Sedation Research Articles

Demonstrating the safety profile of ketamine as procedural conscious sedation in infants; a prospective cohort study of 904 cases

Background: Conscious sedation has both a sedative and an analgesic effect. Ketamine is an increasingly popular choice for procedural conscious sedation in a paediatric day surgery. Ketamine is also cheaper than general anaesthetic. The objective of our study is to investigate the number of adverse events when using ketamine for procedural conscious sedation and demonstrate its safety profile for use in paediatric day surgery in a community setting in infants. Methods: A single-centre, single surgeon, single procedure 5-year longitudinal prospective review of 904 infants undergoing elective day-care surgery using ketamine for procedural conscious sedation between 2016 and 2020. Patients were stratified for pre-anaesthetic co-morbidities based on the American Society of Anesthesiologists (ASA) classification system. Results: All patients were between 4 weeks and 1 year and 98.7% were ASA Class 1. Most children received ketamine intramuscularly and only one child required additional ketamine to maintain procedural conscious sedation. There were no serious adverse events and there were 27 mild adverse events in 26 patients (2.88% patients). The most common adverse event was hypersalivation, which occurred in 11 infants. Conclusions: Ketamine is a safe drug for procedural conscious sedation and should be considered more for infants undergoing elective day-care surgery provided that all staff conducting procedures have advanced training in paediatric and neonatal airway management and resuscitation.

Haemodynamic response to pre-hospital emergency anaesthesia in trauma patients within an urban helicopter emergency medical service.

Pre-hospital emergency anaesthesia is routinely used in the care of severely injured patients by pre-hospital critical care services. Anaesthesia, intubation, and positive pressure ventilation may lead to haemodynamic instability. The aim of this study was to identify the frequency of new-onset haemodynamic instability after induction in trauma patients with a standardised drug regime. A retrospective database analysis was undertaken of all adult patients treated by a physician-led urban pre-hospital care service over a 6-year period. The primary outcome measure was the frequency of new haemodynamic instability following pre-hospital emergency anaesthesia. The association of patient characteristics and drug regimes with new haemodynamic instability was also analysed. A total of 1624 patients were included. New haemodynamic instability occurred in 231 patients (17.4%). Patients where a full-dose regime was administered were less likely to experience new haemodynamic instability than those who received a modified dose regime (9.7% vs 24.8%, p < 0.001). The use of modified drug regimes became more common over the study period (p < 0.001) but there was no change in the rates of pre-existing (p = 0.22), peri-/post-anaesthetic (p = 0.36), or new haemodynamic instability (p = 0.32). New haemodynamic instability within the first 30min following pre-hospital emergency anaesthesia in trauma patients is common despite reduction of sedative drug doses to minimise their haemodynamic impact. It is important to identify non-drug factors that may improve cardiovascular stability in this group to optimise the care received by these patients.

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.

Anesthetic options for Rezūm water vapor therapy Is minimal sedation tolerable for a minimally invasive procedure?

There has been a rapid expansion of the armamentarium for managing benign prostatic hyperplasia (BPH). Due to the invasiveness and complication risks of traditional surgical management, minimally invasive procedures have emerged. Rezūm water vapor therapy is a safe, effective alternative. Given the minimally invasive nature, there is interest in administering conscious sedation over general anesthesia to decrease procedural times and costs and increase accessibility by completing procedures in an office-based setting. We sought to assess and describe patient-reported tolerability for Rezūm completed under oral and deep intravenous sedation. Patients who underwent Rezūm between April and November of 2022 under conscious sedation with oral sedation and local anesthesia (OSLA) or deep intravenous sedation (DIS) were enrolled. Baseline information was collected, and followup interviews were conducted where patient tolerability scores, future anesthetic preferences, and complication data was prospectively obtained. Fourteen patients were enrolled in each group. The OSLA and DIS cohorts had a median tolerability score of 8 (interquartile range [IQR] 3.5) and 9 (IQR 1.75), respectively, indicating highly tolerable experiences. There was no significant difference between groups (p=0.13). On followup, 85.7% of patients in the OSLA and 100% in DIS groups expressed their future preference for conscious sedation over general anesthetic, with no significant difference between the two groups (p=0.46). Our study demonstrates OSLA and DIS are both viable conscious sedation methods for Rezūm, with patients reporting high tolerability to the procedure regardless of sedation choice. Almost all patients receiving conscious sedation would choose to undergo Rezūm using conscious sedation again and had minimal complications.

Comparison of intravenous ketamine and fentanyl sedation in duration of mechanical ventilation in intensive care unit

Background and aims: To compare the duration of mechanical ventilation in patients receiving ketamine compared to fentanyl for sedation in mechanically ventilated patients in intensive care unit. Methods: One hundred and six patients requiring mechanical ventilation were randomized to receive continuous intravenous infusion of either ketamine (1 mg/kg bolus followed by 0.4 to 0.8 mg/kg/h) or fentanyl (1mcg/kg bolus followed by 0.3-0.5 mcg/kg/min) with the dose titrated to achieve Richmond Agitation Sedation Scale (RASS) score of 0 to -1 and Behavioral Pain Scale (BPS) score of 3 to 7. The primary outcome was the duration of mechanical ventilation. Secondary outcomes were sedation score, analgesia score and need of vasopressors. Results: The mean duration of ventilation was 2.5±0.6 days and 2.2±1.0 days (p=0.1) in patients receiving ketamine and fentanyl respectively. More patients required vasopressors: 27 (50.9%) vs 9 (17%) in patients receiving fentanyl compared to ketamine (p&lt;0.05). There were no significant changes in hemodynamic variables after the initiation of the study drug in both the groups. Infusion was discontinued for adverse effects in seven (13%) patients in both the groups. Conclusion: When compared with fentanyl, continuous ketamine infusion was tolerated similarly by critically ill adults, with similar duration of mechanical ventilation. Ketamine sedation was associated with decreased requirement for vasopressors.

Probing polypharmacy, ageing and sex effects on physical function using different tests.

Ageing, sex and polypharmacy affect physical function. This mouse study investigates how ageing, sex and polypharmacy interact and affect grip strength, balance beam and wire hang, correlating and comparing the different test results between and within subgroups. Young (2.5 months) and old (21.5months) C57BL/6J male and female mice (n =10-6/group) were assessed for physical function at baseline on grip strength, balance beam and wire hang with three trials of 60 s (WH60s) and one trial of 300 s (WH300s). Mice were randomised to control or diet containing a high Drug Burden Index (DBI, total anticholinergic and sedative drug exposure) polypharmacy regimen (metoprolol, simvastatin, citalopram, oxycodone and oxybutynin at therapeutic oral doses). Following 6-8weeks of treatment, mice were reassessed. High DBI polypharmacy and control mice both showed age group differences on all tests (p <0.05). Only control mice showed sex differences, with females outperforming males on the WH60s and balance beam for old mice, WH300s for young mice (p <0.05). Polypharmacy reduced grip strength in all subgroups (p <0.05) and only in old females reduced wire hang time and cumulative behaviour and balance beam time and %walked (p <0.05). Physical function assessments were all correlated with each other, with differences between subgroups (p <0.05), and mice within subgroups showed interindividual variability in performance. Age, sex and polypharmacy have variable effects on different tests, and behavioural measures are useful adjuvants to assessing performance. There was considerable within-group variability in change in measures over time. These findings can inform design and sample size of future studies.

Development of a QuEChERS combined with LC-MS/MS method for determining 24 sedatives and anesthetics in animal-derived foods

This study aims to establish a rapid, accurate, safe, inexpensive, and effective method that combines QuEChERS pre-treatment with liquid chromatography-tandem mass spectrometry (LC-MS/MS) for the simultaneous determination of 20 benzodiazepine sedatives (SDTs) and 4 eugenol anaesthetics (AETs) in chicken, canned fish, meat floss, and powdered milk such that technical support can be provided for monitoring residues of 24 SDTs and AETs in the food matrix and for protecting human life and health. Results demonstrated that all 24 SDTs and AETs exhibited good linearity in their corresponding concentration ranges with correlation coefficients (r) of > 0.999. The limit of detection (LOD) and limit of quantification (LOQ) were in the ranges of 0.01–0.22 and 0.03–0.67 µg∙kg−1, respectively, and the recoveries were in the range of 70.04–110.26% (n = 7) with precision in the range of 0.75–9.99% (n = 7) for 24 SDTs and AETs at different concentrations (4, 20, and 100 µg∙kg−1). This method was successfully applied to real samples and provides a convenient tool for detecting residues of SDTs and AETs in animal-derived foods.

Prevention of Induced Abortion - Effect on Pain. Systematic Review of a Database

Review of the current literature on pain prevention in induced abortion.An in - depth analysis of the guidelines of leading international and national organizations for prophylaxis of induced abortion-surgical and medicated abortion during the I-st and II-nd trimester in terms of pain response has been carried out. Shared with the author's many years of practical experience in order to assess the risks and benefits of the application of modern means of prophylaxis in artificial abortion and thus to improve the individual obstetric-gynecological practice. Methods: review of available literature from the last 10 years. Results and discussion:Paracetamol, oral lorazepam and nitric oxide do not improve pain control. Currently, the use of sedation is not recommended for Surgical abortion. Inhalation anaesthesia should not be used for sedation. Intravenous sedation with fentanyl and midazolam is recommended and safe - below 1.0% complications. In Medical abortion, 75.0% of women experience pain severe enough to require analgesia. The pain begins 2.5 to 4 hours after the use of perplex and lasts about an hour. During the extravehicular trimester, taking a higher number of doses intravenously is associated with more severe and frequent pain. In medicated abortion &lt; 14 gw. non-steroidal anti-inflammatory drugs are recommended 30-45 minutes before the procedure. Non-steroidal medicines do not reduce the efficacy of urgencies. Routine administration of paracervical block before 13 gw. when using modern means for medicated abortion is unnecessary. Narcotic analgesics (Tramadol) do not affect pain in early Medical abortion and their routine use is not recommended. Conclusion:In Surgical abortion, analgesia is always offered. Most commonly, analgesics, such as non-steroidal anti-inflammatory drugs local anesthesia (paracervical block with Lidocaine 20.1%; or 10.2%),) and/ or sedation, supplemented with verbal sedation, are sufficient to relieve pain before mechanical cervical dilation and during uterine evacuation. The technique of deep paracervical injection of Lidocacaine at two points is recommended.

Clinical Evaluation of Mahanarayana Taila Matra Basti in Anidra (Primary Insomnia)

Sleep is a naturally recurring state of mind and body. Insomnia disorder is defined as a subjective perception or complaint of inadequate or poor-quality sleep. Anidra has been described in detail by Acharyas in various contexts like Vata Nanatmaja Vikara, Vataja Jwara etc. Panchkarma therapies like Shirodhara, Shirobasti, Shiroabhyang, Shiropichu, Padaabhyang is very useful in treatment of Anidra. Insomnia is the most commonly encountered sleep disorder and occurs 10-50% of the population. Worldwide epidemiological studies assessed the prevalence of insomnia without restrictive criteria as 33% in general population. In Ayurveda, insomnia is described as Anidra and Nidranash under the heading of different disorders and conditions. Allopathic hypnotic drugs are useful for short term treatment in insomnia which is due to acute stage. Long term uses of certain classes of sedatives cause physical dependence, Ayurvedic approach in the disease is by pacifying the Doshas, paying special attention to Vata- Shamana, Santarpana and Srotoshodhak. Hence, with the aim of identifying and establishing an alternative, safer, effective and long-lasting treatment modality, the study entitled “Clinical Evaluation of Mahanarayana Taila Matra Basti in Anidra (Primary Insomnia)” was conducted in 56 patients. They were selected on the basis of standard inclusion and exclusion criteria and randomly allocated to two different treatment groups; Group- A (Mahanarayana Taila Matra Basti) and Group- B (Zolpidem). Total duration of the treatment was of 14 days along with a follow up period of 1 month. Both the interventions were almost equally effective, but in overall improvement of the patients “Group A” had better results than Group B. For better scientific validation, further research studies and clinical trials should be carried out with large sample size and longer duration of treatment.

Airway Management for Emergency Spinal Epidural Hematoma Evacuation With Awake Spine Surgery: Case Report and Literature Review.

Postoperative spinal epidural hematomas (pSEHs) are a rare complication of microdiscectomy surgery. The hematoma may be unnoticed intraoperatively, but timely treatment may prevent permanent neurologic impairment. Airway management in patients with a full stomach is generally performed with rapid sequence intubation and general anesthesia. Awake spine surgery without intravenous analgesia or sedation may be beneficial in patients with a full stomach who are at higher risk for pulmonary aspiration with general anesthesia due to a loss of non-per-oral (NPO) status. The authors propose that it can also be performed in cases of urgent/emergent postsurgical epidural hematoma evacuation. We present the airway management of a 41-year-old man who underwent a minimally invasive microdiscectomy with normal strength immediately after surgery but developed progressive weakness with right foot dorsiflexion, right extensor hallucis longus muscle weakness, and progressive right lower extremity ascending numbness over the course of the first 2 hours after surgery due to an epidural hematoma. The patient underwent urgent awake epidural hematoma evacuation with a spinal anesthetic. Afterward, the patient recovered neurological function and was discharged the following morning. pSEHs are a rare complication of microdiscectomy surgery. The purpose of this article is to describe the novel use of awake spine surgery in emergent epidural hematoma evacuation and demonstrate its feasibility. In emergencies, when a patient is not NPO, awake spine surgery can safely be performed with no sedation, ensuring the patient can protect their airway and avoid the risk of aspiration.

Sedation with propofol and isoflurane differs in terms of microcirculatory parameters: A randomized animal study using dorsal skinfold chamber mouse model

ObjectiveThis study aimed to explore the effects of sedative doses of propofol and isoflurane on microcirculation in septic mice compared to controls. Isoflurane, known for its potential as a sedation drug in bedside applications, lacks clarity regarding its impact on the microcirculation system. The hypothesis was that propofol would exert a more pronounced influence on the microvascular flow index, particularly amplified in septic conditions. Material and methodsRandomized study was conducted from December 2020 to October 2021 involved 60 BALB/c mice, with 52 mice analyzed. Dorsal skinfold chambers were implanted, followed by intraperitoneal injections of either sterile 0.9 % saline or lipopolysaccharide for the control and sepsis groups, respectively. Both groups received propofol or isoflurane treatment for 120 min. Microcirculatory parameters were obtained via incident dark-field microscopy videos, along with the mean blood pressure and heart rate at three time points: before sedation (T0), 30 min after sedation (T30), and 120 min after sedation (T120). Endothelial glycocalyx thickness and syndecan-1 concentration were also analyzed. ResultsIn healthy controls, both anesthetics reduced blood pressure. However, propofol maintained microvascular flow, differing significantly from isoflurane at T120 (propofol, 2.8 ± 0.3 vs. isoflurane, 1.6 ± 0.9; P < 0.001). In the sepsis group, a similar pattern occurred at T120 without statistical significance (propofol, 1.8 ± 1.1 vs. isoflurane, 1.2 ± 0.7; P = 0.023). Syndecan-1 levels did not differ between agents, but glycocalyx thickness index was significantly lower in the isoflurane-sepsis group than propofol (P = 0.001). ConclusionsPropofol potentially offers protective action against microvascular flow deterioration compared to isoflurane, observed in control mice. Furthermore, a lower degree of sepsis-induced glycocalyx degradation was evident with propofol compared to isoflurane.

Mechanical Ventilation, Past, Present, and Future.

Mechanical ventilation (MV) has played a crucial role in the medical field, particularly in anesthesia and in critical care medicine (CCM) settings. MV has evolved significantly since its inception over 70 years ago and the future promises even more advanced technology. In the past, ventilation was provided manually, intermittently, and it was primarily used for resuscitation or as a last resort for patients with severe respiratory or cardiovascular failure. The earliest MV machines for prolonged ventilatory support and oxygenation were large and cumbersome. They required a significant amount of skills and expertise to operate. These early devices had limited capabilities, battery, power, safety features, alarms, and therefore these often caused harm to patients. Moreover, the physiology of MV was modified when mechanical ventilators moved from negative pressure to positive pressure mechanisms. Monitoring systems were also very limited and therefore the risks related to MV support were difficult to quantify, predict and timely detect for individual patients who were necessarily young with few comorbidities. Technology and devices designed to use tracheostomies versus endotracheal intubation evolved in the last century too and these are currently much more reliable. In the present, positive pressure MV is more sophisticated and widely used for extensive period of time. Modern ventilators use mostly positive pressure systems and are much smaller, more portable than their predecessors, and they are much easier to operate. They can also be programmed to provide different levels of support based on evolving physiological concepts allowing lung-protective ventilation. Monitoring systems are more sophisticated and knowledge related to the physiology of MV is improved. Patients are also more complex and elderly compared to the past. MV experts are informed about risks related to prolonged or aggressive ventilation modalities and settings. One of the most significant advances in MV has been protective lung ventilation, diaphragm protective ventilation including noninvasive ventilation (NIV). Health care professionals are familiar with the use of MV and in many countries, respiratory therapists have been trained for the exclusive purpose of providing safe and professional respiratory support to critically ill patients. Analgo-sedation drugs and techniques are improved, and more sedative drugs are available and this has an impact on recovery, weaning, and overall patients' outcome. Looking toward the future, MV is likely to continue to evolve and improve alongside monitoring techniques and sedatives. There is increasing precision in monitoring global "patient-ventilator" interactions: structure and analysis (asynchrony, desynchrony, etc). One area of development is the use of artificial intelligence (AI) in ventilator technology. AI can be used to monitor patients in real-time, and it can predict when a patient is likely to experience respiratory distress. This allows medical professionals to intervene before a crisis occurs, improving patient outcomes and reducing the need for emergency intervention. This specific area of development is intended as "personalized ventilation." It involves tailoring the ventilator settings to the individual patient, based on their physiology and the specific condition they are being treated for. This approach has the potential to improve patient outcomes by optimizing ventilation and reducing the risk of harm. In conclusion, MV has come a long way since its inception, and it continues to play a critical role in anesthesia and in CCM settings. Advances in technology have made MV safer, more effective, affordable, and more widely available. As technology continues to improve, more advanced and personalized MV will become available, leading to better patients' outcomes and quality of life for those in need.

Nootropic Effect of Celastrus paniculatus on Restraint Stress Induced Behavioral and Biochemical Changes in Wistar Albino Rats

Background: Stress most certainly plays a significant role in everyday life. The natural biological balance is disrupted by stressful events, which has a negative impact on normal physiological and psychological function. In the last 20 years, there hasn't been much advancement in the creation of medications, efficient drug delivery systems, or treatments for Central Nervous System (CNS)-related issues. The ancient Ayurvedic herb Celastrus paniculatus (CP) has been used for millennia as a memory booster, anti-inflammatory, analgesic, sedative, and antiepileptic drug. The neuropharmacological effects of the seed extract have been thoroughly studied in a variety of laboratories, and there are numerous findings that support their nootropic function. Aim: To investigate the effects of Celastrus paniculatus against restraint stress, induced behavioral and biochemical changes in male Wistar albino rats. Methods: The animals were divided into five groups. Each group includes six animals. Group I: Control, Group II: Restraint stress (6hrs for 21 days), Group III: Celastrus paniculatus (400mg/kg, orally) and restraint Stress, Group IV: Celastrus paniculatus alone, Group V: Vehicle. The behavioral changes are assessed by Place Preference test, Elevated plus Maze. Animals were euthanized and the discrete regions of the brain were homogenized for biochemical estimation, such as Catalase, SOD, LPO, GPX, GSH, Vitamin C. Animal’s cognitive and anxiety-related behavior and antioxidants were examined the following day after the stress procedure and treatment. Results: Following a period of 21 days of being subjected to restraint stress, the behavioral changes were reduced in stress group when compared to control group, and also the levels of Lipid peroxidase significant (P&lt;0.05) increased in the restraint stress group as compared to the control group. Enzymatic antioxidants such as superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), Vitamin C, Glutathione experienced a significant (P&lt;0.05) reduction in the restraint stress group as opposed to the control group. Conclusion: Chronic restraint stress has adverse effects on the animal’s cognition, memory, and learning abilities as well as anxiety-related behavior. However, Celastrus paniculatus treatment shows enhanced performance in anxiety-related Behavior and antioxidant properties.

Prospective Study of 506 Dogs with Tick Paralysis: Investigating Measures of Severity and Clinical Signs as Predictors of Mortality and Assessing the Benefits of Different Therapeutics.

Survey data from 42 Australian eastern seaboard veterinary practices involving 506 cases are reported with regard to clinical signs, disease severity, mortality, use of pharmaceuticals, and recovery times. New measures of disease severity (visual analogue scales (VAS) and facial expressions) were tested alongside "gold standard" measures (neuromuscular junction (NMJ) scores). Univariable and multivariable logistic regression analyses were conducted to evaluate associations between variables. The VAS scores were progressive, prognostic (especially the respiratory scores) and correlated with the NMJ scores. The presence of inspiratory dyspnoea and crackles on the day of hospitalisation, progressing to expiratory dyspnoea and an expiratory wheeze 24 h later, were highly predictive of mortality. Altered facial features on hospital admission were also highly predictive of mortality. The previously used respiratory score (using various clinical signs) was not predictive of mortality. Older animals had a higher mortality rate, and no gender or breed susceptibility was found. The only pharmaceuticals that were positively associated with mortality were tick antiserum and, in severe cases, antibiotics. The use of many pharmaceutical products (acepromazine, atropine, steroids, antihistamines, antiemetics, diuretics, and S8 anti-anxiety and sedation drugs) had no effect on mortality. More drug classes were used with increasing clinical severity and specific factors (e.g., vomiting/retching, hydration) affected the period of hospitalisation. Geographic variation in respiratory signs and toxicity scores was evident, whereas mortality and disease severity were not different across regions.

Oral Sedation in Pediatric Dentistry

Anxiety, dental phobia, parental expectations, and challenging patient behavior highlight the need for sedation in paediatric dentistry. Various pharmacological drugs are present within the oral sedation which helps in achieving a calm, relaxed patient who can guard their own airway, sustain their own respiration, and respond to vocal commands. An in-depth overview of oral sedation in pediatric dentistry is what this review’s main goal is to deliver. It will provide knowledge for practitioners who wish to administer oral sedative medications to their pediatric patients. The pharmacodynamics and pharmacology of frequently used oral sedative drugs will be discussed, along with pre-operative concerns, monitoring equipment requirements, and physiological considerations of the paediatric patient.

Efficacy of intranasal administration of dexmedetomidine in combination with midazolam for sedation in infant with cleft lip and palate undergoing CT scan: a randomized controlled trial

BackgroundThere is a great challenge to sedation for infants with cleft lip and palate undergoing CT scan, because there is the younger age and no consensus on the type, dosage, and route of drug administration.ObjectiveThis study aimed to evaluate the efficacy of intranasal administration of dexmedetomidine combined with midazolam as a sedative option for infants with cleft lip and palate under imaging procedures.MethodsInfants scheduled for cleft lip and palate repair surgery were randomly assigned to the IND group (intranasal dexmedetomidine 2 µg/kg alone) and the INDM group (intranasal dexmedetomidine 2 µg/kg combined with midazolam 0.05 mg/kg). The primary outcome was the proportion of infants underwent successful computed tomography (CT) scans under intranasal sedation. The secondary outcomes included onset time and duration of sedation, recovery time, Ramsay sedation scale, hemodynamic parameters during sedation, and adverse events. Data analyses involved the unpaired t-test, the repeated-measures analysis of variance test, and the continuity correction χ2 test.ResultsOne hundred five infants were included in the analysis. The proportion of infants underwent successful CT scans under sedation was significantly greater in the INDM group than in the IND group (47 [95.9%] vs. 45 [80.4%], p = 0.016). Additionally, the INDM group had a shorter onset time and a longer duration of sedation statistically (12 [8.5, 17] min vs. 16 [12, 20] min, p = 0.001; 80 [63.6, 92.5] min vs. 68.5 [38, 89] min, p = 0.014, respectively), and their recovery time was significantly longer (43 [30, 59.5] min vs. 31.5 [20.5, 53.5] min, p = 0.006). The difference in Ramsay sedation scale values 20 min after administration was statistically significant between the groups. No statistically significant difference was found between the groups in changes in heart rate and respiratory rate.ConclusionIntranasal administration of dexmedetomidine in combination with midazolam resulted in higher sedation success in comparison with sole dexmedetomidine. However, it has a relatively prolonged duration of sedation and recovery time.Trial registrationChiCTR2100049122, Clinical trial first registration date: 21/07/2021.

Effective doses of ciprofol combined with alfentanil in inhibiting responses to gastroscope insertion, a prospective, single-arm, single-center study

BackgroundCiprofol is a novel intravenous sedative and anesthetic. Studies have shown that it features a rapid onset of action, a fast recovery time, slight inhibition of respiratory and cardiovascular functions, and a low incidence of adverse reactions. This study aims to explore the median effective dose (ED50) and the 95% effective dose (ED95) of ciprofol in inhibiting responses to gastroscope insertion when combined with a low dose of alfentanil, and to evaluate its safety, to provide a reference for the rational use of ciprofol in clinical practices.MethodsWe included 25 patients aged 18–64 years of either sex who underwent gastroscopy under intravenous general anesthesia, with a Body Mass Index (BMI) 18–28 kg/m2, and an American Society of Anesthesiologists (ASA) grade I or II. In this study, the dose-finding strategy of ciprofol followed a modified Dixon’s up-and-down method with an initial dose of 0.30 mg/kg and an increment of 0.02 mg/kg. Ciprofol was administered after intravenous injection of 7 µg/kg of alfentanil, and 2 min later a gastroscope was inserted. When the insertion response of one participant was positive (including body movement, coughing, and eye opening), an escalation of 0.02 mg/kg would be given to the next participant; otherwise, a de-escalation of 0.02 mg/kg would be administered. The study was terminated when negative response and positive response alternated 8 times. A Probit model was used to calculate the ED50 and ED95 of ciprofol in inhibiting responses to gastroscope insertion when combined with alfentanil. Patients’ recovery time, discharge time, vital signs and occurrence of adverse reactions were recorded.ResultsThe ED50 of single-dose intravenous ciprofol injection with 7 µg/kg of alfentanil in inhibiting gastroscope insertion responses was 0.217 mg/kg, and the ED95 was 0.247 mg/kg. Patients’ recovery time and discharge time were 11.04 ± 1.49 min and 9.64 ± 2.38 min, respectively. The overall incidence of adverse reactions was 12%.ConclusionThe ED50 of ciprofol combined with 7 µg/kg of alfentanil in inhibiting gastroscope insertion responses was 0.217 mg/kg, and the ED95 was 0.247 mg/kg. Ciprofol showed a low incidence of anesthesia-related adverse events.Trial registrationhttp://www.chictr.org.cn (ChiCTR2200061727).

Retrospective study on patient comfort and post-operative condition associated with intravenous sedation versus general anesthesia for third molar extraction in ambulatory surgery in a state hospital

Objectives: Third molar extraction requires local or general anesthesia. In public hospitals, general anaesthesia is frequently used to perform the most complex extractions and to accommodate patients' wishes. However, the choice of general anesthesia is at the discretion of the care center. Intravenous sedation is also an option. We suggest that comfort and post-operative condition are better in patients undergoing sedation rather than general anesthesia. This study aimed to evaluate the comfort and post-operative condition after third molar extraction in an 18–50-year-old ambulatory surgical population in a state hospital. Method and materials: In the stomatology and maxillofacial surgery department of Roanne Hospital, two anesthetic protocols are used for third-molar extraction. We retrospectively collected 47 patients who underwent third molar extraction between 1st July 2022 and 31st December 2022. Results were collected by questionnaires and data were retrospectively retrieved from medical records. Results: Twenty patients underwent a general anesthesia and twenty-seven underwent intravenous sedation. The study found no difference for the pain level (p &lt; 0.62) between the two anesthesia techniques. The comparison of the approaches indicated that intravenous sedation required a shorter duration of anesthesia (p &lt; 0.0001) and a shorter time in the recovery room (p &lt; 0.0001). Conclusion: This study indicates the feasibility and the effectiveness of intravenous sedation for patients undergoing third molar extraction in a state hospital. As other studies in the literature that have shown greater satisfaction and better recovery in patients undergoing intravenous sedation compared with general anesthesia.

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.

Propofol Versus Dexmedetomidine for Conscious Sedation During Vaginal Hysterectomy With Pre-emptive Local Anesthesia: A Prospective Cohort Study.

Hysterectomy is the most frequent gynecological surgery. Vaginal hysterectomy (VH) seems to be related to favorable perioperative outcomes compared to abdominal or laparoscopic approaches. As the population ages, anesthesia that is safer for the elderly, such as local anesthesia (LA) with conscious sedation, is gaining popularity and is related to favorable outcomes in patients' recovery compared to general or regional anesthesia. We aimed to evaluate the efficacy of dexmedetomidine versus propofol for women undergoing VH for uterine prolapse under LA and conscious sedation. A prospective study on 40 women with uterine prolapse stage ≥3 who had VH under LA with conscious sedation under either dexmedetomidine (n=20) or propofol (n=20) was performed. A standardized surgical approach with continuous hemodynamic monitoring and sedation assessment using the Ramsay Sedation Scale (RSS) was conducted. The primary endpoint of the study was to determine the percentage of patients receiving intraoperative fentanyl. Analysis of outcomes demonstrated a significant reduction in the proportion of patients requiring intraoperative rescue fentanyl (35% vs. 5%, respectively, p=0.04) and in postoperative pain scores, with more patients achieving an optimal RSS score of 3 in the dexmedetomidine group. Based on the findings of the present study, dexmedetomidine offered superior analgesia and patient comfort compared to propofol, suggesting a favorable anesthetic profile for VH under LA.