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

We investigated analgesia and the adverse effects of epidural sufentanil infusion in a double-blind randomized study of 37 patients undergoing thoracic surgery. Sufentanil 1 microgram/mL was administered at a thoracic (Ts, n = 12) or lumbar level (Ls, n = 11), or combined with bupivacaine 1 mg/mL at a thoracic level (Tsb, n = 14). Postoperatively, the epidural infusion rate was titrated (4-20 mL/h) according to the visual analog pain scale when assessed during function (VAS-F) or the occurrence of side effects. When epidural analgesia failed, nonsteroidal antiinflammatory drugs (NSAIDs) were given. VAS-F was lowest in the Tsb group (Tsb < Ts = Ls) despite its having both the lowest rate of epidural infusion (Tsb < Ts < Ls) and need of additional NSAIDs (Tsb < Ts = Ls). Sedation (Tsb < Ts < Ls) and hypercapnia (Tsb = Ts < Ls) occurred most frequently in the Ls group. Vital capacity (VC) was reduced in all groups by 43%-58% (Ls > Ts) and had recovered only partially at 24 h after discontinuation of the epidural infusion. The slopes of the ventilatory response (minute ventilation [VE], inspiratory flow, and mouth occlusion pressure at 0.1 s [P0.1]) to 7% CO2 decreased during treatment in Ls, Ts, and Tsb groups at the most by 73%, 55%, and 52% (not significant [NS] between groups), 59%, 45%, and 38% (NS between groups), and 81%, 43%, and 18% (Ls > Tsb), respectively. Twenty-four hours after discontinuation of the epidural infusion, there was a complete recovery of the VE, inspiratory flow, and P0.1 response to CO2 in the Tsb group only. The study shows that, after thoracotomy, epidural sufentanil analgesia is optimal when tailored to the site of nociceptive input and combined with bupivacaine.
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PMID:The analgesic efficacy and adverse effects of continuous epidural sufentanil and bupivacaine infusion after thoracotomy. 869 25

Propofol (P) is increasingly used as a sedative during regional anesthesia. Providing titratable sedation and rapid recovery, it can compromise hemodynamic stability. However, in combination with ketamine (K), it provides stable hemodynamics during total intravenous anesthesia, avoiding emergence phenomena. We compared the efficacy, respiratory and hemodynamic profiles, and side effects of these two sedative regimes in patients undergoing spinal anesthesia. Forty patients, ASA physical status I and II, undergoing urologic or orthopedic procedures were randomly assigned to one of two groups (n = 20 each). Group 1 (P + K) received initial doses of 0.4 mg/kg P, 0.1 mg/kg K, followed by an intravenous infusion of 1.2 mg x kg(-1) x h(-1) and 0.3 mg x kg(-1) x h(-1), respectively. Group 2 (P) received bolus 0.5 mg/kg and infusion 1.5 mg x kg(-1) x h(-1). Subsequent infusion rates were titrated to a predetermined sedation level using a 5-point score. Heart rate, arterial pressure, respiratory rate, oxygen saturation end-tidal CO2, and oxygen requirements were recorded. Sedation scores were similar for both groups. There was no difference in total propofol requirements between Group 1 (146 +/- 94 mg) and Group 2 (137 +/- 52 mg) (mean +/- SD). Mean arterial pressure was significantly higher in the P + K group, e.g., 91 mm Hg (86-94) vs 75 mm Hg (69-83) at 30 min (mean +/- SD). Administration of vasopressors and fluids as well as recovery and emergence phenomena were similar between groups. Although the described additive effect of propofol and ketamine was not confirmed, the combination conferred hemodynamic stability during spinal anesthesia.
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PMID:A comparison of propofol with a propofol-ketamine combination for sedation during spinal anesthesia. 917 13

Electrophysiological studies are often distressing for patients. We devised a regime of continuous infusion of midazolam and fentanyl during electrophysiological studies without the presence of a specialist anaesthetist. The effects on key hemodynamic and respiratory variables and level of sedation were evaluated in detail in the first 775 patients. The safety of this practice was evaluated in 1,344 consecutive patients. Doses were calculated according to patients' weight and age. A mean total dose of 26 mg of midazolam and 115 mcg of fentanyl were infused. Satisfactory sedation was achieved in 97% of patients. The mean duration of procedure was 188 +/- 90 minutes. Complete amnesia of the procedure was obtained in 87% of patients. Sedation caused clinically insignificant changes in respiratory rate, oxygen saturation, end-tidal CO2 and blood pressure. There were no major complications related to sedation. Upper airway obstruction, usually minor, occurred in 42% and some restlessness in 20% of sedated patients. The assistance of a specialist anesthetist was required in 0.3% of sedated patients for management of restlessness, hypoventilation, or obstructive sleep apnea. The amount of distress experienced by sedated patients (n = 775) was significantly less compared to a previous series of nonsedated patients (n = 775) undergoing electrophysiological studies (P < 0.001). The degree of distress experienced by patients during electrophysiological studies can be reduced significantly by sedation with intravenous midazolam and fentanyl. Continuous infusion is an efficient, safe, and effective way of administering midazolam and fentanyl.
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PMID:Efficacy and safety of a new protocol for continuous infusion of midazolam and fentanyl and its effects on patient distress during electrophysiological studies. 939 7

The sedative and cardiorespiratory effects of an intramuscular injection of diazepam (3 mg/kg body weight), acepromazine (0.1 mg/kg body weight), or xylazine (2 mg/kg body weight) in ferrets (n = 10, crossover design) was evaluated. Time from injection to assuming lateral recumbency was not significantly different between the three drugs. Duration of recumbency expressed as mean+/-standard deviation was significantly longer with xylazine (68.3+/-20.8 min) than with diazepam (43.2+/-8.2 min) or acepromazine (49.8+/-11.2 min). Sedation was graded to be the best in the xylazine-treated ferrets and worst in the diazepam-treated ferrets. Analgesia was judged only to be present following xylazine injection. Systolic blood pressure, oxyhemoglobin saturation, and end-expired carbon dioxide (CO2) were similar with all three drugs. It was concluded that, at the doses administered, xylazine provided better chemical restraint in the healthy ferret than either acepromazine or diazepam.
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PMID:Comparison of sedative and cardiorespiratory effects of diazepam, acepromazine, and xylazine in ferrets. 959 Apr 52

Flexible fibreoptic bronchoscopy (FOB) has become a useful diagnostic and therapeutic procedure in children. We investigated 26 patients (3-14 years) for FOB using a new sedation strategy. All patients received oral premedication and inhalation of topical anaesthetic. Sedation for bronchoscopy was achieved with a continuous infusion of remifentanil and intermittent boluses of propofol. Propofol injection was repeated if sedation was inadequate. Sedation could be successfully performed in all children without adverse effects. Endtidal CO2 concentration and arterial oxygen saturation remained stable throughout the study. All children were awake 5+/-1.3 min after stopping remifentanil infusion. Sedation with remifentanil/propofol is a new sedation strategy for diagnostic flexible paediatric bronchoscopy in children with spontaneous ventilation.
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PMID:Remifentanil and propofol for sedation in children and young adolescents undergoing diagnostic flexible bronchoscopy. 1063 11

Although retrobulbar and peribulbar regional anaesthetic techniques are used (by both anaesthesiologists and ophthalmologists) in various types of eye surgery, topical anaesthesia of the conjunctiva and cornea, followed--as needed--by sub-Tenon's block, is now common in routine cataract surgery. Intracameral administration of local anaesthetic by the ophthalmologist is also performed. Sedation during ophthalmic surgery is distinctly lighter than for other surgery because it is essential that the patient remains alert and can cooperate with the surgeon. Continuous insufflation of oxygen-enriched air is needed to ascertain that CO2 has been flushed away. With a catheter placed into the nostril, the patient (whose head is draped and 'hidden') can have the end-tidal CO2 monitored. Finger index (FI), a palpation method that assesses the ease of performing retrobulbar block, is introduced. Because of the risk of life-threatening complications in ophthalmic regional anaesthesia, the services of an anaesthesiologist must be available and training of anaesthesia residents in ophthalmic regional anaesthesia is highly recommended.
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PMID:Advances in ophthalmic regional anaesthesia. 1596 94

Dexmedetomidine is a sedative with limited experience in the pediatric population. This is the first study that prospectively evaluates the sedation profile of a dexmedetomidine pilot program for pediatric sedation for radiological imaging studies. In March 2005, our hospital sedation committee approved the replacement of IV pentobarbital with dexmedetomidine as the standard of care for CT imaging. Detailed Quality Assurance (QA) data sheets collect relevant information on each patient, which is then logged into a computerized sedation database. After IRB approval, all QA data was accessed. Sixty-two patients with a mean age of 2.8 years (SD = 1.8, range 0.5-9.7) received IV (IV) dexmedetomidine administered as a 2 mcg/kg loading dose over 10 minutes, followed by repeat boluses of 2 mcg/kg over 10 minutes until target of Ramsay Sedation Score 4 (RSS) achieved. Patients were then maintained on 1 mcg/kg/hr infusion until imaging is completed. Repeated-measures ANOVA indicated that compared to pre-sedation values, the heart rate and mean arterial blood pressure decreased an average of 15% during bolus, infusion and recovery (P < 0.01). No significant changes were observed in respiratory rate or end-tidal CO2. Mean recovery time was 32 +/- 18 minutes. Based on our pilot results, dexmedetomidine may provide a reliable and effective method of providing sedation.
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PMID:Dexmedetomidine for pediatric sedation for computed tomography imaging studies. 1679 Jun 23

We present a series of three children with trisomy 21 and obstructive sleep apnea who required sedation during magnetic resonance imaging of the upper airway. In an effort to provide effective sedation with limited effects on cardiovascular and ventilatory function, sedation was provided by a combination of ketamine and dexmedetomidine. Sedation was initiated with a bolus dose of ketamine (1 mg x kg(-1)) and dexmedetomidine (1 microg x kg(-1)) and maintained by a continuous infusion of dexmedetomidine (1 microg x kg(-1) x h(-1)). One patient required a repeat of the bolus doses of ketamine and dexmedetomidine and an increase of the dexmedetomidine infusion to 2 microg x kg(-1) x h(-1). Effective sedation was provided for all three patients. We noted no clinically significant hemodynamic or respiratory effects. No central apnea was noted although there was a brief episode of upper airway obstruction in one patient which responded to repositioning of the airway. All three patients developed some degree of hypercarbia with maximum P(E)(CO2) values of 6.4, 6.9, and 6.8 kPa (49, 53, and 52 mmHg), respectively. To date, this is the first report regarding the use of this combination in pediatric patients. Given the preliminary success noted in our three patients, prospective trials evaluating the efficacy of a dexmedetomidine-ketamine combination appears warranted.
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PMID:Monitored anesthesia care with a combination of ketamine and dexmedetomidine during magnetic resonance imaging in three children with trisomy 21 and obstructive sleep apnea. 1687 22

Many of the patients undergoing interventional procedures have daily regimens of medications including analgesics, muscle relaxants, and other drugs that can have significant additive/synergistic effects during the perioperative period. Further, many patients also present with comorbid states, including obesity, cardiovascular, and pulmonary disease. Consequently, in the perioperative period, a significant number of patients have suffered permanent neurologic injury, hypoxic brain injury, and even death as a result of over sedation, hypoventilation, and spinal cord injury. In addition, physicians are concerned about aspiration, subsequent complications, and as a result, they ask patients to fast for several hours prior to the procedures. Based on extensive literature and consensus, a minimum fasting period is established as 2 hours before a procedure for clear liquids and 4 hours before procedure for light meals, rather than having all patients fast for 8 hours or even fasting beginning at midnight the night before the procedure. Gastrointestinal stimulants, gastric acid secretion blockers, and antacids may be used, even though not routinely recommended. Due to the nature of chronic pain and anxiety, many patients undergoing interventional techniques may require mild to moderate sedation. Deep sedation and/or general anesthesia for most interventional procedures is considered as unsafe, since the patient cannot communicate acute changes in symptoms, thus, resulting in morbidity and mortality, as well as creating compliance issues. We are adapting the published standards of the American Society of Anesthesiologists for monitoring patients under sedation, regardless of the location of the procedure, either office-based, in a surgery center, or a hospital outpatient department. These standards include monitoring of blood pressure, cardiac rhythm, temperature, pulse oximetry, and continuous quantitative end tidal CO2 monitoring. Sedation must be provided either by qualified anesthesia or non-anesthesia providers, with appropriate understanding of the medications, drug interactions, and resuscitative protocols.KEY WORDS: Guidelines, sedation, fasting status, monitoring, neurological complications.
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PMID:ASIPP Guidelines for Sedation and Fasting Status of Patients Undergoing Interventional Pain Management Procedures. 3115 29


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