Midazolam For Sedation Research Articles

Hypnosis as adjunct therapy to conscious sedation for venous access device implantation in breast cancer: A pilot study.

Recent reviews support that hypnosis has great potential for reducing pain and anxiety during mini-invasive surgery. Here, we assessed the feasibility of hypnotic induction session as adjunct therapy in conscious sedation for venous access device implantation. Primary outcomes were safety and patient satisfaction. Thirty consecutive women with breast cancer were proposed adjunct of hypnosis before implantation under conscious sedation (midazolam: 0.5 mg ± bolus of Ketamin: 5 mg on demand) indicated for chemotherapy. Self-hypnosis was programmed and guided by one of two trained anesthesiologists. Implantation was performed by one of two experimented surgeons. It consisted of blind subclavian implantation of Braun ST 305 devices using a percutaneous technique adapted from Selinger's procedure. Clinical data were prospectively collected and retrospectively analyzed. A comprehensive custom-made questionnaire recorded patient satisfaction. In all, 30/30 patients consented to the procedure. The median age was 54 years (range: 35-77 years). The primary procedure was successful in 29/30. One case was converted into internal jugular vein access after a first attempt. Median length time of the implantation procedure in the operative room was 20 min (range: 10-60 min). Median length time in the recovery room preceding home discharge was 65 min (range: 15-185 min). None of the patients suffered complications. The satisfaction rate was ≥90%, 27/30 patients would get hypnosis in case of reimplantation if necessary and 27/30 would recommend this procedure to others. Hypnosis under conscious sedation appears feasible and safe for port implantation under conscious sedation in cancer patients. Further studies would determine the exact value of hypnosis effectiveness.

The 50% effective dose and 95% effective dose of sufentanil for high intensity focused ultrasound treatment of uterine adenomyosis and myoma

Objective To determine the dose-response relationship of sufentanil combined with midazolam for high intensity focused ultrasoun(HIFU) treatment of uterine adenomyosis and myoma. Methods Thirty two patients have uterine adenomyosis and 30 patients have uterine myoma, ASA classⅠ,Ⅱ, were enrolled. The patients were injected 30 μg/kg midazolam for sedation. Sufentanil was injected intravenously 5 min before the onset of operation. In addition, the sequential method was used in this study. The first dose of sufentanil was 0.10 μg/kg, set geometric series r=1.4 to calculate five step doses, the doses of sufentanil in the next patient was increased or decreased by a step dose according to the analgesia effect of the previous patient. Probit analysis was applied to calculated the ED50(95%CI) and 95% effective dose(ED95)(95%CI) of sufentanil. Results The ED50(95%CI) of sufentanil for uterine adenomyosis is 0.18(0.08-0.26) μg/kg. ED95 (95%CI) of sufentanil for uterine adenomyosis is 0.35(0.26-1.30) μg/kg. The ED50(95%CI) of sufentanil for uterine myoma is 0.13(0.04-0.20) μg/kg. The ED95(95%CI) of sufentanil for uterine myoma is 0.34(0.22-1.20) μg/kg. Conclusions Combined with midazolam 30 μg/kg, sufentanil has different ED50 and ED95 for uterine adenomyosis and myoma. Key words: High intensity focused ultrasound; Midazolam; Sufentanil; Adenomyosis; Myoma; Dose-response relationship

Alfaxalone anaesthesia in Lemur catta following dexmedetomidine–butorphanol–midazolam sedation

ObjectiveTo evaluate the clinical effects and quality of sedation, induction, maintenance and recovery in Lemur catta after dexmedetomidine–butorphanol–midazolam sedation and alfaxalone anaesthesia. Study designProspective, observational study. AnimalsSix male L. catta weighing 3.0 ± 0.6 kg undergoing surgical castration. MethodsLemurs were sedated with intramuscular dexmedetomidine (0.015 mg kg−1), butorphanol (0.2 mg kg−1) and midazolam (0.2 mg kg−1). Anaesthesia was induced with intravenous alfaxalone 0.5 mg kg−1 over 60 seconds; further boluses were administered until tracheal intubation was feasible and final dose recorded. Alfaxalone continuous infusion was used to maintain anaesthesia. Atipamezole (0.15 mg kg−1) was administered during recovery. The quality of sedation, induction, intubation, maintenance and recovery was assessed using a scoring system. Physiological parameters were recorded during sedation, maintenance and recovery. ResultsSedation was achieved in 13.6 ± 5.6 minutes and no reactions were observed during handling or venepuncture. The mean dose of alfaxalone required for induction and maintenance was 2.09 ± 0.65 and 0.08 ± 0.02 mg kg−1 minute−1, respectively. Quality of induction, intubation and maintenance was good in almost all animals. Mild self-limiting muscle twitching was observed after alfaxalone administration in three animals. Cardiorespiratory function was stable in all animals but one. One lemur showed respiratory depression and required oxygen administration and manual ventilation. The mean maintenance time was 29.2 ± 7.4 minutes. The mean times from the end of alfaxalone administration to extubation, atipamezole administration and full recovery were: 15.3 ± 8.0, 22.2 ± 4.6 and 60.0 ± 8.4 minutes, respectively. Recovery was considered good in all animals. Conclusions and clinical relevanceDexmedetomidine–butorphanol–midazolam combination provided reliable sedation and adequate muscle relaxation in L. catta. Alfaxalone proved to be a useful drug for induction and maintenance of anaesthesia and might be considered an option for injectable anaesthesia in lemurs.

Efficacy and safety of flumazenil injection for the reversal of midazolam sedation after elective outpatient endoscopy.

Midazolam sedation during elective endoscopy is widely performed and flumazenil is frequently administered after endoscopy to reverse sedation in clinical practice. This study aimed to investigate the safety and efficacy of flumazenil injections after elective endoscopy under midazolam sedation. Participants who underwent an upper endoscopy under midazolam sedation were randomly divided into two groups. In group I, flumazenil was administered i.v. 10 min after the patient's transfer to the recovery room, and no antidote was injected in group II. The time of stay in the recovery room and adverse events were reviewed through the nursing records. We asked the patients about their pain and degree of satisfaction according to a visual analogue scale (VAS), their memory of the procedure, mental status and the presence of uncomfortable symptoms on the day of the procedure and the day afterwards. The length of stay in recovery was significantly shorter in group I than in group II. No significant differences were found in the number of patients with pain (VAS ≥1), adverse events and discomfort between the two groups. Additionally, there were no differences in the patients' memory of the procedure, satisfaction with sedation, willingness to repeat the endoscopy and mental status. The time in the recovery room after flumazenil administration was significantly shortened, and the use of the drug did not increase the risk of adverse events or discomfort. The use of flumazenil for reversing midazolam sedation seems to be safe and effective.

AB045. 98. Fentanyl versus pethidine used in combination with midazolam for sedation in day service colonoscopy

Background: Colonoscopy is an important and frequently used investigation in the diagnosis of colorectal cancer. Various methods of sedation are used when performing colonoscopy, and these vary depending on the centre or country where the investigation is performed. Propofol, fentanyl, pethidine and midazolam and some of the more frequently used drugs for sedation and analgesia in colonoscopy in different combinations. Both fentanyl and pethidine are used routinely in combination with midazolam for sedation in colonoscopy in many centres in Ireland and are both found to be safe and effective as found in previous studies. However comparison of the effectiveness of each drug with regards to patient experience, safety, recovery time and overall outcome during colonoscopy has not been well established. The primary objective in this study is to compare if there is any significant difference between pethidine and fentanyl used in combination with midazolam as sedation in colonoscopy.

Determination of the maximum tolerated dose of intranasal sufentanil and midazolam in Chinese: a pilot study.

The purpose of this study was to determine the maximum tolerated dose (MTD, the dose of causing 10% respiratory depression) of intranasal sufentanil (SUF) and midazolam (MID) for sedation during gastroscopy by continual reassessment method (CRM). Patients (18-65years old) scheduled for gastroscopy were recruited in this study. Subjects received intranasal SUF and MID for sedation. The dose of MID (5mg) was fixed, while the dose of SUF was increased progressively (six incremental doses ranging from 0-0.60μg/kg, n=3 for each dose). The first cohort received a conservative, predetermined dose of 5mg MID and 0μg/kg SUF, subsequent cohorts received doses of SUF that were determined by the responses of all previous patients using Bayesian-based software. The dose allocated to the next cohort is the one with an updated posterior response probability closest to 10%. Thirty Chinese patients scheduled for gastroscopy were included. Probability of respiratory depression at each dose was as follows: 5mg MID + 0μg/kg SUF, 0.4%; 5mg MID + 0.1μg/kg SUF, 0.8%; 5mg MID + 0.2μg/kg SUF, 1.8%; 5mg MID + 0.3μg/kg SUF, 3.7%; 5mg MID + 0.4μg/kg SUF, 9.9%; 5mg MID + 0.5μg/kg SUF, 17.8%; 5mg MID + 0.6μg/kg SUF, 36.0%. The MTD of intranasal MID and SUF for sedation during gastroscopy causing 10% respiratory depression is 5mg MID + 0.4μg/kg SUF, based on CRM.

Role of intranasal midazolam as a procedural sedative in children aged 6 months to 12 years: An open-label randomized controlled study

Objectives: The objectives of the study were to evaluate the efficacy and the adverse effects of intranasal midazolam compared to intravenous (IV) midazolam for procedural sedation in children between 6 months and 12 years of age using the University of Michigan sedation scale. Design: Prospective open-label randomized controlled trial. Setting: Children requiring sedation for any invasive or non-invasive procedure in the Department of Paediatrics, between June 2012 and May 2014. Participants: A total of 246 children aged between 6 months and 12 years of age were enrolled and sequentially allocated into the study by computer-generated block randomization. Intervention: As per randomization, participants were administered intranasal or IV midazolam before the procedure. Procedure was done 5 min after IV and 15 min after intranasal administration. Main outcome measures: Sedation score was rated using the University of Michigan Sedation Score. The ease of performance, numbers of successfully completed procedures, and adverse effects were noted. Results: Intranasal midazolam provided better sedation scores (p<0.001) and ease of procedure scores (p=0.026) compared to IV, especially in the age group from 6 months to 6 years. Both groups gave comparable successful procedure completion rates. The most commonly encountered side effect with intranasal was nasal irritation (p<0.001). Conclusion: Intranasal midazolam provided significantly better sedation and ease of procedure scores when compared to IV, with fewer adverse effects. Hence, it can be put to use in resource-limited settings.

Evaluation of sedative and antinociceptive effects of dexmedetomidine, midazolam and dexmedetomidine–midazolam in tegus (Salvator merianae)

ObjectiveTo evaluate dexmedetomidine, midazolam and dexmedetomidine–midazolam for sedation and antinociception in tegus. Study designProspective, crossover, randomized, blinded study. AnimalsSix healthy tegus (Salvator merianae) weighing 1.6±0.3 kg. MethodsTegus were administered intramuscularly saline (0.5 mL; CON), dexmedetomidine (0.2 mg kg−1; DX), midazolam (1 mg kg−1; MZ) and dexmedetomidine–midazolam (same doses; DM). Heart rate (HR) and respiratory frequency (fR) were recorded before treatment (baseline) and 15, 30 minutes, 1, 2, 3, 4, 6, 8, 12 and 24 hours after the treatments. Sedation scores were recorded according to resistance to manual restraint, posture and response to noxious stimulus, at baseline and 5, 10, 15, 30 minutes, 1, 2, 3, 4, 6, 8, 12 and 24 hours after the treatments. Antinociception was evaluated by measurement of latency of limb withdrawal reflex (LWR) to thermal stimulus, recorded at baseline and 15 minutes, 1, 2, 4, 8, 12 and 24 hours after the treatments. ResultsLower HR (DX and DM) and fR (MZ, DX and DM) than CON were measured 15 minutes after the treatment and for up to 6 hours. Sedation was mild to moderate in MZ, deep in DM and absent in DX, although animals showed behavioral changes in DX, with increase in aggressiveness. Median (interquartile range) duration of sedation were 170 (50; 235) minutes in MZ and 230 (115; 235) minutes in DM. Recovery period was prolonged in both treatments, surpassing the duration of the experiment. Higher LWR than CON was detected from 15 minutes until 12 hours in DX and DM. Conclusions and clinical relevanceMidazolam provided sedation without antinociception, and dexmedetomidine provided antinociception without sedation. Drug combination increased the duration of sedation but not antinociception. Due to increased duration of sedation, reversal of effects with flumazenil and atipamezole should be considered after conclusion of clinical procedures.

Trends in narcotics and sedative use during mechanical ventilation of preterm infants in Canadian neonatal intensive care units

ObjectiveMechanical ventilation (MV) in preterm infants (PTI) causes discomfort. Whether it causes pain is controversial. Meta analysis reviews of published work on PTI during MV have shown no clinically significant impact of opioids on pain scales, and hence not recommended for routine use in neonatal intensive care units (NICUs). Similarly regular use of sedative midazolam is also not recommended. Therefore we hypothesized a downward trend in narcotics and sedatives used in MV of PTI in NICUs. This study aimed to assess trends of sedatives and narcotics use during MV of PTI in Canadian NICUs during 2004-2009. MethodsPTI born at gestational age (GA) of 24 hours were identified retrospectively from the Canadian Neonatal Network database for 2004-2009. PTI were excluded if moribund on admission, had major congenital anomalies, surgery (except laser eye surgery), necrotizing enterocolitis, chest tube or history of maternal narcotic abuse. PTI were classified according to whether they received any narcotics (morphine, fentanyl, methadone, sufentanyl, meperidine, alfentynl and codiene) or sedatives (chloral hydrate, midazolam, lorazepam, phenobarbital, pentobarbital, ketamine and propofol) for > 24 consecutive hours during MV. Trends of narcotics and sedatives were assessed using the Cochrane-Armitage Trend test separately for PTI born at <29 and 29-34 weeks of GA. ResultsAmong 5 638 study subjects, 2 169 (38.5%) received narcotics and 897 (15.9%) received sedatives. The most common narcotics were morphine (62.2%) and fentanyl (63.8%) and sedatives were phenobarbital (44.9%) and chloral hydrate (44.2%). A significant decreasing trend (P <0.01) in the use of any sedatives during MV was observed in PTI <29 and 29-34 weeks of GA. However, the use of any narcotics during MV increased significantly (P=0.03) among PTI <29 weeks of GA, and no change in trend was detected for PTI born at 29-34 weeks of GA. ConclusionsThe use of sedatives during MV in PTI born at <35 weeks of GA was positively affected, however the narcotics use during MV remained constant for PTI born at 29-34 weeks, and increased in extremely low GA group (less than 29 weeks) suggesting evidence based practice change was not observed during the study period.

Propofol versus meperidine and midazolam as a conscious sedation in percutaneous vertebroplasty: Prospective randomized trial

Background: Percutaneous vertebroplasty is a minimally invasive procedure, usually performed under local anesthesia with either general anesthesia or conscious sedation. In this study, we compared the efficacy and safety of propofol versus the combined use of meperidine and midazolam for conscious sedation in percutaneous vertebroplasty. Methods: This prospective randomized study was conducted within 6 months on sixty patients undergoing percutaneous vertebroplasty. The patients were divided into two equal groups: Group I received propofol, while Group II received meperidine and midazolam. The time required to achieve sufficient sedation, emergence time, recovery time, hemodynamic monitoring throughout the procedure, patient's and surgeon's satisfaction, and incidence of postprocedural complications were all recorded. Bispectral index and end-tidal carbon dioxide measurement were used to assess sedation level and to ensure patient safety throughout the procedure. Results: Demographic data from both groups were comparable. The time taken to reach sufficient sedation, emergence time, and recovery time were shorter in Group I than that in Group II (P = 0.001). Patients in both groups were hemodynamically stable throughout the procedure. Surgeon's satisfaction was higher in Group I (96%) than that in Group II (80%), while patient's satisfaction was nearly equal in both groups, without significant postoperative complications. Conclusions: Propofol was superior to the combined use of midazolam and meperidine for conscious sedation in percutaneous vertebroplasty. It helped in achieving a moderate sedation level in less time and offered rapid emergence from sedation, with shorter recovery time.

A Comparison of Dexmedetomidine with Midazolam for Sedation in Elderly Patients Undergoing Regional Anaesthesia

A Comparison of Dexmedetomidine with Midazolam for Sedation in Elderly Patients Undergoing Regional Anaesthesia

Midazolam Sedation During Thoracoscopy Under Local Anesthesia

Midazolam Sedation During Thoracoscopy Under Local Anesthesia

Ketamine–propofol versus ketamine–midazolam for procedural sedation and analgesia in children with hematological malignancies: a randomized, open-labeled, cross-over trial

Background The use of procedural sedation and analgesia for painful procedures in children with hematological malignancies has become a standard practice in recent time. We compared the occurrence of hypoxia, apnea, and pain between ketamine–propofol and ketamine–midazolam combination. Patients and methods This randomized, open-labeled cross-over study was conducted in 60 children aged 1–15 years scheduled for bone marrow aspiration and, or intrathecal chemotherapy. They were divided into two groups of 30 to receive either ketamine–propofol or ketamine–midazolam. Sedation was performed by trained anesthetists according to the study protocol. Data were analyzed with independent t-test, χ2-test and Fisher’s exact test. P value 0.05 or less was considered significant. Results A total of 120 procedures were performed. One (1.7%) patient in each group had hypoxia, (P=0.8). The oxygen saturation decreased to 83 and 88% in ketamine–propofol and ketamine–midazolam groups, respectively. This was accompanied by bradycardia with a heart rate of 56 and 58 beats/min, respectively. Both events responded to oxygen therapy. There was no episode of apnea, and all maintained spontaneous respiration. The number of patients with a pain score of at least 5 during the procedure was comparable; ketamine–propofol group [6 (10%)] versus ketamine–midazolam group [4 (6.7%)] (P=0.4). Hallucinations were more common in the ketamine–propofol group [4(6.7%)] than the ketamine–midazolam group [0 (0%)] (P=0.05). Conclusion The occurrence of hypoxia, apnea, and pain was comparable following the administration of ketamine–propofol and ketamine–midazolam combination.

Intranasal Midazolam and Fentanyl for Analgesia and Sedation in Infants in the Neonatal Intensive Care Unit

Intranasal Midazolam and Fentanyl for Analgesia and Sedation in Infants in the Neonatal Intensive Care Unit

1% versus 2% lignocaine for airway anesthesia in endobronchial ultrasound-guided transbronchial needle aspiration: A pilot, double-blind, randomized controlled trial.

Background and Objectives:No previous study has compared different concentrations of lignocaine for topical anesthesia during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In this pilot study, we compared 1% versus 2% lignocaine for topical airway anesthesia during EBUS-TBNA.Methods:In this double-blind, randomized trial, subjects were randomized to receive either 1% or 2% lignocaine for “spray-as-you-go” administration. All received combined moderate intravenous sedation (midazolam and fentanyl). Ten percent pharyngeal lignocaine spray (two sprays) and nebulized lignocaine (2.5 ml of 4% solution) were administered to all subjects. Administration of additional lignocaine was allowed at operator's discretion. The primary endpoints were operator-rated overall procedural satisfaction and cough, each assessed on visual analog scale (VAS), while the secondary outcomes included patient-rated faces pain scale scores, cumulative lignocaine dose, number of subjects receiving lignocaine >8.2 mg/kg, doses of midazolam/fentanyl between groups, and adverse events during procedure.Results:The mean (standard deviation [SD]) VAS scores for operator-rated procedure satisfaction were 64.2 (25.6) and 68.7 (23.7) in 1% and 2% group, respectively (P = 0.35). The median (interquartile range) VAS scores for operator-rated cough were 48.4 (23.9–69.9) in 1% group and 38.7 (18.6–69.5) in 2% group (P = 0.24). The mean [SD] cumulative lignocaine received in the 2% lignocaine group (248.6 [29.1] mg) was significantly greater than in 1% lignocaine group (178.5 [14.6] mg) (P < 0.01).Conclusion:One percent lignocaine is equally efficacious as 2% lignocaine for topical anesthesia during EBUS-TBNA, at a significantly lower cumulative lignocaine dose.

Dexmedetomidine versus midazolam for sedation in mechanically ventilated children: a randomized controlled trial

Dexmedetomidine versus midazolam for sedation in mechanically ventilated children: a randomized controlled trial

Propofol–midazolam versus propofol–dexmedetomidine as a deep sedation for endoscopic retrograde cholangio-pancreaticoduodenoscopy

Background Endoscopic retrograde cholangio-pancreaticoduodenoscopy (ERCP) is a day procedure for diagnostic or therapeutic biliary problems. Many kinds of sedation are used to provide patients comfort and facilitate work. Propofol and midazolam is the preferred cocktail. Dexmedetomidine with sedo-analgesic properties makes it another suitable regimen. The aim of this study was to compare the efficacy of adding either midazolam or dexmedetomidine to propofol for procedural sedation during ERCP. Patients and methods This study was conducted in Mansoura University Hospitals, Gastroenterology Center. A total of 84 patients (40–80 years), American Society of Anesthesiologist II, III, and IV scheduled for ERCP were randomly allocated into two groups: the PM group received propofol–midazolam and the group PD received propofol–dexmedetomidine. Heart rate, mean arterial blood pressure, and SpO2 were recorded at basal, intraoperative, postanesthesia care unit (PACU), till discharge. O2 desaturation, total dose of propofol, intraoperative complications, patients, and surgeon satisfaction were recorded. Results Heart rate and mean arterial blood pressure showed a significant reduction in group D compared with group M. Onset of deep sedation shows a significant reduction in group D versus group M. Recovery time and onset of discharge from the postanesthesia care unit shows statistically significant prolongation in group D versus group M. The total dose of propofol, intraoperative complications and also surgeon and patient satisfaction were comparable. Conclusion Administration of 1-μg/kg loading dose of dexmedetomidine or midazolam 1 mg intravenous, followed by intravenous propofol (1 mg/kg) and then 10 mg increments can produce an effective and smooth sedation without causing hemodynamic or respiratory side effects. So, dexmedetomidine could be an important alternative to midazolam for sedation in ERCP and other short procedures.

Intranasal dexmedetomidine with and without buccal midazolam for procedural sedation in autistic children: a double-blind randomised controlled trial

BackgroundChildren with autism are often difficult to manage in the hospital setting, and they often require sedation for diagnostic procedures. Intranasal dexmedetomidine has been used increasingly in children for procedural sedation. This study was designed to compare the successful sedation rate of intranasal dexmedetomidine with and without buccal midazolam on children with autism. MethodsThis single-centre, double-blind randomised controlled trial was approved and conducted in the Guangzhou Women and Children's Medical Centre, China. Children aged 1–12 years with a diagnosis of autism who required sedation for a CT study or an auditory brainstem response test (ABR), or both, were recruited. Exclusion criteria included known allergy or hypersensitivity to dexmedetomidine or midazolam, renal or hepatic dysfunction, nasal discharge, or rhinorrhea. Children were randomly assigned to receive either dexmedetomidine with placebo (group D) or dexmedetomidine with midazolam (group DM). Randomisation lists with block of 6 and age stratification (1–4, 5–8, and 9–12 years) were produced by an independent statistician. All participants and investigators were masked to group allocation. Children assigned to group D received 3 μg/kg of intranasal dexmedetomidine by atomiser and buccal placebo in the form of syrup, children assigned to group DM received 3 μg/kg of intranasal dexmedetomidine with 0·2 mg/kg of buccal midazolam (5 mg/mL) mixed with simple syrup. The primary outcome was the proportion of participants with sedation success allowing completion of CT, ABR, or concurrent CT and ABR test without restrain. We analysed the success rate using the χ2 test. This study was approval by the Institutional Review Board of Guangzhou Women and Children Medical Centre (approval number 2013053110) and registered with the Chinese Clinical Trial Registry (ChiCTR-TRC-14004761). Informed consent was obtained from parents or legal guardians. FindingsBetween June 9, 2014, and Nov 9, 2015, 192 children completed the study, 97 were assigned to group D and 95 to group DM. 82 children from group D and 91 from group DM had CT studies. 51 children from group D and 55 children from group DM had ABR. Among these children, 38 children from group D and 49 from group DM had concurrent CT and ABR test. The success rate was significantly higher in the group DM than in the group D for CT (86/91 [94·5%] vs 67/82 [81·7%]; p=0·009), ABR (38/55 [69·1%] vs 25/51 [49·0%]; p=0·035], and for concurrent CT and ABR (32/49 [65·3%] vs 16/38 [42·1%]; p=0·031). No children had respiratory depression or haemodynamic disturbances that required medical intervention. Of the 95 children who received dexmedetomidine, two had hypotension and six had bradycardia. Of the children who received dexmedetomidine/midazolam, five had hypotension and nine had bradycardia. No children had concurrent hypotension and bradycardia. InterpretationWhen buccal midazolam was added to intranasal dexmedetomidine, 95% of children with autism were successfully sedated for CT, and over 65% for ABR. Since the administration of intranasal and buccal sedatives required little cooperation, this technique could be especially useful for sedation in children with autism. FundingDepartment of Anaesthesiology, Guangzhou Women and Children's Medical Centre.

Volatile sedation in the intensive care unit: A systematic review and meta-analysis.

Volatile sedation in the intensive care unit (ICU) may reduce the number of adverse events and improve patient outcomes compared with intravenous (IV) sedation. We performed a systematic review and meta-analysis comparing the effects of volatile and IV sedation in adult ICU patients. We searched the PubMed, Embase, Cochrane Central Register, and Web of Science databases for all randomized trials comparing volatile sedation using an anesthetic-conserving device (ACD) with IV sedation in terms of awakening and extubation times, lengths of ICU and hospital stay, and pharmacologic end-organ effects. Thirteen trials with a total of 1027 patients were included. Volatile sedation (sevoflurane or isoflurane) administered through an ACD shortened the awakening time [mean difference (MD), -80.0 minutes; 95% confidence intervals (95% CIs), -134.5 to -25.6; P = .004] and extubation time (MD, -196.0 minutes; 95% CIs, -305.2 to -86.8; P < .001) compared with IV sedation (midazolam or propofol). No differences in the lengths of ICU and hospital stay were noted between the 2 groups. In the analysis of cardiac effects of sedation from 5 studies, patients who received volatile sedation showed lower serum troponin levels 6 hours after ICU admission than patients who received IV sedation (P < .05). The effect size of troponin was largest between 12 and 24 hours after ICU admission (MD, -0.27 μg/L; 95% CIs, -0.44 to -0.09; P = .003). Compared with IV sedation, volatile sedation administered through an ACD in the ICU shortened the awakening and extubation times. Considering the difference in serum troponin levels between both arms, volatile anesthetics might have a myocardial protective effect after cardiac surgery even at a subanesthetic dose. Because the included studies used small sample sizes with high heterogeneity, further large, high-quality prospective clinical trials are needed to confirm our findings.

Percutaneous endoscopic gastrostomy under conscious sedation in patients with amyotrophic lateral sclerosis is safe: an observational study.

Amyotrophic lateral sclerosis (ALS) is a progressive neuromuscular disease that causes muscle weakness with respiratory and swallowing dysfunction, eventually leading to death. Permanent enteral feeding is indicated in almost all patients. A percutaneous endoscopic gastrostomy (PEG) tube is considered the first choice, usually performed under conscious sedation (intravenous midazolam). Guidelines are very cautious with respect to sedation in ALS because of the risk for respiratory complications. In our tertiary referral hospital, conscious sedation has been used for many years.Our aim was to review 30-day complications in PEG performed under conscious sedation in ALS patients (without noninvasive positive pressure ventilation during the procedure). A retrospective review, including all ALS patients undergoing PEG under conscious sedation from October 2009 to April 2016, was performed. Analysis included 45 (44% men) patients receiving intravenous midazolam sedation (mean dose 5 mg) during PEG placement, age 36-91 years (mean: 68.7 years). Forced vital capacity (FVC) was 24-116% (mean 68%), of which mild to moderate dysfunction (FVC 50-69%) was present in 42.2% of patients and (very) severe dysfunction (FVC <50%) in 8.8%. No respiratory complications (e.g. aspiration pneumonia) were observed. Other complications, for example, infection, bleeding and peritonitis occurred in, respectively, 8.9, 2.2 and 0%. Mean survival after PEG placement was 13.4 months (range: 1-45 months). Conscious sedation during PEG insertion in ALS patients did not lead to respiratory complications or to an increase in other complications. Our data indicate that conscious sedation can be used safely in ALS patients with mild to moderate pulmonary dysfunction.