Sedation Group Research Articles

Pain Control and Hemodynamic Changes due to Moderate Sedation during Cardiac Catheterization

Background: Moderate sedation is a practice of promoting patient comfort during cardiac catheterization. However, few studies have evaluated the effectiveness of moderate sedation in patients undergoing cardiac catheterization. Objective: To determine the efficacy of moderate sedation in patients undergoing cardiac catheterization. Materials and Methods: The authors retrospectively analyzed patients undergoing cardiac catheterization. They were divided into the moderate sedation group, which received midazolam, fentanyl, or combined midazolam and fentanyl, and the control group, which received no sedative medication. The primary endpoint was self-reported pain score during the procedure. The secondary endpoint was a hemodynamic variation during the procedure. Propensity-score matching was used to reduce confounding biases. Results: One hundred ninety-six patients were included, with 111 patients in the moderate sedation group and 85 patients in the control group. The proportion of patients who experienced any pain was significantly lower in the moderate sedation group than in the control group at 3.6% versus 11.8% (p=0.028). No significant difference was found in the average change in the systolic blood pressure at –9 mmHg versus –4 mmHg (p=0.097) and the heart rate at –1 bpm versus –2 bpm (p=0.289) obtained at baseline and that at the end of the procedure between the moderate sedation group and the control group. However, the change in the diastolic blood pressure (DBP) measured at baseline and at the end of the procedure was significantly lower in the moderate sedation group than in the control group at –4 mmHg versus –1 mmHg (p=0.039). Conclusion: Moderate sedation by using a low-dose fentanyl, midazolam, or combined fentanyl and midazolam is associated with fewer episodes of pain and better DBP stability during cardiac catheterization. Keywords: Conscious sedation; Midazolam; Coronary angiography; Percutaneous coronary intervention; Cardiac catheterization

Evaluation of Anaesthetic Approaches in Transcatheter Aortic Valv Implantation Procedures.

Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement and has become a popular treatment modality for inoperable or patients at high surgical risk with severe aortic stenosis. We aimed to evaluate our perioperative anaesthetic experiences with patients undergoing TAVI under sedation or general anaesthesia (GA). One hundred and fifty-nine patients who underwent TAVI procedures were enrolled. Effects on TAVI outcomes of sedation and GA were compared. The duration of surgery and anaesthesia was significantly longer in patients who received GA. Insertion site complication and post-TAVI pacemaker implantation rates were similar between the groups, but the frequency of intraoperative complications (10% vs. 0.8%; P=0.015), intraoperative hypotension (35.3% vs. 70%; P < 0.001), and acute kidney injury (12.6% vs. 27.5%; P=0.028) was significantly higher in the GA group. Stroke occurred in seven patients, and all were in the sedation group. GA is related to increased procedure time and acute kidney injury; therefore, local anaesthesia and sedation may be the first option in patients undergoing TAVI.

The efficacy of non-anesthesiologist-administered propofol sedation with a target-controlled infusion system during double-balloon endoscopic retrograde cholangiopancreatography

BackgroundThe sedation method used during double-balloon endoscopic retrograde cholangiopancreatography (DB-ERCP) differs among countries and/or facilities, and there is no established method. This study aimed to evaluate the efficacy of non-anesthesiologist-administered propofol (NAAP) sedation using a target-controlled infusion (TCI) system during DB-ERCP.MethodsThis retrospective study was conducted between May 2017 and December 2020 at an academic center. One hundred and fifty-six consecutive patients who underwent DB-ERCP were sedated by gastroenterologists using diazepam (n = 77) or propofol with a TCI system (n = 79), depending on the period. The primary endpoint was a comparison of poor sedation rates between the two groups. Poor sedation was defined as a condition requiring the use of other sedative agents or discontinuation of the procedure. Secondary endpoints were sedation-related adverse events and risk factors for poor sedation.ResultsPoor sedation occurred significantly more often in the diazepam sedation group (diazepam sedation, n = 12 [16%] vs. propofol sedation, n = 1 [1%]; P = 0.001). Vigorous body movements (3 or 4) (diazepam sedation, n = 40 [52%] vs. propofol sedation, n = 28 [35%]; P = 0.038) and hypoxemia (< 85%) (diazepam sedation, n = 7 [9%] vs. propofol sedation, n = 1 [1%]; P = 0.027) occurred significantly more often in the diazepam sedation group. In the multivariate analysis, age < 70 years old (OR, 10.26; 95% CI, 1.57–66.98; P = 0.015), BMI ≥ 25 kg/m2 (OR, 11.96; 95% CI, 1.67–85.69; P = 0.014), and propofol sedation (OR, 0.06; 95% CI, 0.01–0.58; P = 0.015) were associated factors for poor sedation.ConclusionsNAAP sedation with the TCI system during DB-ERCP was safer and more effective than diazepam sedation.

Septoplasty and Bilateral Inferior Turbinate Surgery under Local Anesthesia with Deep Sedation versus General Anesthesia, A Retrospective Randomized Comparative Control Study

AIM: The main target of this study was to investigate the safety and efficacy and the benefits of the use of local anesthesia during septal and bilateral turbinate surgery. METHODS: This prospective, randomized control study was conducted on 140 patients between the ages of 17 and 65, though the period from march 2021 to November 2022, who were booked for septal and bilateral turbinate surgery who were randomly allocated into two groups study group (1) involving 35 patients (42 males and 28 females with mean age 34.3 ± 11.9 years old) who were received local anesthesia with deep sedation and control group (2) involving 35 patients (52 males and 18 females with mean age 33.3 ± 11.4) who were received general anesthesia from march 2021 to November 2022. RESULTS: Local anesthesia with sedation group showed a significantly less Total operation time (33.3 ± 2.62 min), real surgical time (23.64 ± 2.70 min), intraoperative blood loss (33.9 ± 2.3 mL), hospital stay duration (7.1 ± 0.7), post-operative pain (8.6%), post-operative nasal packing (8.6%), patient satisfaction (9.3 ± 0.7), and total hospital cost (17.14 ± 1.25 $), with no significant deference regarding to nausea and vomiting (5.7%), Compared to the other control group. CONCLUSION: Septoplasty with bilateral turbinate surgery under local anesthesia with deep sedation is easy, safe, reliable, and costless that to be done under general anesthesia.

Pain Management of Patients under General Anaesthesia Nalbuphine Alone or Nalbuphine with Ketorolac

Objective: To compare the efficacy of Nalbuphine alone versus Nalbuphine with Ketorolac for the management of pain in for open cholecystectomy under general anaesthesia. Study Design: Comparative prospective study. Place and Duration of Study: Anaesthesia department of CMH, Okara Cantt Pakistan, June 2019- March 2020. Methodology: Patients were divided into two Groups by the lottery method, Group-A, Nalbuphine (.12milligram/kilogram) and Group-B (Nalbuphine .06millig/kilogram+ Ketorolac 15milligram).They were all given standard anesthetic drugs and analgesics in above mentioned dose at the start of surgery. Patients were assessed regarding postoperative pain intensity using the Numerical Pain Rating Scale at 5minute, 30 minutes and 1 hour after shifting to recovery. Rescue analgesia for moderate to severe pain at 30 minutes was documented. Nausea, vomiting and sedation were also noted in both groups. Results: Sedation in Group A was 8(10.7%) as compared in Group-B 4(5.3%).The frequency of nausea and vomiting in Group A and Group-B was 6(8.0%), 4(5.3%), and 5(6.7%), 2(2.7%) respectively. Rescue analgesia being lower in Group-A compared to Group-B which was statistically significant, for moderate to severe pain at 30 minutes after shifting. Group-A 10(13.3%) of cases while Group-B 55(73.3%) of cases producing p-value 0.001.A statistically significant difference regarding pain score between both groups, p-value &lt;0.001. Conclusion: Intravenous Nalbuphine (0.12 mg/kg) was more effective in reducing pain intensity and postoperative analgesic requirements after surgery as compared to Nalbuphine (.6mg/kg)+ Ketorolac (15mg) in combination.

A comparative study between butorphanol and tramadol as adjuvant with epidural bupivacaine for post-operative analgesia after pelvi-acetabular surgery

Epidural analgesia using local anaesthetic agent is popular simple, effective &amp; economical way of providing postoperative analgesia. In few previous study opioids were added with local anaesthetics, so that even small doses can provide profound analgesia of longer duration with less side effects. We compared the efficacy of epidural butophanol with tramadol as adjuvant with bupivacaine, for postoperative analgesia in view of safety profile among opioids. Sixty patients undergoing pelvi-acetabular surgery were randomly assigned into two groups B &amp; T in double blinded fashion. Group B received 2ml Butorphanol (2mg) &amp; group T received 2ml of tramadol(100mg) as adjuvant with 8ml Bupivacaine (0.125%) as first does. 1ml Butorphanol (1mg) in group B &amp; 1 ml Tramadol(50mg) in group T as adjuvant with 9ml Bupivacaine (0.125%) as subsequent does when VAS&amp;#62;4. Quality of analgesia assessed using VAS for 24hours. Duration of analgesia calculated by time of first analgesia request. Post-operative nausea vomiting &amp; sedation compared. Both butorphanol group &amp; tramadol group provide adequate analgesia but significantly lesser requirement of analgesic doses was observed in the group T compared to Group B. Duration of analgesia in Group B was about 6-7 hour &amp; in Group T was about 8-9 hours. More PONV in Group T &amp; more sedation in group B seen. Therefore, it suggests that epidural bupivacaine with butorphanol has better quality of analgesia in comparison with bupivacaine with tramadol. Although bupivacaine with tramadol has longer duration of analgesia but causes significant nausea &amp; vomiting.

Analgesia and sedation strategy for mechanically ventilated patients in the respiratory ICU

Abstract Background Mechanical ventilation is typically required for ICU patients as part of their care. This recommends the use of analgesia and sedation in a balanced strategy to alter patients’ comfort and assist synchronization with mechanical ventilation while avoiding the downsides of excessive sedation. Objective The aim of the study was to compare between deep sedation and light sedation, analgesia, and no sedation strategies and their effects on the length of mechanical ventilation, and their effects on patients’ prognosis. Patients and methods This cohort prospective pilot study was conducted at the medical respiratory ICU at Ain Shams University Hospital in Cairo, Egypt, on 54 patients separated into four groups according to the type of sedation and analgesia suited for each patient’s severity condition. Results In this study, 54 mechanically ventilated patients in respiratory ICU were recruited. The patients were divided into group 1: no sedation or analgesia, group 2: analgesia only, group 3: light sedation, and group 4: deep sedation. There was a significant difference in Acute Physiology and Chronic Health Evaluation score and severity%, although the Acute Physiology and Chronic Health Evaluation score and severity % were the highest in group 1 (25.53, 55.11%) and group 4 (23.40, 47.68%), but the prognosis was poorer in group 4 and was affected by deep sedation (100% death rate) than that in group 1 (60.0%). The average infusion rate of fentanyl and the total dose were significantly different between groups, the highest being in the deep sedation group. ICU length of stay was nonsignificant between groups but it was lower in group 4 (median: 9 days) than other groups. The average rate of dormicum infusion in the deep sedation group was 5 µg, while there was no daily vacation period; so, it can be explained that higher doses of sedation and analgesia in group 4 affected their prognosis to be poorer than other groups. Delirium occurred in 80% of group 4 patients, but only in 6.7% of subgroups, indicating a highly significant difference. Complications either metabolic, cardiac, or hematologic in the postextubation period were higher in group 4 (60%), than in group 1 (47.7%), group 2 (40%), and group 3 (15%). Conclusion Light sedation and analgesia strategies with daily sedation interruption would have a better survival outcome and cause fewer issues in patients, who were on mechanical ventilation than a heavy sedation approach.

Ultrasound-Guided Popliteal Sciatic Nerve Block: A Minimally Invasive Method for Pain Control During Endovascular Treatment of Critical Limb Ischemia

PurposeTo evaluate the safety and effectiveness of ultrasound-guided popliteal sciatic nerve block (PSNB) for pain control in endovascular treatment of critical limb ischemia (CLI). Materials and MethodsThis retrospective study included 252 patients who underwent endovascular treatment for CLI between January 2020 and August 2022. Of these, 69 patients underwent PSNB, whereas moderate procedural sedation and analgesia was delivered in 183 patients. Pain scores were assessed using the visual analog scale (VAS) before and during the intervention. Technical and clinical success of PSNB, duration of the procedure, time to onset of nerve block, time for block resolution, and adverse events were recorded. Patient and operator satisfaction were assessed using the Likert scale. ResultsAll PSNB procedures were technically and clinically successful, and the mean procedural duration of PSNB was 5.0 minutes ± 0.8 (range, 4–7 minutes). Prolonged effect of PSNB was observed in 3 patients, which resolved within 24 hours. No adverse events were encountered. Median VAS score was significantly lower in the PSNB group than in the moderate procedural sedation and analgesia group during endovascular treatment (0 [range, 0–2] vs 3 [range, 0–7]; P < .001). Patient satisfaction was comparable (“very satisfied” in 66 [95.7%] vs 161 [88.0%]; P = .069). However, operator satisfaction was significantly higher in the PSNB group (“very satisfied” in 69 [100%] vs 161 [88.0%]; P = .003). ConclusionsPSNB is safe and effective for pain control during endovascular treatment of CLI. Low adverse event rates with high patient and operator satisfaction make PSNB a reasonable alternative for high-risk patients.

Effect of Sedation Strategy on the Hospital Length of Stay and ICU Length of Stay after On-Pump Cardiac Surgeries

Over the past decades, many approaches have been changed in intensive care and in anesthesiology. Most of these changes were included in the guidelines now well known as fast-track protocols (protocols for enhanced recovery after surgery). Cardiac anesthesiology was not an exception. Preoperative, intraoperative and postoperative management of the patient are the main components of these protocols, which are aimed at reducing the length of stay (LOS) of patients in the hospital and intensive care units (ICU).&#x0D; The aim. To detect the relationship between the sedation strategy and the duration of the hospital LOS and the ICU LOS.&#x0D; Materials and methods. This was a randomized, controlled, parallel study. We analyzed 194 patients over 18 years of age who underwent cardiac surgical treatment using artificial blood circulation. Statistical data processing was carried out on the basis of GraphPad Prism 9.0 software.&#x0D; Results. According to our research, the average hospital LOS was 7.779 ± 2.844 days in the propofol group (n = 95), 7.188 ± 1.601 days in the dexmedetomidine group (n = 16). In the group where patients were sedated with a combination of drugs (n = 83), the average length of hospitalization was 5.904 ± 1.535 days. The average ICU LOS was 2.463 ± 1.090 days in the propofol group and 2.375 ± 1.360 days in the dexmedetomidine group. In the group where patients were sedated with a combination of drugs (n = 83), the average ICU LOS was 2.361 ± 0.8776 days. The hospital LOS of patients who were sedated with a combination of drugs was lower (p &lt; 0.0001). When comparing the ICU LOS, no difference was found in all three sedation groups (p = 0.3903).&#x0D; According to the analysis conducted in the propofol group, the ICU LOS was shorter in patients who did not receive vasoactive therapy (p = 0.0299). In the dexmedetomidine sedation group, no difference was found between the ICU LOS in patients with or without vasoactive support (p = 0.5289). In the group of patients who underwent sedation with a combination of drugs, the ICU LOS was shorter in the group of patients who underwent correction with vasoactive drugs (p &lt; 0.0001).&#x0D; Conclusion. Sedation with a drug combination (dexmedetomidine and propofol) may reduce hospital LOS (p &lt; 0.0001). There was no influence of any sedation strategy on the ICU LOS (p = 0.3903). Early initiation of vasoactive support with sedative drug combination (dexmedetomidine and propofol) shortens the ICU LOS (p &lt; 0.0001).

THE EFFECT OF SEDATION STRATEGY ON THE FREQUENCY OF POSTOPERATIVE ARRHYTHMIAS AFTER CARDIAC SURGERIES WITH BYPASS

Introduction: Postoperative arrhythmias are a frequent problem after surgical interventions, both noncardiac and cardiac surgeries. A 20% higher frequency of rhythm disturbances occurs in patients after cardiac surgery. Postoperative arrhythmia has many variations. Such arrhythmias include atrial fibrillation, atrial flutter, ventricular arrhythmias, and bradyarrhythmias. There are many conflicting facts about the effect of sedative drugs, which are most often used at the moment: propofol, dexmedetomidine, on reducing the frequency of postoperative arrhythmias. Purpose: To analyze whether there is a difference in the frequency of postoperative arrhythmia in patients in different groups sedated with propofol, dexmedetomidine and their combination. Materials and methods: This is a randomized controlled parallel study. The study included 356 patients over 18 years of age who underwent cardiac surgeries operative treatment. 194 patients were analyzed. Statistical data processing was carried out on the basis of GraphPad Prism 9.0 software. Results: Of the total number of patients in the propofol sedation group without prior rhythm disturbance, in whom arrhythmia was detected in the postoperative period, n=13 patients were registered. In the dexmedetomidine sedation group, postoperative arrhythmia was observed in 8 patients, which is also 50 % of the total number of patients in this group. Among 8 patients in whom postoperative arrhythmia was registered, 5 patients did not have rhythm problems before surgery. Of the total number of patients in the group of sedation with a combination of drugs without previous rhythm disturbance, postoperative arrhythmia was detected in 19 patients. When analyzing the frequency of postoperative arrhythmias, no difference in the frequency of postoperative arrhythmias has been detected in all three sedation strategies (p=0.1107). Conclusions: According to the data we obtained, no difference was found in the frequency of postoperative arrhythmias in patients after cardiac surgery in any of the sedation groups (p=0.1107).

Effects of Propofol on Perioperative Sleep Quality in Patients Undergoing Gastrointestinal Endoscopy: A Prospective Cohort Study

PurposeSome patients experience sleep disturbances after endoscopy performed under sedation. This study aimed to evaluate the effects of propofol on sleep quality after gastrointestinal endoscopy (GE). DesignThis study was a prospective cohort study. MethodsThis study enrolled 880 patients who underwent GE. Patients who chose to undergo GE under sedation received intravenous propofol, whereas the control group did not. The Pittsburgh Sleep Quality Index (PSQI) was measured before GE (PSQI-1) and 3 weeks (PSQI-2) after GE. The Groningen Sleep Score Scale (GSQS) was used before GE (GSQS-1) and 1 (GSQS-2) and 7 days (GSQS-3) after GE. FindingsThere was a significant increase in GSQS scores from baseline to days 1 and 7 after GE (GSQS-2 vs GSQS-1, P < .001, GSQS-3 vs GSQS-1, P = .008). However, no significant changes were observed in the control group (GSQS-2 vs GSQS-1, P = .38, GSQS-3 vs GSQS-1, P = .66). On day 21, there were no significant changes in the baseline PSQI scores over time in either group (sedation group, P = .96; control group, P = .95). ConclusionsGE with propofol sedation negatively affected sleep quality for 7 days after GE but not 3 weeks after GE.

Incremental value of continuous non-invasive blood pressure control to assess hypotension during atrial fibrillation ablation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Atrial Fibrillation (AF) ablation is associated with continuous blood pressure (BP) variations related to anesthesiological regimen and energy delivery. Conventional BP monitoring with non-invasive periodic brachial BP controls can miss potential hypotensive events. Continuous non-invasive blood pressure (CNBP) measurement using the volume-clamp method (Clearsight) was demonstrated to be a reliable and effective tool for the assessment of BP during AF ablation. Purpose Aim of the study was to investigate the incidence of hypotensive events during AF ablation. Methods We included consecutive patients scheduled for AF ablation and monitored in parallel with a periodic (10 minutes) brachial BP cuff and in continuous with the CNBP System (Clearsight). All CNBP data were analyzed with the Acumen Analytics software for hypotension evaluation. According to the anesthesiological regimen, patients were divided in 2 Groups, the General Anesthesia (GA) and the Deep Sedation (DS) group. Area under the threshold (AUT, mmHg x min) of 65 mmHg and Time Weighted Average (TWA, mmHg, i.e., the AUT divided by the total duration of procedure in minutes) of area under threshold (MAP &amp;lt;65 mmHg) were compared between the two groups. Results Forty-eight patients were included, 10 (21%) in the General Anesthesia Group and 38 (79%) in the Sedation Group. Hypotension was detected in 18 patients, 9/10 (90%) were recorded in the GA group and 9/38 (23.7%) in the DS one. A total of 85 hypotensive events were recorded, 68 (80%) in the GA and 17 (20%) in the DS Group. In the overall population, mean duration of hypotensive events was 4.87 minutes (range 0 – 14.73 minutes), mean MAP &amp;lt; 65 mmHg was 54.25 ± 7.2 mmHg, mean AUT (MAP &amp;lt;65 mmHg) was 79.4 mmHg x min (range 0 – 1237.7) and mean TWA was 0.41 mmHg (range 0 – 6.9). Hypotensions were more often documented in GA than in DS patients (mean difference 6.35 events/procedure, C.I. 2.66 – 10.10, p&amp;lt;0.05) so as AUTs (mean difference 319.90 mmHg x min, C.I. 30.00 – 609.80, p=0.034) and TWAs (mean difference 1.64 mmHg, C.I. 0.18 – 3.09, p=0.032) which were significantly higher in the GA group. Brachial periodic BP measurement every 10 minutes missed the majority (n=52, 61.2%) of hypotensive events. Conclusions CNBP demonstrated a high incidence of hypotension during AF ablation, specially under GA, which are usually missed by the standard intermittent brachial non-invasive BP monitoring. Real time hypotension predictive CNBP indexes could be valuable in this setting.

Postoperative Deep Sedation after Microvascular Reconstructive Surgery for Oral Cancer Increases the Risk of Early Postoperative Pneumonia

This study investigated the effect of postoperative deep sedation after oral cancer reconstructive surgery on the occurrence of early postoperative pneumonia and early postoperative delirium. We obtained medical records of 108 consecutive patients who underwent microvascular reconstructive surgery at Tsukuba University Hospital for oral cancer between January 2013 and December 2021. Forty-six of them woke soon after surgery. Ten of these forty-six patients were restless and required immediate sedation within 3 h after surgery. The comparison between sedation group and no sedation group revealed early postoperative pneumonia in the no sedation group; however, sedation was not related to early postoperative delirium. The preoperative albumin levels of patients with postoperative pneumonia were significantly different (p = 0.03) than those of patients without postoperative pneumonia. The performance status (p = 0.02), preoperative albumin level (p = 0.02), and age 75 years or older (p = 0.02) were significantly associated with postoperative delirium. Restless patients and those who could not be sedated experienced delirium and pneumonia. The risk of pneumonia was increased for patients who were difficult to sedate.

Comparison of the effects of general anesthesia and deep sedation on anesthesia complications and mortality in endoscopic retrograde cholangiopancreatography procedures

Introduction: Endoscopic retrograde cholangiopancreatography is extremely painful and uncomfortable when performed without anesthesia. However, the type of anesthesia to be applied remains a matter of debate. In this study, general anesthesia and sedation procedures were compared in endoscopic retrograde cholangiopancreatography performed by the same anesthesia and surgical team over a 5-year period. Materials and Method: Patients aged over 65 years were divided into two groups, general anesthesia and sedation, and their data were analyzed retrospectively. Anesthesia complications, surgical complications, duration of the procedure, need for intensive care, and length of hospital stay and intensive care needs were compared between groups in 2812 patients. Results: Data from 1885 patients were analyzed. The procedure time and hospital stay were shorter, and anesthesia-related complication rate was lower in the general anesthesia group. Although not statistically significant, mortality was higher, and the need for intensive care was similar to the sedation group. The complication rate significantly increased in patients aged over 75 years Conclusion: Endoscopic retrograde cholangiopancreatography can be performed under deep sedation or general anesthesia. The experience of the anesthetist is an important factor for this choice. The use of sedation in geriatric patients is associated with more complications that require airway interventions. In addition, anesthesia complications due to prolonged procedures were more common in the sedation group. Conclusion: In our study, it was observed that general anesthesia was safer for endoscopic retrograde cholangiopancreatography procedures performed in geriatric patients by an experienced anesthesia and surgical team. Keywords: Geriatrics; Cholangiopancreatography; Anesthesia, General; Deep Sedation.

Nasal drip of dexmedetomidine for optimal sedation during PICC insertion in pediatric burn care.

For peripherally inserted central catheter (PICC) inserting, tranquil cooperation of children for an extended period is often required. Therefore, sedation is routinely induced clinically prior to PICC inserting. Chloral hydrate is a commonly used sedative for children. However, its clinical acceptance has remained low. And the sedation effect is non-satisfactory. Previous studies have confirmed the safety and effectiveness of intravenous/oral dosing or nasal dripping for sedation during the examinations of electrocardiography and computed tomography. Yet few studies have assessed the sedating efficacy of dexmedetomidine nasal drops for PICC inserting. From a cohort of 40 hospitalized patients scheduled for PICC inserting, 15 children employing a novel sedative mode of dexmedetomidine nasal drops at a dose of 2 ug/kg were assigned into group A while group B included another 25 children sedated routinely via an enema of 10% chloral hydrate at a dose of 0.5 mL/kg. The Ramsay's scoring criteria were utilized for assessing the status of sedation. Two groups were observed with regards to success rate of sedation, onset time of sedation and occurrences of adverse reactions. Statistical inter-group differences existed in success rate and onset time of sedation. The success rate of group A was higher than that of group B (93.3% vs 64.0%, X2 = 4.302, P = .038 < 0.05). Group A had a faster onset of sedation than group B (14.86 ± 2.57 vs 19.06 ± 3.40 minutes, t = 3.781, P = .001 < 0.05). No inter-group difference of statistical significance existed in occurrence of adverse reactions (P = 1.000 > 0.05). Logistic regression analysis showed that the success rate of sedation in group A was higher than that in group B, and the difference was statistically significant (P = .036 < 0.05). For sedating burn children, nasal dripping of dexmedetomidine is both safe and effective during PICC inserting. Without any obvious adverse reaction, it may relieve sufferings and enhance acceptance.

The use of Endo barrier for prevention of COVID-19 infection enables upper gastrointestinal endoscopy with high patient satisfaction in private clinic.

In the midst of the coronavirus disease 2019 (COVID-19) infection pandemic, practitioners who perform endoscopic examinations need to prevent infections through procedures, along with routine medical care. By using continuous suction, Endo barrier is thought to be effective in preventing the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) droplets and aerosols. The study aimed to evaluate patient discomfort and satisfaction with the use of the Endo barrier during esophagogastroduodenoscopy (EGD). The study evaluated the system's effectiveness as well as the system's preparation time and the amount of burden on the medical staff. EGD was performed on 788 consecutive cases using the Endo barrier. A questionnaire was used to survey patients after the procedure on four points: discomfort (feeling of pressure, breathlessness) and good points (feeling of relief and satisfaction) using a visual analog scale. In addition, patients were divided into two groups according to sedation status: with sedation (69.7%) and without sedation (30.3%), and their scores were compared. Additionally, the preparation time of the Endo barrier was measured. Patient discomfort was reported as minimal, resulting in a high level of satisfaction using this system. Although the overall results were better in the sedation group, the overall evaluation of the non-sedated group was also favorable. Furthermore, preparation time (30 s) was less burdensome for medical staff. The Endo barrier is an easy-to-implement tool to prevent COVID-19 infection in private clinics, and both patients and staff were highly satisfied with the device with or without the use of sedation during EGD.

Effects of different regimens of sedation on mechanically ventilated patients

Background: Up to one-third of intensive care unit (ICU) patients worldwide undergo mechanical ventilation. These patients frequently require analgesics and sedatives-potent medications with clear benefits and significant side effects. Objective: The current study intended to assess the effects of application of different regimens of sedation on mechanically ventilated patients regarding the length of ventilator days, length of hospital stay, multiple organ dysfunctions, ventilator-associated pneumonia (VAP), and mortality. Methods: One hundred adult patients who are intubated for any cause and attached to mechanical ventilation for more than 24 h will be included in this study. Drugs used for sedation were propofol and midazolam. Patients underwent history taking, clinical examination, laboratory investigations, chest X-ray, and electrocardiogram on admission. Results: At the end of this study, it was found that there was a significant increase in the sedation holiday group (Group II) over the no sedation group (Group I) regarding multiple organ dysfunction score, VAP, ventilator days, ICU stay, and hospital stay but there was no significant difference between both groups regarding mortality, spontaneous breathing trials, Glasgow Coma Scale, and complete blood count. Conclusions: Our results demonstrate that the use of sedatives can cause prolongation in the duration of mechanical ventilation, length of stay in the ICU, and total length of hospital stay. In addition, there is an increased risk of morbidity and mortality. It is possible to use a strategy of no sedation for critically ill patients undergoing mechanical ventilation without fears of failure.

Sedation-free upper gastrointestinal endoscopy and its cost-effectiveness

This study aimed to determine the success rate of sedation-free upper gastrointestinal (GI) endoscopy and evaluate the cost-effectiveness of this drug-free approach.The study included patients who underwent gastroscopy between February 2020 and December 2022. Demographic information such as age and gender, along with clinical data including whether the procedure was performed with sedation and the patients' tolerance status, were recorded. Statistical analysis revealed no significant difference between the sedation and sedation-free groups in terms of procedural success. Interestingly, a notable cost difference of 43% was observed between the two groups, with the sedation-free group demonstrating higher cost-effectiveness. Despite the nearly 50% higher cost associated with administering sedation, there was no significant disparity in the successful completion of the procedure between the two groups. The findings of this study indicate that sedation-free upper GI endoscopy can achieve comparable success rates to the sedation-assisted approach. Moreover, the cost-effectiveness analysis highlights the economic advantage of the drug-free alternative, given the substantial cost reduction observed in the sedation-free group. This study underscores the feasibility of implementing sedation-free procedures as a cost-effective and successful option for upper GI endoscopy

The Effect of Anesthesia Type Applied in Transcatheter Aortic Valve Implantation.

Different results have been obtained in studies on the effect of anesthesia type applied during transcatheter aortic valve implantation on in-hospital outcomes. In this study, we aimed to investigate the association of the type of anesthesia with the lenght of stay in the intensive care unit and the need for inotropes in patients undergoing transcatheter aortic valve implantation. A total of 140 patients who underwent transcatheter aortic valve implantation between January 2016 and January 2022 were retrospectively analyzed. The patients were divided into 2 groups as deep sedation and general anesthesia according to the type of anesthesia. The mean age of all patients was 78.5 ± 8.6 years, and 69 of the patients (49.3%) were female. Length of stay in intensive care unit, midazolam dosage, use of inotropic agents, and procedural hypotension were significantly lower in the deep sedation group than in the general anesthesia group [(1[1-2] vs. 1[1-2.5] days, P = 0.03), (2.1 ± 0.4 mg/kg vs. 2.3 ± 05, P = 0.02), (39 (37.9%) vs. 22 (59.5%), P = 0.02), (41 (39.8%) vs. 25 (67.6%), P = 0.004)]. General anesthesia was associated with increased use of inotropic agents during transcatheter aortic valve implantation compared to deep sedation (odds ratio = 2.93 95% CI = 1.18-7.30, P = 0.02). The use of inotropes is less in transcatheter aortic valve implantation procedures performed under deep sedation and length of stay in intensive care unit is shorter.

Феназепам® и Дексмедетомидин при плановых чрескожных коронарных вмешательствах. Сравнительный анализ

INTRODUCTION: Intraprocedural analgosedation in planned percutaneous coronary interventions is a priority method of anesthesia, since it provides comfort for patient in comparison with when it is absent; it leads to a fast recovery of patients and reduction of the incidence of complications in comparison with the general anesthesia. The question of the optimal sedation method is still open. AIM: To carry out a comparative analysis of sedation with Phenazepam® and Dexmedetomidine in planned percutaneous coronary interventions in patients with stable coronary heart disease. MATERIALS AND METHODS: A prospective randomized study was conducted from September 2021 to January 2022. The study included patients with stable ischemic heart disease (serum troponin T level less than 0.32 ng/ml; absence of anginous pain at the beginning of X-ray endovascular intervention), who had planned percutaneous coronary intervention. The Phenazepam® sedation group included 40 patients, including 30.0% (n = 12) women and 70.0% (n = 28) men. 40 patients were included in the Dexmedetomidine sedation group: 30.0% (n = 12) women, 70.0% (n = 28) men. RESULTS: There was a statistically significant (p &lt; 0.001) reduction of blood pressure and heart rate in patients in the group of sedation with Dexmedetomidine at the stage of stenting of the coronary artery, compared with analogous parameters in the group of sedation with Phenazepam®. Patients in the group of sedation with Dexmedetomidine developed chest pain at the stage of coronary artery stenting reliably 3.13 times less often (p = 0.024) than patients of the group of sedation with Phenazepam® (OR: 0.32; 95% CI: 0.13–0.80). With use of Dexmedetomidine, relief of anginal pain with narcotic analgesics was required 20 times less often (p &lt; 0.001) than with Phenazepam® (OR: 0.05; 95% CI: 0.01–0.38). One can confidently speak about the superiority and safety of analgosedation with Dexmedetomidine in planned percutaneous coronary interventions over sedation with Phenazepam®. CONCLUSIONS: Dexmedetomidine provides deeper sedation and sufficient pain relief in patients in planned percutaneous coronary interventions than Phenazepam®. At the same time, Dexmedetomidine has a more pronounced hypotensive and a negative chronotropic effect.