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Latest & greatest articles for sedation
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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
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
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
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
2008LancetControlled trial quality: predicted high
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.
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
A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures 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.
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
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
Midazolam or ketamine for procedural sedation of children in the emergency department BestBets: Midazolam or ketamine for procedural sedation of children in the emergency department Midazolam or ketamine for procedural sedation of children in the emergency department Report By: Andrew Munro - Specialist in Emergency Medicine FACEM Search checked by Ian Machonochie - Consultant in Paediatric Emergency Medicine Institution: Coffs Harbour Base Hospital, NSW, Australia Date Submitted: 28th May 2003 (...) Date Completed: 27th July 2007 Last Modified: 18th June 2007 Status: Green (complete) Three Part Question In [children needing painful procedures in the emergency department] is [ midazolam or ketamine] [ safer and more effective at achieving conscious sedation]? Clinical Scenario A mother brings her five year old son to the Emergency Department (ED) with a deep scalp laceration having fallen onto the corner of a coffee table. The wound requires sutures. For various reasons the option
Routine follow-up visits not necessary after third molar removal under sedation. This was a randomised controlled trial (RCT) conducted in the US.People were recruited to the trial who required surgical removal of at least two impacted third molars under intravenous sedation on an outpatient basis. They were treated by board-certified oral and maxillofacial surgeons. Participants were divided randomly into two groups: the first was given a 2-week postoperative follow-up appointment (...) ).A routine follow-up visit following third molar removal under intravenous sedation is not necessary in patients aged between 15 and 35 years. Pre-operative and postoperative instructions should be clear, however. A selective review policy may be appropriate if a patient is mentally retarded, is taking psychoactive drugs, or has an intra-operative complications or a has made a complaint via telephone.
Low-dose ketamine in addition to propofol for procedural sedation and analgesia in the emergency department Low-dose ketamine in addition to propofol for procedural sedation and analgesia in the emergency department Low-dose ketamine in addition to propofol for procedural sedation and analgesia in the emergency department Loh G, Dalen D CRD summary This review concluded that there is insufficient evidence to recommend the routine use of low-dose ketamine combined with propofol for procedural (...) sedation in the emergency department setting. Although the review has a number of weaknesses, this conclusion is appropriate. Authors' objectives To evaluate the safety and efficacy of low-dose intravenous ketamine with intravenous propofol for sedation and analgesia during emergency department procedures. Searching MEDLINE, EMBASE, BioMed Central, the Cochrane Library, International Pharmaceutical Abstracts and Google Scholar were searched from inception to February 2007; key search terms were
Does music reduce anxiety during invasive procedures with procedural sedation: an integrative research review Does music reduce anxiety during invasive procedures with procedural sedation: an integrative research review Does music reduce anxiety during invasive procedures with procedural sedation: an integrative research review Vanderboom T CRD summary The review concluded that music therapy may be effective in lowering blood pressure and reducing medication requirements for participants who (...) underwent invasive procedures. Weak results and differences between studies made the author recommend further research. The reliability of the author's cautious conclusions are uncertain due to lack of reporting of review methods and details of individual studies including results. Authors' objectives To evaluate the effectiveness of music therapy in reducing anxiety during invasive procedures with procedural sedation. Searching CINAHL, The Cochrane Library, Expanded Academic Index, Proquest, PsycINFO
Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. Lorazepam is currently recommended for sustained sedation of mechanically ventilated intensive care unit (ICU) patients, but this and other benzodiazepine drugs may contribute to acute brain dysfunction, ie, delirium and coma, associated with prolonged hospital stays, costs, and increased mortality. Dexmedetomidine induces sedation via (...) different central nervous system receptors than the benzodiazepine drugs and may lower the risk of acute brain dysfunction.To determine whether dexmedetomidine reduces the duration of delirium and coma in mechanically ventilated ICU patients while providing adequate sedation as compared with lorazepam.Double-blind, randomized controlled trial of 106 adult mechanically ventilated medical and surgical ICU patients at 2 tertiary care centers between August 2004 and April 2006. Patients were sedated