Amount Of Sedation Research Articles

Effect of Low-dose Atracurium on Laryngeal Mask Airway Insertion Conditions: A Randomized Double-blind Clinical Trial.

Background:The amount of sedation and muscle relaxation of the jaw may have an impact on complications caused by laryngeal mask airway (LMA). The aim of this study is to evaluate the effect of low-dose Atracurium on conditions of insertion, complications, and hemodynamic responses to LMA insertion following induction of anesthesia with propofol, in patients undergoing cataract surgery.Patients and Methods:In this double-blind randomized clinical trial study, 60 patients were randomly divided into two groups. Initially, the patients in the study group received 0.15 mg/kg intravenous injection of atracurium, and the patients in the control group received 2 ml of intravenous injection of normal saline, after which anesthesia in both groups were induced with midazolam, fentanyl, lidocaine, and propofol. The amount of jaw relaxation, ease of insertion, and the time needed for insertion, hemodynamic responses and complications of LMA insertion were evaluated.Results:Jaw relaxation and ease of LMA insertion in the study group was significantly better than that of the control group (P = 0.02). Average time needed for LMA placement in the study group (5/06 ± 0.52 second) was significantly lower than the control group (5/76 ± 0.67 second) (P = 0.001). Hemodynamic response to LMA insertion was similar in both groups. Sore throat at recovery and 24 h after surgery in the control group was significantly higher than that of the study group (3/30 vs. 10/30) (P = 0.01).Conclusions:Using low doses of atracurium decreases the time needed for LMA insertion and sore throat after the operation. Atracurium also increases jaw relaxation and facilitates the placement of LMA.

Effects of adding different doses of clonidine to intrathecal bupivacaine for spinal anesthesia in cesarean sectionss

Purpose: This study investigated the effects of three different doses of clonidine in combination with intrathecal hyperbaric bupivacaine on the quality of the blockade and maternal-fetal repercussions in parturients undergoing elective cesarean section. Materials an Methods: Following ethics committee approval, ASA I and II patients of age group 20-35 years, scheduled for cesarean section, were chosen for this study. Patients were randomly distributed into three equal groups of 35 patients in each using a computer-generated sequence of numbers. The patients received hyperbaric bupivacaine (two ml) with 15 μg of clonidine (BC15 group) or 30 μg of clonidine (BC30 group) or 60 μg of clonidine (BC60 group). Hemodynamic parameters, onset, peak and duration of sensory and motor block, sedation scores, Apgar scores, side effects, and duration of postoperative analgesia were compared. Results: All groups were comparable with respect to demographic profile, onset, peak and duration of sensory and motor block, and overall hemodynamic stability. The authors observed dose-dependent variability in duration of analgesia and sedation. Duration of analgesia was significantly higher in BC60 group as compared to the other two groups (577.13 ± 120.30 vs. 422.06 ± 112.47 and 376.21 ± 87.21 minutes, respectively). Sedation was also more in BC 60 group. Conclusion: Intrathecal addition of 15 and 30 μg clonidine are better options when sedation is not desirable; on the contrary, addition of 60 μg provides excellent quality of spinal analgesia when some amount of sedation is acceptable or required without any deleterious effects on the mother and baby.

Effect of a low dose of midazolam on high blood pressure in dental patients: a randomised, double-blind, placebo-controlled, two-centre study

Some patients have transient hypertension before dental treatment as a result of anxiety and stress. Midazolam is an anxiolytic, and thought to be effective for the management of this sort of transient hypertension. We have evaluated in a randomised, controlled trial whether a low dose of midazolam can lower blood pressure in dental patients to an acceptable level without excessive sedation. Suitable patients were randomised to be given midazolam (trial group) or physiological saline (control group) intravenously. Blood pressure, heart rate, degree of anxiety, and amount of sedation were measured before and after injection. After injection, blood pressure in the trial group significantly decreased to clinically acceptable levels compared with controls. The degree of anxiety in the trial group was also significantly less than that in the control group, but there were no significant differences in sedation. These results suggest that injection of a low dose of midazolam stabilises the blood pressure of dental patients with transient hypertension.

Efectividad de aplicación de reiki para disminuir el fracaso en el destete ventilatorio. Ensayo clínico

IntroductionAdmission to intensive care unit (ICU) is a difficult and stressful time for the patient, with the application of different techniques, such as intubation and ventilation support withdrawal or ⿿weaning⿿, which may fail due to anxiety. ObjectivesTo determine whether Reiki is useful in reducing weaning failure, as well as reducing the number of days of mechanical ventilation (MV), length of stay in ICU, amount of sedatives, amines, and antipsychotics. MethodRandomized clinical trial. Scope: ICU of a Level III University Hospital. Population: ICU patients connected to Mechanical Ventilation for more than 48hours, with a signed informed consent. Patients in a terminal condition or potential organ donors were excluded. Sample: 256 patients divided into two groups: intervention group (GI) and placebo (GP). The intervention involves the application of Reiki, and a simulated technique within the placebo group. An analysis was made of the absolute and relative frequencies, with a significance level of P<.05, 95% CI ResultsThe percentage of failures at weaning was 9% in GI and 9.5% in GP (P=.42). The mean number of days on MV was 8.85 days for GI and 9.66 for the GP (P=.53). The mean dose of sedatives: GI 1078mg and 1491mg GP. The dose of Haloperidol was lower in the GI (5.30mg vs 16.81mg GP) (P=.03, 95% CI; -21.9 to -1.13). ConclusionsReiki reduces the agitation of patients. A decrease was objectively observed in the number of days of Mechanical Ventilation, length of stay, lower doses of sedatives, and a slight decrease in the weaning failure in the GI. No statistically significant difference was found in the main variable.

Study of prevention and control of delirium in ventilated patients by simulating blockage of circadian rhythm with sedative in intensive care unit

To explore the effect of giving sedatives according to the circadian rhythm in prevention of occurrence of delirium and the prognosis of patients undergoing mechanical ventilation in intensive care unit (ICU). A prospective double-blinded randomized controlled trial (RCT) was conducted. The patients admitted to Department of Critical Care Medicine of the Second Hospital of Lanzhou University from July 2014 to February 2015, undergoing invasive mechanical ventilation over 12 hours were enrolled. All the patients were given fentanyl for analgesia, and they were randomly divided into simulated circadian clock group (study group, n = 35) and non-simulated circadian clock group (control group, n = 35). The patients in each group were subdivided into three subgroups according to the kinds of sedative drugs, namely dexmedetomidine group (n = 8), propofol group (n = 14), and dexmedetomidine combined with propofol group (combination group, n = 13). Visual analogue scale (VAS) standard and Richmond agitation-sedation scale (RASS) were used to control the analgesic and to quantify the depth of sedation by titrating the dose of sedative drugs, the simulated circadian clock was set to control the RASS score at 0-1 during the day, and -1 to -2 at night in study group. The RASS score in the control group was set at -1 to -2 day and night. The urine 6-hydroxy acid melatonin (aMT6s) levels at different time points in the first diurnal rhythm (06:00, 12:00, 18:00, 24:00) were determined by enzyme linked immunosorbent assay (ELISA). The incidence of delirium, severe hypotension, severe bradycardia and other adverse reactions, duration of mechanical ventilation and the time of extubation, length of ICU stay, amount of sedative and analgesic drugs used were recorded. The correlation between delirium and other indexes was analyzed by using Spearman correlation analysis. (1) There were no significant differences in gender, age, acute physiology and chronic health evaluation II (APACHEII) score among groups. (2) Urine aMT6s levels did not show circadian rhythm in both groups, aMT6s level at 06:00 in study group showed an increasing tendency as compared with the control group, but the difference was not statistically significant. (3) Compared with the control group, the incidence of delirium was significantly lowered in the study group (14.3% vs. 37.1%, P = 0.029), but no significant differences were found in the incidence of severe hypotension or severe bradycardia (20.0% vs. 25.7%, 11.4% vs. 20.0%, both P > 0.05). In simulated circadian clock group, the incidence of delirium in dexmedetomidine group was significantly lower than that of the propofol group (6.3% vs. 32.1%, P < 0.05). (4) Compared with control group with the same sedative, the duration of mechanical ventilation, extubation time, length of ICU stay were significantly shortened, and the dosage of sedative drugs used was reduced in study group (all P < 0.05). In simulated circadian clock group, the duration of mechanical ventilation in dexmedetomidine group was significantly shorter than that of propofol group and combination group (hours: 75.75±26.78 vs. 102.00±26.31 and 100.31±25.38, both P < 0.05), and the length of ICU stay was significantly shorter than that of propofol group (days: 5.75±1.04 vs. 7.00±1.52, P < 0.05). (5) The occurrence of delirium was positively correlated with duration of mechanical ventilation (r = 0.705), extubation time (r = 0.704), length of ICU stay (r = 0.666, all P = 0.000), and no correlation was found between the occurrence of delirium and aMT6s level at 06:00, 12:00, 18:00, and 24:00 (r = -0.135, r = 0.163, r = 0.269, r = -0.077, all P > 0.05). Administration of sedatives according to simulating circadian time could decrease the duration of mechanical ventilation, extubation time, and the length of ICU stay, decrease the dosage of sedative drugs, and reduce the incidence of delirium. Dexmedetomidine could reduce the incidence of delirium, and improve the prognosis of patients.

Clinical Efficacy, Safety, and Feasibility of Using Video Glasses during Interventional Radiologic Procedures: A Randomized Trial

PurposeTo evaluate the clinical efficacy, safety, and feasibility of implementing video glasses in a variety of interventional radiologic (IR) procedures. Materials and MethodsBetween August 2012 and August 2013, 83 patients undergoing outpatient IR procedures were randomized to a control group (n = 44) or an experimental group outfitted with video glasses (n = 39). State-Trait Anxiety Inventory (STAI) scores, sedation and analgesia doses, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), pain scores, and procedure times were obtained. Complications and adverse events related to the use of video glasses were recorded. Postprocedural staff surveys and patient satisfaction surveys were completed. ResultsWomen had greater preprocedural anxiety than men (P = .0056), and patients undergoing vascular interventions had greater preprocedural anxiety than those undergoing nonvascular interventions (P = .0396). When assessed after the procedure, patients who wore video glasses had significantly reduced levels of anxiety (−7.7 vs −4.4, respectively; P = .0335) and average MAP (−6.3 vs 2.1, respectively; P = .0486) compared with control patients. There was no significant difference in amount of sedation and analgesia, HR, RR, pain score, or procedure time between groups. No significant adverse events related to the use of video glasses were observed. Postprocedural surveys showed that video glasses were not distracting and did not interfere or pose a safety issue during procedures. Patients enjoyed using the video glasses and would use them again for a future procedure. ConclusionsVideo glasses can be safely implemented during IR procedures to reduce anxiety and improve a patient’s overall experience.

Variación de la masa muscular y el peso en el paciente crítico

ObjectivesQuantify the muscle mass and body weight variation in critically ill patients and to identify associated factors. MethodA descriptive follow-up study. Data for demographic variables, body weight, fluid balance, daily kilocalories, the amount of sedation and muscle relaxants received and motor physiotherapy applied were collected.Three consecutive measurements were performed in the brachial biceps and quadriceps rectus by using ultrasound, upon admission and every 5 days until discharge. Results68 patients were included. Average age was of 73.5 [57-78,5] years. The median length of stay was 9.5 [5.5 -15] days. The median 16 (SD=5.7) daily kilocalories per kg/weight, 91.2% received sedation, 44.1% received muscle relaxants and 20% received physiotherapy.The patients presented a muscle wasting of 4.9 (SD=3.9)mm, p <.001 in the brachial biceps and 5.6 (SD=4.8)mm, p <.001 in the quadriceps rectus. Regression analysis selected the length of stay and the muscle relaxants are the most influential variables in the brachial biceps muscle wasting (R2=0.4), and length of stay as the most influential in the quadriceps rectus muscle wasting (R2=0.3). Patient's mean body weight on admission was of 81.1 (SD=15)kg and 81.2 (SD=14.2)kg on discharge, p=.95. ConclusionsThe critically ill patient presents a significant muscle waste related with the length of stay and the treatment received with muscle relaxants. Patients are being discharged with a similar body weight to which they were admitted but with a significant reduction of muscle mass.

Sedation practice and comfort during colonoscopy: lessons learnt from a national screening programme.

Medication may be used to manage discomfort during colonoscopy but practice varies. The relationship between medication use and comfort during colonoscopy was examined in the English Bowel Cancer Screening Programme. Data related to patient comfort and medication use from all 113,316 examinations performed within the English Bowel Cancer Screening Programme between 1 January 2010 and 31 December 2012 were analysed. Comfort was rated on the five-point Modified Gloucester Comfort Scale: 1, no discomfort; 5, severe discomfort. Scores of 4 and 5 were considered to indicate significant discomfort. Correlations between the proportion of examinations associated with significant discomfort and the amounts of medication used by colonoscopists were assessed using Spearman's ρ. Logistic regression modelling examined the independent predictors of significant discomfort. Patients had a mean age of 65.7 years, and 58% were male. Examinations were performed by 290 endoscopists. In 91% of examinations, there was no significant discomfort reported during examination; however, there was considerable variation between individual colonoscopists (range 76.1-99.2%).Intravenous sedation and opiate analgesia were used during most examinations, but there was wide variation between colonoscopists, with a median (range) usage of 95.1% (4.1-100%) and 97.3% (5.6-100%), respectively. There was no association between the amount of sedation and analgesia used and significant discomfort (ρ<0.2). On multivariate analysis, significant discomfort was found to be more common among female individuals [odds ratio (OR)=2.0], on incomplete examinations (OR=6.7), and among patients with diverticulosis (OR=1.4). There was wide variation in medication practice among English screening colonoscopists, but this was unrelated to the occurrence of significant discomfort.

P291 Obstructive Sleep Apnoea Screening For Patients Undergoing Bronchoscopy - Is It Required?

Introduction A recent meta-analysis shows obstructive sleep apnoea (OSA) increases the incidence of postoperative desaturation, respiratory failure, cardiac events, and ICU transfers (Kaw, R., et al, 2012). A study in gastrointestinal endoscopy showed no increased risk of cardiopulmonary complications in OSA screening positive patients (Mador, M. J., et al, 2012). There are no published studies in patients with OSA undergoing bronchoscopy, as far as we are aware. It has been suggested that patients should be screened for OSAS prior to endoscopy and bronchoscopy. Methods Nursing staff in the bronchoscopy suite used a validated OSA screening tool STOP-BANG score prior to the procedure. The physician performing the rpocedure was unaware of the score. The amount of sedation used during the procedure is recorded. Sedation score, Respiratory Rate (RR), Oxygen Sturation (SpO2) were documented 0,30,60,120 min post procedure. Results Procedures were performed in 57 patients; diagnostic bronchoscopy 28, EBUS 29. Twenty-three patients (40.3%) were identified high risk for OSA (STOP-BANG score 3 or above). The mean age was 64 +/- 15. Male 29 (50.8%). There was no statistically significant difference in: amount of sedation used (midazolam, fentanyl or both), lignocaine use, initial sedation score, RR, SpO2, between high and low risk group. (Table 1). There was no correlation between initial sedation score with STOP-BANG score. There was no evidence of deeper sedation, drop in RR or SpO2 noticed in the post procedure observation period in the high risk group. Median length of observation was same in both groups. There were no complications or emergency admissions. Conclusion In this small study there is no evidence of increased cardio respiratory complications in patients at high risk for OSA undergoing bronchoscopy under conscious sedation. References Kaw, R, et al. Meta-analysis of association between obstructive sleep apnoea and postoperative outcome. Br J Anaesth 2012;109(6):897-906 Mador, MJ, et al. D patients at risk of sleep apnea have an increased risk of cardio-respiratory complications during endoscopy procedures? Sleep Breath 2012;16(3):609-615

Does Mandatory Documentation of Colonoscopy Duration Enhance Adenoma Detection Rate?

Introduction: Our institution has recently mandated documentation of duration of all colonoscopies by endoscopists as a quality improvement initiative. Adenoma detection rate (ADR), an important quality indicator of colonoscopy, is known to be improved with a withdrawal time of at least 6 minutes. However, there is sparse data on influence of mandatory documentation of total colonoscopy times on ADR. Aims of this study were to determine if mandatory documentation of colonoscopy duration enhances ADR and the number of adenomas detected per patient. Methods: Chart review of screening colonoscopies performed at our institution for 6 months in premandatory period (PRE; January 2013 to June 2013) and for 9 months in post-mandatory period (POST; July 2013 to March 2014). Patients over age 50 years undergoing screening or surveillance colonoscopy with adequate bowel preparation and complete colonoscopy were included. Patient demographics and colonoscopy findings such as indication, quality of bowel preparation, and type and amount of sedation were reviewed. Patients with IBD, polyposis syndromes, prior colonic resection, and poor bowel preparation were excluded. ADR was defined as proportion of colonoscopies with at least 1 adenoma detected. Procedure duration was defined as time from endoscope insertion to removal out of the patient. Data is presented as mean plus standard deviation, median (25th, 75th percentiles), or N (%). Univariate analysis, analysis of variance, Kruskal-Wallis tests, Pearson’s Chi-square tests and Wilcoxon rank sum tests were performed, and SAS (version 9.3, SAS institute, Cary, NC) was used for statistical analysis. Results: A total of 578 subjects were included in the analysis (254 in PRE and 324 in POST). Average age at time of colonoscopy was 64±9 years, and 52% were male. Patient demographics and colonoscopy findings were similar in PRE and POST. Mean procedure duration was 25.9+16.8 minutes in POST. ADR was 41.7% in PRE compared to 46.6% in POST (p=0.24). The findings were similar in the subgroup of average risk subjects. There was a trend suggesting that a higher number of adenomas per patient, particularly in the distal colon, were likely to be found in the POST. This trend was not observed in the subgroup of average risk patients (p=0.88). There was only trivial correlation between procedure duration and number of adenomas detected per patient (rho 0.27; 95% CI 0.017, 0.38). Conclusion: Mandatory documentation of colonoscopy duration does not seem to impact ADR. It might increase the number of adenomas detected per patient, mainly in the distal colon. Further studies are needed to evaluate these findings.

Predictors for cecal insertion time: the impact of abdominal visceral fat measured by computed tomography.

Several factors affect the risk for longer cecal insertion time. The aim of this study was to identify the predictors of longer insertion time and to evaluate the effect of visceral fat measured by CT. This is a retrospective observational study. Outpatients for colorectal cancer screening who underwent colonoscopies and CT were enrolled. Computed tomography was performed in individuals who requested cancer screening and in those with GI bleeding. Information on obesity indices (BMI, visceral adipose tissue, and subcutaneous adipose tissue area), constipation score, history of abdominal surgery, poor preparation, fellow involvement, diverticulosis, patient discomfort, and the amount of sedation used was collected. The cecal insertion rate was 95.2% (899/944), and 899 patients were analyzed. Multiple regression analysis showed that female sex, lower BMI, lower visceral adipose tissue area, lower subcutaneous adipose tissue area, higher constipation score, history of surgery, poor bowel preparation, and fellow involvement were independently associated with longer insertion time. When obesity indices were considered simultaneously, smaller subcutaneous adipose tissue area (p = 0.038), but not lower BMI (p = 0.802) or smaller visceral adipose tissue area (p = 0.856), was associated with longer insertion time; the other aforementioned factors remained associated with longer insertion time. In the subanalysis of normal-weight patients (BMI <25 kg/m), a smaller subcutaneous adipose tissue area (p = 0.002), but not a lower BMI (p = 0.782), was independently associated with a longer insertion time. Longer insertion time had a positive correlation with a higher patient discomfort score (ρ = 0.51, p < 0.001) and a greater amount of midazolam use (ρ = 0.32, p < 0.001). This single-center retrospective study includes a potential selection bias. In addition to BMI and intra-abdominal fat, female sex, constipation, history of abdominal surgery, poor preparation, and fellow involvement were predictors of longer cecal insertion time. Among the obesity indices, high subcutaneous fat accumulation was the best predictive factor for easier passage of the colonoscope, even when body weight was normal.

Correlation of patient-reported outcomes of sedation and sedation assessment scores in critically ill patients

PurposePatient-reported outcomes (PROs) are recommended as indicators of quality in the intensive care unit. We studied the correlation between PROs of sedation quality and a universal sedation assessment scale in critically ill patients. Materials and methodsTwenty-nine mechanically ventilated adults admitted to a surgical/trauma or medical intensive care unit requiring continuous infusion sedation for 24 hours or more were prospectively included. Patient-reported outcomes were evaluated through sedation questionnaire 24 hours post–continuous infusion sedation. The primary outcome was the correlation of PROs with Sedation-Agitation Scale (SAS) scores. ResultsMean (SD) SAS scores per 12-hour nursing shift for propofol (n = 179), midazolam (n = 42), and dexmedetomidine (n = 8) were 3.78 (77), 3.31 (1.1), and 2.98 (0.76), respectively. The mean score for survey questions addressing perceptions of comfort was 5.3 (1, complete comfort; 10, not comfortable at all). Of the patients, 34%, 7%, and 52% would want more, less, or the same amount of sedation, respectively, if this situation were to arise again. Patient perception of comfort correlated with the percent time at goal SAS score; r = 0.31 (P < .05). ConclusionPatient-reported outcomes of sedation correlate with the percentage of time spent in the goal range of scores for a universal sedation assessment scale. These findings represent initial attempts to appreciate the patient's perspective in the management and monitoring of agitation.

Neurally adjusted ventilatory assist (NAVA) in pediatric intensive care—A randomized controlled trial

Neurally adjusted ventilatory assist (NAVA) has been shown to improve patient-ventilator synchrony during invasive ventilation. The aim of this trial was to study NAVA as a primary ventilation mode in pediatric intensive care and to compare it with current standard ventilation modes. One hundred seventy pediatric intensive care patients were randomized to conventional ventilation or NAVA. The primary endpoints were time on the ventilator and the amount of sedation needed. To enable comparison between sedative agents, a "sedative unit" was defined for each drug. The median time on the ventilator was 3.3 hr in the NAVA group and 6.6 hr in the control group (P = 0.17), and the length of stay in the PICU 49.5 hr in the NAVA group and 72.8 hr in the control group (P = 0.10, per protocol P = 0.03). The amount of sedation needed in the total patient population did not differ between the groups (P = 0.20), but when postoperative patients were excluded (19 vs. 20 patients), the amount was significantly lower in the NAVA group (0.80 vs. 2.23 units/hr, P = 0.03). Lower peak inspiratory pressure and a lower inspired oxygen fraction were found in the NAVA group (P = 0.001 for both). Arterial blood CO2 tensions were slightly higher in the NAVA group up to 32 hr of treatment (P = 0.008). There were no significant differences in the other ventilatory or vital parameters, arterial blood gas values or complications. We found NAVA to be a safe and feasible primary ventilation mode for use with children. It outscored standard ventilation in some aspects, as it was able to enhance oxygenation even at lower airway pressures and led to reduced use of sedatives during longer periods of treatment.

Grading the Quality of Bowel Preparation

In colonoscopy, even a complete examination has little diagnostic accuracy when the endoscopic view of the mucosa was impaired by residual stool. Therefore, an assessment of the visibility of the mucosa is important, in order to be able to judge the reliability of positive, but even more importantly, negative findings during colonoscopy.Insufficient visualization can result in lesions, especially small or flat ones, being missed. Poor bowel preparation may also result in difficult progression, an increased risk of complications, prolonged procedure duration and an increase in the amount of sedatives and analgetics required. Poor bowel preparation is also a frequent cause for incomplete procedures.The optimal grading scale uses objective terminology, is validated, and informs both on segmental as overall bowel preparation quality. The Boston bowel preparation scale fulfils all these criteria, making it the most uses bowel preparation scale in colorectal cancer screening programs.

Randomized controlled trial of daily interruption of sedatives in critically ill children

To study the feasibility of daily interruption of sedatives in critically ill children. Prospective randomized controlled open-label trial, performed in a pediatric intensive care unit of a tertiary care teaching and referring hospital. 30 children (0-12 years) receiving mechanically ventilation for >24 h were included. In the intervention group, all sedatives were stopped daily and restarted when COMFORT-behavior score ≥17. The control group received standard care. Primary end points were amounts of sedatives and number of bolus medications in the first 3 days after enrollment and number of (near) incidents. Secondary end points were duration of mechanical ventilation, length of stay in pediatric intensive care, and changes in COMFORT-behavior score. Midazolam and morphine use were lower in the intervention group compared with the control group (P = 0.007 and P = 0.02, respectively), whereas the number of bolus medications did not differ between groups. Two complications were recorded: one patient (intervention group) lost his intravenous line, and one patient (control group) had an unplanned extubation. Duration of mechanical ventilation was significantly shorter in the intervention group compared with the control group (median [interquartile range] of 4 [3-8] and 9 [4-10] days, respectively, P = 0.03). Length of stay in the PICU in the intervention group was significantly shorter than in the control group (median [interquartile range] of 6 [4-9] and 10 [7-15] days, respectively, P = 0.01). Daily interruption of sedatives in critically ill children is feasible, results in decreased use of sedation, earlier extubation, and shorter length of stay.

PTH-190 Does the Amount of Sedation have an Impact on the Diagnostic Yield of Double Balloon Enteroscopy ? Experience From a Tertiary Centre

IntroductionDouble balloon enteroscopy (DBE) offers the ability for diagnostic and therapeutic intervention in the small bowel. The procedure takes an average of an hour to carry out and can be...

Intravenous glucagon beneficial during colonoscopy in patient with IBS

Background and Aim: Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain or discomfort and altered bowel habits. Patients with IBS requiring colonoscopy take longer time to cecum with higher need for medications used for conscious sedation. Glucagon is routinely used during endoscopic procedures to reduce peristalsis that interfere with the procedure. However, randomized controlled data using glucagon during endoscopic procedures are lacking. We designed a prospective randomized placebo-controlled trial to study the effect of intravenous glucagon given during colonoscopy. Materials and Methods: We received approval from the FDA for this off-label use of glucagon during colonoscopy. This is a double-blind randomized placebo-controlled study. Patients were selected based on ROME III criteria for IBS; patients who met Rome III criteria and had an indication for colonoscopy for age-specific colon cancer screening or for work up of any alarm signs. We selected 34 patients meeting the Rome III for IBS and randomized into Group A and Group B. Both the performing endoscopist and patients were blinded. These patients in both groups initially received a standard dose of conscious sedation, up to 100 mcg of fentanyl and up to 5 mg of midazolam intravenously. In Group A, 17 patients, in addition to conscious sedation, received 1 ml saline as placebo. In Group B, 17 patients, in addition to conscious sedation, received 1 mg of intravenous glucagon. Parameters evaluated were as follows: 1) Total time required for colonoscopy 2) Completion of colonoscopy as documented by cecal intubation or visualization of appendicular orifice 3) Level of comfort in patient concerned to postprocedure spasmodic pain, which was based on Wong-Baker FACES pain rating scale and 4) Calculate the amount of sedation required in both groups of patients and also at what extent glucagon helped to decrease the requirement of sedatives. Data was analyzed using the student t-test.

Body mass index predicts cecal insertion time: The higher, the better

It is essential to determine the factors that predict prolonged procedural time during colonoscopy. The aim of this study was to determine the effect of body mass index (BMI) on cecal insertion time (CIT) during colonsocopy. Consecutive outpatients who received colonoscopies over a 10 month period (April-October 2007) were enrolled. Exclusion criteria included colonic resection, strictures or exophytic masses precluding colonic evaluation. Data were collected for age, sex, race, height, weight, BMI, waist circumference, prior history of abdominal or pelvic surgery, history of diverticulosis, participation of fellow, CIT, quality of colon cleansing and the amount of sedation used during the procedure. A total of 1430 patients (586 men and 844 women; mean age 60.3 years) were included in the final analysis. The mean CIT was 648.5 seconds (SE = 11.47). Older age, female gender, fellow involvement, poor bowel preparation and lower BMI were associated with prolonged mean CIT on linear regression analysis ((R2) = 0.116; P < 0.001). Mean CIT declined linearly with increasing BMI. A higher BMI is strongly associated with progressively shorter CIT.

Tu1732 Effect of Body Mass Index on Procedure Time, Amount of Sedation, and Prep Quality During Screening Colonoscopy

Tu1732 Effect of Body Mass Index on Procedure Time, Amount of Sedation, and Prep Quality During Screening Colonoscopy

Comparison of left and right ventricular dimensions, systolic and diastolic function between 1.0T Open MRI and 1.5T cylindrical MRI

Background Cardiac MRI is the reference standard for cardiac morphology and functional assessment of left and right ventricular (LV,RV) end-diastolic and -systolic volumes (EDV, ESV), stroke volume (SV), ejection fraction (EF) and myocardial mass (Mass) due to its high image resolution tissue differentiation. Because of its cylindrical shape and resulting spatial restrictions, a significant amount of obese and claustrophobic patients, at least 10-15%, cannot be studied at all or only with higher amounts of sedation. Recently, 1.0T open MRI, which offers more space due to its different magnet architecture, has been introduced mainly for orthopaedic purposes but until now has rarely been used for cardiovascular functional measurements. We sought to investigate the performance of 1.0T open MRI for cardiovascular function and to compare LVand RV-EDV, -ESV, -SV, -EF, longitudinal RV and LV function and Mass for both 1.0 and 1.5T.