRAS

    Institute of Scientific and Technical Information of China (English)

    Zhang Shunhua; Zhang Yuehui

    2012-01-01

    Let H be a finite-dimensional hereditary algebra over an algebraically closed field k and CFm be the repetitive cluster category of H with m ≥ 1.We investigate the properties of cluster tilting objects in CFm and the structure of repetitive clustertilted algebras.Moreover,we generalize Theorem 4.2 in [12](Buan A,Marsh R,Reiten I.Cluster-tilted algebra,Trans.Amer.Math.Soc.,359(1)(2007),323-332.) to the situation of CFm,and prove that the tilting graph KCFm of CFm is connected.

  20. Propofol vs pentobarbital for sedation of children undergoing magnetic resonance imaging: results from the Pediatric Sedation Research Consortium.

    Science.gov (United States)

    Mallory, Michael D; Baxter, Amy L; Kost, Susanne I

    2009-06-01

    Pentobarbital and propofol are commonly used to sedate children undergoing magnetic resonance imaging (MRI). The Pediatric Sedation Research Consortium (PSRC) was created in 2003 to improve pediatric sedation process and outcomes. To use PSRC records to compare the effectiveness, efficiency and adverse events of propofol vs pentobarbital for sedation of children undergoing MRI. Pediatric Sedation Research Consortium records of children aged 6 months to 6 years who were primarily sedated with either i.v. pentobarbital or propofol were included. Participating PSRC investigators obtained institutional review board approval before data collection. Of 11 846 sedations for MRI, 7079 met inclusion criteria (propofol: n = 5072; pentobarbital: n = 2007). Demographic details were similar between the two groups. Ideal sedation was produced in 96.45% of the pentobarbital group and in 96.8% of the propofol group (P = 0.478), but pentobarbital was more likely to result in poor sedation cancelling the procedure (OR 5.88; CI 2.24, 15.40). Propofol resulted in physiologic changes more frequently than did pentobarbital (OR 5.69; CI 1.35, 23.97). Pentobarbital was associated with prolonged recovery (OR 16.82; CI 4.98, 56.8), unplanned admission (OR 5.60; CI 1.02, 30.82), vomiting (OR 36.76; CI 4.84, 279.2) and allergic complication (OR 9.15; CI 1.02, 82.34). The incidence of airway complications was not significantly different between the two. The median recovery time for patients receiving propofol was 30 min, whereas for pentobarbital it was 75 min (P propofol provides more efficient and effective sedation than pentobarbital for children undergoing MRI. Although apnea occurred with a greater frequency in patients who received propofol, the rate of apnea and airway complications for propofol was not statistically different from that seen in patients who received pentobarbital.

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

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    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

  2. Resistance to change of operant variation and repetition.

    Science.gov (United States)

    Doughty, A H; Lattal, K A

    2001-09-01

    A multiple chained schedule was used to compare the relative resistance to change of variable and fixed four-peck response sequences in pigeons. In one terminal link, a response sequence produced food only if it occurred infrequently relative to 15 other response sequences (vary). In the other terminal link, a single response sequence produced food (repeat). Identical variable-interval schedules operated in the initial links. During baseline, lower response rates generally occurred in the vary initial link, and similar response and reinforcement rates occurred in each terminal link. Resistance of responding to prefeeding and three rates of response-independent food delivered during the intercomponent intervals then was compared between components. During each disruption condition, initial- and terminal-link response rates generally were more resistant in the vary component than in the repeat component. During the response-independent food conditions, terminal-link response rates were more resistant than initial-link response rates in each component, but this did not occur during prefeeding. Variation (in vary) and repetition (in repeat) both decreased during the response-independent food conditions in the respective components, but with relatively greater disruption in repeat. These results extend earlier findings demonstrating that operant variation is more resistant to disruption than is operant repetition and suggest that theories of response strength, such as behavioral momentum theory, must consider factors other than reinforcement rate. The implications of the results for understanding operant response classes are discussed.

  3. 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

  4. Repetitive elements in parasitic protozoa

    Directory of Open Access Journals (Sweden)

    Clayton Christine

    2010-05-01

    Full Text Available Abstract A recent paper published in BMC Genomics suggests that retrotransposition may be active in the human gut parasite Entamoeba histolytica. This adds to our knowledge of the various types of repetitive elements in parasitic protists and the potential influence of such elements on pathogenicity. See research article http://www.biomedcentral.com/1471-2164/11/321

  5. Outcomes of moderate sedation in paediatric dental patients.

    Science.gov (United States)

    Özen, B; Malamed, S F; Cetiner, S; Özalp, N; Özer, L; Altun, C

    2012-06-01

    The aim of this study was to evaluate the outcomes of moderate sedation with nitrous oxide/oxygen (N(2) O/O(2)) alone or combined with different dosages and administration routes of midazolam in uncooperative paediatric dental patients using the Bispectral Index System (BIS). This one-year clinical study examined first-visit moderate sedation performed in 240 healthy children aged 4-6 years. Subjects were randomly divided into four groups according to drug, route and dosage, as follows: Group 1 - 0.20 mg/kg midazolam (40 mg/ml) delivered intranasally; Group 2 - 0.75 mg/kg midazolam (15 mg/3 ml) delivered orally; Group 3 - 0.50 mg/kg midazolam (15 mg/3 ml) delivered orally. All children in these three groups also received inhalation sedation with 50%-50% N(2) O/O(2), whereas children in Group 4 received inhalation sedation with 50%-50% N(2) O/O(2) only. The outcome of sedation was evaluated as either 'successful', 'failed' or 'not accepted'. The highest success rate was found in Group 1 (0.20 mg/kg intranasally, 87%), followed by Group 2 (0.75 mg/kg orally, 79%). The overall mean success rate for all groups was 73%. Moderate sedation can be successfully used in the clinical management of paediatric dental patients, with both intranasal and oral sedation using midazolam in conjunction with nitrous oxide found to be effective methods. © 2012 Australian Dental Association.

  6. 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.)

  7. Pediatric critical care physician-administered procedural sedation using propofol: a report from the Pediatric Sedation Research Consortium Database.

    Science.gov (United States)

    Kamat, Pradip P; McCracken, Courtney E; Gillespie, Scott E; Fortenberry, James D; Stockwell, Jana A; Cravero, Joseph P; Hebbar, Kiran B

    2015-01-01

    Increasing demand for pediatric procedural sedation has resulted in a marked increase in provision of pediatric procedural sedation by pediatric critical care physicians both inside and outside of the ICU. Reported experience of pediatric critical care physicians-administered pediatric procedural sedation is limited. We used the Pediatric Sedation Research Consortium database to evaluate a multicenter experience with propofol by pediatric critical care physicians in all settings. Review of national Pediatric Sedation Research Consortium database to identify pediatric procedural sedation provided by pediatric critical care physicians from 2007 to 2012. Demographic and clinical data were collected to describe pediatric procedural sedation selection, location, and delivery. Multivariable logistic regression analysis was performed to identify risk factors associated with pediatric procedural sedation-related adverse events and complications. A total of 91,189 pediatric procedural sedation performed by pediatric critical care physicians using propofol were included in the database. Median age was 60.0 months (range, 0-264 months; interquartile range, 34.0-132.0); 81.9% of patients were American Society of Anesthesiologists class I or II. Most sedations were performed in dedicated sedation or radiology units (80.9%). Procedures were successfully completed in 99.9% of patients. A propofol bolus alone was used in 52.8%, and 41.7% received bolus plus continuous infusion. Commonly used adjunctive medications were lidocaine (35.3%), opioids (23.3%), and benzodiazepines (16.4%). Overall adverse event incidence was 5.0% (95% CI, 4.9-5.2%), which included airway obstruction (1.6%), desaturation (1.5%), coughing (1.0%), and emergent airway intervention (0.7%). No deaths occurred; a single cardiac arrest was reported in a 13-month-old child receiving propofol and ketamine, with no untoward neurologic sequelae. Risk factors associated with adverse event included: location of

  8. Dexmedetomidine hydrochloride as a long-term sedative

    Directory of Open Access Journals (Sweden)

    Kunisawa T

    2011-07-01

    Full Text Available Takayuki KunisawaSurgical Operation Department, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, JapanAbstract: Dexmedetomidine undoubtedly is a useful sedative in the intensive care setting because it has a minimal effect on the respiratory system. Dexmedetomidine infusions lasting more than 24 hours have not been approved since the first approval was acquired in the US in 1999. However, in 2008, dexmedetomidine infusions for prolonged use were approved in Colombia and in the Dominican Republic, and the number of countries that have granted approval for prolonged use has been increasing every year. This review discusses the literature examining prolonged use of dexmedetomidine and confirms the efficacy and safety of dexmedetomidine when it is used for more than 24 hours. Dexmedetomidine was administered at varying doses (0.1–2.5 µg/kg/hour and durations up to 30 days. Dexmedetomidine seems to be an alternative to benzodiazepines or propofol for achieving sedation in adults because the incidences of delirium and coma associated with dexmedetomidine are lower than the corresponding incidences associated with benzodiazepines and propofol, although dexmedetomidine administration can cause mild adverse effects such as bradycardia. Controlled comparative studies on the efficacy and safety of dexmedetomidine and other sedatives in pediatric patients have not been reported. However, dexmedetomidine seems to be effective in managing extubation, reducing the use of conventional sedatives, and as an alternative for inducing sedation in patients for whom traditional sedatives induce inadequate sedation. Prolonged dexmedetomidine infusion has not been reported to have any serious adverse effects. Dexmedetomidine appears to be an alternative long-term sedative, but further studies are needed to establish its efficacy and safety.Keywords: dexmedetomidine, prolonged sedation, long-term

  9. Autism and exergaming: effects on repetitive behaviors and cognition

    Directory of Open Access Journals (Sweden)

    Anderson-Hanley C

    2011-09-01

    Full Text Available Cay Anderson-Hanley, Kimberly Tureck, Robyn L Schneiderman Department of Psychology, Union College, Schenectady, NY, USA Abstract: Autism is a neurodevelopmental disorder that leads to impairment in social skills and delay in language development, and results in repetitive behaviors and restricted interests that impede academic and social involvement. Physical exercise has been shown to decrease repetitive behaviors in autistic children and improve cognitive function across the life-span. Exergaming combines physical and mental exercise simultaneously by linking physical activity movements to video game control and may yield better compliance with exercise. In this investigation, two pilot studies explored the potential behavioral and cognitive benefits of exergaming. In Pilot I, twelve children with autism spectrum disorders completed a control task and an acute bout of Dance Dance Revolution (DDR; in Pilot II, ten additional youths completed an acute bout of cyber cycling. Repetitive behaviors and executive function were measured before and after each activity. Repetitive behaviors significantly decreased, while performance on Digits Backwards improved following the exergaming conditions compared with the control condition. Additional research is needed to replicate these findings, and to explore the application of exergaming for the management of behavioral disturbance and to increase cognitive control in children on the autism spectrum. Keywords: autism, repetitive behaviors, exergaming, exercise, executive function

  10. Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students

    Directory of Open Access Journals (Sweden)

    Anneser, Johanna

    2016-02-01

    Full Text Available Objectives: In November 2015, the German Federal Parliament voted on a new legal regulation regarding assisted suicide. It was decided to amend the German Criminal Code so that any “regular, repetitive offer” (even on a non-profit basis of assistance in suicide would now be considered a punishable offense. On July 2, 2015, a date which happened to be accompanied by great media interest in that it was the day that the first draft of said law was presented to Parliament, we surveyed 4th year medical students at the Technical University Munich on “physician-assisted suicide,” “euthanasia” and “palliative sedation,” based on a fictitious case vignette study. Method: The vignette study described two versions of a case in which a patient suffered from a nasopharyngeal carcinoma (physical suffering subjectively perceived as being unbearable vs. emotional suffering. The students were asked about the current legal norms for each respective course of action as well as their attitudes towards the ethical acceptability of these measures.Results: Out of 301 students in total, 241 (80% participated in the survey; 109 answered the version 1 questionnaire (physical suffering and 132 answered the version 2 questionnaire (emotional suffering. The majority of students were able to assess the currently prevailing legal norms on palliative sedation (legal and euthanasia (illegal correctly (81.2% and 93.7%, respectively, while only a few students knew that physician-assisted suicide, at that point in time, did not constitute a criminal offense. In the case study that was presented, 83.3% of the participants considered palliative sedation and the simultaneous withholding of artificial nutrition and hydration as ethically acceptable, 51.2% considered physician-assisted suicide ethically legitimate, and 19.2% considered euthanasia ethically permissible. When comparing the results of versions 1 and 2, a significant difference could only be seen in the

  11. 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.

  12. 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.

  13. 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"....

  14. 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...

  15. 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"....

  16. Repetition suppression and repetition priming are processing outcomes.

    Science.gov (United States)

    Wig, Gagan S

    2012-01-01

    Abstract There is considerable evidence that repetition suppression (RS) is a cortical signature of previous exposure to the environment. In many instances RS in specific brain regions is accompanied by improvements in specific behavioral measures; both observations are outcomes of repeated processing. In understanding the mechanism by which brain changes give rise to behavioral changes, it is important to consider what aspect of the environment a given brain area or set of areas processes, and how this might be expressed behaviorally.

  17. 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.

  18. Pediatric Procedural Sedation Using the Combination of Ketamine and Propofol Outside of the Emergency Department: A Report From the Pediatric Sedation Research Consortium.

    Science.gov (United States)

    Grunwell, Jocelyn R; Travers, Curtis; Stormorken, Anne G; Scherrer, Patricia D; Chumpitazi, Corrie E; Stockwell, Jana A; Roback, Mark G; Cravero, Joseph; Kamat, Pradip P

    2017-08-01

    Outcomes associated with a sedative regimen comprised ketamine + propofol for pediatric procedural sedation outside of both the pediatric emergency department and operating room are underreported. We used the Pediatric Sedation Research Consortium database to describe a multicenter experience with ketamine + propofol by pediatric sedation providers. Prospective observational study of children receiving IV ketamine + propofol for procedural sedation outside of the operating room and emergency department using data abstracted from the Pediatric Sedation Research Consortium during 2007-2015. Procedural sedation services from academic, community, free-standing children's hospitals, and pediatric wards within general hospitals. Children from birth to less than or equal to 21 years old. None. A total of 7,313 pediatric procedural sedations were performed using IV ketamine + propofol as the primary sedative regimen. Median age was 84 months (range, Pediatric Sedation Research Consortium data, we describe the diverse use of IV ketamine + propofol for procedural sedation in the largest reported cohort of children to date. Data from this study may be used to design sufficiently powered prospective randomized, double-blind studies comparing outcomes of sedation between commonly administered sedative and analgesic medication regimens.

  19. Cohesive Function of Lexical Repetition in Text

    Institute of Scientific and Technical Information of China (English)

    张莉; 卢沛沛

    2013-01-01

    Lexical repetition is the most direct form of lexical cohesion,which is the central device for making texts hang together. Although repetition is the most direct way to emphasize,it performs the cohesive effect more apparently.

  20. 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 ...

  1. Current state of sedation/analgesia care in dentistry.

    Science.gov (United States)

    Leitch, Jason; Macpherson, Avril

    2007-08-01

    Dentistry treatment is one of the most anxiety-inducing events in people's lives. The development of pain and anxiety-control techniques has always been very closely aligned to the development of dentistry. The purpose of this review is to summarize the recent literature in this field. The literature in the last 12 months falls into four main categories: dental anxiety and its influence on patient care, dental sedation for children, sedation with benzodiazepines for dentistry, and intravenous propofol sedation for dentistry. Considerable progress is being made with a number of innovative techniques. Oral midazolam for children and patient-controlled propofol show very promising results. More research is needed before propofol can be recommended for use without anaesthetic staff. The recently published systematic review of sedation in children outlines gaps in the literature and contains recommendations for future work.

  2. Patient satisfaction during and following procedural sedation for ...

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia 2015; 21(4):29-34 ... consecutive patients undergoing procedural sedation for dental-related outpatient procedures were .... and from patients, a response rate of 50% for mailing methods.

  3. Hypnosis for sedation in transesophageal echocardiography: a comparison with midazolam.

    Science.gov (United States)

    Eren, Gulay; Dogan, Yuksel; Demir, Guray; Tulubas, Evrim; Hergunsel, Oya; Tekdos, Yasemin; Dogan, Murat; Bilgi, Deniz; Abut, Yesim

    2015-01-01

    Transesophageal echocardiography (TEE), being a displeasing intervention, usually entails sedation. We aimed to compare the effects of hypnosis and midazolam for sedation in TEE. A prospective single-blinded study conducted on patients scheduled for TEE between April 2011 and July 2011 at a university in Istanbul, Turkey. A total of 41 patients underwent sedation using midazolam and 45 patients underwent hypnosis. Patients were given the State-Trait Anxiety Inventory (STAI) test for anxiety and continuous performance test (CPT) for alertness before and after the procedure. The difficulty of probing and the overall procedure rated by the cardiologist and satisfaction scores of the patients were also documented. Anxiety was found to be less and attention more in the hypnosis group, as revealed by STAI and CPT test scores (P Hypnosis proved to be associated with positive therapeutic outcomes for TEE with regard to alleviation of anxiety and maintenance of vigilance, thus providing more satisfaction compared to sedation with midazolam.

  4. Could conscious sedation with midazolam for dental procedures be ...

    African Journals Online (AJOL)

    2012-04-25

    Apr 25, 2012 ... Minor oral surgical procedures and tooth extraction processes requiring no saline irrigation, however, ..... ketamine conscious ıntravenous sedation on pain, swelling, and trismus after surgical extraction of third molars.

  5. 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...

  6. Ketamine, propofol, and ketofol use for pediatric sedation.

    Science.gov (United States)

    Alletag, Michelle J; Auerbach, Marc A; Baum, Carl R

    2012-12-01

    The use of a combination of ketamine and propofol (ketofol) for procedural sedation and analgesia in the emergency department setting shows promise as an agent that may minimize adverse effects of ketamine or propofol as single agents. This article provides a summary of current literature regarding ketofol. It also reviews the comparative pharmacokinetics, adverse effects, and dosing of ketamine, propofol, and ketofol as agents for procedural sedation and analgesia.

  7. Sedation of Pediatric Patients in Magnetic Resonance Imaging

    Science.gov (United States)

    2000-01-03

    midazolam, and atropine with a propofol infusion is used for pediatric sedation for magnetic resonance imaging (Worrell & McCune, 1993). First used as an...after the infusion is discontinued (Stoelting & Miller, 1994). Propofol is frequently used alone 7 Pediatric Sedation 8 during MRI examinations...drugs used in pediatrics , such as midazolam, ketamine and propofol , will be discussed. The primary focus will be the drug affect on the patient’s

  8. 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

  9. 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.

  10. 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 ...

  11. 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...

  12. [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.

  13. 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...

  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. 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.

  16. 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.

  17. The neural correlates of picture naming facilitated by auditory repetition

    Directory of Open Access Journals (Sweden)

    Heath Shiree

    2012-02-01

    Full Text Available Abstract Background Overt repetition of auditorily presented words can facilitate picture naming performance in both unimpaired speakers and individuals with word retrieval difficulties, but the underlying neurocognitive mechanisms and longevity of such effects remain unclear. This study used functional magnetic resonance imaging to examine whether different neurological mechanisms underlie short-term (within minutes and long-term (within days facilitation effects from an auditory repetition task in healthy older adults. Results The behavioral results showed that both short- and long-term facilitated items were named significantly faster than unfacilitated items, with short-term items significantly faster than long-term items. Neuroimaging analyses identified a repetition suppression effect for long-term facilitated items, relative to short-term facilitated and unfacilitated items, in regions known to be associated with both semantic and phonological processing. A repetition suppression effect was also observed for short-term facilitated items when compared to unfacilitated items in a region of the inferior temporal lobe linked to semantic processing and object recognition, and a repetition enhancement effect when compared to long-term facilitated items in a posterior superior temporal region associated with phonological processing. Conclusions These findings suggest that different neurocognitive mechanisms underlie short- and long-term facilitation of picture naming by an auditory repetition task, reflecting both phonological and semantic processing. More specifically, the brain areas engaged were consistent with the view that long-term facilitation may be driven by a strengthening of semantic-phonological connections. Short-term facilitation, however, appears to result in more efficient semantic processing and/or object recognition, possibly in conjunction with active recognition of the phonological form.

  18. 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

  19. Remifentanil for Sedation of Children With Traumatic Brain Injury.

    Science.gov (United States)

    Hungerford, James L; O'Brien, Nicole; Moore-Clingenpeel, Melissa; Sribnick, Eric A; Sargel, Cheryl; Hall, Mark; Leonard, Jeffrey R; Tobias, Joseph D

    2017-01-01

    To determine whether remifentanil would provide adequate sedation while allowing frequent and reproducible neurologic assessments in children admitted to the pediatric intensive care unit (PICU) with traumatic brain injury (TBI) during mechanical ventilation. Retrospective review. Tertiary care PICU. Thirty-eight patients over a 30-month period. Median age was 9 years (interquartile range [IQR] 2.25-12 years). The median Glasgow Coma Scale (GCS) was 9 (IQR: 8-10). All patients were tracheally intubated and receiving mechanical ventilation. A continuous infusion of remifentanil was started at 0.1 μg/kg/min, and bolus doses of 0.25 to 1 μg/kg were administered every 3 to 5 minutes as needed to reach the desired sedation level. Infusions were stopped at least hourly to perform neurologic examinations. The median remifentanil dose was 0.25 μg/kg/min with an IQR of 0.1 and 0.6 μg/kg/min. The maximum dose for any patient in the cohort was 2 μg/kg/min. Median duration of therapy with remifentanil was 20 hours (IQR: 8-44 hours). Adequate sedation was achieved with sedation scores (State Behavioral Scale) meeting target levels with a median value of 100% of the time (IQR: 79%-100%). Neurologic examinations were able to be performed within a median of 9 minutes (IQR: 5-14 minutes) of pausing the infusion. No serious safety events occurred. In 68% of the patients, neurologic examinations remained reassuring during remifentanil infusion, and patients were extubated. The remaining patients were transitioned to traditional sedative agents for long-term management of their traumatic injuries once the neurologic status was deemed stable. This data suggest that remifentanil is a suitable sedative agent for use in children with TBI. It provides a rapid onset of sedation with recovery that permits reliable and reproducible clinical examination.

  20. Circuit considerations for repetitive railguns

    Energy Technology Data Exchange (ETDEWEB)

    Honih, E.M.

    1986-01-01

    Railgun electromagnetic launchers have significant military and scientific potential. They provide direct conversion of electrical energy to projectile kinetic energy, and they offer the hope of achieving projectile velocities greatly exceeding the limits of conventional guns. With over 10 km/sec already demonstrated, railguns are attracting attention for tactical and strategic weapons systems and for scientific equation-of-state research. The full utilization of railguns will require significant improvements in every aspect of system design - projectile, barrel, and power source - to achieve operation on a large scale. This paper will review fundamental aspects of railguns, with emphasis on circuit considerations and repetitive operation.

  1. Autism and exergaming: effects on repetitive behaviors and cognition.

    Science.gov (United States)

    Anderson-Hanley, Cay; Tureck, Kimberly; Schneiderman, Robyn L

    2011-01-01

    Autism is a neurodevelopmental disorder that leads to impairment in social skills and delay in language development, and results in repetitive behaviors and restricted interests that impede academic and social involvement. Physical exercise has been shown to decrease repetitive behaviors in autistic children and improve cognitive function across the life-span. Exergaming combines physical and mental exercise simultaneously by linking physical activity movements to video game control and may yield better compliance with exercise. In this investigation, two pilot studies explored the potential behavioral and cognitive benefits of exergaming. In Pilot I, twelve children with autism spectrum disorders completed a control task and an acute bout of Dance Dance Revolution (DDR); in Pilot II, ten additional youths completed an acute bout of cyber cycling. Repetitive behaviors and executive function were measured before and after each activity. Repetitive behaviors significantly decreased, while performance on Digits Backwards improved following the exergaming conditions compared with the control condition. Additional research is needed to replicate these findings, and to explore the application of exergaming for the management of behavioral disturbance and to increase cognitive control in children on the autism spectrum.

  2. 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.

  3. Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students

    Science.gov (United States)

    Anneser, Johanna; Jox, Ralf J.; Thurn, Tamara; Borasio, Gian Domenico

    2016-01-01

    Objectives: In November 2015, the German Federal Parliament voted on a new legal regulation regarding assisted suicide. It was decided to amend the German Criminal Code so that any “regular, repetitive offer” (even on a non-profit basis) of assistance in suicide would now be considered a punishable offense. On July 2, 2015, a date which happened to be accompanied by great media interest in that it was the day that the first draft of said law was presented to Parliament, we surveyed 4th year medical students at the Technical University Munich on “physician-assisted suicide,” “euthanasia” and “palliative sedation,” based on a fictitious case vignette study. Method: The vignette study described two versions of a case in which a patient suffered from a nasopharyngeal carcinoma (physical suffering subjectively perceived as being unbearable vs. emotional suffering). The students were asked about the current legal norms for each respective course of action as well as their attitudes towards the ethical acceptability of these measures. Results: Out of 301 students in total, 241 (80%) participated in the survey; 109 answered the version 1 questionnaire (physical suffering) and 132 answered the version 2 questionnaire (emotional suffering). The majority of students were able to assess the currently prevailing legal norms on palliative sedation (legal) and euthanasia (illegal) correctly (81.2% and 93.7%, respectively), while only a few students knew that physician-assisted suicide, at that point in time, did not constitute a criminal offense. In the case study that was presented, 83.3% of the participants considered palliative sedation and the simultaneous withholding of artificial nutrition and hydration as ethically acceptable, 51.2% considered physician-assisted suicide ethically legitimate, and 19.2% considered euthanasia ethically permissible. When comparing the results of versions 1 and 2, a significant difference could only be seen in the assessment of

  4. Dexmedetomidine compared with propofol for pediatric sedation during cerebral angiography.

    Science.gov (United States)

    Peng, Ke; Li, Jian; Ji, Fu-Hai; Li, Zhi

    2014-06-01

    Sedation of pediatric patients undergoing cerebral angiography is challenging. Although dexmedetomidine is used for sedation in various procedures, it has not been reported for pediatric patients undergoing cerebral angiography. This study compared the safety and efficacy of dexmedetomidine with that of propofol for cerebral angiography in pediatric patients. Sixty-two patients (6-15 years) scheduled for elective cerebral angiography were apportioned randomly and equally to receive either propofol or dexmedetomidine sedation. Patients in the propofol group received an initial bolus of intravenous propofol (1 mg/kg) and a maintenance infusion of 100 μg/kg/min. Patients in the dexmedetomidine group received an initial bolus of intravenous dexmedetomidine (1 μg/kg over 10 min) and a maintenance infusion of 1 μg/kg/h. An additional bolus of propofol 0.5 mg/kg or dexmedetomidine 0.25 μg/kg was repeated if needed. Procedure time, time to recovery and adverse events associated with sedation were recorded. All cerebral angiographies were completed successfully under sedation with dexmedetomidine or propofol. Mean cerebral angiography time was 36 ± 10 min in the propofol group and 31 ± 7 min in the dexmedetomidine group (P = 0.047). The percentage of airway events and total adverse events were significantly higher in the propofol group (P propofol group (P propofol or dexmedetomidine, dexmedetomidine may be a better alternative because of fewer respiratory adverse events.

  5. 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.

  6. 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

  7. [Patient safety recommendations for out of operating room procedure sedation].

    Science.gov (United States)

    Arnal Velasco, D; Romero García, E; Martínez Palli, G; Muñoz Corsini, L; Rey Martínez, M; Postigo Morales, S

    There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable. We created a working group of experts within the Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR) to prepare a series of recommendations through a non-systematic review. These recommendations were validated by an expert panel of 31 anaesthesiologists through two rounds of an adaptation of the Delphi Method where more than 70% agreement was required. The resulting recommendations include previous evaluation, material and staffing needs for sedation for procedures, post-sedation recommendations and activity and quality control advice. We present patient centred recommendations for the safe use of sedation for out of the operating room procedures from the point of view of the professionals with the most experience in its administration. We believe that these can be used as a guide to reduce variability and increase patient safety in the organisation of healthcare. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Patient safety recommendations for out of operating room procedure sedation.

    Science.gov (United States)

    Arnal Velasco, D; Romero García, E; Martínez Palli, G; Muñoz Corsini, L; Rey Martínez, M; Postigo Morales, S

    2016-12-01

    There is an increasing and more complex demand for sedation for procedures out of the operating room. For different reasons, nowadays the administration of sedation varies considerably. We believe that a patient safety approach rather an approach out of corporate or economic interests is desirable. We created a working group of experts within the Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR) to prepare a series of recommendations through a non-systematic review. These recommendations were validated by an expert panel of 31 anaesthesiologists through two rounds of an adaptation of the Delphi Method where more than 70% agreement was required. The resulting recommendations include previous evaluation, material and staffing needs for sedation for procedures, post-sedation recommendations and activity and quality control advice. We present patient centred recommendations for the safe use of sedation for out of the operating room procedures from the point of view of the professionals with the most experience in its administration. We believe that these can be used as a guide to reduce variability and increase patient safety in the organisation of healthcare. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. 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.

  10. The safety of propofol sedation for elective nonintubated esophagogastroduodenoscopy in pediatric patients.

    Science.gov (United States)

    Rajasekaran, Surender; Hackbarth, Richard M; Davis, Alan T; Kopec, John S; Cloney, Deborah L; Fitzgerald, Robert K; Hassan, Nabil E; Ndika, Akunne N; Cornelius, Kathleen; McCullough, Allison; Sanfilippo, Dominic

    2014-07-01

    To evaluate the safety of deep sedation provided by pediatric intensivists for elective nonintubated esophagogastroduodenoscopy. Retrospective observational study. The sedation program at the Helen DeVos Children's Hospital. A 4-year retrospective analysis was done on all outpatient elective pediatric esophagogastroduodenoscopy procedures performed in an intensivist run sedation program. Safety was examined by reviewing the occurrence of minor and major adverse effects during esophagogastroduodenoscopy sedation. Interventions were studied and reported. None. During the study period, 12,447 sedations were performed by the pediatric sedation program for various procedures. Two thousand one hundred forty-seven patients received 2,325 sedations (18.6%) for esophagogastroduodenoscopies performed for various indications. During the same time period, 53 (one for every 40 esophagogastroduodenoscopy sedations) were screened, found unsuitable for nonintubated sedation, and referred for general anesthesia. There were 2,254 sedations with propofol, 65 methohexital, five ketamine, and one fentanyl/midazolam sedation. Propofol sedation proved safe with a 2.1% prevalence of minor adverse events and no major events. Methohexital, on the other hand, had higher rate (p propofol (odds ratio, 8.6; 95% CI, 4.1-18.2; p propofol is a safe and effective agent for esophagogastroduodenoscopy sedation.

  11. Digital repetitive control under varying frequency conditions

    OpenAIRE

    Ramos Fuentes, Germán Andrés

    2012-01-01

    The tracking/rejection of periodic signals constitutes a wide field of research in the control theory and applications area and Repetitive Control has proven to be an efficient way to face this topic; however, in some applications the period of the signal to be tracked/rejected changes in time or is uncertain, which causes and important performance degradation in the standard repetitive controller. This thesis presents some contributions to the open topic of repetitive control workin...

  12. 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...

  13. Impact of office-based intravenous deep sedation providers upon traditional sedation practices employed in pediatric dentistry.

    Science.gov (United States)

    Tarver, Michael; Guelmann, Marcio; Primosch, Robert

    2012-01-01

    This survey intended to determine how the implementation of office-based IV deep sedation by a third party provider (OIVSED) impacted the traditional sedation practices employed in pediatric dentistry private practice settings. A digital survey was e-mailed to 924 members of the American Academy of Pediatric Dentistry practicing in California, Florida, and New York, chosen because these states had large samples of practicing pediatric dentists in geographically disparate locations. 151 pediatric dentists using OIVSED responded to the survey. Improved efficiency, safety and quality of care provided, and increased parental acceptance were reported advantages of this service. Although less costly than hospital-based general anesthesia, the average fee for this service was a deterrent to some parents considering this option. Sixty-four percent of respondents continued to provide traditional sedation modalities, mostly oral sedation, in their offices, as parenteral routes taught in their training programs were less often selected. OIVSED users reported both a reduction in the use of traditional sedation modalities in their offices and use of hospital-based GA services in exchange for perceived improvements in efficiency, safety and quality of care delivered. Patient costs, in the absence of available health insurance coverage, inhibited accessing this service by some parents.

  14. 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...... 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...... 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 propofol dose (p = 0.001) were associated...

  15. [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.

  16. 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).

  17. 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.

  18. Dexmedetomidine compared with propofol for pediatric sedation during cerebral angiography

    Directory of Open Access Journals (Sweden)

    Ke Peng

    2014-01-01

    Full Text Available Background: Sedation of pediatric patients undergoing cerebral angiography is challenging. Although dexmedetomidine is used for sedation in various procedures, it has not been reported for pediatric patients undergoing cerebral angiography. This study compared the safety and efficacy of dexmedetomidine with that of propofol for cerebral angiography in pediatric patients. Materials and Methods: Sixty-two patients (6-15 years scheduled for elective cerebral angiography were apportioned randomly and equally to receive either propofol or dexmedetomidine sedation. Patients in the propofol group received an initial bolus of intravenous propofol (1 mg/kg and a maintenance infusion of 100 μg/kg/min. Patients in the dexmedetomidine group received an initial bolus of intravenous dexmedetomidine (1 μg/kg over 10 min and a maintenance infusion of 1 μg/kg/h. An additional bolus of propofol 0.5 mg/kg or dexmedetomidine 0.25 μg/kg was repeated if needed. Procedure time, time to recovery and adverse events associated with sedation were recorded. Results: All cerebral angiographies were completed successfully under sedation with dexmedetomidine or propofol. Mean cerebral angiography time was 36 ± 10 min in the propofol group and 31 ± 7 min in the dexmedetomidine group (P = 0.047. The percentage of airway events and total adverse events were significantly higher in the propofol group (P < 0.05. Heart rate decreased in the dexmedetomidine group and mean arterial pressure decreased in the propofol group (P < 0.05, each. Conclusion: Although cerebral angiography can be performed successfully under sedation with either propofol or dexmedetomidine, dexmedetomidine may be a better alternative because of fewer respiratory adverse events.

  19. Tramadol does not enhance sedation induced by acepromazine in dogs.

    Science.gov (United States)

    Monteiro, Eduardo R; Lobo, Renan B; Nunes, Juarez S; Rangel, Julia P P; Bitti, Flavia S

    2016-10-01

    The sedative effect of acepromazine combined with 2 doses of tramadol [3 and 5 mg/kg body weight (BW)] was compared with the sedative effect of acepromazine alone in dogs and the effects of each sedative protocol on cardiorespiratory variables were examined. This was a prospective, randomized, blinded, crossover study. Each of 6 dogs received 3 treatments at 1-week intervals. During all anesthetic episodes, dogs received 0.05 mg/kg BW acepromazine. Approximately 25 min later, dogs were given physiological saline (control) or tramadol [3 mg/kg BW (TR3) or 5 mg/kg BW (TR5)]. All drugs were administered intravenously. Variables evaluated included heart rate (HR), respiratory rate (RR), systolic, mean, and diastolic blood pressures (SAP, MAP, and DAP), and sedation [by use of a simple descriptive scale (SDS, range: 0 to 3) and a numeric rating scale (NRS, range: 0 to 10)]. Variables were recorded 25 min after acepromazine and for 80 min after saline or tramadol. Acepromazine administration resulted in mild sedation in most dogs and decreased RR, SAP, MAP, and DAP in all treatments. Tramadol administration did not significantly increase SDS or NRS scores compared to acepromazine alone. The only exception to this rule was observed at 20 min after TR3, when NRS was higher in this group than in the control treatment. Administration of tramadol (TR3 and TR5) decreased HR. Under the conditions of this study, sedation induced by acepromazine with tramadol was similar to that of acepromazine alone. The main adverse effects of the combination were a decrease in blood pressure and HR, without clinical significance.

  20. The use of dexmedetomidine in intensive care sedation

    Directory of Open Access Journals (Sweden)

    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

  1. [Repetition and fear of dying].

    Science.gov (United States)

    Lerner, B D

    1995-03-01

    In this paper a revision is made of the qualifications of Repetition (R) in Freuds work, i.e. its being at the service of the Pleasure Principle and, beyond it, the binding of free energy due to trauma. Freud intends to explain with this last concept the "fort-da" and the traumatic dreams (obsessively reiterated self-reproaches may be added to them). The main thesis of this work is that R. is not only a defense against the recollection of the ominous past (as in the metaphorical deaths of abandonment and desertion) but also a way of maintaining life and identify fighting against the inescapable omninous future (known but yet experienced), i.e. our own death. Some forms of R. like habits, identificatory behaviors and sometimes even magic, are geared to serve the life instinct. A literary illustration shows this desperate fight.

  2. Pressure rig for repetitive casting

    Science.gov (United States)

    Vasquez, Peter (Inventor); Hutto, William R. (Inventor); Philips, Albert R. (Inventor)

    1989-01-01

    The invention is a pressure rig for repetitive casting of metal. The pressure rig performs like a piston for feeding molten metal into a mold. Pressure is applied to an expandable rubber diaphragm which expands like a balloon to force the metal into the mold. A ceramic cavity which holds molten metal is lined with blanket-type insulating material, necessitating only a relining for subsequent use and eliminating the lengthy cavity preparation inherent in previous rigs. In addition, the expandable rubber diaphragm is protected by the insulating material thereby decreasing its vulnerability to heat damage. As a result of the improved design the life expectancy of the pressure rig contemplated by the present invention is more than doubled. Moreover, the improved heat protection has allowed the casting of brass and other alloys with higher melting temperatures than possible in the conventional pressure rigs.

  3. Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety

    NARCIS (Netherlands)

    Barends, Clemens R. M.; Absalom, Anthony; van Minnen, Baucke; Vissink, Arjan; Visser, Anita

    2017-01-01

    Objectives To systematically review the literature comparing the efficacy and safety of dexmedetomidine and midazolam when used for procedural sedation. Materials and Methods We searched MEDLINE, EMBASE and COCHRANE for clinical trials comparing dexmedetomidine and midazolam for procedural sedation

  4. Management of a high risk epileptic patient under conscious sedation: A multidisciplinary approach

    National Research Council Canada - National Science Library

    Chellathurai, Burnice Nalina Kumari; Thiagarajan, Ramakrishnan; Jayakumaran, SelvaKumar; Devadoss, Pradeep; Elavazhagan

    2016-01-01

    .... Midazolam used as a sedative agent has anticonvulsant properties. This case report highlights a case requiring multiple dental procedures carried out in a high risk epileptic patient under conscious sedation.

  5. 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...

  6. 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.

  7. 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.

  8. Intravenous Sedation for Control of Distress during Lumbar Punctures for Pediatric Cancer Patients

    Directory of Open Access Journals (Sweden)

    Jacqueline Ellis

    2000-01-01

    Full Text Available OBJECTIVE: To compare the sedative and amnestic effects, the rapidity of recovery, and the adverse effects of midazolam and propofol for intravenous sedation. The focus of this paper is the effects of intravenous sedation on distress, the acceptability to parents of this intervention for helping their children cope with painful procedures and the utility of an intravenous sedation program administered by an anesthetist.

  9. 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 ...

  10. Arousal modulates auditory attention and awareness: insights from sleep, sedation and disorders of consciousness

    Directory of Open Access Journals (Sweden)

    Srivas eChennu

    2012-03-01

    Full Text Available The interplay between top-down, bottom-up attention and consciousness is frequently tested in altered states of consciousness, including transitions between stages of sleep and sedation, and in pathological disorders of consciousness (the vegetative and minimally conscious states; VS and MCS. One of the most widely used tasks to assess cognitive processing in this context is the auditory oddball paradigm, where an infrequent change in a sequence of sounds elicits, in awake subjects, a characteristic EEG event-related potential (ERP called the mismatch negativity (MMN, followed by the classic P300 wave. The latter is further separable into the slightly earlier, anterior P3a and the later, posterior P3b, linked to bottom-up and top-down attention, respectively. We discuss here the putative dissociations between attention and awareness in disorders of consciousness, sedation and sleep, bearing in mind the recently emerging evidence from healthy volunteers and patients. These findings highlight the neurophysiological and cognitive parallels (and differences across these three distinct variations in levels of consciousness, and inform the theoretical framework for interpreting the role of attention therein.

  11. Arousal modulates auditory attention and awareness: insights from sleep, sedation, and disorders of consciousness.

    Science.gov (United States)

    Chennu, Srivas; Bekinschtein, Tristan A

    2012-01-01

    The interplay between attention and consciousness is frequently tested in altered states of consciousness, including transitions between stages of sleep and sedation, and in pathological disorders of consciousness (DoC; the vegetative and minimally conscious states; VS and MCS). One of the most widely used tasks to assess cognitive processing in this context is the auditory oddball paradigm, where an infrequent change in a sequence of sounds elicits, in awake subjects, a characteristic EEG event-related potential called the mismatch negativity, followed by the classic P300 wave. The latter is further separable into the slightly earlier, anterior P3a and the later, posterior P3b, thought to be linked to task-irrelevant "bottom-up" and task-oriented "top-down" attention, respectively. We discuss here the putative dissociations between attention and awareness in DoC, sedation and sleep, bearing in mind the recently emerging evidence from healthy volunteers and patients. These findings highlight the neurophysiological and cognitive parallels (and differences) across these three distinct variations in levels of consciousness, and inform the theoretical framework for interpreting the role of attention therein.

  12. A prospective evaluation of the incidence of adverse events in nurse-administered moderate sedation guided by sedation scores or Bispectral Index.

    Science.gov (United States)

    Yang, Katie S; Habib, Ashraf S; Lu, Minyi; Branch, M S; Muir, Holly; Manberg, Paul; Sigl, Jeffrey C; Gan, Tong J

    2014-07-01

    Moderate sedation is routinely performed in patients undergoing minor therapeutic and diagnostic procedures outside the operating room. The level of sedation is often monitored by sedation nurses using clinical criteria, such as sedation scores. The Bispectral Index (BIS) is derived from changes in the electroencephalograph profile that may provide an objective measure of the level of sedation. In this prospective observational study, we investigated whether using BIS values to guide sedative drug administration influences the level of sedation and the incidence of adverse events compared with using Ramsay sedation scale (RSS) only in nurse-administered moderate sedation. We hypothesized that both depth of sedation and the incidence of adverse events related to oversedation would decrease when sedation nurses used BIS values to help guide sedative drug administration. Sedation care was provided by trained sedation nurses under the supervision of a physician performing the procedure. The sedation regimen was initiated with IV midazolam 1 to 2 mg and fentanyl 50 mcg or hydromorphone 0.2 mg. Additional small boluses of midazolam, fentanyl, or hydromorphone were administered to maintain an RSS of 2 to 3 (cooperative, oriented, and responding to verbal command). Propofol was not used. Information including patient demographics, type of procedure, medication administered, RSS, and rates of adverse events was recorded by the sedation nurses for each patient on a computer-readable form. The study was divided into 3 phases. In phase 1 (baseline, 6 months' duration), baseline data on sedation practice were prospectively collected. There was no change from standard of care for all patients except that each patient had a BIS sensor attached, but the monitor was covered and nurses were blinded to the BIS values. In phase 2 (training, 3 months), the sedation nurses received comprehensive education on the use of BIS to guide sedative drug administration, pharmacology of commonly

  13. [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.

  14. 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....

  15. 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...

  16. Comparing repetition-based melody segmentation models

    NARCIS (Netherlands)

    Rodríguez López, M.E.; de Haas, Bas; Volk, Anja

    2014-01-01

    This paper reports on a comparative study of computational melody segmentation models based on repetition detection. For the comparison we implemented five repetition-based segmentation models, and subsequently evaluated their capacity to automatically find melodic phrase boundaries in a corpus of 2

  17. Task Repetition and Second Language Speech Processing

    Science.gov (United States)

    Lambert, Craig; Kormos, Judit; Minn, Danny

    2017-01-01

    This study examines the relationship between the repetition of oral monologue tasks and immediate gains in L2 fluency. It considers the effect of aural-oral task repetition on speech rate, frequency of clause-final and midclause filled pauses, and overt self-repairs across different task types and proficiency levels and relates these findings to…

  18. Repetitions: A Cross-Cultural Study.

    Science.gov (United States)

    Murata, Kumiko

    1995-01-01

    This study investigated how repetition is used in conversation among native speakers of British English, native speakers of Japanese, and Japanese speakers of English. Five interactional functions of repetition (interruption-orientated, solidarity, silence-avoidance, hesitation, and reformulation) were identified, as well as the cultural factors…

  19. Digital repetitive control under varying frequency conditions

    CERN Document Server

    Ramos, Germán A; Olm, Josep M

    2013-01-01

    The tracking/rejection of periodic signals constitutes a wide field of research in the control theory and applications area. Repetitive Control has proven to be an efficient way to face this topic. However, in some applications the frequency of the reference/disturbance signal is time-varying or uncertain. This causes an important performance degradation in the standard Repetitive Control scheme. This book presents some solutions to apply Repetitive Control in varying frequency conditions without loosing steady-state performance. It also includes a complete theoretical development and experimental results in two representative systems. The presented solutions are organized in two complementary branches: varying sampling period Repetitive Control and High Order Repetitive Control. The first approach allows dealing with large range frequency variations while the second allows dealing with small range frequency variations. The book also presents applications of the described techniques to a Roto-magnet plant and...

  20. 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

  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. 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.

  3. 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.

  4. 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

  5. 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.

  6. Terminal sedation and euthanasia: A comparison of clinical practices

    NARCIS (Netherlands)

    J.A.C. Rietjens (Judith); J.J.M. van Delden (Johannes); 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)

    2006-01-01

    textabstractBackground: An important issue in the debate about terminal sedation is the extent to which it differs from euthanasia. We studied clinical differences and similarities between both practices in the Netherlands. Methods: Personal interviews were held with a nationwide stratified sample

  7. 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."

  8. 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

  9. 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.

  10. 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.

  11. The current status of procedural sedation for pediatric patients in out-of-operating room locations.

    Science.gov (United States)

    Havidich, Jeana E; Cravero, Joseph P

    2012-08-01

    To illustrate the changes that are occurring in the rapidly growing field of pediatric sedation. In the USA and throughout the world, children receive sedation from a multitude of specialists with varying levels of training. The current pediatric sedation literature reflects a growing body of sedation literature by medical specialists other than anesthesiologists. This article will review the controversial use of propofol by nonanesthesiologists and the manner in which this varied group of providers along with government entities, regulatory agencies, and national organizations contribute to the continuing evolution of sedation practices. The number of diagnostic and therapeutic procedures performed on children outside of the operating room continues to increase. The growing body of pediatric sedation literature suggests anesthesiologists are no longer at the forefront of pediatric sedation training, education, and research. Articles published by nonanesthesiologists describe pediatric sedation services, safety, and quality initiatives, drugs, and original sedation research. Medications that were considered under the realm of anesthesiologists are utilized by nonanesthesiologists to provide sedation to children. Regulating and government agencies, including the Joint Commission and the Center for Medicaid and Medicare Services have recently issued statements on the oversight and practice of sedation. The direction of pediatric sedation is no longer solely under the leadership of anesthesiologists. The use of anesthetic agents, including propofol, have been administered by nonanesthesiologists and reported as safe and effective agents. Nonanesthesiologists and governmental and regulatory agencies influence the delivery of sedation services. The future direction of pediatric sedation will ultimately depend upon the ability of anesthesiologists to collaborate with specialists, hospital administrators, credentialing committees, and oversight agencies in order to

  12. Strategies for Using Repetition as a Powerful Teaching Tool

    Science.gov (United States)

    Saville, Kirt

    2011-01-01

    Brain research indicates that repetition is of vital importance in the learning process. Repetition is an especially useful tool in the area of music education. The success of repetition can be enhanced by accurate and timely feedback. From "simple repetition" to "repetition with the addition or subtraction of degrees of freedom," there are many…

  13. Strategies for Using Repetition as a Powerful Teaching Tool

    Science.gov (United States)

    Saville, Kirt

    2011-01-01

    Brain research indicates that repetition is of vital importance in the learning process. Repetition is an especially useful tool in the area of music education. The success of repetition can be enhanced by accurate and timely feedback. From "simple repetition" to "repetition with the addition or subtraction of degrees of freedom," there are many…

  14. Repetition priming from moving faces.

    Science.gov (United States)

    Lander, Karen; Bruce, Vicki

    2004-06-01

    Recent experiments have suggested that seeing a familiar face move provides additional dynamic information to the viewer, useful in the recognition of identity. In four experiments, repetition priming was used to investigate whether dynamic information is intrinsic to the underlying face representations. The results suggest that a moving image primes more effectively than a static image, even when the same static image is shown in the prime and the test phases (Experiment 1). Furthermore, when moving images are presented in the test phase (Experiment 2), there is an advantage for moving prime images. The most priming advantage is found with naturally moving faces, rather than with those shown in slow motion (Experiment 3). Finally, showing the same moving sequence at prime and test produced more priming than that found when different moving sequences were shown (Experiment 4). The results suggest that dynamic information is intrinsic to the face representations and that there is an advantage to viewing the same moving sequence at prime and test.

  15. Efficiency and safety of inhalative sedation with sevoflurane in comparison to an intravenous sedation concept with propofol in intensive care patients: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Soukup Jens

    2012-08-01

    Full Text Available Abstract Background State of the art sedation concepts on intensive care units (ICU favor propofol for a time period of up to 72 h and midazolam for long-term sedation. However, intravenous sedation is associated with complications such as development of tolerance, insufficient sedation quality, gastrointestinal paralysis, and withdrawal symptoms including cognitive deficits. Therefore, we aimed to investigate whether sevoflurane as a volatile anesthetic technically implemented by the anesthetic-conserving device (ACD may provide advantages regarding ‘weaning time’, efficiency, and patient’s safety when compared to standard intravenous sedation employing propofol. Method/Design This currently ongoing trial is designed as a two-armed, monocentric, randomized prospective phase II study including intubated intensive care patients with an expected necessity for sedation exceeding 48 h. Patients are randomly assigned to either receive intravenous sedation with propofol or sevoflurane employing the ACD. Primary endpoint is the comparison of the ‘weaning time’ defined as the time required from discontinuation of the sedating agent until sufficient spontaneous breathing occurs. Moreover, sedation depth evaluated by Richmond Agitation Sedation Scale and parameters of patient’s safety (that is, vital signs, laboratory monitoring of organ function as well as the duration of mechanical ventilation and overall stay on the ICU are analyzed and compared. An intention-to-treat analysis will be carried out with all patients for whom it will be possible to define a wake-up time. In addition, a per-protocol analysis is envisaged. Completion of patient recruitment is expected by the end of 2012. Discussion This clinical study is designed to evaluate the impact of sevoflurane during long-term sedation of critically ill patients on ‘weaning time’, efficiency, and patient’s safety compared to the standard intravenous sedation concept employing

  16. 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.

  17. 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.

  18. Restricted and repetitive behaviours, sensory processing and cognitive style in children with autism spectrum disorders.

    Science.gov (United States)

    Chen, Yu-Han; Rodgers, Jacqui; McConachie, Helen

    2009-04-01

    Many individuals with autism tend to focus on details. It has been suggested that this cognitive style may underlie the presence of stereotyped routines, repetitive interests and behaviours, and both relate in some way to sensory abnormalities. Twenty-nine children with diagnosis of high functioning autism or Asperger syndrome completed the Embedded Figures Test (EFT), and their parents the Short Sensory Profile and Childhood Routines Inventory. Significant correlations were found between degree of sensory abnormalities and amount of restricted and repetitive behaviours reported. Repetitive behaviours, age and IQ significantly predicted completion time on the EFT. The results suggest a cognitive link between an individual's detail-focused cognitive style and their repetitiveness. No such relationship was found with sensory processing abnormalities, which may arise at a more peripheral level of functioning.

  19. Repetitive self-grooming behavior in the BTBR mouse model of autism is blocked by the mGluR5 antagonist MPEP.

    Science.gov (United States)

    Silverman, Jill L; Tolu, Seda S; Barkan, Charlotte L; Crawley, Jacqueline N

    2010-03-01

    Autism is a neurodevelopmental disorder characterized by abnormal reciprocal social interactions, communication deficits, and repetitive behaviors with restricted interests. BTBR T+tf/J (BTBR) is an inbred mouse strain that shows robust behavioral phenotypes with analogies to all three of the diagnostic symptoms of autism, including well-replicated deficits in reciprocal social interactions and social approach, unusual patterns of ultrasonic vocalization, and high levels of repetitive self-grooming. These phenotypes offer straightforward behavioral assays for translational investigations of pharmacological compounds. Two suggested treatments for autism were evaluated in the BTBR mouse model. Methyl-6-phenylethynyl-pyridine (MPEP), an antagonist of the mGluR5 metabotropic glutamate receptor, blocks aberrant phenotypes in the Fmr1 mouse model of Fragile X, a comorbid neurodevelopmental disorder with autistic features. Risperidone has been approved by the United States Food and Drug Administration for the treatment of irritability, tantrums, and self-injurious behavior in autistic individuals. We evaluated the actions of MPEP and risperidone on two BTBR phenotypes, low sociability and high repetitive self-grooming. Open field activity served as an independent control for non-social exploratory activity and motor functions. C57BL/6J (B6), an inbred strain with high sociability and low self-grooming, served as the strain control. MPEP significantly reduced repetitive self-grooming in BTBR, at doses that had no sedating effects on open field activity. Risperidone reduced repetitive self-grooming in BTBR, but only at doses that induced sedation in both strains. No overall improvements in sociability were detected in BTBR after treatment with either MPEP or risperidone. Our findings suggest that antagonists of mGluR5 receptors may have selective therapeutic efficacy in treating repetitive behaviors in autism.

  20. REDUCTION APPROACHES FOR VIBRATION CONTROL OF REPETITIVE STRUCTURES

    Institute of Scientific and Technical Information of China (English)

    CHEN Wei-min; SUN Dong-chang; WANG Da-jun; WEI Jian-ping; TONG Li-yong; WANG Quan

    2006-01-01

    The reduction approaches are presented for vibration control of symmetric,cyclic periodic and linking structures. The condensation of generalized coordinates, the locations of sensors and actuators, and the relation between system inputs and control forces are assumed to be set in a symmetric way so that the control system posses the same repetition as the structure considered. By employing proper transformations of condensed generalized coordinates and the system inputs, the vibration control of an entire system can be implemented by carrying out the control of a number of sub-structures, and thus the dimension of the control problem can be significantly reduced.

  1. The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium.

    Science.gov (United States)

    Cravero, Joseph P; Beach, Michael L; Blike, George T; Gallagher, Susan M; Hertzog, James H

    2009-03-01

    We used a large database of prospectively collected data on pediatric sedation/anesthesia outside the operating room provided by a wide range of pediatric specialists to delineate the nature and frequency of adverse events associated with propofol-based sedation/anesthesia care. Data were collected by the Pediatric Sedation Research Consortium, a collaborative group of institutions dedicated to improving sedation/anesthesia care for children internationally. Members prospectively enrolled consecutive patients receiving sedation or sedation/anesthesia for procedures. The primary inclusion criterion was the need for some form of sedation/anesthesia to perform a diagnostic or therapeutic procedure outside the operating room. There were no exclusion criteria. Data on demographics, primary illness, coexisting illness, procedure performed, medications used, procedure and recovery times, medication doses outcomes of anesthesia, airway interventions and adverse events were collected and reported using web-based data collection tool. For this study, we evaluated all instances where propofol was used as the primary drug in the sedation/anesthesia technique. Thirty-seven locations submitted data on 49,836 propofol sedation/anesthesia encounters during the study period from July 1, 2004 until September 1, 2007. There were no deaths. Cardiopulmonary resuscitation was required twice. Aspiration during sedation/anesthesia occurred four times. Less serious events were more common with O(2) desaturation below 90% for more than 30 s, occurring 154 times per 10,000 sedation/anesthesia administrations. Central apnea or airway obstruction occurred 575 times per 10,000 sedation/anesthesia administrations. Stridor, laryngospasm, excessive secretions, and vomiting had frequencies of 50, 96, 341, and 49 per 10,000 encounters, respectively. Unexpected admissions (increases in levels of care required) occurred at a rate of 7.1 per 10,000 encounters. In an unadjusted analysis, the rate of

  2. A referential theory of the repetition-induced truth effect.

    Science.gov (United States)

    Unkelbach, Christian; Rom, Sarah C

    2017-03-01

    People are more likely to judge repeated statements as true compared to new statements, a phenomenon known as the illusory truth effect. The currently dominant explanation is an increase in processing fluency caused by prior presentation. We present a new theory to explain this effect. We assume that people judge truth based on coherent references for statements in memory. Due to prior presentation, repeated statements have more coherently linked references; thus, a repetition-induced truth effect follows. Five experiments test this theory. Experiment 1-3 show that both the amount and the coherence of references for a repeated statement influence judged truth. Experiment 4 shows that people also judge new statements more likely "true" when they share references with previously presented statements. Experiment 5 realizes theoretically predicted conditions under which repetition should not influence judged truth. Based on these data, we discuss how the theory relates to other explanations of repetition-induced truth and how it may integrate other truth-related phenomena and belief biases. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Precision markedly attenuates repetitive lift capacity.

    Science.gov (United States)

    Collier, Brooke R; Holland, Laura; McGhee, Deirdre; Sampson, John A; Bell, Alison; Stapley, Paul J; Groeller, Herbert

    2014-01-01

    This study investigated the effect of precision on time to task failure in a repetitive whole-body manual handling task. Twelve participants were required to repetitively lift a box weighing 65% of their single repetition maximum to shoulder height using either precise or unconstrained box placement. Muscle activity, forces exerted at the ground, 2D body kinematics, box acceleration and psychophysical measures of performance were recorded until task failure was reached. With precision, time to task failure for repetitive lifting was reduced by 72%, whereas the duration taken to complete a single lift and anterior deltoid muscle activation increased by 39% and 25%, respectively. Yet, no significant difference was observed in ratings of perceived exertion or heart rate at task failure. In conclusion, our results suggest that when accuracy is a characteristic of a repetitive manual handling task, physical work capacity will decline markedly. The capacity to lift repetitively to shoulder height was reduced by 72% when increased accuracy was required to place a box upon a shelf. Lifting strategy and muscle activity were also modified, confirming practitioners should take into consideration movement precision when evaluating the demands of repetitive manual handling tasks.

  4. Effect of Sedation with Midazolam and Time to Discharge among Pediatric Dental Patients.

    Science.gov (United States)

    Blumer, Sigalit; Peretz, Benjamin; Zisman, Gali; Ratson, Tal

    The aim of this study was to examine the recovery time of children who underwent conscious sedation with oral or rectal midazolam. The medical files in the Department of Pediatric Dentistry of all the children who underwent conscious sedation with midazolam between 3/2013-4/2016 were examined. The total duration of sedation and time to discharge were calculated. Descriptions of the children's behavior before and during sedation were compared. The files of 120 children were retrieved. They included 64 girls, mean (± standard deviation) age 5.7 ± 2.67 years and 56 boys, mean age 4.9 ±1.06 years. The mean weight for the entire cohort was 18.7 ± 5.2 kg. Eighty-one children (67.5%) received oral sedation and 39 (32.5%) received rectal sedation. The mean total duration of sedation was 105 ± 26 min, and the mean time to discharge after treatment was 55:17 ± 22:30 min. A hundred and seven children exhibited positive behavior before undergoing sedation, but the behavior deteriorated during sedation in 36 cases. The time to discharge post-midazolam sedation correlated to the child's age and weight and total amount of administered midazolam. Sedation negatively affected behavior in 43.6% of the cases.

  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. [Hospital Doctors Should Receive Lecture for Sedation According to Joint Commission International].

    Science.gov (United States)

    Ueshima, Hironobu; Komasawa, Nobuyasu; Kitamura, Akira

    2015-08-01

    At our hospital, intending to obtaining an approval from the Joint Commission International (JCI), we conducted a workshop on sedation for all staff physicians. A sedation instructor authorized by the Japanese Association for Medical Simulation gave a lecture using the "practice guidelines for sedation and administration of analgesics for non-anesthesiologists", revised in 2002 by the American Society of Anesthesiologists, following which, a test using 10 true-false questions was conducted, while before and after the lecture a questionnaire survey on the sedation lecture was carried out Among 191 physicians attending the lecture, except for one person, 7 or more questions were answered correctly. From the questionnaires, the sedation lectures were also generally accepted favourably. In the test of understanding, the mistakes were mostly in the sections on "sedation evaluation" "intraoperative monitoring" "pharmaceutical knowledge" and "airway management methods". The sedation lecture in the hospital was effective.

  7. Repetitive behavior profile and supersensitivity to amphetamine in the C58/J mouse model of autism.

    Science.gov (United States)

    Moy, Sheryl S; Riddick, Natallia V; Nikolova, Viktoriya D; Teng, Brian L; Agster, Kara L; Nonneman, Randal J; Young, Nancy B; Baker, Lorinda K; Nadler, Jessica J; Bodfish, James W

    2014-02-01

    Restricted repetitive behaviors are core symptoms of autism spectrum disorders (ASDs). The range of symptoms encompassed by the repetitive behavior domain includes lower-order stereotypy and self-injury, and higher-order indices of circumscribed interests and cognitive rigidity. Heterogeneity in clinical ASD profiles suggests that specific manifestations of repetitive behavior reflect differential neuropathology. The present studies utilized a set of phenotyping tasks to determine a repetitive behavior profile for the C58/J mouse strain, a model of ASD core symptoms. In an observational screen, C58/J demonstrated overt motor stereotypy, but not over-grooming, a commonly-used measure for mouse repetitive behavior. Amphetamine did not exacerbate motor stereotypy, but had enhanced stimulant effects on locomotion and rearing in C58/J, compared to C57BL/6J. Both C58/J and Grin1 knockdown mice, another model of ASD-like behavior, had marked deficits in marble-burying. In a nose poke task for higher-order repetitive behavior, C58/J had reduced holeboard exploration and preference for non-social, versus social, olfactory stimuli, but did not demonstrate cognitive rigidity following familiarization to an appetitive stimulus. Analysis of available high-density genotype data indicated specific regions of divergence between C58/J and two highly-sociable strains with common genetic lineage. Strain genome comparisons identified autism candidate genes, including Cntnap2 and Slc6a4, located within regions divergent in C58/J. However, Grin1, Nlgn1, Sapap3, and Slitrk5, genes linked to repetitive over-grooming, were not in regions of divergence. These studies suggest that specific repetitive phenotypes can be used to distinguish ASD mouse models, with implications for divergent underlying mechanisms for different repetitive behavior profiles.

  8. 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.)

  9. Repetitive Bibliographical Information in Relational Databases.

    Science.gov (United States)

    Brooks, Terrence A.

    1988-01-01

    Proposes a solution to the problem of loading repetitive bibliographic information in a microcomputer-based relational database management system. The alternative design described is based on a representational redundancy design and normalization theory. (12 references) (Author/CLB)

  10. Computer-Related Repetitive Stress Injuries

    Science.gov (United States)

    ... on the shoulder Epicondylitis: elbow soreness often called "tennis elbow" Ganglion cyst: swelling or lump in the wrist ... Bones, Muscles, and Joints Carpal Tunnel Syndrome Medial Epicondylitis Repetitive Stress Injuries Contact Us Print Resources Send ...

  11. 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...

  12. Digital repetitive control under varying frequency conditions

    OpenAIRE

    Ramos Fuentes, Germán Andrés

    2012-01-01

    Premi extraordinari doctorat curs 2011-2012, àmbit d’Enginyeria Industrial The tracking/rejection of periodic signals constitutes a wide field of research in the control theory and applications area and Repetitive Control has proven to be an efficient way to face this topic; however, in some applications the period of the signal to be tracked/rejected changes in time or is uncertain, which causes and important performance degradation in the standard repetitive controller. This the...

  13. Language, interactivity and solution probing: repetition without repetition

    DEFF Research Database (Denmark)

    Cowley, Stephen; Nash, Luarina

    2013-01-01

    , action and perception. We trace this to human interactivity or sense-saturated coordination that renders possible language and human forms of cognition: it links human sense-making to historical experience. People play roles with natural and cultural artifacts as they act, animate groups and live through......Recognition of the importance of autopoiesis to biological systems was crucial in building an alternative to the classic view of cognitive science. However, concepts like structural coupling and autonomy are not strong enough to throw light on language and human problem solving. The argument...... relationships drawing on language that is, at once, artificial and natural. Thus, while constrained by wordings, interactivity is able to fine-tune what we do with action-perception loops. Neither language nor human problem solving reduce to biological sense-making....

  14. 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...

  15. Cost-consequence analysis of remifentanil-based analgo-sedation vs. conventional analgesia and sedation for patients on mechanical ventilation in the Netherlands

    NARCIS (Netherlands)

    M.J. Al (Maiwenn); L. van Hakkaart-van Roijen (Leona); S.S. Tan (Siok Swan); J. Bakker (Jan)

    2010-01-01

    textabstractIntroduction: Hospitals are increasingly forced to consider the economics of technology use. We estimated the incremental cost-consequences of remifentanil-based analgo-sedation (RS) vs. conventional analgesia and sedation (CS) in patients requiring mechanical ventilation (MV) in the

  16. Repetitive subcutaneous implantation of different types of (biodegradable) biomaterials alters the foreign body reaction

    NARCIS (Netherlands)

    van Luyn, MJA; Plantinga, JA; Brouwer, LA; Khouw, IMSL; de Leij, LFMH; van Wachem, PB

    2001-01-01

    In the present study two biodegradable materials (cross-linked collagens) and two non-biodegradable materials (polyurethane and silicone) were applied in a repetitive subcutaneous implantation model in rats. In contrast to the first challenge, the second challenge with the same type of material, but

  17. 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.

  18. Respiratory mechanics in sedated and nonsedated adult llamas.

    Science.gov (United States)

    Lascola, Kara M; Hoffman, Andrew M; Mazan, Melissa R; Bedenice, Daniela

    2007-06-01

    To validate the use of noninvasive pulmonary function testing in sedated and nonsedated llamas and establish reference range parameters of respiratory mechanical function. 10 healthy adult llamas. Pulmonary function testing in llamas included the following: measurement of functional residual capacity (FRC) via helium dilution, respiratory inductance plethysmography (RIP) to assess breathing pattern and flow limitations, esophageal-balloon pneumotachography, and a monofrequency forced oscillatory technique (FOT; 1 to 7 Hz) before and after IM administration of xylazine (0.2 mg/kg). The following mean +/- SD measurements of respiratory function were obtained in nonsedated llamas: FRC (5.60 +/- 1.24 L), tidal volume (1.03 +/- 0.3 L), dynamic compliance (0.83 +/- 0.4 L/cm H(2)O), pulmonary resistance (R(L); 1.42 +/- 0.54 cm H(2)O/L/s), and respiratory system resistance (2.4 +/- 0.9, 2.3 +/- 0.7, 2.2 +/- 0.6, 2.7 +/- 0.7, and 2.5 +/- 0.5 cm H(2)O/L/s at 1, 2, 3, 5, and 7 Hz, respectively) by use of FOT. Measurements of flow limitations via RIP were comparable to other species. Sedation with xylazine induced significant increases in R(L) and maximum change in transpulmonary pressure. Following sedation, a mean 127% increase in R(L) and mean 116% increase in respiratory system resistance were observed across 1 to 7 Hz. The magnitude of change in respiratory system resistance increased with decreasing impulse frequency, suggesting bronchoconstriction. Noninvasive pulmonary function testing is well tolerated in untrained unsedated llamas. These techniques have clinical applications in the diagnosis and treatment of respiratory tract disease, although testing should not be performed after sedation with xylazine.

  19. 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.

  20. 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...

  1. 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...

  2. Consultation with specialist palliative care services in palliative sedation: considerations of Dutch physicians.

    Science.gov (United States)

    Koper, Ian; van der Heide, Agnes; Janssens, Rien; Swart, Siebe; Perez, Roberto; Rietjens, Judith

    2014-01-01

    Palliative sedation is considered a normal medical practice by the Royal Dutch Medical Association. Therefore, consultation of an expert is not considered mandatory. The European Association of Palliative Care (EAPC) framework for palliative sedation, however, is more stringent: it considers the use of palliative sedation without consulting an expert as injudicious and insists on input from a multi-professional palliative care team. This study investigates the considerations of Dutch physicians concerning consultation about palliative sedation with specialist palliative care services. Fifty-four physicians were interviewed on their most recent case of palliative sedation. Reasons to consult were a lack of expertise and the view that consultation was generally supportive. Reasons not to consult were sufficient expertise, the view that palliative sedation is a normal medical procedure, time pressure, fear of disagreement with the service and regarding consultation as having little added value. Arguments in favour of mandatory consultation were that many physicians lack expertise and that palliative sedation is an exceptional intervention. Arguments against mandatory consultation were practical obstacles that may preclude fulfilling such an obligation (i.e. lack of time), palliative sedation being a standard medical procedure, corroding a physician's responsibility and deterring physicians from applying palliative sedation. Consultation about palliative sedation with specialist palliative care services is regarded as supportive and helpful when physicians lack expertise. However, Dutch physicians have both practical and theoretical objections against mandatory consultation. Based on the findings in this study, there seems to be little support among Dutch physicians for the EAPC recommendations on obligatory consultation.

  3. Assessment of patients' awareness and factors influencing patients' demands for sedation in endodontics.

    Science.gov (United States)

    Huh, Yoo Kyeom; Montagnese, Thomas A; Harding, Jarrod; Aminoshariae, Anita; Mickel, Andre

    2015-02-01

    Endodontic therapy is perceived by many as a procedure to be feared. Many studies have reported that fear and anxiety are major deterrents to seeking dental care in general, but only a few deal with the use of sedation in endodontic therapies. The purpose of this study was to assess patients' awareness of and factors influencing the potential demand for sedation in endodontics. We hypothesized that there is an association between demographic factors and the demand for sedation in endodontics. A survey consisting of 24 questions was given to patients 18 years and older who presented to the graduate endodontic clinic. Results were collected and statistically analyzed. Thirty-six percent of patients reported that their perception of sedation was being put to sleep, and 27% perceived it as related to or reducing pain. Concerns associated with endodontic therapy were the fear of pain (35%), fear of needles (16%), difficulty getting numb (10%), and anxiety (7%). The 2 major demographic factors that influenced the demand for sedation were cost and the level of anxiety (P endodontic therapy if the option of sedation was available. The demand for sedation in endodontics is high. Patients' understanding of sedation varies. More patients would consider having endodontic procedures if sedation was available. The provision of sedation by endodontists could result in more patients accepting endodontic therapies. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  4. Changes in blood pressure and heart rate during sedation with ketamine in the pediatric ED.

    Science.gov (United States)

    Patterson, Adam C; Wadia, Shernaz A; Lorenz, Douglas J; Stevenson, Michelle D

    2017-02-01

    Ketamine is commonly used in the emergency department for short, painful procedures. We describe changes in blood pressure (BP) and heart rate (HR) during procedural sedation with ketamine, as these changes have not been well described in children. We performed a secondary analysis of a prospective, observational study involving children aged 8 to 18 years who received procedural sedation with ketamine in a pediatric emergency department. Serial vital signs and sedation scores were recorded from baseline until recovery from ketamine procedural sedation. Time of orthopedic manipulation was also recorded. Linear mixed-effect models were used to evaluate changes in systolic BP (SBP), diastolic BP (DBP), and HR using 3 sedation strata: presedation (baseline), sedated (ketamine administered and patient deeply sedated), and recovery (ketamine administered with patient minimally sedated), controlling for age and weight. Sixty children were enrolled; 10 were excluded due to missing manipulation time. A total of 394 observations were recorded. Mean sedated SBP, DBP, and HR were 8 mm Hg, 4 mm Hg, and 13 beats/min higher than presedation SBP (PKetamine administered during procedural sedation for painful procedures causes a statistically significant but modest increase in SBP, DBP, and HR. Orthopedic manipulation further increases BP. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Propofol versus midazolam/ketamine for procedural sedation in pediatric oncology.

    Science.gov (United States)

    Gottschling, Sven; Meyer, Sascha; Krenn, Thomas; Reinhard, Harald; Lothschuetz, Daniela; Nunold, Holger; Graf, Norbert

    2005-09-01

    Different pharmacologic agents have been used for sedation in children undergoing invasive procedures. The authors prospectively compared the efficacy, the occurrence of adverse effects, cardiovascular parameters, oxygen saturation and induction, and recovery time in propofol with or without morphine versus midazolam/ketamine sedation for procedural sedation in children with malignancies and hematologic disorders. Fifty children received either propofol with or without morphine or ketamine/midazolam sedation for invasive procedures. Intravenous sedation consisted of 0.1 mg midazolam/kg and 1.0 mg ketamine/kg or 2 mg propofol/kg with or without 0.1 mg morphine/kg. Incremental dosages of ketamine or propofol were given, if necessary, to achieve or to maintain adequate sedation levels. Systolic and diastolic blood pressure, heart rate, oxygen saturation, time to induce sedation, recovery time, and adverse effects were recorded. All invasive procedures were successfully completed, with satisfactory sedation levels in all 25 patients in the propofol group and 23 of the 25 patients in the ketamine group. In 14 of the 25 procedures in the propofol group and 4 of the 25 procedures in the ketamine group, sedation was associated with side effects, the most common being oxygen desaturation. There was a significant increase in diastolic blood pressure after ketamine medication and a significant decrease in systolic and diastolic blood pressure and heart rate in the propofol group. Induction and recovery times in the propofol group were significantly shorter. Both regimens for procedural sedation are efficacious in achieving satisfactory sedation levels for invasive procedures. Propofol offers a quicker onset of sedation and a faster, smoother recovery but is associated with a higher rate of side effects. Considering the substantial rate of adverse effects, these procedural sedations should be performed only by physicians trained in advanced airway management and life support.

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. Self-organization of repetitive spike patterns in developing neuronal networks in vitro.

    Science.gov (United States)

    Sun, Jyh-Jang; Kilb, Werner; Luhmann, Heiko J

    2010-10-01

    The appearance of spontaneous correlated activity is a fundamental feature of developing neuronal networks in vivo and in vitro. To elucidate whether the ontogeny of correlated activity is paralleled by the appearance of specific spike patterns we used a template-matching algorithm to detect repetitive spike patterns in multi-electrode array recordings from cultures of dissociated mouse neocortical neurons between 6 and 15 days in vitro (div). These experiments demonstrated that the number of spiking neurons increased significantly between 6 and 15 div, while a significantly synchronized network activity appeared at 9 div and became the main discharge pattern in the subsequent div. Repetitive spike patterns with a low complexity were first observed at 8 div. The number of repetitive spike patterns in each dataset as well as their complexity and recurrence increased during development in vitro. The number of links between neurons implicated in repetitive spike patterns, as well as their strength, showed a gradual increase during development. About 8% of the spike sequences contributed to more than one repetitive spike patterns and were classified as core patterns. These results demonstrate for the first time that defined neuronal assemblies, as represented by repetitive spike patterns, appear quite early during development in vitro, around the time synchronized network burst become the dominant network pattern. In summary, these findings suggest that dissociated neurons can self-organize into complex neuronal networks that allow reliable flow and processing of neuronal information already during early phases of development.

  13. Facilitating memory for novel characters by reducing neural repetition suppression in the left fusiform cortex.

    Directory of Open Access Journals (Sweden)

    Gui Xue

    Full Text Available BACKGROUND: The left midfusiform and adjacent regions have been implicated in processing and memorizing familiar words, yet its role in memorizing novel characters has not been well understood. METHODOLOGY/PRINCIPAL FINDINGS: Using functional MRI, the present study examined the hypothesis that the left midfusiform is also involved in memorizing novel characters and spaced learning could enhance the memory by enhancing the left midfusiform activity during learning. Nineteen native Chinese readers were scanned while memorizing the visual form of 120 Korean characters that were novel to the subjects. Each character was repeated four times during learning. Repetition suppression was manipulated by using two different repetition schedules: massed learning and spaced learning, pseudo-randomly mixed within the same scanning session. Under the massed learning condition, the four repetitions were consecutive (with a jittered inter-repetition interval to improve the design efficiency. Under the spaced learning condition, the four repetitions were interleaved with a minimal inter-repetition lag of 6 stimuli. Spaced learning significantly improved participants' performance during the recognition memory test administered one hour after the scan. Stronger left midfusiform and inferior temporal gyrus activities during learning (summed across four repetitions were associated with better memory of the characters, based on both within- and cross-subjects analyses. Compared to massed learning, spaced learning significantly reduced neural repetition suppression and increased the overall activities in these regions, which were associated with better memory for novel characters. CONCLUSIONS/SIGNIFICANCE: These results demonstrated a strong link between cortical activity in the left midfusiform and memory for novel characters, and thus challenge the visual word form area (VWFA hypothesis. Our results also shed light on the neural mechanisms of the spacing effect in

  14. 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.

  15. Intranasal Dexmedetomidine for Procedural Sedation in Children, a Suitable Alternative to Chloral Hydrate.

    Science.gov (United States)

    Cozzi, Giorgio; Norbedo, Stefania; Barbi, Egidio

    2017-04-01

    Sedation is often required for children undergoing diagnostic procedures. Chloral hydrate has been one of the sedative drugs most used in children over the last 3 decades, with supporting evidence for its efficacy and safety. Recently, chloral hydrate was banned in Italy and France, in consideration of evidence of its carcinogenicity and genotoxicity. Dexmedetomidine is a sedative with unique properties that has been increasingly used for procedural sedation in children. Several studies demonstrated its efficacy and safety for sedation in non-painful diagnostic procedures. Dexmedetomidine's impact on respiratory drive and airway patency and tone is much less when compared to the majority of other sedative agents. Administration via the intranasal route allows satisfactory procedural success rates. Studies that specifically compared intranasal dexmedetomidine and chloral hydrate for children undergoing non-painful procedures showed that dexmedetomidine was as effective as and safer than chloral hydrate. For these reasons, we suggest that intranasal dexmedetomidine could be a suitable alternative to chloral hydrate.

  16. The Prevalence and Phenomenology of Repetitive Behavior in Genetic Syndromes

    Science.gov (United States)

    Moss, Joanna; Oliver, Chris; Arron, Kate; Burbidge, Cheryl; Berg, Katy

    2009-01-01

    We investigated the prevalence and phenomenology of repetitive behavior in genetic syndromes to detail profiles of behavior. The Repetitive Behaviour Questionnaire (RBQ) provides fine-grained identification of repetitive behaviors. The RBQ was employed to examine repetitive behavior in Angelman (N = 104), Cornelia de Lange (N = 101), Cri-du-Chat…

  17. Likelihood methods and classical burster repetition

    CERN Document Server

    Graziani, C; Graziani, Carlo; Lamb, Donald Q

    1995-01-01

    We develop a likelihood methodology which can be used to search for evidence of burst repetition in the BATSE catalog, and to study the properties of the repetition signal. We use a simplified model of burst repetition in which a number N_{\\rm r} of sources which repeat a fixed number of times N_{\\rm rep} are superposed upon a number N_{\\rm nr} of non-repeating sources. The instrument exposure is explicitly taken into account. By computing the likelihood for the data, we construct a probability distribution in parameter space that may be used to infer the probability that a repetition signal is present, and to estimate the values of the repetition parameters. The likelihood function contains contributions from all the bursts, irrespective of the size of their positional errors --- the more uncertain a burst's position is, the less constraining is its contribution. Thus this approach makes maximal use of the data, and avoids the ambiguities of sample selection associated with data cuts on error circle size. We...

  18. Current role of non-anesthesiologist administered propofol sedation in advanced interventional endoscopy

    DEFF Research Database (Denmark)

    Burtea, Daniela Elena; Dimitriu, Anca; Maloş, Anca Elena

    2015-01-01

    the patients and medical personnel. Current guidelines support the use of propofol sedation, which has the same rate of adverse effects as traditional sedation with benzodiazepines and/or opioids, but decreases the procedural and recovery time. Non-anesthesiologist administered propofol sedation has become......, improved satisfaction for patients and doctors, as well as decreased recovery and discharge time. Despite the advantages of non-anesthesiologist administered propofol, there is still a continuous debate related to the successful generalization of the procedures....

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

    Directory of Open Access Journals (Sweden)

    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

  20. 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.

  1. 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...

  2. 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

  3. 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.

  4. Neural dynamics during repetitive visual stimulation

    Science.gov (United States)

    Tsoneva, Tsvetomira; Garcia-Molina, Gary; Desain, Peter

    2015-12-01

    Objective. Steady-state visual evoked potentials (SSVEPs), the brain responses to repetitive visual stimulation (RVS), are widely utilized in neuroscience. Their high signal-to-noise ratio and ability to entrain oscillatory brain activity are beneficial for their applications in brain-computer interfaces, investigation of neural processes underlying brain rhythmic activity (steady-state topography) and probing the causal role of brain rhythms in cognition and emotion. This paper aims at analyzing the space and time EEG dynamics in response to RVS at the frequency of stimulation and ongoing rhythms in the delta, theta, alpha, beta, and gamma bands. Approach.We used electroencephalography (EEG) to study the oscillatory brain dynamics during RVS at 10 frequencies in the gamma band (40-60 Hz). We collected an extensive EEG data set from 32 participants and analyzed the RVS evoked and induced responses in the time-frequency domain. Main results. Stable SSVEP over parieto-occipital sites was observed at each of the fundamental frequencies and their harmonics and sub-harmonics. Both the strength and the spatial propagation of the SSVEP response seem sensitive to stimulus frequency. The SSVEP was more localized around the parieto-occipital sites for higher frequencies (>54 Hz) and spread to fronto-central locations for lower frequencies. We observed a strong negative correlation between stimulation frequency and relative power change at that frequency, the first harmonic and the sub-harmonic components over occipital sites. Interestingly, over parietal sites for sub-harmonics a positive correlation of relative power change and stimulation frequency was found. A number of distinct patterns in delta (1-4 Hz), theta (4-8 Hz), alpha (8-12 Hz) and beta (15-30 Hz) bands were also observed. The transient response, from 0 to about 300 ms after stimulation onset, was accompanied by increase in delta and theta power over fronto-central and occipital sites, which returned to baseline

  5. Efficiency of propofol versus midazolam and fentanyl sedation at a pediatric teaching hospital: a prospective study.

    Science.gov (United States)

    Lightdale, Jenifer R; Valim, Clarissa; Newburg, Adrienne R; Mahoney, Lisa B; Zgleszewski, Steven; Fox, Victor L

    2008-06-01

    Many pediatric endoscopists are adopting propofol in their practices, with the expectation that propofol will increase their overall efficiency. To compare the efficiency of propofol versus midazolam and fentanyl by measuring elapsed times between initial intravenous administration and patient discharge at a pediatric teaching hospital. Endoscopy times were prospectively collected for consecutive patients who were undergoing either anesthesiologist-administered propofol or endoscopist-administered midazolam and fentanyl. The effect of the type of sedation on these times was assessed by using multiple linear regression by adjusting for other candidate predictors, including concomitant use of other sedatives, endotracheal intubation by anesthesiologists, and the presence of fellow trainees. Time to onset of sedation (time sedation started to scope in), procedure time (endoscope in to endoscope out), discharge time (endoscope out to hospital discharge), and total time (sedation started to hospital discharge). The times for 134 children (mean age 12 +/- 5 years) to receive propofol sedation were compared with those of 195 children (13 +/- 5 years) who received midazolam and fentanyl. Midazolam and fentanyl cases disproportionately included EGDs (P propofol had shorter times until sedated, similar procedure times, longer discharge times, and comparable total times. Multivariate analyses confirmed that fellow participation prolonged the procedure times (P propofol times (P propofol sedation in a pediatric teaching endoscopy unit may not lead to faster hospital times when compared with endoscopist-administered midazolam and fentanyl. These results are not explained by controlling for patient characteristics, the presence of a trainee, the sedative doses, or endotracheal intubation for airway management.

  6. 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.

  7. 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.

  8. 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.

  9. [Survey of pediatric sedation in Japan--results of questionnaire to universities of dentistry].

    Science.gov (United States)

    Takeuchi, Lisa; Kuratani, Norifumi; Hoshijima, Hiroshi; Kikuchi, Hirosato

    2010-12-01

    Despite widespread use of sedation for stress management during dental treatment in adults, its prevalence of use for pediatric in patients Japan has not been clarified. We investigated here, the present situation of pediatric sedation by the questionnaire sent to the dental anesthesia departments of university hospitals in Japan. Postal survey was conducted of the dental anesthesia departments of university hospitals (29 institutions) throughout the country. Information was requested on hospital policy of indication and technique of pediatric sedation for dental treatment. The causes for avoiding pediatric sedation were also investigated. The response rate was 86.2% (25/29 institutions). Of these respondents, 16 institutions (64%, 16/25 institutions) employ sedation for pediatric dental treatment stress management. The cases performed were around 1-5 cases every month. However, the criteria for employment of pediatric sedation during dental treatment varied among institutes. They preferred to provide general endotracheal anesthesia for pediatric dental procedures, and tended to avoid sedation without airway security for children. The present survey suggests that pediatric sedation for stress management during dental treatment are employed in more than half of the dental university hospitals. However, there was little consensus regarding pediatric sedation during dental treatment among dental anesthesiologists in Japan.

  10. 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.

  11. Association of BMI With Propofol Dosing and Adverse Events in Children With Cancer Undergoing Procedural Sedation.

    Science.gov (United States)

    Rogerson, Colin M; Abulebda, Kamal; Hobson, Michael J

    2017-09-01

    Obesity increases the risk of complications during pediatric procedural sedation. The risk of being underweight has not been evaluated in this arena. We therefore investigated the association of BMI with sedation dosing and adverse events in children across a range of BMIs. A total of 1976 patients ages 2 to 21 years old with oncologic diagnoses underwent lumbar punctures and/or bone marrow aspirations. All children received a standard adjunctive dose of ketamine before sedation with propofol. Weight categories were stratified by BMI percentile: underweight 85%, and obese >95%. Dosing and adverse events (hypoxia, apnea, bradycardia, or hypotension) were reviewed. There were no differences in propofol dosing for procedural sedation between patients who were normal weight and underweight. However, children who were overweight and those who were obese used less propofol compared with children who were normal weight (P obese. Children who are overweight and children with obesity who require deep sedation can undergo successful sedation with lower propofol dosing relative to children of a normal weight. This dosing strategy may help to mitigate the risks associated with sedating patients who are obese. Notably, children who were underweight had an increased rate of complications despite receiving an equal amount of sedation compared with patients who were normal weight. This should alert the clinicians to the risks associated with sedating children who are underweight. Copyright © 2017 by the American Academy of Pediatrics.

  12. Walking the line. Palliative sedation for existential distress: still a controversial issue?

    Science.gov (United States)

    Schur, Sophie; Radbruch, Lukas; Masel, Eva K; Weixler, Dietmar; Watzke, Herbert H

    2015-12-01

    Adequate symptom relief is a central aspect of medical care of all patients especially in those with an incurable disease. However, as an illness progresses and the end of life approaches, physical or psychoexistential symptoms may remain uncontrollable requiring palliative sedation. Although palliative sedation has become an increasingly implemented practice in the care of terminally ill patients, sedation in the management of refractory psychological symptoms and existential distress is still a controversial issue and much debated. This case report presents a patient who received palliative sedation for the treatment of existential distress and discusses considerations that may arise from such a therapeutic approach.

  13. 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

  14. 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.

  15. How to improve patient satisfaction during midazolam sedation for gastrointestinal endoscopy?

    Science.gov (United States)

    Jin, Eun Hyo; Hong, Kyoung Sup; Lee, Young; Seo, Ji Yeon; Choi, Ji Min; Chun, Jaeyoung; Kim, Sang Gyun; Kim, Joo Sung; Jung, Hyun Chae

    2017-02-14

    To determine the procedure-related factors that affect sedation satisfaction and to make a suggestion to improve it. We prospectively enrolled a total of 456 patients who underwent outpatient endoscopy procedures with midazolam sedation between March 2014 and August 2014. All patients completed both pre- and post-endoscopy questionnaires about sedation expectations and satisfaction. The study cohort included 167 (36.6%) patients who underwent esophagogastroduodenoscopy (EGD), 167 (36.6%) who underwent colonoscopy, and 122 (26.8%) who underwent a combined procedure (EGD and colonoscopy). Over 80% of all patients were satisfied with sedation using midazolam. In univariate and multivariate analyses, total procedure time in the EGD group, younger age (≤ 50 years), and longer colonoscopy withdrawal time in the colonoscopy group were related to decreased satisfaction with sedation. However, in active monitoring and intervention group, there was no decrease in grade of satisfaction despite longer procedure time due to more procedures during colonoscopy. Younger age (≤ 50 years), longer inter-procedure time gap, and colonoscopy withdrawal time were related to decreased satisfaction in the combined EGD and colonoscopy group. Midazolam is still a safe and effective sedative for gastrointestinal endoscopy. Satisfaction with sedation depends on several factors including age (≤ 50 years) and procedure time duration. To improve patient satisfaction with sedation, active monitoring of sedation status by the endoscopist should be considered for patients who require long procedure time.

  16. Use of electricity to sedate Lake Trout for intracoelomic implantation of electronic transmitters

    Science.gov (United States)

    Faust, Matthew D.; Vandergoot, Christopher; Hostnik, Eric T.; Binder, Thomas R.; Mida Hinderer, Julia L.; Ives, Jessica T.; Krueger, Charles Conrad

    2017-01-01

    Use of telemetry data to inform fisheries conservation and management is becoming increasingly common; as such, fish typically must be sedated before surgical implantation of transmitters into the coelom. Given that no widely available, immediate-release chemical sedative currently exists in North America, we investigated the feasibility of using electricity to sedate Lake Trout Salvelinus namaycush long enough for an experienced surgeon to implant an electronic transmitter (i.e., 180 s). Specifically, our study objectives were to determine (1) whether some combination of electrical waveform characteristics (i.e., duty cycle, frequency, voltage, and pulse type) could sedate Lake Trout for at least 180 s; and (2) whether Lake Trout that were sequentially exposed to continuous DC and pulsed DC had greater rates of spinal injury and short-term mortality than control fish. A Portable Electrosedation System unit was used to sedate hatchery and wild Lake Trout. Dual-frequency pulsed-DC and two-stage approaches successfully sedated Lake Trout and had similar induction and recovery times. Lake Trout sedated using the two-stage approach did not have survival rates or spinal abnormalities that were significantly different from those of control fish. We concluded that electricity was a viable alternative to chemical sedatives for sedating Lake Trout before surgical implantation of an electronic transmitter, but we suggest that Lake Trout and other closely related species (e.g., Arctic Char Salvelinus alpinus) may require morphotype-specific electrical waveforms due to their morphological diversity.

  17. 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

  18. Refining borders of genome-rearrangements including repetitions

    Directory of Open Access Journals (Sweden)

    JA Arjona-Medina

    2016-10-01

    Full Text Available Abstract Background DNA rearrangement events have been widely studied in comparative genomic for many years. The importance of these events resides not only in the study about relatedness among different species, but also to determine the mechanisms behind evolution. Although there are many methods to identify genome-rearrangements (GR, the refinement of their borders has become a huge challenge. Until now no accepted method exists to achieve accurate fine-tuning: i.e. the notion of breakpoint (BP is still an open issue, and despite repeated regions are vital to understand evolution they are not taken into account in most of the GR detection and refinement methods. Methods and results We propose a method to refine the borders of GR including repeated regions. Instead of removing these repetitions to facilitate computation, we take advantage of them using a consensus alignment sequence of the repeated region in between two blocks. Using the concept of identity vectors for Synteny Blocks (SB and repetitions, a Finite State Machine is designed to detect transition points in the difference between such vectors. The method does not force the BP to be a region or a point but depends on the alignment transitions within the SBs and repetitions. Conclusion The accurate definition of the borders of SB and repeated genomic regions and consequently the detection of BP might help to understand the evolutionary model of species. In this manuscript we present a new proposal for such a refinement. Features of the SBs borders and BPs are different and fit with what is expected. SBs with more diversity in annotations and BPs short and richer in DNA replication and stress response, which are strongly linked with rearrangements.

  19. Optimal dose of dexmedetomidine for sedation during spinal anesthesia

    Science.gov (United States)

    Ok, Hwoe-Gyeong; Baik, Seong-Wan; Kim, Hae-Kyu; Shin, Sang-Wook; Kim, Kyung-Hoon

    2013-01-01

    Background Sedation in spinal anesthesia can reduce patient's anxiety and discomfort. Dexmedetomidine has a sedative, hypnotic, analgesic, and minimal respiratory depression effect. However, use of the dexmedetomidine is associated with prolonged recovery. This study was designed to investigate the optimal dose of intravenous dexmedetomidine for proper sedation with minimal recovery time in spinal anesthesia. Methods One hundred twenty eight patients, aged 20-70 years (58.8 ± 0.7), were recruited. After performing the spinal anesthesia with hyperbaric bupivacaine (13 mg), a loading dose of dexmedetomidine (1 µg/kg) was administered for 10 min, followed by the maintenance infusion of the following: Group A (n = 33; normal saline), Group B (n = 35; dexmedetomidine 0.2 µg/kg/hr), and Group C (n = 39; dexmedetomidine 0.4 µg/kg/hr). Heart rate, blood pressure, and the bispectral index score (BIS) were recorded during the operation. In the recovery room, modified aldrete score (MAS) was measured. Results There were no significant differences in mean blood pressure and heart rate among the three groups. BIS was not significantly different among the three groups from baseline to 60 min after the infusion of dexmedetomidine. BIS were significantly increased in Group A after 70 and 80 min, and Group A and B after 90, 100, 110 min of dexmedetomidine infusion (P < 0.05). MAS was higher in Group A as compared to Group B and C, within 30 min after admission in the recovery room (P < 0.05). Conclusions The loading dose (1 µg/kg/10 min) of dexmedetomidine was sufficient for surgery of less than 60 min. Dexmedetomidine infusion followed by maintenance dose (0.2 µg/kg/hr) was sufficient for surgery within 90 min. PMID:23741565

  20. Skeletal effects of central nervous system active drugs: anxiolytics, sedatives, antidepressants, lithium and neuroleptics.

    Science.gov (United States)

    Vestergaard, Peter

    2008-09-01

    Many central nervous system active drugs can alter postural balance, increasing the risk of fractures. Anxiolytics and sedatives include the benzodiazepines, and these have been associated with a limited increase in the risk of fractures, even at low doses, probably from an increased risk of falls. No systematic differences have been shown between benzodiazepines with long and short half-lives. Although the increase in risk of fractures was limited, care must still be taken when prescribing for older fall-prone subjects at risk of osteoporosis. Neuroleptics may be associated with a decrease in bone mineral density and a very limited increase in fracture risk. Antidepressants are associated with a dose-dependent increase in the risk of fractures. The increase in relative risk of fractures seems to be larger with selective serotonin reuptake inhibitors (SSRIs) than with tricyclic antidepressants. The reason for this is not known but may be linked to serotonin effects on bone cells and the risk of falls. With the wide use of SSRIs, more research is needed. Lithium is associated with a decrease in the risk of fractures. This may be linked to its effects on the Wnt glycoprotein family, which is a specialised signalling system for certain cell types.

  1. 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...

  2. 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.

  3. 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.

  4. 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

  5. Comparison of midazolam and propofol for sedation in pediatric diagnostic imaging studies.

    Science.gov (United States)

    Sebe, Ahmet; Yilmaz, Hayri Levent; Koseoglu, Zikret; Ay, Mehmet Oguzhan; Gulen, Muge

    2014-05-01

    This study aims to compare the efficacy of propofol and midazolam in terms of adverse effect potentials and to determine the appropriate strategy for pediatric procedural sedation. A total of 200 pediatric patients (aged propofol (Group 1: IV bolus dose of 2 mg/kg during a 2-minute period, IV maintenance dose of 100 mcg/kg/min) or midazolam (Group 2: IV bolus dose of 0.15 mg/kg during a period of 2 to 3 minutes) to achieve sedation. Demographic data, body weight, and clinical status of the patients were evaluated and recorded. The vital signs and sedation levels (ie, Ramsay sedation scale scores) were evaluated and recorded, as well as the complications detected and medications administered in 10-minute intervals throughout the sedation procedure. Findings between the study arms were compared. Arterial blood pressures decreased significantly in both groups (P = 0.001). The patients in Group 1 experienced a greater difference in diastolic blood pressure (P = 0.001) than those in Group 2. Sedation scores in Group 1 were more favorable (P = 0.014) and reached the appropriate sedation level in a shorter time than those in Group 2 (P = 0.010). Likewise, recovery time of patients was shorter in Group 1 than in Group 2 (P = 0.010). Hypoxia was found to be more common in the propofol group, but the difference was not significant (P = 0.333). Propofol seems to be more effective, achieve the appropriate sedation level more quickly, and provide a faster onset of sedation than midazolam in pediatric procedural sedation and analgesia. Propofol is preferred for imaging studies (computed tomography and magnetic resonance imaging) to reduce the occurrence of undesired motion artefacts. Although both drugs are safe to use for sedation before pediatric imaging procedures, propofol is preferred with appropriate preparation.

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

    Directory of Open Access Journals (Sweden)

    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.

  7. Attitudes towards terminal sedation: an empirical survey among experts in the field of medical ethics

    Directory of Open Access Journals (Sweden)

    Hinz José

    2007-04-01

    Full Text Available Abstract Background "Terminal sedation" regarded as the use of sedation in (pre-terminal patients with treatment-refractory symptoms is controversially discussed not only within palliative medicine. While supporters consider terminal sedation as an indispensable palliative medical treatment option, opponents disapprove of it as "slow euthanasia". Against this background, we interviewed medical ethics experts by questionnaire on the term and the moral acceptance of terminal sedation in order to find out how they think about this topic. We were especially interested in whether experts with a professional medical and nursing background think differently about the topic than experts without this background. Methods The survey was carried out by questionnaire; beside the provided answering options free text comments were possible. As test persons we chose the 477 members of the German Academy for Ethics in Medicine, an interdisciplinary society for medical ethics. Results 281 completed questionnaires were returned (response rate = 59%. The majority of persons without medical background regarded "terminal sedation" as an intentional elimination of consciousness until the patient's death occurs; persons with a medical background generally had a broader understanding of the term, including light or intermittent forms of sedation. 98% of the respondents regarded terminal sedation in dying patients with treatment-refractory physical symptoms as acceptable. Situations in which the dying process has not yet started, in which untreatable mental symptoms are the indication for terminal sedation or in which life-sustaining measures are withdrawn during sedation were evaluated as morally difficult. Conclusion The survey reveals a great need for research and discussion on the medical indication as well as on the moral evaluation of terminal sedation. Prerequisite for this is a more precise terminology which describes the circumstances of the sedation.

  8. Current debates on end-of-life sedation: an international expert elicitation study.

    Science.gov (United States)

    Papavasiliou, Evangelia Evie; Payne, Sheila; Brearley, Sarah

    2014-08-01

    End-of-life sedation, though increasingly prevalent and widespread internationally, remains one of the most highly debated medical practices in the context of palliative medicine. This qualitative study aims to elicit and record the perspectives of leading international palliative care experts on current debates. Twenty-one professionals from diverse backgrounds, sharing field-specific knowledge/expertise defined by significant scholarly contribution on end-of-life sedation, were recruited. Open-ended, semi-structured interviews, following a topic-oriented structure reflecting on current debates, were conducted. Results were analysed using thematic content analysis. Three main aspects of sedation were identified and discussed as potentially problematic: (a) continuous deep sedation as an extreme facet of end-of-life sedation, (b) psycho-existential suffering as an ambivalent indication for sedation and (c) withdrawal or withholding of artificial nutrition and hydration as potentially life-shortening. On these grounds, concerns were reported over end-of-life sedation being morally equivalent to euthanasia. Considerable emphasis was placed on intentions as the distinguishing factor between end-of-life acts, and protective safeguards were introduced to distance sedation from euthanasia. This study shows that, despite the safeguards introduced, certain aspects of sedation, including the intentions associated with the practice, are still under question, parallels being drawn between end-of-life sedation and euthanasia. This reaffirms the existence of a grey area surrounding the two practices, already evidenced in countries where euthanasia is legalized. More clarity over the issues that generate this grey area, with their causes being uncovered and eliminated, is imperative to resolve current debates and effectively inform research, policy and practice of end-of-life sedation.

  9. Noise level measurement, a new method to evaluate effectiveness of sedation in pediatric dentistry.

    Science.gov (United States)

    Sabouri, A Sassan; Firoozabadi, Farshid; Carlin, Drew; Creighton, Paul; Raczka, Michelle; Joshi, Prashant; Heard, Christopher

    2014-12-01

    Pediatric dentists perform moderate sedation frequently to facilitate dental treatment in uncooperative children. Assessing the depth and quality of sedation is an important factor in the clinical utilization of moderate sedation. We aimed to determine if the level of noise, created by the children who are undergoing moderate sedation during dental procedures, could be used as a nonsubjective measurement of the depth of sedation and compare it to the Ohio State Behavior Rating Score (OSBRS). Following Institutional Review Board approval and after receiving informed consent, we studied 51 children with a mean age of 4.2 years and average weight of 18.5 kg, who were undergoing restorative or extractive dental procedures, requiring moderate sedation. Sedation efficacy was assessed using OSBRS at several stages of the procedure. The noise level was measured by using a NoisePRO logging device to record the noise level at a rate of every second throughout the procedure. The depth of sedation assessed by OSBRS during the operative procedure was significantly correlated with noise level. The act of administering the local anesthesia and the operative procedure itself were two phases of the encounter that were significantly associated with higher OSBRS as well as noise levels. Measurement of noise level can be used as an effective guide to quantify the depth of sedation at different stages of the dental procedure. It is a nonsubjective and continuous measurement, which could be useful in clinical practice for the administration of moderate sedation during dental procedures. By using noise level analysis we are able to determine successful, poor, and failed sedation outcome. Copyright © 2014. Published by Elsevier B.V.

  10. 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

  11. Scandinavian links

    DEFF Research Database (Denmark)

    Matthiessen, Christian Wichmann; Knowles, Richard D.

    2014-01-01

    centres, one joins more thinly populated regions, and the last one links peripheral areas. Two of them (The Great Belt Link and the Oresund Link) have been constructed and are in full operation. The third (the Fehmarnbelt Link) has been decided 2008 on bilateral government level. The three links...

  12. The neurobiology of repetitive behavior : of mice…

    NARCIS (Netherlands)

    Langen, Marieke; Kas, Martien J H; Staal, Wouter G; van Engeland, Herman; Durston, Sarah

    2011-01-01

    Repetitive and stereotyped behavior is a prominent element of both animal and human behavior. Similar behavior is seen across species, in diverse neuropsychiatric disorders and in key phases of typical development. This raises the question whether these similar classes of behavior are caused by simi

  13. Large-scale detection of repetitions.

    Science.gov (United States)

    Smyth, W F

    2014-05-28

    Combinatorics on words began more than a century ago with a demonstration that an infinitely long string with no repetitions could be constructed on an alphabet of only three letters. Computing all the repetitions (such as ∙∙∙TTT ∙∙∙ or ∙∙∙ CGACGA ∙∙∙ ) in a given string x of length n is one of the oldest and most important problems of computational stringology, requiring time in the worst case. About a dozen years ago, it was discovered that repetitions can be computed as a by-product of the Θ(n)-time computation of all the maximal periodicities or runs in x. However, even though the computation is linear, it is also brute force: global data structures, such as the suffix array, the longest common prefix array and the Lempel-Ziv factorization, need to be computed in a preprocessing phase. Furthermore, all of this effort is required despite the fact that the expected number of runs in a string is generally a small fraction of the string length. In this paper, I explore the possibility that repetitions (perhaps also other regularities in strings) can be computed in a manner commensurate with the size of the output.

  14. Verbal Repetitions and Echolalia in Alzheimer's Discourse

    Science.gov (United States)

    Da Cruz, Fernanda Miranda

    2010-01-01

    This article reports on an investigation of echolalic repetition in Alzheimer's disease (AD). A qualitative analysis of data from spontaneous conversations with MHI, a woman with AD, is presented. The data come from the DALI Corpus, a corpus of spontaneous conversations involving subjects with AD. This study argues that echolalic effects can be…

  15. Neurobehavioural Correlates of Abnormal Repetitive Behaviour

    Directory of Open Access Journals (Sweden)

    R. A. Ford

    1991-01-01

    Full Text Available Conditions in which echolalia and echopraxia occur are reviewed, followed by an attempt to elicit possible mechanisms of these phenomena. A brief description of stereotypical and perseverative behaviour and obsessional phenomena is given. It is suggested that abnormal repetitive behaviour may occur partly as a result of central dopaminergic dysfunction.

  16. Reducing Repetitive Speech: Effects of Strategy Instruction.

    Science.gov (United States)

    Dipipi, Caroline M.; Jitendra, Asha K.; Miller, Judith A.

    2001-01-01

    This article describes an intervention with an 18-year-old young woman with mild mental retardation and a seizure disorder, which focused on her repetitive echolalic verbalizations. The intervention included time delay, differential reinforcement of other behaviors, and self-monitoring. Overall, the intervention was successful in facilitating…

  17. Verbal Repetitions and Echolalia in Alzheimer's Discourse

    Science.gov (United States)

    Da Cruz, Fernanda Miranda

    2010-01-01

    This article reports on an investigation of echolalic repetition in Alzheimer's disease (AD). A qualitative analysis of data from spontaneous conversations with MHI, a woman with AD, is presented. The data come from the DALI Corpus, a corpus of spontaneous conversations involving subjects with AD. This study argues that echolalic effects can be…

  18. The link in Linking

    Science.gov (United States)

    Caldwell, Jane C; Chiale, Pablo A; Gonzalez, Mario D; Baranchuk, Adrian

    2013-01-01

    We present 2 cases of the slow-fast form of AVNRT with initially narrow QRS complexes followed by sudden unexpected transition to persistently wide QRS complexes due to aberrant intraventricular conduction. Introduction of a properly timed extrastimulus in one case and critical oscillations in cycle length due to short-long coupling in the second case set the stage for the initial bundle branch block. However, persistence of the aberrancy pattern once the initial event abated was maintained by the "linking" phenomenon. Delayed, retrograde concealed activation from the contralateral bundle branch perpetuated the initial bundle branch block. PMID:23840106

  19. 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.

  20. 75 FR 73104 - Clinical Development Programs for Sedation Products; Request for Assistance

    Science.gov (United States)

    2010-11-29

    ... sedation products in adult and pediatric age groups. FDA is inviting any interested party, or parties, to... example, pediatric and geriatric age groups often require dose adjustment because of varying metabolic..., Midazolam, Propofol, Ketamine, and Dexmedetomidine are commonly used sedation products. Of these, Midazolam...

  1. [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.

  2. [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.

  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. 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.

  5. 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.

  6. Dutch physicians on the role of the family in continuous sedation

    NARCIS (Netherlands)

    van Tol, Donald G.; Kouwenhoven, Pauline; van der Vegt, Bea; Weyers, Heleen

    In order to relieve intractable suffering of a terminal patient, doctors may decide to continuously sedate a patient until the end of life. Little research is done on the role the family plays during the process of continuous sedation. This study aims to get a view of doctors' experiences with

  7. Evaluation of efficacy of dexmedetomidine versus propofol for sedation in children undergoing magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Kirti Kamal

    2017-01-01

    Conclusion: Propofol had an advantage of providing rapid onset of sedation and quicker recovery time. Dexmedetomidine resulted in a better preservation of respiratory rate and oxygen saturation, so it may be more suitable in children who are prone to respiratory depression. Hence, both the drugs could achieve required sedation in children posted for MRI.

  8. Propofol Versus Midazolam/Fentanyl Sedation for Colonoscopy in the Elderly Patient Population.

    Science.gov (United States)

    Lovett, Pamela; Gómez, Victoria; Hodge, David O; Ladlie, Beth

    2017-06-01

    Despite current literature, data on the most effective sedation and best patient outcomes are insufficient for providing recovery time recommendations for elderly patients undergoing colonoscopy with sedation. We sought to identify the best sedation practice for shorter recovery times. Therefore, a study was conducted to examine recovery times among patients older than 65 years undergoing elective colonoscopy with intravenous sedation with either propofol or the combination of midazolam/fentanyl. A retrospective descriptive, exploratory design was used. We retrospectively reviewed data from patients older than 65 years undergoing outpatient elective colonoscopy at our institution between January and December 2013. Recovery times were evaluated for those administered intravenous propofol or a combination of midazolam/fentanyl. Patient demographics and sedation medications were obtained from patient records. A modified Aldrete score greater than 8 was required for discharge. Recovery time was defined as the time from procedure completion to a modified Aldrete score greater than 8. Propofol sedation was associated with longer recovery times compared with sedation with a combination of midazolam and fentanyl (mean: 50 minutes versus 31 minutes, P < .001). Propofol sedation was not associated with shorter recovery times. Further studies are needed to validate these findings. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  9. 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.

  10. Anxiolytics, Sedatives, and Hypnotics Prescribed by Dentists in Brazil in 2010

    Science.gov (United States)

    Lino, Patrícia Azevedo; Martins, Maria Auxiliadora Parreiras; Silva, Maria Elisa de Souza e

    2017-01-01

    Objective To describe dental prescriptions for anxiolytics, sedatives, and hypnotics for Brazilian outpatients in 2010. Methods A cross-sectional study was conducted using data on the use of anxiolytics, sedatives, and hypnotics from the Brazilian Health Surveillance Agency, Brazil, 2010. For each prescription, prescribed drugs and the prescribed amount were identified. Prescribed medications were classified according to Anatomical Therapeutic Chemical code. We calculated the number of Defined Daily Doses (DDD) for anxiolytics, sedatives, and hypnotics by code, their mean DDD, and DDD per inhabitant per year. Results There were 16,436 prescriptions dispensed, including anxiolytics, sedatives, and hypnotics. These prescriptions corresponded to 3,555,780.50 mg, distributed as 2,286,200.50 mg (64.30%) of anxiolytics and 1,269,580.00 mg (35.70%) of sedatives and hypnotics. This amount allowed treating approximately 474,106 individuals (number of DDD). The anxiolytics most frequently dispensed were bromazepam (25.30%), alprazolam (19.19%), and diazepam (15.60%). Sedatives and hypnotics mostly prescribed were zolpidem (9.55%), midazolam (6.99%), and flunitrazepam (2.14%). The per capita rates (100,000 inhabitants) of anxiolytics and sedatives/hypnotics were 6.83 and 1.78, respectively. Conclusions Benzodiazepines and derivatives were the most frequently prescribed drugs. There was a low rate of dental prescriptions for anxiolytics, sedatives, and hypnotics, although excessive doses were concentrated in the same prescription. PMID:28638826

  11. Anxiolytics, Sedatives, and Hypnotics Prescribed by Dentists in Brazil in 2010

    Directory of Open Access Journals (Sweden)

    Patrícia Azevedo Lino

    2017-01-01

    Full Text Available Objective. To describe dental prescriptions for anxiolytics, sedatives, and hypnotics for Brazilian outpatients in 2010. Methods. A cross-sectional study was conducted using data on the use of anxiolytics, sedatives, and hypnotics from the Brazilian Health Surveillance Agency, Brazil, 2010. For each prescription, prescribed drugs and the prescribed amount were identified. Prescribed medications were classified according to Anatomical Therapeutic Chemical code. We calculated the number of Defined Daily Doses (DDD for anxiolytics, sedatives, and hypnotics by code, their mean DDD, and DDD per inhabitant per year. Results. There were 16,436 prescriptions dispensed, including anxiolytics, sedatives, and hypnotics. These prescriptions corresponded to 3,555,780.50 mg, distributed as 2,286,200.50 mg (64.30% of anxiolytics and 1,269,580.00 mg (35.70% of sedatives and hypnotics. This amount allowed treating approximately 474,106 individuals (number of DDD. The anxiolytics most frequently dispensed were bromazepam (25.30%, alprazolam (19.19%, and diazepam (15.60%. Sedatives and hypnotics mostly prescribed were zolpidem (9.55%, midazolam (6.99%, and flunitrazepam (2.14%. The per capita rates (100,000 inhabitants of anxiolytics and sedatives/hypnotics were 6.83 and 1.78, respectively. Conclusions. Benzodiazepines and derivatives were the most frequently prescribed drugs. There was a low rate of dental prescriptions for anxiolytics, sedatives, and hypnotics, although excessive doses were concentrated in the same prescription.

  12. 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

  13. 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.

  14. 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.

  15. Palliative sedation in the Netherlands : starting-points and contents of a national guideline

    NARCIS (Netherlands)

    Legemaate, J.; Verkerk, M.; van Wijlick, E.; de Graeff, Alexander

    2007-01-01

    In December 2005 the first national guideline for palliative sedation in the Netherlands was published. This guideline was developed by a committee of the Royal Dutch Medical Association, at the request of the Dutch government. The guideline defines palliative sedation as 'the intentional lowering

  16. The practice of palliative sedation in the Netherlands after the launch of the national guideline

    NARCIS (Netherlands)

    S.J. Swart (Siebe)

    2013-01-01

    textabstractPalliative sedation is a medical intervention aimed at relieving intractable suff ering by inducing decreased awareness of symptoms. It is typically considered a palliative option for patients suff ering unbearably in the last days of life. The estimated frequency of palliative sedation

  17. 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...

  18. 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

  19. 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.

  20. 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

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. [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.

  6. Sedation and renal impairment in critically ill patients: a post hoc analysis of a randomized trial

    DEFF Research Database (Denmark)

    Strøm, Thomas; Johansen, Rasmus R.; Prahl, Jens O

    2011-01-01

    an increased urine output in the group receiving no sedation compared to the sedated control group (1.15 ml/kg/hour (0.59 - 1.53) vs. 0.88 ml/kg/hour (0.052 - 1.26), P = 0.03). In addition we saw a decrease in the number of patients with renal impairment according to the RIFLE classification in the group...... receiving no sedation compared to the sedated control group (25 (51%) vs. 41 (76%), P = 0.012). The difference in the two groups with respect to mean arterial blood pressure, fluid balance and use of vasoactive drugs was not significant. CONCLUSIONS: A no sedation strategy to patients undergoing mechanical...

  7. 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.

  8. 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.

  9. 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.

  10. 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.

  11. 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.

  12. [Delirium, analgesia, and sedation in intensive care medicine : Development of a protocol-based management approach].

    Science.gov (United States)

    Wolf, A; Mörgeli, R; Müller, A; Weiss, B; Spies, C

    2017-02-01

    Intensive care treatment has long-term consequences that are often not immediately apparent to the health care providers. The combination of muscle weakness, cognitive damage, and psychological disorders is comprised under the term post-intensive care syndrome (PICS). Analgesia and sedation protocols, as well as nonpharmacological preventive and therapeutic approaches, are effective tools for avoiding complications and improving long-term survival. The principle of "early goal-directed therapy" is fundamental. Here, a treatment target is defined and continuously re-evaluated by validated monitoring methods. Evidence clearly supports a paradigm shift towards patients that are awake, attentive, and able to participate in their therapy. Individualized analgesia and (non)sedation approaches allow a Richmond Agitation-Sedation Scale (RASS) target value of 0/-1 for the majority of patients. Should sedation indeed be necessary, there must be a focus on avoiding oversedation, especially an early deep sedation.

  13. The differential effects of fluency due to repetition and fluency due to color contrast on judgments of truth.

    Science.gov (United States)

    Silva, Rita R; Garcia-Marques, Teresa; Mello, Joana

    2016-09-01

    Two experiments contrast the effects of fluency due to repetition and fluency due to color contrast on judgments of truth, after participants learn to associate high levels of fluency with falseness (i.e., a reversal of the fluency-truth link). Experiment 1 shows that the interpretation of fluency as a sign of truth is harder to reverse when learning is promoted with repetition rather than with perceptual fluency. Experiment 2 shows that when color contrast and repetition are manipulated orthogonally, the reversal of the truth effect learned with color contrast does not generalize to repetition. These results suggest specificities in the processing experiences generated by different sources of fluency, and that their influences can be separated in contexts that allow the contrast of their distinctive features. We interpret and discuss these results in light of the research addressing the convergence vs. dissociation of the effects elicited by different fluency sources.

  14. 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.

  15. 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.

  16. Is routine sedation or topical pharyngeal anesthesia beneficial during upper endoscopy?

    Science.gov (United States)

    Ristikankare, Matti; Hartikainen, Juha; Heikkinen, Markku; Julkunen, Risto

    2004-11-01

    Upper endoscopy is an invasive procedure. However, the benefits of routinely administered sedative medication or topical pharyngeal anesthesic are controversial. The aim of this study was to clarify their effects on patient tolerance and difficulty of upper endoscopy. A total of 252 patients scheduled for diagnostic upper endoscopy were randomly assigned to 4 groups: (1) sedation with midazolam and placebo pharyngeal spray (midazolam group), (2) placebo sedation and lidocaine pharyngeal spray (lidocaine group), (3) placebo sedation and placebo pharyngeal spray (placebo group), and (4) no intravenous cannula/pharyngeal spray (control group). The endoscopist and the patient assessed the procedure immediately after the examination. Another questionnaire was sent to the patients 2 weeks later. Patients in the midazolam group rated the examination easier and less uncomfortable compared with those in the other groups. The differences were especially evident in the questionnaires completed 2 weeks after the examination ( p < 0.001). Lidocaine did not significantly improve patient tolerance. However, endoscopists found the procedure easier in patients in the lidocaine group compared with the midazolam ( p < 0.01) and control groups ( p < 0.01) but not the placebo group. Routine administration of midazolam for sedation increased patient tolerance for upper endoscopy. However, endoscopists found intubation to be more difficult in sedated vs. non-sedated patients. Topical pharyngeal anesthesia did not enhance patient tolerance, but it did make upper endoscopy technically easier compared with endoscopy in patients sedated with midazolam without topical pharyngeal anesthesia, and in patients who had no sedation or pharyngeal anesthesia, but not in patients who received placebo sedation and placebo pharyngeal anesthesia.

  17. 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.

  18. [Determining factors in the sedation of geriatric and oncology patients treated at home].

    Science.gov (United States)

    Zamora-Mur, A; García-Foncillas, R; Zamora-Catevilla, A; Nabal-Vicuña, M; Calderero-Aragón, V; Lostalé-Latorre, F

    2017-04-01

    Sedation, used as a therapeutic measure in the field of Palliative Care, continues to present difficulties for many professionals in its management and indications. Is varied existing literature in this regard, often exclusive cancer patients. Our objective is to analyse the characteristics of patients attended by a Home Care Support Team who required sedation compared to non-sedated patients, for possible determining factors for its use that could help in decision-making. A prospective analytical study conducted in Barbastro (Huesca) from September 2007 to February 2011. The study population are patients referred to the Home Care Support Team of Barbastro. Age, sex, medical history, symptoms, previous and current Barthel, Karnofsky, primary caregiver, previous drugs, drugs after intervention, sedation yes/no. Required sedation 16.6% (n=106) of the cases (N=638). Sedated patients were younger, with no differences in sex, and the large majority (83%) were oncology patients. The presence of metastases showed no differences in need for sedation. Sedated patients have an increased functional impairment, determined by Barthel index decreased and a worse Karnofsky. Sedated patients showed increased frequency of uncontrolled symptoms, except psychomotor agitation, a fact determined by the medications used pre- and post-intervention. The presence of neoplastic disease, marked with existence of functional decline, and uncontrolled clinical need for certain medications to control symptoms may determine the need for sedation at the end of the process, above other factors such as patient comorbidity. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  19. 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.

  20. Repetitive Myocardial Infarctions Secondary to Delirium Tremens

    Directory of Open Access Journals (Sweden)

    David Schwartzberg

    2014-01-01

    Full Text Available Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal.

  1. Robust Repetitive Controller for Fast AFM Imaging

    CERN Document Server

    Necipoglu, Serkan; Has, Yunus; Guvenc, Levent; Basdogan, Cagatay

    2012-01-01

    Currently, Atomic Force Microscopy (AFM) is the most preferred Scanning Probe Microscopy (SPM) method due to its numerous advantages. However, increasing the scanning speed and reducing the interaction forces between the probe's tip and the sample surface are still the two main challenges in AFM. To meet these challenges, we take advantage of the fact that the lateral movements performed during an AFM scan is a repetitive motion and propose a Repetitive Controller (RC) for the z-axis movements of the piezo-scanner. The RC utilizes the profile of the previous scan line while scanning the current line to achieve a better scan performance. The results of the scanning experiments performed with our AFM set-up show that the proposed RC significantly outperforms a conventional PI controller that is typically used for the same task. The scan error and the average tapping forces are reduced by 66% and 58%, respectively when the scan speed is increased by 7-fold.

  2. Carbon dioxide insufflation during colonoscopy in deeply sedated patients

    Institute of Scientific and Technical Information of China (English)

    Rajvinder Singh; Eu Nice Neo; Nazree Nordeen; Ganesananthan Shanmuganathan; Angelie Ashby; Sharon Drummond; Garry Nind

    2012-01-01

    AIM:To compare the impact of carbon dioxide (CO2) and air insufflation on patient tolerance/safety in deeply sedated patients undergoing colonoscopy.METHODS:Patients referred for colonoscopy were randomized to receive either CO2 or air insufflation during the procedure.Both the colonoscopist and patient were blinded to the type of gas used.During the procedure,insertion and withdrawal times,caecal intubation rates,total sedation given and capnography readings were recorded.The level of sedation and magnitude of patient discomfort during the procedure was assessed by a nurse using a visual analogue scale (VAS) (0-3).Patients then graded their level of discomfort and abdominal bloating using a similar VAS.Complications during and after the procedure were recorded.RESULTS:A total of 142 patients were randomized with 72 in the air arm and 70 in the CO2 arm.Mean age between the two study groups were similar.Insertion time to the caecum was quicker in the CO2 group at 7.3 min vs 9.9 min with air (P =0.0083).The average withdrawal times were not significantly different between the two groups.Caecal intubation rates were 94.4% and 100% in the air and CO2 groups respectively (P =0.012).The level of discomfort assessed by the nurse was 0.69 (air) and 0.39 (CO2) (P =0.0155) and by the patient 0.82 (air) and 0.46 (CO2) (P =0.0228).The level of abdominal bloating was 0.97 (air) and 0.36 (CO2) (P =0.001).Capnography readings trended to be higher in the CO2 group at the commencement,caecal intubation,and conclusion of the procedure,even though this was not significantly different when compared to readings obtained during air insufflation.There were no complications in both arms.CONCLUSION:CO2 insuffiation during colonoscopy is more efficacious than air,allowing quicker and better cecal intubation rates.Abdominal discomfort and bloating were significantly less with CO2 insufflation.

  3. [Palliative sedation: Current situation and areas of improvement].

    Science.gov (United States)

    Nabal, Maria; Palomar, Concepción; Juvero, M Teresa; Taberner, M Teresa; León, Miguel; Salud, Antonieta

    2014-01-01

    To determine the prevalence, epidemiology and registration status of palliative sedation (PS) prevalence in a teaching hospital, and to establish areas for improvement. A descriptive retrospective analysis was designed using the records from cancer patients who died between October and December 2010. The variables included were: epidemiological, inpatient unit, refractory symptom, drugs and dosages, and patient participation in the decision making process. The qualitative analysis followed a Delphi process: each participant received the overall performance of the group referred to as mean, median, 25th and 75th percentile. Items selected were those in which there was total or a high consensus. A total of 53 deaths were identified. Just over half (51.92%) received PS. The mean age was 67.46 and 64% were males. The most frequent diagnosis was lung cancer (32.14%). Fifteen of the patient patients were in the Oncology ward, 7 in Hematology, and 4 at the Emergency Department. The PC team took part in 14 of the sedations performed. A refractory symptom was identified in 20. There were 11 cases of dyspnea and 5 cases of delirium. The mean time between admission and PS was 9.5 days. The mean duration of PS was 1.2 days, with a mean number of 2.6 drugs used. There were 20 informed consents which were all verbal. The mean time from last chemotherapy to death was 82 days. For the Delphi process, 12 oncology or palliative care health professionals were included. A consensus was reached on the minimum data to be recorded in case of PS. This list includes: selection criteria, decision-making process and the sedation evolution. PS was applied in half of the patients who died due to dyspnea or delirium. Selection criteria were identified, as well as the type of PS and patient involvement in decision making process. A consensus was also reached on a minimum dataset that would help the clinician to record relevant information in PS. Copyright © 2013 SECA. Published by Elsevier

  4. Comparison of Procedural Sedation for the Reduction of Dislocated Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Jonathan E. dela Cruz

    2014-02-01

    Full Text Available Introduction: Various types of sedation can be used for the reduction of a dislocated total hip arthroplasty. Traditionally, an Opiate/Benzodiazepine combination has been employed. The use of other pharmacologic agents, such as Etomidate and Propofol, has more recently gained popularity. Currently no studies directly comparing these sedation agents have been carried out. The purpose of this study is to compare differences in reduction and sedation outcomes including recovery times of these three different sedation agents. Methods: A retrospective chart review was performed examining 198 patient’s charts who presented with dislocated total hip arthroplasty at two academic affiliated medical centers. The patients were organized into groups according to the type of sedation agent used during their reduction. The percentages of reduction and sedation complications were calculated along with overall recovery times. Reduction complications included fracture, skin or neurovascular injury, and failure of reduction requiring general anesthesia. Sedation complications included use of bag-valve mask and artificial airway, intubation, prolonged recovery, use of a reversal agent, and inability to achieve sedation. The data were then compared for each sedation agent. Results: The reduction complications rates found were 8.7% in the Propofol group, 24.68% in the Etomidate, and 28.85% in the Opiate/Benzodiazepine groups. The reduction complication rate in the Propofol group was significantly different than those of the other two agents (p≤0.01. Sedation complications were found to happen 7.25% of the time in the Propofol group, 11.69% in the Etomidate group, and 21.25% in the Opiate/ Benzodiazepine group with Propofol having complication rates significantly different than that of the Opiate/Benzodiazepine group (p=0.02. Average lengths of recovery were 25.17 minutes for Propofol, 30.83 minutes for Etomidate, and 44.35 minutes for Opiate/ Benzodiazepine with

  5. A repetitive elements perspective in Polycomb epigenetics.

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    Valentina eCasa

    2012-10-01

    Full Text Available Repetitive elements comprise over two-thirds of the human genome. For a long time, these elements have received little attention since they were considered non functional. On the contrary, recent evidence indicates that they play central roles in genome integrity, gene expression and disease. Indeed, repeats display meiotic instability associated with disease and are located within common fragile sites, which are hotspots of chromosome rearrangements in tumors. Moreover, a variety of diseases have been associated with aberrant transcription of repetitive elements. Overall this indicates that appropriate regulation of repetitive elements’ activity is fundamental.Polycomb group (PcG proteins are epigenetic regulators that are essential for the normal development of multicellular organisms. Mammalian PcG proteins are involved in fundamental processes, such as cellular memory, cell proliferation, genomic imprinting, X-inactivation, and cancer development. PcG proteins can convey their activity through long-distance interactions also on different chromosomes. This indicates that the 3D organization of PcG proteins contributes significantly to their function. However, it is still unclear how these complex mechanisms are orchestrated and which role PcG proteins play in the multi-level organization of gene regulation. Intriguingly, the greatest proportion of Polycomb-mediated chromatin modifications is located in genomic repeats and it has been suggested that they could provide a binding platform for Polycomb proteins.Here, these lines of evidence are woven together to discuss how repetitive elements could contribute to chromatin organization in the 3D nuclear space.

  6. Emotional arousal enhances word repetition priming

    OpenAIRE

    Thomas, Laura A.; LaBar, Kevin S.

    2005-01-01

    Three experiments were conducted to determine if emotional content increases repetition priming magnitude. In the study phase of Experiment 1, participants rated high-arousing negative (taboo) words and neutral words for concreteness. In the test phase, they made lexical decision judgements for the studied words intermixed with novel words (half taboo, half neutral) and pseudowords. In Experiment 2, low-arousing negative (LAN) words were substituted for the taboo words, and in Experiment 3 al...

  7. The Rhythms of Echo. Variations on Repetition

    Directory of Open Access Journals (Sweden)

    Rosa María Aradra Sánchez

    2015-04-01

    Full Text Available This paper presents a study on the echo as metric and rhetorical procedure. It makes a brief tour through some of the poetic manifestations of echo in the Spanish literary tradition, and a brief tour through the attention that metric theory has paid to this phenomenon. Then it stops at the possibilities that rhetoric offers for its analysis from the generic approach of the discursive repetition phenomena.

  8. Repetitive behaviour in autism: Imaging pathways and trajectories

    NARCIS (Netherlands)

    Langen, M.J.G.

    2009-01-01

    Repetitive behaviour in autism: Imaging pathways and trajectories Repetitive and rigid behaviour is one of the core symptoms of autism, a severe and lifelong child psychiatric disorder. Although repetitive behaviour symptoms often form a significant impairment for affected individuals, systematic st

  9. Neural Correlates of Restricted, Repetitive Behaviors in Autism Spectrum Disorders

    Science.gov (United States)

    2014-12-01

    Restrictive Repetitive Behaviors in Autism Spectrum Disorder . Authors: T.Q.Nguyen, B...Manoach. Functional Connectivity of the Dorsal Anterior Cingulate Cortex Predicts Restrictive Repetitive Behaviors in Autism Spectrum Disorder We...Introduction: Although restricted , repetitive behaviors (RRBs) are a highly disabling core feature of Autism Spectrum Disorders (ASDs), they

  10. Lingual Kinematics during Rapid Syllable Repetition in Parkinson's Disease

    Science.gov (United States)

    Wong, Min Ney; Murdoch, Bruce E.; Whelan, Brooke-Mai

    2012-01-01

    Background: Rapid syllable repetition tasks are commonly used in the assessment of motor speech disorders. However, little is known about the articulatory kinematics during rapid syllable repetition in individuals with Parkinson's disease (PD). Aims: To investigate and compare lingual kinematics during rapid syllable repetition in dysarthric…

  11. Repetitive Elements in Mycoplasma hyopneumoniae Transcriptional Regulation

    Science.gov (United States)

    Cattani, Amanda Malvessi; Siqueira, Franciele Maboni; Guedes, Rafael Lucas Muniz; Schrank, Irene Silveira

    2016-01-01

    Transcriptional regulation, a multiple-step process, is still poorly understood in the important pig pathogen Mycoplasma hyopneumoniae. Basic motifs like promoters and terminators have already been described, but no other cis-regulatory elements have been found. DNA repeat sequences have been shown to be an interesting potential source of cis-regulatory elements. In this work, a genome-wide search for tandem and palindromic repetitive elements was performed in the intergenic regions of all coding sequences from M. hyopneumoniae strain 7448. Computational analysis demonstrated the presence of 144 tandem repeats and 1,171 palindromic elements. The DNA repeat sequences were distributed within the 5’ upstream regions of 86% of transcriptional units of M. hyopneumoniae strain 7448. Comparative analysis between distinct repetitive sequences found in related mycoplasma genomes demonstrated different percentages of conservation among pathogenic and nonpathogenic strains. qPCR assays revealed differential expression among genes showing variable numbers of repetitive elements. In addition, repeats found in 206 genes already described to be differentially regulated under different culture conditions of M. hyopneumoniae strain 232 showed almost 80% conservation in relation to M. hyopneumoniae strain 7448 repeats. Altogether, these findings suggest a potential regulatory role of tandem and palindromic DNA repeats in the M. hyopneumoniae transcriptional profile. PMID:28005945

  12. Modeling repetitive motions using structured light.

    Science.gov (United States)

    Xu, Yi; Aliaga, Daniel G

    2010-01-01

    Obtaining models of dynamic 3D objects is an important part of content generation for computer graphics. Numerous methods have been extended from static scenarios to model dynamic scenes. If the states or poses of the dynamic object repeat often during a sequence (but not necessarily periodically), we call such a repetitive motion. There are many objects, such as toys, machines, and humans, undergoing repetitive motions. Our key observation is that when a motion-state repeats, we can sample the scene under the same motion state again but using a different set of parameters; thus, providing more information of each motion state. This enables robustly acquiring dense 3D information difficult for objects with repetitive motions using only simple hardware. After the motion sequence, we group temporally disjoint observations of the same motion state together and produce a smooth space-time reconstruction of the scene. Effectively, the dynamic scene modeling problem is converted to a series of static scene reconstructions, which are easier to tackle. The varying sampling parameters can be, for example, structured-light patterns, illumination directions, and viewpoints resulting in different modeling techniques. Based on this observation, we present an image-based motion-state framework and demonstrate our paradigm using either a synchronized or an unsynchronized structured-light acquisition method.

  13. FRB repetition and non-Poissonian statistics

    CERN Document Server

    Connor, Liam; Oppermann, Niels

    2016-01-01

    We discuss some of the claims that have been made regarding the statistics of fast radio bursts (FRBs). In an earlier paper \\citep{2015arXiv150505535C} we conjectured that flicker noise associated with FRB repetition could show up in non-cataclysmic neutron star emission models, like supergiant pulses. We show how the current limits of repetition would be significantly weakened if their repeat rate really were non-Poissonian and had a pink or red spectrum. Repetition and its statistics have implications for observing strategy, generally favouring shallow wide-field surveys, since in the non-repeating scenario survey depth is unimportant. We also discuss the statistics of the apparent latitudinal dependence of FRBs, and offer a simple method for calculating the significance of this effect. We provide a generalized Bayesian framework for addressing this problem, which allows for direct model comparison. It is shown how the evidence for a steep latitudinal gradient of the FRB rate is less strong than initially s...

  14. Stainless steel crown aspiration during sedation in pediatric dentistry.

    Science.gov (United States)

    Adewumi, A; Kays, David W

    2008-01-01

    Foreign body aspiration (FBA) causes death in more than 300 children every year in the United States. Morbidity and mortality are increased in children due to narrow airways and immature protective mechanisms. Factors to consider in pediatric dentistry are: (1) the patient's age and behavior; (2) presence and extent of disability; (3) local anesthesia; (4) body positioning; and (5) loose teeth. FBA requires prompt recognition and early treatment to minimize potentially serious and sometimes fatal consequences. The purpose of this case report was to describe the aspiration of a stainless steel crown in a 5-year-old boy during conscious sedation. It also discusses how a prompt and accurate diagnosis, early referral, and immediate treatment helped prevent serious complications.

  15. Revision of loop colostomy under regional anaesthesia and sedation.

    Science.gov (United States)

    Ng, Oriana; Thong, Sze Ying; Chia, Claramae Shulyn; Teo, Melissa Ching Ching

    2015-05-01

    Patients presenting for emergency abdominal procedures often have medical issues that cause both general anaesthesia and central neuraxial blockade to pose significant risks. Regional anaesthetic techniques are often used adjunctively for abdominal procedures under general anaesthesia, but there is limited published data on procedures done under peripheral nerve or plexus blocks. We herein report the case of a patient with recent pulmonary embolism and supraventricular tachycardia who required colostomy refashioning. Ultrasonography-guided regional anaesthesia was administered using a combination of ilioinguinal-iliohypogastric, rectus sheath and transversus abdominis plane blocks. This was supplemented with propofol and dexmedetomidine sedation as well as intermittent fentanyl and ketamine boluses to cover for visceral stimulation. We discuss the anatomical rationale for the choice of blocks and compare the anaesthetic conduct with similar cases that were previously reported.

  16. Analgesics, sedatives, anticonvulsant drugs, and the cooled brain.

    Science.gov (United States)

    Wassink, Guido; Lear, Christopher A; Gunn, Katherine C; Dean, Justin M; Bennet, Laura; Gunn, Alistair J

    2015-04-01

    Multiple randomized controlled trials have shown that prolonged, moderate cerebral hypothermia initiated within a few hours after severe hypoxia-ischemia and continued until resolution of the acute phase of delayed cell death reduces mortality and improves neurodevelopmental outcome in term infants. The challenge is now to find ways to further improve outcomes. In the present review, we critically examine the evidence that conventional analgesic, sedative, or anticonvulsant agents might improve outcomes, in relation to the known window of opportunity for effective protection with hypothermia. This review strongly indicates that there is insufficient evidence to recommend routine use of these agents during therapeutic hypothermia. Further systematic research into the effects of pain and stress on the injured brain, and their treatment during hypothermia, is essential to guide the rational development of clinical treatment protocols. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Postinjection Delirium/Sedation Syndrome with Olanzapine Depot Injection

    Science.gov (United States)

    Sarangula, Sadhvi Mythili; Mythri, Starlin Vijay; Sanjay, Y.; Reddy, M. S.

    2016-01-01

    After 1 year of introduction of olanzapine long-acting injectable (LAI) in India, many psychiatrists believe that it is a very affordable, well-tolerated, and effective second generation long-acting antipsychotic depot compared to not well tolerated but cheap first generation antipsychotic depots and to other second generation depots which are costly. However, reports of its possible adverse events in clinical settings are not yet published. We report what probably might be the first case of postinjection delirium/sedation syndrome (PDSS) in India. Although the occurrence is uncommon, incorrect understanding of this event may hinder the future use of the potentially useful olanzapine LAI. We review the available literature on the proposed diagnostic guidelines, mechanism of this event, precautions, and management of PDSS. PMID:27570354

  18. 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.

  19. Randomized perturbed posturography: methodology and effects of midazolam sedation.

    Science.gov (United States)

    Ledin, T; Gupta, A; Larsen, L E; Odkvist, L M

    1993-05-01

    To study quiescent stance without applying external disturbances is not a theoretically appealing way to unveil the dynamic properties of human equilibrium. Methods to disturb equilibrium range from standing on foam surface, attaching vibrators to the calves to interfere with somatosensation, and exposure to body-position tracking environments, as in dynamic posturography (EquiTest). The EquiTest apparatus was modified by a menu-driven software to allow arbitrary movements of the support surface and visual surround, and force data were recorded for subsequent analysis. The support surface was randomly moved in the antero-posterior direction. First equilibrium was studied on the stable support surface, then low (RMS 1.3 cm) and high (RMS 2.6 cm) amplitude movements were used. Vision was either present or absent at all test amplitudes. Equilibrium was evaluated by the confidence (61%) ellipse sway area and average sway velocity during 45 s. Eleven healthy subjects aged 23-36 years (mean 29) were sedated with a short acting sedative, midazolam 0.1 mg/kg. Randomized perturbed posturography was conducted at baseline, and at about 60, 120 and 180 min after injection. Psychomotor tests were conducted at baseline, and at 30, 90, 150 and 210 min. Large interindividual variations were found. One subject could not be tested at all at 60 min due to sleepiness, whereas some subjects felt nearly full awake at 30 min. Sway areas were larger at 60 min, but not subsequently. At 60 min, sway velocities with open eyes were higher, just as when vision was absent and low amplitude movements were used. Later no effects could be shown.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Preserved modular network organization in the sedated rat brain.

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    Dany V D'Souza

    Full Text Available Translation of resting-state functional connectivity (FC magnetic resonance imaging (rs-fMRI applications from human to rodents has experienced growing interest, and bears a great potential in pre-clinical imaging as it enables assessing non-invasively the topological organization of complex FC networks (FCNs in rodent models under normal and various pathophysiological conditions. However, to date, little is known about the organizational architecture of FCNs in rodents in a mentally healthy state, although an understanding of the same is of paramount importance before investigating networks under compromised states. In this study, we characterized the properties of resting-state FCN in an extensive number of Sprague-Dawley rats (n = 40 under medetomidine sedation by evaluating its modular organization and centrality of brain regions and tested for reproducibility. Fully-connected large-scale complex networks of positively and negatively weighted connections were constructed based on Pearson partial correlation analysis between the time courses of 36 brain regions encompassing almost the entire brain. Applying recently proposed complex network analysis measures, we show that the rat FCN exhibits a modular architecture, comprising six modules with a high between subject reproducibility. In addition, we identified network hubs with strong connections to diverse brain regions. Overall our results obtained under a straight medetomidine protocol show for the first time that the community structure of the rat brain is preserved under pharmacologically induced sedation with a network modularity contrasting from the one reported for deep anesthesia but closely resembles the organization described for the rat in conscious state.

  1. Pediatric procedural sedation with propofol using a higher initial bolus dose.

    Science.gov (United States)

    Young, Timothy P; Lim, Jennifer J; Kim, Tommy Y; Thorp, Andrea W; Brown, Lance

    2014-10-01

    We sought to describe the doses of propofol used for sedation in our pediatric emergency department, along with the range of procedures performed under propofol sedation. We also planned to describe clinically important physiologic changes seen and physician satisfaction with propofol at the doses observed. This was a prospective observational case series. Physicians completed a data collection form after the propofol sedation. The physicians were asked to report physiologic changes that occurred during sedation and rate their satisfaction with propofol as a sedation agent on a 100-mm visual analog scale. Eight hundred eighty-six sedation events were reported. The median initial dose of propofol given was 2.0 mg/kg and the median total dose was 3.6 mg/kg. Propofol was used for a wide range of procedures. The most common physiologic change was desaturation/hypoxia (desaturation to propofol for pediatric sedation was well tolerated and useful for a wide range of procedures. Physicians should expect to find a high level of satisfaction with this dose.

  2. Challenging Propofol Sedation in Gastrointestinal Endoscopy: High Risk Patients and High Risk Procedures

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    Eduardo Redondo-Cerezo

    2012-12-01

    Full Text Available Sedation is increasingly becoming a must for most endoscopic procedures. Non-anesthesiologist administration of propofol is the standard of practice in many European countries. Nevertheless, despite anesthesiology societies concerns about sedation guided by endoscopist, practitioners find some limits to propofol administration, related to high risk patients or high risk and complex procedures, which can be long lasting and technically challenging. The main patient related risk factors for sedation are elderly patients, obesity, ASA≥3 patients, individuals with craniofacial abnormalities or with pharyngolaringeal tumors, patients with an acute gastrointestinal bleeding, under pain medications, sedatives, antidepressants, or who consume significant amounts of alcohol or drugs. Procedure related risk factors have more to do with the duration and complexity of the procedure than with other factors, in which considering a general anesthesia allows the endoscopist to concentrate on a difficult task. Published papers addressing the most challenging sedation groups in endoscopy are exploring and even trespassing previously assumed frontiers, and new scenarios are opening to the endoscopist, increasing his/her autonomy, reducing costs and giving patients levels of comfort previously unknown. In this review we analyse each risk group determining the ones in which a sedation protocol could be widely applied, and other in which the published evidence does not guarantee a safe endoscopist guided propofol sedation.

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

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    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.

  4. Survey of Sedation and Analgesia Practice Among Canadian Pediatric Critical Care Physicians.

    Science.gov (United States)

    Garcia Guerra, Gonzalo; Joffe, Ari R; Cave, Dominic; Duff, Jonathan; Duncan, Shannon; Sheppard, Cathy; Tawfik, Gerda; Hartling, Lisa; Jou, Hsing; Vohra, Sunita

    2016-09-01

    Despite the fact that almost all critically ill children experience some degree of pain or anxiety, there is a lack of high-quality evidence to inform preferred approaches to sedation, analgesia, and comfort measures in this environment. We conducted this survey to better understand current comfort and sedation practices among Canadian pediatric intensivists. The survey was conducted after a literature review and initial focus groups. The survey was then pretested and validated. The final survey was distributed by email to 134 intensivists from 17 PICUs across Canada using the Research Electronic Data Capture system. The response rate was 73% (98/134). The most commonly used sedation scores are Face, Legs, Activity, Cry, and Consolability (42%) and COMFORT (41%). Withdrawal scores are commonly used (65%). In contrast, delirium scores are used by only 16% of the respondents. Only 36% of respondents have routinely used sedation protocols. The majority (66%) do not use noise reduction methods, whereas only 23% of respondents have a protocol to promote day/night cycles. Comfort measures including music, swaddling, soother, television, and sucrose solutions are frequently used. The drugs most commonly used to provide analgesia are morphine and acetaminophen. Midazolam and chloral hydrate were the most frequent sedatives. Our survey demonstrates great variation in practice in the management of pain and anxiety in Canadian PICUs. Standardized strategies for sedation, delirium and withdrawal, and sleep promotion are lacking. There is a need for research in this field and the development of evidence-based, pediatric sedation and analgesia guidelines.

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

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    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.

  6. Observational study of patient-ventilator asynchrony and relationship to sedation level.

    Science.gov (United States)

    de Wit, Marjolein; Pedram, Sammy; Best, Al M; Epstein, Scott K

    2009-03-01

    Clinicians frequently administer sedation to facilitate mechanical ventilation. The purpose of this study was to examine the relationship between sedation level and patient-ventilator asynchrony. Airway pressure and airflow were recorded for 15 minutes. Patient-ventilator asynchrony was assessed by determining the number of breaths demonstrating ineffective triggering, double triggering, short cycling, and prolonged cycling. Ineffective triggering index (ITI) was calculated by dividing the number of ineffectively triggered breaths by the total number of breaths (triggered and ineffectively triggered). Sedation level was assessed by the following 3 methods: Richmond Agitation-Sedation Scale (RASS), awake (yes or no), and delirium (Confusion Assessment Method for the intensive care unit [CAM-ICU]). Twenty medical ICU patients underwent 35 observations. Ineffective triggering was seen in 17 of 20 patients and was the most frequent asynchrony (88% of all asynchronous breaths), being observed in 9% +/- 12% of breaths. Deeper levels of sedation were associated with increasing ITI (awake, yes 2% vs no 11%; P CAM-ICU, coma [15%] vs delirium [5%] vs no delirium [2%]; P < .05; RASS, 0, 0% vs -5, 15%; P < .05). Diagnosis of chronic obstructive pulmonary disease, sedative type or dose, mechanical ventilation mode, and trigger method had no effect on ITI. Asynchrony is common, and deeper sedation level is a predictor of ineffective triggering.

  7. Dexmedetomidine sedation in a child with frontonasal encephalocoele scheduled for MRI

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    Mamta Bhardwaj

    2014-01-01

    Full Text Available Paediatric patients undergoing radiological imaging often require sedation to minimise motion artefacts. Sedation during Magnetic Resonance Imaging (MRI poses many challenges to the anaesthetist. Inadequate or failed sedation results in difficulty in keeping them motionless while maintaining respiratory and hemodynamic stability. Secondly, limited access to the patient may pose a safety risk during MRI. Dexmedetomidine, an α2-adrenoceptor agonist, has recently been used as a sedative for diagnostic imaging studies. We report a use of dexmedetomidine for sedation in MRI suite in a child with frontonasal encephalocoele. A two-year-old girl child weighing 11 kg was scheduled for MRI of the brain and paranasal sinuses with nasal cavity under anaesthesia at our institute. After applying standard monitoring, an initial loading dose of dexmedetomidine was given @ 2 μg kg−1 over 10 min followed by continuous infusion of dexmedetomidine @ 1 μg kg−1 h−1. Sedation was monitored by the Ramsay Sedation Score (RSS, and as soon as a score of 5 was achieved, the child was transferred to the MRI table. Anaesthetic conditions were excellent, with minimal change in vital signs during the entire 35 min duration of the scan. Imaging was successful with no motion artefacts.

  8. Sedation in oral and maxillofacial day care surgery: A comparative study between intravenous dexmedetomidine and midazolam.

    Science.gov (United States)

    Mishra, Niranjan; Birmiwal, Krishna Gopal; Pani, Nibedita; Raut, Subhrajit; Sharma, Gaurav; Rath, Krushna Chandra

    2016-01-01

    Sedation is an important component of day care oral and maxillofacial surgical procedures under local anesthesia. Although various sedative drugs in different regimens have been used for sedation, an ideal agent and regimen are yet to be established. The aim of this study is to compare the efficacy of intravenous (IV) dexmedetomidine and midazolam as a sedative agent for day care oral and maxillofacial surgical procedures. The study was conducted in the Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India. A total of sixty adult patients of age group 18-65 years, of either sex were randomly selected equally in two groups for the study. One group named Group D received dexmedetomidine and the other named Group M received midazolam. Patients were evaluated for oxygen saturation (SPO2), respiration rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), Ramsay sedation score, bispectral index (BIS) score, amnesia, Aldrete score, relaxation during the surgery, and drug preference. Midazolam was associated with greater amnesia. Dexmedetomidine was associated with lower heart rate, SBP, and DBP. There was no significant difference in SPO2, RR, Aldrete score, Ramsay sedation score, and BIS score between the two drugs. Patient preference and relaxation were more in dexmedetomidine group. IV dexmedetomidine is a comparable alternative to midazolam for sedation in day care oral and maxillofacial surgery under local anesthesia. It is the preferred drug when a lower heart rate and blood pressure or less amnesia is needed without any serious side effects.

  9. Comparison of Midazolam and Propofol for BIS-Guided Sedation During Regional Anaesthesia

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    Priyanka Khurana

    2009-01-01

    Full Text Available Regional anaesthesia has become an important anaesthetic technique. Effective sedation is an essential for regional techniques too. This study compares midazolam and propofol in terms of onset& recovery from sedation, dosage and side effects of both the drugs using Bispectral Index monitoring. Ninety eight patients were randomly divided into two groups,one group recieved midazolam infusion while the other recieved propofol infusion until BIS reached 75. We observed Time to reach desired sedation, HR, MABP, time for recovery, dose to reach sedation and for maintenance of sedation and side effects if any. The time to reach required sedation was 11 min in Midazolam group(Group I while it was 6 min in Propofol group(Group II (p=0.0. Fall in MABP was greater with propofol. Recovery in with midazolam was slower than with propofol (18.6 ± 6.5 vs 10.10±3.65 min (p=0.00. We concluded that both midazolam and propofol are effective sedatives, but onset and offset was quicker with propofol, while midazolam was more cardiostable.

  10. The Efficacy of Two Intravenous Sedative Drugs in Management of Uncooperative Children for Dental Treatments

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    Nasser Kaviani

    2015-03-01

    Full Text Available Statement of the Problem: Some children do not show an appropriate coopera-tion with their dentist. A number of them cannot be managed by local anesthesia and the usual techniques used to control behaviors, so further steps are required to control their pain and anxiety. Pharmaceutical control is recommended through sedation or general anesthesia. Purpose: This study was aimed to evaluate two groups of drugs in intravenous sedation method. Materials and Method: In this clinical trial intervention study, patients were randomly divided into two groups of 18 and 20 and each group received either intravenous midazolam-ketamine or midazolam-fentanyl. During the procedure, 0.25mg midazolam was administered to both groups if needed. The scores of intraoperative sedation and operation conditions were evaluated and recorded by dental sedation teacher groups (DSTG system in the 10th, 20th, 30th and 40th minutes of the operation. The results were analyzed by SPSS (version 16 using independent T-test, Wilcoxon, Mann-Whitney and Pearson Chi-Square tests as appropriated. Results: There was no significant difference between the two groups in sedation period (p= 0.55, recovery time (p= 0.18, Frankl score (p= 0.83(, score of in-traoperative sedation and operating conditions (p> 0.05, and sedation complications (p= 0.612. In addition, no complication occurred in recovery. Conclusion: There was no significant difference between the two drug groups; both were appropriate in controlling children’s behavior.

  11. The Efficacy of Two Intravenous Sedative Drugs in Management of Uncooperative Children for Dental Treatments

    Science.gov (United States)

    Kaviani, Nasser; Ashrafi, Sanaz; Jabbarifar, Seyed Ebrahim; Ghaffari, Elham

    2015-01-01

    Statement of the Problem Some children do not show an appropriate cooperation with their dentist. A number of them cannot be managed by local anesthesia and the usual techniques used to control behaviors, so further steps are required to control their pain and anxiety. Pharmaceutical control is recommended through sedation or general anesthesia. Purpose This study was aimed to evaluate two groups of drugs in intravenous sedation method. Materials and Method In this clinical trial intervention study, patients were randomly divided into two groups of 18 and 20 and each group received either intravenous midazolam-ketamine or midazolam-fentanyl. During the procedure, 0.25mg midazolam was administered to both groups if needed. The scores of intraoperative sedation and operation conditions were evaluated and recorded by dental sedation teacher groups (DSTG) system in the 10th, 20th, 30th and 40th minutes of the operation. The results were analyzed by SPSS (version 16) using independent T-test, Wilcoxon, Mann-Whitney and Pearson Chi-Square tests as appropriated. Results There was no significant difference between the two groups in sedation period (p= 0.55), recovery time (p= 0.18), Frankl score (p= 0.83(, score of intraoperative sedation and operating conditions (p> 0.05), and sedation complications (p= 0.612). In addition, no complication occurred in recovery. Conclusion There was no significant difference between the two drug groups; both were appropriate in controlling children’s behavior. PMID:26106632

  12. Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam.

    Science.gov (United States)

    das Neves, Jose Francisco Nunes Pereira; das Neves Araújo, Mariana Moraes Pereira; de Paiva Araújo, Fernando; Ferreira, Clarice Martins; Duarte, Fabiana Baeta Neves; Pace, Fabio Heleno; Ornellas, Laura Cotta; Baron, Todd H; Ferreira, Lincoln Eduardo Villela Vieira de Castro

    2016-01-01

    Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient's pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  13. [Terminal sedation: consultation with a second physician as is the case in euthanasia and assisted suicide].

    Science.gov (United States)

    Ponsioen, B P; Schuurman, W H A Elink; van den Hurk, A J P M; van der Poel, B N M; Runia, E H

    2005-02-26

    In terminally-ill patients in the Netherlands deep sedation by means of a continuous subcutaneous infusion with midazolam occurs more frequently than euthanasia and assisted suicide. Deep terminal sedation is applied to relieve symptoms during the phase of dying, but in contrast to euthanasia and assisted suicide, does not hasten death. In three terminally-ill patients, a 65-year-old man suffering from pulmonary carcinoma, a 94-year-old woman with general malaise, nausea and anorexia, and a 79-year-old woman in the final stage of ovarian carcinoma, a general-practitioner advisor was consulted about an end-of-life decision--deep terminal sedation versus euthanasia or assisted suicide. The first two patients were given deep sedation until death, in both cases a day and a half later. The third patient's request for euthanasia was considered to meet the legal criteria for euthanasia. Compliance with the Dutch statutory criteria for due care in euthanasia and assisted suicide might also be helpful when deciding about terminal deep sedation, but the role and responsibility of the attending physician may differ. However, the radical effects of sedation on the terminally-ill patient and the rapid changes in the clinical situation of the patient when the decision to sedate is taken, both emphasize the need for consultation with another physician.

  14. Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.

    LENUS (Irish Health Repository)

    Harewood, G C

    2011-05-17

    Background  In behavioural economics, a \\'nudge\\' describes configuration of a choice to encourage a certain action without taking away freedom of choice. Aim  To determine the impact of a \\'nudge\\' strategy - prefilling either 3 mL or 5 mL syringes with midazolam - on endoscopic sedation practice. Methods  Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3 mL or 5 mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. Results  Overall, 120 patients received sedation for EGD [59 (5 mL), 61 (3 mL)] and 86 patients were sedated for colonoscopy [38 (5 mL), 48 (3 mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2 mg) vs. 3-mL group (3.3 mg), (P < 0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1 mg) vs. 3-mL group (3.3 mg), (P < 0.0001). There was no significant difference in mean meperidine dose (42.1 mg vs. 42.8 mg, P = 0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. Conclusions  These findings demonstrate that \\'nudge\\' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of \\'nudges\\' in impacting other aspects of endoscopic practice.

  15. Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.

    LENUS (Irish Health Repository)

    Harewood, G C

    2012-02-01

    BACKGROUND: In behavioural economics, a \\'nudge\\' describes configuration of a choice to encourage a certain action without taking away freedom of choice. AIM: To determine the impact of a \\'nudge\\' strategy - prefilling either 3mL or 5mL syringes with midazolam - on endoscopic sedation practice. METHODS: Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3mL or 5mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. RESULTS: Overall, 120 patients received sedation for EGD [59 (5mL), 61 (3mL)] and 86 patients were sedated for colonoscopy [38 (5mL), 48 (3mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2mg) vs. 3-mL group (3.3mg), (P<0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1mg) vs. 3-mL group (3.3mg), (P<0.0001). There was no significant difference in mean meperidine dose (42.1mg vs. 42.8mg, P=0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. CONCLUSIONS: These findings demonstrate that \\'nudge\\' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of \\'nudges\\' in impacting other aspects of endoscopic practice.

  16. Auditory functional magnetic resonance in awake (nonsedated) and propofol-sedated children.

    Science.gov (United States)

    Gemma, Marco; Scola, Elisa; Baldoli, Cristina; Mucchetti, Marta; Pontesilli, Silvia; De Vitis, Assunta; Falini, Andrea; Beretta, Luigi

    2016-05-01

    Functional Magnetic Resonance Imaging (fMRI) is often used in preoperative assessment before epilepsy surgery, tumor or cavernous malformation resection, or cochlear implantation. As it requires complete immobility, sedation is needed for uncooperative patients. The aim of this study was to compare the fMRI cortical activation pattern after auditory stimuli in propofol-sedated 5- to 8-year-old children with that of similarly aged nonsedated children. When possible, children underwent MRI without sedation, otherwise it was induced with i.v. propofol 2 mg·kg(-1) and maintained with i.v. propofol 4-5 mg·kg(-1) ·h(-1) . Following diagnostic MRI, fMRi was carried out, randomly alternating two passive listening tasks (a fairy-tale and nonsense syllables). We studied 14 awake and 15 sedated children. During the fairy-tale task, the nonsedated children's blood-oxygen-level-dependent (BOLD) signal was bilaterally present in the posterior superior temporal gyrus (STG), Wernicke's area, and Broca's area. Sedated children showed similar activation, with lesser extension to Wernicke's area, and no activation in Broca's area. During the syllable task, the nonsedated children's BOLD signal was bilaterally observed in the STG and Wernicke's area, in Broca's area with leftward asymmetry, and in the premotor area. In sedated children, cortical activation was present in the STG, but not in the frontal lobes. BOLD signal change areas in sedated children were less extended than in nonsedated children during both the fairy-tale and syllable tasks. Modeling the temporal derivative during both the fairy-tale and syllable tasks, nonsedated children showed no response while sedated children did. After auditory stimuli, propofol-sedated 5- to 8-year-old children exhibit an fMRI cortical activation pattern which is different from that in similarly aged nonsedated children. © 2016 John Wiley & Sons Ltd.

  17. 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.

  18. 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.

  19. Intravenous dexmedetomidine versus propofol for intraoperative moderate sedation during spinal anesthesia: A comparative study

    Directory of Open Access Journals (Sweden)

    Pratibha Jain Shah

    2016-01-01

    Full Text Available Background and Aims: There has been a paradigm shift of focus toward quality of spinal anesthesia with sedation being an integral aspect of this regional anesthesia technique. Thus, this study was designed to compare efficacy of intravenous dexmedetomidine and propofol for moderate sedation during spinal anesthesia. Material and Methods: A total of 120 patients of age group 18-60 years of American Society of Anesthesiologists grade I & II, posted for surgeries under spinal anesthesia were randomly divided in to three groups (n = 40 each; Group D received infusion of dexmedetomidine 1 μg/kg over 10 min followed by maintenance infusion of 0.5 μg/kg/h. Group P received infusion of propofol 6 mg/kg/h for 10 min followed by the infusion maintenance of 2.5 mg/kg/h. Group C (control group received normal saline. Level of sedation (using observer′s assessment of alertness/sedation score, pain intensity (by visual analogue scale, onset and recovery from sedation, hemodynamic changes, and overall patient′s satisfaction were assessed. Results: The onset and recovery from sedation were significantly earlier with propofol (15.57 ± 1.89 min vs. 27.06 ± 2.26 min; P < 0.001 however intraoperative sedation (level 4, and overall patient′s satisfaction was significantly better with dexmedetomidine group (p < 0.05. Duration of postoperative analgesia was significantly prolonged with dexmedetomidine (225.53 ± 5.61 min vs. 139.60 ± 3.03 min; P = 0.0013. Mean heart rate and blood pressure were significantly lower in the propofol group (P < 0.05. Conclusion: Dexmedetomidine with its stable cardio-respiratory profile, better sedation, overall patient′s satisfaction, and analgesia could be a valuable adjunct for intraoperative sedation during spinal anesthesia.

  20. Sedative Prescriptions Are Common at Opioid Initiation: An Observational Study in the Veterans Health Administration.

    Science.gov (United States)

    Mosher, Hilary J; Richardson, Kelly K; Lund, Brian C

    2017-03-18

     Concurrent use of sedatives, especially anxiolytics, and opioids is associated with increased risk of medication-related harms. To the extent that multiple prescribers are involved, approaches to influence patterns of coprescribing will differ from those to influence prescribing within a single drug class.  Describe the proportion of new opioid recipients with concurrent sedative medications at opioid initiation and determine whether these medications were prescribed by the same prescriber.  We used national Department of Veterans Affairs (VA) outpatient pharmacy administration data to identify veterans who received a new opioid prescription between October 20, 2010, and September 1, 2011 (FY 2011), preceded by a 365-day opioid-free period. Concurrent sedative use was defined as a skeletal muscle relaxant, benzodiazepine, atypical antipsychotic, or hypnotic filled on the opioid start date or before and after the opioid start date with a gap of less than twice the day supply of the prior fill.  Concurrent sedative use at opioid initiation was 21.4% (112,408/526,499) in FY 2011. The proportion of concurrent recipients who received at least one concurrent sedative prescribed by a provider other than the opioid prescriber was 61.4% (69,002/112,408). The proportion of recipients who received a sedative concurrent with opioid initiation from the same prescriber varied across sedative class. Benzodiazepines and opioids were prescribed by the same provider in 41.1% (15,520/37,750) of concurrent users.  One in five patients newly prescribed opioids also had a sedative prescription. Less than half of patients with concurrent opioid and benzodiazepine prescriptions received these from the same provider. Efforts to reduce concurrent opioid and sedative prescribing will require addressing care coordination.

  1. 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.

  2. [Analysis of palliative sedation in hospitalised elderly patients: Effectiveness of a protocol].

    Science.gov (United States)

    Mateos-Nozal, Jesús; García-Cabrera, Lorena; Montero Errasquín, Beatriz; Cruz-Jentoft, Alfonso José; Rexach Cano, Lourdes

    2016-01-01

    To measure changes in the practice of palliative sedation during agony in hospitalised elderly patients before and after the implementation of a palliative sedation protocol. A retrospective before-after study was performed in hospitalised patients over 65 years old who received midazolam during hospital admission and died in the hospital in two 3-month periods, before and after the implementation of the protocol. Non-sedative uses of midazolam and patients in intensive care were excluded. Patient and admission characteristics, the consent process, withdrawal of life-sustaining treatments, and the sedation process (refractory symptom treated, drug doses, assessment and use of other drugs) were recorded. Association was analysed using the Chi(2) and Student t tests. A total of 143 patients were included, with no significant differences between groups in demographic characteristics or symptoms. Do not resuscitate (DNR) orders were recorded in approximately 70% of the subjects of each group, and informed consent for sedation was recorded in 91% before vs. 84% after the protocol. Induction and maintenance doses of midazolam followed protocol recommendations in 1.3% before vs 10.4% after the protocol was implemented (P=.02) and adequate rescue doses were used in 1.3% vs 11.9% respectively (P=.01). Midazolam doses were significantly lower (9.86mg vs 18.67mg, P<.001) when the protocol was used than when it was not used. Ramsay sedation score was used in 8% vs. 12% and the Palliative Care Team was involved in 35.5% and 16.4% of the cases (P=.008) before and after the protocol, respectively. Use of midazolam slightly improved after the implementation of a hospital protocol on palliative sedation. The percentage of adequate sedations and the general process of sedation were mostly unchanged by the protocol. More education and further assessment is needed to gauge the effect of these measures in the future. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights

  3. A fixed-dose ketamine protocol for adolescent sedations in a pediatric emergency department.

    Science.gov (United States)

    Street, Megan H; Gerard, James M

    2014-09-01

    To assess provider and patient satisfaction with a fixed-dose ketamine protocol for procedural sedation of adolescent subjects. We further compared data for normal weight (body mass index [BMI] ≤ 25 kg/m(2)) vs overweight/obese subjects (BMI >25 kg/m(2)). Prospective, observational cohort study of adolescent patients undergoing procedural sedation in a pediatric emergency department. Adequate sedation was defined as a Ramsay Sedation Score (RSS) ≥ 5. Subjects received an initial 50 mg intravenous ketamine dose followed by 25 mg intravenous doses to maintain an RSS ≥ 5. The sedating physician, procedural physician, and sedating nurse independently rated the sedations on a 100 mm visual analog scale (0 = "very unsatisfied", 100 = "very satisfied"). Subjects and their guardians were contacted 12-24 hours postsedation. Forty-three subjects (26 normal weight, 17 overweight/obese), aged 12-17 years, were enrolled in the study. An RSS ≥ 5 was observed in 35 (81.4%) of the subjects following the initial 50 mg ketamine dose and in the remaining 8 subjects following the first additional 25 mg dose. The median combined provider satisfaction score for the sedations was 92.7 (IQR 83.7-95.0) and was similar for the normal weight and overweight/obese groups (93.1 [IQR 84.6-95.9] vs 89.7 [IQR 83.7-93.5], respectively, P = .27). Subjects and guardians in both groups reported high rates of satisfaction. The fixed-dose ketamine protocol resulted in an adequate level of sedation and high provider/patient satisfaction for the majority of patients regardless of weight or BMI status. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. 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.

  5. Does dexmedetomidine cause less airway collapse than propofol when used for deep sedation?

    Science.gov (United States)

    Watt, Stacey; Sabouri, Sassan; Hegazy, Rafeek; Gupta, Puneet; Heard, Christopher

    2016-12-01

    The risk of airway collapse in patients undergoing deep sedation is a major concern. In this study, we compared the airway patency of deep sedation provided by propofol with the airway patency of deep sedation provided by dexmedetomidine in magnetic resonance imaging (MRI) procedures. This comparison was done using MRI static and dynamic images and comparing these images to baseline after sevoflurane induction. After institutional review board approval, children who were scheduled for MRI procedures were given an inhalation induction, had intravenous access established, and were randomized to receive either dexmedetomidine 1-μg/kg load followed by 1-μg/(kg h) infusion or propofol infusion at 300 μg/(kg min) reduced to 250-μg/(kg min) infusion. MR images were then obtained. Airway patency and collapse were assessed at the level of the posterior midtongue in the axial and sagittal planes. The degree of airway collapse was assessed by determining the percent change in the airway caliber from its minimum to maximum value. After conclusion of the MRI procedure, the study patients were immediately observed by a blinded observer to determine their level of sedation according to the Ramsey sedation scale. MRI scanner at Women and Children's Hospital of Buffalo. Forty children between the ages of 3 and 7 years. Comparison of the utilization of propofol against dexmedetomidine infusions for deep sedation to determine the degree of airway collapse. Magnetic resonance images were then obtained using a 1.5-T GE Excite 12.0 scanner. Airway patency and collapse were assessed at the level of the posterior midtongue in the axial and sagittal planes. The degree of airway collapse was assessed by determining the percent change in the airway caliber from its minimum to maximum value. After conclusion of the MRI procedure, the study patients were immediately observed by a blinded observer to determine their level of sedation according to the Ramsey sedation scale. Our study

  6. [The dispute and prospect of sedation and analgesia treatments in outpatient dental procedures].

    Science.gov (United States)

    Cong, Yu

    2015-12-01

    The topic of eliminating the fear or pain of patients during dental therapy is gaining increasing attention from dentists across the country. The field of painless dental therapeutics involves a wide range of subjects, including stomatology, anesthesiology, and hospital management. We summarized the characteristics of sedation and analgesia technology in outpatient oral therapy, reviewed the common sedative and analgesic treatments, and discussed the disputes on the use of sedation and analgesia in dental procedures. We also reviewed the trends and breakthroughs in this area on the basis of our own clinica experiences.

  7. Deep sedation for endoscopic retrograde cholangiopancreatography: a comparison between clinical assessment and NarcotrendTM monitoring

    Directory of Open Access Journals (Sweden)

    Somchai Amornyotin

    2011-03-01

    Full Text Available Somchai Amornyotin, Wiyada Chalayonnawin, Siriporn KongphlayDepartment of Anesthesiology and Siriraj GI Endoscopy Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, ThailandIntroduction: Moderate to deep sedation is generally used for endoscopic retrograde cholangiopancreatography (ERCP. The depth of sedation is usually judged by clinical assessment and electroencephalography-guided monitoring. The aim of this study was to compare the clinical efficacy of clinical assessment and NarcotrendTM monitoring during deep-sedated ERCP.Methods: One hundred patients who underwent ERCP in a single year were randomly assigned to either group C or group N. Patients in group C (52 were sedated using the Modified Observer’s Assessment of Alertness/Sedation (MOAA/S scale. Patients in group N (48 were sedated using the NarcotrendTM system. The MOAA/S scale 1 or 2 and the NarcotrendTM index 47–56 to 57–64 were maintained during the procedure. The primary outcome variable of the study was the successful completion of the endoscopic procedure. The secondary outcome variables were the total dose of propofol used during the procedure, complications during and immediately after procedure, and recovery time.Results: All endoscopies were completed successfully. The mean total dose of propofol in group C was significantly lower than that in group N. However, the mean dose of propofol, expressed as dose/kg or dose/kg/h in both groups, was not significantly different (P = 0.497, 0.136. Recovery time, patient tolerance and satisfaction, and endoscopist satisfaction were comparable between the two groups. All sedation-related adverse events during and immediately after the procedure, such as hypotension, hypertension, tachycardia, bradycardia, transient hypoxia, and upper airway obstruction, in group C (62.2% were significantly higher than in group N (37.5% (P = 0.028.Conclusion: Clinical assessment and NarcotrendTM-guided sedation using

  8. A randomized, blinded comparison of chloral hydrate and midazolam sedation in children undergoing echocardiography.

    Science.gov (United States)

    Wheeler, D S; Jensen, R A; Poss, W B

    2001-07-01

    The objective of this prospective, randomized, and blinded study was to compare the use of chloral hydrate versus oral midazolam sedation in children undergoing echocardiography. No adverse effects (nausea, vomiting, paradoxical agitation, or significant deviations from baseline vital signs) were noted with either medication. No differences were noted in onset of sedation between the 2 groups, however, the time to complete recovery was significantly shorter with midazolam than with chloral hydrate. The children in the chloral hydrate group had a significantly deeper level of sedation and were more likely to receive a more nearly comprehensive echocardiographic evalation.

  9. 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.

  10. fMRI repetition suppression: neuronal adaptation or stimulus expectation?

    Science.gov (United States)

    Larsson, Jonas; Smith, Andrew T

    2012-03-01

    Measurements of repetition suppression with functional magnetic resonance imaging (fMRI adaptation) have been used widely to probe neuronal population response properties in human cerebral cortex. fMRI adaptation techniques assume that fMRI repetition suppression reflects neuronal adaptation, an assumption that has been challenged on the basis of evidence that repetition-related response changes may reflect unrelated factors, such as attention and stimulus expectation. Specifically, Summerfield et al. (Summerfield C, Trittschuh EH, Monti JM, Mesulam MM, Egner T. 2008. Neural repetition suppression reflects fulfilled perceptual expectations. Nat Neurosci. 11:1004-1006) reported that the relative frequency of stimulus repetitions and non-repetitions influenced the magnitude of repetition suppression in the fusiform face area, suggesting that stimulus expectation accounted for most of the effect of repetition. We confirm that stimulus expectation can significantly influence fMRI repetition suppression throughout visual cortex and show that it occurs with long as well as short adaptation durations. However, the effect was attention dependent: When attention was diverted away from the stimuli, the effects of stimulus expectation completely disappeared. Nonetheless, robust and significant repetition suppression was still evident. These results suggest that fMRI repetition suppression reflects a combination of neuronal adaptation and attention-dependent expectation effects that can be experimentally dissociated. This implies that with an appropriate experimental design, fMRI adaptation can provide valid measures of neuronal adaptation and hence response specificity.

  11. Storytelling and Repetitive Narratives for Design Empathy

    DEFF Research Database (Denmark)

    Fritsch, Jonas; Judice, Andrea; Soini, Katja

    2007-01-01

    Today it is widely established in design research that empathy is an important part of creating a true understanding of user experience as a resource for design. A typical challenge is how to transmit the feeling of empathy acquired by user studies to designers who have not participated in the user...... study. In this paper, we show how we attained an empathic understanding through storytelling and aroused empathy to others using repetitive narratives in an experimental presentation bringing forth factual, reflective and experiential aspects of the user information. Taking as a starting point our...... experiences with the design project Suomenlinna Seclusive, we conclude with the potential of using narratives for invoking design empathy....

  12. A miniature high repetition rate shock tube.

    Science.gov (United States)

    Tranter, R S; Lynch, P T

    2013-09-01

    A miniature high repetition rate shock tube with excellent reproducibility has been constructed to facilitate high temperature, high pressure, gas phase experiments at facilities such as synchrotron light sources where space is limited and many experiments need to be averaged to obtain adequate signal levels. The shock tube is designed to generate reaction conditions of T > 600 K, P shock waves with predictable characteristics are created, repeatably. Two synchrotron-based experiments using this apparatus are also briefly described here, demonstrating the potential of the shock tube for research at synchrotron light sources.

  13. Storytelling and Repetitive Narratives for Design Empathy

    DEFF Research Database (Denmark)

    Fritsch, Jonas; Judice, Andrea; Soini, Katja

    2007-01-01

    Today it is widely established in design research that empathy is an important part of creating a true understanding of user experience as a resource for design. A typical challenge is how to transmit the feeling of empathy acquired by user studies to designers who have not participated in the user...... study. In this paper, we show how we attained an empathic understanding through storytelling and aroused empathy to others using repetitive narratives in an experimental presentation bringing forth factual, reflective and experiential aspects of the user information. Taking as a starting point our...... experiences with the design project Suomenlinna Seclusive, we conclude with the potential of using narratives for invoking design empathy....

  14. The repetitive component of the sunflower genome

    Directory of Open Access Journals (Sweden)

    T. Giordani

    2014-08-01

    Full Text Available The sunflower (Helianthus annuus and species belonging to the genus Helianthus are emerging as a model species and genus for a number of studies on genome evolution. In this review, we report on the repetitive component of the H. annuus genome at the biochemical, molecular, cytological, and genomic levels. Recent work on sunflower genome composition is described, with emphasis on different types of repeat sequences, especially LTR-retrotransposons, of which we report on isolation, characterisation, cytological localisation, transcription, dynamics of proliferation, and comparative analyses within the genus Helianthus.

  15. A partially blinded randomised controlled trial of patient-maintained propofol sedation and operator controlled midazolam sedation in third molar extractions.

    Science.gov (United States)

    Leitch, J A; Anderson, K; Gambhir, S; Millar, K; Robb, N D; McHugh, S; Kenny, G N C

    2004-09-01

    Patient-maintained sedation using propofol has recently been shown to be effective for dental surgery. We compared this new technique to the established technique of operator administered midazolam. The two groups were compared before, during and after sedation. The two primary outcomes were time until discharge and oxygen saturation. Vital signs, anxiety and psychomotor skills were also compared. State anxiety was reduced to a greater extent in the propofol group (mean difference 10 (SD 4) mm; p = 0.010. Propofol patients recovered quicker (mean difference 7 (SD 1.4) min; p = 0.001). Propofol patients had a smaller reduction in arterial oxygen saturation (mean difference 0.8 (SD 0.3)%; p = 0.030), and a reduced increase in heart rate (mean difference 9 (SD 2) beats.min(-1); p < 0.001). Both techniques were well tolerated and safe. Propofol sedation offered superior anxiolysis, quicker recovery, less amnesia and less depression of simple psychomotor function.

  16. Sedation med propofol til koloskopi. Gennemgang af et Cochrane-review

    DEFF Research Database (Denmark)

    Høj, Anders Thorsmark; Vilmann, Peter

    2010-01-01

    The Cochrane collaboration metaanalysis of propofol use during colonoscopy found a faster patient recovery, higher patient satisfaction and unchanged complication rate compared to traditional sedatives. Patient groups consisted mostly of ASA I-II-patients, therefore the study is inconclusive...

  17. Propofol for sedation during colonoscopy- A survey of a Cochrane review

    DEFF Research Database (Denmark)

    Høj, Anders Thorsmark

    2010-01-01

    The Cochrane collaboration metaanalysis of propofol use during colonoscopy found a faster patient recovery, higher patient satisfaction and unchanged complication rate compared to traditional sedatives. Patient groups consisted mostly of ASA I-II-patients, therefore the study is inconclusive...

  18. Tetany During Intravenous Conscious Sedation in Dentistry Resulting From Hyperventilation-Induced Hypocapnia

    National Research Council Canada - National Science Library

    McCarthy, Caroline; Brady, Paul; O'Halloran, Ken D; McCreary, Christine

    2016-01-01

    ...) and an elevated minute ventilation that exceeds metabolic demand. This report describes a case of hyperventilation-induced hypocapnia resulting in tetany in a 16-year-old girl undergoing orthodontic extractions under intravenous conscious sedation...

  19. [Anesthesia and sedation by admixture of xenon-oxygen in dentistry. Part I].

    Science.gov (United States)

    Rabinovich, S A; Zavodilenko, L A; Babikov, A S

    2014-01-01

    The modern out-patient dental treatment which is performed under combined anesthesia with of xenon-oxygen inhalations provides comfortable conditions for the doctor and the patient, effective anesthesia and safe level of the sedation controlled by dentist.

  20. Sedation methods for transthoracic echocardiography in children with Trisomy 21-a retrospective study.

    Science.gov (United States)

    Miller, Jeff; Ding, Lili; Spaeth, James; Lam, Jennifer; Paquin, Joanna; Lin, Erica; Divanovic, Allison; Li, Bi Lian; Baskar, Shankar; Loepke, Andreas W

    2017-05-01

    Many children with Trisomy 21 have neurologic or behavioral problems that make it difficult for them to remain still during noninvasive imaging studies, such as transthoracic echocardiograms (TTEcho). Recently, intranasal dexmedetomidine sedation has been introduced for this purpose. However, dexmedetomidine has been associated with bradycardia. Children with Trisomy 21 have been reported to have a higher risk of bradycardia and airway obstruction with sedation or anesthesia compared to children without Trisomy 21. Our aim was to quantify the incidence of age-defined bradycardia and other adverse effects in patients with Trisomy 21 under sedation for TTEcho using a variety of sedation and anesthesia techniques available and utilized at our institution in this challenging patient population, including intranasal dexmedetomidine, oral pentobarbital, general anesthesia with propofol, and general anesthesia with sevoflurane. Our primary hypothesis was that intranasal dexmedetomidine sedation would result in a significantly higher risk of bradycardia in patients with Trisomy 21, compared with other sedative or anesthetic regimens. This is a retrospective, observational study of 147 consecutive patients with Trisomy 21 who were sedated or anesthetized for transthoracic echocardiography. Efficacy of sedation was defined as no need for rescue sedation or conversion to an alternate technique. Lowest and highest heart rate, systolic blood pressure, oxygen saturation, and PR interval from formal electrocardiograms were extracted from the electronic medical record. These data were compared to age-defined normal values to determine adverse events. Four methods of sedation or anesthesia were utilized to perform sedated transthoracic echocardiography: general anesthesia with sevoflurane by mask, general anesthesia with sevoflurane induction followed by intravenous propofol maintenance, oral pentobarbital, and intranasal dexmedetomidine. Intranasal dexmedetomidine 2.5 mcg·kg(-1

  1. Donepezil in the treatment of opioid-induced sedation: report of six cases.

    Science.gov (United States)

    Slatkin, N E; Rhiner, M; Bolton, T M

    2001-05-01

    Donepezil, an oral acetylcholinesterase inhibitor approved for the treatment of Alzheimer's disease, was given to 6 cancer pain patients having sedation related to the analgesic use of opioids. Each patient was taking more than 200 mg of oral morphine equivalents per day, and several were receiving complex analgesic regimens consisting of multiple adjuvant medications. Sedation improved at least moderately in 5 of the patients and mildly in 1 after they began taking donepezil. Patients reported a decrease in episodes of spontaneous sleeping during the day, fewer myoclonic twitches, improved daily function and greater social interaction. Several also reported improved sleep at night. Analgesia was not compromised by the use of donepezil, and in some cases it appeared improved. Donepezil may be a valuable alternative to psychostimulants in the treatment of opioid-induced sedation. A prospective controlled trial comparing the treatment effects of psychostimulants and donepezil on patients having opioid-induced sedation is underway.

  2. A Review of the Effects of Sedation on Thermoregulation: Insights for the Cardiac Catheterization Laboratory.

    Science.gov (United States)

    Conway, Aaron

    2016-06-01

    To examine the effects that the sedative and analgesic medications commonly used in the cardiac catheterization laboratory have on thermoregulation. A structured review strategy was used. MEDLINE and CINAHL were searched for published studies, and reference lists of retrieved studies were scrutinized for further studies. Data were extracted using a standardized extraction tool. A total of nine studies examined the effect that sedative and analgesic medications have on thermoregulation. Midazolam has minimal impact on thermoregulation, whereas opioids, dexmedetomidine, and propofol markedly decrease vasoconstriction and shivering thresholds. Patients who receive sedation in the cardiac catheterization laboratory may be at risk of hypothermia because of the use of medications that impair thermoregulation. Further research is required to identify the prevalence of unplanned hypothermia during sedation in the cardiac catheterization laboratory. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  3. Circulatory responses to propofol-ketamine combination compared to propofol alone for sedation during spinal anesthesia

    National Research Council Canada - National Science Library

    Nengroo, S; Lone, AQ; Naqash, I

    2011-01-01

    The present study was undertaken to establish the efficacy of low dose propofol-ketamine infusion in maintaining hemodynamic stability when used for sedation as compared to propofol alone during spinal anesthesia...

  4. Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation

    OpenAIRE

    Acworth, J; Purdie, D.; Clark, R

    2001-01-01

    Objectives—This study compared intranasal midazolam (INM) with a combination of intravenous ketamine and intravenous midazolam (IVKM) for sedation of children requiring minor procedures in the emergency department.

  5. Fentanyl-midazolam vs. midazolam-ketamine regarding patient sedation analgesia for emergency orthopedic procedures

    National Research Council Canada - National Science Library

    Ali Abdolrazaghnejad; Mohsen Banaie

    2017-01-01

    The aim of the present study was to investigate two pharmaceutical groups including fentanyl-midazolam and midazolam-ketamine used as patient seda-tion analgesia for the orthopedic emergency procedures...

  6. Evident cognitive impairments in seemingly recovered patients after midazolam-based light sedation during diagnostic endoscopy

    Directory of Open Access Journals (Sweden)

    Yen-Hsuan Hsu

    2015-06-01

    Conclusion: Midazolam-based light sedation induced selective cognitive impairments and prolonged cognitive impairments occurred in patients with advanced age. A longer observation time and further screening were recommended for patients due to their at risk state.

  7. Longer brainstem auditory evoked response latencies of individuals with fragile X syndrome related to sedation.

    Science.gov (United States)

    Miezejeski, C M; Heaney, G; Belser, R; Brown, W T; Jenkins, E C; Sersen, E A

    1997-04-18

    Brainstem auditory evoked response latencies were studies in 75 males (13 with fragile X syndrome, 18 with mental retardation due to other causes, and 44 with no disability). Latency values were obtained for each ear for the positive deflections of waves I (P1), III (P3), and V (P5). Some individuals with mental retardation required sedation. Contrary to previous report, latencies obtained for individuals with fragile X did not differ from those obtained for persons without mental retardation. Persons receiving sedation, whether or not their retardation was due to fragile X, had longer latencies for wave P5 than persons who did not receive sedation. This effect of sedation may also explain the previously reported increased latencies for persons with fragile X.

  8. Spectral entropy as a monitor of depth of propofol induced sedation.

    LENUS (Irish Health Repository)

    Mahon, Padraig

    2012-02-03

    OBJECTIVE: The aim of this prospective, observational study was to evaluate State and Response entropy (Entropy(TM) Monitor, GE Healthcare, Finland), indices as measures of moderate ("conscious") sedation in healthy adult patients receiving a low dose propofol infusion. Sedation was evaluated using: (I) the responsiveness component of the OAA\\/S scale (Observer\\'s Assessment of Alertness\\/Sedation scale) and (II) multi-channel electroencephalogram (EEG) interpretation by a clinical expert. METHODS: 12 ASA I patients were recruited. A target-controlled infusion of propofol was administered (using Schnider\\'s pharmacokinetic model) with an initial effect site concentration set to 0.5 microg ml(-1). A 4 minute equilibrium period was allowed. This concentration was increased at 4 minute intervals by 0.5 microg ml(-1) to a maximum of 2.0 microg ml(-1). State (SE) and Response (RE), entropy values were recorded for each 4 minute epoch together with clinical sedation scores (OAA\\/S) and continuous multi-channel EEG. The multi-channel EEG recorded during the final minute of each 4 minute epoch or "patient\\/time unit" was presented to a neurophysiologist who assigned a label "sedated\\/not sedated". SE\\/RE values were compared in patient\\/time units with clinical or EEG evidence of sedation versus those without. RESULTS: Mean SE and RE values were less in patient\\/time units when clinical evidence of sedation was present, [mean = 86.8 (95% CI, 84.0-88.3) and 94.3 (95%CI, 92-96.1)], P = 0.002 and P = 0.001, respectively. In patient\\/time units assigned the label "sedated" by the clinical neurophysiologist assessing the multi-channel EEG, SE and RE values were less [mean = 87.5 (95% CI, 86.3-88.4) and 95.0 (95% CI, 93.8-96.1)] P = 0.001 and P < 0.001, respectively. CONCLUSIONS: A statistically significant decrease in SE and RE values was demonstrated in patient\\/time units in which clinical or EEG evidence of sedation was present. We conclude that spectral entropy

  9. 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....

  10. Evaluation of nitrous oxide-oxygen and triclofos sodium as conscious sedative agents

    Directory of Open Access Journals (Sweden)

    Priya Subramaniam

    2017-01-01

    Full Text Available Background: Conscious sedation is used in the pediatric dentistry to reduce fear and anxiety in children and promote favorable treatment outcomes. To achieve them, the primary clinical need is for a well-tolerated, effective, and expedient analgesic and sedative agent that is safe to use. Aim: The aim of the present study was to evaluate the efficacy of nitrous oxide-oxygen and triclofos sodium as conscious sedative agents in 5–10-year-old children. Methodology: Sixty children aged 5–10 years showing anxious, uncooperative, and apprehensive behavior were randomly divided and assigned into two groups (Groups A and B such that Group A received 40% nitrous oxide-60% oxygen and Group B received triclofos sodium in the dose of 70 mg/kg body weight, given 30 min before the treatment procedure. During the whole course of sedation procedure, the response of the child was assessed using Houpt's behavior rating scale. The acceptance of route of drug administration by the patient and parent was also assessed. Data obtained were statistically evaluated using the Mann–Whitney U-test and Chi-square test. Results: Children sedated with triclofos sodium were significantly more drowsy and disoriented compared to those sedated with nitrous oxide. The overall behavior of children in both the groups was similar. Good parental acceptance was observed for both the routes of administration. Patients accepted the oral route significantly better than inhalation route. Conclusion: Both nitrous oxide-oxygen and triclofos sodium were observed to be effective sedative agents, for successful and safe use in 5–10-year-old dental patients. Patients showed a good acceptance of the oral route compared to the inhalation route for sedation.

  11. Effective dose of dexmedetomidine to induce adequate sedation in elderly patients under spinal anesthesia

    OpenAIRE

    2015-01-01

    Background During sedation with dexmedetomidine, a dose adjustment may be needed based on the invasiveness of the procedure, the patient's general condition, and their age. We aim here to determine the effective dose (ED) of dexmedetomidine to induce an adequate depth of sedation in elderly patients undergoing spinal anesthesia. Methods In this study, 47 patients aged 65 years or older, American Society of Anesthesiologists physical status I or II, undergoing spinal anesthesia were included. ...

  12. 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.

  13. A Comparison of Dexmedetomidine Sedation With and Without Midazolam for Dental Implant Surgery

    OpenAIRE

    Wakita, Ryo; Kohase, Hikaru; Fukayama, Haruhisa

    2012-01-01

    Dexmedetomidine (DEX) has a minimal respiratory depressive effect, which is beneficial for dentistry; however, it has the disadvantage of permitting an intraoperative arousal response such that the patient appears to be suddenly no longer sedated, and it has a variable amnestic effect. Since midazolam (MDZ) in an appropriate dose has a profound amnesic effect, we investigated whether additional MDZ compensates for the disadvantage of DEX and enables a better quality of sedation. Forty-three s...

  14. A pilot study of the efficacy of oral midazolam for sedation in pediatric dental patients.

    OpenAIRE

    Haas, D. A.; Nenniger, S. A.; Yacobi, R.; Magathan, J. G.; Grad, H. A.; Copp, P. E.; Charendoff, M. D.

    1996-01-01

    Oral midazolam is being used for conscious sedation in dentistry with little documentation assessing its efficacy. In order to accumulate preliminary data, a randomized, double-blind, controlled, crossover, multi-site pilot study was conducted. The objective was to determine if 0.6 mg/kg of oral midazolam was an equally effective or superior means of achieving conscious sedation in the uncooperative pediatric dental patient, compared with a commonly used agent, 50 mg/kg of oral chloral hydrat...

  15. Comparison of Midazolam and Propofol for BIS-Guided Sedation During Regional Anaesthesia

    OpenAIRE

    Priyanka Khurana; Ankit Agarwal; R. K. Verma; Gupta, P K

    2009-01-01

    Summary Regional anaesthesia has become an important anaesthetic technique. Effective sedation is an essential for regional techniques too. This study compares midazolam and propofol in terms of onset & recovery from sedation, dosage and side effects of both the drugs using Bispectral Index monitoring. Ninety eight patients were randomly divided into two groups,one group recieved midazolam infusion while the other recieved propofol infusion until BIS reached 75. We observed Time to reach desi...

  16. Sedation in gastrointestinal endoscopy: Where are we at in2014?

    Institute of Scientific and Technical Information of China (English)

    Alexandre Oliveira Ferreira; Marília Cravo

    2015-01-01

    Gastrointestinal endoscopies are invasive and unpleasantprocedures that are increasingly being used worldwide.The importance of high quality procedures (especiallyin colorectal cancer screening), the increasing patientawareness and the expectation of painless examination,increase the need for procedural sedation. The bestsingle sedation agent for endoscopy is propofol which,due to its' pharmacokinetic/dynamic profile allows fora higher patient satisfaction and procedural qualityand lower induction and recovery times, while ma-maintaining

  17. Effect of environmental noise and music on dexmedetomidine-induced sedation in dogs

    Directory of Open Access Journals (Sweden)

    Julia D. Albright

    2017-07-01

    Full Text Available Background Previous studies in human patients suggest depth of sedation may be affected by environmental noise or music; however, related data in domestic animals is limited. The objective of the current study was to investigate the effect of noise and music on dexmedetomidine-induced (DM- 10 µg/kg, IM sedation in 10 dogs. Methods In a crossover design, post-DM injection dogs were immediately subjected to recorded human voices at either 55–60 decibel (dB (Noise 1 or 80–85 dB (Noise 2; classical music at 45–50 dB (Music; or background noise of 40–45 dB (Control+. Control− included IM saline injection and exposure to 40–45 dB background noise. Sedation was assessed via monitoring spontaneous behavior and accelerometry (delta-g throughout three 20-min evaluation periods: baseline, noise exposure, and post-treatment. Sedation was further assessed during two restraint tests at 30 min (R1 and 40 min (R2 post-injection. A mixed model for crossover design was used to determine the effect of noise exposure and time on either spontaneous behavior scores or delta-g. The restraint scores were analyzed using a two-way repeated measures ANOVA. Results Spontaneous behavior scores indicated less sedation during Noise 2 compared to Control+ (P = 0.05. R2 restraint scores for all DM treatments except Noise 2 indicated significantly higher sedation than Control− [C+ (P = 0.003, M (P = 0.014 and N1 (P = 0.044]. Discussion Results suggest that the quality of sedation is negatively impacted by high-intensity noise conditions (80–85 dB, but exposure to music did not improve sedation in this population of research dogs.

  18. Effect of environmental noise and music on dexmedetomidine-induced sedation in dogs.

    Science.gov (United States)

    Albright, Julia D; Seddighi, Reza M; Ng, Zenithson; Sun, Xiaocun; Rezac, D J

    2017-01-01

    Previous studies in human patients suggest depth of sedation may be affected by environmental noise or music; however, related data in domestic animals is limited. The objective of the current study was to investigate the effect of noise and music on dexmedetomidine-induced (DM- 10 µg/kg, IM) sedation in 10 dogs. In a crossover design, post-DM injection dogs were immediately subjected to recorded human voices at either 55-60 decibel (dB) (Noise 1) or 80-85 dB (Noise 2); classical music at 45-50 dB (Music); or background noise of 40-45 dB (Control+). Control- included IM saline injection and exposure to 40-45 dB background noise. Sedation was assessed via monitoring spontaneous behavior and accelerometry (delta-g) throughout three 20-min evaluation periods: baseline, noise exposure, and post-treatment. Sedation was further assessed during two restraint tests at 30 min (R1) and 40 min (R2) post-injection. A mixed model for crossover design was used to determine the effect of noise exposure and time on either spontaneous behavior scores or delta-g. The restraint scores were analyzed using a two-way repeated measures ANOVA. Spontaneous behavior scores indicated less sedation during Noise 2 compared to Control+ (P = 0.05). R2 restraint scores for all DM treatments except Noise 2 indicated significantly higher sedation than Control- [C+ (P = 0.003), M (P = 0.014) and N1 (P = 0.044)]. Results suggest that the quality of sedation is negatively impacted by high-intensity noise conditions (80-85 dB), but exposure to music did not improve sedation in this population of research dogs.

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Safety of midazolam for sedation of HIV-positive patients undergoing colonoscopy

    Science.gov (United States)

    Triant, Virginia A.; Ehrenfeld, Jesse M.; Lu, Zhigang; Arpino, Paul; Losina, Elena

    2014-01-01

    Summary Concerns regarding possible interactions between midazolam and antiretroviral medicines have caused clinicians to use second-line sedatives, such as diazepam, instead. We demonstrated that patients who received midazolam during colonoscopy had similar clinical outcomes as those who received diazepam. Background Because of concerns regarding interactions between midazolam and antiretroviral therapy (ART), alternative sedatives are sometimes used during procedural sedation. Our objective was to compare outcomes in patients on ART who received intravenous (IV) midazolam versus IV diazepam, a second-line agent, during colonoscopy. Methods We conducted a retrospective analysis of adult HIV-infected patients who underwent colonoscopy over a 3.5-year period. Primary outcomes were sedation duration, nadir systolic blood pressure, nadir oxygen saturation, abnormal cardiac rhythm, and change in level of consciousness using a standardized scale. We calculated rates of adverse events according to benzodiazepine use and identified risk factors for complications using univariate and multivariate analyses. Results We identified 136 patients for this analysis: 70 received midazolam-based sedation and 66 received a diazepam-based regimen. There were no significant differences between the two groups with respect to sedation duration (48 versus 45.7 minutes, P = 0.68), nadir systolic blood pressure (97 versus 101.6 mmHg, P = 0.06), nadir oxygen saturation (94.6 versus 94.8%, P = 0.72), or rate of abnormal cardiac rhythm (11.4 versus 19.7%, P = 0.18). More patients in the midazolam group experienced a depressed level of consciousness (91 versus 74%, P = 0.0075), but no patient required reversal of sedation or became unresponsive. Conclusions Although IV midazolam interacts with ART, we did not find evidence that patients who received this agent for procedural sedation had clinical outcomes statistically different from those who received diazepam. These findings should be

  1. 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....

  2. Current methods of sedation in dental patients - a systematic review of the literature

    Science.gov (United States)

    Silvestre-Rangil, Javier; Cutando-Soriano, Antonio; López-Jiménez, Julián

    2016-01-01

    Objetive The main objective of this systematic literature review is to identify the safest and most effective sedative drugs so as to ensure successful sedation with as few complications as possible. Study Design A systematic literature review of the PubMed MEDLINE database was carried out using the key words “conscious sedation,” “drugs,” and “dentistry.” A total of 1,827 scientific articles were found, and these were narrowed down to 473 articles after applying inclusion and exclusion criteria. These 473 studies were then individually assessed for their suitability for inclusion in this literature review. Results A total of 21 studies were selected due to their rigorous study design and conduciveness to further, more exhaustive analysis. The selected studies included a total of 1,0003 patients classified as ASA I or II. Midazolam was the drug most frequently used for successful sedation in dental surgical procedures. Ketamine also proved very useful when administered intranasally, although some side effects were observed when delivered via other routes of administration. Both propofol and nitrous oxide (N2O) are also effective sedative drugs. Conclusions Midazolam is the drug most commonly used to induce moderate sedation in dental surgical procedures, and it is also very safe. Other sedative drugs like ketamine, dexmedetomidine and propofol have also been proven safe and effective; however, further comparative clinical studies are needed to better demonstrate which of these are the safest and most effective. Key words:Conscious sedation, drugs, dentistry. PMID:27475684

  3. 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

  4. Non-sedation versus sedation with a daily wake-up trial in critically ill patients recieving mechanical ventilation - effects on long-term cognitive function

    DEFF Research Database (Denmark)

    Nedergaard, Helene Korvenius; Jensen, Hanne Irene; Stylsvig, Mette;

    2016-01-01

    , including 200 patients. Inclusion criteria will be adult patients who are intubated and on mechanical ventilation with an expected duration of more than 24 hours. Exclusion criteria will be patients who are comatose at admission and patients with conditions requiring therapeutic coma (i.e., severe head...... trauma, status epilepticus, patients treated with therapeutic hypothermia and patients with severe hypoxia). The experimental intervention will be non-sedation supplemented with pain management during mechanical ventilation. The control intervention will be sedation with a daily wake-up attempt...

  5. The use of office-based sedation and general anesthesia by board certified pediatric dentists practicing in the United States.

    Science.gov (United States)

    Olabi, Nassim F; Jones, James E; Saxen, Mark A; Sanders, Brian J; Walker, Laquia A; Weddell, James A; Schrader, Stuart M; Tomlin, Angela M

    2012-01-01

    The purpose of this study is to explore the use of office-based sedation by board-certified pediatric dentists practicing in the United States. Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based sedation is an emerging trend. This study examines and compares these two models of office-based sedations. A survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) based on gender, age, years in practice, practice types, regions, and years as a diplomate of the ABPD was completed by 494 active members. The results were summarized using frequencies and percentages. Relationships of dentist age, gender, and number of years in practice with the use of intravenous (IV) sedation was completed using two-way contingency tables and Mantel-Haenszel tests for ordered categorical data. Relationships of office-based sedation use and the type of one's practice were examined using Pearson chi-square tests. Of the 1917 surveys e-mailed, 494 completed the survey for a response rate of 26%. Over 70% of board-certified US pediatric dentists use some form of sedation in their offices. Less than 20% administer IV sedation, 20 to 40% use a dentist anesthesiologist, and 60 to 70% would use dentist anesthesiologists if one were available.

  6. 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

  7. In vivo sedative and muscle relaxants activity of Diospyros lotus L

    Institute of Scientific and Technical Information of China (English)

    Abdur; Rauf; Ghias; Uddin; Bina; Shaheen; Siddiqui; Haroon; Khan

    2015-01-01

    Objective: To evaluate the sedative effect of Diospyros lotus L(D. lotus) extract in mice using the open field and Rota rod tests.Methods: For the sedative and muscle relaxants activities of extract/fractions of the plant, invivo open field and phenobarbitone-induced sleeping time were used, while the Roda rod test was employed in animals for the assessment of muscle relaxant activity.Results: Results from this investigation revealed that the extracts of D. lotus have exhibited significant sedative effect in mice(45.98%) at 100 mg/kg i.p. When the extract was partitioned with different solvents, the n-hexane fraction was inactive whereas the chloroform fraction was the most active with 82.67% sedative effect at 50 and 100 mg/kg i.p. On the other hand,the ethyl acetate and n-butanol fractions displayed significant sedative effects(55.65% and40.87%, respectively) at 100 mg/kg i.p. Among the tested extract/fractions, only chloroform and ethyl acetate fractions showed significant(P < 0.05) muscle relaxant activity in the Rota rod test.Conclusions: In short, our study provided scientific background to the traditional uses of D.lotus as sedative.

  8. Propofol Sedation for ERCP Procedures: A Dilemna? Observations from an Anesthesia Perspective

    Directory of Open Access Journals (Sweden)

    Davinder Garewal

    2012-01-01

    Full Text Available Propofol sedation for endoscopic retrograde cholangiopancreatography (ERCP procedures is a popular current technique that has generated controversy in the medical field. Worldwide, both anesthetic and nonanesthetic personnel administer this form of sedation. Although the American and Canadian societies of gastroenterologists have endorsed the administration of propofol by nonanesthesia personnel, the US Food and Drug Administration (FDA has not licensed its use in this manner. There is some evidence for the safe use of propofol by nonanesthetic personnel in patients undergoing endoscopy procedures, but there are few randomized trials addressing the safety and efficacy of propofol in patients undergoing ERCP procedures. A serious possible consequence of propofol sedation in patients is that it may result in rapid and unpredictable progression from deep sedation to general anesthesia, and skilled airway support may be required as a rescue measure. Potential complications following deep propofol sedation include hypoxemia and hypotension. Propofol sedation for ERCP procedures is an area of clinical practice where discussion and mutual cooperation between anesthesia and nonanesthesia personnel may enhance patient safety.

  9. Standing sedation with medetomidine and butorphanol in captive African elephants (Loxodonta africana).

    Science.gov (United States)

    Lüders, I; Tindall, B; Young, D; van der Horst, G; Botha, S; Luther, I; Maree, L; Bertschinger, H J

    2016-03-01

    Doses for standing sedation allowing for various procedures in otherwise inaccessible, untrained captive African elephant bulls are presented. Thirty-three standing sedations were performed in 12 males aged 8-30 years (one to four sedations per animal). Each bull received a combination of 0.009 ± 0.002 mg/kg medetomidine and 0.03 ± 0.007 mg/kg butorphanol. Full sedation was reached on average 25.5 min after injection. The addition of hyaluronidase (1000-2000 IU) significantly reduced time to full sedation to 16.5 min (paired t test, P = 0.024). Reversal was induced with intramuscular atipamezole 0.008 (±0.002) and naltrexone 0.035 (±0.015) mg/kg. Recovery took on average 7 min (3-18 min). The medetomidine/butorphanol combination provided safe standing sedation for smaller procedures.

  10. Oral sedation for dental treatment in young children in a hospital setting.

    Science.gov (United States)

    Lourenço-Matharu, L; Roberts, G J

    2010-10-09

    Conscious sedation for young children is a rapidly developing area of clinical activity. Many studies have shown positive results using oral midazolam on children. These case series investigated oral midazolam conscious sedation as an alternative to general anaesthesia in a clinical service setting. The purpose of this work was to determine the safety and efficacy of oral midazolam for conscious sedation in children undergoing dental treatment. Patients were selected by colleagues for treatment under oral sedation. The main general criteria were weight below 36 kilos and ASA I, II, or III. Midazolam 0.5 mg/kg was administered orally. A pulse oximeter was applied to a finger to monitor vital signs and the Houpt scale was used to assess behaviour. A total of 510 children aged between 13 months and 11 years were included. The behaviour of 379 (74%) was excellent or very good. The pulse rate and peripheral oxygenation were within the normal range for all patients. The main adverse effects were diplopia and post-sedation dysphoria. Oral midazolam is a safe and effective method of sedation although some children were agitated and distressed either during or after treatment. Parents need to be warned about this.

  11. Continuous sedation until death as physician-assisted suicide/euthanasia: a conceptual analysis.

    Science.gov (United States)

    Lipuma, Samuel H

    2013-04-01

    A distinction is commonly drawn between continuous sedation until death and physician-assisted suicide/euthanasia. Only the latter is found to involve killing, whereas the former eludes such characterization. I argue that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia in that both involve killing. This is established by first defining and clarifying palliative sedation therapies in general and continuous sedation until death in particular. A case study analysis and a look at current practices are provided. This is followed by a defense of arguments in favor of definitions of death centering on higher brain (neocortical) functioning rather than on whole brain or cardiopulmonary functioning. It is then shown that continuous sedation until death simulates higher brain definitions of death by eliminating consciousness. Appeals to reversibility and double effect fail to establish any distinguishing characteristics between the simulation of death that occurs in continuous sedation until death and the death that occurs as a result of physician-assisted suicide/euthanasia. Concluding remarks clarify the moral ramifications of these findings.

  12. The role of short-term memory impairment in nonword repetition, real word repetition, and nonword decoding: A case study.

    Science.gov (United States)

    Peter, Beate

    2017-09-21

    In a companion study, adults with dyslexia and adults with a probable history of childhood apraxia of speech showed evidence of difficulty with processing sequential information during nonword repetition, multisyllabic real word repetition and nonword decoding. Results suggested that some errors arose in visual encoding during nonword reading, all levels of processing but especially short-term memory storage/retrieval during nonword repetition, and motor planning and programming during complex real word repetition. To further investigate the role of short-term memory, a participant with short-term memory impairment (MI) was recruited. MI was confirmed with poor performance during a sentence repetition and three nonword repetition tasks, all of which have a high short-term memory load, whereas typical performance was observed during tests of reading, spelling, and static verbal knowledge, all with low short-term memory loads. Experimental results show error-free performance during multisyllabic real word repetition but high counts of sequence errors, especially migrations and assimilations, during nonword repetition, supporting short-term memory as a locus of sequential processing deficit during nonword repetition. Results are also consistent with the hypothesis that during complex real word repetition, short-term memory is bypassed as the word is recognized and retrieved from long-term memory prior to producing the word.

  13. A phonetic approach to consonant repetition in early words.

    Science.gov (United States)

    Kim, Namhee; Davis, Barbara L

    2015-08-01

    The goal of this study was to evaluate movement-based principles for understanding early speech output patterns. Consonant repetition patterns within children's actual productions of word forms were analyzed using spontaneous speech data from 10 typically developing American-English learning children between 12 and 36 months of age. Place of articulation, word level patterns, and developmental trends in CVC and CVCV repeated word forms were evaluated. Labial and coronal place repetitions dominated. Regressive repetition (e.g., [gag] for "dog") occurred frequently in CVC but not in CVCV word forms. Consonant repetition decreased over time. However, the children produced sound types available reported as being within young children's production system capabilities in consonant repetitions in all time periods. Findings suggest that a movement-based approach can provide a framework for comprehensively characterizing consonant place repetition patterns in early speech development.

  14. Repetition and Reactance in Graham’s "Underneath" Poems

    Directory of Open Access Journals (Sweden)

    Roghayeh Farsi

    2017-09-01

    Full Text Available The present paper gives a detailed analysis and interpretation of 16 poems in Jorie Graham's collection, Swarm (2000, which bear "UNDERNEATH" as their main titles. The poems are marked with different types of repetition such as graphological repetition, word, phrase, and sentential repetition, semantic repetition, and syntactic repetition. The study draws on Lakoff and Johnson's theories on metaphor and Brehm and Brehm’s reactance theory. It is argued "underneath" is a conceptual (orientational metaphor which signifies a state of being limited, lack of control and freedom, and loss of power. The paper investigates the speaker's reactant behavior in "Underneath" poems, seeking a way to restore her lost freedom. Reactance behaviors can be skepticism, inertia, aggression, and resistance. It is concluded despite her thematic inertia, representing her submission to the oppressed state, her stylistic reactance reflected in repetitions, innovations, and disruptive diction stands for her attempts to regain her lost control.

  15. Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Hatzidakis, A.A.; Charonitakis, E.; Athanasiou, A.; Tsetis, D.; Chlouverakis, G.; Papamastorakis, G.; Roussopoulou, G.; Gourtsoyiannis, N.C

    2003-02-01

    AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127.

  16. Endoscopic-assisted electrohydraulic shockwave lithotripsy in standing sedated horses.

    Science.gov (United States)

    Röcken, Michael; Fürst, Anton; Kummer, Martin; Mosel, Gesine; Tschanz, Theo; Lischer, Christoph J

    2012-07-01

    To report use of transendoscopic electrohydraulic shockwave lithotripsy for fragmentation of urinary calculi in horses. Case series. Male horses (n = 21). Fragmentation of cystic calculi (median, 6 cm diameter; range, 4-11 cm diameter) was achieved by transurethral endoscopy in standing sedated horses using an electrohydraulic shockwave fiber introduced through the biopsy channel of an endoscope. The fiber was advanced until it contacted the calculus. Repeated activation of the fiber was used to disrupt the calculus into fragments calculus removal was achieved in 20 horses (95%) with mean total surgical time of 168.6 minutes (range, 45-450). In the 20 horses with single calculi, 1-6 sessions were required to completely fragment the calculus. Except for 1 horse, in which perineal urethrotomy was eventually performed for complete fragment removal, fragments calculi were excreted via the urethra. Postoperative complications included hematuria because of severe mucosal erosion (n = 2), dysuria because of a trapped urethral fragment (2), small amount of urinary debris (1). One horse was euthanatized because of bladder rupture. Complete clearance of calculi and urinary debris was confirmed endoscopically 20 (3-45) days after the last session. Telephone follow-up (mean, 18.8 months; range, 7-24 months) revealed that horses had returned to previous activity levels without recurrence of clinical signs. Transendoscopic electrohydraulic lithotripsy appears to be an effective method for fragmentation of low-density calcium carbonate cystic calculi in male horses. Copyright 2012 by The American College of Veterinary Surgeons.

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

    Directory of Open Access Journals (Sweden)

    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

  18. Success rate of pneumatic reduction of intussusception with and without sedation.

    Science.gov (United States)

    Feldman, Oren; Weiser, Giora; Hanna, Mona; Devir, Ori; Balla, Uri; Johnson, David W; Kozer, Eran; Shavit, Itai

    2017-02-01

    Pneumatic reduction of ileocolic intussusception is often performed without sedation. The aim of this study was to evaluate the success rate of pneumatic reduction of intussusception with and without sedation. We conducted a retrospective cohort study in Israel in two tertiary care centers using a similar protocol for pneumatic reduction of intussusception. In one center, patients had pneumatic reduction of intussusception under propofol-based sedation, while in the other, patients had pneumatic reduction of intussusception without any sedation. Children aged 3 months to 8 years who were diagnosed with ileocolic intussusception between January 1, 2008 and July 31, 2015 were included in the study. Multivariable regression was used to adjust for the possible confounders of age, gender, number of cases of intussusception prior to the study period, time period from the beginning of symptoms to emergency department admission (12 h), and time period from emergency department admission to the beginning of pneumatic reduction of intussusception. Secondary outcomes of the study included the proportion of bowel perforations during the procedure, and the proportion of early (within 48 h) recurrence of intussusception. The sedation and nonsedation cohorts included 124 and 90 patients, respectively. The cohorts were comparable with regard to demographic characteristics, hemodynamic vital signs on admission to the emergency department, blood gases tests during emergency department stay, and time variables prior to reduction of intussusception. Multivariable regression revealed reduction of intussusception success rates of 89.5% and 83.3% for the sedation group and nonsedation group, respectively, with an adjusted odds ratio of 1.2, 95% CI 1.1-5.3. Three sedated patients and 0 nonsedated patients developed bowel perforations during the procedure. Rates of early recurrence of intussusception of sedated patients and nonsedated patients were 5.1% (6/117) and 1.3% (1

  19. 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

  20. FEMA Hazard Mitigation Assistance Repetitive Flood Claims (RFC) Data

    Data.gov (United States)

    Department of Homeland Security — This dataset contains closed and obligated projects funded under the following Hazard Mitigation Assistance (HMA) grant programs: Repetitive Flood Claims (RFC). The...

  1. A review of neuroimaging findings in repetitive brain trauma.

    Science.gov (United States)

    Koerte, Inga K; Lin, Alexander P; Willems, Anna; Muehlmann, Marc; Hufschmidt, Jakob; Coleman, Michael J; Green, Isobel; Liao, Huijun; Tate, David F; Wilde, Elisabeth A; Pasternak, Ofer; Bouix, Sylvain; Rathi, Yogesh; Bigler, Erin D; Stern, Robert A; Shenton, Martha E

    2015-05-01

    Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease confirmed at postmortem. Those at highest risk are professional athletes who participate in contact sports and military personnel who are exposed to repetitive blast events. All neuropathologically confirmed CTE cases, to date, have had a history of repetitive head impacts. This suggests that repetitive head impacts may be necessary for the initiation of the pathogenetic cascade that, in some cases, leads to CTE. Importantly, while all CTE appears to result from repetitive brain trauma, not all repetitive brain trauma results in CTE. Magnetic resonance imaging has great potential for understanding better the underlying mechanisms of repetitive brain trauma. In this review, we provide an overview of advanced imaging techniques currently used to investigate brain anomalies. We also provide an overview of neuroimaging findings in those exposed to repetitive head impacts in the acute/subacute and chronic phase of injury and in more neurodegenerative phases of injury, as well as in military personnel exposed to repetitive head impacts. Finally, we discuss future directions for research that will likely lead to a better understanding of the underlying mechanisms separating those who recover from repetitive brain trauma vs. those who go on to develop CTE.

  2. FEMA Hazard Mitigation Assistance Severe Repetitive Loss (SRL) Data

    Data.gov (United States)

    Department of Homeland Security — This dataset contains closed and obligated projects funded under the following Hazard Mitigation Assistance (HMA) grant programs: Severe Repetitive Loss (SRL). The...

  3. Communication Links

    OpenAIRE

    2003-01-01

    This interactive tutorial helps learners to: Identify key upward, lateral, downward, and informal communication links in their organizations. , Reflect on the benefits, control, satisfaction, information filters, and feedback mechanism of various communication links in the organizations. OCL1000 Communicating Change in Complex Organizations

  4. Operative links

    DEFF Research Database (Denmark)

    Wistoft, Karen

    2010-01-01

    as networks: second, a semantic perspective on discourses and concepts of health, and, third, a health pedagogical perspective on participation, intervention, and roles. This paper argues for the importance of 'operative links' between different levels in health strategies. It is proposed that such links...

  5. Repetitive control of electrically driven robot manipulators

    Science.gov (United States)

    Fateh, Mohammad Mehdi; Ahsani Tehrani, Hojjat; Karbassi, Seyed Mehdi

    2013-04-01

    This article presents a novel robust discrete repetitive control of electrically driven robot manipulators for tracking of a periodic trajectory. We propose a novel model, which presents the highly non-linear dynamics of robot manipulator in the form of linear discrete-time time-varying system. Based on the proposed model, we develop a two-term control law. The first term is an ordinary time-optimal and minimum-norm (TOMN) control by employing parametric controllers to guarantee stability. The second term is a novel robust control to improve the control performance in the face of uncertainties. The robust control estimates and compensates uncertainties including the parametric uncertainty, unmodelled dynamics and external disturbances. Performance of the proposed method is compared with two discrete methods, namely the TOMN control and an adaptive iterative learning (AIL) control. Simulation results confirm superiority of the proposed method in terms of the convergence speed and precision.

  6. Studies of the uncanny: the repetition factor

    Directory of Open Access Journals (Sweden)

    Julia Teitelroit Martins

    2011-06-01

    Full Text Available Freud’s essay The Uncanny (Das Unheimliche offers many indications for the comprehension of an aesthetics of the uncanny which deserve to be explored. Nonetheless, a concept traverses it from beginning to end: the return – which enables its reading under the light of Beyond the pleasure principle, written along the same span of time. Emphasis is given to the uncanny in the sense of repetition of the different – a paradox in terms, like the strangely familiar uncanny. In order to test the validity of an aesthetic reading under this perspective, follows an analysis of the brief short story “A terceira margem do rio” (“The third margin of the river”, by Guimarães Rosa.

  7. Object color affects identification and repetition priming.

    Science.gov (United States)

    Uttl, Bob; Graf, Peter; Santacruz, Pilar

    2006-10-01

    We investigated the influence of color on the identification of both non-studied and studied objects. Participants studied black and white and color photos of common objects and memory was assessed with an identification test. Consistent with our meta-analysis of prior research, we found that objects were easier to identify from color than from black and white photos. We also found substantial priming in all conditions, and study-to-test changes in an object's color reduced the magnitude of priming. Color-specific priming effects were large for color-complex objects, but minimal for color-simple objects. The pattern and magnitude of priming effects was not influenced either by the extent to which an object always appears in the same color (i.e., whether a color is symptomatic of an object) or by the object's origin (natural versus fabricated). We discuss the implications of our findings for theoretical accounts of object perception and repetition priming.

  8. Characterizing Aciniform Silk Repetitive Domain Backbone Dynamics and Hydrodynamic Modularity

    Directory of Open Access Journals (Sweden)

    Marie-Laurence Tremblay

    2016-08-01

    Full Text Available Spider aciniform (wrapping silk is a remarkable fibrillar biomaterial with outstanding mechanical properties. It is a modular protein consisting, in Argiope trifasciata, of a core repetitive domain of 200 amino acid units (W units. In solution, the W units comprise a globular folded core, with five α-helices, and disordered tails that are linked to form a ~63-residue intrinsically disordered linker in concatemers. Herein, we present nuclear magnetic resonance (NMR spectroscopy-based 15N spin relaxation analysis, allowing characterization of backbone dynamics as a function of residue on the ps–ns timescale in the context of the single W unit (W1 and the two unit concatemer (W2. Unambiguous mapping of backbone dynamics throughout W2 was made possible by segmental NMR active isotope-enrichment through split intein-mediated trans-splicing. Spectral density mapping for W1 and W2 reveals a striking disparity in dynamics between the folded core and the disordered linker and tail regions. These data are also consistent with rotational diffusion behaviour where each globular domain tumbles almost independently of its neighbour. At a localized level, helix 5 exhibits elevated high frequency dynamics relative to the proximal helix 4, supporting a model of fibrillogenesis where this helix unfolds as part of the transition to a mixed α-helix/β-sheet fibre.

  9. Up-dosing of non-sedating antihistamines in chronic urticaria: Need for well-designed clinical trials in India

    OpenAIRE

    Anant D. Patil

    2014-01-01

    Urticaria is a heterogeneous group of diseases. Chronic urticaria significantly impacts quality-of-life of patients. Second generation, non-sedating antihistamines are recommended as first line treatment for chronic spontaneous urticaria. In patients with inadequate control of symptoms, increase in dosage of non-sedating antihistamines up to four fold has been recommended. This recommendation is based on low cost, good safety and good evidence of efficacy of non-sedating, second generation an...

  10. Endoscopic ultrasound sedation in the United Kingdom: Is life without propofol tolerable?

    Science.gov (United States)

    Campbell, Jennifer Anne; Irvine, Andrew James; Hopper, Andrew Derek

    2017-01-01

    There is compelling evidence to support the quality, cost effectiveness and safety profile of non-anesthesiologist-administered propofol for endoscopic ultrasound (EUS). However in the United Kingdom, it is recommended that the administration and monitoring of propofol sedation for endoscopic procedures should be the responsibility of a dedicated and appropriately trained anaesthetist only. The majority of United Kingdom EUS procedures are performed with opiate and benzodiazepine sedation rather than anaesthetist led propofol lists due to anaesthetist resource availability. We sought to prospectively determine the tolerability and safety of EUS with benzodiazepine and opiate sedation in single United Kingdom centre. Two hundred consecutive patients undergoing either EUS or oesophago-gastroduodenoscopy (OGD) with conscious sedation were prospectively recruited with a 1:1 enrolment ratio. Patients completed questionnaires pre and post procedure detailing anticipated and actual pain experienced on a 1-10 visual analogue scale. Demographics, procedure duration, sedation doses and willingness to repeat the procedure were also recorded. EUS procedures lasted significantly longer than OGDs (15 min vs 6 min, P < 0.0001), however, there was no difference in anticipated pain scores between the groups (EUS 3.37/10 vs OGD 3.47/10, P = 0.46). Pain scores indicated EUS was better tolerated than OGD (1.16/10 vs 1.88/10, P = 0.03) although higher doses of sedation were used for EUS procedures. There were no complications identified in either group. We feel our study demonstrates that the tolerability of EUS with opiate and benzodiazepine sedation is acceptable.

  11. The impact of different antiepileptic drugs on the sedation of children during magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Isil Davarci

    2014-10-01

    Full Text Available Background and objectives:The induction and inhibition of cytochrome P450 isoenzymes by antiepileptic drugs lead to changes in the clearance of anesthetic drugs eliminated via hepatic metabolism. We investigated the duration of the sedation and additional anesthetic needs during magnetic resonance imaging in epileptic children receiving antiepileptic drugs that cause either enzyme induction or inhibition.Methods:In American Society of Anesthesiology I–II, 120 children aged 3–10 years were included. Group 1: children using antiepileptic drugs that cause cytochrome P450 enzyme induction; Group 2: those using antiepileptic drugs that cause inhibition; and Group 3: those that did not use antiepileptic drugs. Sedation was induced with the use of 0.05 mg kg−1 midazolam and 1 mg kg−1 propofol. An additional 0.05 mg kg−1 of midazolam and rescue propofol (0.5 mg kg−1 were administered and repeated to maintain sedation. The duration of sedation and the additional sedation needed were compared.Results:The duration of the initial dose was significantly shorter in Group I compared with groups II and III (p = 0.001, p = 0.003, respectively. It was significantly longer in Group II compared with groups I and III (p = 0.001, p = 0.029, respectively. The additional midazolam needed for adequate sedation was increased in Group I when compared with groups II and III (p = 0.010, p = 0.001, respectively. In addition, the rescue propofol dose was significantly higher only in Group I when compared with Group III (p = 0.002.Conclusion:In epileptic children, the response variability to the initial sedative agents during the magnetic resonance imaging procedure resulting from the inhibition or induction of the cytochrome P450 isoenzymes by the antiepileptic drugs mandated the titration of anesthetic agents.

  12. Effects of sedation during upper gastrointestinal endoscopy on endocrine response and cardiorespiratory function

    Directory of Open Access Journals (Sweden)

    G. Yetkin

    2007-12-01

    Full Text Available Upper gastrointestinal endoscopy is often accompanied by tachycardia which is known to be an important pathogenic factor in the development of myocardial ischemia. The pathogenesis of tachycardia is unknown but the condition is thought to be due to the endocrine response to endoscopy. The purpose of the present study was to investigate the effects of sedation on the endocrine response and cardiorespiratory function. Forty patients scheduled for diagnostic upper gastrointestinal endoscopy were randomized into 2 groups. While the patients in the first group did not receive sedation during upper gastrointestinal endoscopy, the patients in the second group were sedated with intravenous midazolam at the dose of 5 mg for those under 65 years or 2.5 mg for those aged 65 years or more. Midazolam was administered by slow infusion. In both groups, blood pressure, ECG tracing, heart rate, and peripheral oxygen saturation (SpO2 were monitored during endoscopy. In addition, blood samples for the determination of cortisol, glucose and C-reactive protein levels were obtained from patients in both groups prior to and following endoscopy. Heart rate and systolic arterial pressure changes were within normal limits in both groups. Comparison of the two groups regarding the values of these two parameters did not reveal a significant difference, while a statistically significant reduction in SpO2 was found in the sedation group. No significant differences in serum cortisol, glucose or C-reactive protein levels were observed between the sedated and non-sedated group. Sedation with midazolam did not reduce the endocrine response and the tachycardia developing during upper gastrointestinal endoscopy, but increased the reduction in SpO2.

  13. Dexmedetomidine versus propofol for sedation in patients undergoing vitreoretinal surgery under sub-Tenon′s anesthesia

    Directory of Open Access Journals (Sweden)

    Ashraf Ghali

    2011-01-01

    Full Text Available Purpose: The purpose of this study was to evaluate the hemodynamic, respiratory effects, the recovery profile, surgeons, and patients satisfaction with dexmedetomidine sedation compared with those of propofol sedation in patients undergoing vitreoretinal surgery under sub-Tenon′s anesthesia. Methods: Sixty patients were enrolled in this prospective, single-blind, randomized study. The patients were divided into two groups to receive either dexmedetomidine (group D or propofol (group P. Sedation level was titrated to a Ramsay sedation scale (RSS of 3. Hemodynamic and respiratory effects, postoperative recovery time, analgesic effects, surgeons and patients satisfaction were assessed. Results: Both groups provided a similar significant reduction in heart rate and mean arterial pressure compared with baseline values. The respiratory rate values of the dexmedetomidine group were significantly higher than those in the propofol group. The oxygen saturation values of the dexmedetomidine group were significantly higher than those of the propofol group. The expired CO 2 was similar in both groups. Postoperatively, the time to achieve an Aldrete score of 10 was similar in both groups. Dexmedetomidine patients have significantly lower visual analog scale for pain than propofol patients. The surgeon satisfaction with patients′ sedation was similar for both groups. The patients′ satisfaction was higher in the dexmedetomidine group. Conclusion: Dexmedetomidine at similar sedation levels with propofol was associated with equivalent hemodynamic effects, maintaining an adequate respiratory function, similar time of discharge from PACU, better analgesic properties, similar surgeon′s satisfaction, and higher patient′s satisfaction. Thus, dexmedetomidine may prove to be a valuable adjuvant for sedation in patients undergoing vitreoretinal surgery under sub-Tenon′s anesthesia.

  14. Role of organisational structure in implementation of sedation protocols: a comparison of Canadian and French ICUs.

    Science.gov (United States)

    Dodek, Peter; Chanques, Gerald; Brown, Glen; Norena, Monica; Grubisic, Maja; Wong, Hubert; Jaber, Samir

    2012-09-01

    Use of sedation protocols is associated with fewer mechanical ventilation days in critically ill patients. Canadian intensive care units (ICUs) often have a higher nurse-patient ratio and more specialised training of ICU nurses than French ICUs. Considering these differences, the purpose of this study was to compare implementation of sedation protocols as indicated by frequency of sedation assessment and response to levels of sedation between a Canadian and a French ICU. This was a retrospective observational study of 30 patients who were mechanically ventilated for at least 24 h in each of two tertiary care ICUs in Vancouver, Canada and Montpellier, France. The authors tabulated all Richmond Agitation-Sedation Scale scores, frequency of score measurement, target scores, frequency and magnitude of scores that were out of target range, and the response to these scores within 1 h of measurement. Practices between the two hospitals were compared using regression modelling, adjusting for patient age, sex, and Acute Physiology and Chronic Health Evaluation (APACHE) II score. Although sedation scores were measured more frequently in the Canadian ICU, there were fewer appropriate adjustments in medications in response to scores that were outside the target range in this ICU than in the French ICU, which had a lower nurse-patient ratio and no specialised training of nurses (OR 0.26 (95% CI 0.13 to 0.50) for scores that were higher than target, and OR 0.14 (95% CI 0.07 to 0.28) for scores that were lower than target). Differences in sedation management between these ICUs are likely related to factors other than nurse-patient ratio or specialised training of ICU nurses.

  15. An open-access endoscopy screen correctly and safely identifies patients for conscious sedation.

    Science.gov (United States)

    Kothari, Darshan; Feuerstein, Joseph D; Moss, Laureen; D'Souza, Julie; Montanaro, Kerri; Leffler, Daniel A; Sheth, Sunil G

    2016-11-01

    Open-access scheduling is highly utilized for facilitating generally low-risk endoscopies. Preprocedural screening addresses sedation requirements; however, procedural safety may be compromised if screening is inaccurate. We sought to determine the reliability of our open-access scheduling system for appropriate use of conscious sedation. We prospectively and consecutively enrolled outpatient procedures booked at an academic center by open-access using screening after in-office gastroenterology (GI) consultation. We collected the cases inappropriately booked for conscious sedation and compared the characteristics for significant differences. A total of 8063 outpatients were scheduled for procedures with conscious sedation, and 5959 were booked with open-access. Only 78 patients (0.97%, 78/8063) were identified as subsequently needing anesthesiologist-assisted sedation; 44 (56.4%, 44/78) were booked through open-access, of which chronic opioid (47.7%, 21/44) or benzodiazepine use (34.1%, 15/44) were the most common reasons for needing anesthesiologist-assisted sedation. Patients on chronic benzodiazepines required more midazolam than those not on chronic benzodiazepines (P = .03) of those patients who underwent conscious sedation. Similarly, patients with chronic opioid use required more fentanyl than those without chronic opioid use (P = .04). Advanced liver disease and alcohol use were common reasons for patients being booked after in-office consultation and were significantly higher than those booked with open-access (both P open-access scheduling. © The Author(s) 2016. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-Sen University.

  16. The different effects of intravenous propofol and midazolam sedation on hemodynamic and heart rate variability.

    Science.gov (United States)

    Win, Ni Ni; Fukayama, Haruhisa; Kohase, Hikaru; Umino, Masahiro

    2005-07-01

    Heart rate (HR) and arterial blood pressure (BP) changes have been reported during conscious sedation with propofol and midazolam. One potential mechanism to explain these changes is that propofol and midazolam affect HR and BP via changes in the cardiac autonomic nervous system. Two specific hypotheses were tested by HR variability analysis: 1) propofol induces predominance of parasympathetic activity, leading to decreased HR and BP, and 2) midazolam induces predominance of sympathetic activity, leading to increased HR and decreased BP. Thirty dental patients were included in a prospective, randomized study. HR, BP, low frequency (LF), high frequency (HF), and entropy were monitored during the awake, sedation, and recovery periods and depth of sedation was assessed using the Observer's Assessment of Alertness/Sedation score. Propofol induced a significant decrease in total power (503 +/- 209 ms(2)/Hz versus 162 +/- 92 ms(2)/Hz) and LF/HF ratio (2.5 +/- 1.2 versus 1.0 +/- 0.4), despite the absence of any change in HR during the sedation period compared with baseline. Midazolam decreased normalized HF (34 +/- 10% versus 10 +/- 4%) but did not significantly change LF/HF ratio (2.3 +/- 1.1 versus 2.2 +/- 1.4) and increased HR in the sedation period. Compared with baseline, propofol was associated with a significant increase in normalized HF in the recovery period (34 +/- 11% versus 44 +/- 12%) and a significant decrease in HR, whereas midazolam was associated with an increase in LF/HF ratio (2.3 +/- 1.1 versus 3.7 +/- 1.8) with no change in HR. These results indicated a dominant parasympathetic effect of propofol and a dominant sympathetic effect of midazolam in both periods. These results should be considered during conscious sedation, especially in patients at risk of cardiovascular complications.

  17. Spectral entropy as an objective measure of sedation state in midazolam-premedicated patients

    Directory of Open Access Journals (Sweden)

    Hany A Mowafi

    2012-01-01

    Full Text Available Context: Objective assessment of sedation depth is a valuable target. Spectral entropy is an anesthetic depth monitor based on the analysis of the electroencephalogram signal. Aims: To evaluate the performance of spectral entropy as an objective measure of sedation state in midazolam-premedicated patients and to correlate it with a clinically assessed sedation score. Settings and Design: This prospective double-blind placebo-controlled study was performed in King Fahd Hospital of the university. Methods: Eighty adult ASA I-II patients were randomly assigned into 4 groups. Patients were premedicated using 0.02, 0.04, or 0.06 mg/kg midazolam or saline intramuscularly. The effect of these doses on the Observer′s Assessment of Alertness and Sedation (OAA/S scale, hemodynamic variables, response entropy (RE, and state entropy (SE, was evaluated at 10, 20, and 30 min after premedication. Statistical analysis: Spearman Rank-order correlation analysis to examine the relation between OAA/S and entropy. The ability of spectral entropy to predict the depth of sedation was evaluated using Smith prediction probability. Results: Midazolam doses ≥0.04 mg/kg produced significant decreases in RE, SE, and OAA/S scores. There was a strong correlation between midazolam dose and OAA/S scale, RE, and SE since Spearman Rank R values were 0.792, 0.822, and 0.745, respectively (P<0.001. In addition, RE and SE were strong predictors of OAA/S level during midazolam sedation with no significant difference in prediction between the 2 entropy components. Conclusions: Spectral entropy is a reliable measure for the sedative premedication. It may be used to objectively assess the adequacy of midazolam premedication and to determine the dose requirement.

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

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    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.

  19. Bispectral index score and observer′s assessment of awareness/sedation score may manifest divergence during onset of sedation: Study with midazolam and propofol

    Directory of Open Access Journals (Sweden)

    Dipanjan Bagchi

    2013-01-01

    Full Text Available Background: Correlation between the clinical and electroencephalogram-based monitoring has been documented sporadically during the onset of sedation. Propofol and midazolam have been studied individually using the observer′s assessment of awareness/sedation (OAA/S score and Bispectral index score (BIS. The present study was designed to compare the time to onset of sedation for propofol and midazolam using both BIS and OAA/S scores, and to find out any correlation. Methods: A total of 46 patients (18-60 years, either sex, American Society of Anesthesiologists (ASA I/II posted for infraumbilical surgeries under spinal anaesthesia were randomly allocated to receive either injection propofol 1 mg/kg bolus followed by infusion 3 mg/kg/h (Group P, n=23 or injection midazolam 0.05 mg/kg bolus followed by infusion 0.06 mg/kg/h (Group M, n=23. Spinal anaesthesia was given with 2.5 ml to 3.0 ml of 0.5% bupivacaine heavy. When sensory block reached T6 level, sedation was initiated. The time to reach BIS score 70 and time to achieve OAA/S score 3 from the start of study drug were noted. OAA/S score at BIS score 70 was noted. Data from 43 patients were analyzed using SPSS 12 for Windows. Results: Time to reach BIS score 70 using propofol was significantly lower than using the midazolam (P<0.05. Time to achieve OAA/S score 3 using propofol was comparable with midazolam (P=0.358. Conclusion: A divergence exists between the time to reach BIS score 70 and time to achieve OAA/S score 3 using midazolam, compared with propofol, during the onset of sedation.

  20. Anaesthetic and sedative agents used for electrical cardioversion.

    Science.gov (United States)

    Lewis, Sharon R; Nicholson, Amanda; Reed, Stephanie S; Kenth, Johnny J; Alderson, Phil; Smith, Andrew F

    2015-03-22

    Electrical cardioversion is an effective procedure for restoring normal sinus rhythm in the hearts of patients with irregular heart rhythms. It is important that the patient is not fully conscious during the procedure, as it can be painful and distressing. The drug used to make patients unaware of the procedure should rapidly achieve the desired level of sedation, should wear off quickly and should not cause cardiovascular or respiratory side effects. We aimed to compare the safety, effectiveness and adverse events associated with various anaesthetic or sedative agents used in direct current cardioversion for cardiac arrhythmia in both elective and emergency settings.We sought answers to the following specific questions.• Which drugs deliver the best outcomes for patients undergoing electrical cardioversion?• Does using a particular agent confer advantages or disadvantages?• Is additional analgesic necessary to prevent pain? We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) on 27 March 2014. Our search terms were relevant to the review question and were not limited by outcomes. We also carried out searches of clinical trials registers and forward and backward citation tracking. We considered all randomized controlled trials and quasi-randomized and cluster-randomized studies with adult participants undergoing electrical cardioversion procedures in the elective or emergency setting. Two review authors independently assessed trial quality and extracted data, consulting with a third review author for disagreements. We used standard Cochrane methodological procedures, including assessment of risk of bias for all studies. We included 23 studies with 1250 participants that compared one drug with one or more other drugs. Of these comparisons, 19 studies compared propofol with another drug. Seven of these compared propofol with etomidate (four of which

  1. Conscious sedation for endoscopic and non-endoscopic interventional gastrointestinal procedures: meeting patients' expectations, missing the standard

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-02-01

    AIM: To assess the level of sedation, patient satisfaction and frequency of unplanned events with conscious sedation for interventional procedures. MATERIALS AND METHODS: One hundred and seventeen patients were assessed prospectively before, during and after procedures. Blood pressure, pulse, oxygen saturation and sedation level were monitored and patients followed up after 24 h. Sedation was scored after drugs were given in accordance with an established protocol. Doses were recorded, as were patients' weight, age and ASA grade and any unplanned events and their management. RESULTS: Seventy-six of the 117 patients (65%) had no unplanned event, 20 (17.1%) became agitated, 15 (12.8%) hypotensive, three (2.6%) hypoxic and three (2.6%) had more than one response. Twelve patients required active management. Fifty-two (44.4%) had a sedation level of {<=}3 (responsive to verbal commands), but 39 (33.3%) reached level 6. Median doses were midazolam 6 mg (1-20 mg) and pethidine 50 mg (12.5-100 mg). Ninety-three percent were satisfied with their sedation. No adverse effects were observed after 24 h. CONCLUSION: Despite using a sedation protocol, unplanned events occurred in 35% (95% CI=27-44%) of patients, although not all required active management. The sedation levels reached in some exceeded guidelines. Unplanned events were commoner with increased sedation level. Patient satisfaction was high and no permanent damage was observed.

  2. The pediatric sedation unit: a prospective analysis of parental satisfaction.

    Science.gov (United States)

    Connor, Matthew P; Dion, Gregory R; Borgman, Matthew; Maturo, Stephen

    2014-12-01

    As financial pressures drive health care to be more cost-effective and efficient, performing procedures outside the main operating room (MOR) is becoming more common. Pediatric sedation units (PSU) have proven both effective and safe at providing anesthesia for children. However, there is limited data available regarding the PSU and its potential application in pediatric otolaryngology. To evaluate the experience of performing pediatric outpatient procedures in a PSU through a parental satisfaction survey. Pediatric otolaryngology procedures performed in the PSU were prospectively recorded in a database. A prospective survey analysis was performed that measured parental satisfaction with scheduling/registration for surgery, nursing care, surgeon care, facility environment, timing/duration, and overall satisfaction. Parents completed this survey for outpatient procedures performed in either the PSU or in the MOR. The same attending surgeon was involved in all cases, with the only independent variable being the location of the surgery. Fifty surveys were collected for each group, and the surveys scores were statistically compared using nonparametric statistical analysis. Parental satisfaction was high in both the PSU and OR, with mean overall satisfaction scores of 4.8 and 4.9 (respectively) on an ordinal scale from 1 to 5. Parents reported greater clarity in preoperative information in the MOR (mean 4.8) compared to the PSU (mean 4.6) (pparents reported that MOR procedures started on time more often than those in the PSU (90-64%, pparent survey has identified education prior to surgery and timeliness of surgery as two areas to improve to meet the satisfaction standard provided by the OR. Published by Elsevier Ireland Ltd.

  3. The golden ratio of gait harmony: repetitive proportions of repetitive gait phases.

    Science.gov (United States)

    Iosa, Marco; Fusco, Augusto; Marchetti, Fabio; Morone, Giovanni; Caltagirone, Carlo; Paolucci, Stefano; Peppe, Antonella

    2013-01-01

    In nature, many physical and biological systems have structures showing harmonic properties. Some of them were found related to the irrational number φ known as the golden ratio that has important symmetric and harmonic properties. In this study, the spatiotemporal gait parameters of 25 healthy subjects were analyzed using a stereophotogrammetric system with 25 retroreflective markers located on their skin. The proportions of gait phases were compared with φ, the value of which is about 1.6180. The ratio between the entire gait cycle and stance phase resulted in 1.620 ± 0.058, that between stance and the swing phase was 1.629 ± 0.173, and that between swing and the double support phase was 1.684 ± 0.357. All these ratios did not differ significantly from each other (F = 0.870, P = 0.422, repeated measure analysis of variance) or from φ (P = 0.670, 0.820, 0.422, resp., t-tests). The repetitive gait phases of physiological walking were found in turn in repetitive proportions with each other, revealing an intrinsic harmonic structure. Harmony could be the key for facilitating the control of repetitive walking. Harmony is a powerful unifying factor between seemingly disparate fields of nature, including human gait.

  4. The Golden Ratio of Gait Harmony: Repetitive Proportions of Repetitive Gait Phases

    Directory of Open Access Journals (Sweden)

    Marco Iosa

    2013-01-01

    Full Text Available In nature, many physical and biological systems have structures showing harmonic properties. Some of them were found related to the irrational number known as the golden ratio that has important symmetric and harmonic properties. In this study, the spatiotemporal gait parameters of 25 healthy subjects were analyzed using a stereophotogrammetric system with 25 retroreflective markers located on their skin. The proportions of gait phases were compared with , the value of which is about 1.6180. The ratio between the entire gait cycle and stance phase resulted in 1.620 ± 0.058, that between stance and the swing phase was 1.629 ± 0.173, and that between swing and the double support phase was 1.684 ± 0.357. All these ratios did not differ significantly from each other (, , repeated measure analysis of variance or from (, resp., t-tests. The repetitive gait phases of physiological walking were found in turn in repetitive proportions with each other, revealing an intrinsic harmonic structure. Harmony could be the key for facilitating the control of repetitive walking. Harmony is a powerful unifying factor between seemingly disparate fields of nature, including human gait.

  5. 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

  6. Iconicity in Discourse: The Case of Repetition in Japanese.

    Science.gov (United States)

    Ishikawa, Minako

    This analysis of repeated utterances in Japanese conversational discourse focuses on repetition as an expression of iconicity. In the analysis of a 30-minute conversation among 4 Japanese speakers, the iconic meanings expressed by both reduplication and conversational repetition are highlighted. The iconicity characteristic of conversational data…

  7. Evidence-Based Behavioral Interventions for Repetitive Behaviors in Autism

    Science.gov (United States)

    Boyd, Brian A.; McDonough, Stephen G.; Bodfish, James W.

    2012-01-01

    Restricted and repetitive behaviors (RRBs) are a core symptom of autism spectrum disorders (ASD). There has been an increased research emphasis on repetitive behaviors; however, this research primarily has focused on phenomenology and mechanisms. Thus, the knowledge base on interventions is lagging behind other areas of research. The literature…

  8. Visual attention to advertising : The impact of motivation and repetition

    NARCIS (Netherlands)

    Pieters, RGM; Rosbergen, E; Hartog, M; Corfman, KP; Lynch, JG

    1996-01-01

    Using eye-tracking data, we examine the impact of motivation and repetition on visual attention to advertisements differing in argument quality. Our analyses indicate that repetition leads to an overall decrease in the amount of attention. However, while at first high motivation subjects attend to t

  9. On the Functions of Lexical Repetition in English Texts

    Institute of Scientific and Technical Information of China (English)

    XIAO Fuliang

    2016-01-01

    Lexical repetition, as a cohesive device of an English text, can help make up a cohesive and coherent text. Therefore, in English textual learning, it is helpful for students to know about different patterns and functions of lexical repetition to improve their English level and ability.

  10. Serial rapists and their victims: reenactment and repetition.

    Science.gov (United States)

    Burgess, A W; Hazelwood, R R; Rokous, F E; Hartman, C R; Burgess, A G

    1988-01-01

    The major finding in this study of 41 serial rapists is the large numbers of reported and unreported victims. For over 1200 attempted and completed rapes, there were 200 convictions. The hidden rapes or earliest nonreported victims of these men as boys and adolescents were identified from their families, their neighborhood, and their schools. Examining the possible link between childhood sexual abuse and criminal behavior in this sample of 41 serial rapists, 56.1% were judged to have at least one forced or exploitive abuse experience in boyhood, as compared to a study of 2,972 college males reporting 7.3% experiencing boyhood sexual abuse. Looking within the abused samples, 56.1% of the rapists reported forced sex, compared to the college sample's 30.4%. Also, the rapist sample revealed higher rates of family member as abuser (48.4%), compared to 22.2% for the college sample. Retrospective reconstruction of the sexual activities and assertive behaviors of these men as boys reveals that 51% of the boys reenact the abuse as a preadolescent with their earliest victims being known to them (48% as neighborhood girls), family (25% as sisters), or girlfriend (25%). The onset of rape fantasies in midadolescence (mean age 16.9) crystalizes the earlier sexually initiated behaviors into juvenile behaviors of spying, fetish burglaries, molestations, and rapes. Repetition of these juvenile behaviors set their criminal patters on strangers--their next group of victims. To reduce victimization, serial rapists need to be identified early and stopped. This means acknowledging and reporting boy sexual abuse. This includes being sensitive to the reenactment behaviors noted in the initiated activities of abused children, which in turn need to be differentiated from peer play. Closer attention needs to be paid to families with incest behavior to insure that younger children are protected. Adolescents showing early repetitive juvenile delinquent behaviors must be assessed for physical

  11. Link Analysis

    Science.gov (United States)

    Donoho, Steve

    Link analysis is a collection of techniques that operate on data that can be represented as nodes and links. This chapter surveys a variety of techniques including subgraph matching, finding cliques and K-plexes, maximizing spread of influence, visualization, finding hubs and authorities, and combining with traditional techniques (classification, clustering, etc). It also surveys applications including social network analysis, viral marketing, Internet search, fraud detection, and crime prevention.

  12. 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

  13. Effect of MRI strength and propofol sedation on pediatric core temperature change.

    Science.gov (United States)

    Isaacson, Diane L; Yanosky, Daniel J; Jones, Richard A; Dennehy, Nancy; Spandorfer, Philip; Baxter, Amy L

    2011-04-01

    To determine core body temperature variations in children undergoing MRI exams on 1.5 Tesla (T) and 3T magnetic field strengths and with and without propofol sedation. Temporal artery temperatures were prospectively collected on 400 consecutive patients undergoing 1.5 Tesla (T) or 3.0T MRI scans. A cumulative logistic regression model was created using age, weight, MRI protocol, sedation status, pre-MRI temperature and MRI strength to assess risk of temperature change. For patients with complete pre- and post-MRI temperature data, mean temperatures did not significantly change (-0.0155°C, 95%CI, -0.035, 0.064; n = 385). Temperature changes differed significantly between propofol-sedated and nonsedated patients (-0.26°C ± .44 versus 0.24°C ± 0.42; P 1°C; 12 were on the 1.5T. All 7 patients (1.8%) who increased >1°C were non-sedates. Clinically significant core body temperature change is uncommon in children undergoing MRI with different magnetic field strengths, and with and without propofol sedation. Copyright © 2011 Wiley-Liss, Inc.

  14. Sedation with midazolam for voiding cystourethrography in children: a randomised double-blind study

    Energy Technology Data Exchange (ETDEWEB)

    Stokland, E.; Jacobsson, B.; Ljung, B. [Dept. of Paediatric Radiology and Clinical Physiology, The Queen Silvia Children' s Hospital, Gothenburg (Sweden); Andreasson, S. [Dept. of Paediatric Anaesthesiology, The Queen Silvia Children' s Hospital, Gothenburg (Sweden); Jodal, U. [Dept. of Paediatrics, The Queen Silvia Children' s Hospital, Gothenburg (Sweden)

    2003-04-01

    Background: Sedation with midazolam facilitates the performance of diagnostic procedures in children, including voiding cystourethrography (VCUG). However, the influence of sedation on voiding and imaging results have not been adequately evaluated. Objective: Midazolam and placebo were compared to assess discomfort during VCUG and to evaluate if sedation influenced the outcome of the examination. Materials and methods: The study was prospective, randomized and double-blind, and included 95 children, 48 in the midazolam group (median age 2.2 years) and 47 in the placebo group (median age 3.2 years). The evaluation included the child's/parent's experience of the VCUG, as well as the examination results. Results: The children/parents in the midazolam group experienced the VCUG as less distressing compared to those in the placebo group (P < 0.001). Forty-six of 48 children sedated with midazolam could void during the imaging procedure compared to 38 of 47 children given placebo (NS). There was no difference in frequency or grade of vesicoureteric reflux or bladder emptying between the groups. Conclusions: When sedation is required to perform VCUG in children, midazolam can be used without negative effect on the outcome of the examination. (orig.)

  15. Efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests

    Directory of Open Access Journals (Sweden)

    Gustavo Falbo Wandalsen

    Full Text Available Abstract Objective: To describe the efficacy and safety of chloral hydrate sedation in infants for pulmonary function tests. Methods: All sedation attempts for pulmonary function tests in infants carried out between June 2007 and August 2014 were evaluated. Obstructive sleep apnea and heart disease were contraindications to the exams. Anthropometric data, exam indication, used dose, outcomes of sedation and clinical events were recorded and described. Results: The sedation attempts in 277 infants (165 boys with a median age of 51.5 weeks of life (14-182 weeks were evaluated. The main indication for the tests was recurrent wheezing (56% and the chloral hydrate dose ranged from 50 to 80mg/kg (orally. Eighteen (6.5% infants had some type of clinical complication, with the most frequent being cough and/or airway secretion (1.8%; respiratory distress (1.4% and vomiting (1.1%. A preterm infant had bradycardia for approximately 15 minutes, which was responsive to tactile stimulation. All observed adverse effects were transient and there was no need for resuscitation or use of injectable medications. Conclusions: The data demonstrated that chloral hydrate at the employed doses is a safe and effective medicament for sedation during short procedures in infants, such as pulmonary function tests. Because of the possibility of severe adverse events, recommendations on doses and contraindications should be strictly followed and infants should be monitored by trained staff.

  16. 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.

  17. Investigation of Efficacy of Lidocaine Spray for Sedated Esophagogastroduodenoscopy in Children.

    Science.gov (United States)

    Basturk, Ahmet; Artan, Reha; Yılmaz, Aygen

    2017-06-01

    Our aim in this study is to investigate efficacy of topical lidocaine spray for sedated esophagogastroduodenoscopy (EGD) in children. The endoscopy of children aged between 3-18 years who underwent EGD in our endoscopy unit. Intravenous (IV) midazolam and ketamine were used for sedation. Prior to sedation, endoscopy nurse applied topical lidocaine 10% with pump spray at 1 mg/kg dose in group 1, and distilled water via identically scaled pump spray in group 2, in a double blinded fashion. Sedation was not applied in 24.1% of the cases in topical lidocaine spray group (LS group) and in 5.7% of the cases in distilled water spray group (DS group). Gag reflex was observed in 6.5% of cases in LS group and 33.3% of cases in DS group (p=0.024), increased oral secretion was observed in 9.3% of cases in LS group and 51.7% of cases in DS group (p=0.038), sore throat was observed in 3.7% of cases in LS group and 35.6% of cases in DS group (p=0.019) and the difference was statistically significant. The study showed that topical pharyngeal lidocaine reduces both requirement and amount of IV sedation before EGD in children and sore throat, gag reflex and decreased oral secretion increase.

  18. Continuous Deep Sedation: A Proposal for Performing More Rigorous Empirical Research.

    Science.gov (United States)

    Morita, Tatsuya; Imai, Kengo; Yokomichi, Naosuke; Mori, Masanori; Kizawa, Yoshiyuki; Tsuneto, Satoru

    2017-01-01

    Continuous deep sedation until death (CDS) is a type of palliative sedation therapy, and it has recently become a focus of intense debate. Marked inconsistencies in intervention procedures (i.e., what is CDS?) and unstandardized descriptions of patient backgrounds lead to difficulty in comparing the results in the literature. The primary aim of this article was to propose a conceptual framework to perform empirical studies on CDS. We propose the definition of CDS using the intervention protocol. As there are two types of CDS proposed in world-wide literature, we recommend to prepare two types of intervention protocol for CDS: "continuous deep sedation as a result of proportional sedation" (gradual CDS) and "continuous deep sedation to rapidly induce unconsciousness" (rapid CDS). In addition, we recommend that researchers characterize study patients' general condition using a validated prognostic tool, Prognosis in Palliative Care Study predictor model-A. Using this conceptual framework, we can compare the outcomes following the same exposures among homogenous patients throughout the world. This article proposes a provisional definition of two types of CDS. Defining CDS using the intervention protocol and describing patient backgrounds using validated prognostic tools enable comparisons and interpretations of empirical research about CDS. More empirical studies are urgently needed. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  19. Current role of non-anesthesiologist administered propofol sedation in advanced interventional endoscopy.

    Science.gov (United States)

    Burtea, Daniela Elena; Dimitriu, Anca; Maloş, Anca Elena; Săftoiu, Adrian

    2015-08-10

    Complex and lengthy endoscopic examinations like endoscopic ultrasonography and/or endoscopic retrograde cholangiopancreatography benefit from deep sedation, due to an enhanced quality of examinations, reduced discomfort and anxiety of patients, as well as increased satisfaction for both the patients and medical personnel. Current guidelines support the use of propofol sedation, which has the same rate of adverse effects as traditional sedation with benzodiazepines and/or opioids, but decreases the procedural and recovery time. Non-anesthesiologist administered propofol sedation has become an option in most of the countries, due to limited anesthesiology resources and the increasing evidence from prospective studies and meta-analyses that the procedure is safe with a similar rate of adverse events with traditional sedation. The advantages include a high quality of endoscopic examination, improved satisfaction for patients and doctors, as well as decreased recovery and discharge time. Despite the advantages of non-anesthesiologist administered propofol, there is still a continuous debate related to the successful generalization of the procedures.

  20. Superiority of split dose midazolam as conscious sedation for outpatient colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Hyuk Lee; Jeong Hwan Kim

    2009-01-01

    AIM: To elucidate the efficacy and safety of a split dose of midazolam in combination with meperidine for colonoscopy. METHODS: Eighty subjects undergoing outpatient colonoscopy were randomly assigned to group A or B. Group A ( n = 40) received a split dose of midazolam in combination with meperidine. Group B ( n = 40) received a single dose of midazolam in combination with meperidine. Outcome measurements were level of sedation, duration of sedation and recovery, degree of pain and satisfaction, procedure-related memory, controllability, and adverse events. RESULTS: Group A had a lower frequency of significant hypoxemia ( P = 0.043) and a higher sedation score on withdrawal of the endoscope from the descending colon than group B ( P = 0.043). Group B recovered from sedation slightly sooner than group A ( P < 0.002). Scores for pain and memory, except insertion-related memory, were lower in group A one week after colonoscopic examination ( P = 0.018 and P < 0.030, respectively). Poor patient controllability was noted by the endoscopist and nurse in group B ( P = 0.038 and P = 0.032, respectively). CONCLUSION: Split dose midazolam in combination with meperidine resulted in a safer, more equable sedation status during colonoscopic examination and a reduction in procedure-related pain and memory, but resulted in longer recovery time.