Amount Of Sedation Research Articles

Nefazodone in Major Depression

One hundred sixty-six patients suffering from major depressive disorders were treated for 8 weeks with nefazodone in an open study in dosage ranges from 200 to 600 mg. This report focuses primarily on the first week of therapy and on the concomitant use of several benzodiazepines, one of which is not metabolized by the cytochrome system (temazepam). Triazolam response was further evaluated as a function of two nefazodone dosage regimens provided during the first week of therapy, one group receiving nefazodone 200 mg/day for 7 days, and another group receiving nefazodone 200 mg/day for 3 days, followed by 4 days with 400 mg/day. Finally, a comparison of three different nefazodone dosages, the third being 400 mg from day 1 on, was also carried out. Outcome measures included Hamilton Rating Scale for Depression total and the total of the three Hamilton Rating Scale for Depression insomnia items, as well as global improvement, a daily completed sleep questionnaire, and adverse event assessment. A combination of nefazodone with a benzodiazepine (BZ) caused more sedation than nefazodone alone; triazolam, the BZ with the shortest half-life and the highest dependence on the cytochrome 450 system for its metabolism, caused the least amount of sedation, and alprazolam and diazepam, the two daytime benzodiazepines, caused the most sedation. Triazolam caused significant and identical reduction of insomnia in both nefazodone groups. Compared with nefazodone 200 mg given as monotherapy, insomnia was significantly improved--not only by triazolam, but also alprazolam and diazepam, but not temazepam. The addition of nefazodone raised triazolam plasma levels to almost 500%, the plasma level of desmethyl-diazepam 87%, and that of alprazolam 34%. Temazepam plasma levels remained unchanged. When prescribing nefazodone with a benzodiazepine, one should expect an improved sleep pattern initially, but at the cost of clinically relevant daytime sedation. The prediction that temazepam, the only BZ not dependent on the cytochrome mechanism for metabolism, should be the least sedating, and triazolam, because of its cytochromic metabolism interference with nefazodone should be the most sedating, could not be confirmed. In fact, triazolam 0.25 mg capsules seem to be the safest treatment of choice when one has to combine a benzodiazepine with nefazodone in initial stages of therapy, at least of the four benzodiazepines tested in this study.

PREVENTION OF HYPOTENSIVE/BRADYCARDIC EVENTS WITH METOPROLOL OR GLYCOPYRROLATE DURING SHOULDER ARTHROSCOPY UNDER INTERSCALENE BLOCK IN THE SITTING POSITION

S285 INTRODUCTION: Surgery performed in the sitting position under interscalene block (ISB) has been associated with sudden, profound bradycardia and severe hypotension. Mechanisms thought to be responsible for this phenomenon include the Bezold-Jarisch relfex (BJR) [1]. Retrospective studies have been divided on whether pre-treatment with beta-blockers may reduce the incidence of these hypotensive - bradycardic events (HBE) [1,2]. This study attempts to develop a prophylactic protocol which will assist in the prevention of this clinical syndrome. METHODS: After review board approval and patient consent, 105 subjects undergoing shoulder arthroscopy in the sitting position under ISB were randomly assigned into one of three groups: placebo (P), metoprolol 2.5 mg increments up to 10 mg or a HR decrease to 60 bpm (M), or glycopyrrolate 2 mcg/kg increments up to 6 mcg/kg or a HR increase to 100 bpm (G). The ISB were accomplished using the paresthesia technique with 10mg/kg of mepivacaine 1.5% with 1:200,000 epinephrine and 0.1 meq/ml of sodium bicarbonate. The study drug was administered within 5 minutes following the ISB, and the patients were then placed in the sitting position. Patients randomized to the G or M group, but whose heart rates were greater than 100 or less than 60, were treated as P patients. Incremental doses of midazolam, fentanyl, and/or propofol, were administered for sedation. If blood pressure increased to levels which interfered with surgical visualization, enaloprilat (Vasotec) 1.25 - 2.5 mg was given intravenously. Heart rate and blood pressure trends were recorded. A HBE was defined as a drop in blood pressure of greater than 30 mmHg in less than 5 minutes or any systolic blood pressure below 90 mmHg, and/or a drop in heart rate of greater than 30 beats per minute in less than 5 minutes or any heart rate below 50 beats per minute. These events were treated with atropine, ephedrine, and/or epinephrine at the discretion of the anesthesiologist. The study was blinded to the patient and to the anesthesiologist analyzing the heart rate and blood pressure trends. Groups were compared using Chi-square analysis with continuity correction assigning significance at p<0.05. RESULTS: All groups were comparable with regard to patient age, ASA status, height, weight, baseline heart rate and blood pressure, amount of sedation, sedation score, and total intravenous fluids. One patient in the G group required general anesthesia and was excluded from the analysis. The use of vasotec was greatest in the G group (34.3%) compared to the M group (16.7%) and the P group (13.9%), but these differences were not statistically significant (p=0.089). Two patients initially randomized to the M group, and 2 patients initially randomized to the G group were included in the P group due to baseline HR conditions as noted above. The incidence of HBE within each group is recorded in Table 1.Table 1CONCLUSIONS: In patients undergoing shoulder arthroscopy in the sitting position under interscalene block, metoprolol, but not glycopyrrolate, significantly reduces the incidence of HBE. This finding supports the hypothesis that the BJR is involved in these events, and that blocking the efferent limb of this reflex is effective prophylaxis.

Con: Early extubation after cardiac surgery does not decrease intensive care unit stay and cost

Con: Early extubation after cardiac surgery does not decrease intensive care unit stay and cost

A prospective comparison of the multiplane probe with the biplane probe in structure visualization and doppler examination during transesophageal echocardiography

To compare the imaging capability of the multiplane probe with that of the biplane probe, 317 consecutive patients were randomized to undergo transesophageal echocardiography with either probe. Images of 24 cardiac structures and nine Doppler signals were graded prospectively on a three-grade system. Both multiplane and biplane probes provided excellent visualization of cardiac structures and Doppler signals, but the multiplane probe was significantly superior to the biplane probe. There were no differences in the number of attempts at esophageal intubation, the amount of sedation used, and the examination time. The number of complications was similar, although all failed intubations occurred with the multiplane probe.

Biofeedback-assisted relaxation to reduce stress in labor.

To test the feasibility and effectiveness of incorporating biofeedback-assisted relaxation techniques into routine instruction in Lamaze classes. A quasi-experimental design (static groups comparison) was used. Lamaze classes. A convenience sample of 33 subjects recruited from 12 Lamaze classes. Duration of first-stage labor, amount of sedation and analgesia during first-stage labor, number of complications, and 1- and 5-minute Apgar scores of the neonates. The experimental subjects reported greater stress during labor than did the control subjects. Although the supplementary instruction in reducing stress seemed to promote relaxation during the prenatal classes, it did not reduce distress during labor and delivery because no mothers attempted to use the technique at that time.

EEG-Parameter in der Überwachung beatmeter Intensivpatienten unter verschiedenen Sedierungsstrategien

Visual evaluation of the EEG and spectral analysis of the background activity are useful in monitoring changes of cerebral function caused by sedatives, hypoxia and changes in state of health. Continuous slow changes of the EEG are indicative of critical situations of cerebral blood flow or metabolism. Monitoring cerebral function of 40 sedated and ventilated patients on an intensive care unit, we found typical EEG changes dependent on different regimes of sedation, amount of sedatives and patient condition. In patients sedated with etomidate, there was a good correlation between the relative power of the delta and beta-band and patient condition. Sedation with thiopental caused flattening and slowing of the EEG, as well as a decrease of total power, if the doses were increased. The EEG was an aid to predicting the outcome of intensive care and to demonstrate the degree of cerebral damage. In patients with septicaemia, cerebral function was more depressed than in patients with cardiac failure. Spectral analysis and computed parameters proved to be valuable in monitoring cerebral changes caused by sedation and state of health in ventilated patients.

Patterns in perinatal mortality: A study of 100 months

A survey of 8½ years of perinatal mortality records from the Methodist Hospital of Dallas is presented. The presentation is motivated by the slow decline of perinatal mortality in the United States since 1950 and the lag of this decline behind that of western Europe. The survey encompasses 28,313 births and 689 perinatal deaths. Immaturity is found to be the largest single category and also to be associated with all other categories in 66 per cent of the deaths. The question is raised of a relationship between the increasing number of deaths from respiratory distress in the immature neonate and the amount of sedation and type of anesthesia used during premature labor and delivery.

An objective evaluation of a prepared childbirth program

There was a very significant relationship between interest in mothers' classes, actually taking them, and the receiving of support during labor. Preparation did not significantly increase the number of mothers who nursed their babies, but did increase the number selecting rooming-in. The prepared mothers had fewer fears concerning pregnancy than the nonprepared. Preparation increases as the age of the mother increases, as the education of the mother and father increases, and as the occupational scale of the father increases. None of these factors seem to influence support.Absence of dyspareunia, occasional or frequent orgasm, the use of internal absorptives, and depression at the time of menstruation relate to a high selection of classes. It appears that the type of person who voluntarily selects mothers' classes is as important as classes themselves, in terms of the effects that preparation seems to have on labor.Preparation does not seem to alter the various time relationships in labor, amount of sedation, or anesthesia. Those who receive support are apparently being given medication earlier in labor, receiving more total doses, more units of analgesia, and have an increase in duration of labor. It appears that medication in the latent phase is the most likely explanation for the latter.

Treatment of tetanus of the newborn.

TETANUS of the newborn, formerly nearly always fatal, has been more amenable to therapy in recent years; antiserum, sedation, and penicillin have improved the prognosis.* The nutrition of these patients has continued to present a problem to pediatricians; at the meeting of the American Pediatric Society in 1954 the problem was referred to as very difficult. 8 It is therefore the purpose of the present report to point out the advantages of the percutaneous intravenous drip when combined with the within a room protective effect of an incubator. Most of the baby's needs may be satisfied without repeated pain, handling, noise, flashing lights, or other undesirable stimuli. A decrease in number and intensity of such stimuli is followed by a decreased incidence of those events which are most likely to end the case fatally: tetanic convulsive or laryngospastic episodes. It also follows that the amount of sedation may be