Sedation Group Research Articles

Sleep Characteristics of Patients Admitted to Intensive Care Units after Major Abdominal Surgery

Purpose : The aim of this study was to investigate sleep parameters and architecture in patients admitted to the intensive care unit (ICU) on the day of abdominal surgery. Methods : A total of ten patients who underwent laparotomy under general anesthesia at the hepatopancreatobiliary surgery department of a general hospital in Busan, South Korea participated in this observational study. We measured total sleep time (TST), sleep efficiency (SE), wake after sleep onset (WASO), and sleep stages on their first night in the ICU using the WatchPAT300. Furthermore, we used nonparametric statistics to examine differences in postoperative sleep based on sedative administration. Results : The Median (IQR) TST for the participants was 399.50(263.80) minutes; the SE was 75.1 (30.4)%; the WASO rate was 27.8(30.6)%; and the WASO frequency was 5.50(8.50) times. Patients’ rapid eye movement (REM) sleep time was 114.31(87.88) minutes, with 55.8(11.9)% of N1, 18.2(5.3)% of N2, and 24.8 (11.7)% of N3 sleep stages. The sedation group had a longer TST (Z=-2.619, p =.008), higher SE (Z=-2.611, p =.008), lower WASO rate (Z=-2.611, p =.008), smaller number of WASOs (Z=-2.627, p =.008), and longer REM sleep (Z=-2.617, p =.008) compared to the non-sedation group. Conclusion : We observed a high rate of light sleep and awakenings during sleep in patients admitted to the ICU after surgery. Moreover, non-sedated patients lacked either deep or REM sleep. Sleep-improving interventions are needed for non-sedated surgical patients who are admitted to the ICU.

Efficacy and safety of esketamine combined with propofol for conscious sedation in painless colonoscopy: a prospective, randomized, double-blind controlled clinical trial

BackgroundWe explored the efficacy and safety of esketamine combined with propofol for conscious sedation in painless colonoscopy.MethodsA total of 195 patients who underwent painless colonoscopy surgery were randomly divided into three groups: the propofol deep sedation group (group DS), the sufentanil combined with propofol for conscious sedation (group CS1) and the esketamine combined with propofol for conscious sedation (group CS2). The primary outcomes of this study included the incidence of hypoxemia, hypotension, hypertension, and bradycardia and excellent and good rates of anaesthesia during colonoscopy. The secondary outcomes included perioperative changes in vital signs (MAP, HR, and SpO2), anaesthesia induction time, dischargeable time, patient and endoscopist satisfaction scores, and incidence of postoperative nausea and vomiting (PONV), drowsiness, dizziness, propofol injection pain, assisted ventilation and vasoactive medications.ResultsThe incidence of intraoperative hypoxemia in the DS group was significantly greater than that in the CS1 and CS2 groups (χ2 = 7.081, P = 0.029). The incidence of hypotension in the CS2 group was significantly lower than that in the DS and CS1 groups (χ2 = 16.278, P < 0.001). The risk of hypoxemia was 5.727 times higher in Group DS than in Group CS2 (OR 5.727; 95%CI 1.203–27.273), and the risk of hypotension was 9.864 times higher in Group DS than in Group CS2 (OR 9.864; 95%CI 2.770–35.120). The risk of hypotension in Group CS1 was 5.167 times that in Group CS2 (OR 5.167; 95%CI 1.396–19.117). The incidence of propofol injection pain, assisted ventilation, ephedrine usage and drowsiness in the DS group was significantly greater than that in the CS1 and CS2 groups (χ2 = 57.618, P < 0.001; χ2 = 9.544, P = 0.008; χ2 = 14.820, P = 0.001; χ2 = 37.257, P < 0.001). The incidence of dizziness during recovery in the CS1 group was significantly greater than that in the DS and CS2 groups (χ2 = 6.594, P = 0.037). The dischargeable time in the DS group was significantly greater than that in the CS1 and CS2 groups (F = 53.039, P < 0.001). The satisfaction scores of the endoscopist and patients in the DS group were significantly lower than those in the CS1 and CS2 groups (F = 17.390, P < 0.001; F = 19.282; P < 0.001).ConclusionsIn conclusion, esketamine combined with propofol for conscious sedation can be safely and effectively used for painless colonoscopy and has fewer complications.It is recommended for painless colonoscopy.

Characterization of sedation strategies in real-world use of pulsed field ablation: sub-analysis of the EU-PORIA registry

Abstract Background/Introduction With the introduction of pulsed field ablation (PFA) to treat patients with atrial fibrillation (AF), there has been interest in studying workflow and sedation strategies to better understand how this new technology can be integrated into clinical practice. Purpose Characterize the use of general anesthesia (GA) versus deep sedation during real-world use of the pentaspline PFA catheter to treat AF. Methods EU-PORIA is an all-comer AF registry enrolling consecutive patients treated with the pentaspline PFA catheter at seven high-volume centers in Europe. Patients were treated based on institutional standard of care. During follow-up, any episode of atrial tachycardia (AT) or AF lasting longer than 30 seconds was considered an arrhythmia recurrence. Results EU-PORIA enrolled 1233 patients, of which 250 ablation cases were performed under GA and 983 cases were performed with deep sedation. Six out of the 7 participating centers employed a single sedation strategy (2 GA; 4 deep sedation), with one center doing a mix of both sedation and GA. The patient population treated with GA had fewer female patients (30% vs 40%; p=0.04), a lower prevalence of hypertension (43% vs 57%; p&amp;lt;0.01), and fewer paroxysmal AF patients (54% vs 62%; p&amp;lt;0.01). The ablation strategy was performed based on operator’s discretion. In the GA group, 72% of patients received a pulmonary vein isolation (PVI)-only ablation approach versus 90% of patients in the sedation group (p&amp;lt;0.01). The most common additional lesion set performed was posterior wall isolation which accounted for 23% and 7% of cases in the GA and sedation groups, respectively (p&amp;lt;0.01). Procedure times and fluoroscopy times were significantly shorter in the sedation group versus the GA group (51 [36-84] min vs 75[60-90] min; 13 [8-19] min vs 19 [15-26] min; p&amp;lt;0.01 for both). Mapping was used in 60% of cases in the GA group versus only 26% of cases in the sedation group. Overall, there were no differences in the incidence of serious adverse events, and no difference in chronic treatment success. At 1-year follow-up, 74.8% of patients (187/250) in the GA group and 73.8% of patients (725/983) in the sedation group were free from recurrent AF/AT. Conclusion(s) In this registry, the use of deep sedation for AF ablation with the pentaspline PFA catheter demonstrated a safety and efficacy profile consistent with those procedures performed under GA. The majority of the deep sedation procedures were PVI-only and performed in a less progressed AF disease state. It is worth noting that there may be certain patient populations and center restrictions where GA will remain the necessary approach for AF ablation. This characterization of real-world use warrants further evaluation to understand optimal sedation strategies that can be used with PFA technologies.

Comparative Study on the Effectiveness, Safety, and Economic Costs of Endoscopic Submucosal Dissection for Colorectal Tumors Under Conscious Sedation and General Anesthesia.

Endoscopic submucosal dissection (ESD) is a minimally invasive surgical procedure used for en bloc removal of colorectal tumors. Although colorectal ESD is ideally conducted under conscious sedation, it is often performed under general anesthesia because of its complexity and lengthy duration. Currently, there is limited research on colorectal ESD performed under conscious sedation. The purpose of this study was to evaluate the effectiveness, safety, and economic cost of colorectal ESD under conscious sedation compared to general anesthesia. Retrospective analysis of 301 patients who underwent ESD treatment for colorectal tumors at the Endoscopy Center of Peking University Cancer Hospital from January 2018 to November 2020. Patients were divided into the sedation group (group S, n=88) and the general anesthesia group (group A, n=213) based on the anesthetic method. To balance the confounding factors between the 2 groups, 75 matched pairs were obtained after using propensity score matching (PSM). Intraoperative and postoperative parameters were then compared between the matched groups. After PSM, there was no statistically significant difference between group S and group A in terms of the surgical time, en bloc resection rate, and complete resection rate. There was also no statistically significant difference in the occurrence rates of bleeding, perforation, and post-ESD electrocoagulation syndrome (PEECS) between the 2 groups. However, the length of hospital stay was significantly shorter in group S (1.23±0.89d) than in group A (5.92±3.05d) ( P <0.05). The hospitalization costs were also significantly lower in group S (16482.34±13154.32 yuan) compared with group A (34743.74±13779.40 yuan) (P < 0.05 ). Compared to general anesthesia, performing ESD for colorectal tumors under conscious sedation has equivalent effectiveness and safety while shortening the hospital stay and reducing the economic costs.

Efficacy of virtual reality therapy versus pharmacological sedation for reducing pain and anxiety during coronary catheterisation procedures: A prospective randomised controlled trial.

The use of virtual reality (VR) therapy has grown considerably, as it is effective for reducing pain and anxiety in different clinical areas. However, it has not been well evaluated for coronary angiography and angioplasty. This study aimed to compare VR therapy with pharmacological sedation (Sedation) for reducing pain in patients undergoing a planned coronary angiography or coronary/peripheral angioplasty. In this prospective randomized controlled trial, patients were randomly allocated to one of two groups before catheterization: a Sedation group (injection of midazolam and fentanyl) or a VR group (Deepsen VR headset). The primary outcome measure was the maximum pain during the procedure (visual analogue scale: 0-10). The secondary outcome measures were anxiety following the procedure (Spielberger State Anxiety Inventory: 20-80), the occurrence of arterial spasm, the haemodynamic profile and patient satisfaction. The VR group (n = 63) had a mean pain rating of 2.5; for the Sedation group (n = 59) this was 1.0. This did not meet the criterion for non-inferiority. Anxiety was comparable between the two groups (VR: 25.4; Sedation: 24.7), as was the occurrence of arterial spasm (VR: 7.9%; Sedation: 8.5%; p = 0.91), but blood pressure was higher in the VR group (140.2/71.7 mmHgvs. 121.8/64.7 mmHg). There were no VR-related adverse effects, and patient satisfaction was high for both groups. Virtual reality therapy was not non-inferior to pharmacological sedation for reducing pain during coronary angiography or angioplasty. However, it reduced anxiety to a comparable level. Virtual reality therapy represents an alternative to pharmacological sedation, which is well accepted by patients.

Characteristics of cases for which esophageal endoscopic submucosal dissection under general anesthesia is recommended.

Esophageal endoscopic submucosal dissection (ESD) performed under general anesthesia can potentially provide more stable treatment in difficult cases than that under sedation. We evaluated the clinical characteristics and outcomes of ESD performed under general anesthesia compared with those under propofol sedation and discussed the cases in which general anesthesia is recommended. In total, 292 lesions in 265 consecutive patients undergoing esophageal ESD at Yamaguchi University Hospital from 2013 to 2023 were included in this retrospective study. ESD was performed under general anesthesia for 92 lesions in 81 patients and under propofol sedation for 200 lesions in 184 patients. Tumor long-axis diameter was larger (39.8 ± 14.4mm vs. 32.4 ± 9.9mm, p < 0.01) and dissection speed was faster (10.5 ± 5.9 mm2/min vs. 7.5 ± 4.2 mm2/min, p < 0.01) in the general anesthesia group versus the sedation group. In the sedation group, a treatment history of pharyngeal cancer was significantly associated with a slower dissection speed (p = 0.037). The sedation group showed higher frequencies of hypoxemia (0% vs 9.8%, p < 0.01), interruption due to body movement (0% vs 13%, p < 0.01), and acute adverse events (21.7% vs 33.5%, p = 0.05). A treatment history of pharyngeal cancer was shown to be the significant factor contributing to acute adverse events (p = 0.018). Esophageal ESD under general anesthesia can be a treatment option in patients with difficulty in performing stable procedures with propofol sedation. Especially in patients with a treatment history of pharyngeal cancer in whom ESD is more difficult to be performed and who are at higher risk for acute adverse events, general anesthesia can be considered.

Early Cognitive Function after Deep Sedation Using Different Anesthetic Agents in Pediatric Patients: A Prospective, Randomized Controlled Trial.

Background and Objectives: The impact of anesthetic agents on memory and cognitive function following general anesthesia is of great interest, particularly regarding their effects on the developing pediatric brain. While numerous studies have examined the relationship between anesthetic drugs and brain function, research focusing on early cognitive function following sedation remains limited. Materials and Methods: This study was a prospective, randomized controlled trial involving 148 pediatric patients scheduled for hematological procedures, specifically bone marrow aspiration (BMA) and intrathecal chemotherapy (ITC). Patients were divided into two groups based on the primary anesthetic used: the inhalational sedation group (IHG), in which sevoflurane was used, and the intravenous sedation group (IVG), which received propofol infusion. Apart from the main anesthetic agent, all sedation methods were consistent across both groups. A cognitive function test administered before sedation involved memorizing four distinct images, each associated with a different number. Then, the patients were asked to identify the omitted image upon awakening in the recovery room. Herein, this pre- vs. post-sedation test is called the early recognition assessment (ERA) tool. The primary outcome was the correct response rate after sedation for the two groups. Secondary outcomes included the sedation score, the behavior response score, and the correct response rates according to the number of sedation procedures. Results: This study included 130 patients in the final analysis, with 74 originally assigned to each group. The initial cognitive assessment revealed no significant difference in performance between the anesthetic agents. In addition, no differences were observed in the rates of correct responses or post-sedation scores after repeated procedures. However, the IVG demonstrated higher behavior response scores compared to the IHG. Conclusions: There were no significant differences in the rates of correct responses using the ERA tool between the two groups, irrespective of the number of sedation procedures performed. While some differences were noted in preoperative, intraoperative, and post-anesthesia care, these did not significantly impact the cognitive outcomes measured.

Comparison of the use of remifentanil in infusion and patient-controlled methods for sedation purposes

Aims: In this study, the infusion and patient-controlled with PCA device use of remifentanil used for sedation were compared in patients who were planned to undergo spermatic vein ligation under local anesthesia. Methods: Thirty patient between the ages of 15-45 who were in the ASA I-II group were included in the study. They were randomly divided into 3 groups: continuous infusion (Group I), patient-controlled sedation (Group P) and control group (Group C). All patients were premedicated with 0.07 mg/kg midazolam intravenously (IV). 0.1 µg/kg/min remifentanil was given to Group I, 0.5 µg/kg bolus remifentanil was given to Group P, and physiological saline was given to Group C via a PCA (patient-controlled analgesia) device. The patients' hemodynamic parameters, sedation levels, anxiety scores, drug consumption amounts, patient satisfaction and side effects were recorded in the intraoperative and postoperative periods. During the operation, 2-3 L/min oxygen was administered via mask to patients whose SpO2 fell below 93%. Results: Respiratory depression was more common in Group I but respiratory rate did not fall below 8 in any group. In Group I, 7 patient, in Group P, 4 patient required intraoperative oxygen. The total amount of drug consumed was 64.4 µg in Group P and 147.5 µg in Group I. Although the number of PCA requests was not different, 4 patients in Group I, 2 patients in Group P and 1 patient in Group C never pressed the device. In terms of patient satisfaction, 30% of the patients in Group I said it was excellent, while in Group C it was not evaluated as perfect. The number of patients who evaluated the method as excellent and very good was higher in Group P than Group I. Conclusion: Remifentanil sedation with a PCA device can be used safely compared to infusion in patients undergoing spermatic vein ligation under local anesthesia.

Efficacy of Continuous Infusion Ketamine for Analgosedation in the Medical Intensive Care Unit: A Propensity-Weighted Analysis

Background: Few randomized controlled trials have evaluated the use of ketamine vs opiate-based analgosedation. Methods: A retrospective cohort analysis of 169 mechanically ventilated patients admitted to the medical intensive care unit (MICU) at an academic medical center was conducted to evaluate efficacy of ketamine vs opiate-based analgosedation by comparing the percentage of time within target sedation range. The primary outcome was percentage of time within target sedation range (RASS -1 to +1) within first 72 hours of primary sedation initiation. Secondary outcomes including percentage of time under-sedated, over-sedated, and in coma; use of concomitant analgesic, sedative, and antipsychotic agents; presence of delirium; percentage of CPOT scores at goal; and hemodynamic effects were also evaluated. Results: After weighting, the mean percentage of time at RASS goal for ketamine patients was 43.0% compared to 41.4% for opiate-based sedation patients. Ketamine was not significantly non-inferior to opiate-based sedation for the mean percentage of time at RASS goal (P = .11). The median percentage of CPOT scores at goal was 13.3% higher in the ketamine group (P = .042). Patients in the ketamine group received significantly less additional sedative agents than the patients in the opiate-based sedation group. Conclusion: A similar percent of time at RASS goal was found for the ketamine analgosedation group compared to the opiate-based sedation group, although this did not reach statistical signicance for non-inferiority due to lack of statistical power. This study found a higher percentage of CPOT scores within goal with less additional sedative agents required compared to an opiate-based sedation regimen.

Comparison of the effects of child-centered playful companionship and pharmacological sedation in alleviating preoperative anxiety in preschool children

Objective: To investigate the effectiveness of child-centered playful companionship and sedative medication in alleviating preoperative anxiety in preschool children. Methods: A retrospective analysis was conducted on 3 825 preschool children (3-6 years) who underwent elective surgery at Shanghai Children's Medical Center from April 2021 to March 2022. The children were divided into three groups based on the preoperative anxiolytic intervention: child-centered playful companionship group (n=2 198), pharmacological sedation group (n=1 281), and no intervention group (n=346). The pharmacological sedation group received intranasal dexmedetomidine at 2 μg/kg or oral midazolam syrup at 0.5 mg/kg. The child-centered playful companionship group received care from certified preoperative sedation nurses using a child-centered playful nursing model. The no intervention group did not receive any anti-anxiety measures due to various subjective and objective reasons. Preoperative separation anxiety scores (PSAS), sedation medication usage, and Ramsay sedation scores were recorded for all children. The primary outcome was the success rate of separation based on PSAS scores across different anxiolytic intervention groups, while the secondary outcome was the Ramsay sedation score. Results: The child-centered playful companionship group included 1 462 boys and 736 girls, with a median age [M (Q1, Q3)]of 59 (49, 69) months. The pharmacological sedation group included 824 boys and 457 girls, with a median age of 52 (42, 61) months; and the no intervention group included 212 boys and 134 girls, with a median age of 57 (48, 69) months. The success rate of separation in the child-centered playful companionship group was 95.6% (2 102/2 198), and in the pharmacological sedation group was 93.8% (1 202/1 281), both significantly higher than the 43.6% (151/346) of the no intervention group (all P<0.05). Among the 1 281 children in the pharmacological sedation group, 785 received oral midazolam and 496 received intranasal dexmedetomidine. Compared to the intranasal dexmedetomidine group, the oral midazolam group was younger, had a lower body weight and a higher proportion of American Society of Anesthesiologists (ASA) class Ⅲ (all P<0.05). The success rate of separation was 93.4% (733/785) in the oral midazolam group and 94.6% (469/496) in the intranasal dexmedetomidine group, with no statistically significant difference (P=0.392). The Ramsay sedation score was 2 (2, 2) in the intranasal dexmedetomidine group, better than the 2 (2, 2) of the oral midazolam group (P=0.024). Conclusion: Both child-centered playful companionship and pharmacological sedation effectively alleviate preoperative anxiety in preschool children.

Pain and heart rate variability in neonates receiving dexmedetomidine.

Neonates in a NICU experience pain. Based on the cardiovascular and nociceptive systems link, a Newborn Infant Parasympathetic Evaluation (NIPE) monitor was designed to assess pain. The use of α2-agonists as analgesic-sedative drugs has increased in neonates. Given their effect on the autonomic system, we hypothesized that their use may alter NIPE's measurement capacity. Data were prospectively collected. The included patients were evaluated using combined pain assessment systems. Sixteen newborns requiring sedoanalgesia underwent a total of 84 pain assessments. A good correlation was found between the NIPE-index and the COMFORT-neo and the crSO2 (cerebral regional oxygen saturation). No correlation was found in premature infants. By sedation group, the correlation remained in those receiving α2-agonist. NIPE is a reliable tool for pain assessment. Further studies in premature infants are needed. The use of α2-agonist does not alter the measuring capacity of NIPE. The correlation between NIPE-index and crSO2 was also demonstrated.

The Efficacy of Inhaled Methoxyflurane Versus Intravenous Sedation for the Reduction of Acute Shoulder Dislocation

Purpose: Anterior shoulder dislocation is one of the most common emergency orthopedic conditions. In general practice, intravenous sedation is the standard treatment to relax patients during shoulder reduction procedures. Sedatives and analgesics are drugs that have side effects after administration, especially when administered intravenously. They can depress neurological function and cause respiratory and cardiovascular system side effects. Self-inhaled methoxyflurane relieves moderate to severe pain. Hospitals may benefit from minimized respiratory and cardiovascular side effects. Methods: This randomized controlled trial included 50 patients who were randomly assigned to two groups: the inhaled methoxyflurane group (Inh Group) and the intravenous sedation group (IV Group). All patients were assessed for efficacy, procedure duration, pain score during reduction, patient satisfaction, and adverse effects. Results: Fifty patients satisfied the inclusion requirement: 25 each in the Inh and IV Groups. Reduction was successfully achieved in 92% and 88% of the patients in the Inh and IV Group, respectively. The mean procedural time was 6.4 min and 15.4 min the Inh and IV Group, respectively. Moreover, the mean recovery time was 22.5 min in the Inh Group and 32.4 min in the IV Group. Conclusions: Inhaled methoxyflurane has better efficacy in reducing acute shoulder dislocation than intravenous sedation alone. Procedural and recovery times were shorter in the Inh Group. Adverse events (hemodynamic instability, desaturation, nausea, vomiting, drowsiness, and dizziness) were more frequent in the IV Group than in the Inh Group.

A Meta-Analysis Comparing General Anesthesia, Deep Sedation, and Conscious Sedation for Catheter Ablation of Atrial Fibrillation

Background: The optimal anesthesia strategy during catheter ablation of atrial fibrillation (AF) remains controversial. This meta-analysis compared general anesthesia, deep sedation, and conscious sedation in terms of procedural time and complications. Methods: Literature searches were conducted in PubMed, EMBASE, and Web of Science databases. Mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- and random-effect models on the basis of the heterogeneity among studies, as assessed by I2 statistics. The random-effect model was used when the heterogeneity was high (I2 &gt; 50%). Publication bias was evaluated through funnel plots and Egger's tests. Results: Sixteen studies were included in this study. No significant difference was observed in procedural time between the general anesthesia and conscious sedation groups (MD: –8.1479 minutes, 95% CI: from –27.6836 to 11.3878, seven studies). Deep sedation was associated with procedural time (MD: 131.8436 minutes, 95% CI: 99.6540–164.0332, eight studies). The rate of serious intraprocedural complications was 1.5% (95% CI: 1.2%–1.9%) with deep sedation (seven studies). Conscious/analog sedation had 26%–29% higher odds of perioperative complications than general anesthesia (OR: 1.2622, 95% CI: 1.0273–1.5507, nine studies). Significant heterogeneity was present across studies. Conclusions: This meta-analysis found no significant difference in procedural time between general anesthesia and conscious sedation for AF ablation. Deep sedation was associated with longer procedural time. Conscious sedation appeared to have a higher risk of perioperative complications than general anesthesia. Further randomized trials are warranted to determine the optimal anesthesia strategy.

Implications of sedation during the use of noninvasive ventilation in children with acute respiratory failure (SEDANIV Study)

BackgroundThe objective of this study was to analyze the effects of sedation administration on clinical parameters, comfort status, intubation requirements, and the pediatric intensive care unit (PICU) length of stay (LOS) in children with acute respiratory failure (ARF) receiving noninvasive ventilation (NIV).MethodsThirteen PICUs in Spain participated in a prospective, multicenter, observational trial from January to December 2021. Children with ARF under the age of five who were receiving NIV were included. Clinical information and comfort levels were documented at the time of NIV initiation, as well as at 3, 6, 12, 24, and 48 h. The COMFORT-behavior (COMFORT-B) scale was used to assess the patients’ level of comfort. NIV failure was considered to be a requirement for endotracheal intubation.ResultsA total of 457 patients were included, with a median age of 3.3 months (IQR 1.3–16.1). Two hundred and thirteen children (46.6%) received sedation (sedation group); these patients had a higher heart rate, higher COMFORT-B score, and lower SpO2/FiO2 ratio than did those who did not receive sedation (non-sedation group). A significantly greater improvement in the COMFORT-B score at 3, 6, 12, and 24 h, heart rate at 6 and 12 h, and SpO2/FiO2 ratio at 6 h was observed in the sedation group. Overall, the NIV success rate was 95.6%-intubation was required in 6.1% of the sedation group and in 2.9% of the other group (p = 0.092). Multivariate analysis revealed that the PRISM III score at NIV initiation (OR 1.408; 95% CI 1.230–1.611) and respiratory rate at 3 h (OR 1.043; 95% CI 1.009–1.079) were found to be independent predictors of NIV failure. The PICU LOS was correlated with weight, PRISM III score, respiratory rate at 12 h, SpO2 at 3 h, FiO2 at 12 h, NIV failure and NIV duration. Sedation use was not found to be independently related to NIV failure or to the PICU LOS.ConclusionsSedation use may be useful in children with ARF treated with NIV, as it seems to improve clinical parameters and comfort status but may not increase the NIV failure rate or PICU LOS, even though sedated children were more severe at technique initiation in the present sample.

P-494 Empowering women’s comfort! Sedation experts provide enhanced oocyte retrieval experiences with deep sedation

Abstract Study question What are the patient-reported-outcomes (PROs) and patient-reported-experiences (PREs) of deep sedation performed by sedation practitioners during oocyte retrievals compared to light-sedation by the fertility nurse? Summary answer Women undergoing oocyte retrievals with deep sedation by a sedation practitioner had a better experience and classified sedation the preferred method compared to light-sedation. What is known already Vaginal oocyte retrieval is a key step in modern IVF. The procedure is painfull, requiring systemic analgesics and anxiolytics which is called sedation. Light sedation is still the norm in the Netherlands although women prefer stronger analgesia, less anxiety, and less side effects such as nausea and vomiting from the opiods. From a safety point of view, the ministry of health (IGJ) recommends to perform sedation in an out-patient setting only by sedation professionals. It is known dat deep sedation delivered by trained sedation practitioners in an outpatient clinic is feasible in the Netherlands in other fields (gastroenterology etc). Study design, size, duration Prospective cohort study. In September 2021, moderate-to-deep sedation was introduced for oocytes retrievals for 5 days per week. In weekends, light sedation by the fertility nurse remained the standard. This enabled us to study PROs, defined as the view of participating women of their healthcare status, and PREs, defined as the perception of the received care, in both sedation strategies. PROs were assessed with the validated EuroQol-5D-5L questionnaire and PREs with the Iowa-Satisfaction-with Anesthesia-Scale (ISAS). Participants/materials, setting, methods All women who were scheduled for oocyte retrieval were asked to participate in PRO and PRE assessment. We assessed PROs at three time points: (i) day of trigger, (ii) 6-8 hours after discharge, (iii) 24-32 hours after oocyte retrieval. PREs were assessed 24-32 hours after oocyte retrieval. We intended to include 400 consecutive women. We performed mixed-model-analysis for between-group comparison of treatment and time effects (PROs) and a multivariate regression analysis (PRE). Main results and the role of chance A total of 460 women were scheduled for oocyte retrieval. Moderate-to deep sedation was offered 361 women and 352 (98%) received this. Light sedation was offered 83 women and 76 (92%) received this. Women with less than 3 follicles usually received analgesia only; their data were not used. Concerning the PROs, complete baseline questionnaires were available for 404/440 (93%) of women We found a significant time effect on “anxiety/sadness symptoms” which where high at (i) day of trigger in both groups and lowered at (ii) 6-8 hours after discharge; and a significant time effect in “pain” at (ii) 6-8 hours after discharge. We found no treatment effect of moderate-to-deep sedation versus light sedation for the PROs (p = 0.62). Concerning the PREs, the ISAS was scored for 398/440 (90%) of women. The maximum ISAS score is 3 points. The mean ISAS score was significantly higher in the moderate-to-deep sedation group compared to light sedation, indicating a better experience (1.8 ± 0.7 vs 0.9 ± 0.9, p = &amp;lt;0.001). Moderate-to-deep sedation was rewarded higher compared to light sedation because of less pain during the procedure (4 points better), more satisfaction (1 point better) and preference for same sedation in the future (1,5 points better). Limitations, reasons for caution The results are only applicable to the patient population of a tertiary out patient care setting. Wider implications of the findings Measurement of PREs (ISAS) should be standard-of-care to measure experiences of ambulant sedation. Our interpretation is that gynaecologists should abandon light sedation by non-anaesthesiologists and we suggest to provide deep sedation by the sedation professionals only. Trial registration number not applicable

General anesthesia versus sedation for endovascular thrombectomy: Meta-analysis and trial sequential analysis of randomized controlled trials

BackgroundThe endovascular thrombectomy procedure has become an established standard of care in clinical practice for the management of acute ischemic stroke. However, the anesthesia modality on endovascular thrombectomy remains controversial. The aim of this meta-analysis was to investigate the impact of general anesthesia compared to sedation on immediate and 3-month neurological outcomes in patients undergoing endovascular thrombectomy. MethodsPubMed, Scopus, and Embase databases were systematically searched to identify randomized controlled trials (RCTs) comparing general anesthesia with sedation in patients undergoing endovascular thrombectomy. The primary outcomes assessed were immediate and 3-month neurological function as well as the rate of successful recanalization. Additionally, secondary outcomes included pulmonary infection and symptomatic intracerebral hemorrhage. ResultsThe analysis included eight randomized controlled trials with a total of 1352 patients (General Anesthesia group,N = 609; Sedation group,N = 743) for endovascular thrombectomy. Pooled data revealed that general anesthesia achieved successful reperfusion in 84.3 %, whereas the sedation group had a rate of 70.7 % (RR = 1.77, 95 % CI 1.33 to 2.35, P < 0.0001). Furthermore, Trial Sequential Analysis (TSA) confirmed the significant impact of general anesthesia on achieving successful reperfusion. The meta-analyses found no differences in the rates of favorable cerebral outcome, as evaluated by the National Institutes of Health Stroke Scale (NIHSS) at 24–48 h and the modified Rankin Scale (mRS) at 3 months, between the general anesthesia (GA) and sedation groups. However, The incidence of pulmonary infection was significantly higher in the GA group compared to the sedation group (RR = 1.86, 95 % CI 1.07 to 3.23; P = 0.03). The incidence of symptomatic intracranial hemorrhage did not differ between the groups receiving general anesthesia and sedation. ConclusionGeneral anesthesia enhances the efficacy of recanalization without no improvement in cerebral function, while concurrently increasing the susceptibility to pulmonary infection among patients undergoing endovascular thrombectomy for acute ischemic stroke.

Multicenter, randomized, controlled comparative-effectiveness study comparing virtual reality to sedation and standard local anesthetic for pain and anxiety during epidural steroid injections

BackgroundThe main objective of this study was to determine whether virtual reality (VR) reduces procedure-related pain and other outcomes for epidural steroid injections (ESI). Randomized controlled study was undertaken in academic centers in the U.S. and Thailand where 146 patients with lumbosacral radiculopathy undergoing an ESI were allocated to immersive VR with local anesthetic, sedation with midazolam and fentanyl + local anesthetic, or local anesthetic alone.The primary outcome was procedure-related pain recorded on a 0-10 scale. Other immediate-term outcome measures were pain from a standardized subcutaneous skin wheal, procedure-related anxiety, ability to communicate, satisfaction, and time to discharge. Intermediate-term outcome measures at 4 weeks included back and leg pain scores, function, and success defined as a >2-point decrease in average leg pain coupled with a score >5/7 on a Patient Global Impression of Change scale. FindingsProcedure-related pain scores with both VR (mean 3·7 (SD 2·5)) and sedation (mean 3·2 (SD 3·0)) were lower compared to control (mean 5·2 (SD 3·1); mean differences -1.5 (-2.7, -0.4) and -2.1 (-3.3, -0.9), respectively), but VR and sedation scores did not significantly differ (mean difference 0.5 (-0.6, 1.7)). Among secondary outcomes, communication was decreased in the sedation group (mean 3·7 (SD 0·9)) compared to the VR group (mean 4·1 (SD 0·5); mean difference 0.4 (0.1, 0.6)), but neither VR nor sedation was different than control. The trends favoring sedation and VR over control for procedure-related anxiety and satisfaction were not statistically significant. Post-procedural recovery time was longer for the sedation group compared to both VR and control groups. There were no meaningful intermediate-term differences between groups except that medication reduction was lowest in the control group. InterpretationVR provides comparable benefit to sedation for procedure-related pain, anxiety and satisfaction, but with fewer side effects, superior communication and a shorter recovery period. FundingFunded in part by grants from MIRROR, Uniformed Services University of the Health Sciences, U.S. Dept. of Defense, grant # HU00011920011. Equipment was provided by Harvard MedTech, Las Vegas, NV

EVALUATING ERCP OUTCOMES: GENERAL ANESTHESIA VS. CONSCIOUS SEDATION IN A TERTIARY CARE SETTING

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a critical technique for diagnosing and treating conditions affecting the biliary and pancreatic ducts. Recently, there has been a shift towards employing general anesthesia instead of conscious sedation for these interventions to enhance comfort and efficiency, particularly in intricate cases. This investigation evaluates the decision-making process behind general anesthesia over conscious sedation and assesses their comparative effectiveness and associated complication rates. Methods: Conducted as a retrospective cohort study at Akhtar Saeed Medical and Dental College Lahore, Pakistan, in the period from November 2023 to April 2024, this research involved 380 ERCP patients equally divided into two groups: one administered general anesthesia and the other, conscious sedation. Comprehensive data collection included patient demographics, specific criteria before the procedure, procedural details, and outcomes. The analysis utilized SPSS version 26.0, applying independent t-tests and chi-square tests for continuous and categorical variables, respectively, alongside logistic regression to pinpoint procedural outcomes and complications predictors. Results: Both the general anesthesia and conscious sedation groups, averaging ages of 55.2 and 54.8 years, respectively, showed no significant disparity in BMI, ASA scores, or reasons for ERCP. Success rates of the procedures did not significantly differ, standing at 85% for general anesthesia and 83% for conscious sedation, with complication rates at 20% and 18%, respectively. Metrics such as post-procedure pain, hospitalization duration, and patient satisfaction remained statistically similar across both groups. Conclusions: The study concludes that general anesthesia for ERCP is just as effective and safe as conscious sedation, with both methods showing equivalent success and complication rates. These results advocate for a tailored, patient-centric approach in selecting anesthesia techniques for ERCP, ensuring no procedural effectiveness or patient safety compromise.

Early Postnatal Exposure to Midazolam Causes Lasting Histological and Neurobehavioral Deficits via Activation of the mTOR Pathway.

Exposure to general anesthetics can adversely affect brain development, but there is little study of sedative agents used in intensive care that act via similar pharmacologic mechanisms. Using quantitative immunohistochemistry and neurobehavioral testing and an established protocol for murine sedation, we tested the hypothesis that lengthy, repetitive exposure to midazolam, a commonly used sedative in pediatric intensive care, interferes with neuronal development and subsequent cognitive function via actions on the mechanistic target of rapamycin (mTOR) pathway. We found that mice in the midazolam sedation group exhibited a chronic, significant increase in the expression of mTOR activity pathway markers in comparison to controls. Furthermore, both neurobehavioral outcomes, deficits in Y-maze and fear-conditioning performance, and neuropathologic effects of midazolam sedation exposure, including disrupted dendritic arborization and synaptogenesis, were ameliorated via treatment with rapamycin, a pharmacologic mTOR pathway inhibitor. We conclude that prolonged, repetitive exposure to midazolam sedation interferes with the development of neural circuitry via a pathologic increase in mTOR pathway signaling during brain development that has lasting consequences for both brain structure and function.

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.