Intravenous Conscious Sedation Research Articles

Light Conscious Sedation in Patients with Previous Acute Myocardial Infarction Needing Exodontia: An Observational Study

AimThis study evaluated a protocol of light conscious sedation for multimodal analgesia in patients with a clinical history of acute myocardial infarction requiring tooth extraction and to assess postoperative pain by using the quantity intake of acetaminophen as the indicator.Material and methodsAll 50 patients received preliminary anxiolysis via oral chlordemethyldiazepam administration. After 15 to 20 minutes, only patients reporting they were not fully relaxed received additional intravenous diazepam before tooth extraction. Acetaminophen 1000 mg was suggested as the preferred postoperative analgesic drug.ResultsThe studied patients included 39 women and 11 men with a mean age of 69.4 ± 17.1 years. They were classified according to the American Society of Anesthesiologists Physical Status classification system as follows: 12 patients belonging to class II, 32 patient to class III, and the remaining six to class IV. Based on the Modified Dental Anxiety Scale, six patients were phobic and seven anxious. Nevertheless, intravenous conscious sedation was needed in 23 patients via diazepam. The first day after surgery, 76% of patients took acetaminophen, and 58% took acetaminophen the second day, with a mean two-day total intake of acetaminophen of 1020 ± 789 mg/day. Stratified statistical analysis was performed and revealed that 60.87% of patients receiving intravenous diazepam needed to take acetaminophen on the first day after dental extraction in contrast to the 88.89% of patients who did not receive intravenous diazepam (χ2 test; P = .021).ConclusionsOur data suggest that anxiety related to dental procedures is widespread, although often unmentioned by patients. Moreover, the percentage of patients needing analgesics during the first 24 hours following surgery demonstrated that overall perioperative pain might be controlled by the light conscious sedation protocol for patients with previous acute myocardial infarction proposed in the current study.

Creation of a score to predict risk of high conscious sedation requirements in patients undergoing endoscopy

The administration of intravenous conscious sedation to patients undergoing GI endoscopy carries a risk of cardiopulmonary adverse events. Our study aim was to create a score that stratifies the risk of occurrence of either high-dose conscious sedation requirements or a failed procedure. Patients receiving endoscopy via endoscopist-directed conscious sedation were included. The primary outcome was occurrence of sedation failure, which was defined as one of the following: (1) high-dose sedation, (2) the need for benzodiazepine/narcotic reversal agents, (3) nurse-documented poor patient tolerance to the procedure, or (4) aborted procedure. High-dose sedation was defined as >10 mg of midazolam and/or >200 μg of fentanyl or the meperidine equivalent. Patients with sedation failure (n= 488) were matched to controls (n= 976) without a sedation failure by endoscopist and endoscopy date. Significant associations with sedation failure were identified for age, sex, nonclonazepam benzodiazepine use, opioid use, and procedure type (EGD, colonoscopy, or both). Based on these 5 variables, we created the high conscious sedation requirements (HCSR) score, which predicted the risk of sedation failure with an area under the curve of 0.70. Compared with the patients with a risk score of 0, risk of a sedation failure was highest for patients with a score≥3.5 (odds ratio, 17.31; P= 2× 10-14). Estimated area under the curve of the HCSR score was 0.68 (95% confidence interval, 0.63-0.72) in a validation series of 250 cases and 250 controls. The HCSR risk score, based on 5 key patient and procedure characteristics, can function as a useful tool for physicians when discussing sedation options with patients before endoscopy.

Higher Sedation Requirements Among Inflammatory Bowel Disease Patients Undergoing Colonoscopy for Disease Activity Assessment or Dysplasia Surveillance

Abstract Background and Aims Patients with inflammatory bowel disease (IBD) require colonoscopy for diagnosis, disease activity assessment, and dysplasia surveillance. Few studies have evaluated anesthesia needs of IBD patients during procedures. This study aimed to examine sedation requirements of IBD patients undergoing colonoscopy. Methods A retrospective cohort study of IBD and non-IBD patients presenting for colonoscopy between August 2015 and December 2016 was undertaken. Data collected included patient and procedure focused variables. Sedation was categorized as intravenous conscious sedation (IVCS) or monitored anesthesia care (MAC). Results: A total of 522 consecutive colonoscopies (212 IBD, 310 non-IBD) between August 2015 and December 2016 met criteria for inclusion. In total, 323 cases utilized IVCS (56 IBD, 267 non-IBD) and 196 used MAC (155 IBD, 41 non-IBD). Compared with non-IBD patients (13.2%), more IBD patients (73.1%) required MAC (P < 0.01). For IVCS cases, IBD patients required more midazolam (5.73 mg versus non-IBD 4.31 mg; P <0.01) and opioid (IBD 157.59 µg fentanyl equivalents versus non-IBD 119.41 µg; P < 0.01). Diphenhydramine was more frequently added to IVCS for IBD cases (IBD 25.0% versus non-IBD 1.9%; P < 0.01). For MAC cases, propofol dosage was not significantly different between groups (IBD 355.64 mg versus non-IBD 317.104 mg; P = 0.29). IBD colonoscopies took longer (IBD 22.7 versus non-IBD 17.2 min; P < 0.01) and more patients had recent narcotic use (IBD 21.2% versus non-IBD 9.0%; P < 0.01). Conclusions IBD patients required more IVCS, including greater diphenhydramine use with longer procedure times compared with non-IBD patients. These findings suggest MAC should be considered for IBD procedural sedation.

Optimizing the treatment of pain and anxiety in pediatric emergencies: the role of accreditation

Pervasive disparities exist in the treatment of pain and anxiety in pediatric patients presenting to hospitals with emergency conditions. This finding has been demonstrated worldwide, and is especially exacerbated in general emergency departments, which treat both adults and children. Policies to promote appropriate analgesia in the context of pediatric emergency care have been developed by several professional societies and governmental agencies in the United States; however, progress has been uneven, and data regarding these questions is lacking.In their excellent article, Capua and her co-authors address this precise problem through a unique methodology, by surveying nurse directors of both pediatric accredited and non-accredited emergency departments. Survey questions focused on availability of pharmacological and non-pharmacological modalities, and on the prevalence with which providers administered both oral and parenteral medications. The results demonstrated widespread availability of evidence based analgesic and anxiolytic treatment, ranging from medical clowns and specific holding positions, to use of intravenous opiates and conscious sedation. No significant differences were found associated with accreditation.These results are surprising and seem to call into question the value of pediatric accreditation. However, an alternative hypothesis would be that accreditation has succeeded, and the results reflect a large spillover effect, in which providers trained in accredited institutions bring these advanced practices to their local departments. Regionalization has been promoted for emergency care of many acute conditions such as trauma, stroke, and myocardial infarction. These results suggest that for pediatric emergencies, at least in regard to analgesia, the answer likely lies in dissemination of knowledge, rather than super specialization. In other words, bring the expertise to the children, not the children to the experts. Further research in this area could focus on optimal ways to achieve such knowledge translation.

Real-time MR-guided brain biopsy using 1.0-T open MRI scanner.

To evaluate the safety, feasibility and diagnostic performance of real-time MR-guided brain biopsy using a 1.0-T open MRI scanner. Medical records of 86 consecutive participants who underwent brain biopsy under the guidance of a 1.0-T open MRI scanner with real-time and MR fluoroscopy techniques were evaluated retrospectively. All procedures were performed under local anaesthesia and intravenous conscious sedation. Diagnostic yield, diagnostic accuracy, complication rate and procedure duration were assessed. The lesions were divided into two groups according to maximum diameters: ≤ 1.5 cm (n = 16) and > 1.5 cm (n = 70). The two groups were compared using Fisher's exact test. Diagnostic yield and diagnostic accuracy were 95.3% and 94.2%, respectively. The diagnostic yield of lesions ≤ 1.5 cm and > 1.5 cm were 93.8% and 95.7%, respectively. There was no significant difference in diagnostic yield between the two groups (p > 0.05). Mean procedure duration was 41 ± 5 min (range 33-49 min). All biopsy needles were placed with one pass. Complication rate was 3.5% (3/86). Minor complications included three cases of a small amount of haemorrhage. No serious complications were observed. Real-time MR-guided brain biopsy using a 1.0-T open MRI scanner is a safe, feasible and accurate diagnostic technique for pathological diagnosis of brain lesions. The procedure duration is shortened and biopsy work flow is simplified. It could be considered as an alternative for brain biopsy. • Real-time MRI-guided brain biopsy using a 1.0-T open MRI scanner is safe, feasible and accurate. • No serious complications occurred in real-time MRI-guided brain biopsy. • Procedure duration is shortened and biopsy work flow is simplified.

Feasibility and safety of using local anaesthesia with conscious sedation during complex cardiac implantable electronic device procedures

We assessed the feasibility and safety of using local anaesthesia with conscious sedation as an alternative to general anaesthesia during complex and noncomplex cardiac implantable device procedures. We enrolled 279 consecutive patients who underwent cardiac device implantation/replacement at our tertiary/quaternary cardiac specialist hospital during a 17-month study period. Continuous combined intravenous conscious sedation with propofol and midazolam plus fentanyl and local anaesthesia were used for all procedures. Among the patients, 113, 59, 43, and 64 patients underwent pacemaker implantation, implantable cardiac defibrillator implantation, cardiac resynchronisation therapy device implantation, and generator exchange, respectively. The procedural success rate was 100%, with no apnoea or hypoxia episodes requiring therapeutic intervention. None of the patients required conversion to general anaesthesia. The mean surgical duration was longer for complex vs. noncomplex procedures (p = 0.003). The minimum mean arterial pressure during complex procedures was slightly lower than that during noncomplex procedures (p = 0.03). The perioperative (<24 h) mortality rate was 0%, and neither complexity group required tracheal intubation. Only two patients (0.7%) required unplanned intensive care unit admission for further surveillance. Our findings suggest that local anaesthesia with conscious sedation is a safe and feasible option for cardiac device implantation procedures, including complex procedures.

Practice Guidelines for Intravenous Conscious Sedation in Dentistry (Second Edition, 2017).

Practice Guidelines for Intravenous Conscious Sedation in Dentistry (Second Edition, 2017).

Practice Guidelines for Intravenous Conscious Sedation in Dentistry (2nd Edition, 2017) Developed for Dentists in Japan by the Japanese Dental Society of Anesthesiology.

Practice Guidelines for Intravenous Conscious Sedation in Dentistry (2nd Edition, 2017) Developed for Dentists in Japan by the Japanese Dental Society of Anesthesiology.

Preoperative Anxiety and Its Influence on Patient and Surgeon Satisfaction in Patients Receiving Dental Implant Surgeries Performed Under Intravenous Conscious Sedation.

The aims of this study were to evaluate the relationship of age, sex, and type and duration of the surgery with preoperative anxiety in patients undergoing dental implant surgeries under intravenous conscious sedation, and to assess preoperative anxiety association with the postoperative satisfaction of both the patient and surgeon. This prospective study included 180 patients receiving dental implant surgeries under intravenous conscious sedation by means of midazolam, fentanyl, and propofol. Preoperative anxiety (Corah Dental Anxiety Scale), number of implants, duration of surgery, surgeon satisfaction (evaluated as three categories: patient too awake and nervous, adequate sedation, or patient too asleep), and patient satisfaction (classified as five levels: agreeable, neither agreeable nor disagreeable, slightly uncomfortable, unpleasant, traumatic) were recorded. All 180 patients completed the study, and 72.2% of them experienced moderate or high levels of anxiety. The mean Corah scale score was 9.2 ± 3.5. Anxiety was significantly higher among men but showed no relation to age. A significant relationship was found between patient anxiety and the number of implants: those patients who received eight or more implants, with a duration of surgery longer than 60 minutes, had lower anxiety. Surgeon satisfaction was adequate in 90% of the cases. Patients evaluated the procedure as agreeable in 34.4% of cases, neither agreeable nor disagreeable in 26.7%, slightly uncomfortable in 29.4%, unpleasant in 7.8%, and traumatic in 1.7%. High anxiety levels were related with poor patient satisfaction but not with surgeon satisfaction. Preoperative anxiety was moderate or high in two-thirds of patients undergoing dental implant surgeries, having a negative influence on patient satisfaction, but not affecting surgeon satisfaction. Additionally, the intravenous conscious sedation technique was considered a satisfactory technique by the surgeon to control anxiety.

Septoplasty: Scepter Balloon Angioplasty for Vasospasm after Aneurysmal Subarachnoid Hemorrhage

Introduction: Balloon angioplasty can be a requisite approach for the treatment of symptomatic and/or severe vasospasm. Dual-lumen microcatheter balloons have multiple potential advantages for this indication including accommodating a 0.014-inch wire and the potential to deliver superselective vasodilators directly via the microcatheter prior to angioplasty. Methods: The authors reviewed a 3-year institutional experience with the Scepter XC balloon (Microvention, Tustin, CA, USA) in the treatment of postaneurysmal subarachnoid hemorrhage vasospasm, focusing on treatment methods, angiographic, and clinical results. Results: Sixty-four vessels were treated in 18 patients. Fifteen cases were performed under intravenous (i.v.) conscious sedation (83%). The mean pretreatment stenosis was 59% (range 40-80), and the mean post-treatment stenosis was 12% (range 0-40). Five vessels in 3 patients were subsequently retreated via angioplasty for recurrent vasospasm (8%). There were no complications related to the passage of the balloon microcatheter or inflation of the balloon such as dissection or vessel rupture. Of 14 patients with delayed cerebral ischemia, 7 had complete symptomatic resolution after treatment, and 3 had significant symptomatic improvement. Four patients did not improve after treatment though 3 already had confirmed infarcts on imaging prior to angiography. Conclusion: The Scepter XC is a safe and effective balloon microcatheter for angioplasty of cerebral vasospasm after subarachnoid hemorrhage, allowing for superselective delivery of a vasodilator. Its ease of deliverability and visibility often allows for the performance of the procedure under i.v. conscious sedation.

Response to: Role of Transpedicular Percutaneous Vertebral Biopsy for Diagnosis of Pathology in Vertebral Compression Fractures

Study design Retrospective observational study. Purpose To identify the role of percutaneous vertebral biopsy in histopathological diagnosis of vertebral compression fractures and to identify the frequency of unexpected malignancy in vertebral compression fractures. Overview of literature Vertebral compression fractures are common in the Indian population. Magnetic resonance imaging and nuclear imaging have some limitations in the diagnosis of definitive pathology of vertebral compression fractures. Therefore, histological confirmation is necessary for definitive diagnosis and to plan appropriate management for patient. Methods A retrospective observational study was conducted involving 84 patients who underwent percutaneous vertebral biopsy between 2010 and 2014. We performed C-arm guided percutaneous transpedicular core vertebral biopsy of vertebral compression fractures under combination of local anesthesia and intravenous conscious sedation. Results Sufficient biopsy material was obtained in 79 of the 84 cases. In the other five cases, biopsy material was not sufficient for reporting. Out of the 79 cases, osteoporotic pathology was detected in 69 patients, malignancy was detected in 8 patients and no pathology was found in 2 patients. Two patients with distant metastases to vertebra were identified. Primary spinal malignancy was detected in 6 patients (1 unsuspected plasmacytoma, 5 diagnosed malignancy preoperatively). So, the frequency of unsuspected malignancy of this study was 1.19% (1/84). None of the patients had any complications. Conclusions C-arm guided percutaneous transpedicular vertebral biopsy is useful in obtaining definitive histopathological diagnosis of vertebral compression fractures, especially in differentiating malignant and non-malignant vertebral compression fractures and helping plan appropriate management of patients. The rate of unexpected malignancy in vertebral compression fracture was 1.19%.

Can intravenous conscious sedation with midazolam be effective at facilitating surgical dentistry in adolescent orthodontic patients? A service evaluation.

Background Surgical dentistry during orthodontic care often occurs in adolescence and may involve surgical removal or exposure of teeth. The invasive nature of treatment, combined with dental anxiety, means care can often be provided under general anaesthesia (GA). Best-practice guidelines however endorse conscious sedation as an alternative, where appropriate. Although a limited number of studies have shown safe and effective use of intravenous conscious sedation (IVCS) with midazolam in this cohort, robust evidence to support routine use is lacking. Aim To assess whether IVCS with midazolam can effectively facilitate surgical dentistry in adolescent orthodontic patients in primary care.Method A retrospective service evaluation was undertaken reviewing clinical records of adolescents (aged 12-15 years) undergoing surgical exposure and/or surgical removal of teeth under IVCS with midazolam.Results A total of 174 adolescents (mean age 14.2 years) attended for treatment between 2009 and 2015. Of these adolescents, 98.9% (N = 172) allowed cannulation, with all surgical dentistry completed during a single visit. Midazolam dose ranged from 2-7 mg with 79.1% of patients having good or excellent cooperation and three minor adverse events occurring.Conclusion This service evaluation shows IVCS with midazolam can effectively facilitate surgical orthodontics in carefully selected adolescents. There is however a distinct need to further explore potential for this technique to provide a viable alternative to GA.

Risk factor analysis of additional administration of sedative agent and patient dissatisfaction in intravenous conscious sedation using midazolam for third molar extraction.

ObjectivesThe primary purpose of this study was to investigate the factors related with additional administration of sedative agent during intravenous conscious sedation (IVS) using midazolam (MDZ). The secondary purpose was to analyze the factors affecting patient satisfaction.Materials and MethodsClinical data for 124 patients who had undergone surgical extraction of mandibular third molar under IVS using MDZ were retrospectively investigated in this case-control study. The initial dose of MDZ was determined by body mass index (BMI) and weight. In the case of insufficient sedation at the beginning of surgery, additional doses were injected. During surgery, peripheral oxygen saturation, bispectral index score (BIS), heart rate, and blood pressure were monitored and recorded. The predictor variables were sex, age, BMI, sleeping time ratio, dental anxiety, Pederson scale, and initial dose of MDZ. The outcome variables were additional administration of MDZ, observer's assessment of alertness/sedation, intraoperative amnesia, and patient satisfaction. Descriptive statistics were computed, and the P-value was set at 0.05.ResultsMost patients had an adequate level of sedation with only the initial dose of MDZ and were satisfied with the treatment under sedation; however, 19 patients needed additional administration, and 13 patients were unsatisfied. In multivariable logistic analysis, lower age (odds ratio [OR], 0.825; P=0.005) and higher dental anxiety (OR, 5.744; P=0.003) were related to additional administration; lower intraoperative amnesia (OR, 0.228; P=0.002) and higher BIS right before MDZ administration (OR, 1.379; P=0.029) had relevance to patient dissatisfaction.ConclusionThe preoperative consideration of age and dental anxiety is necessary for appropriate dose determination of MDZ in the minor oral surgery under IVS. The amnesia about the procedure affects patient satisfaction positively.

Colonoscopy quality with Entonox®vs intravenous conscious sedation: 18608 colonoscopy retrospective study.

AIMTo compare colonoscopy quality with nitrous oxide gas (Entonox®) against intravenous conscious sedation using midazolam plus opioid.METHODSA retrospective analysis was performed on a prospectively held database of 18608 colonoscopies carried out in Lothian health board hospitals between July 2013 and January 2016. The quality of colonoscopies performed with Entonox was compared to intravenous conscious sedation (abbreviated in this article as IVM). Furthermore, the quality of colonoscopies performed with an unmedicated group was compared to IVM. The study used the following key markers of colonoscopy quality: (1) patient comfort scores; (2) caecal intubation rates (CIRs); and (3) polyp detection rates (PDRs). We used binary logistic regression to model the data.RESULTSThere was no difference in the rate of moderate-to-extreme discomfort between the Entonox and IVM groups (17.9% vs 18.8%; OR = 1.06, 95%CI: 0.95-1.18, P = 0.27). Patients in the unmedicated group were less likely to experience moderate-to-extreme discomfort than those in the IVM group (11.4% vs 18.8%; OR = 0.71, 95%CI: 0.60-0.83, P < 0.001). There was no difference in caecal intubation between the Entonox and IVM groups (94.4% vs 93.7%; OR = 1.08, 95%CI: 0.92-1.28, P = 0.34). There was no difference in caecal intubation between the unmedicated and IVM groups (94.2% vs 93.7%; OR = 0.98, 95%CI: 0.79-1.22, P = 0.87). Polyp detection in the Entonox group was not different from IVM group (35.0% vs 33.1%; OR = 1.01, 95%CI: 0.93-1.10, P = 0.79). Polyp detection in the unmedicated group was not significantly different from the IVM group (37.4% vs 33.1%; OR = 0.97, 95%CI: 0.87-1.08, P = 0.60).CONCLUSIONThe use of Entonox was not associated with lower colonoscopy quality when compared to intravenous conscious sedation using midazolam plus opioid.

Conscious Sedation in Minor Oral Surgery with Midazolam IV Versus Nasal Spray a Comparative Study

Aim: The purpose of this study was to assess the effectiveness of nasal spray midazolam by comparing it with conventional intravenous midazolam conscious sedation in minor oral surgical procedures. Objective: To assess the safety and effectiveness of the midazolam nasal spray in comparison to its IV midazolam. Patients and methods: Total forty number of patients were selected, and they were divided in to two groups. Group A for intra nasal midazolam atomized spray (n=20) and Group B for intravenous midazolam (n=20). Physiological parameters, anxiety score, sedation rating, patient’s cooperation score, retrograde and anterograde amnesia were recorded for each patient during preoperative, intra operative and postoperative period. Final evaluation of safety and efficacy in the nasal and intravenous routes of midazolam drug during minor oral surgery were compared. Results: In the present study both intranasal and intravenous groups showed decrease in SBP and DBP intra operatively but in physiological limits and increase in the average pulse rates in the both groups. The average oxygen saturation levels were maintained to normal range in both the groups. The average respiratory rate decreased in the both intranasal and intravenous groups during surgical procedure. The preoperative to postoperative anxiety scores were decreased significantly in the both groups and there was no significant difference in pre to postoperative anxiety scores in between the groups. Conclusion: Both intravenous and intranasal routes of administration of midazolam showed patient cooperation, satisfaction and clinical effectiveness. Intranasal route of midazolam spray is effective in reduction of subjective stress feelings, reliable anxiolysis while preserving protective reflexes.

Course report: Intravenous conscious sedation training for the whole team.

Course report: Intravenous conscious sedation training for the whole team.

Mo1004 Does Topical Lidocaine Reduce The Amount of Intravenous Conscious Sedation Required To Complete Diagnostic Upper Endoscopy and Shorten Recovery Time? A Double Blinded, Randomized, Placebo Controlled Study

Mo1004 Does Topical Lidocaine Reduce The Amount of Intravenous Conscious Sedation Required To Complete Diagnostic Upper Endoscopy and Shorten Recovery Time? A Double Blinded, Randomized, Placebo Controlled Study

Association between Type of Sedation and the Adverse Events Associated with Gastrointestinal Endoscopy: An Analysis of 5 Years' Data from a Tertiary Center in the USA.

Background/AimsThe landscape of sedation for gastrointestinal (GI) endoscopic procedures and the nature of the procedures themselves have changed over the last decade. In this study, an attempt is made to analyze the frequency and etiology of all major adverse events associated with GI endoscopy. MethodsAll adverse events extracted from the electronic database and local registry were analyzed. Although the data analysis was retrospective, the adverse events themselves were documented prospectively. These events were evaluated after subdivision into propofol-based anesthesia and intravenous conscious sedation groups. ResultsCardiorespiratory events, including cardiac arrest, were the most common adverse events during esophagogastroduodenoscopy, while bleeding was more frequent in patients undergoing colonoscopy. Pancreatitis was the most frequent adverse event in patients undergoing endoscopic retrograde cholangiopancreatography. The frequencies of most adverse events were significantly higher in patients anesthetized with propofol. Automatic regression modeling showed that the type of sedation, the American Society of Anesthesiologists physical status classification, and the procedure type were some of the predictors of immediate life-threatening complications. ConclusionsClearly, our regression modeling suggests a strong association between the type of sedation as well as various patient factors and the frequency of adverse events. The possible reasons for our results are the changing demographics, the worsening comorbidities of the patient population, and the increasing technical complexity of these procedures. Although extensive use of propofol has increased patient satisfaction and procedure acceptability, its use is also associated with more frequent adverse events.

(635) - Impact of Operator and Anesthesia Choice on Bronchoscopic Biopsy Yield and Complications

Flexible bronchoscopy with bronchoalveolar lavage and transbronchial biopsy is the gold standard for the diagnosis of infection, acute rejection, and airway complications in lung transplant recipients. In the hands of an experienced operator, bronchoscopy carries minimal risk. The outcome of all bronchoscopies performed in the first year following lung transplantation at the Hospital of the University of Pennsylvania was recorded retrospectively. Records were included if lung transplantation was performed from January 2011 to December 2013. A total of 549 bronchoscopies were performed on 132 patients. Three hundred bronchoscopies were done on bilateral lung transplants and 249 on single lung transplants. Intravenous conscious sedation managed by the pulmonologist was used in 459 cases and 90 were done under general anesthesia. The bronchoscopy was performed during a rotation with a novice fellow in 168 of the 549 cases. The mean number of samples sent for analysis was 9.09±3.5 pieces, with a mean number of samples with alveolated tissue of 7.08±3.2. With novice fellows, the mean number sent was 8.82 with 6.97 pieces of alveolated tissue. These numbers were 9.10 and 7.12 versus 9.17 and 6.67 under conscious sedation and general anesthesia, respectively. There were complications in 82 (14.9%) of the bronchoscopies. We purposely had a sensitive definition of to be able to capture all unexpected events that were described in the report. These included: Bleeding controlled with suctioning, bleeding requiring the use of iced saline or epinephrine, bleeding requiring an endotracheal tube or bronchial blocker, pneumothorax without need for tube thoracostomy, pneumothorax requiring tube thoracostomy, hypoxemia requiring intervention during the procedure, hypoxemia requiring admission, sepsis linked to the procedure, and death. There was no significant difference in complications based on trainee level. There were more complications when procedures were performed under intravenous conscious sedation, with complications noted in 77 cases (16.8%) versus in 5 cases (5.6%) performed under general anesthesia. Bronchoscopy can be performed safely with no change in procedural yield or complications when novice trainees participate. While it does not affect yield, complications can potentially be reduced by the use of general anesthesia.

Tetany During Intravenous Conscious Sedation in Dentistry Resulting From Hyperventilation-Induced Hypocapnia

Hyperventilation can be a manifestation of anxiety that involves abnormally fast breathing (tachypnea) and an elevated minute ventilation that exceeds metabolic demand. This report describes a case of hyperventilation-induced hypocapnia resulting in tetany in a 16-year-old girl undergoing orthodontic extractions under intravenous conscious sedation. Pulse oximetry is the gold standard respiratory-related index in conscious sedation. Although the parameter has great utility in determining oxygen desaturation, it provides no additional information on respiratory function, including, for example, respiratory rate. In this case, we found capnography to be a very useful aid to monitor respiration in this patient and also to treat the hypocapnia.