Use Of Sedation Research Articles

Remimazolam Pilot for Office-Based Dental Sedation: Adverse Events, Awareness and Outcomes

In recent years, remimazolam has gained approval for use in adult procedural sedation in both the United Kingdom and the United States, potentially offering an alternative to conventional sedatives like propofol and midazolam for procedural sedation. However, there is a limited body of literature that systematically reviews the outcomes of a remimazolam-alfentanil combination protocol for routine office-based dental procedures. The primary objective of this pilot study was to assess the occurrence of significant adverse events associated with the use of a remimazolam-alfentanil sedation protocol for adult dental procedures. Secondary outcomes included evaluating physiological responses, sedation effectiveness, patient and clinician satisfaction and the incidence of intraprocedural awareness. Notably, no significant adverse events were reported among the 25 adult subjects who received remimazolam and alfentanil, and all dental procedures were successfully completed. Patients and clinicians expressed high levels of satisfaction, and patients did not report any distressing memories associated with the dental procedure. These findings suggest that in a limited cohort, the remimazolam-alfentanil regimen appears to be well tolerated and effective for office-based dental procedures in adult patients, with a low risk of adverse events, acceptable hemodynamic effects, rapid onset and recovery and minimal intraoperative awareness. This study provides valuable insights into the potential use of the remimazolam-alfentanil combination in dental sedation practice.

Patterns of Polydrug Use Classes Among a Subset of Latino Male Seasonal Workers in South Florida: A Latent Class Analysis

ABSTRACT Background Little is known about polydrug use among Latino seasonal farmworkers. This cross-sectional study with male Latino seasonal workers (LSWs) living in South Florida categorized distinct classes of drug use and then characterized each drug use typology by demographic, structural, and psychological factors. Methods One hundred and twenty-five male LSWs were recruited during community events using convenience sampling between July 2019-March 2020. Latent class analysis was conducted by leveraging measures of self-reported use of nine drugs in the past year (sedatives, cannabis, stimulants, heroin, opioids, cocaine, PCP, hallucinogens, and inhalants). Correlates of latent class membership were examined using 3-step categorical latent variable logistic regression. Analyses were performed using Mplus version 8 and SAS 9.4. Results Four drug use classes were identified, male LSWs who exhibited: 1) use of illegal opioids only (n = 32); 2) concurrent cannabis and cocaine use (n = 75); 3) concurrent sedative and cannabis use (n = 13); and 4) high concurrent drug use (n = 5). About 84.7% of the sample reported use of at least one drug in the past 12 months. LSWs who identified as White and were married or in a stable relationship were likely to only use illegal opioids. LSWs with less than high school education and self-reported good to excellent health were more likely to use cannabis and cocaine. Men with moderate to severe anxiety and self-reported bad health were classified as engaging in sedative and cannabis co-use. Survivors of physical abuse were more commonly classified as people using high concurrent substances relative to non-abused men among the four classes. Conclusions This pilot study suggests the presence of heterogeneity in polydrug use classes among LSWs in South Florida.

Extubation in operating room versus early extubation in ICU after open-heart surgery in patients with CHDs.

The "Fast track" protocol is an early extubation strategy to reduce ventilator-associated complications and induce early recovery after open-heart surgery. This study compared clinical outcomes between operating room extubation and ICU extubation after open-heart surgery in patients with CHD. We retrospectively reviewed 215 patients who underwent open-heart surgery for CHDs under the scheduled "Fast track" protocol between September 2016 and April 2022. The clinical endpoints were post-operative complications, including bleeding, respiratory and neurological complications, and hospital/ICU stays. The patients were divided into operating room extubation (group O, n = 124) and ICU extubation (group I, n=91) groups. The most frequently performed procedures were patch closures of the atrial septal (107/215, 49.8%) and ventricular septal (89/215, 41.4%) defects. There were no significant differences in major post-operative complications or ICU and hospital stay duration between the two groups; however, patients in group I showed longer mechanical ventilatory support (0.0 min vs. 59.0 min (interquartile range: 17.0-169.0), p < 0.001). Patients in Group O showed higher initial lactate levels (3.2 ± 1.7 mg/dL versus 2.5 ± 2.0 mg/dL, p = 0.007) and more frequently used additional sedatives and opioid analgesics (33.1% versus 19.8%, p = 0.031). Extubation in the operating room was not beneficial for patients during post-operative ICU or hospital stay. Early extubation in the ICU resulted in more stable hemodynamics in the immediate post-operative period and required less use of sedatives and analgesics.

Device-assisted enteroscopy performance measures in the United Kingdom: DEEP-UK quality improvement project.

Device-assisted enteroscopy (DAE) has become a well-established diagnostic and therapeutic tool for the management of small-bowel pathology. We aimed to evaluate the performance measures for DAE across the UK against the quality benchmarks proposed by the European Society of Gastrointestinal Endoscopy (ESGE). We retrospectively collected data on patient demographics and DAE performance measures from electronic endoscopy records of consecutive patients who underwent DAE for diagnostic and therapeutic purposes across 12 enteroscopy centers in the UK between January 2017 and December 2022. A total of 2005 DAE procedures were performed in 1663 patients (median age 60 years; 53% men). Almost all procedures (98.1%) were performed for appropriate indications. Double-balloon enteroscopy was used for most procedures (82.0%), followed by single-balloon enteroscopy (17.2%) and spiral enteroscopy (0.7%). The estimated depth of insertion was documented in 73.4% of procedures. The overall diagnostic yield was 70.0%. Therapeutic interventions were performed in 42.6% of procedures, with a success rate of 96.6%. Overall, 78.0% of detected lesions were marked with a tattoo. Patient comfort was significantly better with the use of deep sedation compared with conscious sedation (99.7% vs. 68.5%; P<0.001). Major adverse events occurred in only 0.6% of procedures. Performance measures for DAE in the UK meet the ESGE quality benchmarks, with high diagnostic and therapeutic yields, and a low incidence of major adverse events. However, there is room for improvement in optimizing sedation practices, standardizing the depth of insertion documentation, and adopting marking techniques to aid in the follow-up of detected lesions.

The effectiveness of a telephone smoking cessation program in mental health clinic patients by level of mental well-being and functioning: a secondary data analysis of a randomized clinical trial

BackgroundFew studies have examined the effectiveness of telephone smoking cessation interventions by severity of behavioral health symptoms. Using data from a telephone counseling study, we examined whether abstinence rates varied by level of behavioral health symptoms.MethodsThe parent study recruited adults who smoke cigarettes (N = 577) referred by mental health providers at six Veterans Health Administration facilities. Participants were randomized to specialized telephone counseling (intervention) or state Quitline referral (control). Participants completed assessments at baseline and 6 months, including the BASIS-24, a self-report measure of behavioral health symptoms and functioning. We used the BASIS-24 median to dichotomize participants as having high or low scores. The primary outcome was 30-day self-reported abstinence at 6 months. We compared groups on outcomes by logistic regression and performed an interaction effect analysis between treatment assignment and groups.ResultsAt baseline, those with high behavioral health symptoms scores reported heavier nicotine dependence and more sedative and/or antidepressant use, compared to participants with low behavioral health symptoms. At 6 months, participants with low behavioral health symptoms scores in the intervention reported higher rates of 30-day abstinence compared to those in the control arm (26% vs 13%, OR = 2.3, 95% CI = 1.8, 2.9). People with high behavioral health symptoms scores reported no difference in 30-day abstinence between the treatment assignments at 6 months (12% vs. 13%, OR = 1.1, 95% CI = 0.6, 2.0).ConclusionsOnly participants with low behavioral health symptoms scores reported higher abstinence rates in the intervention compared to the state Quitline. Future research can examine alternative approaches for people with worse mental well-being and functioning.Trial registrationThe parent study is registered at www.clinicaltrials.gov NCT00724308.

Polysubstance use and post-discharge mortality risk among hospitalized patients with opioid use disorder

Polysubstance use is becoming increasingly common and presents several harms. This study aimed to examine the association of comorbid cocaine, alcohol (binge drinking), and sedative use with mortality among hospitalized patients with opioid use disorder (OUD).A subsample of adult medical/surgical hospital patients with OUD who were seen by a hospital addiction consultation service in Baltimore City and enrolled in a randomized trial of a patient navigation intervention were included in this study (N = 314; 45 % female; 48 % White; mean age = 44). Death certificate data from the Maryland Division of Vital Records was used, covering 3.3–5.5 years post-discharge. Multivariable proportional hazards Cox regression and competing risks regression were used to estimate all-cause mortality and overdose mortality, respectively, as a function of concurrent use of cocaine, alcohol (binge drinking), and non-prescribed sedatives at baseline.In the 30 days prior to hospital admission, 230 (73 %) participants used cocaine, 64 (20 %) binge drank, and 45 (14 %) used non-prescribed sedatives. Nearly one-third (N = 98; 31 %) died during the observation period. Drug overdose caused 53 % (N = 52) of deaths. Older age (HR = 1.03 [1.01,1.05]; P = 0.001), less than high school education (HR = 0.36 [0.24,0.54]; P < 0.001), and past 30-day sedative use (HR = 2.05 [1.20,3.50]; P = 0.008) were significantly associated with all-cause mortality. The risk of overdose mortality was 62 % lower (HR = 0.38 [0.22,0.66]; P = 0.001) for those who completed high school. No other characteristics were significantly associated with overdose mortality.The concurrent use of opioids and sedatives increases the post-discharge mortality risk among hospitalized patients with OUD. Interventions are needed to prevent mortality among this high-risk population.

Sexual dysfunction in Wilson disease: Prevalence and influencing factors

Wilson disease is a rare neurogenetic disorder that receives significant attention due to its manifestations, such as jaundice, cirrhosis, tremor, dystonia, and others. However, the impact of Wilson disease on sexual function has been overlooked. In this study, we aimed to investigate current status of sexual dysfunction in Wilson disease. In this study, we investigated the sexual function status and possible influencing factors of 245 Wilson disease patients by questionnaire. Our study identified sexual dysfunction as a prevalent issue in Wilson disease patients, with an overall prevalence of 49.0 %, of which 33.9 % in males and 63.7 % in females, both higher than the prevalence of sexual dysfunction in the normal Chinese population. Compared with non-sexual dysfunction patients, sexual dysfunction was more common in the older age group, females, less educated, rural residence, no occupation, lower income, taking sedatives/antipsychotics, and high SIS scores (P < 0.05). Our binary logistic regression analysis revealed that older age (OR: 1.103, 95 %CI: 1.058–1.151, P < 0.001), being female (OR: 5.900,95 %CI: 2.966–11.736, P < 0.001), and the use of antipsychotics or sedatives (OR: 3.277,95 %CI: 1.065–10.077, P < 0.05) were all positively linked with an increased risk of sexual dysfunction. Despite the well-known symptoms of Wilson disease, sexual dysfunction is also a frequent issue in Wilson disease patients, necessitating further attention.

Pengaruh Pemberian Aromaterapi Lemon dan Minuman Jahe Terhadap Pengurangan Emesis Gravidarum pada Ibu Hamil Trimester I

Emesis gravidarum, or excessive nausea and vomiting during early pregnancy, is a common issue frequently experienced by pregnant women. Most cases of pregnancy-related nausea and vomiting can be managed through outpatient care and the use of sedatives and anti-emetics. However, the treatment of hyperemesis gravidarum, a more severe form of pregnancy-related nausea and vomiting, can be approached both pharmacologically and non-pharmacologically. One non-pharmacological approach involves the use of aromatherapy with lemon essential oil and the consumption of ginger-infused beverages. This study aims to analyze the effects of lemon aromatherapy and ginger beverage consumption on reducing emesis gravidarum symptoms in first-trimester pregnant women at the Kaubun Health Center. The research employs a Pretest-Posttest without Control Group design, with a sample of 30 first-trimester pregnant respondents. Statistical analysis using the Wilcoxon test reveals a significant difference in the reduction of emesis gravidarum symptoms between the group receiving lemon aromatherapy and the group consuming ginger beverages, with a p-value of 0.001. Based on these findings, it can be concluded that the administration of lemon aromatherapy and ginger beverage consumption has a positive impact on reducing emesis gravidarum symptoms in first-trimester pregnant women. This non-pharmacological approach can be an effective alternative for managing emesis gravidarum during early pregnancy.

Efficacy of haloperidol to decrease the burden of delirium in adult critically ill patients: the EuRIDICE randomized clinical trial

BackgroundThe role of haloperidol as treatment for ICU delirium and related symptoms remains controversial despite two recent large controlled trials evaluating its efficacy and safety. We sought to determine whether haloperidol when compared to placebo in critically ill adults with delirium reduces days with delirium and coma and improves delirium-related sequelae.MethodsThis multi-center double-blind, placebo-controlled randomized trial at eight mixed medical-surgical Dutch ICUs included critically ill adults with delirium (Intensive Care Delirium Screening Checklist ≥ 4 or a positive Confusion Assessment Method for the ICU) admitted between February 2018 and January 2020. Patients were randomized to intravenous haloperidol 2.5 mg or placebo every 8 h, titrated up to 5 mg every 8 h if delirium persisted until ICU discharge or up to 14 days. The primary outcome was ICU delirium- and coma-free days (DCFDs) within 14 days after randomization. Predefined secondary outcomes included the protocolized use of sedatives for agitation and related behaviors, patient-initiated extubation and invasive device removal, adverse drug associated events, mechanical ventilation, ICU length of stay, 28-day mortality, and long-term outcomes up to 1-year after randomization.ResultsThe trial was terminated prematurely for primary endpoint futility on DSMB advice after enrolment of 132 (65 haloperidol; 67 placebo) patients [mean age 64 (15) years, APACHE IV score 73.1 (33.9), male 68%]. Haloperidol did not increase DCFDs (adjusted RR 0.98 [95% CI 0.73–1.31], p = 0.87). Patients treated with haloperidol (vs. placebo) were less likely to receive benzodiazepines (adjusted OR 0.41 [95% CI 0.18–0.89], p = 0.02). Effect measures of other secondary outcomes related to agitation (use of open label haloperidol [OR 0.43 (95% CI 0.12–1.56)] and other antipsychotics [OR 0.63 (95% CI 0.29–1.32)], self-extubation or invasive device removal [OR 0.70 (95% CI 0.22–2.18)]) appeared consistently more favorable with haloperidol, but the confidence interval also included harm. Adverse drug events were not different. Long-term secondary outcomes (e.g., ICU recall and quality of life) warrant further study.ConclusionsHaloperidol does not reduce delirium in critically ill delirious adults. However, it may reduce rescue medication requirements and agitation-related events in delirious ICU patients warranting further evaluation.Trial registration: ClinicalTrials.gov (#NCT03628391), October 9, 2017.

A review of biological agents and small molecules in the management of atopic dermatitis

Atopic dermatitis (AD) is a recurrent, chronic, and non-infectious inflammatory dermatoses characterized by persistent itching of the skin. It has multifactorial causes characterized by a tetrad of a (i) genetic predisposition, (ii) disturbed epidermal barrier, (iii) immune dysregulation, and (iv) deranged skin microbiome. At present, treatment is aimed at maintaining the epidermal barrier function by the use of emollients, sedative, and non-sedative antihistamines targeting the itch pathway, immunosuppressants in the form of steroids as well as steroid sparing agents to control the chronic persistent inflammatory response. However, newer emerging therapy in the form of biologics gives a promising approach to control the chronic, persistent inflammatory response by targeting the specific cytokines involved in pathogenesis of AD.

Obstructive Sleep Apnea in Adults and Ear, Nose, and Throat (ENT) Health: A Narrative Review.

Obstructive sleep apnea (OSA), a form of sleep-disordered breathing, is a significant health concern that leads to substantial morbidity. The collapse or occlusion of the upper airway, which results in reduced or cessation of airflow, is the pathophysiology of sleep apnea. The condition has been attributed to numerous cardiovascular, metabolic, and neuropsychological issues and carries serious health concerns. The ensuing intermittent hypoxia and sleep disruption set off a chain of physiological reactions that aid in developing endothelial dysfunction, systemic inflammation, and oxidative stress. The following line of treatment depends on the appropriate diagnosis of sleep apnea and the underlying cause. The gold standard for diagnosis is polysomnography (PSG), which assesses different physiological parameters during sleep. However, because polysomnography is expensive, patients may use more friendly screening and diagnostic testing kits, like home sleep apnea testing. The clinical symptoms and head and neck history may reveal essential risk factors. The primary objectives of management treatments for sleep apnea are to lessen symptoms, enhance sleep quality, and reduce any health concerns that may be present. It is advised to start with lifestyle changes such as quitting alcohol and sedative use, losing weight, and exercising frequently. The primary treatment for moderate to severe sleep apnea is continuous positive airway pressure (CPAP) therapy, which includes administering pressurized air to keep the airway open while you sleep. Oral appliances, positional therapy, surgery, and complementary therapies are other treatment choices that can be adapted to each patient's needs and preferences. The goal of the review is to evaluate the morphological and functional aspects of the upper airway, including the nose and throat, that influence the onset and severity of OSA. With a focus on the interaction between otorhinolaryngologists, sleep medicine specialists, and other healthcare professionals, we aim to consider how OSA affects otorhinolaryngology-related medical issues, look at any potential reciprocal relationships, and provide a summary of the interdisciplinary management strategy for OSA. We tried to analyse the various surgical and non-surgical therapy options for OSA management available in the otorhinolaryngology field for improving OSA symptoms and results.

IMPORTANCE OF KNOWLEDGE ABOUT CONDUCT, CARE AND PREVENTION IN DENTAL TREATMENT IN PATIENTS WITH DOWN SYNDROME: a literature review

Down Syndrome, also known as Trisomy 21, was recognized in 1866 and proven in 1958. Down Syndrome is characterized by incorrect chromosomal distribution, with 3 main chromosomal changes possible: Simple or standard trisomy. Translocation or Mosaicism. It is estimated that the incidence of Down Syndrome is 3% of the world population. Being one of the main causes of intellectual disability, patients with DS also have similar physical characteristics, in addition to the common presence of systemic changes and changes in the oral cavity. Dental care in patients with DS must be early, thus avoiding the worsening of oral changes. During dental care, it is extremely important that the dentist uses techniques that facilitate treatment, offering greater comfort for the patient. Techniques similar to those used in pediatric dentistry can be used. In addition to these techniques, other means can be used, such as, in more extreme cases, general anesthesia, which is not recommended for these syndromic patients due to some physical changes that generally make orotracheal intubation difficult; the use of conscious sedation through the administration of benzodiazepines or the inhalation of nitrous oxide gas, being considered a good resource, making it possizle to carry out simpler procedures such as prophylaxis to less complex surgeries.

Effects of aromatherapy on patient satisfaction with procedural abortion at less than 10 weeks’ gestation: A randomized controlled trial

ObjectivesThis study aimed to compare satisfaction with procedural abortion prior to 10 weeks’ gestation in patients randomized to lavender essential oil aromatherapy vs placebo (jojoba oil). Study designThis randomized trial compared lavender aromatherapy vs placebo in patients undergoing procedural abortion <10 weeks’ gestation. Participants self-administered and inhaled oil during their procedures. Our primary outcome was composite mean score on the Iowa Satisfaction with Anesthesia Scale. Participants completed the State-Trait Anxiety Inventory, a visual analog scale reporting maximum procedural pain, and reported postprocedure aromatherapy acceptability. ResultsWe analyzed 112 participants randomized to aromatherapy (n = 57) vs placebo (n = 55). Baseline characteristics were similar between groups. We found no difference in overall satisfaction (mean Iowa Satisfaction with Anesthesia Scale scores aromatherapy: 0.72 ± 0.96 vs placebo: 0.46 ± 0.98, p = 0.17) or maximum procedural pain (median visual analog scale score aromatherapy: 65 [range: 4–95] vs placebo: 63 [range: 7–97], p = 0.91). Independent predictors of satisfaction included the use of oral sedation (B: 0.36; 95% CI: 0.04–0.69), state anxiety (B: −0.45; 95% CI: −0.79 to −0.10), and maximum procedural pain (B: −0.17; 95% CI: −0.25 to −0.09). The aromatherapy participants were significantly more likely to have found inhaling scented oil helpful during their procedure (71.9% vs 45.5%; p = 0.005) and would recommend it to a friend who needed a procedural abortion (86.0% vs 56.4%; p = 0.0005) compared to those in the placebo group. Additionally, patients in the aromatherapy group were significantly more likely to agree with the statement, “If I need another procedural abortion, I would want to inhale scented oil during my procedure” (87.7% vs 70.9%; p = 0.03). ConclusionsThe adjunctive use of lavender aromatherapy during first-trimester procedural abortion does not improve satisfaction with anesthesia but is highly valued by patients. ImplicationsOral opioids as an adjunct to standard analgesics during procedural abortion (ibuprofen and paracervical block) do not decrease pain, and nonopioid options are lacking. Given current limited anesthesia options, aromatherapy could serve as an affordable and acceptable nonopioid adjunct to current standard of care during procedural abortion. ClinicalTrials.gov IdentifierNCT04969900.

PHARMACEUTICAL CARE IS AN IMPORTANT COMPONENT OF THE RATIONAL USE OF SEDATIVE DRUGS

Backround. Stress is one of the most urgent problems of modern society, which determines the increase in the consumption of sedative drugs.&#x0D; Aim: to analyze the role of pharmaceutical care in ensuring the rational use of sedatives.&#x0D; Materials and methods. 124 pharmacists and 101 pharmacy visitors were surveyed. The work used methods: standardization, sociological survey, graphics, and statistics.&#x0D; Results. It was found that almost 80% of respondents reported sleep disorders and anxiety, while only 27% sought help from a specialist. More than 90% of pharmacists confirmed that since the beginning of the military invasion, the number of requests from visitors to dispense sedative drugs, mostly without a doctor's prescription, has increased significantly. Thus, almost 40% of respondents used self-prescription and self-medication of sedatives.&#x0D; It was found that pharmacists (90%) recommend more often, and visitors (56%) choose herbal sedatives. In addition, 70% of pharmacists noted requests from visitors to dispense the drug hidazepam without a doctor's prescription. When dispensing sedatives, more than half of the surveyed pharmacists do not use the "Symptomatic treatment of stress" protocol. Visitors to pharmacies, who mostly did not receive recommendations on the rules for the use of sedatives, noted the appearance of undesirable reactions after their use, such as drowsiness and weakness during the day (48.8%), sleep disorders (22.0%), dizziness (34.1 %), development of addiction (22.0%).&#x0D; Conclusion. Providing high-quality pharmaceutical care is a prerequisite for effective and safe sedative therapy. At the same time, it is important to conduct thematic improvement for pharmacists in psychopharmacology.

Clasificación de gravedad y variables de influencia del síndrome poscuidado intensivo

ObjectiveThe study aims to characterize postintensive care syndrome by classifying the severity of the disease and identifying the variables of influence in 2 highly complex intensive care units for adults in Colombia. MethodA descriptive, cross-sectional, prospective study was carried out to characterize survivors of critical illness using the Healthy Aging Brain Care–Monitor in a sample of 135 patients. Postintensive care syndrome severity was classified using Gaussian mixture models for clustering, and the most influencing variables were identified through ordinal logistic regression. ResultsClustering based on Gaussian mixture models allowed the classification of postintensive care syndrome severity into mild, moderate, and severe classes, with an Akaike information criterion of 308 and an area under the curve of 0.80, which indicates a good fit; thus, the mild class was characterized by a score on the HABC-M Total scale≤9; the moderate class for a HABC-M Total score≥10 and≤42 and the severe class for a HABC-M Total score≥43. Regarding the most influencing variables, the probability of belonging to the moderate or severe classes was related to male sex (91%), APACHE II score (22.5%), age (13%), intensive care units days of stay (10.6%), the use of sedation, analgesia and neuromuscular blockers. ConclusionIntensive care units survivors were characterized using the HABC-M scale, which made it possible to classify postintensive care syndrome through Gaussian mixture models clustering into mild, moderate, and severe, and to identify variables that had the major influence on the presentation of postintensive care syndrome.

Analysis of the Use of Non-Invasive Lung Ventilation Support in Newborns and Young Children after Cardiac Surgery

Background. Non-invasive ventilatory support for artificial lung ventilation (ALV) in infants with congenital heart disease after cardiac surgery helps to reduce the duration of invasive ALV, reduce the number of mechanical and infectious complications, and reduce or eliminate the need for sedation.&#x0D; The aim. To analyze the experience of using non-invasive ventilatory support after surgical correction of congenital heart disease in infants and compare its effectiveness with invasive mechanical ventilation.&#x0D; Materials and methods. We conducted a retrospective analysis of the use of non-invasive ALV and its effectiveness compared to invasive mechanical ventilation in children under 1 year of age after cardiac surgery from 2020 to 2022 at the Department of Cardiac Arrest in Newborns and Young Children of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. During this period, 134 patients were operated on (38 children under 1 month old, 96 children under 1 year old). In the postoperative period, 85 children (55.9%) needed prolonged mechanical ventilation (more than 24 hours), of which non-invasive ventilation support was used in 32 patients (37.6%) and invasive ventilation in 53 (62.3%) patients.&#x0D; Results. The patients on non-invasive ALV (n = 32) had lower weight (p = 0.23), shorter ventilation time (p = 0.56), and the time spent at the intensive care unit (p = 0.61), required less sedation (p = 0.29), and had lower mortality (p = 0.42) compared to the group of children who received only invasive ventilatory support (n = 53), but this difference was not statistically significant. The need for non-invasive ventilation was higher in 9 (28.12%) infants than in 8 (15.09%) other infants and was statistically significant (p &lt; 0.001).&#x0D; Conclusions. Our study showed that the use of non-invasive ALV can shorten the length of stay at the intensive care unit and the time spent on ventilation, reduce or avoid the use of sedation, and prevent pulmonary complications (infectious and mechanical) with long-term treatment. However, there was no significant difference between non-invasive and invasive ventilation in terms of mortality.

Safety of Magnetic Resonance Imaging in Pregnancy.

Magnetic resonance imaging is being increasingly used to diagnose and follow up avariety of medical conditions in pregnancy, both for maternal and fetal indications. However, limited data regarding its safe use in pregnancy may be asource of anxiety and avoidance for both patients and their healthcare providers. In this review, we critically discuss the main safety concerns of Magnetic Resonance Imaging (MRI) in pregnancy including energy deposition, acoustic noise, and use of contrast agents, supported by data from animal and human studies. Use of maternal sedatives and concerns related to occupational exposure in pregnant personnel are also addressed. Exposure to gadolinium-based contrast agents and sedation for MRI during pregnancy should be avoided whenever feasible.

25 Severe and Life-threatening Opioid, Stimulant, and Sedative Use in Canadian Youth: A One-time Survey of Paediatricians and Paediatric Subspecialists

Abstract Background Toxic drug supply is a public health emergency in Canada. The syndemic impact of Covid-19 has exacerbated the adverse outcomes of overdose, driving up mortality rates. Despite the fact that opioid use disorder is predominantly viewed as an adult issue, an increasing number of youth in Canada experience severe-life threatening overdose; it is the leading cause of death in youth ages 10-18 in Western Canada. Epidemiologic data related to this population remains limited. 1.Objectives: To determine the minimum incidence of children and adolescents presenting with severe or life-threatening opioid, stimulant, and sedative exposure among youth presenting to Canadian paediatricians and paediatric subspecialists. 2.To describe the treatment and services available for youth presenting with substance use to paediatric care in Canada. Design/Methods A one-time cross-sectional survey of Canadian paediatricians and paediatric subspecialists using the Canadian Paediatric Surveillance System (CPSP) was conducted in the Spring of 2022. A population denominator of 2,900,866 was selected based on Statistics Canada census data for children and youth 12-18 in 2021. Data were analyzed using Stata v15.1. Results 1027 respondents (response rate: 37%) completed the survey, of whom 934 (90.9%) reported providing care to children and youth 12 years and above. 115 (12.3%) respondents indicated managing a youth with severe or life-threatening substance use in the prior 24 months. Most providers operated in urban settings (n=95, 84.8%), but there were cases reported in suburban (n=9, 8.0%) and rural/remote (n=8, 7.1%) environments as well. Calculated minimum cumulative incidence per 100,000/year were: opioid overdose 2.94; opioid use requiring pharmacotherapy 1.69; stimulant toxicity 3.22; and sedative toxicity 3.1 (Table 1). Respondents also reported service availability for youth substance use. Respondent awareness of the availability of overdose-related services was high for outpatient mental health services (85.4% for 12 to15-year-olds, 86.1% for 16 to18-year-olds), but poor to moderate (25.3%-53.1%) for all other surveyed services, including inpatient stabilization and intensive outpatient management. Conclusion Paediatricians and paediatric subspecialists interface significantly with youth experiencing severe substance use and overdose. The minimum calculated incidence rates provided are significant and concerning at the population level, despite excluding youth that do not seek physician care after overdose. Paediatric providers have limited awareness of service availability for youth that use substances. Further studies and knowledge translation are required.

Nonpharmacological Interventions to Reduce Sedation and General Anesthesia in Pediatric MRI: A Meta-analysis.

Nonpharmacological strategies are increasingly used in pediatric procedures, but in pediatric MRI, sedation and general anesthesia are still commonly required. To evaluate the effectiveness of nonpharmacological interventions in reducing use of sedation and general anesthesia in pediatric patients undergoing MRI, and to investigate effects on scan time, image quality, and anxiety. We searched Ovid Medline, CINAHL, Embase, and CENTRAL from inception through October 10, 2022. We included randomized controlled trials and quasi-experimental designs comparing the effect of a nonpharmacological intervention with standard care on use of sedation or general anesthesia, scan time, image quality, or child and parental anxiety among infants (<2 years), children, and adolescents (2-18 years) undergoing MRI. Standardized instruments were used to extract data and assess study quality. Forty-six studies were eligible for the systematic review. Limited to studies on children and adolescents, the meta-analysis included 20 studies with 33 873 patients. Intervention versus comparator analysis showed that nonpharmacological interventions were associated with reduced need for sedation and general anesthesia in the randomized control trials (risk ratio, 0.68; 95% confidence interval, 0.48-0.95; l2 = 35%) and nonrandomized studies (risk ratio, 0.58; 95% confidence interval, 0.51-0.66; l2 = 91%). The effect was largest among children aged 3 to 10 years when compared with older children and adolescents aged 11 to 18 years. There was substantial heterogeneity among nonrandomized studies. Nonpharmacological interventions must be considered as standard procedure in infants, children, and adolescents undergoing MRI.

Use of enteral nutrition and factors influencing feeding intolerance in severely ill patients in the intensive care unit

Purpose: To investigate the use of enteral nutrition (EN) and factors influencing feeding intolerance (FI) in severely ill patients in intensive care unit (ICU).Methods: Retrospective data collection was performed on records of 247 severely ill patients admitted to ICU of the West China Hospital, Chengdu, China between January 2020 and December 2022. Data were divided into two groups: FI group (n = 107) and non-FI group (n = 140). Influencing factors of FI were analyzed by univariate and multivariate analysis, and the use of EN was analyzed.Results: Defined daily doses (DDDs) of enteral nutrition emulsion TPF-T (Ruineng), enteral nutrition suspension (Baipuli) and enteral nutrition emulsion TPF (Ruixian) were most prevalent. The DDDs of enteral nutrition suspension (Nengquanli 1.5) increased, while that of Nengquanli 1.0 decreased. Univariate analysis showed significant differences between FI and non-FI groups in start time of EN, addition of dietary fiber, Acute Physiology and Chronic Health Evaluation (APACHE) II score, use of sedatives, types of antibiotics used, use of vasoactive drugs and oral potassium preparation, mechanical ventilation and hypoalbuminemia (p &lt; 0.05). Multivariate analysis showed that addition of dietary fiber, APACHE II score ≥ 20 points, sedatives use, types of antibiotics used ≥ 2, oral potassium preparation and hypoalbuminemia were independent risk factors of FI.Conclusion: Use of EN in ICU is consistent. Factors that influence FI in critically ill patients include dietary fiber, APACHE II score, use of sedatives, use of antibiotics, use oral potassium preparations and hypoalbuminemia. Knowledge of these risk factors and timely measures are of great significance in avoiding FI in ICU.