Injection Of Midazolam Research Articles

Efficacy of virtual reality therapy versus pharmacological sedation for reducing pain and anxiety during coronary catheterisation procedures: A prospective randomised controlled trial.

The use of virtual reality (VR) therapy has grown considerably, as it is effective for reducing pain and anxiety in different clinical areas. However, it has not been well evaluated for coronary angiography and angioplasty. This study aimed to compare VR therapy with pharmacological sedation (Sedation) for reducing pain in patients undergoing a planned coronary angiography or coronary/peripheral angioplasty. In this prospective randomized controlled trial, patients were randomly allocated to one of two groups before catheterization: a Sedation group (injection of midazolam and fentanyl) or a VR group (Deepsen VR headset). The primary outcome measure was the maximum pain during the procedure (visual analogue scale: 0-10). The secondary outcome measures were anxiety following the procedure (Spielberger State Anxiety Inventory: 20-80), the occurrence of arterial spasm, the haemodynamic profile and patient satisfaction. The VR group (n = 63) had a mean pain rating of 2.5; for the Sedation group (n = 59) this was 1.0. This did not meet the criterion for non-inferiority. Anxiety was comparable between the two groups (VR: 25.4; Sedation: 24.7), as was the occurrence of arterial spasm (VR: 7.9%; Sedation: 8.5%; p = 0.91), but blood pressure was higher in the VR group (140.2/71.7 mmHgvs. 121.8/64.7 mmHg). There were no VR-related adverse effects, and patient satisfaction was high for both groups. Virtual reality therapy was not non-inferior to pharmacological sedation for reducing pain during coronary angiography or angioplasty. However, it reduced anxiety to a comparable level. Virtual reality therapy represents an alternative to pharmacological sedation, which is well accepted by patients.

Relative Bioavailability Study of Midazolam Intramuscularly Administered with the Needle-Free Auto-Injector ZENEO® in Healthy Adults.

Intramuscular (IM) midazolam is indicated for the treatment of status epilepticus. Administration must be efficient to rapidly terminate prolonged seizures and prevent complications. The objective of this study was to compare, in terms of relative bioavailability and bioequivalence, IM midazolam injection by needle-free auto-injector, in different settings, to IM midazolam injection by a conventional syringe and needle. In this open-label, randomized, four-period crossover study, healthy adults received single doses of midazolam (10mg) under fasting conditions. The reference treatment (conventional syringe) was administered once, on bare skin in the thigh. The tested treatment (the needle-free auto-injector ZENEO®) was administered three times: on bare skin in the thigh, on bare skin in the ventrogluteal area, and through clothing in the thigh. Repeated plasma samples were collected to obtain 36-h pharmacokinetic (PK) profiles. Primary PK parameters were area under the plasma concentration-time curve, from time zero to the last measurable time point (AUC0-t) and from time zero to infinity (AUC0-∞), and the maximum observed plasma concentration (Cmax). Forty adults were enrolled and included in the PK analysis set. In all comparisons, the 90% confidence interval (CI) of the least-squares geometric mean ratios for AUC0-t and AUC0-∞ were within the bioequivalence range of 80-125%, with low intra-individual coefficients of variation (< 20.5% for all parameters in all comparisons). Bioequivalence was also met for Cmax in all comparisons except when comparing the tested treatment through clothing versus the reference treatment, where the 90% CI lower limit was slightly outside the bioequivalence range (78.8%). With all tested treatments Cmax was slightly lower, but early mean plasma concentrations (first 10min post-dosing) were higher when compared to the reference treatment. In general, all treatments were well tolerated, with maximum sedation 0.5-1h post-injection. This study establishes that IM midazolam injection on bare skin in the thigh with the ZENEO® is bioequivalent to IM midazolam injection with a syringe and needle. An acceptable relative bioavailability, compatible with emergency practice, was also shown in multiple settings. Higher mean concentrations within the first 10min with the ZENEO® device, and quicker two-step injection suggest a faster onset of action, and thereby an earlier seizure termination, thus preventing the occurrence of prolonged seizure and neurological complications. ClinicalTrials.gov identifier: NCT05026567. Registration first posted August 30, 2021, first patient enrolled May 9, 2022.

Comparative evaluation of nebulized versus intravenous dexmedetomidine on intubating conditions during awake fiberoptic nasotracheal intubation

BackgroundThere is a search for an ideal agent to facilitate awake fiberoptic intubation (AFOI). Dexmedetomidine is a selective α2 agonist which can be administered through intravenous, intramuscular, buccal, intranasal & inhalational routes. It provides good intubation conditions without oxygen desaturation but may cause hypotension and bradycardia when administered intravenously. Hence, alternative routes of administering dexmedetomidine which may improve its safety profile are worth exploring. MethodsIn this randomised, controlled, double-blind trial, 46 ASA I/II adult participants scheduled for elective ENT surgery were randomly allocated to Group ND (Nebulised Dexmedetomidine) (n = 23) to receive nebulisation with dexmedetomidine 1μg.kg−1 and Group ID (Intravenous Dexmedetomidine) (n = 23) to receive intravenous dexmedetomidine 1μg.kg−1 before AFOI. All the patients received injection midazolam 1 mg i.v. as premedication before anaesthesia was initiated. The primary outcome was the cough score. The secondary outcomes were the RSS, SAYGO boluses, post-intubation score, hemodynamic parameters, recall of the procedure, patient satisfaction score and any side effects. ResultsThe cough score was significantly lower in nebulized group (2.43 ± 0.992 vs 3.52 ± 1.082) with p = 0.001. RSS(3.30 ± 0.926 vs 4.22 ± 1.126; p = 0.004), number of SAYGO boluses required (2.74 ± 0.864 vs 3.57 ± 1.161; p = 0.009) & the post intubation score (1.48 ± 0.593 vs 2.17 ± 0.778; p = 0.001) were also significantly lower in nebulized group. ConclusionsNebulisation with dexmedetomidine results in desirable degree of sedation and better tolerance of the procedure with adequate attenuation of the haemodynamic responses to intubation.

Excess Deaths in the United Kingdom: Midazolam and Euthanasia in the COVID-19 Pandemic

Macro-data during the COVID-19 pandemic in the United Kingdom (UK) are shown to have significant data anomalies and inconsistencies with existing explanations. This paper shows that the UK spike in deaths, wrongly attributed to COVID-19 in April 2020, was not due to SARS-CoV-2 virus, which was largely absent, but was due to the widespread use of Midazolam injections which were statistically very highly correlated (coefficient over 90 percent) with excess deaths in all regions of England during 2020. Importantly, excess deaths remained elevated following mass vaccination in 2021, but were statistically uncorrelated to COVID vaccination, while remaining significantly correlated to Midazolam injections. The widespread and persistent use of Midazolam in UK suggests a possible policy of systemic euthanasia. Unlike Australia, where assessing the statistical impact of COVID vaccination on excess deaths is relatively straightforward, UK excess deaths were closely associated with the use of Midazolam and other medical intervention. The iatrogenic pandemic in the UK was caused by euthanasia deaths from Midazolam and also, likely caused by COVID vaccination, but their relative impacts are difficult to measure from the data, due to causal proximity of euthanasia. Global investigations of COVID-19 epidemiology, based only on the relative impacts of COVID disease and vaccination, may be inaccurate, due to the neglect of significant confounding factors in some countries.

Intranasal Dexmedetomidine With Intravenous Midazolam: A Safe and Effective Alternative in the Paediatric MRI Sedation.

Background and aims MRI sedation in paediatrics includes challenges like respiratory depression, maintaining haemodynamic stability and use of neuroprotective drugs, since MRI is performed in remote places outside the operating room with a lack of support staff and nonavailability of choice of medications and equipments. Theprimary aim was to use a combination of the drugs to encounter the above challenges and look for its efficacy. The secondary aim of the study was to determine the rate of successful completion of MRIin children using a combination of intranasal dexmedetomidine and intravenous midazolam - without the need for rescue sedatives. Methods This isan observational study involving 60 children in the age group between two months and six years undergoing an MRI. Children belonging to the American Society of Anesthesiology (ASA) 1 and 2 were given intranasal dexmedetomidine3µg/kg, time to onset of sedation was noted and injection of midazolam 0.1 mg/kg was given intravenously. MRI was started once the child was asleep. Children who woke up during the MRI were supplemented with inj. propofol 0.5-1mg/kg and were documented. Results The median time duration for MRI was 38.7 min and the onset of sedation after intranasal dexmedetomidine was 18.7 min. The scan was successfully completed with a combination of intranasal dexmedetomidine and intravenous midazolam in 86.7% and only 13.3% of the children woke up either at the start or in between the scan and required the addition of propofol. Conclusion Drugs used for sedation during MRI should not cause respiratory depression and be safe for the developing brain.The above study has shown that a combination of intranasal dexmedetomidine and intravenous midazolam is effective and safe in performing MRIs in paediatrics.

Effect of preoperative cluster care nursing on patient compliance during preoperative isolation of pediatric patients before cochlear implant surgery

ObjectiveThis study investigates the effect of pre-operative cluster care nursing on patient compliance during preoperative isolation of pediatric patients from their family members before cochlear implant surgery. Study methodsA total of 350 pediatric patients who underwent cochlear implant surgery at Sichuan Rehabilitation Hospital from January 2021 to December 2022 were enrolled. The children were divided into two groups:Experimental group (group E) consisted of 182 children who received pre-operative cluster care nursing, and control group (group C) consisted of 168 children who received pre-operative routine nursing. The compliance scores of the two groups of patients when separated from their families before entering the operating room and the number of patients requiring intravenous injection of midazolam were recorded. ResultsThe compliance scores of group E were significantly lower than those of group C (t = 4.141, P < 0.001). The percentage of patients requiring intravenous injection of midazolam was recorded: it was 21.98% (40/182) in group E and 42.26% (71/168) in group C. Notably, the injection rate of midazolam in group E was significantly lower than that in group C (χ2 = 16.597, P < 0.001). ConclusionPre-operative cluster care nursing can improve patient compliance and reduce the use of sedative drugs during preoperative isolation of pediatric patients from their family members for cochlear implant surgery.

Prevention of Pressor response to Laryngoscopy: A Comparison of Lignocaine with Dexmedetomidine

Objective: To compare intravenous Lignocaine with Dexmedetomidine for prevention of pressor response to laryngoscopy. Study design and setting: Randomized Clinical Trial at Anesthesia Department, RIHS Islamabad. (1st May2019 To 30th October 2019) Methodology: 68 patients with age 20-60 years, ASA status(I or II), planned for elective surgeries under GA were included in this study and randomly divided into groups A and B by lottery method. Patients with history of hypertension, heart blocks, beta-blockers were excluded from study. Group-A patients were given injection Lignocaine 2% 1mg/kg 1min before induction and Group-B patients were given injection Dexmedetomidine 1ug/kg 15 min before induction of anesthesia. After premedication with injection Midazolam, Nalbuphine, and Ondansetron, Induction of anesthesia was done with injection Propofol and Cisatracurium. Patients were intubated. Use of stylet,BURP maneuver, incidence of laryngospasm was noted. Vitals before and after intubation were noted. Results: There was no significant difference in demographic profile,use of a stylet, BURP maneuver and laryngospasm in both groups. ANOVA test shows significant decrease in change in Systolic BP in Dexmedetomidine group at 2 and 3 minutes after intubation as compared to Lignocaine group however Diastolic BP and Heart rate was comparable in both groups. Paired t test showed a significant decrease in Systolic and Diastolic BP in both groups( more in Dexmedetomidine group).Regarding heart rate paired t test showed insignificant difference in Lignocaine group and significant difference in Dexmedetomidine group. Conclusion: Intravenous Dexmedetomidine is superior to Lignocaine to prevent pressor response to laryngoscopy

Diagnostic accuracy and safety of electromagnetic navigation transthoracic needle biopsy under moderate sedation for the diagnosis of peripheral pulmonary lesions.

Novel approaches using virtual computed tomography (CT) guidance, namely electromagnetic navigation transthoracic needle biopsy (EMN-TTNB), enable physicians to perform percutaneous lung biopsies. However, there are very few studies on the clinical experiences of EMN-TTNB, and in previous studies, the procedure was usually performed under deep sedation. This study aimed to determine the diagnostic accuracy and safety of EMN-TTNB under moderate sedation. We conducted a retrospective analysis of patients who underwent EMN-TTNB under moderate sedation between May 2021 and November 2022 at Hallym University Dongtan Sacred Heart Hospital in South Korea. Moderate sedation was achieved with midazolam injection in the bronchoscopy room using the Veran SPiNperc EM guidance system (Veran Medical, St Louis, MO, USA). Clinical data were collected by review of medical records, and diagnostic accuracy and safety were calculated. Thirty-two patients were enrolled (mean age 70.8±11.1 years); 56.3% were male. The mean size of the pulmonary lesions was 36.9±17.4 mm, and the median (interquartile range) distance from the pleura was 15.5 (0.0-30.0) mm. The diagnostic accuracy of EMN-TTNB was 75.0% (21/28), excluding four indeterminate cases. Fourteen patients (50.0%, 14/28) had true-positive and seven patients (25.0%, 7/28) had true-negative lesions. There were no severe adverse reactions such as pneumothorax, respiratory failure, or death, except one case of hemoptysis. EMN-TTNB under moderate sedation showed an acceptable diagnostic accuracy and good safety profile. The new technology allows physicians to perform percutaneous lung biopsies without the intervention of a radiologist or anesthesiologist.

Conscious Sedation Methods for Blepharoplasty in Day Surgery.

Midazolam and fentanyl, in combination, are the most commonly used medications for conscious sedation in day aesthetic surgeries. Dexmedetomidine is popularly used in the sedation protocol of our hospital due to its reduced respiratory depression. However, its sedation benefits in facial aesthetic surgeries, like blepharoplasty, have not been well-evaluated. We retrospectively compared individuals sedated with midazolam and fentanyl bolus injection (N = 137) and those sedated with dexmedetomidine infusion (N = 113) to determine which is more suitable for blepharoplasty with a mid-cheek lift. The total amount of local anesthetic (p < 0.001), postoperative pain (p = 0.004), ketoprofen administration (p = 0.028), and the number of hypoxia episodes (p < 0.001) and intraoperative hypertension (p = 0.003) were significantly lower in the dexmedetomidine group. Hypoxia severity (p < 0.001) and minor hematoma formation (p = 0.007) were also significantly lower in the dexmedetomidine group. Sedation with dexmedetomidine infusion is associated with less hematoma formation than sedation with midazolam and fentanyl bolus pattern due to hemodynamic stability and analgesic effects. Dexmedetomidine infusion may be a good alternate sedative for lower blepharoplasty.

Evaluating efficacy and safety of sub-anesthetic dose esketamine as an adjuvant to propofol/remifentanil analgosedation and spontaneous respiration for children flexible fibreoptic bronchoscopy: a prospective, double-blinded, randomized, and placebo-controlled clinical trial.

Background: Flexible fiberoptic bronchoscopy (FFB) for children is widely performed under sedation. Currently, the optimal sedation regimen remains unclear. Esketamine is an N-methyl-D-aspartic acid (NMDA) receptor antagonist, which has stronger sedative and analgesic effects and exerts less cardiorespiratory depression than other sedatives. The purpose of this study was to evaluate whether a subanesthetic dose of esketamine as an adjuvant to propofol/remifentanil and spontaneous ventilation compared with control reduces the procedural and anesthesia-related complications of FFB in children. Materials and methods: Seventy-two children ≤ 12years of age who were scheduled for FFB were randomly assigned, in a 1:1 ratio, to the esketamine-propofol/remifentanil (Group S, n = 36) or to the propofol/remifentanil group (Group C, n = 36). All children were retained spontaneous ventilation. The primary outcome was the incidence of oxygen desaturation (respiratory depression). Perioperative hemodynamic variables, blood oxygen saturation (SPO2), end-tidal partial pressure of carbon dioxide (PetCO2), respiratory rate (R), and the Bispectral index (BIS), induction time, procedural time, recovery time, the time to the ward from the recovery room, consumption of propofol and remifentanil during the procedure and the appearance of adverse events, including paradoxical agitation following midazolam administration, injection pain, laryngospasm, bronchospasm, PONV, vertigo, and hallucination were also compared. Results: The incidence of oxygen desaturation was significantly lower in Group S (8.3%) compared to Group C (36.1%, p = 0.005). The perioperative hemodynamic profile including SBP, DBP, and HR were more stable in Group S than that in Group C (p < 0.05). Consumption of propofol and remifentanil was lower in Group S than in Group C (p < 0.05). Furthermore, PAED scores, cough scores and injection pain were lower in the Group S than in Group C (p < 0.05). The recovery time of Group S was slightly longer than that of Group C (p < 0.05). Nobody happened paradoxical agitation following midazolam administration, PONV, vertigo, and hallucinations in both groups (p > 0.05). Conclusion: Our findings indicate that a subanesthetic dose of esketamine as an adjuvant to propofol/remifentanil and spontaneous respiration is an effective regimen for children undergoing FFB. Our findings will provide a reference for clinical sedation practice during these procedures in children. Clinical Trail Registration: Chinese clinicaltrials.gov registry (identifier: ChiCTR2100053302).

Randomised, prospective, blinded, clinical trial of opioid-free injectable anaesthesia with or without multimodal analgesia in kittens undergoing ovariohysterectomy.

This study compared an opioid-free injectable anaesthetic protocol with or without multimodal analgesia in kittens undergoing ovariohysterectomy. In this prospective, randomised, blinded, clinical trial, 29 healthy kittens (mean ± SD weight 1.55 ± 0.46 kg; aged 10 weeks to 6 months) were included. Anaesthesia was performed with an intramuscular injection of ketamine (4 mg/kg), dexmedetomidine (40 μg/kg) and midazolam (0.25 mg/kg). In the multimodal group (MMG), cats (n = 14) received meloxicam (0.1 mg/kg SC) and intraperitoneal bupivacaine 0.25% (2 mg/kg), whereas the same volume of saline was administered in the control group (CG; n = 15). Atipamezole (0.4 mg/kg IM) was given 15 mins after ovariohysterectomy. Postoperative pain was assessed using the UNESP-Botucatu multidimensional feline pain assessment scale - short form. Rescue analgesia (buprenorphine 0.02 mg/kg IM in MMG/CG and meloxicam 0.1 mg/kg SC in CG) was administered if pain scores were ⩾4/12. Soft food intake (after 2 and 60 mins) was evaluated at specific time points postoperatively. Statistical analyses were performed with linear models and post-hoc pairwise comparison with Benjamini-Hochberg corrections (P <0.05). The prevalence of rescue analgesia was higher in the CG (n = 15/15) than the MMG (n = 1/14; P <0.001). Pain scores at 1 h, 2 h and 4 h postoperatively were higher in the CG (4.1 ± 2.8, 4.8 ± 3.0 and 5.3 ± 1.2, respectively) than in the MMG (1.6 ± 1.0, 1.1 ± 1.0 and 0.9 ± 0.8, respectively; P <0.001). Food intake (%) at 1 h postoperatively was higher in the MMG after 2 and 60 mins (10.4 ± 9 and 71.9 ± 29, respectively) than in the CG (1.4 ± 2 and 13.9 ± 7, respectively; P <0.001). This opioid-free protocol using multimodal analgesia produced adequate postoperative pain relief, while almost eliminating the need for rescue analgesia in kittens undergoing ovariohysterectomy. Pain decreased food intake.

Comparison between Effects of Midazolam and Dexmedetomidine as Sedative in Elective Caesarean Section under Spinal Anaesthesia

This randomized clinical trial compares midazolam and dexmedetomidine in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects, and adverse effects of both the drugs in elective Caesarian section under spinal anaesthesia. The study included 60 ASA grade-I patients between age 20- and 40-years undergoing elective Caesarean sections under subarachnoid anaesthesia, from January 2022 to June 2022. Patients were randomly allocated to one of the two groups: midazolam group (Group-I, n=30), who received midazolam in a single dose of 0.10mg/kg and Dexmedetomidine group (Group-II, n=30), who received dexmedetomidine in a single dose of 2mcg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5-minute intervals until arousal of the patient. The onset of sedation i.e., time from IV (intravenous) injection of Midazolam or Dexmedetomidine to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e., time from closing of the eye lids to OAA/S score of 5 (patient is awake clinically) were noted. Any complication during operation was documented. The patient’s satisfaction with the sedation was assessed by the 5-point ‘Likert verbal rating scale’. There was no significant difference of mean blood pressure and mean heart rate between the two groups at different time intervals (P&gt;0.05). Time of onset of sedation was significantly delayed in dexmedetomidine group (P&lt;0.05). Duration of sedation was comparable between the two groups (P&gt;0.05). Incidence of peroperative complications were comparable between the two groups (P&gt;0.05). Haemodynamic effects and adverse effects of two drugs were comparable. Therefore, it is recommended that either midazolam or dexmedetomidine can be used for sedation in single dose technique during subarachnoid block for Caesarean section.&#x0D; CBMJ 2023 January: Vol. 12 No. 01 P: 99-106

Comparison of Effects of Stress and Midazolam on Retrograde and Anterograde Amnesia in Patients Undergoing General Anesthesia.

The identification of different factors affecting anesthesia and physiological changes during anesthesia can be effective in improving the quality of anesthesia. Midazolam is a benzodiazepine that has been used for many years for sedation under anesthesia. Stress is also an important factor affecting memory and other physiological changes, such as blood pressure and heart rate. his study aimed to investigate the effects of stress on retrograde and anterograde amnesia among patients undergoing general anesthesia. This multi-center, parallel, stratified, randomized controlled trial was performed on patients undergoing non-emergency abdominal laparotomy. The patients were divided into high- and low-stress groups according to the Amsterdam Preoperative Anxiety and Information Scale. Then, both groups were randomly divided into three subgroups receiving 0, 0.02, or 0.04 mg/kg of midazolam. Recall cards were shown to patients at 4 minutes, 2 minutes, and immediately before injection to determine retrograde amnesia and at 2 minutes, 4 minutes, and 6 minutes after injection to determine anterograde amnesia. Hemodynamic changes were recorded during intubation. The chi-square and multiple regression tests were used to analyze the data. Midazolam injection was associated with the development of anterograde amnesia in all groups (P < 0.05); however, it had no effect on the development of retrograde amnesia (P < 0.05). Midazolam could decrease the systolic and diastolic blood pressure and heart rate during intubation (P < 0.05). Stress also caused retrograde amnesia in patients (P < 0.05); nevertheless, it had no effect on anterograde amnesia (P > 0.05). Stress and midazolam injection could not affect the oxygen levels during intubation. The results showed that midazolam injection could induce anterograde amnesia, hypotension, and heart rate; nonetheless, it had no effect on retrograde amnesia. Stress was associated with retrograde amnesia and increased heart rate; however, it was not associated with anterograde amnesia.

Analysis of the effect of midazolam on pain in a rat model of lumbar disc herniation based on the p38 MAPK signaling pathway

To investigate the effect of midazolam on pain in lumbar disc herniation model rats based on p38 MAPK signaling pathway. Fifty SPF-grade Sprague-Dawley healthy rats, half male and half female, were selected and randomly divided into normal group, model group, and low-dose, medium-dose, high-dose groups. Model group and low-dose, medium-dose, high-dose groups were initially modeled for lumbar disc herniation. Intraperitoneal injection of saline was performed in rats of normal and model groups; and in the low-dose, medium-dose, and high-dose groups, intraperitoneal injection of midazolam was performed with doses of 30, 60, and 90 mg/kg, respectively. Interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), 5-hydroxytryptamine (5-HT), β-endorphin (β-EP), substance P (SP), neuropeptide Y (NPY) were detected in the serum of rats by enzyme-linked immunoassay. The expression of p38 MAPK and matrix metalloproteinase-3(MMP-3) protein were detected by Western blot in the tissues of rats of each group. The levels of TNF-α, IL-1β and β-EP were higher and the level of 5-HT was lower in the model group than in the normal group(P<0.05);the levels of TNF-α, IL-1β and β-EP were lower and the level of 5-HT was higher in the low-dose, medium-dose and high-dose groups than in the model group(P<0.05). The levels of SP and NPY increased in the model group compared with the normal group (P<0.05) and the levels of SP and NPY decreased in the low-dose, medium-dose and high-dose groups compared with the model group (P<0.05). The expression of p38 MAPK and MMP-3 increased in the model group compared with the normal group (P<0.05); the expression of p38 MAPK and MMP-3 decreased in the low-dose, medium-dose and high-dose compared with the model group(P<0.05). Midazolam may ameliorate the immune inflammatory response in rats with a model of lumbar disc herniation, possibly regulated through the p38MAPK signaling pathway.

Higher anesthetic dose requirement for sedation in children with autism spectrum disorder compared to neuro-atypical controls- a prospective observational study

IntroductionChildren with Autism Spectrum Disorders (ASD) are known to require general anesthesia or sedation for undergoing procedures like Magnetic Resonance Imaging (MRI). The dose required for sedation may vary depending on multiple factors. The aim of this study was to compare the sedative requirements of children with ASD with those who do not have ASD for undergoing MRI. MethodsThirty-four children with ASD and 31 neuro-atypical controls (children with other neurological disorders undergoing MRI) were recruited into the study. Children were premedicated with injection midazolam 0.1 mg/kg. This was followed by dexmedetomidine 2 mcg/kg over 2 min, followed by 2 mcg/kg/hour infusion inside the MRI gantry. If the above anesthetic was insufficient to make the child immobile, a bolus dose of thiopentone 3 mg/kg was supplemented and this was compared between the two groups. The children were monitored with ECG, and oxygen saturation. Since, these children were on sedative medications, each patient was given a sedation score depending on the number of sedative medications, the child was receiving. ResultsTwenty one of 34 children in the ASD group required thiopentone for sedation while 5 of 31 in the control group required thiopentone supplementation (p < 0.001). The thiopentone requirement continued to be significantly different between the two groups at each level of sedation score (0, 1, 2 +) (p < 0.004). ConclusionChildren with ASD required higher anesthetic dose for sedation compared to neuro-atypical controls for MRI. This study has shown that dexmedetomidine can be safely used for children with autism and additional sedatives are often required for imaging.

Combination Therapy With Nicardipine and Isosorbide Dinitrate to Prevent Spasm in Transradial Percutaneous Coronary Intervention (from the NISTRA Multicenter Double-Blind Randomized Controlled Trial)

Verapamil and nitroglycerin are widely used to prevent radial artery spasm (RAS) during percutaneous cardiovascular procedures. However, these agents are not typically available in most African countries and consequently, isosorbide dinitrate is often the only spasmolytic treatment. Our aim was to compare the efficacy of isosorbide dinitrate alone versus isosorbide dinitrate used together with nicardipine to prevent RAS during transradial coronary procedures. This was a randomized controlled double-blind multicenter trial. Patients (n=1,523) were randomized to receive either a sole therapy of isosorbide dinitrate (n=760) or the combination of isosorbide dinitrate and nicardipine (n=763). Our primary end point was the occurrence of RAS; defined as considerable perceived hindrance of catheter advancement. Our secondary end points were severe RAS; defined as (1) severe arm pain, (2) the need for either morphine or midazolam treatment, and (3) necessity for crossover to the contralateral radial or femoral artery. RAS incidence was reduced with the combination therapy versus isosorbide dinitrate alone (15% vs 25%, p <0.001), with a number needed to treat of 10 patients. There was also a significant reduction in the incidence of the secondary end points with combination therapy (3.6% vs 8.2%, p <0.001), with a number needed to treat of 22 patients. This result was driven by reductions in both femoral crossover (0.5% vs 2.4%, p=0.003) and the use of morphine or midazolam injections (1.6% vs 3.5%, p=0.02) with combination therapy. In conclusion, we demonstrated the superiority of the combination therapy of isosorbide dinitrate and nicardipine over isosorbide dinitrate alone in reducing the incidence of RAS.

To Compare the Intravenous Bolus Dose of Propofol With an Equipotent Dose of Intravenous Thiopentone for the Facilitation of Laryngeal Mask Airway Insertion.

Objectives Insertion of laryngeal mask airway has been facilitated by using a variety of induction agents and their combinations with minimal side effects. The current prospective study is a randomized, double-blind study conducted using induction agents, namely, propofol and its equipotent dose of thiopentone, for laryngeal mask airway insertion, and to compare their side effects in patients undergoing minor surgeries requiring general anaesthesia. Methods This prospective study was carried out at the Anaesthesiology and Critical Care Department of Gauhati Medical College and Hospital (GMCH), Assam, India. The randomized, double-blinded study comprised 80 patients aged 18 to 60 years undergoing minor surgeries (≤45 minutes) under general anaesthesia fitting into the American Society of Anesthesiologists (ASA) physical status I and II and Mallampati score (MPS) 1 and 2. The participants were randomly divided into two groups in a 1:1 ratio. Group A (n= 40) received propofol(2.5 mg/kg), while group B (n = 40) received thiopentone(5 mg/kg) injections for induction of anaesthesia. Pre-medication with midazolam (0.04 mg/kg)injectionand fentanyl (1.5 mcg/kg) injectionwas provided to patients in both groups. Post-laryngeal mask airway insertion, parameters like conditions for insertion, time taken for laryngeal mask airway insertion, overall response,and haemodynamic parameters were recorded. The data analysis was executed using equivalence tests considering a two-sided p< 0.05 as significant. Results Group Ahad a higher and statistically significant ease of insertion (p = 0.029). The mean insertion time was notably different between the two groups (p < 0.001). The difference in the overall response to insertion showed no statistical significance in the two groups. Statistically, a significant difference was found in falls in heart rate and various blood pressure levels between the groups (p < 0.001). Conclusion Propofol at a rate of 2.5 mg/kg was found to be superior to thiopentone at a rate of 5 mg/kg as far as suppression of upper airway reflexes in laryngeal mask airway insertion.

Midazolam Induced Abnormal Movements in Preterm Newborns: Case Series

Objectives − The aim of our article is to highlight the adverse effects of midazolam, which causes abnormal behavior and a paradoxical behavioral reaction, although it is used for sedation and seizure control, as well as preoperative and procedure-related sedation in neonates.Case Presentation − We report myoclonic seizure-like abnormal activity in four preterm neonates, who received intravenous midazolam for sedation before laser photocoagulation for retinopathy of prematurity and seizures. All neonates had a long NICU stay, but were clinically well before undergoing the procedure. Cases 1, 2 and 3 developed multifocal seizure-like abnormal movements after receiving a midazolam injection for photocoagulation therapy for retinopathy of prematurity. Case 4 developed multifocal seizure-like abnormal movements after receiving an injection of midazolam for seizures. In all the cases the seizure-like abnormal movements were controlled by phenobarbitone.Conclusion − Midazolam is increasingly being used in NICUs, but caution must be exercised while administering it in preterm neonates with comorbidities. It is difficult to identify the neonates at risk, but it is necessary to be aware of and cautious about the adverse effects of midazolam when administering the drug.

Choice of injection time of conscious sedation and its impact on pain control in colonoscopy.

The aim of this study was to identify the effect of different injection times on pain during colonoscopy procedure. In this retrospective study, the data of patients who underwent colonoscopy from June 2020 to September 2020 were assessed to investigate the effect of different injection time of sedative drugs (midazolam and dezocine). The primary endpoint was evaluating the pain intensity of the patients using visual analogue scale (VAS) immediately after colonoscopy . A total of 152 patients were eligible for this study. Of them, 76 received midazolam and dezocine injection 1 min prior to the colonoscopy procedure (the 1 Min group) and the other 76 patients received the injection 3 min prior to the procedure (the 3 Min group). The vital signs of all patients were stable except for one patient who was diagnosed with inflammatory bowel disease in the 3 Min group. A transient drop in blood pressure for this patient was observed during colonoscopy but returned to normal after general treatment. The two groups had similar rates of cecal intubation (84.21% vs. 90.97%, P = 0.22), addition of sedative drugs during procedure (2.63% vs. 5.26%, P = 0.68), and adequate bowel preparation (Boston Bowel Preparation Scale ≥6, 61.84% vs. 61.84%, P = 1.0). However, patients in the 3 Min group had significantly lower VAS than those in the 1 Min group [0 (0, 1) vs. 1 (0, 2), P = 0.041]. The timing of drug injection during conscious sedation may affect pain control during colonoscopy, with 3 min prior to the procedure showing lower VAS.

Effects of intravenous lidocaine on hypoxemia induced by propofol-based sedation for gastrointestinal endoscopy procedures: study protocol for a prospective, randomized, controlled trial

BackgroundOxygen-desaturation episodes, blood pressure drops, and involuntary body movement are common problems that occur in propofol-based sedation in the procedure of painless gastrointestinal (GI) endoscopy. As a widely used analgesic adjuvant, intravenous lidocaine can reduce the consumption of propofol during ERCP or colonoscopy. However, it is still unknown how lidocaine affects the incidence of oxygen-desaturation episodes and cardiovascular events, and involuntary movement during painless GI endoscopy. Therefore, we aimed to assess the effectiveness and safety of intravenous lidocaine in propofol-based sedation for GI endoscopy.MethodsWe will conduct a single-center, prospective, randomized, double-blind, saline-controlled trial. A total number of 300 patients undergoing painless GI procedures will be enrolled and randomly divided into the lidocaine group (Group L) and the control group (Group C). After midazolam and sufentanil intravenous injection, a bolus of 1.5 mg/kg lidocaine was immediately injected and followed by a continuous infusion of 4 mg/kg/h in the lidocaine group, whereas the same volumes of saline solution in the control group. Then, propofol was titrated to produce unconsciousness during the procedure. The primary outcome will be the incidence of oxygen-desaturation episodes. Secondary outcomes will be the incidence of involuntary body movement, discomfort symptoms, propofol consumption, endoscopist, and patient satisfaction.DiscussionPropofol-based deep sedation without intubation is widely used in painless GI endoscopy. However, adverse events such as hypoxemia often occur clinically. We expect to assess the effect of lidocaine on reducing the incidence of oxygen-desaturation episodes, cardiovascular events, and involuntary body movement. We believe that the results of this trial will provide an effective and safe method for painless GI endoscopy.Trial registrationChinese Clinical Trial Registry ChiCTR2100053818. Registered on 30 November 2021.