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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

Triazolam is increasing in popularity as a premedication prescribed by dentists to help their fearful and anxious patients tolerate the potentially aversive nature of some dental procedures. Recent anecdotal reports suggest that incremental sublingual dosing of triazolam may be an effective technique for producing conscious sedation in the dental setting. Although promising, no laboratory or clinical data have been available to evaluate the efficacy or safety of this approach. This study was designed to determine the pharmacokinetics and sedative effects of incremental sublingual dosing of triazolam (total, 1.0 mg) in healthy adults. Ten healthy adult volunteers received sublingual triazolam (0.25 mg) followed by additional doses after 60 (0.50 mg) and 90 (0.25 mg) minutes. Plasma triazolam concentrations, clinical effects (Observer's Assessment of Alertness/Sedation score), and processed electroencephalogram (bispectral index score) were measured intermittently for 3 hours. Plasma triazolam concentrations (mean +/- SD, 5.1 +/- 1.1 ng/mL) and drug effects (Observer's Assessment of Alertness/Sedation score, 2 +/- 1; and the bispectral index score, 62 +/- 16) were greatest in all subjects at the end of the 3-hour evaluation period. Eight of the subjects had Observer's Assessment of Alertness/Sedation scores consistent with the definition of deep sedation or general anesthesia (Observer's Assessment of Alertness/Sedation score, <3) at some of the later time points in the 180 minutes of data collection. In comparison, 4 of the subjects had bispectral index scores less than 60 during these later time points of data collection. Given the considerable intersubject variability in triazolam concentrations and effects, additional research is needed to assess this multidosing strategy before it can be endorsed as a useful and safe sedation technique for managing fearful and anxious patients in dental practice.
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PMID:Pharmacokinetics and clinical effects of multidose sublingual triazolam in healthy volunteers. 1641 96

Fear of dentistry is a pervasive and persistent phenomenon that contributes to avoidance of dental care and results in a substantial public health problem. While the use of incremental enteral sedation has increased, there is a paucity of published evidence to evaluate its safety. This study sought to assess the safety of individualized dosing of enteral sedation for adults in the dental outpatient setting. The authors sent a mail survey to members of the Dental Organization for Conscious Sedation (DOCS) concerning their practice and practitioner characteristics. Anonymous treatment forms with monitoring records were collected from respondents and analyzed for pre-specified adverse event criteria. The majority of respondents reported practicing incremental enteral sedation for two to five years, accounting for less than 10% of their practice. Incremental enteral sedation, either alone or in combination with nitrous oxide and oxygen, was used most frequently. Monitoring with both pulse oximetry and automated blood pressure (BP) were prevalent. Triazolam was the drug used most commonly for enteral sedation. Of the 7740 cases submitted, 1686 (21.8%) met event criteria; the most frequent event was a decrease of more than 25% in diastolic BP from pre-drug baseline. Neither provider training nor the percentage of practices engaged in incremental enteral sedation were associated with any event; however, practicing incremental enteral sedation for less than 12 months was a significant predictor of any event (p = 0.001). Risk of having an event was not related to practice factors (that is, the time spent practicing incremental enteral sedation, the percentage of the practice devoted to practicing incremental enteral sedation, the number of cases performed, or the type of monitoring) or training factors. This survey represents the largest number of subjects reported in the literature concerning enteral sedation. These observations provide evidence for the safety of enteral sedation when these drugs and combinations are administered by properly-trained dentists who monitor patients with pulse oximetry, BP measurement, and direct observation.
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PMID:Evidence of safety for individualized dosing of enteral sedation. 1789 17

Previous work described the pharmacokinetics and clinical effects of multidose sublingual triazolam (Halcion; Pharmacia & Upjohn Co, Kalamazoo, Mich). This laboratory study evaluated the hypothesis that incremental dosing of triazolam produces dose-dependent central nervous system depression that is profound and long lasting. Forty-nine healthy adults between the ages of 21 and 39 years, not receiving dental treatment, were randomly assigned to placebo (n = 12) or 1 of 3 triazolam groups (0.25-mg single dose, n = 12; 0.5 mg divided between 2 equal doses for 60 minutes, n = 12; or 0.75 mg divided among 3 doses for 90 minutes, n = 13). Plasma triazolam concentrations were determined. Bispectral index (BIS) and the Observer Assessment of Alertness/Sedation scale were used to assess sedation. Plasma triazolam concentrations increased with time in all subjects, with Tmax and Cmax both increasing dose dependently. Compared with placebo, all dosing paradigms produced dose-dependent BIS suppression and sedation. The single dose of 0.25 mg reached its peak BIS suppression at 90 (81 +/- 7) minutes and sedation at 120 (3.6 +/- 0.5) minutes and returned to baseline before 360 minutes. In contrast, incremental dosing of 0.5 and 0.75 mg produced profound and long-lasting BIS suppression and sedation that did not plateau until either 180 or 210 minutes as measured by the BIS index (67 +/- 14 and 60 +/- 16 at 0.5 and 0.75 mg, respectively) and 150 minutes as measured by the Observer Assessment of Alertness/Sedation scale (3.2 +/- 1.0 and 2.7 +/- 0.4 at 0.5 and 0.75 mg, respectively). These data more fully characterize the effects of incremental dosing with sublingual triazolam and provide additional insight for discharge safety recommendations.
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PMID:Expanded studies of the pharmacokinetics and clinical effects of multidose sublingual triazolam in healthy volunteers. 1974 41