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Latest & greatest articles for sedation
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Propofol for sedation during colonoscopy. Propofol is increasingly used for sedation during colonoscopy, with many recent reports of randomized controlled trials (RCTs) and large non-randomized case series.The primary objective was to identify, analyze and summarize RCTs comparing the relative effectiveness, patient acceptance and safety of propofol for colonoscopy, to traditional sedatives (narcotics and/or benzodiazepines).The secondary objective was to synthesize the studies comparing (...) propofol administration by anesthesiologists to that by non-anesthesiologists for sedation during colonoscopy.We searched Medline, Cancerlit, EMBASE, CINAHL, LILACS, Biological Abstracts, Web of Science and the Cochrane Controlled Trials Registry database between January 1980 and June 2007; and conference proceeding abstracts for DDW, EUGW and ACG between 1990 and June 2007. There were no language restrictions.Randomized controlled trials comparing use of propofol and traditional agents
Palliative sedation. Guidelines and Measures | Agency for Healthcare Research & Quality HHS.gov Search ahrq.gov Search ahrq.gov Menu Topics A - Z Healthcare Delivery Latest available findings on quality of and access to health care Searchable database of AHRQ Grants, Working Papers & HHS Recovery Act Projects AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund You are here Guidelines and Measures Funding for the National Guideline Clearinghouse (NGC) has ended. Learn more
Does the time of fasting affect complication rates during ketamine sedation BestBets: Does the time of fasting affect complication rates during ketamine sedation Does the time of fasting affect complication rates during ketamine sedation Report By: Ray McGlone - Consultant in Emergency Medicine Search checked by Simon Carley - Consultant in Emergency Medicine Institution: Lancaster Royal Infirmary Original author: Ray McGlone Original institution: Lancaster Royal Infirmary Current web editor (...) : Tom Bartram - middle grade A+E Date Submitted: 4th March 2005 Last Modified: 14th August 2008 Status: Green (complete) Three Part Question [In children undergoing ketamine sedation] is [prolonged fasting (6 hours or more) better than short term fasting (3 hours)] at [reducing the incidence of vomiting and other complications of sedation] Clinical Scenario A 4 year old boy is brought to the emergency department having fallen over at home. He has sustained a 3 cm deep laceration to the forehead. He
A randomized trial of daily awakening in critically ill patients managed with a sedation protocol: a pilot trial Protocolized sedation (PS) and daily sedative interruption (DI) in critically ill patients have both been shown to shorten the durations of mechanical ventilation (MV) and intensive care unit (ICU) stay. Our objective was to determine the safety and feasibility of a randomized trial to determine whether adults managed with both PS + DI have a shorter duration of MV than patients (...) managed with PS alone.Prospective randomized, concealed, unblinded, multicenter, pilot trial.Three university-affiliated medical-surgical ICUs.Sixty-five adults anticipated to require MV >48 hrs and receiving sedative/analgesic infusions.Patients were randomized to PS alone, or PS + DI. PS was implemented by bedside nurses; sedatives/analgesics were titrated to achieve Sedation Agitation Score (SAS) 3-4. The PS + DI group also had infusions interrupted daily until the patients awoke.Diagnosis, age
Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Comparison of the effect of protocol-directed sedation with propofol vs. midazolam by nurses in intensive care: efficacy, haemodynamic stability and patient satisfaction The aim of this study was to compare the effect of protocol-directed sedation propofol vs. midazolam by nurses in intensive care on efficacy, haemodynamic stability and patient satisfaction.Protocols represent one method potentially to reduce treatment delays and ensure that medical care is administered in a standardised manner (...) . Propofol and midazolam are often used for sedation in intensive care units.A randomised, prospective cohort study and data were collected in 2003. The subjects were randomised either into propofol (n = 32) or into midazolam (n = 28) group. Efficacy of sedation, haemodynamic stability, pulse oximetry saturation, Acute Physiology and Chronic Health Evaluation II (APACHE II score), weaning time from mechanical ventilation, duration of mechanical ventilation, length of stay at intensive care unit, sedative
Intra-articular block compared with conscious sedation for closed reduction of ankle fracture-dislocations. A prospective randomized trial Ankle fracture-dislocations require urgent reduction to protect the soft tissues, to minimize articular injury, and to allow swelling to decrease. Conscious sedation is commonly used to provide analgesia for closed reduction of this injury. We hypothesized that an intra-articular block of the ankle would provide similar analgesia and the ability to reduce (...) the ankle with a lower risk than conscious sedation.Between September 2005 and January 2007, forty-two patients with an ankle fracture-dislocation presented to our emergency department and were enrolled in a prospective randomized study. The patients were given either conscious sedation or an intra-articular lidocaine block for the reduction and for the application of a plaster splint. After the reduction maneuver, the patients used a visual analog pain scale to rate the level of pain before, during
A cost-effectiveness analysis of propofol versus midazolam for procedural sedation in the emergency department To determine the incremental cost-effectiveness of using propofol versus midazolam for procedural sedation (PS) in adults in the emergency department (ED).The authors conducted a cost-effectiveness analysis from the perspective of the health care provider. The primary outcome was the incremental cost (or savings) to achieve one additional successful sedation with propofol compared (...) . A standard meta-analytic technique was used to calculate the weighted mean difference in recovery times and obtain mean drug doses from patient-level data from a randomized controlled trial. Probabilistic sensitivity analyses were conducted to examine the uncertainty around the estimated incremental cost-effectiveness ratio using Monte Carlo simulation.Choosing a sedation strategy with propofol resulted in average savings of $17.33 (95% confidence interval [CI] = $24.13 to $10.44) per sedation performed
Safety and clinical effectiveness of midazolam versus propofol for procedural sedation in the emergency department: a systematic review To synthesize the evidence comparing the adverse event (AE) profile and clinical effectiveness of midazolam and propofol for procedural sedation (PS) in adults in the emergency care setting.The authors conducted a systematic review of randomized controlled trials (RCTs) and observational studies reporting the use of either midazolam and/or propofol for adult PS
Continuous deep sedation for patients nearing death in the Netherlands: descriptive study. To study the practice of continuous deep sedation in 2005 in the Netherlands and compare it with findings from 2001.Questionnaire study about random samples of deaths reported to a central death registry in 2005 and 2001.Nationwide physician study in the Netherlands.Reporting physicians received a questionnaire about the medical decisions that preceded the patient's death; 78% (n=6860) responded in 2005 (...) and 74% (n=5617) in 2001.Characteristics of continuous deep sedation (attending physician, types of patients, drugs used, duration, estimated effect on shortening life, palliative consultation). Requests for euthanasia.The use of continuous deep sedation increased from 5.6% (95% confidence interval 5.0% to 6.2%) of deaths in 2001 to 7.1% (6.5% to 7.6%) in 2005, mostly in patients treated by general practitioners and in those with cancer (in 2005, 47% of sedated patients had cancer v 33% in 2001
Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Approaches to removal of sedation and mechanical ventilation for critically ill patients vary widely. Our aim was to assess a protocol that paired spontaneous awakening trials (SATs)-ie, daily interruption of sedatives-with spontaneous breathing trials (SBTs).In four tertiary-care hospitals, we (...) randomly assigned 336 mechanically ventilated patients in intensive care to management with a daily SAT followed by an SBT (intervention group; n=168) or with sedation per usual care plus a daily SBT (control group; n=168). The primary endpoint was time breathing without assistance. Data were analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00097630.One patient in the intervention group did not begin their assigned treatment protocol because of withdrawal
Effect of music on procedure time and sedation during colonoscopy: a meta-analysis Effect of music on procedure time and sedation during colonoscopy: a meta-analysis Effect of music on procedure time and sedation during colonoscopy: a meta-analysis Tam W W, Wong E L, Twinn S F CRD summary This review concluded that listening to music was effective in reducing procedure time and amount of sedation used during colonoscopy, and should be promoted. The recommendation for promoting listening (...) to music during colonoscopy should be regarded with some caution because the reduction in procedure time was fairly small and the analysis of the amount of sedation used had some limitations. Authors' objectives To assess the effectiveness of music in reducing procedure time and amount of sedation used during colonoscopy. Searching MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, AMED and ACP Journal Club were searched up to March 2007 for English-language papers. Search terms
Adverse events associated with ketamine for procedural sedation in adults Adverse events associated with ketamine for procedural sedation in adults Adverse events associated with ketamine for procedural sedation in adults Strayer RJ, Nelson LS CRD summary The review concluded that when ketamine was used for procedural sedation in adults, cardiorespiratory adverse events were rare but dysphoric emergence phenomena occurred in 10% to 20% patients and there was a likelihood of airway obstruction (...) . The reliability of the authors’ conclusions is uncertain due to review process limitations and uncertain quality and design of the many included studies. Authors' objectives To evaluate the safety of the use of ketamine for procedural sedation in adults. Searching PubMed, EMBASE, TOXNET (to May 2006) and The Cochrane Library were searched for publications in English, Spanish, Russian, French, Portuguese and German; search terms were reported. Australian Adverse Drug Reactions Bulletin, European Public
Intraarticular lidocaine versus intravenous procedural sedation with narcotics and benzodiazepines for reduction of the dislocated shoulder: a systematic review Intraarticular lidocaine versus intravenous procedural sedation with narcotics and benzodiazepines for reduction of the dislocated shoulder: a systematic review Intraarticular lidocaine versus intravenous procedural sedation with narcotics and benzodiazepines for reduction of the dislocated shoulder: a systematic review Fitch RW, Kuhn (...) JE CRD summary This review found that the use of intra-articular lidocaine for reduction of the dislocated shoulder resulted in fewer complications and less time spent in the emergency department when compared with opiate/benzodiazepine combinations for intravenous sedation. The increasing use of newer short-acting sedatives for sedation brings into question the applicability of this study to modern practice. Authors' objectives To determine if intra-articular lidocaine was as effective
A cost-effectiveness analysis of propofol versus midazolam for procedural sedation in the emergency department A cost-effectiveness analysis of propofol versus midazolam for procedural sedation in the emergency department A cost-effectiveness analysis of propofol versus midazolam for procedural sedation in the emergency department Hohl C M, Nosyk B, Sadatsafavi M, Anis A H Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each (...) abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary This study examined the cost-effectiveness of using propofol (PRO) in comparison with midazolam (MID) for procedural sedation in adults in the emergency department. The authors concluded that the use of PRO was an effective and cost-saving alternative to MID from the perspective of the health service provider
A randomized trial of protocol-directed sedation management for mechanical ventilation in an Australian intensive care unit To compare protocol-directed sedation management with traditional non-protocol-directed practice in mechanically ventilated patients.Randomized, controlled trial.General intensive care unit (24 beds) in an Australian metropolitan teaching hospital.Adult, mechanically ventilated patients (n = 312).Patients were randomly assigned to receive sedation directed by formal (...) , estimated that protocol sedation management was associated with a 22% decrease (95% confidence interval 40% decrease to 2% increase, p = .07) in the occurrence of successful weaning from mechanical ventilation.This randomized trial provided no evidence of a substantial reduction in the duration of mechanical ventilation or length of stay, in either the intensive care unit or the hospital, with the use of protocol-directed sedation compared with usual local management. Qualified high-intensity nurse
Short-acting agents for procedural sedation and analgesia in Canadian emergency departments: a review of clinical outcomes and economic evaluation Short-acting agents for procedural sedation and analgesia in Canadian emergency departments: a review of clinical outcomes and economic evaluation Short-acting agents for procedural sedation and analgesia in Canadian emergency departments: a review of clinical outcomes and economic evaluation Bond K, Fassbender K, Karkhaneh M, Spooner C, Horton J (...) , Sivilotti MLA, Campbell SG, Vandermeer B, Tjosvold L, Seal R, Rowe BH Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Bond K, Fassbender K, Karkhaneh M, Spooner C, Horton J, Sivilotti MLA, Campbell SG, Vandermeer B, Tjosvold L, Seal R, Rowe BH. Short-acting agents for procedural sedation and analgesia in Canadian emergency departments: a review
Safety and clinical effectiveness of midazolam versus propofol for procedural sedation in the emergency department: a systematic review Safety and clinical effectiveness of midazolam versus propofol for procedural sedation in the emergency department: a systematic review Safety and clinical effectiveness of midazolam versus propofol for procedural sedation in the emergency department: a systematic review Hohl CM, Sadatsafavi M, Nosyk B, Anis AH CRD summary This review concluded that midazolam (...) and propofol were equally safe and effective for procedural sedation of adults in the emergency department, and that use of one agent over the other should be guided by resource utilisation and treatment costs. The authors’ conclusions appeared to reflect the evidence, but the limitations with the included studies should be borne in mind. Authors' objectives To compare the safety and effectiveness of midazolam and/or propofol for procedural sedation in adults in the emergency department. Searching PubMed
The use of propofol for medium and long-term sedation in critically ill adult patients: a meta-analysis Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.