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Early cognitive impairment after sedation for colonoscopy: the effect of adding midazolam and/or fentanyl to propofol 19617584 2009 10 21 2009 11 05 2014 11 20 1526-7598 109 5 2009 Nov Anesthesia and analgesia Anesth. Analg. Early cognitive impairment after sedation for colonoscopy: the effect of adding midazolam and/or fentanyl to propofol. 1448-55 10.1213/ane.0b013e3181a6ad31 The sedative drug combination that produces minimal cognitive impairment and optimal operating conditions during (...) colonoscopy has not been determined. We sought to determine if the use of propofol alone results in less cognitive impairment at discharge than the use of propofol plus midazolam and/or fentanyl in patients presenting for elective outpatient colonoscopy. Two hundred adult patients presenting for elective outpatient colonoscopy were randomized to receive propofol alone or propofol plus midazolam, and/or fentanyl for IV sedation. Baseline cognitive function was measured using the computerized CogState test
Randomized clinical trial of propofol with and without alfentanil for deep procedural sedation in the emergency department 19845550 2009 10 22 2011 03 23 2013 11 21 1553-2712 16 9 2009 Sep Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Acad Emerg Med Randomized clinical trial of propofol with and without alfentanil for deep procedural sedation in the emergency department. 825-34 10.1111/j.1553-2712.2009.00487.x The objectives were to compare (...) the efficacy, occurrence of adverse events, and recovery duration of propofol with and without alfentanil for use in procedural sedation in the emergency department (ED). This was a randomized nonblinded prospective trial of adult patients undergoing procedural sedation for painful procedures in the ED. Patients with pain before the procedure were given intravenous (IV) morphine sulfate until their pain was adequately treated at least 20 minutes before starting the procedure. Patients received 1 mg/kg
Randomized trial of light versus deep sedation on mental health after critical illness 19602975 2009 08 19 2009 09 16 2015 11 19 1530-0293 37 9 2009 Sep Critical care medicine Crit. Care Med. Randomized trial of light versus deep sedation on mental health after critical illness. 2527-34 10.1097/CCM.0b013e3181a5689f : To investigate if light sedation favorably affects subsequent patient mental health compared with deep sedation. Symptoms of posttraumatic stress disorder are common in patients (...) after they have undergone prolonged mechanical ventilation and are associated with sedation depth. : Randomized, open-label, controlled trial. : Single tertiary care center. : Adult patients requiring mechanical ventilation. : Patients were randomized to receive either light (patient awake and cooperative) or deep sedation (patient asleep, awakening upon physical stimulation). : Self-reported measures of posttraumatic stress disorder, anxiety, and depression were collected at intensive
Last-resort options for palliative sedation. Despite receiving state-of-the-art palliative care, some patients still experience severe suffering toward the end of life. Palliative sedation is a potential way to respond to such suffering, but access is uneven and unpredictable, in part because of confusion about different kinds of sedation. Proportionate palliative sedation (PPS) uses the minimum amount of sedation necessary to relieve refractory physical symptoms at the very end of life. To (...) relieve suffering may require progressive increases in sedation, sometimes to the point of unconsciousness, but consciousness is maintained if possible. Palliative sedation with the intended end point of unconsciousness (PSU) is a more controversial practice that may be considered for much fewer refractory cases. There is more ethical consensus about PPS than PSU. In this article, the authors explore the clinical, ethical, and legal issues associated with these practices. They recommend
A critical review of daily sedation interruption in the intensive care unit 19077018 2009 05 05 2009 07 23 2009 05 05 1365-2702 18 9 2009 May Journal of clinical nursing J Clin Nurs A critical review of daily sedation interruption in the intensive care unit. 1239-49 10.1111/j.1365-2702.2008.02513.x Daily sedation interruption (DSI) has been proposed as a method of improving sedation management of critically ill patients by reducing the adverse effects of continuous sedation infusions (...) . To critique the research regarding daily sedation interruption, to inform education, research and practice in this area of intensive care practice. Literature review. Medline, CINAHL and Web of Science were searched for relevant key terms. Eight research-based studies, published in the English language between 1995-December 2006 and three conference abstracts were retrieved. Of the eight articles and three conference abstracts reviewed, five originated from one intensive care unit (ICU) in the USA
Randomized clinical trial of Entonox versus midazolam-fentanyl sedation for colonoscopy 19283736 2009 03 18 2009 03 26 2013 11 21 1365-2168 96 4 2009 Apr The British journal of surgery Br J Surg Randomized clinical trial of Entonox versus midazolam-fentanyl sedation for colonoscopy. 361-8 10.1002/bjs.6467 Intravenous sedation for colonoscopy is associated with cardiorespiratory complications and delayed recovery. The aim of this randomized clinical trial was to compare the efficacy of Entonox (...) (50 per cent nitrous oxide and 50 per cent oxygen) and intravenous sedation using midazolam-fentanyl for colonoscopy. Some 131 patients undergoing elective colonoscopy were included. Patients completed a Hospital Anxiety and Depression questionnaire, letter cancellation tests and pain scores on a 100-mm visual analogue scale before, immediately after the procedure and at discharge. They also completed a satisfaction survey at discharge and 24 h after the procedure. Sixty-five patients were
General anaesthesia or conscious sedation for reducing a dislocated hip prosthesis? BestBets: General anaesthesia or conscious sedation for reducing a dislocated hip prosthesis? General anaesthesia or conscious sedation for reducing a dislocated hip prosthesis? Report By: Nick Payne - Consultant in Emergency Medicine Search checked by Steve Jones - Consultant in Critical Care and Emergency Medicine Institution: Wythenshawe Hospital and Manchester Royal Infirmary Date Submitted: 1st March 2000 (...) Date Completed: 11th March 2009 Last Modified: 11th March 2009 Status: Green (complete) Three Part Question In [patients with dislocated hip prosthesis] does [general anaesthesia or conscious sedation] give a [better reduction rate]? Clinical Scenario An otherwise fit 71-year old lady presents to your department having slipped on the ballroom floor during a tea dance. She is unable to weight bear and has pain in her left hip. X-ray reveals a dislocation of her hip prosthesis, and she tells you
A phase 3, randomized, double-blind study to assess the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy 18641105 2009 01 12 2009 01 26 2016 10 25 1931-3543 135 1 2009 Jan Chest Chest A phase 3, randomized, double-blind study to assess the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy. 41-7 10.1378/chest.08-0623 Fospropofol disodium is a water (...) -soluble prodrug of propofol with unique pharmacokinetic/pharmacodynamic properties. This randomized, double-blind, multicenter study evaluated the use of fospropofol in patients undergoing flexible bronchoscopy. Patients >or= 18 years of age were randomized (2:3) to receive fospropofol, 2 mg/kg or 6.5 mg/kg, after pretreatment with fentanyl, 50 microg. Supplemental doses of each were given per protocol. The primary end point was sedation success, which was defined as follows: three consecutive
Sedation versus general anaesthesia for provision of dental treatment in under 18 year olds. BACKGROUND: A significant proportion of children have caries requiring restorations or extractions, and some of these children will not accept this treatment under local anaesthetic. Historically this has been managed in children by use of a general anaesthetic; however use of sedation may lead to reduced morbidity and cost. The aim of this review is to compare the efficiency of sedation versus general (...) anaesthesia for the provision of dental treatment for children and adolescents under 18 years. OBJECTIVES: We evaluated the intra- and post-operative morbidity, effectiveness and cost effectiveness of sedation versus general anaesthesia for the provision of dental treatment for under 18 year olds. SEARCH STRATEGY: We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library; Issue 4, 2008); MEDLINE (OVID) (1950 to October Week 2, 2008); EMBASE (OVID) (1974 to Week 42
Predictors of airway and respiratory adverse events with ketamine sedation in the emergency department: an individual-patient data meta-analysis of 8,282 children Predictors of airway and respiratory adverse events with ketamine sedation in the emergency department: an individual-patient data meta-analysis of 8,282 children Predictors of airway and respiratory adverse events with ketamine sedation in the emergency department: an individual-patient data meta-analysis of 8,282 children Green SM (...) , Roback MG, Krauss B, Brown L, McGlone RG, Agrawal D, McKee M, Weiss M, Pitetti RD, Hostetler MA, Wathen JE, Treston G, Garcia Pena BM, Gerber AC, Losek JD, Emergency Department Ketamine Meta-Analysis Study Group CRD summary This review concluded that patients sedated with ketamine were at higher risk of airway and respiratory adverse events if they were younger than 21 years, or if physicians used co-administered anticholinergics or benzodiazepines. The quality and variability of raw data
Predictors of emesis and recovery agitation with emergency department ketamine sedation: an individual-patient data meta-analysis of 8,282 children Predictors of emesis and recovery agitation with emergency department ketamine sedation: an individual-patient data meta-analysis of 8,282 children Predictors of emesis and recovery agitation with emergency department ketamine sedation: an individual-patient data meta-analysis of 8,282 children Green SM, Roback MG, Krauss B, Brown L, McGlone RG (...) , Agrawal D, McKee M, Weiss M, Pitetti RD, Hostetler MA, Wathen JE, Treston G, Garcia Pena BM, Gerber AC, Losek JD, Emergency Department Ketamine Meta-Analysis Study Group CRD summary This individual patient analysis suggested that there might be a higher risk of emesis for patients sedated with ketamine if they were young adolescents or physicians used an initial dose of ≥2.5mg/kg or total dose of ≥5mg/kg. Low quality variable raw data and potential biases from the search and analytical methods caused
Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. 19188334 2009 02 04 2009 02 09 2016 10 17 1538-3598 301 5 2009 Feb 04 JAMA JAMA Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. 489-99 10.1001/jama.2009.56 Gamma-aminobutyric acid receptor agonist medications are the most commonly used sedatives for intensive care unit (ICU) patients, yet preliminary evidence indicates that the alpha(2) agonist dexmedetomidine may (...) have distinct advantages. To compare the efficacy and safety of prolonged sedation with dexmedetomidine vs midazolam for mechanically ventilated patients. Prospective, double-blind, randomized trial conducted in 68 centers in 5 countries between March 2005 and August 2007 among 375 medical/surgical ICU patients with expected mechanical ventilation for more than 24 hours. Sedation level and delirium were assessed using the Richmond Agitation-Sedation Scale (RASS) and the Confusion Assessment Method
Subdissociative-dose ketamine versus fentanyl for analgesia during propofol procedural sedation: a randomized clinical trial 18754820 2008 10 14 2008 12 16 2013 11 21 1553-2712 15 10 2008 Oct Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Acad Emerg Med Subdissociative-dose ketamine versus fentanyl for analgesia during propofol procedural sedation: a randomized clinical trial. 877-86 10.1111/j.1553-2712.2008.00219.x The authors sought to compare (...) the safety and efficacy of subdissociative-dose ketamine versus fentanyl as adjunct analgesics for emergency department (ED) procedural sedation and analgesia (PSA) with propofol. This double-blind, randomized trial enrolled American Society of Anesthesiology (ASA) Class I or II ED patients, aged 14-65 years, requiring PSA for orthopedic reduction or abscess drainage. Subjects received 0.3 mg/kg ketamine or 1.5 mug/kg fentanyl intravenously (IV), followed by IV propofol titrated to deep sedation
Propofol for sedation during colonoscopy. BACKGROUND: Propofol is increasingly used for sedation during colonoscopy, with many recent reports of randomized controlled trials (RCTs) and large non-randomized case series. OBJECTIVES: The primary objective was to identify, analyze and summarize RCTs comparing the relative effectiveness, patient acceptance and safety of propofol for colonoscopy, to traditional sedatives (narcotics and/or benzodiazepines).The secondary objective was to synthesize (...) the studies comparing propofol administration by anesthesiologists to that by non-anesthesiologists for sedation during colonoscopy. SEARCH STRATEGY: We searched Medline, Cancerlit, EMBASE, CINAHL, LILACS, Biological Abstracts, Web of Science and the Cochrane Controlled Trials Registry database between January 1980 and June 2007; and conference proceeding abstracts for DDW, EUGW and ACG between 1990 and June 2007. There were no language restrictions. SELECTION CRITERIA: Randomized controlled trials
Palliative sedation. Palliative sedation. | National Guideline Clearinghouse Search Sign In Username or Email * Password * Remember Me Don't have an account? Guideline Summary NGC:006066 This guideline summary has been withdrawn from NGC. Please update your bookmarks. View all withdrawn summaries in the . About NGC Guideline Summaries NGC's guidelines summaries contain information systematically derived from original guidelines. New on NGC Guideline Summaries NGC:011081 2016 NGC:011079 2016 NGC
Does the time of fasting affect complication rates during ketamine sedation BestBets: Does the time of fasting affect complication rates during ketamine sedation Does the time of fasting affect complication rates during ketamine sedation Report By: Ray McGlone - Consultant in Emergency Medicine Search checked by Simon Carley - Consultant in Emergency Medicine Institution: Lancaster Royal Infirmary Original author: Ray McGlone Original institution: Lancaster Royal Infirmary Current web editor (...) : Tom Bartram - middle grade A+E Date Submitted: 4th March 2005 Last Modified: 14th August 2008 Status: Green (complete) Three Part Question [In children undergoing ketamine sedation] is [prolonged fasting (6 hours or more) better than short term fasting (3 hours)] at [reducing the incidence of vomiting and other complications of sedation] Clinical Scenario A 4 year old boy is brought to the emergency department having fallen over at home. He has sustained a 3 cm deep laceration to the forehead. He
A randomized trial of daily awakening in critically ill patients managed with a sedation protocol: a pilot trial 18552687 2008 07 02 2008 07 17 2013 11 21 1530-0293 36 7 2008 Jul Critical care medicine Crit. Care Med. A randomized trial of daily awakening in critically ill patients managed with a sedation protocol: a pilot trial. 2092-9 10.1097/CCM.0b013e31817bff85 Protocolized sedation (PS) and daily sedative interruption (DI) in critically ill patients have both been shown to shorten (...) were randomized to PS alone, or PS + DI. PS was implemented by bedside nurses; sedatives/analgesics were titrated to achieve Sedation Agitation Score (SAS) 3-4. The PS + DI group also had infusions interrupted daily until the patients awoke. Diagnosis, age [mean +/- SD] (53 +/- 18.3 vs. 62.1 +/- 16.7 yrs) and Acute Physiology and Chronic Health Evaluation II (27.7 +/- 8.4 vs. 26.6 +/- 8.4) were similar in the PS and PS + DI groups, respectively. The median duration of MV in the PS and PS + DI
Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Comparison of the effect of protocol-directed sedation with propofol vs. midazolam by nurses in intensive care: efficacy, haemodynamic stability and patient satisfaction 18482144 2008 05 16 2008 07 18 2015 11 19 1365-2702 17 11 2008 Jun Journal of clinical nursing J Clin Nurs Comparison of the effect of protocol-directed sedation with propofol vs. midazolam by nurses in intensive care: efficacy, haemodynamic stability and patient satisfaction. 1510-7 10.1111/j.1365-2702.2007.02128.x The aim (...) of this study was to compare the effect of protocol-directed sedation propofol vs. midazolam by nurses in intensive care on efficacy, haemodynamic stability and patient satisfaction. Protocols represent one method potentially to reduce treatment delays and ensure that medical care is administered in a standardised manner. Propofol and midazolam are often used for sedation in intensive care units. A randomised, prospective cohort study and data were collected in 2003. The subjects were randomised either
Intra-articular block compared with conscious sedation for closed reduction of ankle fracture-dislocations. A prospective randomized trial 18381308 2008 04 02 2008 04 29 2016 11 24 1535-1386 90 4 2008 Apr The Journal of bone and joint surgery. American volume J Bone Joint Surg Am Intra-articular block compared with conscious sedation for closed reduction of ankle fracture-dislocations. A prospective randomized trial. 731-4 10.2106/JBJS.G.00733 Ankle fracture-dislocations require urgent (...) reduction to protect the soft tissues, to minimize articular injury, and to allow swelling to decrease. Conscious sedation is commonly used to provide analgesia for closed reduction of this injury. We hypothesized that an intra-articular block of the ankle would provide similar analgesia and the ability to reduce the ankle with a lower risk than conscious sedation. Between September 2005 and January 2007, forty-two patients with an ankle fracture-dislocation presented to our emergency department