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

Heavy i.v. sedation is often used in upper GI endoscopy. Sedation, however, creates the need for recovery facilities and precludes patients from returning to their normal daily activities. This is undesirable, since endoscopy is routinely performed as an out-patient procedure. Also the cost for medication and recovery facilities militate against the indiscriminate use of i.v. sedative premedication. The present study was undertaken in an attempt to establish what proportion of patients can benefit from oral premedication, and whether such an administration route can eliminate some of the disadvantages associated with i.v. sedation. Four hundred out-patients were randomized to receive orally either triazolam, 0.125 mg, or placebo. Of the patients, 359 were evaluable; 177 received placebo and 182 triazolam. All major aspects of the procedure were covered using visual analogue scale questionnaires for the endoscopist and patient. There were no differences in endoscopic experience, or sex and age distribution between the groups. Triazolam reduced patient discomfort, 38.6 +/- 25.6 vs 44.8 +/- 30.1 (p = 0.0379). Recollection of post-endoscopy information was the same in both groups. One patient complained of drowsiness following the procedure. No patient needed to stay in hospital to complete recovery. Endoscopy quality was identical in the two groups. Oral premedication has the potential to be of significant value, may optimize the use of endoscopy resources, and does not impair patient activities post-endoscopy.
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PMID:Oral sedation for diagnostic upper endoscopy. 191 46

A prospective, randomized study was performed in 87 patients to compare the safety, efficacy and dose requirements of two sedation techniques for stereotactic headframe application. Sedation administration and headframe application averaged 30 min. Fifty patients weighing 76 +/- 13 kg (mean +/- SD) received mean doses of 154 micrograms fentanyl plus 5.5 mg droperidol i.v. (FD group). An additional 37 patients weighing 76 +/- 19 kg received mean doses of 127 micrograms fentanyl plus 6.7 mg Valium (diazepam; FV group). Both treatments provided excellent hemodynamic stability and a low incidence of adverse side effects while providing adequate analgesia and sedation. The incidence of anesthetist-assessed patient anxiety and discomfort was more favorable in the FD group.
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PMID:Sedation for stereotactic headframe application: a randomized comparison of two techniques. 332 51

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

During regional anaesthesia, sedation can be used to obviate any discomfort which is unrelated to a technical insufficiency of the block or a particular anxiety of the patient. Sedation increases the acceptability of the technique by the patient. The main characteristics of propofol are its short onset time of action, and the rapid reversibility of its effects after the end of its administration. For induction of anaesthesia, propofol is given as a bolus injection, an average dose being 10 to 20 mg. Maintenance is best achieved with a continuous infusion, at a rate of 3 to 4 mg.kg-1.h-1. Titration of propofol allows the ideal stage of sedation to be reached (MacKenzie Grade 3), followed by a fast recovery. Close monitoring of the patient is mandatory and should include clinical supervision and pulse oximetry in all cases.
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PMID:[Use of Diprivan in addition to locoregional anesthesia]. 787 54

Seventy-two healthy dogs required sedation and analgesia for a variety of procedures causing discomfort or pain. They were treated either with the alpha 2-agonist medetomidine at 40 micrograms/kg (15 intravenously and 17 intramuscularly), or 80 micrograms/kg (15 intravenously and 15 intramuscularly) or with xylazine plus l-methadone (1.0 mg)(10 intravenously). The levels of sedation, analgesia and safety were compared clinically and by measurements of the effects on the electrocardiogram (ECG) and blood gases, body temperature, haematology and clinical chemistry. Sedation was achieved reliably with both medetomidine and xylazine plus l-methadone but its onset, depth and duration were influenced by the dose and route of administration. In the medetomidine-treated dogs, intravenous administration resulted in more rapid sedation and the effects of the higher dose were deeper and longer lasting. The small dogs receiving 40 micrograms/kg may have been underdosed. The initial analgesic effects in response to a pin prick to the body surface were sufficient and similar for both drugs, except for the intramuscular dose of 40 micrograms/kg medetomidine. Analgesia for the clinical procedures was less reliable with medetomidine and was not always adequate even at the high dose, but xylazine plus l-methadone assured analgesia in almost every case. Medetomidine resulted in marked bradycardia, lasting as long as the sedation and the ECG revealed a sinus arrhythmia with sinoatrial and atrioventricular blocks grade I and II as a sign of interference with transduction. The bradycardia with xylazine plus l-methadone was less pronounced. A decrease in respiratory rate accompanying sedation had no influence on blood gases and blood acidity in the dogs treated with medetomidine but caused a respiratory acidosis with xylazine plus l-methadone. Body temperature decreased with all treatments for the duration of the period of sedation. Blood glucose concentration increased to a similar extent in all treatment groups, but all other haematological and clinicochemical variables remained unchanged. Treatment with the specific alpha 2 antagonist, atipamezole, reversed the sedation and cardiovascular and pulmonary effects due to medetomidine within minutes.
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PMID:Clinical comparison of medetomidine with xylazine/l-methadone in dogs. 865 Sep 15

At Flinders Medical Centre in Adelaide, eye surgery under local anaesthesia (peribulbar block) has been carried out in the day ophthalmic surgery unit since 1987. In a subset of 536 patients, 112 patients required additional anaesthesia (supplementary retrobulbar block or regional muscle infiltration) to achieve full ocular paresis, and 10 patients required intraoperative supplementation of anaesthesia because of discomfort. Six patients had their surgery postponed (one had a retrobulbar haemorrhage and five became anxious after the procedure commenced). Sedation was rarely required and there were no adverse effects of the anaesthetic on surgical procedures or patients' vision. The authors conclude that peribulbar block provides satisfactory anaesthesia and that day ophthalmic surgery is safe and effective.
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PMID:Day ophthalmic surgery: aspects of perioperative care. 915 52

Sedation, anesthesia, protection of the airway during general anesthesia, and control of pain in the perioperative period are important considerations in the management of sheep, goats, and cattle. Though ruminants are classically considered farm animals and are often intended for the production of food and fiber, these species are used extensively in research and teaching and they are increasingly important as companion animals. Whatever their use may be, anesthetic and analgesic drugs and techniques should be used to ensure minimal stress and discomfort during the perioperative period.
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PMID:General anesthetic techniques in ruminants. 891 91

Sedation is being used increasingly in children to allay anxiety and discomfort. Sedation can also increase the efficiency of performing both diagnostic and therapeutic procedures in children. There are a wide array of available sedation methods that are used by radiologists, gastroenterologists, hematologists/oncologists and emergency room physicians everyday. Indiscriminate use of sedatives has led to seizures, respiratory arrests and death in a variety of practice settings. With improved monitoring capability, more potent drugs and better understanding of the pharmacokinetics in children, it is possible to provide batter care.
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PMID:Sedation in pediatric patients. 1082 60

A nationwide prospective study was conducted in France in 89 university and primary referral hospitals' liver units to evaluate practices of liver biopsy and the occurrence of complications. A total of 2,084 biopsies were analyzed, recording the indication, hemostasis parameters, experience of operator, route of biopsy, use of ultrasonography (US), type of hospitalization, side effects, and complications. Pain, anxiety, and discomfort were evaluated by patients by visual analogue scale (VAS). Biopsies were performed by experienced physicians (>150 procedures performed) in 72%, and hepato-gastroenterologists in 89% of the cases. Hepatitis C was the indication in 54%. Sedation or premedication (atropine) was given in 46%. US-guidance was used in 56% of the cases. A day-care procedure was used in 27%. No deaths occurred, but severe complications were observed in 0.57% and increased with the number of passes and decreased with experience of operator, use of atropine, and US-guidance. Pain was independently related to general anesthesia, experience of the operator, female sex, and hepatitis C. Anxiety was increased in women. Discomfort was increased by venous access and decreased with an experienced operator. Acceptance of additional biopsies was related to a day-care procedure and independently related to general anesthesia and multiples passes. This study showed that (1) liver biopsy procedures vary greatly in France, (2) hepatitis C is the main indication for liver biopsy at present, (3) US-guidance should be developed to reduce severe complications, and (4) day-care procedures increase acceptance of a future biopsy and should also be used more often.
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PMID:Practices of liver biopsy in France: results of a prospective nationwide survey. For the Group of Epidemiology of the French Association for the Study of the Liver (AFEF). 1096 Apr 38

Sedation allows patients to tolerate unpleasant procedures while maintaining adequate cardiorespiratory function and the ability to respond purposefully to verbal command. For ophthalmic surgery patient's anxiety and discomfort can be relieved during placement of a peribulbar block and during surgery by intravenous sedation. Intravenous sedation should only be administered by an anesthetist. Three different classes of drugs are used for intravenous sedation: analgesics (fentanyl and alfentanil), benzodiazepines (midazolam) and profofol, an intravenous anesthetic. Sedation may result in ventilatory, cardiovascular and neurologic complications. Excessive sedation can induce hypoventilation from central ventilatory depression or airway obstruction. Uncontrolled and unexpected movements of the head could result in major surgical complications. For the prevention of the complications related to sedation the same monitoring as for general anesthesia is essential.
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PMID:[Premedication and sedation complications during ophthalmic anesthesia]. 1108 50


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