Latest & greatest articles for sedation

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Top results for sedation

1. COVID-19: Sedation-Ventilation Liberation of COVID Patients

COVID-19: Sedation-Ventilation Liberation of COVID Patients COVID-19: SEDATION-VENTILATION LIBERATION OF COVID+ PATIENTS A Rapid Guidance Summary from the Penn Medicine Center for Evidence-based Practice Last updated May 6, 2020 12:00 pm All links rechecked April 27 th unless otherwise noted. Key questions answered in this summary • How should sedatives be dosed? • What fluid resuscitation approach should be taken with ventilated patients? • How often should spontaneous breathing tests (...) be attempted? • What are the criteria to begin a spontaneous breathing test? • What is the protocol for a spontaneous breathing test? Summary of major recommendations • Minimizing continuous sedation and instead favoring bolused sedation to targeted endpoints reduces number of days of mechanical ventilation. • Patients with ARDS should receive minimal fluid resuscitation. • Ventilator weaning tests should be attempted daily upon improvement of respiratory status. • Ventilator weaning protocol should follow

2020 Centre for Evidence-Based Practice, Penn Medicine

2. Is ketamine sedation without local anesthesia sufficient for pediatric laceration repair? A double-blind randomized clinical trial

Is ketamine sedation without local anesthesia sufficient for pediatric laceration repair? A double-blind randomized clinical trial Is Ketamine Sedation Without Local Anesthesia Sufficient for Pediatric Laceration Repair? A Double-Blind Randomized Clinical Trial - PubMed This site needs JavaScript to work properly. Please enable it to take advantage of the complete set of features! Clipboard, Search History, and several other advanced features are temporarily unavailable. National Institutes (...) Share Permalink Copy Page navigation Am J Emerg Med Actions . 2020 Mar 19;S0735-6757(20)30172-8. doi: 10.1016/j.ajem.2020.03.030. Online ahead of print. Is Ketamine Sedation Without Local Anesthesia Sufficient for Pediatric Laceration Repair? A Double-Blind Randomized Clinical Trial , , , Affiliations Expand Affiliations 1 Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea. 2 Department of Emergency Medicine, Seoul National University Bundang

2020 EvidenceUpdates

3. Ketamine Procedural Sedation for Children in EDs

Ketamine Procedural Sedation for Children in EDs The Royal College of Emergency Medicine Best Practice Guideline KETAMINE PROCEDURAL SEDATION FOR CHILDREN IN THE EMERGENCY DEPARTMENT Revised: February 2020 Ketamine Procedural Sedation for Children in The Emergency Department (Feb 2020) 15 Summary of recommendations 1. Ketamine sedation may be appropriate for a procedure that is painful, or frightening after all other options have been considered. 2. Ketamine should not be used for sedation (...) in the Emergency Department for children under the age of 1 year. Ketamine should be only be used by clinicians with significant relevant experience in the use of ketamine when performing procedural sedation in children aged between 2-5 years. 3. Ketamine sedation should take place in an area with full resuscitation facilities immediately available. 4. Safe sedation requires adequate senior medical and nursing cover in the Emergency Department when any sedation takes place. 5. Ketamine sedation requires

2020 Royal College of Emergency Medicine

4. 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

5. Impact of Timing of Preprocedural Opioids on Adverse Events in Procedural Sedation (Abstract)

Impact of Timing of Preprocedural Opioids on Adverse Events in Procedural Sedation The risk of respiratory depression is increased when opioids are added to sedative agents. In our recent multicenter emergency department (ED) procedural sedation cohort, we reported a strong association between preprocedural opioids and sedation-related adverse events. We sought to examine the association between timing of opioids and the incidence of adverse sedation outcomes.We conducted a secondary analysis (...) of a prospective cohort of children aged 0 to 18 years who received sedation for a painful procedure in six Canadian pediatric EDs from July 2010 to February 2015. The primary risk factor was timing of opioid administration, adjusted for age, opioid type, preprocedural and sedation medications, and procedure type. Outcomes were 1) oxygen desaturation, 2) vomiting, and 3) positive pressure ventilation (PPV).Of the 6,295 children in the original cohort, 1,806 (29%) received a preprocedural opioid. Patients

2020 EvidenceUpdates

6. Oral Ondansetron to Reduce Vomiting in Children Receiving Intranasal Fentanyl and Inhaled Nitrous Oxide for Procedural Sedation and Analgesia: A Randomized Controlled Trial (Abstract)

Oral Ondansetron to Reduce Vomiting in Children Receiving Intranasal Fentanyl and Inhaled Nitrous Oxide for Procedural Sedation and Analgesia: A Randomized Controlled Trial Intranasal fentanyl and inhaled nitrous oxide are increasingly combined to provide procedural sedation and analgesia in the pediatric emergency setting. This regimen is attractive because of its nonparenteral administration, but is associated with a higher incidence of vomiting than nitrous oxide alone. We seek to assess (...) whether prophylactic oral ondansetron use could reduce the incidence of vomiting associated with intranasal fentanyl and nitrous oxide for procedural sedation compared with placebo.This was a double-blind, randomized controlled trial of oral ondansetron versus placebo conducted at a single tertiary care pediatric emergency department. Children aged 3 to 18 years with planned sedation with intranasal fentanyl and nitrous oxide were randomized to receive oral ondansetron or placebo 30 to 60 minutes

2020 EvidenceUpdates

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Pharmacological Agents for Procedural Sedation and Analgesia

Pharmacological Agents for Procedural Sedation and Analgesia 1 The Royal College of Emergency Medicine Best Practice Guideline March 2019 (Revised) Pharmacological Agents for Procedural Sedation and Analgesia in the Emergency Department 2 Summary of recommendations 1. Every Emergency Department should have a procedural sedation policy that is regularly reviewed, and audited 2. The procedural sedation policy should provide guidelines for pharmacological agents that are routinely used (...) in the Department 3. A pro-forma should be used for procedural sedation and analgesia (PSA) as a checklist and as an auditable record of the procedure 4. Adverse events should be reported using the SIVA reporting tool 3 Scope This document provides guidelines for the use of common pharmacological agents in sedation in the Emergency Department in the UK. It provides guidelines for the use of these agents for adults and children (excluding neonates). This guideline only applies to pharmacological agents used

2019 Royal College of Emergency Medicine

17. 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

18. 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

19. 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

20. 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