Level Of Sedation In Patients Research Articles

Surgical vs ultrasound-guided lumbar erector spinae plane block for pain management following lumbar spinal fusion surgery.

Spinal surgery is associated with severe diffuse pain in the postoperative period. Effective pain management plays an essential role in reducing morbidity and mortality. This study is designed to compare the ultrasound-guided erector spinae plane (ESP) block and surgical infiltrative ESP block for postoperative analgesia management after lumbar spinal fusion surgery. The patients who underwent two or three levels of posterior lumbar spinal fusion surgery were randomly allocated into one of three groups with 30 patients each (Group SE = Surgical ESP block; Group UE = ultrasound-guided ESP block; Group C = Controls). The primary aim was to compare postoperative opioid consumption, and the secondary aim was to evaluate postoperative dynamic and static pain scores and the incidence of opioid-related adverse effects. There was a significant difference in terms of opioid consumption, rescue analgesia on demand, and both static and dynamic pain scores between groups at all time periods (p < 0.05). Group SE and Group UE had lower pain scores and consumed fewer opioids than the controls (p < 0.05). However, the Group UE had lower pain scores and opioid consumption than the Group SE. The sedation level of patients was significantly higher in the control group than in the other two groups. Also, nausea was more common in controls than in the other groups. While both surgical and ultrasound-guided ESP blocks reduced opioid consumption compared to the controls, the patients who received ultrasound-guided ESP blocks experienced better postsurgical pain relief than those in the other groups (surgical ESP and controls).

The arousal effect of sugammadex reversal of neuromuscular blockade differs with anesthetic depth in propofol-remifentanil anesthesia: a randomized controlled trial

Sugammadex reverses neuromuscular blockade by encapsulating steroidal neuromuscular blockers; therefore, it does not pharmacologically affect sedation levels. However, some clinicians avoid using it because of sudden unwanted acting out or patient arousal. Previous studies suggested sugammadex-induced awakening, but frontal muscle contraction after sugammadex administration compromised reliability of results obtained from EEG-based anesthesia depth monitoring tools like bispectral index (BIS). We hypothesized that sugammadex would affect patients’ arousal depending on their baseline levels of sedation. We evaluated arousal signs after sugammadex administration with BIS between 25 − 35 and 45 − 55 under steady-state propofol-remifentanil anesthesia at the end of a surgery (n = 33 in each group). After sugammadex administration, twelve patients with a BIS of 45 − 55 showed clinical signs of awakening but none with a BIS of 25 − 35 (36.4% vs. 0%, P = 0.001). The distribution of the modified observer’s assessment of alertness/sedation scale scores was also significantly different between the two groups (P < 0.001). Changes in the BIS were significantly greater in the BIS 45 − 55 than in the 25 − 35 group (median difference, 7; 95% CI 2 − 19, P = 0.002). Arousal after sugammadex was affected by patient sedation levels, and clinical signs of awakening appeared only in those with BIS 45 − 55. Unwanted arousal of the patient should be considered when using sugammadex under shallow anesthesia.Clinical trial registry number: Clinical Trial Registry of Korea (https://cris.nih.go.kr; Principal investigator: Jieae Kim; Registration number: KCT0006248; Date of first registration: 11/06/2021).

S100B as a predictor of delirium in critically ill obstetric patients: A nested case-control study.

Delirium is a neuropsychiatric illness that lasts for a short period of time. The incidence of delirium in the intensive care unit (ICU) varies from 20% to 80%. A nested case-control study was carried out in the obstetric ICU. Individuals were divided into three groups: critically ill obstetric women who had delirium on admission (Group A), women who developed delirium within follow-up of 7 days (Group B), and women who did not develop delirium after follow-up of 7 days (Group C). The APACHE II score was used to assess critical illness severity. The Richmond Agitation-Sedation Scale was used to assess the alertness or sedation level of patients, and the Confusion Assessment Method (ICU scale) was used to assess the presence of delirium. S100B was measured by human S100B calcium-binding protein B ELISA kit (Elabscience Biotechnology, Houston, USA). Severe preeclampsia and antepartum eclampsia were significantly associated with delirium. S100B levels in Group B were found to be significantly higher than those in Group C. S100B levels were higher in patients with >2 morbidities in comparison to patients with two morbidities. At a cutoff value of >169.25 pg/ml, S100B had a sensitivity of 74% and a specificity of 87.2% to discriminate cases of delirium from nondelirium. The rise in S100B levels was approximately three times greater in those who developed delirium as compared to those who did not. It is a more specific predictor of delirium.

Monitoring Level of Hypnosis using Stationary Wavelet Transform and Singular Value Decomposition Entropy with Feedforward Neural Network.

Classifying the patient's depth of anesthesia (LoH) level into a few distinct states may lead to inappropriate drug administration. To tackle the problem, this paper presents a robust and computationally efficient framework that predicts a continuous LoH index scale from 0-100 in addition to the LoH state. This paper proposes a novel approach for accurate LoH estimation based on Stationary Wavelet Transform (SWT) and fractal features. The deep learning model adopts an optimized temporal, fractal, and spectral feature set to identify the patient sedation level irrespective of age and the type of anesthetic agent. This feature set is then fed into a multilayer perceptron network (MLP), a class of feed-forward neural networks. A comparative analysis of regression and classification is made to measure the performance of the chosen features on the neural network architecture. The proposed LoH classifier outperforms the state-of-the-art LoH prediction algorithms with the highest accuracy of 97.1% while utilizing minimized feature set and MLP classifier. Moreover, for the first time, the LoH regressor achieves the highest performance metrics (R2 = 0.9, MAE = 1.5) as compared to previous work. This study is very helpful for developing highly accurate monitoring for LoH which is important for intraoperative and postoperative patients' health.

Comparison of the Effect of Olanzapine, Haloperidol and Quetiapine on the Resolution of Individual Delirium Symptoms in ICU Patients: A Double-blind, Clinical Trial Study

Introduction: Considering that haloperidol is a first-generation antipsychotic drug known as the primary treatment for delirium, it causes extrapyramidal side effects, and olanzapine and quetiapine are second-generation antipsychotic drugs without extrapyramidal side effects. In this study, we compared the effects of olanzapine and quetiapine with haloperidol on the resolution of individual delirium symptoms.&#x0D; Materials and Methods: In a double-blind clinical trial study, 90 patients admitted to the ICU in three groups received haloperidol at a dose of 2.5 mg/day, while in the second group, patients received olanzapine at an amount of 2.5- 10.5mg/day. In the third group, they received quetiapine at a dose of 12.5 to 75 mg daily. Then, patients' sedation levels were measured according to RASS criteria, and their disease severity was evaluated according to APACHE II criteria.&#x0D; Results: During 15 work shifts in the first, second, third, seventh, and tenth days, sedation scores in all three groups decreased significantly (p-v &lt;0.05), and all three drugs were effective in subsiding patients' agitation in 10 days. In the evening and night of the first day, the sedation score in the quetiapine group was higher than the other two groups; however, after the treatment period and in the work shifts of the seventh and tenth days, the patients in the quetiapine group had the lowest sedation score on the RASS scale. Also, after starting drug treatment in the three groups, the mean severity of the disease was significantly different in the three groups (p-v &lt;0.05), so that on the third and seventh day, the olanzapine group had the lowest and the haloperidol group had the highest disease severity. But on the tenth day, the severity of the disease was lowest in the patients in the quetiapine group.&#x0D; Conclusion: As a result of this study, it was found that quetiapine, olanzapine, and haloperidol had the most significant effect in improving the sedation level of patients with delirium according to RASS criteria, respectively, and the use of atypical antipsychotic drugs had more favorable outcomes than typical ones in controlling patients' delirium.

The Effect of Sedation Protocol on Sedation Level and Pharmacological and Non-Pharmacological Interventions on Mechanically Ventilated Patients.

Background:The use of analgesics and sedatives to provide sedation for Patients in Intensive Care Unit (ICU) is inevitable. The present study aimed to determine the effect of sedation protocol using the Richmond Agitation- Sedation Scale on sedation level and amount of pharmacological and non-pharmacological interventions on patients under mechanical ventilation.Materials and Methods:This randomized clinical trial was conducted on 79 patients under mechanical ventilation in Zanjan. The patients were recruited using the blocking randomized sampling method. In the experiment group, the sedation was provided hourly, using the Richmond sedation Protocol, during the mechanical ventilation period. The level of sedation and pharmacological and nonpharmacological interventions were compared in the two groups using Fisher exact test.Results:Totally, 40 patients in the experiment and 39 patients in the control groups were evaluated. No significant difference was found between the two groups in terms of confounding variables (age, sex, level of consciousness, Acute Physiologic and Chronic Health Evaluation (APACHE) II criterion, underlying disease, and cause of hospitalization). The level of sedation in the experiment group was significantly closer to the ideal score of the Richmond Scale compared to the control group (p < 0.001). The experimental group received significantly more non-pharmacological interventions and fewer pharmacological interventions compared to the control group (P < 0.001).Conclusions:Using a sedation protocol could provide better sedation levels in patients under mechanical ventilation, and reduce the use of sedative medications, and consequently, the cost of hospitalization. Further research is suggested.

Movements and trends in intensive care pain treatment and sedation: What matters to the patient?

Oversedation, delirium and immobilisation in the intensive care unit are associated with increased length of stay in the unit. Routines of systematic pain and sedation assessment and the use of valid tools are highly stressed in international guidelines. For improving the quality of pain treatment and sedation in a Norwegian intensive care unit, in 2009-2015, we compared supplementation with an analgosedation approach and the existing systematic approach, measured by the adherence to current international pain, sedation and delirium guidelines. In a longitudinal study following the Standards for Reporting Implementation Studies, pain, sedation, delirium and mobilisation data from patients' complete intensive care unit stays, encompassing three separate periods of 4-6months, were compared. The primary outcome was adherence to current protocol including assessment and documentation of patients' level of pain, sedation and prevalence of delirium at least every 8hr, early mobilisation and titration towards a light level of sedation. We included 205 patients, corresponding to 1,607 patient intensive care unit days. The patient sedation levels, measured by the Richmond Agitation and Sedation Scale, decreased significantly, from -2.2 in 2009--1.7 in 2015, so did the amount of administrated propofol. Mean pain scores measured by the numeric rating scale during activity were maximum 3.1 in 2014, decreasing to 2.2 in 2015. In patients not able to self-report, pain mean scores were 1.7 in 2014 and 1.6 in 2015, measured by the Critical Care Pain Observational Tool. The number of patients unable to assess for delirium decreased significantly. By discounting the group of patients unable to assess, the prevalence of delirium varied from 32%, 25% and 33%. The goal of having an awake patient able to cooperate, with acceptable levels of pain, was gradually achieved during a 6-year period. The results showed that pain treatment and sedation in the intensive care unit primarily succeeded in the setting of an established routine of systematic assessment and documentation. The results of the study draw attention to pain treatment, sedation and delirium in intensive care patients, as well as implementation strategies aimed at achieving healthcare personnel's adherence to international guidelines in clinical practice.

The efficacy of dexmedetomidine and propofol for sedation in endoscopic ultrasonography: A comparative study

Background: Efficacy and safety of dexmedetomidine as a sedative agent has not been studied in a procedure such as endoscopic ultrasound (EUS) where propofol is being used extensively to provide a deep level of sedation. The present study was conducted to compare the efficacy of dexmedetomidine and propofol to achieve adequate sedation levels in patients undergoing EUS.Methods: Sixty patients scheduled for EUS under sedation for the diagnostic and therapeutic purpose were randomly divided into two groups. Thirty patients in Group D received dexmedetomidine while 30 Group P patients received propofol. The recovery from sedation was assessed using the modified Aldrete's score. Once the modified Aldrete's score of 10/10 was achieved, the patients' perception regarding the pain was assessed using the Visual Analog Scale (VAS) score. Primary outcome measures were VAS score and vital parameters, whereas secondary outcome measures were gag reflex and recovery from sedation using the modified Aldrete's score. Comparison of quantitative and qualitative variables between the groups was done using unpaired Student's t-test and Chi-square test or Fisher's exact test, respectively.Results: The absence of gag reflex was significantly higher in patients who received dexmedetomidine. Dexmedetomidine was found to have greater hemodynamic stability compared with propofol-treated patients. Dexmedetomidine achieved similar levels of sedation to propofol, although with a slower onset of sedation.Conclusions: The use of dexmedetomidine was associated with greater hemodynamic stability and absence of gag reflex.

Bioanalytical method to detect midazolam in plasma.

Midazolam (MDZ) is the first choice in palliative sedation, and commonly used in sleep induction in anesthesia, with rapid onset of action. However, monitoring of the level of sedation in patients is not accurate. We developed and validated a bioanalytical method to detect MDZ in plasma using high-performance liquid chromatography (HPLC) coupled to a photodiode array detector (PDA) for future monitoring of sedation. MDZ was extracted by solid-phase extraction (SPE). Analyses were performed on a C18 column, using 0.05% triethylamine and acetonitrile as mobile phase, analyzing at 220 nm. Recovery was evaluated by comparing extracted and nonextracted solutions. Precision, accuracy, linearity, limits of detection (LD) and quantification (LQ), specificity and selectivity were determined. The mean recovery obtained by SPE was 101.03%. The method was linear in the range 1.0-50.0 μg/mL. The LD and LQ were, respectively, 0.43 and 1.43 μg/mL. The specificity of the MDZ peak was adequate. The method was able to detect MDZ among other drugs. Plasma anticoagulants showed no interference with the drug detection. The bioanalytical method using HPLC-PDA and SPE was successfully validated and showed linearity, precision, accuracy, specificity and high sensitivity for detection of MDZ in human plasma.

Effect of Neuromuscular Blocking Agents on Sedation Requirements in Trauma Patients with an Open Abdomen.

The appropriate level of sedation in patients with an open abdomen following damage control laparotomy (DCL) is debated. Chemical paralysis with neuromuscular blocking agents (NMBAs) has been used to decrease time to abdominal closure. We sought to evaluate the effect of NMBA use on sedation requirements in patients with an open abdomen and to determine the effect of sedation on patient outcomes. A retrospective cohort study was conducted at an American College of Surgeons' verified level 1 trauma center. Adult trauma patients who underwent DCL between 2009 and 2015 were included. Patients with an intensive care unit length of stay of less than 48hours and those who died before abdominal closure were excluded. The NMBA+ group received continuous NMBA within 24hours of DCL; the NMBA- group did not. The primary outcome was cumulative sedation dose during the 7days following DCL. Secondary outcomes included Richmond Agitation-Sedation Scale (RASS) score, mechanical ventilation-free days, and delirium-coma-free days. Delirium-coma-free days were analyzed with linear regression. A total of 222 patients were included (NMBA+ 125; NMBA- 97). Demographics were similar between groups including age, Injury Severity Score, and mechanism of injury. The median time to closure in the overall cohort was 2days (interquartile range [IQR] 1-2days). Propofol and fentanyl were the primary sedatives used. The NMBA+ group received higher cumulative doses of propofol (NMBA+ 5405mg, IQR 3103-10,573mg; NMBA- 3601mg, IQR 1605-6887mg; p=0.007), but not of fentanyl. Time to abdominal closure, but not NMBA use, was associated with a higher cumulative propofol dose on multivariate analysis. The NMBA+ group had significantly lower RASS scores on the first 3days following DCL. Mechanical ventilation-free days (NMBA+ 20days vs NMBA- 18days, p=0.960) and delirium-coma-free days (NMBA+ 18days vs NMBA- 18days, p=0.610) were similar between the groups. On linear regression, cumulative propofol dose was associated with fewer delirium-coma-free days (β-coefficient -0.007, 95% confidence interval -0.015 to -0.003). In trauma patients managed with DCL, higher cumulative sedative doses were administered in patients who received adjunctive NMBA, although NMBA therapy was not associated with a higher cumulative propofol dose on multivariate analysis. Consideration must be given to the potential effect of sedation on delirium and awakening following DCL.

Acute Pain Assessment in Sedated Patients in the Postanesthesia Care Unit.

Acute postoperative pain remains inadequately assessed and managed. A valid instrument that assesses acute pain in sedated postanesthesia care unit (PACU) patients is needed. Two behavioral pain assessment instruments, the NonVerbal Pain Scale Revised (NVPS-R) and Critical-care Pain Observation Tool (CPOT), were used to determine whether these instruments adequately assess acute pain in the PACU. A crossover study design was used. The study was conducted in the Medical Services Administration at the Puerto Rico Medical Center. Upon PACU arrival, patient sedation levels were evaluated using the Richmond Agitation Sedation Scale. Acute pain was assessed using the CPOT (scored, 0 to 8) and the NVPS-R (scored, 0 to 10) at timepoints 0, 15, 30, 45, 60, 90, and 120 minutes. Descriptive statistics and mixed model regression analysis were used to compare pain score assessment between instruments. Clinically significant increases in vital signs and respiratory indicators using the NVPS-R were not seen in patients with significant pain at time 0, 15, and 120 minutes. The CPOT vocalization indicator was more frequent in patients with significant pain. Findings suggest that NVPS-R and CPOT can assess acute pain in sedated PACU patients. In patients with significant pain, the CPOT vocalization indicator was more consistent than physiological and respiratory indicators in detecting acute pain. Thus, our data do not support the exclusive use of vital sign indicators to assess acute pain, suggesting the superiority of the CPOT for the assessment of acute pain in sedated PACU patients.

Automatic Classification of Sedation Levels in ICU Patients Using Heart Rate Variability.

To explore the potential value of heart rate variability features for automated monitoring of sedation levels in mechanically ventilated ICU patients. Multicenter, pilot study. Several ICUs at Massachusetts General Hospital, Boston, MA. Electrocardiogram recordings from 40 mechanically ventilated adult patients receiving sedatives in an ICU setting were used to develop and test the proposed automated system. Richmond Agitation-Sedation Scale scores were acquired prospectively to assess patient sedation levels and were used as ground truth. Richmond Agitation-Sedation Scale scores were grouped into four levels, denoted "unarousable" (Richmond Agitation- Sedation Scale = -5, -4), "sedated" (-3, -2, -1), "awake" (0), "agitated" (+1, +2, +3, +4). A multiclass support vector machine algorithm was used for classification. Classifier training and performance evaluations were carried out using leave-oneout cross validation. An overall accuracy of 69% was achieved for discriminating between the four levels of sedation. The proposed system was able to reliably discriminate (accuracy = 79%) between sedated (Richmond Agitation-Sedation Scale < 0) and nonsedated states (Richmond Agitation-Sedation Scale > 0). With further refinement, the methodology reported herein could lead to a fully automated system for depth of sedation monitoring. By enabling monitoring to be continuous, such technology may help clinical staff to monitor sedation levels more effectively and to reduce complications related to over- and undersedation.

Comparison of the effects of patient controlled analgesia (PCA) using dexmedetomidine and propofol during septoplasty operations: a randomized clinical trial.

IntroductionSeptoplastical surgery to correct septum deviation can be performed under either local or general anesthesia. During local anesthesia, sedation helps to provide minimum anxiety/discomfort. Our aim was to evaluate the effects of patient-controlled analgesia using dexmedetomidine and propofol on sedation level, analgesic requirement, and patient satisfaction.Study designA prospective, randomized-parallel clinical study.MethodsFifty patients undergoing septoplastical surgery at our university hospital were randomized into two groups. A nasopharyngeal cotton tampon soaked in 0.25 % adrenaline solution was placed, and 1 mg midazolam and 1 mcg/kg fentanyl were applied 5 min before the injections of a surgical local anesthetic. Loading dose was 0.5 mg/kg propofol (Group I) and 1 mcg/kg dexmedetomidine (Group II). The sedation was sustained by a bolus dose of 0.2 mg/kg and continuous basal infusion dose of 0.5 mg/kg/h propofol in Group I, or by a bolus dose of 0.05 µg/kg and continuous basal infusion dose of 0.4 mcg/kg/h dexmedetomidine in Group II. The primary outcomes were patient satisfaction via patient-controlled anesthesia and analgesic demand. Secondary outcomes were sedation level of patients under local anesthesia.ResultsIn Group II, SpO2 levels were significantly higher than in Group I. Intraoperative and postoperative analgesic requirements were lower in Group II than in Group I. There were no statistically significant differences in patient satisfaction, hemodynamic parameters, nausea and vomiting between the two groups.ConclusionDexmedetomidine can be used safely as an analgesic and sedation drug in septoplastic surgery.

Assessment of Nociceptive Responsiveness Levels during Sedation-Analgesia by Entropy Analysis of EEG

The level of sedation in patients undergoing medical procedures is decided to assure unconsciousness and prevent pain. The monitors of depth of anesthesia, based on the analysis of the electroencephalogram (EEG), have been progressively introduced into the daily practice to provide additional information about the state of the patient. However, the quantification of analgesia still remains an open problem. The purpose of this work was to analyze the capability of prediction of nociceptive responses based on refined multiscale entropy (RMSE) and auto mutual information function (AMIF) applied to EEG signals recorded in 378 patients scheduled to undergo ultrasonographic endoscopy under sedation-analgesia. Two observed categorical responses after the application of painful stimulation were analyzed: the evaluation of the Ramsay Sedation Scale (RSS) after nail bed compression and the presence of gag reflex (GAG) during endoscopy tube insertion. In addition, bispectrum (BIS), heart rate (HR), predicted concentrations of propofol (CeProp) and remifentanil (CeRemi) were annotated with a resolution of 1 s. Results showed that functions based on RMSE, AMIF, HR and CeRemi permitted predicting different stimulation responses during sedation better than BIS.

Modelling of the Sedative Effects of Propofol in Patients undergoing Spinal Anaesthesia: A Pharmacodynamic Analysis.

Sedation can increase patient comfort during spinal anaesthesia. Understanding the relationship between the propofol effect-site concentration (Ce) and patient sedation level could help clinicians achieve the desired sedation level with minimal side effects. We aimed to model the relationship between the propofol Ce and adequate and deep sedation and also incorporate covariates. Thirty patients scheduled for orthopaedic surgery received spinal anaesthesia with 0.5% bupivacaine. Propofol was administered via an effect-site target-controlled infusion device using the Schnider pharmacokinetic model. The pharmacodynamic models for both adequate sedation [Observer's Assessment of Alertness/Sedation (OAA/S) scores of 3-4] and deep sedation (OAA/S scores of 1-2) were developed using nonlinear mixed-effects modelling. Increments in the propofol Ce were associated with increased depths of sedation. In the basic model, the estimated population Ce50 values for adequate and deep sedation were 0.94 and 1.52 μg/ml, respectively. The inclusion of the patient's age and sensory block level for adequate sedation and of age for deep sedation as covariates significantly improved the basic model by decreasing the objective function's minimum value from 10696.72 to 10677.92 (p = 0.0003). The simulated Ce50 values for adequate sedation in 20-year-old patients with a T12 sensory level and in 80-year-old patients with a T4 level were 1.63 and 0.53 μg/ml, respectively. Both age and sensory block level should be considered for adequate sedation, and the propofol concentration should be reduced for elderly patients with a high spinal block to avoid unnecessarily deep levels of sedation.

Prediction of Nociceptive Responses during Sedation by Linear and Non-Linear Measures of EEG Signals in High Frequencies.

The level of sedation in patients undergoing medical procedures evolves continuously, affected by the interaction between the effect of the anesthetic and analgesic agents and the pain stimuli. The monitors of depth of anesthesia, based on the analysis of the electroencephalogram (EEG), have been progressively introduced into the daily practice to provide additional information about the state of the patient. However, the quantification of analgesia still remains an open problem. The purpose of this work is to improve the prediction of nociceptive responses with linear and non-linear measures calculated from EEG signal filtered in frequency bands higher than the traditional bands. Power spectral density and auto-mutual information function was applied in order to predict the presence or absence of the nociceptive responses to different stimuli during sedation in endoscopy procedure. The proposed measures exhibit better performances than the bispectral index (BIS). Values of prediction probability of Pk above 0.75 and percentages of sensitivity and specificity above 70% were achieved combining EEG measures from the traditional frequency bands and higher frequency bands.

Sedation assessment in a mobile intensive care unit: a prospective pilot-study on the relation of clinical sedation scales and the bispectral index.

IntroductionThe critically-ill undergoing inter-hospital transfers commonly receive sedatives in continuation of their therapeutic regime or to facilitate a safe transfer shielded from external stressors. While sedation assessment is well established in critical care in general, there is only little data available relating to the special conditions during patient transport and their effect on patient sedation levels. The aim of this prospective study was to investigate the feasibility and relationship of clinical sedation assessment (Richmond Agitation-Sedation Scale (RASS)) and objective physiological monitoring (bispectral index (BIS)) during patient transfers in our Mobile-ICU.MethodsThe levels of sedation of 30 pharmacologically sedated patients were evaluated at 12 to 17 distinct measurement points spread strategically over the course of a transfer by use of the RASS and BIS. To investigate the relation between the RASS and the BIS, Spearman’s squared rank correlation coefficient (ρ2) and the Kendall’s rank correlation coefficient (τ) were calculated. The diagnostic value of the BIS with respect to the RASS was investigated by its sensitivity and positive predictive value for possible patient awakening. Therefore, measurements were dichotomized considering a clinically sensible threshold of 80 for BIS-values and classifying RASS values being nonnegative.ResultsSpearman’s rank correlation resulted to ρ2 = 0.431 (confidence interval (CI) = 0.341 to 0.513). The Kendall’s correlation coefficient was calculated as τ = 0.522 (CI = 0.459 to 0.576). Awakening of patients (RASS ≥0) was detected by a BIS value of 80 and above with a sensitivity of 0.97 (CI = 0.89 to 1.00) and a positive predictive value of 0.59 (CI = 0.45 to 0.71).ConclusionsOur study demonstrates that the BIS-Monitor can be used for the assessment of sedation levels in the intricate environment of a Mobile-ICU, especially when well-established clinical scores as the RASS are impracticable. The use of BIS is highly sensitive in the detection of unwanted awakening of patients during transfers.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0615-9) contains supplementary material, which is available to authorized users.

A Study of Correlation between Ramsay “Sedation Level” Scale and Richmond “Agitation–Sedation” Scale and Physiological Parameters to Determine the Need for Sedation in Patients Undergoing Mechanical Ventilation, 2013

“Ramsay” scale is currently used to determine the level of sedation in patients undergoing mechanical ventilation. This scale has advantages and disadvantages. The present study aims to investigate the correlation between the scores obtained from Ramsay “Sedation Level” Scale and Richmond “Agitation–Sedation” Scale and physiological parameters to determine the need for sedation in patients undergoing mechanical ventilation. This study was conducted on 100 patients undergoing mechanical ventilation using purposive sampling. Data were analyzed using Pearson correlation coefficient, regression analyses and descriptive statistics. There was a significant positive correlation between the scores of Richmond “scale” and physiological parameters (respiration, heart rate and blood pressure). There was a significant negative relationship between the scores of Ramsay “scale” and two physiological parameters, i.e. respiration rate and blood pressure. There was an intense and inverse correlation between Ramsay and Richmond scales (r=0.907) (p<0.001). Considering the high correlation between Richmond scale and components of physiological parameters compared to Ramsay scale, this instrument is an appropriate scale to measure the level of sedation in patients undergoing mechanical ventilation in the intensive care unit (ICU).

Interaction between EEG and drug concentration to predict response to noxious stimulation during sedation-analgesia: effect of the A118G genetic polymorphism.

The level of sedation in patients undergoing medical procedures is affected by the interaction between the effect of the anesthetic and analgesic agents and the pain stimuli. The presence of the A118G single nucleotide polymorphism (SNP) in the OPRM1 gene affects the requirements of opioids for patients undergoing sedation-analgesia. The purpose of this work is to evaluate the influence of the SNP A118G in OPRM1 on EEG measures for the prediction of the response to pain stimulation during endoscopy procedure. The proposed measures were based on power spectral density and auto-mutual information function. It was found that the statistical performances of the EEG measures improved when the presence of the SNP was taken into account (prediction probability Pk>0.9).

Standard or ultrathin device for colonoscopy?

We read with great interest the article by Töx et al. [1]. The authors compared the use of an ultrathin colonoscope (UTC) and a standard colonoscope with regard to demand for propofol during colonoscopy. They found that use of a new type of UTC was associated with less propofol consumption, lower patient sedation levels, and less pain compared with the standard colonoscope. But the time to intubation of the ileum was longer. These findings have relevance for the clinical practice of colonoscopy but are limited in some respects.