Sedation Group Research Articles

Comparison of propofol-based sedation and midazolam sedation in pediatric bidirectional endoscopy conducted by pediatric gastroenterologists.

The effectiveness and safety of propofol-based sedation and midazolam sedation in pediatric bidirectional endoscopy were compared. We retrospectively analyzed the cases of pediatric patients (≤15 years old) who had undergone bidirectional endoscopy, esophagogastroduodenoscopy, and colonoscopy by pediatric gastroenterologists. Demographic data, indications, sedatives/dosages, clinical outcomes, endoscopic findings, adverse events, and total patient time requirements (total time in which patients stay in our hospital) were compared in the two sedation groups. Ninety-one children (51 boys, 40 girls, mean age 13 years, range 9-15) treated at our hospital were enrolled. Propofol alone or in combination with midazolam and/or pentazocine was administered to 51 patients (propofol-based sedation group). Midazolam alone or in combination with pentazocine was administered to the other 40 patients (midazolam sedation group). In the propofol group, the following mean doses were used: propofol, 96 mg (range 40-145 mg); midazolam, 4.9 mg (range 3-5 mg); and pentazocine, 7.5 mg. In the midazolam group, the mean doses of midazolam and pentazocine were 6.2 mg (range 4-10 mg) and 15 mg, respectively. All procedures were successfully completed by pediatric gastroenterologists. The total procedure times and endoscopic findings were similar in the two groups, but the median patient time requirement in the propofol group was significantly shorter versus the midazolam group (7.3 h vs. 8.4 h, p < 0.001). No adverse events occurred in either group. Propofol-based sedation in pediatric bidirectional endoscopy was safely and effectively performed by pediatric gastroenterologists, and its patient time requirement was shorter than that for midazolam sedation.

Effects of Different Anesthesia Applications on Mood, Depression, and Anxiety Levels in Burn Patients.

Adequate and effective pain management and prevention of depression are essential in patients with burns. This study aims to explore the effects of ketamine sedation in patients with burns in terms of mood disorders, depression, anxiety, and suicidality during postoperative follow-up in the intensive care unit. This study targeted subjects aged 18-65 years, in the ASA I-II class, with basic communication skills, no history of diagnosed mental illness, and no history of neuropsychiatric or cognitive disorders or related treatment. The study was conducted on 67 patients. After preoxygenation, anesthesia induction was practiced with 2 mg/kg intravenous (IV) propofol and 1 mcg/kg IV fentanyl in the general anesthesia group. Anesthesia was continued with a mixture of 0.3-0.5 mcg/kg/min remifentanil, 2% sevoflurane, 50% air, and 50% oxygen. In the sedation group, 1 mcg/kg IV fentanyl and 1 mg/kg IV ketamine were administered at induction; anesthesia was maintained by adding 30-50 mg IV propofol if necessary. The Montgomery-Asberg Depression Rating Scale (MADRS), Hamilton Anxiety Rating Scale (HAM-A), and Beck Scale for Suicidal Ideation (BSSI) have been administered via way of means of a psychiatrist preoperatively and on the primary postoperative day. In intragroup evaluations, MADRS values for the sedation anesthesia group decreased statistically significantly after the anesthesia (11.63 ± 5.49) compared to the preanesthesia period (14.44 ± 7.22) (P < .001). HAM-A scores of both anesthesia groups decreased statistically significantly after anesthesia. No patient was found to have suicidal ideation in all evaluations in which BSSI was used. Patients with burns may have a high potential for depression, anxiety disorders, and suicidal tendencies due to the trauma they have experienced. In these patients, sedation anesthesia with ketamine may reduce negative mood, depression, anxiety, and suicidal tendencies in the postoperative period.

Sedation vs. general anesthesia in stone ureteroscopy: Comparison of efficacy and safety, a post COVID-19 report

IntroductionUreterorenoscopy (URS) for ureteral or renal stones is traditionally performed under general anesthesia (GA). Sedation is an alternative to GA, allowing control of the level of consciousness, spontaneous ventilation, and faster recovery. Our aim was to compare sedation and GA for patients undergoing ureterorenoscopy. Endpoints were stone-free rate (SFR) and complication rates. MethodMonocentric comparative retrospective study including all consecutive ureterorenoscopies for ureteral or renal stone. The inclusion period was dichotomized in two 6-months periods due to the COVID-19 pandemic: from January 1 to July 1, 2019 (URS under GA) and from January 1 to July 1, 2021 (URS under GA or sedation). Stone-free (SF) status was defined as the absence of stone or fragment>4mm after the first ureterorenoscopy. Complication rates were assessed according to the Satava (perioperative complications) and Clavien-Dindo (postoperative complications) classifications. Statistical analysis was performed by Chi-square test. ResultsA total of 185 patients were included for a total of 206 ureterorenoscopies; 82 underwent ureterorenoscopy under GA and 103 under sedation. The median stone size was 10 [7–16] mm. In all, 150 (81%) patients had at least one intrarenal stone. The SFR was similar between the two groups (67% GA group, 69% sedation group, P=0.912). In the sedation group, the mean SFR in ureter was 83.7% vs. 92.5% in the GA group. In renal cavities, the mean SFR was 46.4% in the sedation group vs. 42.5% in the GA group. Satava grade I, IIa, and IIb complications were 5 (6%), 5 (6%), and 1 (1%) in the GA group and 6 (6%), 1 (1%), and 3 (3%) in the sedation group, respectively (P=0.214). The grade I, II, III, and IV Clavien complications were 6 (7%), 3 (4%), 0 (0%), and 2 (2%) in the GA group and 6 (6%), 4 (4%), 1 (1%), and 4 (4%) in the sedation group, respectively (P=0.928). ConclusionOur post COVID-19 study showed no difference in efficacy and safety between ureterorenoscopy under sedation and GA for patients with renal stones. Our results confirm the interest of the sedation procedure, particularly in the context of outpatient surgery. Level of evidence4.

Impact of different ablation strategies during very high power short duration ablation: insights from the multicentric AIR HPSD registry

Abstract Background The very high power short duration ablation by mean of the QDOT Micro catheter was demonstrated to be safe and effective to achieve pulmonary vein isolation (PVI) in atrial fibrillation (AF) patients. Data from large multicentric registries are still lacking. Purpose We sought to investigate whether different ablation approaches may impact procedural outcomes. First, the hybrid approach (Qmode+, 90 W for 4 sec, at the posterior wall of the left atrium and Qmode modality AI-guided at the anterior wall) was compared to the ablation performed exclusively with the Qmode+ modality. Second, we investigated the impact of the type of anesthesia. Methods The AIR HPSD registry is a multicentric real world data registry including patients undergoing AF ablation by mean of the QDOT Micro catheter. The ablation modality (hybrid/ Qmode+) and the type of anesthesia were left to operators’ preference. Results Overall, 330 patients were enrolled, 67% males, 71% had paroxysmal AF, the mean age was 61±11. Pulmonary vein isolation was reached in 100% regardless of the ablation modality or the anesthesia used. As for the first pass isolation (FPI) there was a trend toward higher rates in the hybrid group compared to the Qmode+ group (85% vs 74%, p=0.1). No differences in FPI were found between the general anesthesia/deep sedation group and the conscious sedation group (83% vs 81%, p=0.8), however when considering the Qmode+ group solely, the FPI was significantly higher in the general anesthesia/deep sedation group (84% vs 56%, p=0.006). As for the procedural time, this was significantly shorter in the general anesthesia/deep sedation compared to conscious sedation (82±21 vs 97±35 min, p&amp;lt;0.01), as well as in the Qmode+ group compared to the hybrid group (80±31 vs 102±30 min, p&amp;lt;0.01). Minor complications were observed in 1% of patients with no significant differences between groups. Conclusions The PVI can be safely and effectively obtained with both approaches, hybrid or Qmode+ solely, however the rate of FPI seems higher with the hybrid one. When adopting solely the Qmode+ modality the general anesthesia increases the rate of FPI.

Atrial fibrillation ablation performed under general anesthesia is associated with significantly low arterial blood pressure and higher incidence of hypotensive events

Abstract Introduction Catheter ablation is a pivotal treatment for atrial fibrillation (AF). When performed under general anesthesia (GA), it may be associated to hypotensive events, with unclear prevalence and prognostic impact. Continuous non-invasive blood pressure (CNBP) measurement is a validated and reliable tool for intraprocedural beat-to-beat advanced hemodynamic monitoring. Purpose To assess and compare the hemodynamic impact of GA during AF ablation using a CNBP (ClearSight) system. Methods In an observational single large volume center study we prospectively enrolled all patients undergoing AF ablation at our institution with CNBP monitoring, as per local practice. Patients were assigned to deep sedation (DS) or general anesthesia (GA) group according to the chosen sedation regimen. The following parameters were compared between the two strategies: systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume index (SVI). Hypotension events (HE) (MAP &amp;lt; 65 mmHg) were counted and compared between groups. Results Two hundred patients were enrolled from September 2022 to August 2023. 170 patients underwent AF ablation under DS (76,7% male, mean age 56,77±15,76), while 30 patients were treated under GA (70% male, mean age 60,72±13,79). A total of 117709 measurements were analyzed and compared, for an overall monitoring time of 39293,66 minutes. Patients treated under GA had significantly lower average SBP (104,83±21,48 mmHg vs 138,05±22,09 mmHg, p&amp;lt;0,001), DBP (59,59±11,89 mmHg vs 76,12±12,75 mmHg, p&amp;lt;0,001), MAP (74,96±15,02 mmHg vs 97,12±15,38 mmHg, p&amp;lt;0,001). We also observed significantly lower CO (4,40±1,47 L/min vs 5,16±1,62 L/min, p&amp;lt;0,001), CI (2,22±0,71 L/min/m2 vs 2,61±0,78 L/min/m2, p&amp;lt;0,001) SV (62,37±18,04 mL/beat vs 70,65±24,95 mL/beat, p&amp;lt;0,001) and SVI (31,40±8,54 mL/beat/m2 vs 35,80±12,07 mL/beat/m2, p&amp;lt;0,001). Patients treated under GA witnessed a higher number of per-patient HE (10,53±9,16 vs 0,61±2,07, p&amp;lt;0,001), and higher HE duration (4,8±6,62 min vs 2,82±3,66, p&amp;lt;0,001). Conclusion AF ablation performed under general anesthesia is associated with significantly lower systolic, diastolic, and mean arterial pressure, reduced cardiac output, stroke volume and stroke volume index when compared to deep sedation. Patients undergoing AF ablation under GA witness higher incidence and duration of hypotensive events. CNBP is a valid tool for beat-to-beat procedural hemodynamic assessment and can help identifying and treat hypotensive events. Further studies are needed to assess the potential prognostic impact of intraprocedural hypotension during AF ablation.

Calming effect of traditional Chinese medicine cinnabar based on neurotransmitter content and metal elements concentration in PCPA-induced insomnia rats

IntroductionCinnabar is a commonly utilized mineral traditional Chinese medicine (TCM) in China. It has the functions of clearing the heart and calming the mind. However, there remains a dearth of pharmacological experiments on the metal elements of cinnabar on animal models. Therefore, this study aims to investigate the effects of cinnabar on neurotransmitter levels in p-chlorophenylalanine (PCPA) induced insomnia rats and the content of metal elements in plasma, heart, liver, spleen, lung and kidney of rats. MethodsTissue hematoxylin and eosin (H&E) staining were used to assess the histological changes. The 5-HT and GABA in plasma and hypothalamus of rats were determined by enzyme-linked immunosorbent to evaluate the therapeutic effect. The content of metal elements in plasma, heart, liver, spleen, lung and kidney of rats was determined by ICP-MS. ResultsAfter cured with cinnabar and its processed for fourteen days, the level of 5-HT in the plasma and hypothalamus increased (P<0.05), and the level of GABA decreased (P<0.05). Furthermore, both low dose (1 mg/kg) and high dose (10 mg/kg) of cinnabar resulted in an increase in plasma 5-HT levels;, however, the high dose of cinnabar increased the level of 5-HT more than low dose of cinnabar. The content of metal elements in plasma, hemocyte and heart, liver, spleen, lung and kidney of rats ranged from less than 1 µg.g−1 to hundreds of µg.g−1, among which the highest content was Fe in rat's spleen of cinnabar sedative pill group, and the content is 919 µg.g−1. The content of most metal elements in plasma and hemocyte of rats was significantly lower than that in heart, liver, spleen, lung and kidney. There is no obvious difference of Hg in plasma and tissue of rats between the control group fed normally and rats fed with drugs. DiscussionCinnabar and its products can improve insomnia symptoms in rats by regulating the neurotransmitters 5-HT and GABA. Cinnabar is basically non-toxic in short-term (less than 14 days) use accordance with the dosage prescribed by pharmacopoeia.

A Comparative Analysis of Erector Spinae Plane Block Versus Conscious Sedation in Managing Percutaneous Cholecystostomy Pain.

This study investigates the efficacy of erector spinae plane block (ESPB) for managing perioperative and postoperative pain in patients undergoing percutaneous cholecystostomy (PC) for acute cholecystitis, particularly in high-risk elderly patients with extensive comorbidities and limited functional status. In a retrospective single-center study, 58 high-risk patients scheduled for PC were assessed. ESPB was administered to 23 patients, while 22 received conscious sedation. Pain intensity was measured using the numeric rating scale before any analgesic or ESPB administration, during the procedure and at 1 and 12h post-procedure and secondary outcomes included adverse effects and additional analgesic requirements. The ESPB group experienced significant pain reduction during and post-procedure compared to the conscious sedation group (p = 0.002). Procedure times were shorter (p = 0.015), and postoperative tramadol was less frequently needed in the ESPB group (p = 0.007). The incidence of nausea was also lower in the ESPB group (p = 0.001). No ESPB-related complications were reported. ESPB significantly alleviates perioperative and postoperative pain in PC patients, reducing additional analgesic use and side effects. It holds promise as a key component of pain management for high-risk surgical patients. Level 3, Non-randomized controlled cohort/follow-up study.

Propofol and Dexmedetomidine Ameliorate Endotoxemia-Associated Encephalopathy via Inhibiting Ferroptosis.

Sepsis is recognized as a multiorgan and systemic damage caused by dysregulated host response to infection. Its acute systemic inflammatory response highly resembles that of lipopolysaccharide (LPS)-induced endotoxemia. Propofol and dexmedetomidine are two commonly used sedatives for mechanical ventilation in critically ill patients and have been reported to alleviate cognitive impairment in many diseases. In this study, we aimed to explore and compare the effects of propofol and dexmedetomidine on the encephalopathy induced by endotoxemia and to investigate whether ferroptosis is involved, finally providing experimental evidence for multi-drug combination in septic sedation. A total of 218 C57BL/6J male mice (20-25 g, 6-8 weeks) were used. Morris water maze (MWM) tests were performed to evaluate whether propofol and dexmedetomidine attenuated LPS-induced cognitive deficits. Brain injury was evaluated using Nissl and Fluoro-Jade C (FJC) staining. Neuroinflammation was assessed by dihydroethidium (DHE) and DCFH-DA staining and by measuring the levels of three cytokines. The number of Iba1+ and GFAP+ cells was used to detect the activation of microglia and astrocytes. To explore the involvement of ferroptosis, the levels of ptgs2 and chac1; the content of iron, malondialdehyde (MDA), and glutathione (GSH); and the expression of ferroptosis-related proteins were investigated. The single use of propofol and dexmedetomidine mitigated LPS-induced cognitive impairment, while the combination showed poor performance. In alleviating endotoxemic neural loss and degeneration, the united sedative group exhibited the most potent capability. Both propofol and dexmedetomidine inhibited neuroinflammation, while propofol's effect was slightly weaker. All sedative groups reduced the neural apoptosis, inhibited the activation of microglia and astrocytes, and relieved neurologic ferroptosis. The combined group was most prominent in combating genetic and biochemical alterations of ferroptosis. Fpn1 may be at the core of endotoxemia-related ferroptosis activation.

Tracheal extubation under Narcotrend EEG monitoring at different depths of anesthesia after tonsillectomy in children: a prospective randomized controlled study.

This study aims to investigate whether tracheal extubation at different depths of anesthesia using Narcotrend EEG (NT value) can influence the recovery quality from anesthesia and cognitive function of children who underwent tonsillotomy. The study enrolled 152 children who underwent tonsillotomy and were anesthetized with endotracheal intubation in our hospital from September 2019 to March 2022. These patients were divided into Group A (conscious group, NT range of 95-100), Group B (light sedation group, NT range of 80-94), and Group C (conventional sedation group, NT range of 65-79). A neonatal pain assessment tool, namely, face, legs, activity, cry, and consolability (FLACC), was used to compare the pain scores of the three groups as the primary end point. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scales were used to evaluate the cognitive function of children in the three groups before and after surgery as the secondary end points. Differences were observed in the awakening time and FLACC scores after awakening among the three groups (P < 0.05). Among them, Group A exhibited a significantly shorter awakening time and higher FLACC score after awakening than those in Groups B and C (both P < 0.05). The total incidence of adverse reactions in Group B was significantly lower than that in Groups A and C (P < 0.05). No significant difference was observed in MMSE and MoCA scores before the operation and at 7 days after the operation among the three groups (P > 0.05), but a significant difference was found in MMSE and MoCA scores at 1 day and 3 days after the operation among the three groups (P < 0.05). In addition, MMSE and MoCA scores of the three groups decreased significantly at 1 day and 3 days after the operation than those at 1 day before the operation (P < 0.05). When the NT value of tonsillectomy is between 80 and 94, tracheal catheter removal can effectively improve the recovery quality and postoperative cognitive dysfunction of children.

Combined sedation in pediatric magnetic resonance imaging: determination of median effective dose of intranasal dexmedetomidine combined with oral midazolam

BackgroundThe exact median effective dose (ED50) of intranasal dexmedetomidine combined with oral midazolam sedation for magnetic resonance imaging (MRI) examination in children remains unknow and the aim of this study was to determine the ED50 of their combination.MethodsThis is a prospective dose-finding study. A total of 53 children aged from 2 months to 6 years scheduled for MRI examination from February 2023 to April 2023 were randomly divided into group D (to determine the ED50 of intranasal dexmedetomidine) and group M (to determine the ED50 of oral midazolam). The dosage of dexmedetomidine and midazolam was adjusted according to the modified Dixon’s up-and-down method, and the ED50 was calculated with a probit regression approach.ResultsThe ED50 of intranasal dexmedetomidine when combined with 0.5 mg∙kg− 1 oral midazolam was 0.39 µg∙kg− 1 [95% confidence interval (CI) 0.30 to 0.46 µg∙kg− 1] while the ED50 of oral midazolam was 0.17 mg∙kg− 1 (95% CI 0.01 to 0.29 mg∙kg− 1) when combined with 1 µg∙kg− 1 intranasal dexmedetomidine. The sedation onset time of children with successful sedation in group D was longer than in group M (30.0[25.0, 38.0]vs 19.5[15.0, 35.0] min, P < 0.05). No other adverse effects were observed in the day and 24 h after medication except one dysphoria.ConclusionThis drug combination sedation regimen appears suitable for children scheduled for MRI examinations, offering a more precise approach to guide the clinical use of sedative drugs in children.Trial registrationChinese Clinical Trial Registry, identifier: ChiCTR2300068611(24/02/2023).

SEDATION DEPTH DURING CRITICAL CARE TRANSPORT AND HOSPITALIZATION

The purpose of this study was to determine the differences in attained levels of sedation both within intensive care units and collectively regarding overall outcomes when patients were transported outside a hospital either pre-hospital or while being inter-facility transfer by different critical care agencies, having been exposed to light versus deep quality of anaesthesia. After the ethical approval from the institutional review board, this cross-sectional study was conducted at Khyber Teaching Hospital from 01/06/22 to 31/12/22. The primary outcome measure was the relation of starting deep sedation during transport to deep sedation in the first 48 hours after admission (defined as RASS -3 and less). Secondary outcomes included mechanical ventilation duration, inpatient mortality, total hospital stay length of ICU, and delirium within 48 h; coma may also be observed. Final transport RASS in both the study groups was-4.43±0.49 and-1.5±0.5 (p &lt;0.0001). Mean Hospital duration in both study groups was 13.01±4.8 and 35±5.9 days (p&lt;0.0001). A high percentage of inpatient mortality, delirium, and coma cases was seen in the deep sedation group (p&lt;0.0001). The transfer of patient care from the transport team to the hospital team presents a chance to potentially interrupt the progress of treatment and reassess decisions regarding sedation.

Choice of anesthesia technique is associated with earlier hospital discharge and reduced costs after transcatheter transfemoral aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) has become a viable alternative to palliation in patients with severe aortic stenosis. We compared general anesthesia to conscious sedation for TAVI procedures with respect to post operative morbidity, hospital length of stay, and financial burden. We conducted a retrospective review of prospectively collected data in patients undergoing transfemoral TAVI procedures from 2012 to 2017. Patients were matched based on age and sex and classed into either general anesthesia or conscious sedation groups respectively. Conscious sedation was provided with a dexmedetomidine infusion, and patients in general anesthesia group received a standard induction, tracheal intubation, and maintenance with sevoflurane. The hospital case costs were compared between the two groups before and after adjustment for inflation. We matched 124 pairs for a total of 248 patients. Both groups were similar with respect to demographic data, past medical history, medications, and intraoperative characteristics. There was no difference in postoperative morbidity and mortality between the two groups. The median hospital length of stay was 5 [interquartile range (IQR): 3, 10] and 7 (IQR: 4, 12) days, P=0.01, and after adjustment for inflation, the total hospital case costs were $48,984 (IQR: $44,802, $61,438) Canadian (CAD) vs. $55,333 (IQR: $46,832, $68,702) CAD, P=0.01, in the conscious sedation and general anesthesia groups, respectively. Advancements in TAVI technologies, conscious sedation and a collaborative, multidisciplinary team approach reduces overall length of hospital stay and procedure costs.

Trends in transcatheter aortic valve implantation practice and clinical outcomes at an Irish tertiary referral centre

ObjectiveA paucity of data exists on how transcatheter aortic valve implantation (TAVI) practice has evolved in Ireland. This study sought to analyse temporal trends in patient demographics, procedural characteristics, and...

Effect of anesthesia mode during endovascular treatment on neurological functional outcomes in patients with acute posterior circulation stroke.

To compare the effect of anesthesia mode on the neurological functional outcomes in patients undergoing endovascular treatment for acute posterior circulation ischemic stroke. Clinical data of 656 patients undergoing intravascular therapy for acute posterior circulation ischemic stroke registered in online Acute Stroke Patients for Stroke Management Quality Evaluation Database from January 2017 to December 2022 were retrospectively analyzed. The data included 163 cases with conscious sedation and 493 cases with general anesthesia during the procedure. After propensity score matching, 428 patients were included in the analysis, including 155 cases in the conscious sedation group and 273 cases in the general anesthesia group. The differences of operation mode, etiology type, vascular recanalization, hemorrhagic transformation at 24 h, modified Rankin Scale (mRS) score at 3 months and mortality within 3 months were compared between the two groups. Binary logistic regression was used to explore the effect of different anesthesia mode on neurological functional outcomes. There was a significant difference in operation mode between the two groups (P<0.01), while there were no significant differences in etiology type, vascular recanalization, hemorrhagic transformation at 24 h, mRS score at 3 months or mortality within 3 months (all P>0.05). Binary logistic regression analysis revealed that anesthesia modes were not significantly associated with functional outcomes of patients (OR=1.151, 95%CI: 0.751-1.765, P>0.05). Anesthesia mode (conscious sedation or general anesthesia) will not affect the neurological functional outcomes in patients with acute posterior circulation ischemic stroke undergoing endovascular treatment.

Comparison of supracondylar radial nerve block and procedural sedation analgesia in the reduction of radius fractures

Background and Aim: Distal radius fractures are the most frequent upper extremity fractures in the whole population. The incidence of distal radius fractures is 195.2/100,000, and the rate is increasing. It can occur with low-energy trauma in the elderly associated with osteoporosis. The purpose of this study is to compare the two different treatment groups (1. Sedation analgesia, 2. Supracondylar radial nerve block) in terms of reduction in Visual Analogue Scale (VAS) score, the length of hospital stay, complications, side effects, patient-physician satisfaction, and the ease of application. Materials and Methods: Patients diagnosed with distal radius fracture were enrolled prospectively, to whom the study’s exclusion criteria do not apply. The patients included in the study were randomly separated into two groups. Ketofol was administered to the sedation and analgesia group’s patients at a dose of 0.5 mg/kg (ketamine 0.5 mg/kg, propofol 0.5 mg/kg) intravenously, and supracondylar radial nerve block was performed on the other group’s patients under ultrasound guidance. Results: There were 20 patients (6 male, 14 female) in the sedation and analgesia group and 21 patients (11 male, 10 female) in the supracondylar radial nerve block group. There was no significant difference between the groups regarding patient-physician satisfaction and complications. The length of hospital stay was significantly shorter in the supracondylar radial nerve block group (49.25 ± 4.05) compared with the sedation and analgesia group (125 ± 5.85) (p &lt; 0.01). The mean reduction VAS score in the block group was observed to be lower than the admission VAS score (p &lt; 0.01). Conclusion: Consequently, ultrasound-guided supracondylar radial nerve block would be a valuable alternative to procedural sedation analgesia and could become routine clinical practice in treating distal radius fractures.

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.

Association between sedation during spinal anesthesia and mortality in older patients undergoing hip fracture surgery: A nationwide retrospective cohort study in Japan

Study objectiveIntraoperative sedation plays an important role in the management of regional anesthesia. Few studies have investigated the association of sedation during spinal anesthesia with postoperative mortality in older patients as a primary outcome. This study aimed to test the hypothesis that sedation during spinal anesthesia increases postoperative mortality in older patients undergoing hip fracture surgery. DesignRetrospective, cohort study. SettingAcute and subacute care hospitals in Japan. PatientsPatients aged 65 years and older who received hip fracture surgery under spinal anesthesia between April 2014 and May 2022. ExposureSedation during spinal anesthesia. MeasurementsPostoperative in-hospital all-cause mortality within 30 days. Main resultsIn total, 25,554 eligible patients were identified. Propensity score matching created 4735 pairs, and baseline patient characteristics were acceptably balanced between the sedation and non-sedation groups. There was no significant difference in 30-day postoperative mortality between the two groups (hazard ratio [95% CIs]: 0.92 [0.59–1.44]). ConclusionsThere was no association between sedation during hip fracture surgery in older patients under spinal anesthesia and postoperative mortality. However, these results are limited to our population, and further prospective studies are needed to determine the safety of sedation.

Evaluation of hemodynamic changes and patient-reported outcome measures in surgical therapy with or without intravenous sedation: a prospective controlled clinical study.

To determine whether intravenous (IV) sedation would contribute to the stabilization of patients' hemodynamics during periodontal and oral surgical procedures, and to evaluate the patient-reported outcome measures (PROMs). Periodontal or oral surgery patients were recruited and distributed into two groups: (1) sedation group (SG): intravenous sedation plus local anesthesia; (2) control group (CG): local anesthesia only. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and oxygen saturation (SaO2), were monitored at 15-min intervals from sitting in the dental chair (baseline) until the end of the treatment. In addition, a subjective assessment of PROMs was obtained through a post-operative questionnaire. Forty-nine patients (25 in SG and 24 in CG) were included. The highest SBP and DBP were significantly higher in CG compared to the SG (141.1 ± 18.4 and 133.6 ± 15.1, respectively in SBP; and 85.5 ± 11.0 and 82.9 ± 10.1, respectively in DBP), but no mean significant differences were found between groups (P value of 0.85 and 0.72 for systolic and diastolic BP, respectively). HR and SaO2 did not show statistical intra- and inter-group differences. The overall patient satisfaction score was significantly higher in the SG group compared to CG. Intravenous moderate sedation seems to contribute to the stabilization of patient's hemodynamics, especially the systolic blood pressure, although small differences have been found. Intravenous sedation seems to contribute to stabilize the hemodynamic values, and enhances the patient satisfaction after periodontal and oral surgical treatment in the dental office.

Helping patients choose between pain control options for outpatient procedural abortion at less than 12 weeks' gestation

ObjectivesThis study aimed to identify predictors of patient satisfaction with their chosen pain control regimen for procedural abortion at <12 weeks' gestation in the outpatient setting. Study designIn this prospective cohort study, we developed an instrument to evaluate predictors of satisfaction with pain control regimens among patients choosing local anesthesia alone (paracervical block with 20 mL of 1% buffered lidocaine) or local anesthesia plus intravenous (IV) moderate sedation with 100 mcg of fentanyl and 2 mg of midazolam. Our primary outcome was to identify predictors of satisfaction with both anesthesia cohorts as measured on a 4-point Likert scale, but due to high satisfaction levels in the IV group, we focused our analysis on the local anesthesia group. ResultsWe enrolled 149 patients in the local anesthesia group and 155 in the moderate IV sedation group. The mean procedure pain scores were 6.9 (±2.1) out of 10 in the local group and 4.0 (±2.7) in the IV group (p < 0.0001). More women in the IV group (92%) were satisfied or very satisfied with the amount of pain relief they experienced compared to the local group (66%; p < 0.0001). In the univariable model, only being afraid of a minor medical procedure was predictive of less satisfaction with local anesthesia for pain control (relative risk 0.8 [95% CI, 0.6–0.9]). Age, gestational age, anticipated pain, self-reported pain tolerance, self-reported anxiety, discomfort with the abortion decision, and history of prior vaginal or cesarean delivery or induced abortion did not predict satisfaction levels. ConclusionsFear of minor medical procedures was the only variable that predicted decreased satisfaction with local anesthesia alone for procedural abortion under 12 weeks. ImplicationsReliable predictors for satisfaction with local anesthesia alone for procedural abortion in the outpatient setting remain elusive. Fear of minor medical procedures may serve as an indicator of decreased satisfaction and could be incorporated into patient counseling. Moderate IV sedation is associated with high satisfaction levels.

Association between Anesthesia Management and Preoperative Magnetic Resonance Image Quality in Patients Scheduled for Deep Brain Stimulation Surgery

Aim: To investigate magnetic resonance image quality and the number of motion artifact-related repeated sequences based on anesthesia or sedation management during preoperative MR imaging for DBS surgery.&#x0D; Material and Methods: The medical records of patients who underwent DBS procedures at the hospital of Ondokuz Mayis University, between April 2011 and October 2021 were retrospectively analyzed. Age, gender, and diagnosis information were recorded for each case. Patients were grouped into general anesthesia, sedation, no sedation groups. The evaluation of magnetic resonance images was performed by a specialized in neuroradiology. The radiologist classified the image quality as good, moderate, or poor based on artifacts resulting from unwanted motion.&#x0D; Results: A total of 127 patients, out of 190 patients, were included in the study. There were no significant differences in image quality based on anesthesia/sedation method and airway management (p&gt;0.05). No significant differences were observed in the number of repeated sequences when compared based on anesthesia/sedation method and airway management (p&gt;0.05).&#x0D; Conclusion: General anesthesia, sedation, or no sedation during preoperative magnetic resonance imaging in patients with movement disorders did not result in significant differences in image quality and the number of sequences requiring repetition.