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

Sedation administration and agitation management are fundamental activities in any intensive care unit. A lack of objective measures of agitation and sedation, as well as poor understanding of the underlying dynamics, contribute to inefficient outcomes and expensive healthcare. Recent models of agitation-sedation dynamics have enhanced understanding of the underlying dynamics and enable development of advanced protocols for semi-automated sedation administration. In this research, the agitation-sedation model parameters are identified using an integral-based fitting method developed in this work. Parameter variance is then analysed over 37 intensive care unit patients. The parameter identification method is shown to be effective and computationally inexpensive, making it suited to real-time clinical control applications. Sedative sensitivity, an important model parameter, is found to be both patient-specific and time-varying. However, while the variation between patients is observed to be as large as a factor 10, the observed variation in time is smaller, and varies slowly over a period of days rather than hours. The high fitted model performance across all patients show that the agitation-sedation model presented captures the fundamental dynamics of the agitation-sedation system. Overall, these results provide additional insight into the system and clinical dynamics of sedation management.
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PMID:Parameter identification and sedative sensitivity analysis of an agitation-sedation model. 1693 60

Terminal illnesses can cause distressing symptoms such as severe pain, mental confusions, feelings of suffocation, and agitation. Despite skilled palliative care in some cases these symptoms may not respond to standard interventions. After all other means to provide comfort and relief to a dying patient have been tried and are unsuccessful, clinical caregivers and patients can consider palliative sedation. Sedation in the context of palliative medicine is the monitored use of medications to induce varying degrees of unconsciousness to bring about a state of decreased or absent awareness in order to relieve the burden of otherwise refractory suffering. Palliative sedation is not intended to cause death or shorten life. The patient and family should agree with plans for palliative sedation. Because cases involving palliative sedation are emotionally stressful, the patient, family, and health care workers can all benefit from talking about the complex medical, ethical, and emotional issues they raise.
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PMID:[Palliative sedation]. 1721 42

The goal of the study was to compare the reliability and validity of 3 Sedation Agitation Scale. Two nurses and a physician conducted 130 observations simultaneously. They found an excellent interrater reliability in the Richmond Agitation Sedation Scale (r>0.86), and high correlations between the Richmond Agitation Sedation Scale and the Sedation Agitation Scale and Visual Analog Scale scales (r=0.92, r=0.85). The research findings will help to assert Richmond Agitation Sedation Scale as a daily assessment tool in the intensive care unit, and it will pave the way for construction a sedation protocol according to the Richmond Agitation Sedation Scale level.
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PMID:"Between the fixed and the changing": examining and comparing reliability and validity of 3 sedation-agitation measuring scales. 1731 12

We encountered two cases of diphenhydramine-containing hypnotics overdose, exhibiting delirium and involuntary choreic movement. In case 1, a 32-year-old man ingested 24 tablets of Drewell, each containing 25 mg diphenhydramine, in a suicidal attempt. About four hours after ingestion, he showed generalized convulsion, delirium, and involuntary choreic movements. Intravenous diazepam was ineffective and he was sedated with continuous infusion of propofol. About 15 hours after ingestion and on discontinuing the sedation, he became alert and did not show any neurological abnormality. The blood concentration of diphenhydramine, measured by liquid chromatography/electrospray mass spectrometry (LC/MS), was 1.26 microg/ mL. In case 2, a 24-year-old woman ingested 114 tablets of Drewell and was admitted to our hospital. Her consciousness was impaired and she was treated with intravenous fluids. About four hours after ingestion, she became restless and showed confusion, agitation, and involuntary choreic movements. Sedation with continuous propofol infusion was required. She awoke the next day on discontinuing the sedation, and she did not show any neurological abnormalities. The blood concentration of diphenhydramine was 2.37 microg/mL. It is suggested that physicians should be aware of psychotic-like symptoms and choreic involuntary movement in patients with diphenhydramine-containing hypnotics overdose.
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PMID:[Diphenhydramine poisoning presented with psychotic-like symptoms and choreic involuntary movement: report of two cases]. 1753 63

Atypical antipsychotics will continue to be prescribed for the behavioral symptoms of dementia in the absence of more effective, better tolerated, and safer alternatives. The evidence base, although incomplete, suggests that modest treatment effect sizes are offset by risk of considerable adverse effects. How might this information be best applied to clinical practice? Non-pharmacologic strategies should be implemented in routine clinical practice. Placebo-controlled clinical trials of individual antipsychotic agents have historically reported high placebo response rates; CATIE-AD reported that the sum total of the risk/benefit equation of atypical antipsychotic therapy was no greater than that achieved by placebo. CATIE-AD was designed to study the effectiveness of atypical antipsychotic treatment in community dwelling patients with AD. It is uncertain whether the results can be generalized to the populations of dementia patients residing in nursing homes with more severe cognitive and behavioral impairment. There is some suggestion that nursing home patients with dementia complicated by severe behavioral symptoms, particularly agitation and aggression without accompanying psychosis, might achieve greater benefit from atypical antipsychotic treatment than patients with milder behavioral symptoms. The finding that dementia patients without psychosis may respond more robustly to antipsychotic treatment seems counterintuitive, but may support the hypothesis that the neurobiology of the "psychosis of AD" differs from the psychosis of schizophrenia or bipolar disease. Adverse effects associated with antipsychotic therapy should be aggressively monitored throughout therapy. Treatment-emergent sedation was associated with all of the atypical antipsychotics in CATIE-AD and is probably an important mediator of mortality risk in patients with dementia. Sedation exacerbates pre-existing cognitive impairment and increases the risk of complications such as aspiration pneumonia, so concomitant use of benzodiazepines should be discouraged or limited to short periods with careful observation.' Once initiated, the effectiveness and tolerability of antipsychotic therapy should be evaluated routinely. In Alzheimer's disease, the severity and frequency of behavioral symptoms often decreases as illness progresses. In a stable patient, it is prudent to attempt to taper and discontinue the antipsychotic after 2-8 months of therapy. Better understanding of the potential adverse effects of antipsychotic therapy has increased interest in the effects of the dementia-specific medications on behavioral symptoms. Reductions in neuropsychiatric symptoms have been reported from trials of individual cholinesterase inhibitors, memantine monotherapy, and memantine combined with donepezil in AD patients. Studies of small numbers of patients in open trials of cholinesterase inhibitors (donepezil, rivastigmine, galantamine) and one double-blind placebo controlled trial (rivastigmine) have reported varying degrees of improvement of behavioral symptoms and psychosis of dementia with Lewy bodies (DLB). Delusions, hallucinations, apathy, and agitation/aggression are cited as the symptom categories most likely to show significant improvement. Since few of these studies were prospectively designed to study behavioral symptoms, results must be interpreted cautiously. Treatment of behavioral symptoms in AD and other dementias is challenging. The limitations of current approaches drive the search for effective, well tolerated therapies.
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PMID:Atypical antipsychotics for the treatment of dementia-related behaviors: an update. 1763 94

Multiple studies have been undertaken to show that neurofunction monitors can correlate to objective sedation assessments. Showing a correlation between these 2 patient assessments tools may not be the correct approach for validation of neurofunction monitors. Two different methods of assessing 2 different modes of the patient's response to sedation should not be expected to precisely correlate unless the desire is to replace one method with the other. We provide a brief summary of several sedation scales, physiologic measures and neurofunction monitoring tools, and correlations literature for bispectral index monitoring, and the Ramsay Scale and the Sedation Agitation Scale. Neurofunction monitors provide near continuous information about a different domain of the sedation response than intermittent observational assessments. Further research should focus on contributions from this technology to the improvement of patient outcomes when neurofunction monitoring is used as a complement, not a replacement, for observational methods of sedation assessment.
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PMID:Perspectives on sedation assessment in critical care. 1797 12

This study determined the inter-rater reliability of the Sedation-Agitation Scale (SAS) when used by staff in a tertiary level general intensive care unit (ICU). The study was designed to answer the question in the 'real world', with minimum patient exclusion criteria, do nurses and doctors rate ICU patient's sedation levels using the SAS similarly? A convenient sample of 35 nursing and seven medical staff and a randomly selected sample of 69 patients were used. A nurse and a doctor rated each patient simultaneously using the SAS, with a systematic five-stage arousal process. The results showed that there was exact agreement between the nurses' and doctors' scores in 74% of assessments. The weighted kappa finding of 0.82 indicates very good agreement (reliability). The mean SAS scores recorded for nurses (2.33+/-1.21) and doctors (2.36+/-1.35) were similar. Intraclass correlations for single measures (r=.921, p<.001) and average measures (r=.959, p<.001) indicated individuals who completed multiple ratings did not introduce bias. Where there was a difference between the paired ratings, these were only one level of the SAS away from each other. This research indicates nurses and doctors rate patients' levels of sedation similarly using the SAS. It also provides support for the use of the instrument in general ICUs outside the USA. Research is now needed to determine the value of the SAS in guiding clinical decision-making related to sedation management.
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PMID:Reliability of the Sedation-Agitation Scale between nurses and doctors. 1820 72

Once analgesia is assured, sedation has special relevance in the critically ill ventilated patient's global treatment. Sedatives should be adjusted to individual needs, by administering minimal effective doses to achieve the AIM. This aim must be clearly identified, defined at the beginning of the treatment and revised on a regular basis, ideally at least once per shift. Sedation strategies should foresee the different needs throughout the day within dynamic sedation concept framework. Required sedation depth depends on the patient's psychological characteristics, foreseen evolution and patient tolerance to the support techniques used in treatment. Sedation monitoring permits identification and correction of under- or over-sedation, either of which could negatively influence critically ill patient evolution. The over-sedation concept must be applied to all situations where patients receive more sedation than required. This Spanish Society of Critical Care Medicine's Analgesia and Sedation Work Group recommends the Richmond Agitation Sedation Scale, due to its interrelationship with the Confusion Assessment Method Scale (CAM-ICU), for sedation monitoring in patients under light sedation while it recommends bispectral index sedation monitoring in patients under deep sedation. In the latter case, maintaining values under 40 on the bispectral index doesn't produce any benefits except in patients who require a maximum decrease in neuronal metabolism. To avoid recall phenomena, bispectral monitoring is highly advisable in patients treated with neuromuscular blockers.
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PMID:[Monitoring of sedation]. 1840 38

Management of analgesia and sedation in the intensive care unit requires evaluation and monitoring of key parameters in order to detect and quantify pain and agitation, and to quantify sedation. The routine use of subjective scales for pain, agitation, and sedation promotes more effective management, including patient-focused titration of medications to specific end-points. The need for frequent measurement reflects the dynamic nature of pain, agitation, and sedation, which change constantly in critically ill patients. Further, close monitoring promotes repeated evaluation of response to therapy, thus helping to avoid over-sedation and to eliminate pain and agitation. Pain assessment tools include self-report (often using a numeric pain scale) for communicative patients and pain scales that incorporate observed behaviors and physiologic measures for noncommunicative patients. Some of these tools have undergone validity testing but more work is needed. Sedation-agitation scales can be used to identify and quantify agitation, and to grade the depth of sedation. Some scales incorporate a step-wise assessment of response to increasingly noxious stimuli and a brief assessment of cognition to define levels of consciousness; these tools can often be quickly performed and easily recalled. Many of the sedation-agitation scales have been extensively tested for inter-rater reliability and validated against a variety of parameters. Objective measurement of indicators of consciousness and brain function, such as with processed electroencephalography signals, holds considerable promise, but has not achieved widespread implementation. Further clarification of the roles of these tools, particularly within the context of patient safety, is needed, as is further technology development to eliminate artifacts and investigation to demonstrate added value.
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PMID:Evaluating and monitoring analgesia and sedation in the intensive care unit. 1849 53

A 22-year-old male patient with autism and epilepsy was scheduled to undergo impacted third molar extractions at an outpatient setting. Oral preanesthetic medication with dexmedetomidine and subsequent midazolam with ketamine was acceptable and effective to place intravenous cannula. General anesthesia was maintained with intravenous propofol and dexmedetomidine and operation was performed uneventfully. Sedation with intravenous dexmedetomidine was continued after operation to attenuate and/or manage postoperative problems, such as emergence agitation, dysphoric reactions, pain, opioid-related nausea/vomiting and seizure. He recovered from postoperative sedation and was discharged home without significant problems. Oral and intravenous dexmedetomidine was useful for anesthetic care in the uncooperative patient.
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PMID:[Ambulatory anesthesia for an adult patient with autism and epilepsy: sedation using oral and intravenous dexmedetomidine]. 1854 4


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