Moderate Sedation Research Articles

A 56-year-old woman presented to her primary care physician with a 1-year history of facial flushing and short-lived paroxysms of chest pain. An electrocardiogram was performed which showed normal sinus rhythm and p-mitrale. Transthoracic echocardiography (TTE) revealed normal left ventricle (LV) size and function, moderate to severe aortic regurgitation, moderate mitral regurgitation (MR), moderate tricuspid regurgitation (TR), and mild pulmonic regurgitation. An agitated saline study suggested an intrapulmonary shunt (positive after >10 beats). Cardiac magnetic resonance imaging (CMR) confirmed these findings but reclassified the TR and MR as severe and the LV as dilated. CMR also incidentally noted numerous complex hepatic masses, largest measuring 6cm. Dedicated liver MRI confirmed this, and biopsy showed strong, diffusely positive staining for neuroendocrine markers, consistent with a well-differentiated neuroendocrine tumor (carcinoid). Positron Emission Tomography/Computed Tomography (PET/CT) revealed high uptake in the pancreatic head, cecum, and right scapula in addition to known liver lesions. Treatment with octreotide was initiated after obtaining a baseline serum serotonin level 1489 ng/mL (normal 50-220 ng/mL). The patient reported mild symptoms and NT Pro BNP was elevated at 265 pg/mL (normal <125 pg/mL). Given LV dilation, severe valve disease, and likely concealed symptoms, cardiac surgery consultation was pursued. Transesophageal echocardiogram with moderate sedation was deferred due to risk of carcinoid crisis. In coordination with oncology, surgery was scheduled after initiating octreotide. Preoperative octreotide infusion was administered, and she underwent four-valve replacement with bioprostheses. Intraoperatively, all four valves had thickened, retracted leaflets; a 7 mm patent foramen ovale (PFO) was also identified and closed. Pathology of valve specimens showed extracellular plaque deposition and bland spindle cells, consistent with carcinoid valve disease. The patient had an uneventful postoperative course. Carcinoid heart disease is a rare, morbid manifestation of neuroendocrine tumors, mediated by elevated serotonin and other vasoactive substances causing fibrotic valve dysfunction. It usually affects right-sided valves, but left-sided involvement may occur with intracardiac shunt or pulmonary metastases. This case illustrates the multidisciplinary diagnosis and management of an exceedingly rare form of carcinoid heart disease.

Backround: Cardiovascular disease is the leading cause of morbidity and mortality in pregnant women and accounts for 25% of maternal deaths, with cardiomyopathy accounting for 11%. Peripartum cardiogenic shock is rare. Only 18% of cases present in the antepartum period and even fewer receive mechanical circulatory support (MCS). This patient population requires a multidisciplinary approach and meticulous planning to select the best mode of MCS. Case: A 25-year-old G1P0 was admitted at 29w3d with decompensated heart failure due to idiopathic dilated cardiomyopathy. At 15w she was asymptomatic with an EF of 20-30%, global hypokinesis, LVIDd of 6.2cm, and normal right ventricular size and function. Medical management was initiated. Admission transthoracic echocardiogram (TTE) showed an EF of 10-20%. Right heart catheterization showed RA 12 mmHg, PCWP 29 mmHg, and cardiac index (CI) of 3.4 L/min/m2 by Fick and 3.0 L/min/m2 by thermodilution. A multidisciplinary meeting including heart failure, maternal-fetal medicine, obstetrics anesthesia, and interventional cardiology was convened at 30w3d. Delivery was planned for 31w with pre-emptive placement of MCS. At 30w4d, she underwent placement of a pulmonary artery catheter (RA 13 mmHg, PCWP 24 mmHg, CI by Fick 2.0 L/min/m2) and percutaneous left axillary Impella CP with settings of P8 and flows 3-3.2 L/min. One day later, she experienced chest pain, pulmonary edema, and a drop in CI to 1.8 L/min/m2. She delivered urgently via cesarian section without complications. Impella was unable to be weaned, and she underwent expedited advanced therapies workup with orthotopic heart transplant 16 days later. Discussion: The European Society of Cardiology recommends that MCS should be available and considered for the management of cardiogenic shock in pregnancy, but does not address specific modalities. In our case, we chose Impella CP for several reasons: the ability to place percutaneously under moderate sedation, axillary approach to allow mobility and avoid the gravid uterus, and to maximize cardiac output in the setting of low-output heart failure. This was well tolerated and allowed a safe, although urgent, delivery and was ultimately used as a bridge to transplant. Conclusion: While risks and benefits must be tailored to each patient, early use of MCS in cardiogenic shock has been associated with improved outcomes, and pregnancy should not preclude this option.

Embracing Diversity: Sedative effects vary across drug chemistry and frequency domains.

ABSTRACT Foreign body aspiration is a frightening experience that can be life‐threatening. Although it occurs more frequently in children, it can also affect adults, often related to neurological illness, dental procedures, or accidental aspiration during daily activities. Diagnosis relies on clinical history, imaging and bronchoscopy. We report a case of a 20‐year‐old Cambodian man, a wedding decorator, who accidentally inhaled a sewing pin while laughing during work. He presented with persistent cough and dyspnoea. Chest radiography initially showed the pin in the trachea, which later migrated into the left main bronchus. The foreign body was successfully removed using flexible bronchoscopy under moderate sedation, after local anaesthesia proved inadequate. The patient was discharged the same day without complications. This case demonstrates the effectiveness of flexible bronchoscopy and the importance of timely intervention in preventing surgical intervention, particularly in resource‐limited settings.

The optimal anesthetic strategy for patients undergoing endovascular therapy (EVT) for acute ischemic stroke (AIS) from large vessel occlusion (LVO) remains unclear. To determine if general anesthesia (GA) or moderate sedation for patients who undergo EVT for AIS with LVO is associated with a different functional outcome in 90 days. This was a multicenter randomized clinical trial conducted from July 2018 to August 2023 of patients with AIS who were receiving EVT due to LVO. Patients were recruited from 10 comprehensive stroke centers in the US. Adult patients with occlusion of the carotid artery and the proximal middle and anterior cerebral artery who underwent EVT were eligible for enrollment. Patients were randomized to receive either moderate sedation or GA in 1:1 ratio. The primary outcome was the ordinal modified Rankin Scale (mRS) score at 90 days. A total of 1931 patients were screened for eligibility, and 1671 were excluded due to failure meeting the inclusion criteria. Among 260 individuals with a mean (SD) age of 66.8 (13.3) years included in this intention-to-treat study, 133 were male (52%), and 130 (50%) were randomized to GA and sedation each. At 90 days, a shift in the distribution of ordinal mRS was found favoring GA (odds ratio [OR], 1.22; 95% credible interval [CrI], 0.79-1.87) with an 81% posterior probability of GA superiority. The probability that GA was superior to sedation was 89% (relative risk [RR], 1.2; 95% CrI, 0.9-1.66) and 69% (RR, 1.01; 95% CrI, 0.96-1.08) for 90-day mRS 0 to 2 and successful reperfusion, respectively. Other secondary outcomes were similar. Symptomatic intracerebral hemorrhage was 0.8% (1 of 125 patients) in GA vs 2.4% (3 of 125 patients) in sedation with a posterior probability of GA was superior to sedation of 72% (RR, 0.71; 95% CrI, 0.23-2.16). This randomized clinical trial found that patients with LVO AIS who were treated with EVT using GA had improved rates of 90-day outcomes and higher rates of successful reperfusion compared with those treated using moderate sedation. ClinicalTrials.gov Identifier: NCT03263117.

BackgroundFiberoptic bronchoscopy has developed rapidly as a routine test, especially it played an important role during the COVID-19. The suitable options for moderate sedation medications is necessary. The present study aimed to observation the feasibility and safety of remimazolam in geriatric patients undergoing fiberoptic bronchoscopy.MethodsThis study is a single-center, randomized, parallel controlled trial conducted on patients undergoing fiberoptic bronchoscopy at the Hangzhou First People's Hospital, School of Medicine, Westlake University. A total of 105 geriatric patients undergoing fiberoptic bronchoscopy were divided into 3 groups (n=35) randomly. Group A (remimazolam + fentanyl + local anesthesia); Group B (midazolam + fentanyl + local anesthesia); Group C (local anesthesia).The primary outcomes include all patients’ vital signs(Heart rate,non-invasive blood pressure,saturation of pulse oximetry,end-tidal carbon dioxide, bispectral index, respiratory rate), Modified Observer’s Alertness/Sedatio and the rate of adverse events. Secondary outcomes are onset time of the drug, operation time , recovery time, operator and patient’s satisfaction.ResultsThis study enrolled a total of 105 patients, among them 97 were actually included in the statistics(34 in group A, 30 in group B, and 33 in group C). Compared with group C, the vital signs in group A and B are more stable at T1, T2, T3, and T4 times(P<0.05), the frequency of hypertension in group A and group B was significantly lower (P<0.05). Compared with group B, the onset time and recovery time of group A were shortened (both P<0.05). The satisfaction levels of both patients and operators in group A and group B were higher than those in group C. (P<0.05).ConclusionsIn our study, we found that an intravenous injection of remimazolam at 0.2 mg/kg, combined with fentanyl at 0.5 μg/kg for sedation, along with local anesthesia of the pharynx and tracheal mucosa, and supplemental anesthesia with fentanyl 25 μg every 5 to 10 minutes if necessary, is effective and safe for geriatric patients during fiberoptic bronchoscopy.Trial registrationThis study was registered with the Chinese clinical trial registry.ChiCTR2100047459,the Registration Date is 2021/06/19.

BackgroundGastric cancer is a type of malignant gastrointestinal tumor that poses a serious threat to human life and ranks as the second leading cause of cancer-related mortality worldwide. Although cardia-related diseases are rarely reported in the literature on gastrointestinal disorders, cardia lesions are not uncommon in clinical practice. The development of esophageal cancer may be associated with risk factors for esophageal adenocarcinoma, such as reflux esophagitis, high-fat diet, advanced age, and obesity. During gastroscopy, it is important to note that inadequate visualization of the esophagus may result from various factors, which can affect the diagnosis of esophageal lesions and lead to misdiagnosis or missed diagnoses. Currently, intravenous sedation using a combination of fentanyl and propofol is routinely administered during gastrointestinal endoscopy. The use of propofol in gastroscopy has been shown to improve procedural quality, enhance patient tolerance, and increase the accuracy of endoscopic diagnosis. However, the differences in esophageal exposure between moderate and deep sedation still require further clinical validation.MethodsThis study was a single-center retrospective clinical study. One hundred and twenty elderly overweight patients who underwent sedation for upper gastrointestinal endoscopy at our Gastrointestinal Endoscopy Center from May 2020 to August 2023 were retrospectively collected and divided into a moderate sedation group (Group A) and a deep sedation group (Group B) according to the anesthesia method. Primary outcome index: compare the sedation success rate and cardia exposure degree between the two groups. Secondary outcome indicators: compare the incidence of hypoxia during sedation between the two groups. Comparison of sedation recovery time, pain [visual analog scale (VAS)] and patient satisfaction.ResultsA total of 120 patients aged 60–75 years with body mass index ≧ 25 kg/m2 were enrolled. The general data of the patients in the two groups were comparable (P > 0.05).The sedation success rate was comparable in Groups A and B (94.83% vs. 96.78%, P = 0.594).The degrees of cardia exposure in group A and group B were compared. The degrees of cardia exposure in Group A with scores of 1, 2, 3, and 4 were 12 cases (20.69%), 13 cases (22.41%), 19 cases (32.76%), and 14 cases (24.14%), respectively. The degrees of cardia exposure in group B were 21 cases (33.87%), 19 cases (30.65%), 18 cases (29.03%), and 4 cases (6.45%), respectively. Compared with group B, group A had a higher degree of cardia exposure, and the difference was statistically significant (p = 0.029). The total perioperative adverse reactions were relatively lower in group A compared with group B, and the difference was statistically significant (P = 0.049).The incidence of hypoxia (2%vs11%) and sedation recovery time (10.08 ± 2.18vs.15.38 ± 3.25) were significantly smaller in group A than in group B, and the differences were statistically significant (P < 0.05).The satisfaction with endoscopy was higher in both groups ( 98.28%vs.96.78%, P = 1.000), the difference was not statistically significant.The exposure of the cardia during gastroscopy was not significantly associated with patient gender, comorbidities such as diabetes, hypertension, or chronic obstructive pulmonary disease(COPD), or gastric or bile reflux, but was significantly associated with the depth of anesthesia (P < 0.05).ConclusionBoth moderate and deep sedation are applicable for upper gastrointestinal endoscopy in elderly overweight patients. However, moderate sedation is more suitable than deep sedation for those with unstable cardiopulmonary function. Compared with deep sedation, moderate sedation provides better cardia exposure, a lower incidence of hypoxia, faster recovery time, improved safety, and comparable patient satisfaction, making it worthy of clinical promotion.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12871-025-03387-2.

Factors affecting caregivers&amp;#039; decisions for children&amp;#039;s dental treatment under moderate sedation vs general anaesthesia

BackgroundApproximately 31% of adults experience dental anxiety, which represents a significant barrier to timely care and ultimately results in poor oral health outcomes. Moderate sedation is an effective method of managing anxiety while preserving patient responsiveness. Total intravenous anesthesia (TIVA) combined with target-controlled infusion (TCI) systems, which utilize pharmacokinetic models, enable precise control of drug delivery by maintaining stable effect-site concentrations. This study evaluated the safety and efficacy of moderate TCI-administered sedation using an Eleveld pharmacodynamic-pharmacokinetic model for propofol and remifentanil in dental practice.MethodsThis prospective study included 114 patients who underwent dental procedures at two clinical sites. Moderate sedation was delivered via a TCI-guided Eleveld model, targeting the effect-site concentrations of propofol and remifentanil. The primary outcome was the incidence of adverse events as defined by the Tracking and Reporting Outcomes of Procedural Sedation criteria. The secondary outcomes included procedural duration, drug dosing, vital sign fluctuations, and patient-reported satisfaction.ResultsAfter 7725 min of sedation, no adverse events were reported according to the TROOPS criteria. None of the patients experienced hypoxia (SpO2 <90%), bradycardia (HR < 40 bpm), or clinical over-sedation. Hypotension (MAP < 65 mmHg) occurred in 13 patients who were managed conservatively without intervention. The average recovery time was 10.1 ± 5.2 min. Patient satisfaction was high (99%), with 93.6% of patients reporting little to no recall of the procedure.ConclusionsTCI-based moderate sedation using the Eleveld model for propofol and remifentanil is safe, effective, and well-tolerated in dental settings. The model offers predictable sedation depth, rapid recovery, and high levels of patient satisfaction, supporting its broader implementation in the management of dental anxiety.

Purpose: To assess the current sedation practices among pediatric dentistry residents who completed their training from a children???s teaching hospital to align training methods for current residents. Methods: Using Standards for Quality Improvement Reporting Excellence guidelines, residency graduates were surveyed on current sedation practices. Information collected included demographics, year of residency completion, education experience, type of sedation medications used during residency and currently, emergency protocols, participation in continuing education courses, barriers to the provision of sedation, and clinical protocols. Descriptive statistics were completed, and information was utilized to update current sedation training protocols. Results: Fifty-four of 90 possible former residents responded, for a response of 60 percent. Thirteen respondents (24 percent) currently perform moderate sedation. Predominant sedation medication preferences have shifted from chloral hydrate to midazolam, meperidine, and hydroxyzine through the years. Conclusions: Feedback from previous learners and continual assessment of educational programs can help to align education with unsupervised practice after graduation. Changing trends in sedation practices highlight the crucial significance that residency program sedation curriculum and continuing education courses meet the needs of patients, thereby upholding a high standard of patient safety.

Optimizing sedation to minimize respiratory depression during fiberoptic bronchoscopy (FOB) presents an ongoing challenge. This trial compared the safety and efficacy of remimazolam-remifentanil versus propofol-remifentanil for maintaining spontaneous ventilation in patients undergoing FOB. This pre-registered randomized controlled trial enrolled 103 consecutive candidates for FOB (April 2023 to April 2024). After excluding 10 ineligible participants, 93 were enrolled in a two-phase study. In the initial dose-determination phase, 21 participants underwent dose escalation to establish the induction dose of remimazolam (0.35mg/kg) using the modified Dixon's method. Subsequently, 72 participants were randomly assigned in a 1:1 ratio to remimazolam-remifentanil group (Group R-R) or propofol-remifentanil group (Group P-R) (n = 36 each). Remifentanil was administered by target-controlled infusion (3.0ng/mL plasma concentration) in both groups. Group R-R received remimazolam 0.35mg/kg, while Group P-R received propofol 2.0mg/kg after remifentanil loading. Standardized supplemental doses were administered for inadequate sedation (Modified Observer's Assessment of Alertness/Sedation score >1 or Bispectral index >75). The primary endpoint was the incidence of respiratory depression, defined as SpO2 <95% or a respiratory rate <8breaths/min. Secondary outcomes included procedure completion, movement or cough-related interruptions, hemodynamic stability, adverse events, procedural time, and satisfaction ratings from both bronchoscopists and participants. Group R-R demonstrated a significantly lower incidence of respiratory depression (11.1% vs. 33.3%; P = 0.045) and of hypotension requiring vasopressors (16.7% vs. 41.7%; P = 0.020). However, transient involuntary movements (25.0% vs. 8.3%; P = 0.111) and cough (38.9% vs. 22.2%; P = 0.125) were numerically more frequent in Group R-R, though not statistically significant. All procedures were completed successfully without discontinuation. Hypertension, arrhythmias, procedural times, and satisfaction scores were comparable between groups (all P > 0.05). Compared to propofol-remifentanil, remimazolam-remifentanil provides effective moderate sedation for FOB with superior respiratory safety and reduced hypotension requiring vasopressors, despite a numerically higher incidence of transient movement and cough. It thus represents a promising alternative for maintaining spontaneous ventilation during FOB.

Esophageal food impaction (EFI)resulting in obstruction is a gastrointestinal emergency requiring disimpaction by upper endoscopy. Current guidelines recommend emergent intervention within 24h to reduce risk of complications.However, limited data exist regarding specific factors affecting practice patterns, including timing and setting of endoscopic intervention for EFI. We conducted a retrospective review of 684 patientswho presented with EFIto the emergency department (ED) at three hospitals from 2015-2021. 447 patients met inclusion criteria. We compared hospitalization rates, ED triage-to-endoscopy time, sedation type, endoscopy setting[ED/intensive care unit (ICU), operating room (OR), or endoscopy unit (EU)], and complications for "business hours" (between 8AM and 5PM) and"after hours" procedures (weekends or before 8AM/after 5PM). Among 509 EFI cases, 67.2% were performed "after hours," and 56.2%occurred in the EU. "After hours" endoscopies were over fourfold more likely to involve moderate sedation (OR 4.35 [1.64-11.54]). Mean ED triage-to-endoscopy time was significantly longer for "business hours" cases (11.3 ± 21.2h versus 5.4 ± 10.3h,adjusted p-value = 0.0002). Patients undergoing endoscopy "after hours" were 74% less likely to be hospitalized(0.26 [0.13-0.55]). Although not statistically significant, "after hours" cases had lower complication rates (2.3 versus 4.8%) and in-hospital mortality (0.0% vs 1.2%) compared to "business hours" (p-value ≤ 0.1367 and ≤ 0.1072, respectively). We found that "after hours" endoscopic disimpactions for EFI did not have increased hospitalizations or increased complications relative to "business hours," contrary to current literature. Our findings underscore the safety, efficacy, and feasibility of "after hours" endoscopic intervention for EFI, which may help shape resource allocation and hospital protocols to improve patient outcomes in the future.

Describe the hemodynamic implications of anaesthetic choice among children with heart disease undergoing cardiac catheterisation. Study 1 was a secondary analysis of data obtained during catheterisation-based hemodynamic assessment of infants with hypoplastic left heart syndrome following Stage 1 palliation, randomised in the Single Ventricle Reconstruction trial. Measured and calculated hemodynamics including pulmonary and systemic vascular resistance indexed to body surface area (PVRi and SVRi respectively) and pulmonary/systemic blood flow (Qp/Qs) were analysed with respect to anaesthetic employed during catheterisation, classified as moderate sedation or general anaesthesia. Study 2 consisted of a single centre, prospective analysis of patients requiring percutaneous closure of a patent ductus arteriosus or endomyocardial biopsy after orthotopic heart transplant. Participants underwent hemodynamic assessment first using inhaled volatile anaesthesia (IA), and then transitioned to total intravenous anaesthesia, comparing hemodynamic measures with respect to anaesthetic approach. In Study 1, independent of shunt type, PVRi, and patient size, moderate sedation was associated with a greater than two-fold odds of a Qp/Qs >1 (OR 2.12, 95%CI 1.18-3.87, p = 0.013). In Study 2, while PVRi was similar, SVRi was significantly higher using total intravenous anaesthesia. Among the patent ductus arteriosus subgroup, Qp/Qs increased significantly with a total intravenous anaesthesia relative to IA (p = 0.003); additionally, among the orthotopic heart transplant subgroup, left ventricular end diastolic pressure increased following a transition to total intravenous anaesthesia (p = 0.002). Analyses of hemodynamics during catheterisation support a significant impact of anaesthetic type on hemodynamic values including SVRi, left ventricular end diastolic pressure, and Qp/Qs. Anaesthesia choice and intraprocedural management of SVRi are important considerations when making clinical decisions based on hemodynamic data.

AimsTransoesophageal echocardiography (TEE) is widely used for cardiac assessment and requires moderate sedation due to its semi-invasive nature, carrying potential risks. Music is a non-pharmacological strategy shown to reduce anxiety in various clinical settings. We prospectively investigated whether music could reduce anxiety and/or sedation dosage in patients undergoing TEE.Methods and resultsSixty-three patients (>18 years) referred for TEE were randomized into a music group (n = 31) or control group (n = 32). All completed an anxiety questionnaire and had haemodynamic parameters (blood pressure, heart rate, oxygen saturation) assessed prior to transthoracic echocardiography (TTE). Music was played before TTE and continued throughout TEE in the intervention group. Anxiety and haemodynamic measurements were repeated after TTE, before sedation. Groups were compared for baseline characteristics, anxiety levels, haemodynamic changes, and midazolam dosage. There was no difference between the groups regarding age or sex; control group had more comorbidities. Anxiety levels did not differ between groups at baseline or pre-sedation (P > 0.05). A significant reduction over time was observed only in the music group (P = 0.032 vs. P = 0.069), but group-by-time interaction was not significant (P = 0.347). Regarding anxiety level, it decreased in both groups, more markedly in the music group (P < 0.008 vs. P = 0.04). Diastolic blood pressure also decreased after music exposure (P = 0.024). Midazolam dosage did not differ between groups but was inversely correlated with age.ConclusionAlthough music did not reduce sedation requirements, it significantly decreased anxiety levels and blood pressure; music may be a valuable adjunct to sedation in patients undergoing TEE.

Prospective Evaluation of the Impact of Sedation During LAAO on Cognitive Function Using Oculomotor Biomarkers

Background: The use of magnetic resonance imaging (MRI) under anesthesia or moderate sedation has grown in the pediatric age group. Many radiology departments have scheduling problems for pediatric MRIs, as well as on-site cancellations and delays. A contributing factor could be due to the common practice of scheduling pediatric patients for MRIs at the last minute without first consulting with an anesthesiologist. The literature has relatively little information regarding the causes of cancellation of pediatric MRI performed under anesthesia. We predicted that early anesthetic assessment of children might reduce cancellations.Objective: This study aimed to evaluate the relationship between the reduction of MRI cancellations and the early anesthetic assessment conducted ≥48 hours prior to the MRI.Methods: This is a retrospective case-control study reviewing MRI cancellations in a tertiary-level specialized children's hospital during the period from March 2017 to December 2018. All pediatric patients who underwent MRI under general anesthesia during this period were included for analysis. The sample population was restricted to patients under 14 years old. MRI cases that were cancelled were compared as a case group with MRI cases that were not cancelled as a control group regarding anesthesia assessment, type, demographics, MRI study characteristics, and medical factors.Results: The study included a total of 258 children, with 38 cases and 220 controls. The median age of the patients was 52 months with an IQR of 46.5 months for the case cohort and 58 months with an IQR of 48 months for the control cohort. Statistical analysis of the data indicates that preanesthetic assessment two days or more prior to the MRI reduces the risk of cancellations when compared to other risk factors (P=0.020, CI: 0.69-1.652).Conclusions: Preanesthetic evaluations can reduce MRI rescheduling appointments, additional diagnostic tests, and potential delays in patient care. Operational efficiency can also be improved, along with patient safety and satisfaction. Thus, preanesthetic assessment is vital to reducing MRI cancellations and improving the efficiency of MRI services.

BackgroundThe majority of percutaneous radiofrequency ablation (PRFA) procedures for liver cancer are performed under ultrasound guidance and with moderate sedation. Oxygen desaturation is one of the most common and concerning adverse events that can be challenging to prevent during this procedure. High-flow nasal cannula (HFNC) oxygen therapy is effective in delivering high oxygen flow rates. This study aimed to evaluate the safety of HFNC oxygen therapy in preventing oxygen desaturation in patients undergoing ultrasound-guided PRFA with moderate sedation.MethodsIn this prospective, randomized controlled study, 100 patients who underwent ultrasound-guided PRFA with moderate sedation were randomly divided into two groups: a low-flow oxygen group (6 L/min via an HFNC) and a high-flow oxygen group (40 L/min via an HFNC). The primary outcome was oxygen desaturation. Other adverse events were also recorded.ResultsPatients who received high-flow oxygen (40 L/min) had a lower incidence of mild desaturation (0% vs. 6%, p = 0.24), moderate desaturation (4% vs. 30%; RR 7.5, 95% CI 2.07, 28.58, p = 0.0009), and severe desaturation (0% vs. 4%, p = 0.5) compared to those who received low-flow oxygen (6 L/min). Average oxygen saturation (SpO2) was significantly higher in the high-flow group (p < 0.0001). No significant differences were observed in other adverse events or perioperative variables.ConclusionIn patients undergoing ultrasound-guided PRFA with moderate sedation, high-flow oxygen therapy at 40 L/min through HFNC therapy resulted in higher average oxygen saturation levels and a reduced incidence of oxygen desaturation—particularly moderate and severe desaturation—compared to low-flow oxygen therapy at 6 L/min.Clinical trial registrationIdentifier NCT05212064.

BackgroundBlood pressure (BP) management during the acute phase of intracerebral hemorrhage (ICH) is critical to improving patient prognosis. Besides routine antihypertensive medications, sedo-analgesia (i.e., a combination of sedation and analgesia) can enhance BP control during the acute phase. Nevertheless, the optimal approach remains elusive. The understanding of the evidence base and its application by healthcare practitioners significantly impact patient outcomes, yet studies on this topic are limited. Therefore, the aim of this study was to investigate the practice patterns and beliefs regarding BP management and sedo-analgesia among Chinese healthcare practitioners through questionnaires.MethodsAn anonymous online questionnaire focused on emergency treatments was developed based on four ICH patient scenarios, followed by a cross-sectional survey among Chinese healthcare practitioners using purposive sampling. Respondents were instructed to record their treatment plan and goals based on clinical examination of the patients. Chi-square tests and Mann-Whitney U tests were employed to compare differences in emergency management choices.ResultsBetween December 2021 and February 2022, 263 practitioners from the China Neurocritical Study Group were invited to participate, with 220 valid questionnaires returned, yielding an 83.7% response rate. Respondents included 123 doctors (55.9%) and 97 nurses (44.1%). Among ICH patients with elevated BP (cases 1, 3, and 4), 90.0–97.3% of respondents selected early intensive BP-lowering treatment, with urapidil as the preferred choice, targeting an upper limit of 150 mmHg. In case 2 with a BP of < 120 mmHg, 84/220 (38.2%) preferred to raise BP to 120–140 mmHg. Moreover, analgesia and sedation were selected by 74.1–94.1% and 72.3–95.0% of respondents, respectively. However, the selection of sedation targets varied significantly with respect to occupations and specialties, with critical care physicians preferring moderate sedation (Richmond Agitation and Sedation Scale -3 or below), especially in Case 2.ConclusionChinese healthcare practitioners in the neurology or critical care units are generally aware of the management of BP and sedo-analgesia in patients with ICH and can select appropriate medications and treatment goals. However, the opinions of health practitioners on BP and sedo-analgesia management goals for non-hypertensive ICH patients are conflicting, highlighting the need for additional evidence-based research to support clinical decision-making.

Percutaneous Microwave Ablation of Small (<4 cm) Renal Masses Performed under Moderate Sedation.

Procedural abortion in individuals with opioid dependence: Patient characteristics and pain experience.