Sedation Techniques Research Articles

Volatile versus propofol sedation after cardiac valve surgery: a single-center prospective randomized controlled trial

BackgroundOptimal intensive care of patients undergoing valve surgery is a complex balancing act between sedation for monitoring and timely postoperative awakening. It remains unclear, if these requirements can be fulfilled by volatile sedations in intensive care medicine in an efficient manner. Therefore, this study aimed to assess the time to extubation and secondary the workload required.MethodsWe conducted a prospective randomized single-center trial at a tertiary university hospital to evaluate the postoperative management of open valve surgery patients. The study was randomized with regard to the use of volatile sedation compared to propofol sedation. Sedation was discontinued 60 min after admission for critical postoperative monitoring.ResultsWe observed a significantly earlier extubation (91 ± 39 min vs. 167 ± 77 min; p < 0.001), eye-opening (86 ± 28 min vs. 151 ± 71 min; p < 0.001) and command compliance (93 ± 38 min vs. 164 ± 75 min; p < 0.001) using volatile sedation, which in turn was associated with a significantly increased workload of a median of 9:56 min (± 4:16 min) set-up time. We did not observe any differences in complications. Cardiopulmonary bypass time did not differ between the groups 101 (IQR 81; 113) versus 112 (IQR 79; 136) minutes p = 0.36.ConclusionsUsing volatile sedation is associated with few minutes additional workload in assembling and enables a significantly accelerated evaluation of vulnerable patient groups. Volatile sedation has considerable advantages and emerges as a safe sedation technique in our vulnerable study population.Trial registration: Clinical trials registration (NCT04958668) was completed on 1 July 2021.

The association between different anesthetic techniques and outcomes in patients undergoing transfemoral aortic valve replacement.

There is an increasing number of patients undergoing transfemoral aortic valve replacement (TAVR) with sedation. There is limited data assessing the efficacy and safety of the different types of sedative drugs. The objective was to compare two sedation techniques with regard to the need for vasoactive support, respiratory support, rate of conversion to general anesthesia (GA), common perioperative morbidities, intensive care unit (ICU) stay, and in-hospital mortality. A retrospective chart review study conducted among patients who underwent TAVR at a specialized cardiac center between January 2016 and December 2019. Data collection included patient diagnosis, preoperative comorbidities, intraoperative outcomes, and postoperative outcomes. A total of 289 patients received local anesthesia; 210 received propofol infusion and 79 received a mixed propofol-ketamine infusion (Ketofol). The average age was 75.5 ± 8.9 years and 58.1% of the patients were females. Comparing propofol and ketofol groups, 31.2% and 34.2% of the patients required drug support, 7.6% and 6.3% required conversion to GA, 46.7% and 59.5% required respiratory support, respectively. These intraoperative outcomes were not significantly different between groups, P = 0.540, P = 0.707, and P = 0.105, respectively. In-hospital 30-day mortality in propofol and ketofol groups were 1.9% and 3.8%, respectively, P = 0.396. In both groups, the median post-procedure coronary care unit stay was 26 hours while post-procedure hospital stay was 3 days. There were no significant differences in perioperative or postoperative outcomes in TAVR patients receiving either propofol or ketofol. Propofol infusion, either alone or with ketamine, is reliable and safe, with minimal side effects.

Awake tracheal intubation in routine airway management: A retrospective analysis in a tertiary centre.

While awake tracheal intubation (ATI) is regarded as the gold standard for difficult airway management according to current guidelines, there seems to be a reluctance in its application. This retrospective cohort study, conducted at a German tertiary hospital over a 2-year period, aimed to demonstrate that integrating awake tracheal intubation using flexible bronchoscopy (ATI:FB) into routine airway management makes it a successful and safe approach. In 2019 and 2020, records from the data acquisition system (DAQ) and archived anesthesia records were screened to evaluate the specifics of ATI:FB procedures, focusing on overall success and safety. Analysis included complications, time required for ATI:FB, and potential influencing factors such as patient characteristics, indication, medical/operative specialty, sedation technique, route and experience of anesthesiologist. Logistic regression assessed the impact of various variables on occurrence of complications and linear regression, with log(time) as the dependent variable, evaluated median time required to perform ATI:FB. ATI:FB constituted 4.3 % (n = 1,911) of all airway management procedures, predominantly observed in dental, oral, and maxillofacial surgery (46.5 %) and otorhinolaryngology (38.4 %). The success rate for ATI:FB was notably high at 99.6 %, with only 5.4 % of cases experiencing complications, including technical issues, agitation, and visibility obstruction due to mucous secretion. Complication risk was influenced by the medical specialty and the experience of the anesthesiologist. A strong effect was observed in otorhinolaryngology (OR = 4.54, 95 % CI [1.64; 14.06]). The median time required for ATI:FB was 16 minutes (IQR: 11 to 23), with factors such as indication (p < 0.0001), experience of anesthesiologist (p < 0.0001), sedation technique (p = 0.0408), priority of the procedure (p = 0.0134), and medical/operative specialty (p < 0.0001) affecting the duration. The median time required for ATI:FB differed significantly based on the experience of the anesthesiologist (p < 0.0001). ATI:FB proves successful and safe, with low complications and manageable procedural time. Experience of the anesthesiologist is a modifiable factor enhancing safety, emphasizing the need for ATI:FB integration into routine airway management.

The Impact of Midazolam on Reducing Adverse Events during Bronchoscopy Procedures

Background: Bronchoscopy involves the examination of patient airways by advancing a bronchoscope into the lungs. This procedure is essential for diagnosing and treating respiratory disorders but comes with risks such as hypoxia and arrhythmias. Effective sedation techniques are necessary to mitigate these risks. This study assesses the impact of Midazolam on minimizing adverse events during bronchoscopy. Objectives: The aim is to evaluate the frequency of complications before and after IV Midazolam in patients who have undergone bronchoscopy. The secondary outcomes are the evaluation of the Midazolam’s systemic tolerability and safety in these patients, the rate of coughing and readiness to perform the procedure again. Study Design: A cross-sectional study Duration and place of study conducted in the Department of Pulmonology MTI/LRH from January 2021 to July 2021. Methods: 102 patients were enrolled in this cross-sectional study performed at MTI/LRH. Patients were randomly divided into two groups: Of the patients, 51 patients received Midazolam while 51 patients did not receive any form of sedation. The participants included 50% males and the mean age of the participants was 45 years (SD=12). Comparisons of side effects profiles and the incidences of adverse events were made between the two groups. Results : The rates of overall complications were higher in the Midazolam group where it was 10% and in no-sedation group it was 30%. The proportion of subjects with hypoxia decreased from 15% (the no-sedation group) to 5% (the Midazolam group). The relative risk of this was found to be 0. 3 indicating less occurrence of arrhythmias in the Midazolam group than in the no-sedation group; 3% in the Midazolam group while 10% in the no sedation group. The patients who used Midazolam to help them go through the procedure were also advised and confirmed that they had very little coughing and would attempt the procedure again. Further, Midazolam patients were examined to be having anterograde amnesia regarding the events that occurred during the procedure and the emergent side-effects. Conclusion : It is beneficial in preventing complications during the process of bronchoscopy, enhancing patient care, and is less uncomfortable to the patient; midazolam has an amnestics effect which in a way is good for the patient. It is recommend for use in case of complications of the procedure should occur.

Dexmedetomidine as an Ambulatory Sedation Agent for Abdominal MRI in Patients with Suspected Pheochromocytoma

Background: Pheochromocytoma is a vascular tumor of chromaffin tissue, most commonly at the adrenal medulla, that produces and secretes norepinephrine and epinephrine and is a tumor that secretes catecholamines. Magnetic resonance imaging (MRI) is often used to provide clinical data and remains challenging in pediatrics. We present anesthesia management for abdominal MRI in pediatric patients with suspected pheochromocytoma. Case: A 12-year-old child weighing 25 kg with a diagnosis of suspected pheochromocytoma will have an abdominal MRI for diagnosis with sedation. Intravenous sedation technique using dexmedetomidine loading dose 50 μg for 10 minutes and continued maintenance of dexmedetomidine dose 17.5 μg/hour. Durante's MRI showed stable hemodynamics. Post-MRI of the abdomen, monitoring, and evaluation were carried out in the conscious recovery room and found no complications. Conclusion: The use of dexmedetomidine as a sedation agent in patients with suspected pheochromocytoma generally shows stable hemodynamics in the absence of signs of catecholamine spikes.

Dental Management of a Child with Hunter’s Syndrome and Hydrocephalus: A Case Report

Mucopolysaccharidosis (MPS) type II, or Hunter’s syndrome, is an X-linked recessive disorder with a defect in Glycosaminoglycan (GAG) metabolism resulting in a deficiency of the enzyme Iduronate sulfatase. Hydrocephalus (HC) is a condition in which the volume of Cerebrospinal Fluid (CSF) in the cerebral ventricles is abnormally elevated. HC patients may show macrocephaly and delayed development. A Ventriculoperitoneal (VP) shunt is the most commonly used treatment option. Hereby, the authors present a case report of a nine-year-old male child diagnosed with Hunter’s syndrome and HC. The manuscript provides a comprehensive overview of the dental management strategies involving a team of specialists, including a paediatric dentist and a paediatrician. Key interventions included emphasising assessment of oral health issues related to the syndrome and condition, modification of treatment plans like implementation of a tailored oral hygiene regimen and fluoride treatments, use of sedative techniques to manage anxiety and facilitate thorough dental work, regular follow-up appointments to monitor oral health and accommodate the child’s physical and developmental needs, preventive care, modified treatment techniques, and close monitoring of systemic health. Effective dental management of patients with HC and Hunter’s Syndrome requires a comprehensive, multidisciplinary approach. Tailoring dental care to accommodate the unique needs of these patients can lead to successful outcomes and improved quality of life. This case underscores the importance of collaboration between dental and medical professionals in managing complex cases.

Dental Sedation with Propofol-based Target Controlled Infusions: Changing Sedation Patterns and Our Current Approach after 2800 Office-based Procedures

We describe the changing patterns of our office-based dental sedation technique over the past 5 years, based on the cumulative experience gained from treating 2800 patients. We also report the changing rate over time of minor, clinically insignificant adverse events based on a recent 652-patient audit of our office-based intravenous sedation (IVS). Our current preference, with most patients, is to administer a combination of propofol via a Target Controlled Infusion (TCI) in combination with TCI remifentanil. The rationale and reasons for this and the progressively changing doses of intravenous (IV) agents are discussed. Our office-based TCI IVS technique affords patient safety, high satisfaction rates and much faster discharge times in comparison with discharge times from mainstream hospitals. The surgeons are provided with greater scheduling flexibility plus the ability to operate in their own office with familiar staff.

Comparison of Three Intravenous Sedation Techniques Used for Extracting Mandibular Third Molars in Dental Patients

Comparison of Three Intravenous Sedation Techniques Used for Extracting Mandibular Third Molars in Dental Patients

Use of dexmedetomidine and low-dose ketamine as conscious sedation for fibreoptic bronchoscopy intubation for temporomandibular joint ankylosis secondary to an unsuspecting childhood trauma: a case report

Airway management in the paediatric population is known to be challenging due to its unique anatomical and physiological differences. Maxillofacial injuries further complicate airway management. To date, there is limited evidence to support the technique of airway management and the choice of drugs used in the paediatric population. This case report aims to describe the technique of conscious sedation using dexmedetomidine and ketamine to perform an awake fibreoptic intubation in the case of an 8-year-old boy with limited mouth opening due to a temporo-mandibular joint ankylosis secondary to childhood trauma. The endpoint of this case report showed that this technique proved effective with a good margin of safety in this paediatric patient with an airway concern. Further studies are needed to validate this observation.

Clinical application of esketamine-induced mild sedation technique in outpatient oral surgery

Background &amp; Objective: Sedation is often required in outpatient surgical procedures, performed under local analgesia, to allay the anxiety of the patient, which may lead to involuntary movements of the patient, thus interfering in the smooth course of the surgery. Various sedative drugs have been used by the anesthetists. We compared the effects of mild sedation techniques induced by remifentanil combined with propofol and esketamine combined with propofol on the cardiopulmonary indices of intraoperative patients, and to explore the application of mild sedation techniques in oral outpatient surgery. Methodology: A total of 62 patients undergoing oral surgery were randomly divided into a control group (31 cases, receiving remifentanil combined with propofol) and an observation group (31 cases, receiving esketamine combined with propofol). The vital signs of the patients were monitored at five time points: admission (T0), anesthesia induction (T1), local anesthesia (T2), the beginning of surgery (T3), and the end of surgery (T4), including heart rate (HR), mean arterial pressure(MAP), bispectral index (BIS), respiratory rate, and oxygen saturation(SPO2). Postoperative memory of each step was recorded, and the sedative effect was evaluated by physician and patient using the visual analogue scale (VAS). Results: During surgery, 6 patients in the control group had SpO2 &lt; 90%, and 8 patients experienced coughing or tongue fall, while 1 patient in the observation group had a transient increase in blood pressure. After intravenous administration, all patients had a decrease in HR, and the decrease in the observation group was significantly less than that in the control group (P &lt; 0.05). The BIS values in the observation group were significantly higher than those in the control group during T2 and T3. Conclusion: In oral outpatient surgery, the combination of propofol and esketamine-induced mild sedation can stabilize the hemodynamic indices of patients during surgery, reduce the incidence of complications, and improve patient satisfaction. Abbreviations: BIS- Bispectral Index; HR- Heart Rate; RASS- Richmond Agitation-Sedation Scale; SBP- Systolic Blood Pressure; VAS- Visual Analogue Scale Key words: Mild Sedation; Esketamine; Propofol; Remifentanil; Oral Surgery Citation: Xin Z, Yu T, Wang LL, Qu W, Wang N, Yao M. Clinical application of esketamine-induced mild sedation technique in outpatient oral surgery. Anaesth. pain intensive care 2022;27(6):715−720; DOI: 10.35975/apic.v27i6.2234 Received: May 28, 2023; Revised: October 24, 2023; Accepted: November 08, 2023

The effect of mindfulness meditation on dental anxiety during implant surgery: a randomized controlled clinical trial

Dental implant surgery is almost always associated with patient anxiety. Anxiety during dental surgical procedures triggers an increase in sympathetic activity. Mindfulness meditation (MM) is often associated with high levels of relaxation in the form of increased parasympathetic tone and decreased sympathetic activity. However, the effect of MM on dental anxiety is not clear. The current study aimed to show the effects of a MM as a sedative technique during dental implant surgery by examining the State-Trait Anxiety Inventory (STAI-S), bispectral index (BIS), cortisol levels (CL), systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR) and saturation (SpO2) parameters. HR, SBP, DBP, SpO2, BIS score and CLs were compared at the baseline, immediately before-, during-, and immediately after surgery between the test and control groups. We found that the MM resulted in significant decrease in BIS together with positive effects on hemodynamic parameters (decrease of HR, SBP, DBP and increase of SpO2), psychological findings (improvement on STAI-S scores) and biochemical outcomes (decreased CL). In conclusion, the results demonstrate that MM appeared to be a reliable strategy for managing stress during dental implant operation with benefits in psychological, physiological and biochemical outcomes.

Korean clinical practice guidelines for diagnostic and procedural sedation.

Safe and effective sedation depends on various factors, such as the choice of sedatives, sedation techniques used, experience of the sedation provider, degree of sedation-related education and training, equipment and healthcare worker availability, the patient's underlying diseases, and the procedure being performed. The purpose of these evidence-based multidisciplinary clinical practice guidelines is to ensure the safety and efficacy of sedation, thereby contributing to patient safety and ultimately improving public health. These clinical practice guidelines comprise 15 key questions covering various topics related to the following: the sedation providers; medications and equipment available; appropriate patient selection; anesthesiologist referrals for high-risk patients; pre-sedation fasting; comparison of representative drugs used in adult and pediatric patients; respiratory system, cardiovascular system, and sedation depth monitoring during sedation; management of respiratory complications during pediatric sedation; and discharge criteria. The recommendations in these clinical practice guidelines were systematically developed to assist providers and patients in sedation-related decision making for diagnostic and therapeutic examinations or procedures. Depending on the characteristics of primary, secondary, and tertiary care institutions as well as the clinical needs and limitations, sedation providers at each medical institution may choose to apply the recommendations as they are, modify them appropriately, or reject them completely.

The role of anxiety in patients with hereditary angioedema during oral treatment: a narrative review.

The present study investigated the clinical potential of managing anxiety during dental procedures to reduce acute attacks in patients with hereditary angioedema (HAE). HAE is a rare disease, little known to physicians and dentists, but with an increased hospitalization rate over the years. HAE is due to a deficiency/dysfunction of the C1 esterase inhibitor, leading to increased vascular permeability. Recommendations for HAE management include long-term and short-term prophylaxis and treatment of acute attacks, but the importance of anxiety control is underestimated. The authors reviewed the literature to provide the scientific community with an overview of possible protocols for managing anxiety in dental practice and their effectiveness. Management can be used in prosthetics, periodontal and implant surgery, endodontics, and oral surgery. Our analysis shows that although there are few articles in the indexed literature, protocols for managing anxiety in HAE patients in dentistry will become increasingly prevalent in the daily clinical practice of dentists due to its benefits. The benefits and better control of intraoperative complications and risks may lead clinicians to use sedation, assessment, or anxiety control techniques in daily clinical practice to reduce such attacks. Clinical relevance: This study suggests that controlling and managing anxiety can help prevent and reduce acute angioedema attacks.

Comparison between Effects of Propofol and Dexmedetomidine as Sedative in Elective Caesarean Section under Subarachnoid Anaesthesia

Background: The use of spinal (subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery. Objective: This study was undertaken to compare propofol and dexmedetomidine in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal anaesthesia. Methodology: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I patients undergoing elective Caesarean sections under Subarachnoid anaesthesia during the period January 2022 to June 2022. Patients were randomly allocated to one of two groups designated as Propofol group (Group A, n=30), who received Propofol in a single dose of 0.5mg/kg and Dexmedetomidine group (Group B, n=30), who received Dexmedetomidine in a single dose of 2mcg/kg. The onset of sedation i.e. time from iv (intravenous) injection of propofol or dexmedetomidine to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 (patient is awake clinically) were noted. Any complication during operation was documented. Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups in different time intervals (P&gt;0.05). Time of onset of sedation was significantly delayed in Dexmedetomidine group (P&lt;0.05). The arousal time i.e. duration of sedation was significantly longer with Dexmedetomidine than Propofol (P&lt;0.05). Propofol was associated with significantly higher incidence of some adverse effects like pain in arm during drug administration than Dexmedetomidine (46.66% vs 10.0%, P&lt;0.05). Significant percentage of patients was satisfied with dexmedetomidine than propofol (86.66% vs 13.33%, P&lt;0.001). Conclusion: Duration of sedation is significantly longer with dexmedetomidine than propofol which is beneficial for the patient in single dose technique for sedation. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):65-70

Dexmedetomidine versus Fentanyl as Adjuvant to Propofol Total Intravenous Anesthesia during Endoscopic Retrograde Cholangial-Pancreatography Procedure

Abstract Background Various types of sedation and analgesia technique have been used during endoscopy procedures. Providing an adequate regimen of sedation/analgesia might be considered an art, influencing several aspects of endoscopic procedures: the quality of examination, the patient’s cooperation and the patient and physician’s satisfaction with sedation Objective To compare the effects of Dexmedetomidine/Propofol and Fentanyl/Propofol combination for conscious sedation in patients undergoing ERCP regarding hemodynamic changes, patients and endoscopists satisfaction. Patients and Methods Ninety four (94) ages 18-70 ASA ı-ıı were enrolled in this study. Patients were allocated randomly into two equal groups D/P and F/P groups. Patients received either Fentanyl 1 µg/kg or Dexmedetomidine 1 µg/kg for 10 min, followed by maintenance dose 0.2 µg to 0.5 µg/kg/min. combined with propofol 1 mg/kg IV and maintenance 3 mg/kg/h regimen. With requiring additional dose if sedation level did not reached. Conduct open airway technique was used while applying o through nasal cannula 3 L/min. (MAP, HR and SPO) were recorded before and after sedation procedures then every 10 min. till the end of procedure, recovery time, postoperative complications, patients and endoscopists were recorded. Results the intra procedure HR, and BP showed statistical significant differences between both groups throughout the procedure with lower value in group D/P (p = 0.042) while there were no statistical significance differences regarding MAP and SPO. During postoperative procedure BP and MAP was statistical significant lower in D/P group (p = 0.015). Post procedure recovery time was shorter in group D/P (p = 0.049), regarding PONV was higher in D/P compared to F/P (p = 0.03), both group were statistical significant satisfied. Conclusion In our study we concluded that Dexmedetomidine/ Propofol combination provided adequate sedation with hemodynamic and respiratory stability with accepted few side effects and a good satisfication scores for patients and endoscopists. It was a good competitive to standard sedative as Fentanyl/Propofol in moderate sedation during ERCP.

Mini-dose Bier's block vssystemic analgesia in distal radius fractures: a promising reduction in emergency department throughput time.

Aim: This study compared the effect of the conventional technique of procedural sedation and the mini-dose intravenous regional anesthesia (IVRA). Patients & methods: 45 patients received IVRA, and 47 received iv. ketamine. The pain score, emergency department (ED) length of stay and patients' satisfaction were compared. Results: The study revealed that not only the levels of hemodynamic parameters but also their stability, and the patient's satisfaction in the IVRA group were significantly better. The patients' pain score and ED length of stay were also significantly decreased in those who received IVRA. Conclusion: Mini-dose IVRA technique contributes to better hemodynamic stability, without prominent adverse events, and leads to significant pain control and improved ED throughput time. Clinical Trial Registration: NCT03349216 (ClinicalTrials.gov).

Comparison between Effects of Fentanyl and Dexmedetomidine as Sedative in Elective Caesarean Section Under Subarachnoid Anaesthesia

Background: Regional anaesthesia has become an important anaesthetic technique now a days. The use of spinal (Subarachnoid) anaesthesia is often limited by the unwillingness of patients to remain awake during surgery. Pharmacologically induced tranquility improves acceptance of regional technique. This study compares Fentanyl and Dexmedetomidine in terms of onset and recovery of sedation, haemodynamic effects, respiratory effects and adverse effects of both the drugs during elective Caesarian section under spinal anaesthesia.&#x0D; Materials and methods: This randomized clinical trial included 60 ASA (American Society of Anaesthesiologists) grade I patients between age 20-40 years undergoing elective caesarean sections under subarachnoid anaesthesia during the period January 2022 to June 2022.Patients were randomly allocated to one of two groups: Fentanyl group (Group F, n=30), who received Fentanyl in a single dose of 0.5mcg/kg and Dexmedetomidine group (Group D, n=30), who received Dexmedetomidine in a single dose of 2mcg/kg. Spinal anaesthesia was conducted by injecting a hyperbaric solution of 0.5% bupivacaine 3ml through a 25G spinal needle at L3-4 level. All parameters were documented at 5 min intervals until arousal of the patient. The onset of sedation i.e. time from iv (Intravenous) injection of Fentanyl or Dexmedetomidine to closure of eye lids (OAA/S score of 3) and the arousal time from sedation i.e. time from closing of the eye lids to OAA/S score of 5 (Patient is awake clinically) were noted. Any complication during operation was documented. The patient’s satisfaction with the sedation was assessed by the 5 point ‘Likert verbal rating scale.’&#x0D; Results: There was no significant difference of mean blood pressure and mean heart rate between the two groups in different time intervals (p&gt;0.05). Time of onset of sedation was comparable between Fentanyl and Dexmedetomidine (p value 0.210). The arousal time i.e. duration of sedation was significantly longer with Dexmedetomidine than Fentanyl (p&lt;0.05). Fentanyl was associated with significantly higher incidence of some adverse effects like nausea, vomiting than Dexmedetomidine (46.66% vs 13.33%, p&lt;0.05). Significant percentage of patients was satisfied with Dexmedetomidine than Fentanyl (86.66% vs 20%,p&lt;0.001).&#x0D; Conclusion: The study showed that the arousal time i.e. duration of sedation was significantly longer with Dexmedetomidine which is beneficial for the patient in single dose technique for sedation. Moreover, Fentanyl was associated with high incidence of some adverse effects like nausea, vomiting. Thus it is recommended that Dexmedetomidine is a better choice than Fentanyl for sedation in single dose technique during subarachnoid block for caesarean section.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.22 (1); January 2023; Page 48-52

Bronchoscopist-Directed Continuous Flow Propofol Based Analgosedation during Flexible Interventional Bronchoscopy and EBUS.

Sedation techniques in interventional flexible bronchoscopy and endobronchial ultrasound-guided transbronchial-needle aspiration (EBUS-TBNA) are inconsistent and the evidence for required general anesthesia under full anesthesiologic involvement is scarce. Moreover, we faced the challenge of providing bronchoscopic care with limited personnel. Hence, we retrospectively identified 513 patients that underwent flexible interventional bronchoscopy and/or EBUS-TBNA out of our institution between January 2020 and August 2022 to evaluate our deep analgosedation approach based on pethidine/meperidine bolus plus continuous flow adjusted propofol, the bronchoscopist-directed continuous flow propofol based analgosedation (BDcfP) in a two-personnel setting. Consequently, 502 out of 513 patients received BDcfP for analgosedation. We identified cardiovascular comorbidities, chronic obstructive pulmonary disease, and arterial hypertension as risk factors for periprocedural hypotension. Propofol flow rate did not correlate with hypotension. Theodrenaline and cafedrine might be used to treat periprocedural hypotension. Moreover, midazolam might be used to support the sedative effect. In conclusion, BDcfP is a safe and feasible sedative approach during interventional flexible bronchoscopy and EBUS-TBNA. In general, after the implementation of safety measures, EBUS-TBNA and interventional flexible bronchoscopy via BDcfP might safely be performed even with limited personnel.

Effectiveness and safety of dentist-led conscious sedation using fentanyl with midazolam in dentistry: a five-year retrospective service evaluation.

Background Fentanyl provides systemic analgesia and enhances the sedative effect of benzodiazepines. When midazolam-only sedation is ineffective, fentanyl can be considered as an adjunct, but this advanced sedation technique requires additional training. Studies reporting on the safety and effectiveness of dentist-led conscious sedation using fentanyl and midazolam are lacking.Aims To review the indication of use, safety and effectiveness of fentanyl and midazolam sedation at The Royal London Dental Hospital since its introduction into the service.Method Retrospective data collection of sedation cases from October 2016 to October 2021 was carried out.Results Of the 109 cases included, the majority of patients who had fentanyl (90.8%) had a history of unsuccessful sedation with midazolam. A lower average dose of midazolam was administered when fentanyl was used; the difference was statistically significant (p <0.0001). A higher proportion of patients who had fentanyl and midazolam presented with lower Ellis scores (better operating condition) compared to midazolam-only sedation. No adverse incidents were recorded.Conclusion In this evaluation, the synergistic effects of fentanyl and midazolam resulted in enhanced sedation, anxiolysis and intraoperative conditions. This service evaluation showed some encouraging data regarding the potential safety profile and effectiveness of fentanyl in dental sedation when used by experienced clinicians; however, larger scale studies are required to validate this.

Adjuvant therapies in head and neck cancer treatment and sedative techniques: a narrative review

Adjuvant therapies in head and neck cancer treatment and sedative techniques: a narrative review