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Latest & greatest articles for sedation
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The effect of intraoperative dexmedetomidine on postoperative analgesia and sedation in pediatric patients undergoing tonsillectomy and adenoidectomy The immediate postoperative period after tonsillectomy and adenoidectomy, one of the most common pediatric surgical procedures, is often difficult. These children frequently have severe pain but postoperative airway edema along with increased sensitivity to the respiratory-depressant effects of opioids may result in obstructive symptoms (...) and hypoxemia. Opioid consumption may be reduced by nonsteroidal antiinflammatory drugs, but these drugs may be associated with increased bleeding after this operation. Dexmedetomidine has mild analgesic properties, causes sedation without respiratory depression, and does not have an effect on coagulation. We designed a prospective, double-blind, randomized controlled study to determine the effects of intraoperative dexmedetomidine on postoperative recovery including pain, sedation, and hemodynamics
A cost-minimization analysis of dexmedetomidine compared with midazolam for long-term sedation in the intensive care unit To compare the intensive care unit costs and determine factors influencing these costs in mechanically ventilated patients randomized to dexmedetomidine or midazolam by continuous infusion.Cost minimization analysis of a double-blind, multicenter clinical trial randomizing patients 2:1 to receive dexmedetomidine or midazolam from the institutional perspective.Sixty-eight (...) intensive care units in the United States, Australia, New Zealand, Brazil, and Argentina.A total of 366 intubated intensive care unit patients anticipated to require sedation for >24 hrs.Intensive care unit resource use was compared within the two treatment arms, using the U.S. representative costs for these resources. The analyses characterized patient costs from start of study drug until intensive care unit discharge including costs associated with the intensive care unit stay, costs during mechanical
A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. 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. We aimed to establish whether duration of mechanical ventilation could be reduced with a protocol (...) of no sedation versus daily interruption of sedation.Of 428 patients assessed for eligibility, we enrolled 140 critically ill adult patients who were undergoing mechanical ventilation and were expected to need ventilation for more than 24 h. Patients were randomly assigned in a 1:1 ratio (unblinded) to receive: no sedation (n=70 patients); or sedation (20 mg/mL propofol for 48 h, 1 mg/mL midazolam thereafter) with daily interruption until awake (n=70, control group). Both groups were treated with bolus doses
2010LancetControlled trial quality: predicted high
Propofol for moderate sedation during colonoscopy Propofol for moderate sedation during colonoscopy Propofol for moderate sedation during colonoscopy 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. Report may be purchased from Citation Propofol for moderate sedation during colonoscopy . Lansdale: HAYES, Inc.. 2010 Authors' objectives Propofol (2,6-diisopropylphenol (...) ) is a short-acting, intravenous anesthetic agent, which has been used since the 1990s for inducing general anesthesia. Colonoscopists use propofol at lower concentrations to induce moderate to deep sedation. It is chemically unrelated to other central nervous system medications that are used to sedate patients during colonoscopy such as benzodiazepines. Propofol does not have an analgesic effect; therefore, for moderate sedation, propofol is combined with opiates or barbiturates. Project page URL Indexing
Review article: safety profile of propofol for paediatric procedural sedation in the emergency department Review article: safety profile of propofol for paediatric procedural sedation in the emergency department Review article: safety profile of propofol for paediatric procedural sedation in the emergency department Lamond DW CRD summary This review concluded that use of propofol for paediatric procedural sedation was associated with a low rate of minor adverse events and major adverse events (...) with propofol sedation were extremely rare. These conclusions should be interpreted cautiously given concerns about the review methods and the possibility of publication and language biases. Authors' objectives To assess the adverse events of propofol for paediatric procedural sedation in the emergency department. Searching MEDLINE, EMBASE and The Cochrane Library were searched from inception to December 2008 for studies in English. Search terms were reported. Reference lists of retrieved publications were
Cost-consequence analysis of remifentanil-based analgo-sedation vs conventional analgesia and sedation for patients on mechanical ventilation in the Netherlands 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.
Randomized clinical trial of propofol with and without alfentanil for deep procedural sedation in the emergency department The objectives were to compare the efficacy, occurrence of adverse events, and recovery duration of propofol with and without alfentanil for use in procedural sedation in the emergency department (ED).This was a randomized nonblinded prospective trial of adult patients undergoing procedural sedation for painful procedures in the ED. Patients with pain before the procedure (...) were given intravenous (IV) morphine sulfate until their pain was adequately treated at least 20 minutes before starting the procedure. Patients received 1 mg/kg propofol either with or without a supplemental dose of 10 mug/kg alfentanil for deep procedural sedation. Doses, vital signs, nasal end-tidal CO(2) (ETCO(2)), pulse oximetry, and bispectral electroencephalographic (EEG) analysis scores were recorded. Subclinical respiratory depression was defined as a change in ETCO(2) of >10 mmHg
Early cognitive impairment after sedation for colonoscopy: the effect of adding midazolam and/or fentanyl to propofol The sedative drug combination that produces minimal cognitive impairment and optimal operating conditions during colonoscopy has not been determined. We sought to determine if the use of propofol alone results in less cognitive impairment at discharge than the use of propofol plus midazolam and/or fentanyl in patients presenting for elective outpatient colonoscopy.Two hundred (...) adult patients presenting for elective outpatient colonoscopy were randomized to receive propofol alone or propofol plus midazolam, and/or fentanyl for IV sedation. Baseline cognitive function was measured using the computerized CogState test battery (Cogstate, Melbourne, Australia) before sedation. During the procedure, sedative drug doses, depth of sedation (via the bispectral index and observer's assessment of alertness/sedation score), complications, and treatability were recorded. Patients were
Randomized trial of light versus deep sedation on mental health after critical illness : To investigate if light sedation favorably affects subsequent patient mental health compared with deep sedation. Symptoms of posttraumatic stress disorder are common in patients after they have undergone prolonged mechanical ventilation and are associated with sedation depth.: Randomized, open-label, controlled trial.: Single tertiary care center.: Adult patients requiring mechanical ventilation.: Patients (...) were randomized to receive either light (patient awake and cooperative) or deep sedation (patient asleep, awakening upon physical stimulation).: Self-reported measures of posttraumatic stress disorder, anxiety, and depression were collected at intensive care unit discharge and 4 wks later. The primary outcomes were symptoms of posttraumatic stress disorder, anxiety, and depression 4 wks after intensive care unit discharge.A total of 137 patients were assigned to either the light (n = 69
Last-resort options for palliative sedation. Despite receiving state-of-the-art palliative care, some patients still experience severe suffering toward the end of life. Palliative sedation is a potential way to respond to such suffering, but access is uneven and unpredictable, in part because of confusion about different kinds of sedation. Proportionate palliative sedation (PPS) uses the minimum amount of sedation necessary to relieve refractory physical symptoms at the very end of life (...) . To relieve suffering may require progressive increases in sedation, sometimes to the point of unconsciousness, but consciousness is maintained if possible. Palliative sedation with the intended end point of unconsciousness (PSU) is a more controversial practice that may be considered for much fewer refractory cases. There is more ethical consensus about PPS than PSU. In this article, the authors explore the clinical, ethical, and legal issues associated with these practices. They recommend
A critical review of daily sedation interruption in the intensive care unit Daily sedation interruption (DSI) has been proposed as a method of improving sedation management of critically ill patients by reducing the adverse effects of continuous sedation infusions.To critique the research regarding daily sedation interruption, to inform education, research and practice in this area of intensive care practice.Literature review.Medline, CINAHL and Web of Science were searched for relevant key (...) , USA and Canada.DSI improves patients' physiological and psychological outcomes when compared with routine sedation management. However, research relating to these findings has methodological limitations, such as the use of homogenous samples, single-centre trials and retrospective design, thus limiting their generalisability.DSI may provide clinicians with a simple, cost-effective method of reducing some adverse effects of sedation on ICU patients. However, the evidence supporting DSI is limited
Randomized clinical trial of Entonox versus midazolam-fentanyl sedation for colonoscopy Intravenous sedation for colonoscopy is associated with cardiorespiratory complications and delayed recovery. The aim of this randomized clinical trial was to compare the efficacy of Entonox (50 per cent nitrous oxide and 50 per cent oxygen) and intravenous sedation using midazolam-fentanyl for colonoscopy.Some 131 patients undergoing elective colonoscopy were included. Patients completed a Hospital Anxiety
General anaesthesia or conscious sedation for reducing a dislocated hip prosthesis? BestBets: General anaesthesia or conscious sedation for reducing a dislocated hip prosthesis? General anaesthesia or conscious sedation for reducing a dislocated hip prosthesis? Report By: Nick Payne - Consultant in Emergency Medicine Search checked by Steve Jones - Consultant in Critical Care and Emergency Medicine Institution: Wythenshawe Hospital and Manchester Royal Infirmary Date Submitted: 1st March 2000 (...) Date Completed: 11th March 2009 Last Modified: 11th March 2009 Status: Green (complete) Three Part Question In [patients with dislocated hip prosthesis] does [general anaesthesia or conscious sedation] give a [better reduction rate]? Clinical Scenario An otherwise fit 71-year old lady presents to your department having slipped on the ballroom floor during a tea dance. She is unable to weight bear and has pain in her left hip. X-ray reveals a dislocation of her hip prosthesis, and she tells you
A phase 3, randomized, double-blind study to assess the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy Fospropofol disodium is a water-soluble prodrug of propofol with unique pharmacokinetic/pharmacodynamic properties. This randomized, double-blind, multicenter study evaluated the use of fospropofol in patients undergoing flexible bronchoscopy.Patients >or= 18 years of age were randomized (2:3) to receive fospropofol, 2 (...) mg/kg or 6.5 mg/kg, after pretreatment with fentanyl, 50 microg. Supplemental doses of each were given per protocol. The primary end point was sedation success, which was defined as follows: three consecutive Modified Observer's Assessment of Alertness/Sedation scores of
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 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 under 18 years.We evaluated the intra- and post-operative morbidity, effectiveness and cost effectiveness of sedation versus general anaesthesia for the provision of dental treatment for under 18 year olds.We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library; Issue 4, 2008); MEDLINE (OVID) (1950 to October Week 2, 2008); EMBASE (OVID) (1974 to Week 42, 2008); System for information on Grey Literature
Predictors of emesis and recovery agitation with emergency department ketamine sedation: an individual-patient data meta-analysis of 8,282 children 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.
Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. Gamma-aminobutyric acid receptor agonist medications are the most commonly used sedatives for intensive care unit (ICU) patients, yet preliminary evidence indicates that the alpha(2) agonist dexmedetomidine may have distinct advantages.To compare the efficacy and safety of prolonged sedation with dexmedetomidine vs midazolam for mechanically ventilated patients.Prospective, double-blind, randomized trial (...) conducted in 68 centers in 5 countries between March 2005 and August 2007 among 375 medical/surgical ICU patients with expected mechanical ventilation for more than 24 hours. Sedation level and delirium were assessed using the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method for the ICU.Dexmedetomidine (0.2-1.4 microg/kg per hour [n = 244]) or midazolam (0.02-0.1 mg/kg per hour [n = 122]) titrated to achieve light sedation (RASS scores between -2 and +1) from enrollment until
Subdissociative-dose ketamine versus fentanyl for analgesia during propofol procedural sedation: a randomized clinical trial The authors sought to compare the safety and efficacy of subdissociative-dose ketamine versus fentanyl as adjunct analgesics for emergency department (ED) procedural sedation and analgesia (PSA) with propofol.This double-blind, randomized trial enrolled American Society of Anesthesiology (ASA) Class I or II ED patients, aged 14-65 years, requiring PSA for orthopedic (...) reduction or abscess drainage. Subjects received 0.3 mg/kg ketamine or 1.5 mug/kg fentanyl intravenously (IV), followed by IV propofol titrated to deep sedation. Supplemental oxygen was not routinely administered. The primary outcomes were the frequency and severity of cardiorespiratory events and interventions, rated using a composite intrasedation event rating scale. Secondary outcomes included the frequency of specific scale component events, propofol doses required to achieve and maintain sedation