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Latest & greatest articles for sedation
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Effect of Conscious Sedation vs General Anesthesia on Early Neurological Improvement Among Patients With Ischemic Stroke Undergoing Endovascular Thrombectomy: A Randomized Clinical Trial. Optimal management of sedation and airway during thrombectomy for acute ischemic stroke is controversial due to lack of evidence from randomized trials.To assess whether conscious sedation is superior to general anesthesia for early neurological improvement among patients receiving stroke thrombectomy.SIESTA (...) (Sedation vs Intubation for Endovascular Stroke Treatment), a single-center, randomized, parallel-group, open-label treatment trial with blinded outcome evaluation conducted at Heidelberg University Hospital in Germany (April 2014-February 2016) included 150 patients with acute ischemic stroke in the anterior circulation, higher National Institutes of Health Stroke Scale (NIHSS) score (>10), and isolated/combined occlusion at any level of the internal carotid or middle cerebral artery.Patients were
Early Bispectral Index and Sedation Requirements During Therapeutic Hypothermia Predict Neurologic Recovery Following Cardiac Arrest PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Propofol or Ketofol for Procedural Sedation and Analgesia in Emergency Medicine-The POKER Study: A Randomized Double-Blind Clinical Trial We determine whether emergency physician-provided deep sedation with 1:1 ketofol versus propofol results in fewer adverse respiratory events requiring physician intervention when used for procedural sedation and analgesia.Consenting patients requiring deep sedation were randomized to receive either ketofol or propofol in a double-blind fashion according (...) to a weight-based dosing schedule. The primary outcome was the occurrence of a respiratory adverse event (desaturation, apnea, or hypoventilation) requiring an intervention by the sedating physician. Secondary outcomes included hypotension and patient satisfaction.Five hundred seventy-three patients were enrolled and randomized, 292 in the propofol group and 281 in the ketofol group. Five percent in the propofol group and 3% in the ketofol group met the primary outcome, an absolute difference of 2% (95
Moderate Procedural Sedation in Adult Patients: Guidelines Moderate Procedural Sedation in Adult Patients: Guidelines | CADTH.ca Find the information you need Moderate Procedural Sedation in Adult Patients: Guidelines Moderate Procedural Sedation in Adult Patients: Guidelines Published on: September 26, 2016 Project Number: RB1025-000 Product Line: Research Type: Devices and Systems Report Type: Summary of Abstracts Result type: Report Question What are the evidence-based guidelines regarding (...) moderate procedural sedation for adult patients? Key Message Three evidence-based guidelines were identified regarding moderate procedural sedation for adult patients. Tags anesthesia, diagnostic tests, digestive system, emergency medicine, analgesia, analgesics, benzodiazepines, conscious sedation, diagnostic imaging, emergency medical services, emergency service, hospital, emergency treatment, endoscopy, endoscopy, digestive system, etomidate, fentanyl, hypnotics and sedatives, midazolam, morphine
Dexmedetomidine for ICU Sedation: a Cost-Effectiveness Analysis Dexmedetomidine for ICU Sedation: a Cost-Effectiveness Analysis | CADTH.ca Find the information you need Dexmedetomidine for ICU Sedation: a Cost-Effectiveness Analysis Dexmedetomidine for ICU Sedation: a Cost-Effectiveness Analysis Published on: September 8, 2016 Project Number: HT0015 Product Line: Technology Review Research Type: Devices and Systems Result type: Report The number of drugs available for sedation of patients (...) in the intensive care unit (ICU) is limited, with both benzodiazepines and propofol being commonly used. Dexmedetomidine is a selective alpha-2 adrenergic agonist with sedative properties; it produces a pattern of sedation different from other drugs. The choice of sedative drugs in the ICU setting is important, as the drug selected can affect patient outcomes, making their use an important formulary policy decision for acute-care hospitals. Decisions will be made from a quality of care and a budgetary
Dexmedetomidine for ICU Sedation Dexmedetomidine for ICU Sedation: a Cost-Effectiveness Analysis | CADTH.ca Find the information you need Dexmedetomidine for ICU Sedation: a Cost-Effectiveness Analysis Dexmedetomidine for ICU Sedation: a Cost-Effectiveness Analysis Published on: September 8, 2016 Project Number: HT0015 Product Line: Technology Review Research Type: Devices and Systems Result type: Report The number of drugs available for sedation of patients in the intensive care unit (ICU (...) ) is limited, with both benzodiazepines and propofol being commonly used. Dexmedetomidine is a selective alpha-2 adrenergic agonist with sedative properties; it produces a pattern of sedation different from other drugs. The choice of sedative drugs in the ICU setting is important, as the drug selected can affect patient outcomes, making their use an important formulary policy decision for acute-care hospitals. Decisions will be made from a quality of care and a budgetary perspective, as substantial cost
What Works and What's Safe in Pediatric Emergency Procedural Sedation: An Overview of Reviews Sedation is increasingly used to facilitate procedures on children in emergency departments (EDs). This overview of systematic reviews (SRs) examines the safety and efficacy of sedative agents commonly used for procedural sedation in children in the ED or similar settings.We followed standard SR methods: comprehensive search; dual study selection, quality assessment, data extraction. We included SRs (...) of children (1 month to 18 years) where the indication for sedation was procedure-related and performed in the ED.Fourteen SRs were included (210 primary studies). The most data were available for propofol (six reviews/50,472 sedations) followed by ketamine (7/8,238), nitrous oxide (5/8,220), and midazolam (4/4,978). Inconsistent conclusions for propofol were reported across six reviews. Half concluded that propofol was sufficiently safe; three reviews noted a higher occurrence of adverse events
Inadequate Sedation During Therapeutic Paralysis: Use of Bispectral Index in Critically Ill Patients Patients receiving therapeutic paralysis may experience inadequate sedation due to intrinsic limitations of behavioral sedation assessment. Bispectral index (BIS™) provides an objective measure of sedation; however, the role of BIS™ is not well defined in intensive care unit (ICU) patients on neuromuscular blocking agents (NMBA).The aim of this study was to delineate the relationship between BIS (...) ™ and level of sedation for critically ill patients during therapeutic paralysis.This was a retrospective observational study conducted in ICU patients receiving continuous infusion NMBA and BIS™ monitoring. The primary endpoint was the correlation of BIS™ <60 during therapeutic paralysis with a Richmond Agitation Sedation Score (RASS) of -4 to -5 (i.e., deep or unarousable sedation) at the time of emergence from therapeutic paralysis.Thirty-one patients were included in the analysis. Three
Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: A randomized controlled trial PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Virtual Reality for Pediatric Sedation: A Randomized Controlled Trial Using Simulation. Team training for procedural sedation for pediatric residents has traditionally consisted of didactic presentations and simulated scenarios using high-fidelity mannequins. We assessed the effectiveness of a virtual reality module in teaching preparation for and management of sedation for procedures.After developing a virtual reality environment in Second Life® (Linden Lab, San Francisco, CA) where providers (...) perform and recover patients from procedural sedation, we conducted a randomized controlled trial to assess the effectiveness of the virtual reality module versus a traditional web-based educational module. A 20 question pre- and post-test was administered to assess knowledge change. All subjects participated in a simulated pediatric procedural sedation scenario that was video recorded for review and assessed using a 32-point checklist. A brief survey elicited feedback on the virtual reality module
The Optimal Dose for Oral Midazolam in Order to Achieve Effective Sedation Levels in Pediatric Patients is 0.75mg/kg, as shown by a single trial of ninety patients. UTCAT3045, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title The Optimal Dose for Oral Midazolam in Order to Achieve Effective Sedation Levels in Pediatric Patients is 0.75mg/kg, as shown by a single trial of ninety patients. Clinical Question What (...) is the optimal dosage of oral midazolam in order to achieve effective sedation levels in pediatric dental patients? Clinical Bottom Line For pediatric dental patients, the oral dose of midazolam of 0.75mg/kg has a high level of sedation and cooperation, without increasing adverse effects, as opposed to the standard dose of 0.5mg/kg. This is based on a single trial of ninety patients. Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type
Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures AMERICAN ACADEMY OF PEDIATRIC DENTISTRY RECOMMENDATIONS: BEST PRACTICES 287 Introduction The number of diagnostic and minor surgical procedures per- formed on pediatric patients outside of the traditional operating room setting has increased in the past several decades. As a consequence of this change and the increased awareness of the importance of providing analgesia (...) and anxiolysis, the need for sedation for procedures in physicians’ offices, dental offices, subspecialty procedure suites, imaging facilities, emergency departments, other inpatient hospital settings, and ambulatory surgery centers also has increased markedly. 1–52 In recognition of this need for both elective and emergency use of sedation in nontraditional settings, the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) have published a series of guidelines
SCAI/CCAS/SPA Expert Consensus Statement for Anesthesia and Sedation Practice: Recommendations for Patients Undergoing Diagnostic and Therapeutic Procedures in the Pediatric and Congenital Cardiac Catheterization Laboratory Core Curriculum SCAI/CCAS/SPA Expert Consensus Statement for Anesthesia and Sedation Practice: Recommendations for Patients Undergoing Diagnostic and Therapeutic Procedures in the Pediatric and Congenital Cardiac Catheterization Laboratory Kirsten C. Odegard, 1 MD (Co-Chair (...) ), Robert Vincent, 2 * MD, FSCAI, FACC (Co-Chair), Rahul Baijal, 3 MD, SuAnne Daves, 4 MD, Robert Gray, 5 MD, Alex Javois, 6 MD, Barry Love, 7 MD, Phil Moore, 8 MD, FSCAI, David Nykanen, 9 MD, FSCAI, Lori Riegger, 10 MD, Scott G. Walker, 11 MD, and Elizabeth C. Wilson 2 MD Current practice of sedation and anesthesia for patients undergoing pediatric congenital cardiac catheterization laboratory (PCCCL) procedures is known to vary among institu- tions,amulti
Practice Advisory: FDA Warnings Regarding Use of General Anesthetics and Sedation Drugs in Young Children and Pregnant Women Practice Advisory: FDA Warnings Regarding Use of General Anesthetics and Sedation Drugs in Young Children and Pregnant Women - ACOG Menu ▼ Practice Advisory: FDA Warnings Regarding Use of General Anesthetics and Sedation Drugs in Young Children and Pregnant Women Page Navigation ▼ Share: Practice Advisory: FDA Warnings Regarding Use of General Anesthetics and Sedation (...) Drugs in Young Children and Pregnant Women December 21, 2016 This is an area of evolving care and practice. Fellows should check periodically for revisions and updates. ACOG will communicate important changes and updates to these guidelines. On December 14, 2016, the U.S. Food and Drug Administration (FDA) published a Drug Safety Communications entitled " " (1,2). In this announcement, the FDA announced that it will require warnings to be added to the labels of general anesthetic and sedation drugs
Colonoscopy Outcomes by Duration of NPO Status Prior to Colonoscopy with Moderate or Deep Sedation Department of Veterans Affairs Health Services Research & Development Service Evidence-based Synthesis Program Colonoscopy Outcomes by Duration of NPO Status Prior to Colonoscopy with Moderate or Deep Sedation January 2015 Prepared for: Department of Veterans Affairs Veterans Health Administration Quality Enhancement Research Initiative Health Services Research & Development Service Washington, DC (...) new ESP topics of importance to Veterans and the VA healthcare system. Comments on this evidence report are welcome and can be sent to Nicole Floyd, ESP Coordinating Center Program Manager, at Nicole.Floyd@va.gov. Recommended citation: Example: Shaukat A, Wels J, Malhotra A, Greer N, MacDonald R, Carlyle M, Rutks I, and Wilt T J. Colonoscopy Outcomes by Duration of NPO Status Prior to Colonoscopy with Moderate or Deep Sedation. VA ESP Project #09-009; 2015. This report is based on research
Prospective evaluation of sedation-related adverse events in pediatric patients ventilated for acute respiratory failure PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Sedation versus general anaesthesia for provision of dental treatment to patients younger than 18 years. 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 by the use of a general anaesthetic in children; however, use of sedation may lead to reduced morbidity and cost. The aim of this review was to compare the efficiency of sedation versus (...) general anaesthesia (GA) for provision of dental treatment to children and adolescents younger than 18 years. This review was originally published in 2009 and was updated in 2012 and again in 2015.We will evaluate morbidity and effectiveness of sedation versus GA for provision of dental treatment to patients younger than 18 years. If data become available, we will analyse the cost-effectiveness of different interventions. If data are not available, we will obtain crude estimates of cost.Morbidity can
The Diagnostic Performance of the Richmond Agitation Sedation Scale for Detecting Delirium in Older Emergency Department Patients Delirium is frequently missed in older emergency department (ED) patients. Brief (<2 minutes) delirium assessments have been validated for the ED, but some ED health care providers may consider them to be cumbersome. The Richmond Agitation Sedation Scale (RASS) is an observational scale that quantifies level of consciousness and takes less than 10 seconds to perform
Guidance on the provision of anaesthesia services for sedation 2015 Document Store | The Royal College of Anaesthetists User menu Search Document Store This page displays listings of ALL publications added to the site. You can narrow down the list by entering keywords in the 'Search' field, and selecting 'Apply'. To filter the publications by section, tick the check-boxes of the desired sections, and select 'Apply'. You can set the ordering of the results by the publication title
Standards for Conscious Sedation in the Provision of Dental Care Standards for Conscious Sedation in the Provision of Dental Care The dental faculties of the royal colleges of surgeons and the Royal College of Anaesthetists 2015 Report of the Intercollegiate Advisory Committee for Sedation in Dentistry2 Executive summary 03 Committee members 04 Foreword 06 Introduction 07 Options for care 08 Preparation for sedation 10 Consent for treatment 10 Patient information 11 Fasting 12 Clinical (...) environment for sedation 13 Nature of the clinical team for sedation 14 Techniques of sedation 15 Essential principles of safe sedation practice 15 Specific techniques 16 Peri-operative care 18 Monitoring 18 Complications 18 Recovery, discharge and aftercare 19 Clinical governance and audit 20 Education and training 21 Sections Section 1: Care pathways 23 Section 2: Clinical sedation techniques 25 Section 3: Peri-operative care 30 Section 4: Patient information 32 Section 5: Education and training 34