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Latest & greatest articles for sedation
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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
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
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
Universal adoption of capnography for moderate sedation in adults 1 | Page 02/ 20 1 2 Statement Universal adoption of capnography for moderate sedation in adults undergoing upper endoscopy and colonoscopy has not been shown to improve patient safety or clinical outcomes and significantly increases costs for moderate sedation. Capnography is a method of physiologic monitoring that takes advantage of carbon dioxide properties of absorption in the near-infrared region of the electromagnetic (...) spectrum. This allows for a near continuous assessment of the carbon dioxide level throughout the respiratory cycle as well as a near real-time graphic assessment of respiratory activity. The American Society of Anesthesiologists’ Standards for Basic Anesthetic Monitoring was revised to further expand the role of capnography for procedural sedation and became effective July 1, 2011. (1) In section 3.2.4, this document recommends capnography monitoring to include moderate sedation commonly used
Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. Protocolized sedation and daily sedation interruption are 2 strategies to minimize sedation and reduce the duration of mechanical ventilation and intensive care unit (ICU) stay. We hypothesized that combining these strategies would augment the benefits.To compare protocolized sedation with protocolized sedation plus daily sedation interruption (...) in critically ill patients.Randomized controlled trial of 430 critically ill, mechanically ventilated adults conducted in 16 tertiary care medical and surgical ICUs in Canada and the United States between January 2008 and July 2011.Continuous opioid and/or benzodiazepine infusions and random allocation to protocolized sedation (n = 209) (control) or to protocolized sedation plus daily sedation interruption (n = 214). Using validated scales, nurses titrated infusions to achieve light sedation. For patients
Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. Long-term sedation with midazolam or propofol in intensive care units (ICUs) has serious adverse effects. Dexmedetomidine, an α(2)-agonist available for ICU sedation, may reduce the duration of mechanical ventilation and enhance patient comfort.To determine the efficacy of dexmedetomidine vs midazolam or propofol (preferred usual care) in maintaining sedation (...) sedation for more than 24 hours (midazolam, n = 251, vs dexmedetomidine, n = 249; propofol, n = 247, vs dexmedetomidine, n = 251).Sedation with dexmedetomidine, midazolam, or propofol; daily sedation stops; and spontaneous breathing trials.For each trial, we tested whether dexmedetomidine was noninferior to control with respect to proportion of time at target sedation level (measured by Richmond Agitation-Sedation Scale) and superior to control with respect to duration of mechanical ventilation
The utility of high-flow oxygen during emergency department procedural sedation and analgesia with propofol: a randomized, controlled trial We determine whether high-flow oxygen reduces the incidence of hypoxia by 20% in adults receiving propofol for emergency department (ED) sedation compared with room air.We randomized adults to receive 100% oxygen or compressed air at 15 L/minute by nonrebreather mask for 5 minutes before and during propofol procedural sedation. We administered 1.0 mg/kg (...) of propofol, followed by 0.5 mg/kg boluses until the patient was adequately sedated. Physicians and patients were blinded to the gas used. Hypoxia was defined a priori as an oxygen saturation less than 93%; respiratory depression was defined as an end tidal CO(2) greater than 50 mm Hg, a 10% absolute change from baseline, or loss of waveform.We noted significantly less hypoxia in the 59 patients receiving high-flow oxygen compared with the 58 receiving compressed air (19% versus 41%; P=.007; difference 23
Nurse-administered procedural sedation and analgesia in the cardiac catheter laboratory: an integrative review To identify and appraise the literature concerning nurse-administered procedural sedation and analgesia in the cardiac catheter laboratory.An integrative review method was chosen for this study. MEDLINE and CINAHL databases as well as The Cochrane Database of Systematic Reviews and the Joanna Briggs Institute were searched. Nineteen research articles and three clinical guidelines were (...) identified.The authors of each study reported nurse-administered sedation in the CCL is safe due to the low incidence of complications. However, a higher percentage of deeply sedated patients were reported to experience complications than moderately sedated patients. To confound this issue, one clinical guideline permits deep sedation without an anaesthetist present, while others recommend against it. All clinical guidelines recommend nurses are educated about sedation concepts. Other findings focus on pain
A prospective comparison of procedural sedation and ultrasound-guided interscalene nerve block for shoulder reduction in the emergency department Emergency physicians (EPs) are beginning to use ultrasound (US) guidance to perform regional nerve blocks. The primary objective of this study was to compare length of stay (LOS) in patients randomized to US-guided interscalene block or procedural sedation to facilitate reduction of shoulder dislocation in the emergency department (ED). The secondary (...) . A convenience sample of patients was randomized to either traditional procedural sedation or US-guided interscalene nerve block. Procedural sedation was performed with etomidate as the sole agent. Interscalene blocks were performed by hospital-credentialed EPs using sterile technique and a SonoSite MicroMaxx US machine with a high-frequency linear array transducer. Categorical variables were evaluated using Fisher's exact test, and continuous variables were analyzed using the Wilcoxon rank sum test.Forty
Conscious (Moderate) Sedation Can Be Used Safely On Patients With Obstructive Sleep Apnea UTCAT2112, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Conscious (Moderate) Sedation Can Be Used Safely On Patients With Obstructive Sleep Apnea Clinical Question Is conscious (moderate) sedation safe in patients with obstructive sleep apnea compared to patients without sleep apnea? Clinical Bottom Line Conscious (moderate (...) ) sedation is a safe practice in patients with obstructive sleep apnea, though doses may have to be adjusted compared to patients without OSA. 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) Gill/2011 Veteran population/ 200 patients with OSA, 200 without OSA (control group) Retrospective Chart Review Key results This was a retrospective study on moderate (IV) sedation during endoscopy. The control group
Lack of Evidence Suggests Caution in Using Nitrous Oxide Conscious Sedation in the Pregnant Dental Patient UTCAT2063, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Lack of Evidence Suggests Caution in Using Nitrous Oxide Conscious Sedation in the Pregnant Dental Patient Clinical Question In a healthy patient during a normal pregnancy, is it safe to use nitrous oxide conscious sedation? Clinical Bottom Line The use (...) into consideration. Because the synthetase activity has not been shown to affect humans, there may be special situations where nitrous oxide can be used safely in a pregnant patient. Applicability My two references are contradictory, and currently there are not enough human studies to support the use of nitrous oxide conscious sedation in a pregnant patient. UTHSCSA dental school policy will remain unchanged until further research is presented to fully confirm nitrous oxide safety in the pregnant patient
A randomized controlled trial of ketamine/propofol versus propofol alone for emergency department procedural sedation We compare the frequency of respiratory depression during emergency department procedural sedation with ketamine plus propofol versus propofol alone. Secondary outcomes are provider satisfaction, sedation quality, and total propofol dose.In this randomized, double-blind, placebo-controlled trial, healthy children and adults undergoing procedural sedation were pretreated (...) with intravenous fentanyl and then randomized to receive either intravenous ketamine 0.5 mg/kg or placebo. In both groups, this procedure was immediately followed by intravenous propofol 1 mg/kg, with repeated doses of 0.5 mg/kg as needed to achieve and maintain sedation. Respiratory depression was defined according to any of 5 predefined markers. Provider satisfaction was scored on a 5-point scale, sedation quality with the Colorado Behavioral Numerical Pain Scale, and propofol dose according to the total
Dreaming in sedation during spinal anesthesia: a comparison of propofol and midazolam infusion. Although sedation is often performed during spinal anesthesia, the details of intraoperative dreaming have not been reported. We designed this prospective study to compare 2 different IV sedation protocols (propofol and midazolam infusion) with respect to dreaming during sedation.Two hundred twenty adult patients were randomly assigned to 2 groups and received IV infusion of propofol or midazolam (...) for deep sedation during spinal anesthesia. Patients were interviewed on emergence and 30 minutes later to determine the incidence, content, and nature of their dreams. Postoperatively, patient satisfaction with the sedation was also evaluated.Two hundred fifteen patients (108 and 107 in the propofol and midazolam groups, respectively) were included in the final analysis. The proportion of dreamers was 39.8% (43/108) in the propofol group and 12.1% (13/107) in the midazolam group (odds ratio=4.78; 95
Effect of the centers for medicare & medicaid services policy about deep sedation on use of propofol. On 11 December 2009, the Centers for Medicare & Medicaid Services issued a policy stating that deep sedation can only be administered by an anesthesiologist, a certified registered nurse anesthetist, or a trained medical doctor or a doctor of osteopathy not involved in the performance of a medical procedure. Propofol is a popular sedation agent that is usually administered by anesthesia (...) specialists in a service termed monitored anesthesia care (MAC). Monitored anesthesia care adds substantial new fees to procedural sedation. However, available evidence shows that propofol can be used safely by non-anesthesiologists for procedural sedation. The American Society of Anesthesiologists considers that propofol implies deep sedation and should only be administered by anesthesia specialists. The Centers for Medicare & Medicaid Services policy on deep sedation can be viewed as supporting
Propofol for procedural sedation/anaesthesia in neonates. Elective medical or surgical procedures are commonplace for neonates admitted to NICU. Agents such as opioids are commonly used for achieving sedation/analgesia/anaesthesia for such procedures; however, these agents are associated with adverse effects. Propofol is used widely in paediatric and adult populations for this purpose. The efficacy and safety of the use of propofol in neonates has not been defined.To determine the efficacy (...) and safety of propofol treatment compared to placebo or no treatment or alternate active agents in neonates undergoing sedation or anaesthesia for procedures. To conduct subgroup analyses according to method of propofol administration (bolus or continuous infusion), type of active control agent (neuromuscular blocking agents with or without the use of sedative, analgesics or anxiolytics), type of procedure (endotracheal intubation, eye examination, other procedure), and gestational age (preterm and term
Pain relief for reduction of acute anterior shoulder dislocations: a prospective randomized study comparing intravenous sedation with intra-articular lidocaine The aim was to compare the effectiveness of intra-articular lidocaine (IAL) versus intravenous Demerol and Diazepam (IVS) in reduction of acute anterior shoulder dislocation.This is a prospective randomized study.Emergency room setting.Thirty-one dislocations reduced with IVS, whereas 32 patients were reduced using IAL.The visual analog
American College of Chest Physicians Consensus Statement on the Use of Topical Anesthesia, Analgesia, and Sedation During Flexible Bronchoscopy in Adult Patients CHEST Consensus Statement 1342 Consensus Statement Executive Summary Performing Bronchoscopy With No Sedation There is an equal safety record of sedation 1. vs no sedation in bronchoscopy, but patients’ satisfaction and procedure tol- erance are signi? cantly improved with sedation. Sedation is suggested in all patients un- 2. dergoing (...) bronchoscopy unless contra- indications exist. The extent of sedation (minimal, mod- 3. erate, deep, or general anesthesia) used during bronchoscopy can vary based on American College of Chest Physicians Consensus Statement on the Use of Topical Anesthesia, Analgesia, and Sedation During Flexible Bronchoscopy in Adult Patients Momen M. W ahidi , MD, MBA, FCCP ; Prasoon Jain , MD, FCCP ; Michael Jantz , MD, FCCP ; Pyng Lee , MD, FCCP ; G. Burkhard Mackensen , MD, PhD ; Sally Y . Barbour , PharmD ; Carla
Sedation in Conjunction with Transoesophageal Echocardiography The Cardiac Society of Australia and New Zealand Position Statement on Sedation in Conjunction with Transoesophageal Echocardiography Transoesophageal echocardiography is widely practised in Australia and New Zealand and is an invaluable diagnostic tool for a range of cardiological disorders. The Cardiac Society of Australia and New Zealand recognises that a variety of approaches in regard to sedation of patients for this technique (...) can be used. Some procedures are performed using topical pharyngeal anæsthesia without any sedation or similar adjunctive therapy. Many use topical pharyngeal anæsthesia in association with sedation. This is commonly achieved with intravenous benzodiazepine (e.g. Midazolam) alone or in combination with intravenous narcotic (e.g. Fentanyl). On occasions, transœsophageal echocardiography is performed under general anæsthesia and this approach is frequently used when transœsophageal echocardiography