Agitation-Sedation Scale Score Research Articles

Application of remimazolam transversus abdominis plane block in gastrointestinal tumor surgery.

Transversus abdominis plane block (TAPB) is a block of the abdominal afferent nerve fibers between the internal oblique muscle and the transverse abdominal muscle achieved with local anesthetics. It can effectively block the conduction of the anterior nerve of the abdominal wall and exert a good analgesic effect. However, the effect of combining the block with remimazolam on anesthesia in patients undergoing gastrointestinal tumor surgery is still unclear. To examine the effects of combining TAPB with remimazolam on the stress response and postoperative recovery of gastrointestinal tumor surgery patients. A retrospective analysis was conducted on the clinical data of 102 individuals diagnosed with gastrointestinal malignancies who underwent laparoscopic surgery under general anesthesia between April 2020 and June 2023. The patients were categorized into a control group (n = 51), receiving remimazolam for general anesthesia, and an observation group (n = 51), receiving TAPB combined with remimazolam for general anesthesia. A comparison was made between both groups in terms of hemodynamic parameters, stress markers, pain levels, recovery quality, analgesic effects, and adverse reactions during the perioperative period. The observation group had significantly higher heart rates at time points 1 min after induction and upon leaving the operating room than the control group (P < 0.05). The mean arterial pressure at time point T1 in the observation group was significantly higher than that in the control group (P < 0.05). Five minutes after extubation, the levels of the hormones adrenaline and noradrenaline in the observation group were considerably lower than those in the control group (P < 0.05). At 12 h, 24 h, and 48 h following surgery, the visual analog scale scores of the observation group were considerably lower than those of the control group (P < 0.05). The observation group had shorter awakening and extubation times and lower Riker sedation-agitation scale scores than the control group (P < 0.05). The observation group exhibited considerably fewer effective pump presses, lower fentanyl dosages, and lower incidences of rescue analgesia within 24 h following surgery than the control group (P < 0.05). The application effect of TAPB combined with remimazolam general anesthesia in anesthesia of patients undergoing gastrointestinal tumor surgery is good, which is helpful to promote faster recovery after operation.

Effect of different head-high lateral extubation on adverse reactions in the peri-extubation period of pediatric OSAS surgery under general anesthesia

BackgroundChildren with OSAS are prone to various airway complications during tracheal extubation after tonsillectomy and adenoidectomy due to oropharyngeal secretions and oozing blood. However, few studies have examined the effect of position on airway complications after tracheal extubation in children with OSAS. The aim of this study was to investigate the appropriate position for extubation in children with OASA.MethodsA total of 459 children aged 3–14 years with OSAS who underwent tonsillectomy and adenoidectomy were recruited for this study. All children were treated with the same surgical approach and standard anesthesia methods of induction of anesthesia, tracheal intubation and maintenance of anesthesia. At the end of surgery, the children were delivered to the post anesthesia care unit and randomly divided into three groups: Group A: Head-high 0° in lateral position; Group B: Head-high 15° in lateral position; Group C: Head-high 30° in lateral position. The main outcomes of this study were the pulse oxygen saturation (SpO2) and the Sedation-Agitation Scale (SAS) scores of the children after extubation, the outflow of oral-nasal secretions and the respiratory complications. Secondary outcomes were blood pressure, heart rate, end-respiratory carbon dioxide, respiratory rate, and post-operative awakening time of the children in three groups.ResultsData from a total of 423 children were statistically analyzed, 141 in Group A, 142 in Group B, and 140 in Group C. The main results showed a significant decrease in choking response after extubation in Group B (46.5%) and Group C (40.7%) compared to Group A (60.3%) (P < 0.05). The SAS score for postoperative agitation was higher in Group A (4.6 pm 0.9) than in Group B (4.4 pm 0.7) and Group C (4.3 pm 0.6) (P < 0.05). Also the SpO2 after extubation was higher in Group B (97.2%) and Group C (97.1%) than in Group A (95.8%) (P < 0.05). In contrast, there was no difference in the occurrence of respiratory complication and postoperative agitation in children between Group B and Group C (all P > 0.05). In addition, there was no difference in the amount of oral-nasal secretions among the children in the three groups (all P > 0.05).ConclusionThe head-high 15° lateral position and head-high 30° lateral position can reduce the incidence of airway complications and agitation and provide safe and comfortable extubation conditions for children during the peri-extubation period after tonsillectomy and adenoidectomy, which has certain clinical guidance value.Trial registrationRegistration Number: NO.ChiCTR2200055835(20,01,2022) https://www.chictr.org.cn

A Retrospective Case Series on Valproic Acid for Early Post-Traumatic Seizure Prophylaxis After Traumatic Brain Injury in Patients With Concomitant Agitation.

Purpose: Early post-traumatic seizures occur within 7 days following a traumatic brain injury and may lead to additional brain damage and poor outcomes. Levetiracetam or phenytoin is often used for seizure prophylaxis in this patient population, but valproic acid may be an appropriate therapeutic alternative in patients with concomitant agitation. Evidence for the use of valproic acid for both early post-traumatic seizure prophylaxis and agitation is limited. The purpose of this study is to examine the safety and efficacy of valproic acid for both early post-traumatic seizure prophylaxis and agitation. Methods: This single-center, retrospective case series includes 18 patients who received valproic acid for both early post-traumatic seizure prophylaxis and agitation. Efficacy for early post-traumatic seizure prophylaxis is assessed by the incidence of seizures within 7 days of injury. Efficacy for agitation is assessed by changes in Riker Sedation-Agitation Scale scores during valproic acid therapy. The safety of valproic acid is defined by the incidence of selected adverse events. Results: Among 18 patients with traumatic brain injuries receiving valproic acid for both early post-traumatic seizures and agitation, one patient experienced a seizure during the period of prophylaxis and thrombocytopenia was the most common adverse event. Conclusion: In this small cohort of patients, valproic acid appears be a potential option to prevent early post-traumatic seizures in patients with traumatic brain injuries and concomitant agitation with minimal adverse effects. Randomized, controlled studies are needed to further investigate the role of valproic acid for this indication, including standards for dosing regimens, serum drug monitoring, and the relationship between valproic acid treatment and mortality.

Logistic Regression and Machine Learning Models for Predicting Whether Intensive Care Patients Who Are Alert and Without Delirium Remain As Such for at Least Two More Days.

Background Some intensive care unit patients are alert and without delirium for atleast two consecutive days. These patients, like other critically ill individuals, are at risk for dignity-related distress. An interval ofat least two days would provide for apalliative care multidisciplinary team to be consulted in the late morning or afternoon of day one and visit the next day. An assessment would include the administration of the validated Patient Dignity Inventory in a reflective manner. To determine whether dignity-related distress can be identified and treated during patients' intensive care unit stay, we evaluated whether asubstantive fraction of such patients (≥5%) have asubstantial (>90%) probability ofremaining alert and without delirium in the intensive care unit for at least four consecutive days. Methods The retrospective cohort study used data from one large teaching hospital in the United States of America, from 2012 to June 2022. The inclusion criteria were: a)adults, b)present in an intensive care unit at 12 PM one day and continually sofor the next 48 hours, c)during those two days had every Riker sedation-agitation scale score "4, calm and cooperative," and d) during those two days had all Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scores negative (i.e., no delirium) and all Delirium Observation Screening Scale (DOS) scores less than three (i.e., no delirium). Results Among the 10,314 patients alert and without delirium in an intensive care unit over two-day periods that included threesuccessive 12PMs, 3,826 (37%) maintained this status for at least two successive 12PMs. Six patient characteristics (e.g., hemodynamic infusion or ventilatory support) had value in predicting those 37% ofpatients. However, logistic regression and classification models each predicted a few (≈0.2%) patients with >90% probability of maintaining these criteria. Forecasts were inaccurate for nearly all patients remaining alert and without delirium in the intensive care unit (≈37%) because the models predicted no patient alert, without delirium, and in the intensive care unit for twodays would remain so for at least four days. That ≈63% accuracy was improved upon by random forest machine learning, but only with ≈3% improvement. Conclusion Although many intensive care unit patients remain alert and without delirium for several consecutive days, each patient has a high daily probability of intensive care unit discharge or deterioration in medical condition. Therefore, the results of our prediction modeling show that care models for the assessment and treatment of patients with intensive care unit-associated dignity-related distress should not rely solely on the intensive care unit team but instead should be taken from the perspective ofthe entire hospitalization.

Translation, cross-cultural adaptation, and validation of the Behavioral Activity Rating Scale (BARS) for the Brazilian population.

Few instruments are available in Brazil to evaluate psychomotor activity in psychiatric emergency, clinical, and research settings. This study aimed to perform a cross-cultural adaptation of the Behavioral Activity Rating Scale (BARS) into Brazilian Portuguese and assess the adapted scale's psychometric properties. An expert consensus committee conducted a translation and back-translation of the original scale, resulting in the BARS-BR. Four pairs of physicians administered the BARS-BR and the Sedation-Agitation Scale (SAS) to patients in a hospital psychiatry emergency room and patients in the hospital's psychiatric wards. The BARS-BR was compared to the SAS to assess concurrent validity and internal consistency was evaluated with the Bland-Altman technique. In the emergency room, the correlation coefficients between the first and second assessments were rho = 0.997 and rho = 1.0, respectively. In the hospital wards, the correlation coefficient between the pair of evaluators was rho = 0.951. There were strong correlations between the BARS-BR score of the first examiner and the SAS score of the second examiner (rho = 0.903) and between the SAS score of the first examiner and the BARS-BR score of the second examiner (rho = 0.893). The BARS-BR showed good psychometric properties, and we recommend its use because it constitutes an easy method for assessment of changes in psychomotor activity. Further studies are suggested to evaluate adoption and comprehension of the BARS-BR scale by all classes of healthcare professionals.

753: EVALUATION OF SEDATIVE AND ANALGESIC PRACTICES AND OUTCOMES IN MECHANICALLY VENTILATED PATIENTS

Introduction: Sedative and analgesic agents are used for patient comfort during mechanical ventilation (MV) but can cause deleterious effects such as prolonged MV and delirium. Maintaining light sedation and performing daily awakening trials (DATs) can reduce untoward effects. We assessed the relationship between sedative and analgesic dose and 28-day MV-free survival in medical ICU (MICU), surgical ICU (SICU), and cardiac (CICU) patients, hypothesizing that higher doses would be associated with lower 28-day MV-free survival. Methods: In this single-center retrospective study, MICU, SICU, and CICU patients admitted to a tertiary care hospital from 1/1/21-6/30/21 and on MV admitted for 1-7 days were randomly selected if their goal Sedation Agitation Scale (SAS) score was 3-4. Baseline demographics and clinical characteristics were collected. The primary outcome was correlation between average sedative or analgesic dose and 28-day MV-free survival. Secondary outcomes included time at goal SAS score, DAT completion, and deep sedation (SAS < 3) within 48 hours of intubation. The primary outcome was evaluated using linear regression; secondary outcomes were assessed with descriptive statistics. Results: 411 subjects, including 99 MICU, 54 SICU, and 27 CICU patients, were evaluated. 53% were male and the median age and weight were 66.5 years (IQR, 56-77) and 84 kg (IQR 70-100), respectively. 8% of MICU patients but no SICU or CICU patients had Covid-19. A history of chronic opioid use was most common in MICU and SICU patients (19% and 17%, respectively) and CICU patients most often had a history of chronic kidney disease (33%). Doses of dexmedetomidine, propofol, midazolam, and fentanyl demonstrated poor correlation with 28-day MV-free survival among all patients, with R-squared values of 0.002, 0.06, 0.01, and 0.1, respectively. The association of sedative dose was strongest for midazolam in MICU patients, with each 1mg/hr increase corresponding to a 0.6 day reduction in 28-day MV-free survival. SAS scores were 3-4 70% of the time, SATs were completed in 73% of appropriate cases, and 57% of patients were deeply sedated within 48 hours of intubation. Conclusions: In this regression analysis, sedative and analgesic doses were not associated with 28-day MV-free survival in a mixed critically ill population.

Effect of Parecoxib Sodium Combined with Dexmedetomidine on Analgesia and Postoperative Pain of Patients Undergoing Hysteromyomectomy.

Background Propofol combined with remifentanil is the most common anesthesia method in laparoscopic hysteromyomectomy. However, whether the combination of the two is helpful to patients undergoing hysteromyomectomy still requires unclear. Objective To determine the effect of parecoxib sodium combined with dexmedetomidine on analgesia and postoperative pain of patients undergoing hysteromyomectomy. Methods Altogether, 72 patients receiving hysteromyomectomy in our hospital from February 2017 to March 2019 were enrolled. Among them, 35 patients treated with parecoxib sodium were assigned to the control group, while the rest 37 patients treated with parecoxib sodium combined with dexmedetomidine were assigned to the research group. The following items of the two groups were evaluated: visual analog scale (VAS) score, mechanical pain threshold (MPT), Riker sedation-agitation scale (RSAS) score, and expression of serum cortisol and melatonin. Results At 12 and 24 h after operation, the VAS score of the research group was lower than that of the control group (P < 0.05), and at 6, 12, and 24 h after operation, the MPT of the research group was notably higher than that of the control group (P < 0.05). In addition, at 10 min after extubation, the research group got notably lower RSAS score than the control group (P < 0.05). Before extubation and at 20 min after extubation, the research group showed notably higher melatonin expression and notably lower serum cortisol expression than the control group (both P < 0.05). Conclusion Parecoxib sodium combined with dexmedetomidine can effectively control the postoperative pain of patients undergoing hysteromyomectomy, reduce the incidence of agitation, and effectively control serum cortisol and melatonin in them.

Functional Magnetic Resonance Imaging of Brain Function and Emergence Agitation of Patients with Dexmedetomidine-Assisted General Anesthesia under Comfortable Nursing Intervention.

In order to explore the effects of dexmedetomidine (DEX) on functional magnetic resonance imaging (fMRI) and emergence agitation of patients who underwent general anesthesia surgery with sevoflurane under comfortable nursing intervention, 66 patients who received upper abdominal surgery were selected as research objects. According to nursing and anesthesia methods, the patients were randomly divided into control group (routine nursing and anesthesia), group A (routine nursing and DEX-assisted anesthesia), and group B (comfortable nursing and DEX-assisted anesthesia). The differences in the brain fMRI characteristics, hemodynamic indexes, anesthesia recovery indexes, and nursing satisfaction in the perioperative period were evaluated. The results showed that the regional homogeneity values were different in different brain regions, but there was no difference in the Z value of functional connectivity(P > 0.05). Compared with the control group, heart rate, mean arterial pressure, awakening time, extubation time, the Riker sedation-agitation scale (SAS) score, and anesthetic dosage were signally decreased in group A and group B, while the Ramsay scores, the postanesthesia care unit (PACU) stay, and anesthesia maintenance time in the two groups was obviously increased(P < 0.05). Compared with group A, the extubation time, the SAS score, PACU stay, and hospital stay were all remarkably reduced in group B, while the nursing satisfaction score was greatly increased(P < 0.05). To sum up, DEX was helpful to safely and effectively reduce the occurrence of emergence agitation in patients under general anesthesia surgery with sevoflurane. Besides, comfortable nursing intervention could further reduce the incidence of emergence agitation in patients with general anesthesia, shorten the length of hospital stay, and improve nursing satisfaction.

Clinical application of dexmedetomidine combined with dezocine in local anesthesia for endoscopic dacryocystorhinostomy.

To investigate the clinical effect of dexmedetomidine combined with dezocine in local anesthesia for endoscopic dacryocystorhinostomy (DCR). Ninety patients undergoing elective endoscopic DCR were randomly divided into two groups, local anesthesia group (LA group n = 45) and general anesthesia group (GA group, n = 45). These subjects were all American Society of Anesthesiologists (ASA)-Physical Status I-II patients. The changes of mean arterial pressure (MAP) and heart rate (HR) were observed and recorded before anesthesia (T0), after anesthesia (T1), at the beginning of surgery (T2), and at the end of surgery (T3). The visual analogue scale (VAS) score was observed and recorded immediately after awakening from anesthesia and at 1, 2, 6, and 12h after surgery. Additionally, the occurrence of adverse reactions after surgery and the sedation-agitation scale (SAS) score after awakening were recorded. Compared with the LA group, the MAP and HR of the GA group were significantly lower at T1 and T2, but significantly higher at T3. Local anesthesia was associated with lower VAS score immediately after awakening and at 1, 2, 6, and 12h after surgery. Also, local anesthesia caused a lower incidence of postoperative agitation, nausea, and vomiting. The SAS score in the LA group was markedly higher than that in the GA group. Local anesthesia with dexmedetomidine and dezocine as adjuvants in endoscopic DCR has more stable hemodynamics and reduces the stress response during perioperative period. Also, this anesthesia achieves better postoperative sedation and analgesia effects, reduces postoperative complications, and improves the quality of awakening from anesthesia. Collectively, local anesthesia is a comfortable and safe option for patients with high risks of general anesthesia and those unwilling to receive general anesthesia.

Discussion Guide for the May Article.

Discussion Guide for the May Article.

Prospective Validation of Sedation Scale Scores That Identify Light Sedation: A Pilot Study.

Intensive care unit (ICU) sedation guidelines recommend targeting a light sedation level, but light sedation has no accepted definition, and inconsistent levels have been proposed. To determine Sedation-Agitation Scale and Richmond Agitation-Sedation Scale scores that best describe patients' ability to follow voice commands. This prospective, observational pilot study enrolled a convenience sample of ICU patients receiving mechanical ventilation. Pairs of trained investigators evaluated scores on the Sedation-Agitation Scale and Richmond Agitation-Sedation Scale and ability to follow commands before and up to 2 hours after sedation lightening in a blind, independent, simultaneous fashion. Positive predictive values (PPVs) and likelihood ratios (LRs) of Sedation-Agitation Scale and Richmond Agitation-Sedation Scale scores associated with light sedation (ability to follow at least 3 commands) were calculated. Ninety-six assessments (50 before and 46 after lightening of sedation) were performed in medical ICU patients. Scores best associated with ability to follow at least 3 commands were Sedation-Agitation Scale score of 4 (PPV, 0.88; 95% CI, 0.70-0.98; LR, 14.0) and Richmond Agitation-Sedation Scale score of -1 (PPV, 0.81; 95% CI, 0.61-0.93; LR, 10.7), superior to previously recommended thresholds of Sedation-Agitation Scale score of 3 (PPV, 0.62; 95% CI, 0.48-0.75; LR, 3.1) and Richmond Agitation-Sedation Scale score of -3 (PPV, 0.52; 95% CI, 0.39-0.64; LR, 2.0). The level of sedation most associated with the ability to follow commands appears higher than previously recommended. Further study is needed regarding the effects of sedation level on ICU patients' ability to follow commands and assessment of delirium, pain, and patient preferences.

Natural language processing diagnosed behavioral disturbance vs confusion assessment method for the intensive care unit: prevalence, patient characteristics, overlap, and association with treatment and outcome

PurposeTo compare the prevalence, characteristics, drug treatment for delirium, and outcomes of patients with Natural Language Processing (NLP) diagnosed behavioral disturbance (NLP-Dx-BD) vs Confusion Assessment Method for intensive care unit (CAM-ICU) positivity.MethodsIn three combined medical-surgical ICUs, we obtained data on demographics, treatment with antipsychotic medications, and outcomes. We applied NLP to caregiver progress notes to diagnose behavioral disturbance and analyzed simultaneous CAM-ICU.ResultsWe assessed 2313 patients with a median lowest Richmond Agitation-Sedation Scale (RASS) score of − 2 (− 4.0 to − 1.0) and median highest RASS score of 1 (0 to 1). Overall, 1246 (53.9%) patients were NLP-Dx-BD positive (NLP-Dx-BDpos) and 578 (25%) were CAM-ICU positive (CAM-ICUpos). Among NLP-Dx-BDpos patients, 539 (43.3%) were also CAM-ICUpos. In contrast, among CAM-ICUpos patients, 539 (93.3%) were also NLP-Dx-BDpos. The use of antipsychotic medications was highest in patients in the CAM-ICUpos and NLP-Dx-BDpos group (24.3%) followed by the CAM-ICUneg and NLP-Dx-BDpos group (10.5%). In NLP-Dx-BDneg patients, antipsychotic medication use was lower at 5.1% for CAM-ICUpos and NLP-Dx-BDneg patients and 2.3% for CAM-ICUneg and NLP-Dx-BDneg patients (overall P < 0.001). Regardless of CAM-ICU status, after adjustment and on time-dependent Cox modelling, NLP-Dx-BD was associated with greater antipsychotic medication use. Finally, regardless of CAM-ICU status, NLP-Dx-BDpos patients had longer duration of ICU and hospital stay and greater hospital mortality (all P < 0.001).ConclusionMore patients were NLP-Dx-BD positive than CAM-ICU positive. NLP-Dx-BD and CAM-ICU assessment describe partly overlapping populations. However, NLP-Dx-BD identifies more patients likely to receive antipsychotic medications. In the absence of NLP-Dx-BD, treatment with antipsychotic medications is rare.

Application of Non-Opioids under the Concept of Enhanced Recovery after Surgery under Ultrasound-Guided Iliac Fascia Nerve Block Anesthesia in Elderly Patients with Hip Fracture Surgery

To discuss the application of enhanced recovery after surgery concept in ultrasound-guided iliac fascia nerve block in elderly hip fracture surgery patients and its effect on traumatic stress in patients during perioperative period. Selected 100 elderly patients undergoing hip fracture surgery in our hospital from January 2021 to September 2021. Divided 50 patients of non-opioid ultrasound-guided iliac fascia nerve block anesthesia into observation group and the other 50 patients of opioid (sufentanil) anesthesia into control group. Compared perioperative heart rate and mean arterial pressure indexes of both groups; compared visual analog scale, sedation-agitation scale and mini-mental state examination scores of patients on the 2 d after surgery; compared cortisol, C-reactive protein and interleukin-6 levels in serum of both groups. Compared Harris hip function score, perioperative complications (pressure sores, lower extremity venous thrombosis, lower limbs swelling, lung infection), length of hospital stay and hospitalization expenses of both groups at 3 mo after surgery. Observation group had lower mean arterial pressure and heart rate during spinal canal intubation than control group, which possessed statistical significance (p<0.05). On the 1 d after surgery, observation group had higher visual analog scale score than control group (p>0.05), but had remarkably lower sedation-agitation scale score than control group (p<0.05), and had remarkably higher mini-mental state examination score than control group (p<0.05). At 3 mo after surgery, observation group had higher affected hip joint Harris score than control group (p<0.05), and postoperative complications rate in observation group (8 %) was remarkably lower than control group (16 %), observation group had remarkably lower hospitalization expenses and length of stay than control group, so the divergence possessed statistical significance (p<0.05). Under the concept of enhanced recovery after surgery, nonopioids under ultrasound-guided iliac fascia nerve block anesthesia can better improve hip joint function, reduce postoperative cognitive dysfunction and reduce postoperative complications in geriatric hip fracture surgery. It can remarkably shorten the length of hospitalization and hospitalization expenses. Compared with traditional opioid spinal anesthesia, it can remarkably accelerate the recovery of patients after surgery.

Preschool Confusion Assessment Method for the Intensive Care Unit–Spanish (psCAM-ICU-S): Cross-Cultural Adaptation and Validation in Colombia

Objective: The goal of the present study was to perform a cross-cultural adaptation and clinical validation of the Preschool Confusion Assessment Method for the Intensive Care Unit–Spanish (psCAM-ICU-S) for its clinical use in the Colombian Population.Methods: We designed a Cross-cultural adaptation study followed by a cross-sectional validation study at a Single-center Pediatric Intensive Care Unit (PICU) at a University Hospital in Bogotá, Colombia. The study population was children aged from 6 months to 5 years and 11 months who had been treated in the PICU with a Richmond sedation-agitation scale score of−3 or higher. A three-phase study was carried out. The first phase comprised the application of psychometric tests on the tool. In the second phase, the psCAM-ICU-S was applied to the target population. Patients were evaluated by a nurse and a pediatric intensivist using the psCAM-ICU-S; additionally, a child psychiatrist evaluated each patient using the DSM-V criteria; the psychiatrist evaluation was chosen as the gold standard for the diagnosis of delirium. In the third phase, an evaluation of the tool's effectiveness was carried out by using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios. Interrater agreement was also assessed by using the Fleiss' kappa.Results: Psychometric tests established the instrument's reliability and consistency as well as the clarity of its items. A total of 31 patients were evaluated. On average, the instrument presented a sensitivity of 93.3%, specificity of 94.8%, PPV 78%, NPV 99%, a positive likelihood ratio of 19.93, and a negative ratio of 0.07. The prevalence of delirium was 16.1% by the child psychiatrist and 25.8% using de psCAM-ICU-S. We confirmed high Interrater agreement, Kappa index (0.672–0.902).Conclusions: The psCAM-ICU-S was a valid and reliable instrument for the diagnosis of delirium in critically ill pediatric patients.

Application of Sedation and Analgesia Nursing in Endovascular Treatment of Patients with Acute Ischemic Stroke

Background: For acute ischemic stroke (AIS) patients with anterior circulation occlusion, local anesthesia can significantly shorten the time from endovascular treatment to recanalization. Objective: To investigate the application of individualized sedation and analgesia nursing in endovascular treatment (EVT) of patients with anterior-circulation AIS. Methods: From October 2019 to October 2020, all of 78 patients who underwent EVT with anterior-circulation AIS were retrospectively collected. Before interventional preoperative, doctors and nurses cooperated to comprehensively evaluate the patient's condition. Based on fully considering patients' respiratory function, hemodynamic status and pathological and physiological status, individualized sedation and analgesia targets were formulated. The nurses dynamically assessed the patients' sedation score with Sedation-Agitation Scale (SAS) and analgesia score with Critical-Care Pain Observation Tool (CPOT), monitored the depth of sedation and analgesia in real time, adjusted the drug dose, and maintained the ideal sedation and analgesia state of the patients. During the operation, we actively prevented and dealt with the occurrence of adverse reactions such as hypersedation and respiratory depression, and placed oropharyngeal airway to improve ventilation for patients with retroglossal drop and respiratory depression. Results: The SAS score of 78 patients was 5.8±3.7 while entering the operating room. Among them, 71 patients were treated with the midazolam with an average dose of 5.3±2.7 mg, as well as the SAS score of 3.3±1.8 during the operation, and the other 7 patients were cooperated with consciously. Sixty patients were sedated with fentanyl solution at an average dose of 0.38±0.22mg, and the CPOT score was 4.8±3.2 during the operation. The other 18 patients did not use analgesics. The time of Door to Recanalization (D2R) in 78 patients was 50.8±28.6 min. During the operation, there was good cooperation between doctors and nurses, no case of intracranial hemorrhage and no case died. Conclusion: In the EVT of the anterior-circulation AIS patients, medical cooperation developed individualized sedation and analgesia, and the nurses dynamically evaluated the sedation and analgesia score of the patients. By monitoring the depth of sedation and analgesia in real time to adjust the dosage of drugs, patients can maintain in a moderate sedation and analgesia state to ensure the safety of EVT performed.

Butorphanol versus Propofol in Patients Undergoing Noninvasive Ventilation: A Prospective Observational Study

BackgroundThe present study aimed to explore sedation management in agitated patients who suffered from acute respiratory failure (ARF) and were treated with noninvasive ventilation (NIV).Patients and MethodsWe divided 118 patients undergoing NIV treatment with butorphanol or propofol into two groups: group B (n = 57, butorphanol was initiated at the rate of 0.12 µg/kg/min as a continuous intravenous infusion and then titrated by 0.06 µg/kg/min every half an hour, group P (n = 61, propofol was initiated at the rate of 5 µg/kg/min as a continuous intravenous infusion and then titrated by 1.5 µg/kg/min every half an hour). Score of Sedation Agitation Scale (SAS) in the two groups was maintained between 3 and 4. Medications including sedative, analgesic, and antipsychotic, NIV intolerance score, SAS score, visual analog scale (VAS), medication use and adverse events were recorded repeatedly.ResultsPatients receiving butorphanol required significantly less total amount of fentanyl than patients receiving propofol during NIV to maintain the target VAS [0 (0–0) µg vs 150 (50–200) µg, P< 0.005]. Hemodynamic stability during NIV showed it was better kept in patients treated with butorphanol.ConclusionButorphanol not only decreased the requirements of fentanyl but also enhanced hemodynamic stability in agitated patients suffering from ARF receiving NIV.Trial RegistrationRegistered at http://www.chictr.org.cn/ (ChiCTR1800015534).

Anterior Ethmoidal Nerve Block In Prevention of Post-Operative Agitation Following Nasal Surgeries with Nasal Packs Under General Anesthesia: An Experimental Study

INTRODUCTION&#x0D; Postoperative agitation or emergence agitation during recovery from anesthesia is an important complication of General Anesthesia (GA) especially in otolaryngological surgeries, and nasal surgery in particular. It is potentially harmful to the patients resulting in fall from the operation table, self-extubation, self-removal of nasal pack, hemorrhage etc. Several methods and medications have been tried to reduce it. We studied the effect of anterior ethmoidal nerve block for reducing post-operative agitation for nasal surgeries with nasal packs as it falls in the same operative field.&#x0D; MATERIAL AND METHODS&#x0D; A total of 100 participants undergoing nasal surgeries with nasal pack under GA in the Department of Otolaryngology, Lumbini Medical College, Palpa, Nepal, were randomized into cases and controls by block randomization. The study was done from June 2018 till February 2020. Anterior ethmoidal nerve was blocked with lidocaine injection at the end of surgery in cases. Controls were injected with normal saline. Post-operative agitation was studied with Riker Sedation-Agitation Scale (SAS) and was compared between the two groups.&#x0D; RESULTS&#x0D; There were 50 participants in each group. Emergence agitation in cases and controls at extubation, 30 minutes post-extubation and the next morning was present in 32% and 52%, 4% and 18%, and 0 and 2% respectively. SAS score rapidly decreased in 30 minutes after extubation in controls but was still significantly higher than that of cases.&#x0D; CONCLUSION&#x0D; Anterior ethmoidal nerve block was effective in reducing post-operative agitation significantly during emergence in nasal surgeries with nasal packs.

Effects of Adding a Combined Infraorbital and Infratrochlear Nerve Block to General Anaesthesia in Septorhinoplasty.

PurposeIn this study, we evaluated the hypothesis that preoperative bilateral infraoptic nerve (ION) and infratrochlear nerve (ITN) blocks under general anesthesia with sevoflurane and remifentanil reduced the incidence of emergence agitation (EA), pain scores, and the analgesic consumption after the septorhinoplasty.Patients and MethodsOur study was conducted as a prospective randomized, double-sided blind study. Fifty-two patients whose septorhinoplasty operation was planned under general anesthesia were included in the study. Patients were randomly distributed to either the ION and ITN blocks were performed. Group 1: Bilateral ION and ITN blocks were performed; Group 2: ION and ITN blocks were not performed. Duration of the surgery and anesthesia, Riker Sedation-Agitation Scale (RSAS) score, EA presence, duration of postoperative analgesia, numerical rating scale (NRS) scores, and cumulative dexketoprofen consumption were recorded.ResultsThe RSAS score, NRS score and cumulative dexketoprofen consumption of the patients in Group 1 were statistically significantly lower than the patients in Group 2 (p<0.05). It was also found that patients in Group 1 (n: 8/26) had less EA compared to patients in Group 2 (n: 16/26) and this difference was statistically significant (p: 0.026). Postoperative analgesia duration of patients in Group 1 was found to be statistically significantly higher than patients in Group 2 (p: <0.001). In addition, the number of patients given postoperative dexketoprofen in Group 1 (n: 8/26) was found to be statistically significantly lower than patients in Group 2 (n: 25/26). (p: <0.001).ConclusionBilateral ION and ITN blocks in septorhinoplasty operation is an effective, reliable and simple technique in the treatment of postoperative pain.

Effects of adding ketamine to dexmedetomidine on smooth recovery from isoflurane anesthesia in adults undergoing endoscopic sinus surgery

ABSTRACT Background Recovery from general anesthesia after endoscopic sinus surgery can abruptly become dangerous and having serious complications leading to lost intravenous cannulas, disconnected cables, self extubation, physical injury, increased pain and hemorrhage. This study aimed to evaluate the effects of adding ketamine to dexmedetomidine on smooth recovery from isoflurane anesthesia in adults undergoing endoscopic sinus surgery. Methods A prospective double-blind randomized controlled study. Ten minutes before ending of surgery, 94 patients were randomly divided into two equal groups: Group (KD) (n = 47): received ketamine 0.5 mg/kg and dexmedetomidine 0.5ug/kg completed to 10 ml 0.9% normal saline and Group (C) (n = 47): received 10 ml 0.9% normal saline. Result The extubation, recovery and discharge times were statistically significant prolonged in KD group (6.82 ± 0.76, 8.68 ± 0.81 and17.63 ± 4.8) min compared to C group (4.34 ± 0.61, 6.3 ± 0.72 and14.8 ± 2.7) min respectively. The median Ricker Sedation-Agitation scale (RSAS) score at the recovery time, at admission to PACU, at PACU and at discharge from PACU was statistically significant lower in KD group compared to C group (p < 0.0001). The mean Visual Analogue Scale (VAS) score on arrival to PACU, discharge from PACU, one hour, 2hs, 4hs, 8hs, 12hs and 24hs postoperative and pethidine requirements were statistically significant lower in KD group compared to C group (p < 0.0001). No statistically significant difference in side-effects between groups. Conclusion Adding 0.5 mg ketamine to 0.5ug dexmedetomidine provides smooth recovery from isoflurane anesthesia in adults undergoing endoscopic sinus surgery.

The Feasibility and Safety of No Placement of Urinary Catheter Following Lung Cancer Surgery: A Retrospective Cohort Study With 2,495 Cases

Objectives The study was aimed to investigate the safety and feasibility of avoiding urinary catheterization after surgery in patients undergoing lung cancer resection. Methods Between 1 January 2014 and 31 December 2017, the patients with primary lung cancer who received lobectomy or segmental resection via video-assisted thoracic surgery (VATS) in our department were screened. Based on whether a urinary catheter was inserted after surgery, patients were divided into urinary catheter (UC) group or non-UC group, and rates of postoperative urinary retention (POUR), urinary catheter re-insertion and urinary tract infection (UTI) were compared. Results There was no difference in International prostate symptom score (p = .268) between the groups, but a higher Sedation-Agitation Scale (SAS) score was found in UC group [4.0 (3.0 4.0) vs. 4.0 (2.0, 4.0); p < .001], with a higher proportion of patients with agitation (SAS score > 4; 17.3%, 317/1,835 vs. 12.9%, 86/660, p = .008). In contrast, a higher rate of POUR was observed in non-UC group (11.2%, 74/660 vs. 7.4%, 136/1,835, p = .003), whereas the rate of UTI was significantly lower in this group (5.8%, 38/660 vs. 8.3%, 153/1,835, p = .033). Multivariable analysis revealed the non-placement of UC as the independent factor for POUR (OR: 1.542, 95%CI: 1.135-2.095, p = .006) and UTI (OR: 0.664, 95%CI: 0.459–0.962, p = .031). Conclusion This retrospective study with large sample of 2,495 patients provided evidence to the hypothesis that avoiding urinary catheterization contributed to decrease in the incidence of UTI and was safe and feasible in patients undergoing lung cancer surgery.