Satisfactory Level Of Sedation Research Articles

Nebulized Dexmedetomidine for Sedation and Mask Acceptance in Pediatric Patients Undergoing Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials

PurposeCompare nebulized dexmedetomidine to other sedatives while assessing the level of sedation, mask acceptance, and parental separation anxiety in the pediatric population undergoing surgery. DesignSystematic review and meta-analysis. MethodsMEDLINE (PubMed), Google Scholar, CINAHL, the Cochrane Review Database, Google Scholar, and gray literature were searched for evidence. Risk ratio (RR) and standardized mean difference (SMD) were used to estimate outcomes with suitable effect models. The quality of evidence was rated using the Risk of Bias and the Grades of Recommendation, Assessment, Development, and Evaluation approach. FindingsEight studies (n = 615) were included in the review. Over 30 minutes following premedication, nebulized dexmedetomidine yielded comparable sedation scores to other nebulized treatments (SMD, −0.09; 95% confidence interval [CI], −0.45 to 0.28; P = .64). Subgroup analyses revealed that nebulized dexmedetomidine provided more satisfactory sedation levels compared with midazolam (SMD, −0.82; 95% CI, −1.37 to −0.26; P = .004), although it did not provide a satisfactory sedation level as ketamine (SMD, 0.34; 95% CI, 0.01 to 0.67; P = .04). Furthermore, patients receiving nebulized dexmedetomidine showed higher rates of satisfactory mask acceptance (RR, 1.32; 95% CI, 1.08 to 1.59; P = .007) and favorable parental separation outcomes (RR, 1.17; 95% CI, 1.04 to 1.32; P = .01). ConclusionsNebulized dexmedetomidine is efficacious versus nebulized midazolam but not nebulized ketamine for preprocedural sedation for pediatric patients undergoing general anesthesia. Nonetheless, it demonstrated superior results in facilitating parental separation and mask acceptance.

The Management and Prevention of Delirium in Elderly Patients Hospitalised in Intensive Care Units: A Systematic Review.

Delirium or an acute confusional state (ACS) is characterised as being a frequent and complex hospital complication in older adult patients, which can affect their level of independence and increase patient morbidity and mortality. Critically ill patients in the intensive care unit (ICU) frequently develop ICU delirium, leading to longer hospital and ICU stays, increased mortality and long-term impairment. This review aims to assess existing evidence of interventions that can be considered effective for the management and prevention of delirium in ICUs, reducing short-term morbidity and mortality, ICU and hospital admission times and the occurrence of other long-term complications. For this systematic review, we searched Medline, PubMed, Cochrane Library, CINHAL, LILACS, SciELO and Dialnet from January 2018 to August 2024, in English, Spanish and French. MeSH descriptors were adjusted to search the different databases. We also checked Prospero for ongoing systematic reviews. The electronic search yielded a total of 2656 studies, of which 14 trials met the eligibility criteria, with a total of 14,711 participants. We included eight randomised clinical trial (RCTs), four cohort analyses, one systematic review and one observational trial, including participants over 65 years admitted to the ICU. Ten of these studies were based on pharmacological interventions, three of them examined non-pharmacological interventions and the remaining study examined mixed (pharmacological and non-pharmacological) interventions. Six placebo RCTs were included, plus four reported comparisons between different drugs. Regarding non-pharmacological interventions, nursing programmes focused on optimising modifiable risk factors or the use of therapies such as bright light are emerging. Regarding mixed interventions, we found the combination of invasive techniques and with sedoanalgesia. Due to its satisfactory level of sedation, dexmedetomidine is presented as a viable option because, although olanzapine offers safer results, postoperative administration angiotensin inhibitor systems significantly reduced the incidence of delirium. As for propofol, no significant differences were found. Among the non-pharmacological and mixed therapies, bright light therapy was able to reduce the incidence of delirium, and the combination of epidural/general anaesthesia was effective in all subtypes of delirium. Concerning the remaining interventions, the scientific evidence is still insufficient to provide a definitive recommendation.

COMPARISON OF ORAL MIDAZOLAM,ORAL DEXMEDETOMIDINE AND ORAL MIDAZOLAM KETAMINE COMBINATION FOR PREMEDICATION IN PAEDIATRIC SURGERY

Background: Children especially age group <10years undergoing operation may experience preoperative anxiety & may be uncooperative.This uncooperative behavior of children may be observed at the time of separation from parents, venipuncture or mask application. Untreated anxiety may lead to difficult induction, greater rescue analgesic needs, emergence delirium (ED), behavioural & postoperative psychological effects. An atraumatic premedication, calm separation from parents can minimize these problems and a smooth induction of anaesthesia can be achieved.Method : Prospective randomized double blind active controlled study was conducted in Government medical college & hospital, Aurangabad from 2018 to 2020 after Institution Ethics Committee approval. 75 ASA I & II subjects aged between 2 to 5 year weighing less than 15 Kg posted for elective paediatric surgery under general anaesthesia at tertiary care centre were selected. They were randomly allocated into 3 groups Group M ,Group M K & Group D with 25 subjects in each group using computer generated randomization list. Oral premedication was given in each group 30 minutes before surgery.Baseline heart rate,SBP and RR measured before administering premedication and at 10 minutes intervals up to 30 to 45 minutes after premedication. Results: Sedation & anxiolysis score at induction[S1] was significant higher in Group M K& Group D [p Value <0.05] compared to Group M. Sedation at the time of separation from parents [S2] was better in Group M K & Group D compared to Group M[p Value <0.05].Sedation during Mask Acceptance[S3] was better in Group M K & Group D compared to Group M[p Value <0.05].Wake up Behaviour [when the patient recovers from anaesthesia at end of surgery [S4] ] was assessed & Subjects were more Sedated[post anaesthesia] in Group D when compared to Group m & Group M K[p Value <0.05]. Time taken for maximum change in vital parameters was more in Group D followed by Group M K and Group M respectively p Value 0.001].There was significant changes in Vital parameters in Group D compared to Group M & Group M K .Bradycardia p Value 0.00044] & Hypotension [p Value 0.01]was more significant in Group D when compared to Group MK &Group M Conclusion: Oral Midazolam (0.2mg/kg) & Ketamine (2mg/kg) combination & oral Dexmedetomidine (0.5 g/kg) both provide satisfactory sedation levels & offers significant ease of separation from parents with satisfactory mask acceptance in children<10 years compared to oral Midazolam alone.

Nebulized vs. oral midazolam as a sedative premedication in pediatric anesthesia: A randomized controlled double-blinded study

ABSTRACT Objective This study was carried out to compare different routes of midazolam administration (nebulized vs. oral) to achieve a satisfactory level of sedation, RAMSAY Sedation Score (RSS) of 4, within 30 minutes of midazolam administration in pediatric operative patients. Methods After approval of the ethical committee in Kasr Al-ainy university hospital and obtaining written consent from parents/legal guardians; Seventy-two pediatric patients scheduled for general and urological surgical operations under general anesthesia were included in this randomized double-blinded study. Patients were randomly assigned into one of the two equal groups. Group N: 36 children received nebulized midazolam 0.2 mg/kg in 3 ml normal saline plus 5 ml clear juice 30 min before undergoing general anesthesia (GA). Group O: 36 children received oral midazolam 0.5 mg/kg in 5 ml clear juice plus nebulizer of 3 ml normal saline 30 min before undergoing general anesthesia. Results We found no statistical difference between nebulized and oral midazolam regarding drug acceptance, peri-operative (sedation scores, hemodynamics, and side effects); P-value >0.05 for all values. Conclusion Nebulized midazolam is a good alternative to oral midazolam as a sedative premedication in pediatrics.

EVALUATION OF INTRANASAL MIDAZOLAM AS PREANESTHETIC MEDICATION FOR BRIEF PEDIATRIC SURGICAL PROCEDURES

Background: Operation theatres environment, surgery and anesthesia causes stress and anxiety. This can cause psychological disturbances especially in children. Sedative and anxiolytic premedication have been used to prevent such outcomes.Intranasal route is least traumatic and easily accepted.Intranasal midazolam has been used for premedication in children. Objectives:The study was undertaken to evaluate the efcacy of intranasal midazolam as premedication with regard to degree of sedation,ease of parental separation, response to venepuncture,response to induction,post anesthesia recovery charecteristics and side effects if any. Methods: A prospective comparative study was conducted in the Department of anesthesia viswabharathi medical college penchikalapadu, kurnool from November 2021 to may 2022 children aged between 3 - 6 years, of either sex belonging to ASA Grade I & II posted for elective surgeries were selected randomly and prospective study was done by dividing them into 3 groups. Group NS: Children received 4.mI/kg of Normal Saline ,Group M1:Children received 0.2mg/kg of intranasal midazolam, Group M2: Children received 0.3mg/kg of intranasal midazolam. The statistical software, namely SPSS 16.0 and WINKS SDA 6 were used for the analysis of the data and Microsoft Word and Excel have been used to generate graphs, tables etc. : All the groups were comparable in age,sex,weight and ASA distribution.In midazolamResults M1 group 24(80%),in M2 group 22(65%) the children were dated.In midazolam M1 group,at 10minutes,parental separation in 27(90%).In M2 group,parental separation in 25(75%) children was much easier compared to 4(13.3%) in NS group.Response to venepuncture was more satisfactory in both midazolam groups than normal saline. Response to mask placement was also good in midazolam groups. There was no undue prolongation of recovery time in all the groups. : The study shows that intranasal midazolam 0.2mg/kg administered 15min prior toConclusion induction in children of 3-6years of age produces satisfactory level of sedation,ease of separation from parents, decreased discomfort associated with venepuncture with better mask acceptance. No signicant hemodynamic changes throughout the procedure.

Remimazolam Tosilate Sedation with Adjuvant Sufentanil in Chinese Patients with Liver Cirrhosis Undergoing Gastroscopy: A Randomized Controlled Study.

BackgroundThis prospective, randomized, controlled study evaluated the efficacy and safety of remimazolam tosilate sedation with adjuvant sufentanil, relative to propofol, for Chinese patients with liver cirrhosis undergoing gastroscopy.Material/MethodsPatients with liver cirrhosis (n=148) aged 18–65 years and undergoing gastroscopy were randomly and equally allocated to receive either 0.107 mg/kg remimazolam tosilate (remimazolam group) or 2 mg/kg propofol. Patients received intravenous sufentanil 0.15 μg/kg before the study drug. If necessary, an additional dose of propofol 20 mg was used and repeated. The primary outcome was the satisfaction rating (satisfactory, fair, or unsatisfactory) of the endoscopist with the sedation. Secondary outcomes were complications (respiratory depression, apnea, body movement, bradycardia, hypotension, nausea or vomiting, somnolence, dizziness, and fever) and patient satisfaction.ResultsCompared with the propofol group, the remimazolam group required a longer time to sedation and a shorter time to emergence. The percentage of remimazolam sedations the endoscopist rated satisfactory (90.5%) was higher than that for propofol (77.0%; P=0.026). Patients given remimazolam experienced lower rates of respiratory depression, body movement, and hypotension (2.7, 8.1, 4.1%, respectively), than did the propofol group (17.6, 23.0, 14.9%; P=0.003, 0.013, 0.025). The 2 groups were comparable regarding the other secondary outcomes.ConclusionsFor Chinese patients with liver cirrhosis undergoing gastroscopy, remimazolam tosilate with adjuvant sufentanil provides a satisfactory level of sedation with a good safety profile.

Comparison of the Effects of Oral Midazolam and Intranasal Dexmedetomidine on Preoperative Sedation and Anesthesia Induction in Children Undergoing Surgeries.

Background and Purpose: Premedication with either oral midazolam or intranasal dexmedetomidine prior to surgery remains less than ideal. The aim of this study was to investigate whether the combination of those two drug regimens would have any beneficial effects on the preoperative sedation and the children’s compliance during anesthesia inhalation induction. Experimental Approach: One hundred thirty-eight children aged 2–6 years were randomly allocated into three groups: Group M with oral midazolam 0.5 mg kg−1, Group D with intranasal dexmedetomidine 2 μg kg−1, and Group M + D with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1. The primary outcome was the children’s compliance during inhalation induction with sevoflurane. The secondary outcomes included the preoperative sedative effects, behavior scores, parental separation anxiety scores, and the postoperative incidence of emergence agitation and recovery time. Results: Subjects in Group M + D showed higher satisfaction scores of compliance (p = 0.0049) and mask acceptance (MAS) (p = 0.0049) during anesthesia inhalation induction. Subjects in Group M + D had a significantly shorter time than those in Groups M and D to achieve the desired sedation level (p < 0.001) and remained at a higher sedation score in the holding area and up to the anesthesia induction after drug administration (p < 0.001). Conclusion and Implications: We conclude that pediatric patients premedicated with intranasal dexmedetomidine 1 μg kg−1 plus oral midazolam 0.5 mg kg−1 had significantly improved anesthesia induction compliance, and quicker onset to achieve and maintain a satisfactory level of sedation than those premedicated separately with two drugs. Therefore, the combined premed regimen is a greater choice when we are expecting a higher quality of sedation and a smoother anesthesia induction in children undergoing the surgeries.

Comparative evaluation of nebulized ketamine and its combination with dexmedetomidine as premedication for paediatric patients undergoing surgeries under general anaesthesia

BackgroundVarious drugs have been endorsed but no standardised premedication protocol exists for paediatric patients. Nebulised form of drug not only results in better patient acceptability but also has improved clinical effectiveness. The present study delineates and evaluates the efficacy and safety of nebulised ketamine and combination of nebulised dexmedetomidine and ketamine for premedication in paediatric patients. MethodsProspective randomised controlled study was planned in patients, 3–10 years of age, undergoing surgeries. Patients received either nebulised ketamine (2 mg/kg) (group X, n = 23) or dexmedetomidine 1 μg/kg plus ketamine (1 mg/kg) (group Y; n = 24), 30 min before shifting inside the operation theatre. The sedation level, haemodynamic response and ill-effects were recorded for 30 min. ResultsThe baseline haemodynamic (HR, MAP, RR and SpO2) parameters were normal and comparable in both the groups. There was no significant variation noticed in terms of HR, MAP, RR and SpO2% in either of the groups at 15 min (p < 0.15, p < 0.20, p < 0.85, p < 0.46) and 30 min (p < 0.21, p < 0.97, p < 0.75, p < 0.61) respectively, after receiving premedication. The level of sedation in group Y (score of 4 or less) was found to be better than that achieved by group X patients (p < 0.001). Face mask acceptance was satisfactory in group Y (score of 2 or less) as compared to group X patients (p < 0.001). The parental separation was comparable in both groups (p = 0.46). ConclusionNebulisation is a satisfactory method of premedication for children. A combination of nebulised ketamine with a dose of 1 mg/kg and dexmedetomidine with a dose of 1 μg/kg is capable of producing a satisfactory level of sedation in a more effective manner than sedation induced by nebulised ketamine alone (2 mg/kg).

Propofol Sedation by Pediatric Gastroenterologists for Endoscopic Procedures: A Retrospective Analysis.

Background: There is a substantial literature on the favorable outcome of propofol administration by non-anesthesiologists for endoscopy in adults; however, very few data are currently available on propofol sedation by pediatric gastroenterologists. Aims: to evaluate the safety of propofol sedation by pediatric gastroenterologists.Methods: A retrospective chart review of all children who were sedated by pediatric gastroenterologists in three Northern Israeli hospitals over a 4 years period Demographic and medical characteristics and any data regarding the procedure were extracted from patient's records. The main outcome measurements were procedure completion and reported adverse events.Results: Overall, 1,214 endoscopic procedures for were performed during this period. Complete data was available for 1,190 procedures. All children sedated by pediatric gastroenterologists were classified as ASA I or II. Propofol dosage (in mg/kg) inversely correlated with patient age. The younger the child the higher the dose needed to reach a satisfactory level of sedation (r = −0.397, p < 0.001). The addition of fentanyl significantly decreased propofol dosage needed to provide optimal sedation, p < 0.001. Nine (0.7%) reversible adverse events were reported. All the procedures were successfully completed and all patients were discharged home.Conclusions: We conclude that our approach is safe in children as it is in adults and can be implemented for children with ASA I, II.

Pharmacokinetic profile and partitioning in red blood cells of romifidine after single intravenous administration in the horse.

The aims of this study were to assess the plasma concentrations of romifidine in horses after intravenous injection, to evaluate the red blood cell (RBC) partitioning of the anaesthetic drug, and to improve knowledge regarding its sedative effect in horses describing the pharmacokinetic model. Eight adult Standardbred horses received a single bolus of romifidine at a dosage of 100 μg/kg. Blood samples (5 mL) were collected immediately before romifidine administration (t 0), and at 2, 5, 10, 15, 20, 25, 30, 40, 50, 60, 75, 90, 105, 120, 150 and 180 min after injection. A sedation score was recorded at the same time. The romifidine concentrations in plasma and red blood cells were determined by high performance liquid chromatography (HPLC). The plasma and red blood cell concentrations were correlated with the sedation at each time point. Romifidine produced a satisfactory level of sedation in all animals. The sedation was detectable in all horses for up to 105 min. All the animals returned to normal without any behavioural changes at 180 min. The romifidine concentrations in the red blood cells were significantly higher (P < 0.01) at all time points than those in the plasma. The T1/2β was 148.67 ± 61.59 min and body clearance was 22.55 ± 6.67 mL/kg per min. The results showed that after a single bolus administration of romifidine, a partitioning in the RBCs was detected.

The Effect of Oral Dexmedetomidine Premedication on Preoperative Cooperation and Emergence Delirium in Children Undergoing Dental Procedures.

Introduction The aim of this study was to detect the effect of 1 μg/kg of oral dexmedetomidine (DEX) as premedication among children undergoing dental procedures. Materials and Methods The study involved 100 children between 2 and 6 years of age, ASA I, who underwent full-mouth dental rehabilitation. The DEX group (n = 50) received 1 μg/kg DEX in apple juice, and the control group (n = 50) received only apple juice. The patients' scores on the Ramsay Sedation Scale (RSS), parental separation anxiety scale, mask acceptance scale, and pediatric anesthesia emergence delirium scale (PAEDS) and hemodynamic parameters were recorded. The data were analyzed using chi-square test, Fisher's exact test, Student's t-test, and analysis of variance in SPSS. Results RSS scores were significantly higher in the DEX group than group C at 15, 30, and 45 min (p < 0.05). More children (68% easy separation, 74% satisfactory mask acceptance) in the DEX group showed satisfactory ease of parental separation and mask acceptance behavior (p < 0.05). There was no significant difference in the PAEDS scores and mean hemodynamic parameters of both groups. Conclusions Oral DEX administered at 1 μg/kg provided satisfactory sedation levels, ease of parental separation, and mask acceptance in children but was not effective in preventing emergence delirium. The trial was registered (Protocol Registration Receipt NCT03174678) at clinicaltrials.gov.

A comparison of propofol vs. dexmedetomidine for sedation, haemodynamic control and satisfaction, during esophagogastroduodenoscopy under conscious sedation

Esophagogastroduodenoscopy (EGD) is a common diagnostic procedure which requires sedation for most patients. We undertook a prospective, randomized, double-blinded study to compare the effect of propofol vs. dexmedetomidine on the sedation of outpatients during EGD. Prior to the procedure, outpatients received either propofol at 0·6 mg/kg, with additional doses of 10-20 mg until the Observer's Assessment of Alertness/Sedation Scale (OAA/S) score reached 2-4, or dexmedetomidine at a loading dose of 1 μg/kg over a 10-min period followed by a 0·5 μg/kg/h infusion until the OAA/S score reached 2-4. Vital signs, sedation level, adverse events, patients' and endoscopist's satisfaction score, and an evaluation of the recovery time were assessed. Negligible haemoglobin oxygen saturation (SpO2 ) and respiratory rate variations were observed in both groups, although respiratory depression occurred in two cases (5·9%) in the propofol group. Mean arterial pressure (MAP) in the propofol group decreased during the procedure compared with baseline (P < 0·05) and was also lower in comparison with the dexmedetomidine group (P < 0·05). Heart rate (HR) decreased after the loading dose in the dexmedetomidine group (P < 0·05). More patients in the propofol group underwent deeper sedation at the beginning of the procedure (P < 0·05), although the recovery time was comparable between the two groups (P > 0·05). Three cases (9·1%) in the dexmedetomidine group were delayed because of dizziness, bradycardia and nausea. There was a higher satisfaction score among patients in the propofol group (P < 0·05), although the endoscopist's satisfaction score was comparable between the two groups (P > 0·05). Propofol and dexmedetomidine provide a relatively satisfactory level of sedation without clinically notable adverse effects during EGD. In addition, patients preferred propofol administration for the deeper sedation and rapid recovery, and dexmedetomidine exhibited minimal adverse effects on respiratory function.

Outcome of pediatric procedural sedation & analgesia in a tertiary care hospital in Pakistan.

Background and Objective:Procedural sedation and analgesia (PSA) is pharmacologically induced state which allows patients to tolerate painful procedures while maintaining protective reflexes. It is the standard of care but there is limited data from Pakistan. Our objective was to assess the safety of the procedural sedation and analgesia in pediatric population at a tertiary care setting.Methods:A retrospective notes and record review was conducted at the Aga Khan University Hospital, Karachi over 4 years from April 2010 to August 2014. Patients were between ages 6 months to 16 years and were in low risk category. The combination of Ketamine and Propofol were used. Data collected on the standardized hospital PSA form. All procedures were performed by two trained persons.Results:A total of 3489 diagnostic and therapeutic procedures were performed. Satisfactory level of sedation was achieved for 3486 (99%) of procedures. Adverse events occurred in 21 (0.6%) patients including: 12 (0.3%) episodes of hypoxia, 07 (0.2%) episodes of apnea, 02 (0.06%) episodes of post sedation hallucination. No major events were noted.Conclusion:Procedural sedation & analgesia for children using Propofol and Ketamine is found safe and effective in our setting.

Oral Midazolam-Ketamine versus Midazolam alone for Procedural Sedation of Children Undergoing Computed Tomography; a Randomized Clinical Trial.

Motion artifacts are a common problem in pediatric radiographic studies and are a common indication for pediatric procedural sedation. This study aimed to compare the combination of oral midazolam and ketamine (OMK) with oral midazolam alone (OM) as procedural sedatives among children undergoing computed tomography (CT) imaging. The study population was comprised of six-month to six-year old patients with medium-risk minor head trauma, who were scheduled to undergo brain CT imaging. Patients were randomly allocated to two groups: one group received 0.5 mg/kg midazolam (OM group; n = 33) orally and the other one received 0.2 mg/kg midazolam and 5 mg/kg ketamine orally (OMK group; n=33). The vital signs were monitored and recorded at regular intervals. The primary outcome measure was the success rate of each drug in achieving adequate sedation. Secondary outcome measures were the time to achieve adequate sedation, time to discharge from radiology department, and the incidence of adverse events. Adequate sedation was achieved in five patients (15.2%) in OM group and 15 patients (45.5%) in OMK group, which showed a statistically significant difference between the groups (p = 0.015). No significant difference was noted between OM and OMK groups with respect to the time of achieving adequate sedation (33.80 ± 7.56 and 32.87 ± 10.18 minutes, respectively; p = 0.854) and the time of discharging from radiology department (89.60 ± 30.22 and 105.27 ± 21.98 minutes, respectively; p=0.223). The complications were minor and similar among patients of both groups. This study demonstrated that in comparison with OM, OMK was more effective in producing a satisfactory level of sedation in children undergoing CT examinations without additional complications; however, none of these two regimens fulfilled clinical needs for procedural sedation.

Comparison of Effects of Dexmedetomidine-ketamine and Dexmedetomidine-midazolam Combinations in Transurethral Procedures

To compare the effects of dexmedetomidine-ketamine and dexmedetomidine-midazolam combinations on the recovery time, hemodynamic and respiratory variables, and side effects in patients undergoing transurethral procedures. Sixty patients scheduled for elective outpatient transurethral procedure were randomized into 2 groups. In the group K, a ketamine-dexmedetomidine combination was administered, and in the group M, midazolam-dexmedetomidine was administered, to provide sedation/analgesia. Pain and sedation levels were assessed using visual analog score (VAS) and Ramsey Sedation Scale, respectively. The recovery time was assessed with the scale of Aldrete. Time was measured and recorded to the moment at which patient responses brought the Aldrete score to 10 points. Time to eye opening and length of stay in the recovery room were recorded. Group M showed significantly lower mean arterial pressure (MAP) values at 5 and 10 minutes during the procedure when compared with group K (P = .02 and P = .01, respectively). Visual analogue scale scores were greater in group M than in group K at 5 and 10 minutes for the transurethral procedure (P = .039 and P = .028, respectively). Sedation scores were similar between groups during the procedure. Time to eye opening and length of recovery room stay were shorter (P < .001 and P < .001, respectively), and Aldrete scores were greater in group K than group M. Both combinations provided satisfactory sedation levels, but the dexmedetomidine-ketamine combination provided better analgesia and hemodynamic stability, with less nausea and vomiting and shorter recovery time, than the dexmedetomidine-midazolam combination.

Drug-induced sleep endoscopy in adults with sleep-disordered breathing: Technique and the VOTE Classification system

Drug-induced sleep endoscopy (DISE) offers an unique evaluation of the upper airway. After pharmacologic induction of unconscious sedation, it is possible to evaluate endoscopically the structures contributing to upper airway obstruction in sleep disordered breathing. The authors describe DISE techniques and the VOTE classification system for reporting of DISE findings. The VOTE classification focuses on the primary structures that contribute to upper airway obstruction and represents a common language to describe the patterns of obstruction during DISE. The latter can facilitate the scientific evaluation of DISE, including its role in directing treatment.

Effects of Different Doses of Remifentanil Infusion on Hemodynamics and Recovery in Children Undergoing Pediatric Diagnostic Cardiac Catheterization

The present study aimed to compare 2 different doses of remifentanil infusion on hemodynamics, recovery period, and complications in children undergoing diagnostic pediatric cardiac catheterization. A prospective study. A university hospital. Children undergoing diagnostic cardiac catheterization (n = 60). Children (2-12 years of age) scheduled for elective diagnostic cardiac catheterization under sedation were included in this study. The patients were assigned randomly to 2 groups as follows: patients in group 1 (n = 30) received a remifentanil infusion of 0.1 μg/kg/min, and patients in group 2 (n = 30) received a remifentanil infusion of 0.2 μg/kg/min. Heart rate (HR), systolic and diastolic blood pressures (BPs), oxygen saturation (SpO(2)), respiratory rate (RR), sedation, and recovery scores were recorded. There were no significant differences between the groups in terms of systolic and diastolic BPs, HR, SpO(2), and RR during the study period. Additional drugs were required for 15 children in group 1; however, 27 patients maintained a satisfactory level of sedation with the 0.2-μg/kg/min remifentanil infusion. The time to achieve a recovery score of ≥5 was significantly shorter in group 2 than in group 1 (4.1 ± 0.3 minutes v 6.8 ± 0.8 minutes). No postoperative complications were reported in either group. After oral midazolam premedication and local prilocaine infiltration, 0.2 μg/kg/min of remifentanil provided adequate sedation without any hemodynamic compromise during pediatric diagnostic cardiac catheterization.

Local analgesic techniques for the equine head

Horses are excitable animals by nature and are often particularly sensitive to and intolerant of palpation around their head and ears. However, it is frequently necessary to perform procedures around the head, during routine veterinary examination and treatments, and prophylactic dental procedures. Such procedures are often poorly tolerated by the horse and may result in potentially violent avoidance behaviour, preventing safe completion of the procedure. In addition, due to the high cost of general anaesthesia, and its reported risks of morbidity and mortality, and due to the high demands on time and personnel, the ability to perform many investigative, surgical and dental procedures safely in the conscious, sedated horse is attractive. Regional and local nerve blocks are commonly used to enhance the analgesia achieved under general anaesthesia, for oral surgical procedures in other species, including dogs (Beckman and Legende 2002; Lantz 2003) and man (Reiter 1980; Johnson 1982; Lefevre 1991), and for surgical procedures on the distal limbs in horses. Traditionally, restraint of horses for procedures on the head has been achieved with the assistance of an experienced handler, nose twitches and administration of sedatives, especially α-2 agonist drugs. The α-2 agonists produce a satisfactory level of sedation and analgesia, particularly when used in combination with opiates including butorphanol (Torbugesic)1, methadone (Physeptone)2 and morphine (Morphine Sulphate)3. Although adequate, chemically-assisted restraint can be achieved using these techniques in many horses and for many minor procedures, the horse undoubtedly still experiences considerable pain, which is both noxious and undesirable. Therefore, from a welfare perspective, with respect to the horse, and from an efficacy and safety perspective with respect to the veterinarian, it is highly desirable to achieve a greater degree of regional analgesia and muscle relaxation than is possible using sedatives alone, particularly when doing invasive procedures requiring a high degree of precision. The use of regional or local anaesthetic techniques produces superior analgesia resulting in better compliance, safer restraint, reduced doses of sedative drugs and greater duration of sedation, and consequently facilitates shorter operating times. In addition, head-shy behaviour, which can be learned as a consequence of noxious veterinary procedures on the head, is less likely to be reinforced.

Intra-individual propofol dosage variability in children undergoing repetitive procedural sedations

Objectives: Propofol sedation/anesthesia has been used successfully in children undergoing procedural sedation. We prospectively assessed intra- and inter-individual variability in propofol dosage for sedation in repetitive procedures in children with malignancies. Patients and methods: A total of 80 procedures including lumbar puncture, radiation therapy, magnetic resonance imaging, bone marrow biopsiy, endoscopy, drainage of ascites (range: 2–19 procedures/patient) were performed in 24 children (mean age: 9,6±5,4 years). The mean propofol induction dose was 2,61±0,74mg.kg-1 to achieve deep sedation. Primary outcome measure was the inter- and intra-individual propofol dosage required to achieve adequate sedation; secondary outcome measures were the number of adverse effects, the need for therapeutic interventions, and cardiovascular parameters. Results: All 80 procedures were completed with satisfactory sedation levels. There was a remarkable inter- and intra-individual variability in propofol dosage required to achieve adequate sedation (interindividual range 1.1–4.1mg.kg-1; intraindividual difference concerning the needed propofol induction 0.0–2.2mg.kg-1, 25% of the patients had a dose range of 0.0–0.5mg.kg-1, 37,5% >0.5–1.0mg.kg-1, 37,5% >1.0–2.2mg.kg-1. In 10% (n=8) of the procedures side effects were seen, mainly short episodes of desaturation which required no or only minor interventions. Conclusions: Due to great inter- and intra-individual differences, propofol dosage should be titrated towards the desired level of sedation. Thus propofol can be adjusted to the individual's need while achieving adequate sedation. Considering the substancial rate of adverse effects procedural sedation with propofol should be performed only by physicians experienced in advanced pediatric cardiorespiratory support.

Intra-individual propofol dosage variability in children undergoing repetitive procedural sedations

Objectives: Propofol sedation/anesthesia has been used successfully in children undergoing procedural sedation. We prospectively assessed intra- and inter-individual variability in propofol dosage for sedation in repetitive procedures in children with malignancies. Patients and methods: A total of 80 procedures including lumbar puncture, radiation therapy, magnetic resonance imaging, bone marrow biopsiy, endoscopy, drainage of ascites (range: 2–19 procedures/patient) were performed in 24 children (mean age: 9,6±5,4 years). The mean propofol induction dose was 2,61±0,74mg.kg-1 to achieve deep sedation. Primary outcome measure was the inter- and intra-individual propofol dosage required to achieve adequate sedation; secondary outcome measures were the number of adverse effects, the need for therapeutic interventions, and cardiovascular parameters. Results: All 80 procedures were completed with satisfactory sedation levels. There was a remarkable inter- and intra-individual variability in propofol dosage required to achieve adequate sedation (interindividual range 1.1–4.1mg.kg-1; intraindividual difference concerning the needed propofol induction 0.0–2.2mg.kg-1, 25% of the patients had a dose range of 0.0–0.5mg.kg-1, 37,5% >0.5–1.0mg.kg-1, 37,5% >1.0–2.2mg.kg-1. In 10% (n=8) of the procedures side effects were seen, mainly short episodes of desaturation which required no or only minor interventions. Conclusions: Due to great inter- and intra-individual differences, propofol dosage should be titrated towards the desired level of sedation. Thus propofol can be adjusted to the individual's need while achieving adequate sedation. Considering the substancial rate of adverse effects procedural sedation with propofol should be performed only by physicians experienced in advanced pediatric cardiorespiratory support.