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Latest & greatest articles for sedation
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Sedation for Patients in ICU 1 Intensive Care Society Review of Best Practice for Analgesia and Sedation in the Critical Care EDITORS: Tony Whitehouse*, Catherine Snelson*, Mike Grounds§ CONTRIBUTING AUTHORS: Mike Grounds§, Catherine Snelson*, Tony Whitehouse*, Jeremy Willson*, Laura Tulloch ‡ , Lucie Linhartova ‡ , Anwar Shah * , Richard Pierson ‡ , Kaye England* June 2014 On Behalf of the Sedation Committee of the Intensive Care Society United Kingdom * Consultant Critical Care (...) contained within them, especially drug doses, is correct by way of independent sources. The authors accept no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in the review. Should you find any errors in this document, they should be reported to the Intensive Care Society. 3 2 Contents 1 Disclaimer 2 2 Contents 3 3 Index of Tables and Figures 8 4 Abbreviations 9 5 Introduction 10 6 Factors that affect the requirement for sedation
The complexity of nurses' attitudes and practice of sedation at the end of life: a systematic literature review 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.
Comparison of the bispectral index monitor with the Comfort score in assessing level of sedation of critically ill children PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
State Behavioral Scale: A sedation assessment instrument for infants and young children supported on mechanical ventilation PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Opioid-sparing effect of preemptive bolus low-dose ketamine for moderate sedation in opioid abusers undergoing extracorporeal shock wave lithotripsy: a randomized clinical trial Ketamine has been used as part of a multimodal analgesia regime in opioid abusers undergoing general anesthesia. We studied the opioid-sparing effect of a very low-dose bolus of ketamine as part of moderate sedation for opioid abuse patients undergoing extracorporeal shock wave lithotripsy.In this randomized, placebo (...) -controlled clinical trial, 190 opioid abusers were enrolled. They were stratified into 2 blocks based on their daily opioid consumption. Both blocks were then randomized to receive 0.1 mg/kg IV ketamine (group K) or placebo (group P). Lithotripsy was performed under moderate sedation with intermittent bolus doses of remifentanil (0.2 µg/kg) to alleviate pain. The total remifentanil dose (primary outcome) and respiratory adverse events (secondary outcome) were compared in the 2 groups.Remifentanil
Safe Sedation Practice for Healthcare Procedures: Standards and Guidance Safe Sedation Practice for Healthcare Procedures Standards and Guidance October 20131 Safe Sedation Practice for Healthcare Procedures Academy of Medical Royal Colleges 2 Executive Summary 4 Working Party Members 5 Introduction 6 Background to Implementing and Ensuring Safe Sedation Practice for Healthcare Procedures in Adults 2001 1 7 What has changed in the last 12 years? 10 Definitions – what is sedation? 12 Practical (...) components of good sedation practice 12 The target state 13 Pre-assessment 13 Information and consent 14 Fasting 15 Patient management and choice of technique for conscious sedation 15 Titration to effect 16 Multiple drugs and anaesthetic drugs/infusions 18 Use of antagonist drugs 18 Extremes of age – the very young, the elderly and frail, or at-risk patient 19 Monitoring and the use of supplementary oxygen 20 The team and the role of the operator-sedationist 21 Factors supporting the case for dedicated
Propofol-based versus dexmedetomidine-based sedation in cardiac surgery patients Propofol-based versus dexmedetomidine-based sedation in cardiac surgery patients Propofol-based versus dexmedetomidine-based sedation in cardiac surgery patients Curtis JA, Hollinger MK, Jain HB 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 aimed to evaluate the clinical outcomes and costs of sedation regimens, containing propofol or dexmedetomidine, after cardiac surgery. The authors concluded that dexmedetomidine-based sedation was clinically beneficial, with similar mortality and total hospital charges. The study methods and results were well reported, apart from the cost details. The results were susceptible to bias, and the authors
Dexmedetomidine for sedation of cardiac surgical patients Dexmedetomidine for sedation of cardiac surgical patients Dexmedetomidine for sedation of cardiac surgical patients Mitchell MD, Fishman N, Umscheid CA Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation Mitchell MD, Fishman N, Umscheid CA. Dexmedetomidine for sedation of cardiac surgical patients
Procedural Sedation for Diagnostic Imaging in Children by Pediatric Hospitalists using Propofol: Analysis of the Nature, Frequency, and Predictors of Adverse Events and Interventions PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Palliative sedation in end-of-life care and survival: a systematic review Palliative sedation in end-of-life care and survival: a systematic review Palliative sedation in end-of-life care and survival: a systematic review Maltoni M, Scarpi E, Rosati M, Derni S, Fabbri L, Martini F, Amadori D, Nanni O CRD summary The review found that palliative sedation in terminally ill adults with cancer, when appropriately indicated and used correctly, did not appear to have a detrimental effect on survival (...) . The reliability of the authors' conclusions is unclear because of the low quality of the included studies, lack of reporting of study quality details and some limitations of the review process. Authors' objectives To evaluate the effect of palliative sedation on survival in patients with advanced cancer. Searching MEDLINE and EMBASE were searched from January 1980 to December 2010 to identify studies published in English. Search terms were reported. A manual search of the bibliographies of identified articles
Sedation versus general anaesthesia for provision of dental treatment in under 18 year olds. A significant proportion of children have caries requiring restorations or extractions, and some of these children will not accept this treatment under local anaesthetic. Historically this has been managed in children by the use of a general anaesthetic, however use of sedation may lead to reduced morbidity and cost. The aim of this review is to compare the efficiency of sedation versus general (...) anaesthesia for the provision of dental treatment for children and adolescents aged under 18 years.This review was originally published in 2009 and updated in 2012.We evaluated the intra- and postoperative morbidity, effectiveness and cost effectiveness of sedation versus general anaesthesia for the provision of dental treatment for under 18 year olds.In this updated review we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7); MEDLINE (Ovid) (1950
Chloral hydrate or midazolam: which is better for sedating children for painless diagnostic imaging? BestBets: Chloral hydrate or midazolam: which is better for sedating children for painless diagnostic imaging? Chloral hydrate or midazolam: which is better for sedating children for painless diagnostic imaging? Report By: Dr Michelle Hare - Consultant in Paediatrics Institution: Sheffield Children's Hospital, Western Bank, Sheffield, South Yorkshire, UK Date Submitted: 14th September 2012 Last (...) Modified: 14th September 2012 Status: Green (complete) Three Part Question In [children who require sedation for painless diagnostic imaging] is [chloral hydrate better than midazolam] in achieving [effective and safe sedation]? Clinical Scenario A 2-year-old child is acutely admitted at night to a district general hospital following a prolonged focal seizure. A CT scan of the head without sedation fails as the child is too active and distressed, and as the on-call paediatric registrar, you
Safe and effective procedural sedation for gastrointestinal endoscopy in children Safe and effective procedural sedation for gastrointestinal endoscopy in children Safe and effective procedural sedation for gastrointestinal endoscopy in children Van Beek EJ, Leroy PL CRD summary The review concluded that propofol-based therapy was the most effective regimen for procedural sedation during gastrointestinal endoscopy in children. Given the potential for bias in the review process, limitations (...) in quality assessments, and variation in study outcomes, the authors' conclusions may not be reliable. Authors' objectives To assess the safety and effectiveness of procedural sedation in children undergoing gastrointestinal endoscopy. Searching MEDLINE, EMBASE and The Cochrane Library were searched for published studies from January 1995 up to January 2011; search terms were reported. Reference lists of retrieved articles, reviews, editorials and guidelines were also searched. Study selection Studies
Conscious Sedation in Dentistry Scottish Dental Clinical Effectiveness Programme - SDCEP Scottish Dental Clinical Effectiveness Programme Navigate this website Welcome The Scottish Dental Clinical Effectiveness Programme (SDCEP) provides user-friendly, evidence-based guidance to support dental teams to provide high quality healthcare that is safe, effective and person centred. SDCEP works in partnership with the (TRiaDS) collaboration, the (SDPBRN) , the (QIiPT) , and the (SDPF). These comprise
In IV sedation used for dental surgery, neither fentanyl or nalbuphine more effective as an analgesic UTCAT2298, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title In IV Sedation Used for Dental Surgery, Neither Fentanyl or Nalbuphine More Effective As An Analgesic Clinical Question In a patient undergoing IV moderate conscious sedation associated with dental surgery, is fentanyl or nalbuphine more effective as a peri (...) -operative analgesic? Clinical Bottom Line Neither fentanyl or nalbuphine is shown to have a clinical advantage as a peri-operative analgesic associated with IV moderate sedation in the dental office. Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) Dolan/1998 50 patients, ASA 1 or 2 RCT Key results Dental surgery patients who required IV sedation, were given equipotent doses of either fentanyl or nalbuphine
Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Ketamine-propofol combination (ketofol) versus propofol alone for emergency department procedural sedation and analgesia: a randomized double-blind trial We determine whether a 1:1 mixture of ketamine and propofol (ketofol) for emergency department (ED) procedural sedation results in a 13% or more absolute reduction in adverse respiratory events compared with propofol alone.Participants were randomized to receive either ketofol or propofol in a double-blind fashion. Inclusion criteria were aged (...) 14 years or older and American Society of Anesthesiology class 1 to 3 status. The primary outcome was the number and proportion of patients experiencing an adverse respiratory event as defined by the Quebec Criteria. Secondary outcomes were sedation consistency, efficacy, and time; induction time; and adverse events.A total of 284 patients were enrolled, 142 per group. Forty-three (30%) patients experienced an adverse respiratory event in the ketofol group compared with 46 (32%) in the propofol
Capnographic Monitoring Reduces the Incidence of Arterial Oxygen Desaturation and Hypoxemia During Propofol Sedation for Colonoscopy: A Randomized, Controlled Study (ColoCap Study) The aim of this randomized study was to determine whether intervention based on additional capnographic monitoring reduces the incidence of arterial oxygen desaturation during propofol sedation for colonoscopy.Patients (American Society of Anesthesiologists classification (ASA) 1-3) scheduled for colonoscopy under (...) propofol sedation were randomly assigned to either a control arm with standard monitoring (standard arm) or an interventional arm in which additional capnographic monitoring (capnography arm) was available. In both study arms, detection of apnea or altered respiration induced withholding propofol administration, stimulation of the patient, chin lift maneuver, or further measures. The primary study end point was the incidence of arterial oxygen desaturation (defined as a fall in oxygen saturation (SaO(2
Procedural sedation with propofol for painful orthopaedic manipulation in the emergency department expedites patient management compared with a midazolam/ketamine regimen: a randomized prospective study The use of procedural sedation and analgesia to allow painful orthopaedic manipulations in the emergency department has become a standard practice over the last decade. Both propofol and midazolam/ketamine are attractive sedative regimens for routine use in the emergency department. We (...) hypothesized that sedation with propofol as compared with midazolam/ketamine will save time in the emergency department. The purpose of the present study was to compare the recovery time, the total sedation time, and the adverse events of procedural sedation and analgesia induced with propofol as compared with midazolam/ketamine.This prospective randomized study was conducted in the emergency department of a tertiary care, university-affiliated medical center. All sedations and orthopaedic manipulations
Should capnography be routinely used during procedural sedation in the Emergency Department? BestBets: Should capnography be routinely used during procedural sedation in the Emergency Department? Should capnography be routinely used during procedural sedation in the Emergency Department? Report By: Dr Fiona Burton - ST6 Emergency Medicine Search checked by Mr Philip Anderson - Consultant Emergency Medicine Institution: Western Infirmary Date Submitted: 25th April 2011 Date Completed: 13th (...) February 2012 Last Modified: 15th February 2012 Status: Green (complete) Three Part Question In [a patient undergoing procedural sedation], does [the use of capnogrpahy] [reduce adverse respiratory events]? Clinical Scenario A 35 year old man has a dislocated shoulder that will need to be reduced. He will require sedation and will be monitored with standard monitoring (ECG, BP, SpO2). You wonder if addition of capnography would be beneficial for the patient? Search Strategy Ovid MEDLINE 1948