Latest & greatest articles for sedation

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Top results for sedation

1. Comparison of Intraoperative Sedation With Dexmedetomidine Versus Propofol on Acute Postoperative Pain in Total Knee Arthroplasty Under Spinal Anesthesia: A Randomized Trial (Abstract)

Comparison of Intraoperative Sedation With Dexmedetomidine Versus Propofol on Acute Postoperative Pain in Total Knee Arthroplasty Under Spinal Anesthesia: A Randomized Trial In patients undergoing total knee arthroplasty under spinal anesthesia, we compared the postoperative analgesic effect of intraoperative sedation with dexmedetomidine versus propofol. We hypothesized that sedation with dexmedetomidine would result in lower postoperative opioid analgesic consumption than with propofol.Forty (...) -eight patients were enrolled and randomly assigned to either a dexmedetomidine group (n = 24), which received a loading dose of 1 μg/kg dexmedetomidine over 10 minutes, followed by a continuous infusion of 0.1-0.5 μg·kg·hour, or a propofol group (n = 24), which received a continuous infusion of propofol via a target-controlled infusion to maintain the effect-site concentration within a range of 0.5-2.0 μg/mL. The drug infusion rate was determined according to the sedation level, targeting a modified

2020 EvidenceUpdates

2. Ketamine for emergency sedation of agitated patients: A systematic review and meta-analysis (Abstract)

Ketamine for emergency sedation of agitated patients: A systematic review and meta-analysis Prior studies suggest that ketamine is effective for acute agitation in the emergency department (ED) and prehospital settings. This systematic review and meta-analysis aims to evaluate the rate of sedation and need for airway management in patients given ketamine for management of acute agitation. Methods: We performed a systematic review of publications describing the use of ketamine to control (...) agitation in the ED and prehospital settings. Studies were included if they included agitated patients, used ketamine to control agitation, occurred in the ED and prehospital setting and measured sedation status or need for airway management. Following data abstraction, a meta-analysis was performed to synthesize the rate of effective sedation and the need for airway management. Result: 13 studies met the inclusion criteria. 10 studies were conducted in the prehospital setting and 3 in the ED setting

2020 EvidenceUpdates

3. During Conscious Sedation the Risk of Adverse Events Is Likely Increased in Obese Children Compared to Those of Healthy Weight

During Conscious Sedation the Risk of Adverse Events Is Likely Increased in Obese Children Compared to Those of Healthy Weight UTCAT3394, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title During Conscious Sedation the Risk of Adverse Events Is Likely Increased in Obese Children Compared to Those of Healthy Weight Clinical Question Are obese children undergoing conscious sedation at increased risk for adverse events (...) compared to children who are at healthy weight? Clinical Bottom Line For children with childhood obesity, conscious sedation may lead to more adverse events including oxyhemoglobin desaturation, nausea and true apnea. However, additional evidence is needed to know if there is any clinical and statistical difference between obese children and healthy weight children during conscious sedation. This is supported by both a cross-sectional retrospective study and a review of literature on the relationship

2019 UTHSCSA Dental School CAT Library

4. Association of General Anesthesia vs Procedural Sedation With Functional Outcome Among Patients With Acute Ischemic Stroke Undergoing Thrombectomy: A Systematic Review and Meta-analysis. (Abstract)

Association of General Anesthesia vs Procedural Sedation With Functional Outcome Among Patients With Acute Ischemic Stroke Undergoing Thrombectomy: A Systematic Review and Meta-analysis. General anesthesia during thrombectomy for acute ischemic stroke has been associated with poor neurological outcome in nonrandomized studies. Three single-center randomized trials reported no significantly different or improved outcomes for patients who received general anesthesia compared with procedural (...) sedation.To detect differences in functional outcome at 3 months between patients who received general anesthesia vs procedural sedation during thrombectomy for anterior circulation acute ischemic stroke.MEDLINE search for English-language articles published from January 1, 1980, to July 31, 2019.Randomized clinical trials of adults with a National Institutes of Health Stroke Scale score of at least 10 and anterior circulation acute ischemic stroke assigned to receive general anesthesia or procedural

2019 JAMA

5. Early Sedation with Dexmedetomidine in Critically Ill Patients. Full Text available with Trip Pro

Early Sedation with Dexmedetomidine in Critically Ill Patients. Dexmedetomidine produces sedation while maintaining a degree of arousability and may reduce the duration of mechanical ventilation and delirium among patients in the intensive care unit (ICU). The use of dexmedetomidine as the sole or primary sedative agent in patients undergoing mechanical ventilation has not been extensively studied.In an open-label, randomized trial, we enrolled critically ill adults who had been undergoing (...) ventilation for less than 12 hours in the ICU and were expected to continue to receive ventilatory support for longer than the next calendar day to receive dexmedetomidine as the sole or primary sedative or to receive usual care (propofol, midazolam, or other sedatives). The target range of sedation-scores on the Richmond Agitation and Sedation Scale (which is scored from -5 [unresponsive] to +4 [combative]) was -2 to +1 (lightly sedated to restless). The primary outcome was the rate of death from any

2019 NEJM Controlled trial quality: predicted high

6. Is the Level of Sedation Depth in the Early Postintubation Period Associated With Worse Patient Outcomes? Full Text available with Trip Pro

Is the Level of Sedation Depth in the Early Postintubation Period Associated With Worse Patient Outcomes? Is the Level of Sedation Depth in the Early Postintubation Period Associated With Worse Patient Outcomes? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 73, Issue 5, Pages 488–490 Is the Level of Sedation Depth in the Early Postintubation Period Associated With Worse Patient Outcomes? x Michael (...) Gottlieb , MD (EBEM Commentator) , x Keya A. Patel , MD (EBEM Commentator) , x William G. McDowell , MD (EBEM Commentator) Department of Emergency Medicine, Rush University Medical Center, Chicago, IL DOI: | Publication History Published online: December 20, 2018 Expand all Collapse all Article Outline Take-Home Message Compared with deep sedation, light sedation early in the postintubation course is associated with reduced mortality, decreased length of ICU stay, and fewer days of mechanical

2019 Annals of Emergency Medicine Systematic Review Snapshots

7. Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures | From the American Academy of Pediatrics | Pediatrics '); document.write(''); } function OAS_AD(pos) { if (OAS_version >= 11 && typeof(OAS_RICH)!='undefined') { OAS_RICH(pos); } else { OAS_NORMAL(pos); } } //--> Search (...) for this keyword Source User menu Sections Sign up for highlighting editor-chosen studies with the greatest impact on clinical care. From the American Academy of Pediatrics Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures Charles J. Coté , Stephen Wilson , AMERICAN ACADEMY OF PEDIATRICS , AMERICAN ACADEMY OF PEDIATRIC DENTISTRY Abstract The safe sedation of children for procedures requires a systematic approach

2019 American Academy of Pediatrics

8. Dexmedetomidine (Dexdor) - Sedation of non-intubated adult patients prior to and/or during diagnostic or surgical procedures requiring sedation

Dexmedetomidine (Dexdor) - Sedation of non-intubated adult patients prior to and/or during diagnostic or surgical procedures requiring sedation Published 11 February 2019 Statement of advice SMC2161 dexmedetomidine 100 micrograms/ml concentrate for solution for infusion (Dexdor®) Orion Pharma UK Limited 11 January 2019 ADVICE: in the absence of a submission from the holder of the marketing authorisation dexmedetomidine (Dexdor®) is not recommended for use within NHSScotland. Indication under (...) review: Sedation of non-intubated adult patients prior to and/or during diagnostic or surgical procedures requiring sedation, i.e. procedural/awake sedation. The holder of the marketing authorisation has not made a submission to SMC regarding this product in this indication. As a result we cannot recommend its use within NHSScotland. Advice context: No part of this advice may be used without the whole of the advice being quoted in full. This advice represents the view of the Scottish Medicines

2019 Scottish Medicines Consortium

9. Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit: A Rapid Review

Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit: A Rapid Review ICU pain, agitation, delirium, sedation and mobilisation CPGs: A Rapid Review 1 Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit: A Rapid Review Citation Corey Joseph & Angela Melder. April 2018. Clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care (...) unit: A Rapid Review. Centre for Clinical Effectiveness, Monash Health, Melbourne, Australia. Contact cce@monashhealth.org Executive Summary Background The Program Medical Director for Critical Care has requested a review of clinical practice guidelines for pain, agitation, delirium, sedation and mobilisation in the intensive care unit (ICU) to inform future implementation of a new clinical practice guideline in the ICU. Objectives The objective of this review was to review and summarise current

2019 Monash Health Evidence Reviews

10. Premedication With Midazolam or Haloperidol to Prevent Recovery Agitation in Adults Undergoing Procedural Sedation With Ketamine: A Randomized Double-Blind Clinical Trial (Abstract)

Premedication With Midazolam or Haloperidol to Prevent Recovery Agitation in Adults Undergoing Procedural Sedation With Ketamine: A Randomized Double-Blind Clinical Trial We evaluate the effect of midazolam and haloperidol premedication for reducing ketamine-induced recovery agitation in adult patients undergoing procedural sedation. We also compare physician satisfaction and recovery time.We randomized emergency department patients older than 18 years who needed procedural sedation to receive (...) 1 of the following 3 interventions in double-blind fashion 5 minutes before receiving intravenous ketamine at 1 mg/kg: intravenous distilled water, intravenous midazolam at 0.05 mg/kg, or intravenous haloperidol at 5 mg. Our main study outcomes were recovery agitation as assessed by the maximum observed Pittsburgh Agitation Scale score and by the Richmond Agitation-Sedation Scale score at 5, 15, and 30 minutes after ketamine administration. Our secondary outcomes were clinician satisfaction

2019 EvidenceUpdates

11. Safety and Efficacy of Remimazolam Compared With Placebo and Midazolam for Moderate Sedation During Bronchoscopy (Abstract)

Safety and Efficacy of Remimazolam Compared With Placebo and Midazolam for Moderate Sedation During Bronchoscopy While the complexity of flexible bronchoscopy has increased, standard options for moderate sedation medications have not changed in three decades. There is a need to improve moderate sedation while maintaining safety. Remimazolam was developed to address shortcomings of current sedation strategies.A prospective, double-blind, randomized, multicenter, parallel group trial (...) was performed at 30 US sites. The efficacy and safety of remimazolam for sedation during flexible bronchoscopy were compared with placebo and open-label midazolam.The success rates were 80.6% in the remimazolam arm, 4.8% in the placebo arm (P < .0001), and 32.9% in the midazolam arm. Bronchoscopy was started sooner in the remimazolam arm (mean, 6.4 ± 5.82 min) compared with placebo (17.2 ± 4.15 min; P < .0001) and midazolam (16.3 ± 8.60 min). Time to full alertness after the end of bronchoscopy

2019 EvidenceUpdates

12. Vomiting is the most common adverse effect among children and young people sedated for emergency procedures

Vomiting is the most common adverse effect among children and young people sedated for emergency procedures Vomiting is the most common adverse effect among children and young people sedated for emergency procedures Discover Portal Discover Portal Vomiting is the most common adverse effect among children and young people sedated for emergency procedures Published on 27 September 2016 doi: Vomiting is the most common adverse event when sedating a child or young person undergoing a procedure (...) in the emergency department, occurring in 55.5 out of 1,000 cases. Agitation occurred in 17.9/1,000 cases, and hypoxia – lack of oxygen – in 14.8 out of 1,000 cases. Serious breathing problems needing intervention to provide ventilation were rare, but highlight the need for experienced staff when giving sedation to children. This systematic review included 41 studies, six of which were UK-based. It pooled the frequency of adverse events when using different sedation drugs, alone or in combination

2019 NIHR Dissemination Centre

13. Effect of conscious sedation with midazolam and fentanyl on the overall quality of colonoscopy: a prospective and randomized study. (Abstract)

Effect of conscious sedation with midazolam and fentanyl on the overall quality of colonoscopy: a prospective and randomized study. a prospective, randomized study was performed to assess the influence of conscious sedation on the overall quality of colonoscopy, simultaneously quantifying its effect on the scientific quality, perceived quality and patient safety.patients referred for a colonoscopy were included in the study and were randomized to receive or not receive sedation. Demographic (...) data, indication for colonoscopy, cecal intubation, introduction and withdrawal time, resected adenomas and complications during the exploration were collected. Thirty days later, a satisfaction questionnaire was performed (GHAA 9-me) and patients were asked about complications after the examination.a total of 5,328 patients were included, the average age was 62 ± 15.22 years, 47% were male, 3,734 were sedated and 1,594 were not sedated. The sedated patients had a shorter endoscope insertion time

2019 Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva Controlled trial quality: uncertain

14. Sedation of children undergoing dental treatment. Full Text available with Trip Pro

Sedation of children undergoing dental treatment. Children's fear about dental treatment may lead to behaviour management problems for the dentist, which can be a barrier to the successful dental treatment of children. Sedation can be used to relieve anxiety and manage behaviour in children undergoing dental treatment. There is a need to determine from published research which agents, dosages and regimens are effective. This is the second update of the Cochrane Review first published in 2005 (...) and previously updated in 2012.To evaluate the efficacy and relative efficacy of conscious sedation agents and dosages for behaviour management in paediatric dentistry.Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1) in the Cochrane Library (searched 22 February 2018); MEDLINE Ovid (1946 to 22 February 2018); and Embase Ovid (1980 to 22

2018 Cochrane

15. Nitrous Oxide Compared With Intravenous Sedation for Second-Trimester Abortion: A Randomized Controlled Trial (Abstract)

Nitrous Oxide Compared With Intravenous Sedation for Second-Trimester Abortion: A Randomized Controlled Trial To assess whether inhaled nitrous oxide is noninferior to intravenous (IV) sedation for pain control during outpatient surgical abortion between 12 and 16 weeks of gestation.We enrolled women undergoing surgical abortion at 12-16 weeks of gestation into a multisite, double-blind clinical trial. Participants were randomized to sedation with nitrous oxide (70% nitrous/30% oxygen) or IV (...) fentanyl (100 micrograms) and midazolam (2 mg). Paracervical block was administered to both groups. The primary outcome measure was immediate postabortion recall of maximum pain on a 100-mm visual analog scale.Between August 2016 and March 2017, we assessed 170 women for eligibility and enrolled 39, 19 in the nitrous group and 20 in the IV sedation group. Seven participants in the nitrous group (36.8%) required conversion to IV sedation for inadequate pain control. No participants in the IV sedation

2018 EvidenceUpdates

16. Continuous infusion versus intermittent bolus doses of fentanyl for analgesia and sedation in neonates: an open-label randomised controlled trial (Abstract)

Continuous infusion versus intermittent bolus doses of fentanyl for analgesia and sedation in neonates: an open-label randomised controlled trial Adequate data on fentanyl pharmacokinetics in neonates are lacking. The study was performed to compare serum concentrations and clinical outcome between continuous infusion (CI) and intermittent bolus (IB) doses of fentanyl for analgesia and sedation in neonates.In this open-label randomised controlled trial, neonates requiring 24-48 hours (...) of mechanical ventilation and fentanyl administration were recruited. In CI regimen, 1 mcg/kg loading dose was followed by 1 mcg/kg/hour infusion. In IB regimen, 1mcg/kg/dose was administered every 4 hours.Maximum six blood samples were collected in 48 hours from each baby at prespecified time points for estimating serum fentanyl concentration. Secondary outcomes were pain scores (Neonatal Infant Pain Scale and Neonatal Pain, Agitation and Sedation Scale for acute and ongoing pain, respectively

2018 EvidenceUpdates

17. Protocol-directed sedation versus non-protocol-directed sedation in mechanically ventilated intensive care adults and children. Full Text available with Trip Pro

Protocol-directed sedation versus non-protocol-directed sedation in mechanically ventilated intensive care adults and children. The sedation needs of critically ill patients have been recognized as a core component of critical care that is vital to assist recovery and ensure humane treatment. Evidence suggests that sedation requirements are not always optimally managed. Suboptimal sedation, both under- and over-sedation, have been linked to short-term (e.g. length of stay) and long-term (e.g (...) . psychological recovery) outcomes. Strategies to improve sedation assessment and management have been proposed. This review was originally published in 2015 and updated in 2018.To assess the effects of protocol-directed sedation management compared to usual care on the duration of mechanical ventilation, intensive care unit (ICU) and hospital mortality and other patient outcomes in mechanically ventilated ICU adults and children.We used the standard search strategy of the Cochrane Anaesthesia, Critical

2018 Cochrane

18. CRACKCast E195 – Procedural Sedation and Analgesia

CRACKCast E195 – Procedural Sedation and Analgesia CRACKCast E195 - Procedural Sedation and Analgesia - CanadiEM CRACKCast E195 – Procedural Sedation and Analgesia In , by Owen Scheirer November 5, 2018 This updated episode of CRACKCast cover’s Rosen’s Chapter 004, Procedural Sedation and Analgesia (9th Ed.). These topics are core knowledge that we use every day in the Emergency Department. Shownotes – Key Concepts Safe, effective procedural sedation requires high-level skills and information (...) and sound protocols, including patient monitoring. Patients should be discharged in the company of a responsible adult and should remain with a responsible adult for 4 to 8 hours after recovery and discharge Propofol is the agent of choice for deep sedation in the ED but requires supplementation with an opioid analgesic when a painful procedure is planned. Absence of a pre-procedure fasting period is not a contraindication to procedural sedation for an emergent and/or time-sensitive condition. Pulse

2018 CandiEM

19. Policy for Selecting Anesthesia Providers for the Delivery of Office-based Deep Sedation/General Anesthesia

Policy for Selecting Anesthesia Providers for the Delivery of Office-based Deep Sedation/General Anesthesia AMERICAN ACADEMY OF PEDIATRIC DENTISTRY ORAL HEALTH POLICIES 139 Purpose The American Academy of Pediatric Dentistry ( AAPD) recognizes that it is the exclusive responsibility of dental prac- titioners, when employing anesthesia providers to administer office-based deep sedation/general anesthesia, to verify and carefully review the credentials and experience of those providers. 1 (...) sedation/general anesthesia was provided in a surgical center or hospital-based setting by an anesthesiologist selected and vetted by the facility or insti- tution. The dental surgeon had little, if any, choice as to who would provide these services. Current trends find an increasing number of dental providers electing to complete such care in the confines of their office using the services of an anesthesia provider. 2 Over the last decade, office-based deep sedation/ general anesthesia in the dental

2018 American Academy of Pediatric Dentistry

20. Sedation during minimal invasive surfactant therapy: a randomised controlled trial (Abstract)

Sedation during minimal invasive surfactant therapy: a randomised controlled trial Although sedation for endotracheal intubation of infants is widely adopted, there is no consensus whether sedation should be used for minimal invasive surfactant therapy (MIST). We compared, in a randomised controlled setting, the level of stress and comfort of preterm infants during MIST with and without receiving low-dose sedation.Infants between 26 and 36 weeks gestational age were randomised to receive either (...) low-dose sedation (1 mg/kg propofol intravenous) or no premedication during MIST procedure. Standard comfort care was given in both groups, which consisted of administering sucrose in the cheek pouch of the infant and containment. Primary end point was the percentage of infants assessed to be comfortable during the procedure (COMFORTneo-score <14). Secondary parameters included complications of both the MIST procedure and low-dose sedation administration.In total, 78 infants were randomised

2018 EvidenceUpdates