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Query: UMLS:C0600097 (Sedation)
 1,337 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prolonged therapeutic paralysis with pancuronium is commonly used in ICUs to facilitate mechanical ventilation of patients with respiratory failure. Sedation is usually given concomitantly to reduce patient discomfort, but assessment of its adequacy is made difficult by the paralysis. We recently cared for a former ICU nurse who required prolonged mechanical ventilation and paralysis and received morphine as a sedative. When she recovered, she was able to relate her experiences. She stressed the need for very frequent reorientation to time and her desire for constant explanation and re-explanation of all procedures being done by the nursing and physician staff. Her experiences provide insights that allow all ICU staff to provide better care for patients requiring therapeutic paralysis.
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PMID:Perceptions of a critically ill patient experiencing therapeutic paralysis in an ICU. 669 Feb 10

Esophagogastroduodenoscopy is most commonly performed for evaluation of epigastric pain, severe heartburn, chronic nausea and other dyspepsia syndromes that are not relieved by medical therapy. It should not be performed as an in-office procedure in patients with unstable angina, respiratory failure, active upper gastrointestinal bleeding or hemodynamic instability. Although office esophagogastroduodenoscopy is safe for low-risk patients, the risks associated with anesthesia and the need for postprocedure observation may require other patients to undergo the procedure in a hospital setting. Use of a local anesthetic throat spray reduces the gag response that occurs when the endoscope is swallowed. Sedation is commonly achieved with intravenous administration of a benzodiazepine plus a narcotic, and the effects of these drugs can be rapidly reversed. Complications are rare and most frequently result from medications rather than from the procedure itself.
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PMID:Esophagogastroduodenoscopy for the family physician. 827 10

Introduction Termination of artificial life-support in critically-ill patients without chance of recovery or with severe damage is frequent in the intensive care unit (UCI). Patients and methodsWe studied the present situation concerning the withdrawal of life support in Spain using data collected over 10 years in referral hospitals with pediatric ICUs. Forty-nine patients were included, of which 43 had chronic diseases.ResultsThe most frequent causes of admission to the pediatric ICU in this type of patiens was respiratory failure followed by cardiovascular surgery. The family seemed to be a key element when taking a decision although in a few cases the medical team acted paternalistically. The most common ways of limiting life-support were withholding or withdrawing some treatments (mainly mechanical ventilation and vasoactive drugs) and implementing do-not-resuscitate orders. Sedation and suitable pain management were widely used in terminal care. After the decision to limit life-support was made, six patients were discharged from the pediatric ICU. ConclusionsAlthough each case should be treated individually, because of the wide variation found in the limitation of life-support, we suggest the need for common guidelines that could help the decision-making process.
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PMID:[End-of-life decision-making in critical care]. 1246 72

Bronchiolitis is a prevalent viral disease in infants. Many of these infants require hospital admission and mechanical ventilation due to respiratory failure or apnea. The clinical and pathophysiological spectrum of this disease can range from two extremes, obstructive and restrictive disease, on which the indication for mechanical ventilation and the modality used should be based. Non-invasive ventilation is especially indicated in both obstructive and hypoxemic restrictive patterns and a pressure-controlled modality is recommended. In obstructive patterns, air trapping must be monitored, while in restrictive patterns the addition of positive end-expiratory pressure (PEEP) is indicated. High-frequency oscillatory ventilation is indicated in restrictive patterns with sever hypoxemia despite conventional ventilatory support or in cases of significant air leak syndromes. In all cases, a permissive hypercapnia strategy is recommended to prevent barotrauma. Sedation and muscle relaxation should be considered to facilitate adaptation to the ventilator and to try to limit the risks of air trapping, air leak, and barotrauma.
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PMID:[Ventilation in special situations. Mechanical ventilation in bronchiolitis]. 1464 22

Sedation in children is increasingly emerging as a minimally invasive technique that may be associated with local anaesthesia or diagnostic and therapeutic procedures which do not necessarily require general anaesthesia. Standard monitoring requirements are not sufficient to ensure an effective control of pulmonary ventilation and deep sedation. Capnography in pediatric sedation assesses the effect of different drugs on the occurrence of respiratory failure and records early indicators of respiratory impairment. The Bispectral index (BIS) allows the reduction of dose requirements of anaesthetic drugs, the reduction in the time to extubation and eye opening, and the reduction in the time to discharge. In the field of pediatric sedation, capnography should be recommended to prevent respiratory complications, particularly in spontaneous ventilation. The use of the BIS index, however, needs further investigation due to a lack of evidence, especially in infants. In this paper, we will investigate the role of capnography and the BIS index in improving monitoring standards in pediatric sedation.
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PMID:Capnography and the bispectral index-their role in pediatric sedation: a brief review. 2097 66

Sedation in patients with acute or chronic respiratory disease needing ventilatory support is provocative. Agitation, anxiety and pain interfere with the measures to alleviate respiratory failure and to improve gas exchanges (invasive or non-invasive ventilation), while most sedatives and analgetics are respiratory depressants. Benzodiazepines, propofol and opioids are widely used, but it does not exist a consensus in medication selection, sedation and pain score scales recommended, implementation of protocols of sedation and recovery from the drugs administrated. The use of old and new sedative/analgesic medication, frequently combined, generates the need for understanding pharmacological interferences and for a strategy in preventing oversedation. Creating a specific protocol and guidelines in each respiratory ICU for sedation/analgesia in mechanically ventilated patients can improve outcome and reduce the ICU and hospital stay.
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PMID:[Sedation of patients with respiratory failure in ICU]. 2342 50

Use of ketamine in patients requiring extracorporeal membrane oxygenation (ECMO) has rarely been reported, and the optimal dosing strategy remains unclear. A patient admitted with hypoxic respiratory failure required ECMO in addition to continuous infusion of low-dose ketamine following titration of opioid and sedative medications to high doses. After initiation of ketamine, infusion rates of opioids and/or sedatives were maintained or decreased. Recorded Richmond Agitation-Sedation Scale (RASS) scores were -4 to -5 and documented pain scores were 0. No adverse effects were reported while receiving low-dose ketamine. This case illustrates that use of low-dose ketamine infusion may be a useful adjunctive agent in patients receiving ECMO and high-dose opioid and sedative medications.
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PMID:High-Dose Sedation and Analgesia During Extracorporeal Membrane Oxygenation: A Focus on the Adjunctive Use of Ketamine. 2686 21

Some patients are agitated and unable to tolerate conventional preoxygenation methods, including face mask oxygen or noninvasive positive-pressure ventilation. Sedation with ketamine for preoxygenation, also known as delayed sequence intubation, is a technique that can be used to achieve preoxygenation in this patient population. No complications of delayed sequence intubation have previously been reported. A 60-year-old woman presented with acute hypoxic respiratory failure. Despite application of high-flow oxygen (60 L/min) with a nonrebreather face mask, her oxygen saturation remained at 93%. She would not accept a noninvasive positive-pressure ventilation mask, although she remained alert, with vigorous respiratory effort. She received 25 mg of intravenous ketamine (0.31 mg/kg) to allow application of noninvasive positive-pressure ventilation. One minute after receiving ketamine, she developed apnea; bag-valve-mask ventilation was initiated, and she received succinylcholine and etomidate and was intubated on the first attempt, without complication. She had no respiratory effort between the onset of apnea and pharmacologic paralysis. Apnea can occur in critically ill patients who receive ketamine to facilitate preoxygenation. Sedation remains a valuable technique to enable optimal preoxygenation in agitated patients; however, clinicians should not perform this technique lightly and should be prepared to secure the patient's airway immediately.
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PMID:Apnea After Low-Dose Ketamine Sedation During Attempted Delayed Sequence Intubation. 2844 97

Sedation is generally required during endotracheal intubation and mechanical ventilation in infants and children. While there are many options for the provision of sedation, the most commonly used agents such as midazolam and fentanyl demonstrate a context-sensitive half-life, which may result in a prolonged effect when these agents are discontinued following a continuous infusion. We present a 20-month-old infant who required endotracheal intubation due to respiratory failure following seizures. At the referring hospital, multiple laryngoscopies were performed with the potential for airway trauma. To maximize rapid awakening and optimize respiratory function surrounding tracheal extubation, sedation was transitioned from fentanyl and midazolam to remifentanil for 18-24 hours prior to tracheal extubation. The unique pharmacokinetics of remifentanil are presented in this study, its use in this clinical scenario is discussed, and its potential applications in the pediatric intensive care unit setting are reviewed.
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PMID:Sedation with a remifentanil infusion to facilitate rapid awakening and tracheal extubation in an infant with a potentially compromised airway. 2782 8

Endoscopic procedures, such as transesophageal echocardiography, gastroscopy, and airway fibroscopy, routinely are performed in a heterogenous population of patients for diagnostic/interventional purposes (eg, transfemoral aortic valve replacement, airway fibroscopies, and intubation). Sedation frequently is administered to achieve an appropriate degree of patient compliance and procedure success. Patients with reduced respiratory reserve or those who are overly sedated, however, may develop hypoxia and respiratory failure during endoscopies, necessitating premature termination of the examination itself. In recent years, periprocedural noninvasive ventilation has been used to improve oxygenation and avoid general anesthesia. New technology has been developed, and noninvasive ventilation masks that allow for the insertion of an endoscopic probe have become available in clinical practice. Positive preliminary results have been reported in several clinical contexts, including traditional and hybrid operating rooms and intensive care units. Ventilatory support has been delivered during prolonged transesophageal cardiac examinations and interventions, broncoscopic maneuvers, and in difficult airway scenarios. Furthermore, the availability of innovative dedicated devices has allowed for some interventional procedures that require endoscopy to be peformed with the patient under sedation and on ventilatory support with noninvasive ventilation instead of general anesthesia. These approaches might be further expanded in the future and possibly reduce costs, organizational requirements, and complications compared using standard management with general anesthesia.
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PMID:Noninvasive Ventilation During Endoscopic Procedures: Rationale, Clinical Use, and Devices. 2931 19


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