Sedation Requirements Research Articles

Pulsed-field versus cryoballoon ablation for atrial fibrillation-Impact of energy source on sedation and analgesia requirement.

Pulsed field ablation (PFA) represents a novel, nonthermal energy modality that can be applied for single-shot pulmonary vein isolation (PVI) in atrial fibrillation (AF). Comparative data with regard to deep sedation to established single-shot modalities such as cryoballoon (CB) ablation are scarce. The aim of this study was to compare a deep sedation protocol in patients receiving PVI with either PFA or CB. Prospective, consecutive AF patients undergoing PVI with a pentaspline PFA catheter were compared to a retrospective CB-PVI cohort of the same timeframe. Study endpoints were the requirements of analgesics, cardiorespiratory stability, and sedation-associated complications. A total of 100 PVI patients were included (PFA n = 50, CB n = 50, mean age 66 ± 10.6, 61% male patients, 65% paroxysmal AF). Requirement of propofol, midazolam, and sufentanyl was significantly higher in the PFA group compared to CB [propofol 0.14 ± 0.04 mg/kg/min in PFA vs. 0.11 ± 0.04 mg/kg/min in CB (p = .001); midazolam 0.00086 ± 0.0004 mg/kg/min in PFA vs. 0.0006295 ± 0.0003 mg/kg/min in CB (p = .002) and sufentanyl 0.0013 ± 0.0007 µg/kg/min in PFA vs. 0.0008 ± 0.0004 µg/kg/min in CB (p < .0001)]. Sedation-associated complications did not differ between both groups (PFA n = 1/50 mild aspiration pneumonia, CB n = 0/50, p > .99). Nonsedation-associated complications (PFA: n = 2/50, 4%, CB: n = 1/50, 2%, p > .99) and procedure times (PFA 75 ± 31, CB 84 ± 32 min, p = .18) did not differ between groups. PFA is associated with higher sedation and especially analgesia requirements. However, the safety of deep sedation does not differ to CB ablation.

A randomized double blind study to evaluate the effect of nebulized dexmedetomidine on the haemodynamic response to laryngoscopy – Intubation and intubation conditions

: A cardiovascular stress response is frequently brought on by direct laryngoscopy and intubation. It is widely known that the sympathetic adrenal stimulation elicited by mechanical stimulation to the upper respiratory tract is what causes the haemodynamic response during laryngoscopy and intubation. The study's goal was to assess the impact of preoperative dexmedetomidine nebulization on the patient's hemodynamic response to laryngoscopy- intubation and the intubation conditions.: The American Society of Anaesthesiologists (ASA) I &amp; II adult patients, of either gender, undergoing elective surgeries requiring tracheal intubation were randomized to receive nebulized dexmedetomidine (Group D) or 0.9% saline (Group P), 30 minutes prior to the induction of anesthesia. This study was conducted in the department of anesthesia and critical care at the Christian Medical College in Ludhiana. Following laryngoscopy, the patient's heart rate and non-invasive systolic and diastolic blood pressure will be monitored for 10 minutes. The intubation conditions were noted during laryngoscopy.Total 100 patients with 50 in each group were included. At the time of laryngoscopy and after the intubation 1 min, 3 min,5 min, 7min and 10 min there were significantly lower trend in increasing HR, SBP, DBP and RPP in dexmedetomidine group versus saline. The intubation score representing conditions for intubation was significantly better in the dexmedetomidine group (P=0.013) than the saline group. There was no significant side effect noted (p=1.000). There was significant reduction in intraoperative analgesic and sedative requirement observed in dexmedetomidine groupOur study concluded that the nebulized dexmedetomidine attenuated haemodynamic response to laryngoscopy- intubation and provided better intubation conditions without significant side effects. We advise using nebulized dexmedetomidine pre-operatively for a surgical procedure requiring general anesthesia in order to reduce the haemodynamic response to intubation and to facilitate intubation conditions without experiencing any severe adverse effects.

Is quadratus lumborum block combined with low dose-spinal anesthesia an effective alternative to general anesthesia in patients undergoing percutaneous nephrolithotomy?

General anesthesia in high-risk patients has many complications and needs long preoperative preparations and postoperative intensive care unit (ICU). Therefore the present study aimed to evaluate the efficacy of combined low-dose spinal anesthesia with quadratus lumborum block (QLB) as an alternative to general anesthesia for patients undergoing percutaneous nephrolithotomy. A prospective study was conducted at the urology department of Al-Azhar University Hospitals in Cairo, Egypt, from January 2021 to January 2022. The study included 60 patients of ASA ll-lll scheduled for percutaneous nephrolithotomy. All patients received low-dose spinal anesthesia (5 mg bupivacaine) and QLB (QL1-QL2-QL3) approaches. The primary observation parameter was the efficacy of this technique as an alternative to general anesthesia. The secondary parameters measured were evaluation of need for intraoperative narcotics, postoperative pain score (VAS), and patients satisfaction as assessed using a 5-point Likert Scale. None of the patients was given general anesthesia, and intraoperative sedation was given to nineteen patients (32.2%). No hemodynamic changes were observed in all patients. There was a significant correlation between the use of intraoperative sedation and stone site, intraoperative blood loss, and hospital stay. Pain intensity on VAS at rest and movement was low until the 24th postoperative hour. Patient satisfaction score was 3, 4, and 5 in 1 (1.7%), 4 (6.7%), and 55 (91.6%) patients, respectively. Combined low-dose spinal anesthesia with quadratus lumborum block is an effective alternative to general anesthesia in patients undergoing PCNL procedures with good postoperative analgesia. Patients with lower calyceal punctures have a lower incidence of intraoperative sedation requirements.

Evaluation of Ultrasound- Guided Quadratus Lumborum Block for Postoperative Analgesia after Hip Surgery

Abstract Background With improvement of surgical technique, hip surgery became more frequent with increased need for adequate postoperative analgesia The main advantage of quadratus lumborum block (QLB) compared to spinal anaesthesia is the extension of local anesthetic agent beyond the transverses abdominis plane to the thoracic paravertebral space producing extensive analgesia and prolonged action. Aim of the Work to assess the analgesic efficacy of ultrasound-guided (US) trans-muscular QLB compared to spinal anaesthesia during Hip surgery and in the early postoperative period regarding pain relief, provision of comfort, and improved respiratory functions. Patients and Methods 64 patients were randomly allocated to one of 2 groups (n = 32; each); group QLB received US-guided QLB before induction of spinal anesthesia using 0.2 ml/kg bupivacaine 0.25%. Group Spinal Anaesthesia alone: received Spinal anaesthesia alone, 3.5 ml of 0.5% bupivacaine plus 25 µg fentanyl. QLB results in decreased incidence and severity of postoperative pain resulting in a decrease in incidence and degree of sedation and total opioid requirement. The quadratus lumborum block was more efficient than the spinal anaesthesia alone. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) in QLB group were superior to that for the spinal anaesthesia group. Conclusion patients having preoperative single shot QLB, as an adjuvant to spinal anesthesia, have significant less time for discharge from the postoperative care unit and better postoperative pain control compared to spinal anesthesia alone for hip surgery, in terms of VAS score and total opioid consumption as well as frequency of need.

A Comparative Study of Transversus Abdominis Plane Block versus Quadratus Lumborum Block for Postoperative Analgesia following Lower Abdominal Surgeries

Abstract Background Operations rate increased those days and postoperative pain control. The goal of postoperative pain management is provision of comfort, early mobilization and improved respiratory function without causing inadequate sedation and respiratory compromise, which can be achieved through using multimodal analgesic therapy, preference for regional techniques, avoidance of sedatives, non-invasive ventilation with supplemental oxygen and early mobilization. Aim of the Work This work aims to compare the efficacy of Transversus Abdominis Plane (TAP) Block versus Quadratus Lumborum 2 (QL 2) Block on postoperative period regarding pain control, total opioid given in the first 24-hour post-operative, VAS score and first time to ask for analgesia in patients undergoing lower abdominal surgeries. Patients and Methods After approval of the anesthesiology department and scientific and ethical committees, this Randomized controlled trial study was conducted in Ain Shams University Hospitals. Forty patients scheduled for elective lower abdominal surgeries were included in this study. The patients' age was ranged from 21 to 65 years and with the American Society of Anesthesiologists (ASA) Class-I and II. At the end of the surgery, patients were randomized using a random number table and the use of a closed envelopes technique to receive either quadratus lumborum block (Group QLB), or TAP (transversus abdominis plane) block (Group TAP), each group constitutes of 20 patients. Results In this study, the effect of quadratus lumborum block and transversus abdominis plane block result of decreased incidence and severity of postoperative pain (VAS) resulting in decrease in incidence and degree of sedation and opioid total requirement. The present study showed that the quadratus lumborum block was more efficient than the tansversus abdominis plane block. The first rescue for analgesia (pethidine), total pethidine consumption and pain scores (visual analog scale) indicated that the superiority of the QL block technique affected the TAP block technique. The patients of group TAB had higher pain scores and were the first to ask for rescue analgesia; therefore, they had highest total pethidine consumption in the first 24 hours postoperatively in comparison to patients of group QLB. This is mainly due to the extension of the local anesthetic agent beyond the transverse abdominal plane to the thoracic paravertebral space, which then results in more analgesia, even somatic and visceral pain control. Conclusion Quadratus lumborum block was the most effective technique in providing analgesia after lower abdominal surgeries in comparison to transversus abdominis plane block and even more time covering to rescue opioid.

A pilot feasibility study of an ultrasound-based tool to assess muscle mass in children with liver disease

Background: Sarcopenia is associated with adverse outcomes following liver transplantation, and at-risk children must be identified and prehabilitated. The gold standard for assessing sarcopenia in end-stage liver disease (ESLD) is CT assessment of the total Psoas Muscle Area (tPMA). However, radiation exposure and sedation requirements make this approach impractical for children. The bilateral anterior thigh thickness (BATT) is the cumulative measurement of the rectus femoris and vastus intermedius muscles by ultrasound and has been used to identify sarcopenia in adults. There are no studies assessing muscle mass in children using ultrasound. We hypothesized that measuring BATT with ultrasound in children with ESLD is feasible and is associated with sarcopenia. Methods: A prospective pilot feasibility study of patients with ESLD on the liver transplantation waitlist and age-matched healthy controls. BATT was measured by a single operator using ultrasound. tPMA indices were determined by CT imaging, along with clinical and anthropometric data. Results: Thirty children were studied between September 2021 and December 2022, 15 listed patients aged 4–30 months, and 15 controls aged 4–32 months. No major technical challenges or complications were encountered while performing the ultrasounds. Median BATTs of 30.8 mm (interquartile range: 27.9–32.8 mm) versus 32.7 mm (interquartile range: 31.8–36.9 mm) were demonstrated in the ESLD and control groups, respectively, and p = 0.01. A positive correlation (R = 0.603) was demonstrated between BATT and tPMA at the L4-5 level among patients with ESLD. No correlation was observed between BATT and anthropometrics. Conclusions: This study yields novel data on the feasibility of ultrasound to measure mid-thigh thickness in children with ESLD and suggests a correlation between BATT and tPMA, the gold standard for diagnosing sarcopenia. It sets the stage for ultrasound as a simple, noninvasive, and easily repeatable tool for assessing sarcopenia in children.

Pilot Study: Personalized Medicine in Endoscopy, Can Pharmacogenomics Predict Response to Conscious Sedation?

Adequate response to moderate (conscious) sedation varies significantly between individuals. Polymorphisms in genes encoding drug metabolizing enzymes can lead to inter-individual variability in drug efficacy, potentially influencing sedation requirements during endoscopic procedures. The aim of this study was to assess the potential role of inter-individual variation in inherited polymorphisms of drug-metabolizing enzymes, cytochrome P450 (CYP450), specifically CYP3A4 and CYP3A5, in sedation requirements for outpatient endoscopic procedures. A retrospective analysis of sedation requirements and pharmacogenomics data in 106 unique patients who received outpatient esophagogastroduodenoscopy (EGD), colonoscopy, or both between December 2011 and February 2019 was conducted. Patients were divided into two groups based on their sedation requirements during endoscopy (high vs. normal sedation). Patients with reduced a CYP2C19 metabolism (poor + intermediate metabolizers) (odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.16-0.91, p = 0.03), poor CYP3A5 metabolism (OR = 0.25, 95% CI: 0.095-0.65, p = 0.0046), and poor UGT1A1 (OR = 2.76, 95% CI: 1.07-7.13, p = 0.08) had higher odds of requiring normal sedation compared to those with CYP2C19 increased metabolism, CYP3A5 intermediate metabolism, and UGT1A1 intermediate metabolism. Information about inter-individual variation in (CYP450) genes may be useful for determining the sedation requirements for outpatient endoscopic procedures. We found that patients with reduced CYP2C19 metabolism, poor CYP3A5 metabolism, and poor UGT1A1 metabolism were more likely to require normal sedation requirements during outpatient endoscopic procedures.

Effect of Classical Music on Depth of Sedation and Induction Propofol Requirements in Dogs.

The main objective of this prospective, randomized, blind, cross-over experimental study was to evaluate the effect of classical music on the depth of sedation and propofol requirements for the induction of anaesthesia in dogs. Twenty dogs were involved, and each was subjected to three different treatments with a 3-month gap: Chopin music, Mozart music, and no music, via loudspeakers. The dogs were premedicated with acepromazine and butorphanol by intramuscular injection, and anaesthesia was induced using propofol intravenously. To compare the depth of sedation and propofol requirements for the induction of anaesthesia among the different treatments, we utilized non-parametric tests (Kruskal-Wallis test) for the depth of sedation due to a slight deviation from the normal distribution and parametric (ANOVA) for propofol requirements. When exposed to music (Chopin or Mozart), dogs exhibited deeper sedation and required less propofol for their intubation compared to the no-music treatment (p < 0.05). Exposure to classical music had a positive impact on the level of sedation, and more profound central nervous system depression seemed to contribute to approximately 20% lower propofol dose requirements for tracheal intubation. Therefore, classical music during the preoperative period appeared to exert a beneficial effect, at least when applying the specific pre-anaesthetic medications used in the present study.

Intravenous Dexmedetomidine-Ketamine Versus Ketamine-Propofol for Procedural Sedation in Adults Undergoing Short Surgical Procedures: A Randomized Controlled Trial.

Background and objective Moderate to deep sedation is a prerequisite during total intravenous anesthesia for short-duration surgeries, and it can be achieved by using individual drugs or in combination. Our study compared dexmedetomidine-ketamine (DK) versus ketamine-propofol (KP) in terms of sedation, procedural interference, hemodynamics, and incidence of side effects in patients undergoing short surgical procedures. Methods A total of 194 patients scheduled for short-duration elective surgeries were randomly allocated into two groups. Group DK received a loading dose of 1 µg/kg of dexmedetomidine and 1 mg/kg of ketamine followed by a maintenance infusion of dexmedetomidine at 0.3 µg/kg/h. Group KP received a loading dose of 1 mg/kg of ketamine and 1 mg/kg of propofol followed by a maintenance infusion of propofol at 25 µg/kg/h. For procedural interference, a rescueketamine bolus was administered at 0.25 mg/kg. Patients were monitored for the requirement of rescue ketamine bolus, procedural interference, hemodynamics, sedation, recovery time, and adverse effects. Results The procedural interference was higher in group KP than in group DK and the difference was statistically significant (P=0.001). The time to the first rescue bolus was 8.72 ± 4.47 minutes in group KP and 10.82 ± 4.01 minutes in group DK, with a difference of 2.1 minutes (p=0.026). There was no statistically significant difference in the sedation scores between both groups except at time points of six minutes and 15 minutes. Conclusion For short-duration procedures, the DK combination is superior tothe KP combination in terms of procedural interference and time to the first rescue bolus, while both groups were comparable with regard to safety and hemodynamics.

Efficacy of virtual reality distraction technique for anxiety and pain control in orthopedic forearm surgeries performed under supraclavicular brachial plexus block: A randomized controlled study

ABSTRACT Background Virtual reality (VR) distraction has been considered an alternative to medication to treat acute pain related to different procedures. This study aimed to evaluate the safety and efficacy of VR in reducing anxiety and pain in patients having orthopedic forearm operations under supraclavicular brachial plexus block. Methods This was an open-label, parallel-group, randomized trial. Thirty adult patients with American Society of Anesthesiologists physical status I or II were enrolled for orthopedic forearm operations performed under supraclavicular brachial plexus block. The patients were randomized into two equal groups. In the VR group, 15 patients performed the procedure with the use of VR and administration of midazolam according to the patient’s request, while in the control group, 15 patients received 2 mg midazolam followed by a titration dose according to the patient’s request. The primary outcome was the total intravenous sedation needed for the patient. Secondary outcomes included total perioperative analgesic utilization, incidence of harmful effects, patient satisfaction rating, and hemodynamic parameters. Results Virtual distraction technique significantly reduced the intraoperative midazolam consumption (2.00 ± 0.00 vs 6.67 ± 2.09 mg, respectively, p < 0.001) compared to the control group. The total perioperative analgesic consumption, incidence of adverse effects, and hemodynamic parameters were not significantly different in both groups. Patients who performed the block with the VR distraction technique showed better satisfaction scores compared to the control group (9.60 ± 0.51 vs 8.53 ± 0.92, respectively, p = 0.001). Conclusion In orthopedic forearm surgeries under supraclavicular nerve block, the VR distraction technique can reduce intraoperative sedation requirements and improve patient satisfaction.

Impact of COVID-19 on Sedation Requirements during Veno-Venous Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome.

COVID-19-associated ARDS (C-ARDS) is mentioned to express higher analgosedation needs, in comparison to ARDS of other etiologies. The objective of this monocentric retrospective cohort study was to compare the analgosedation needs between C-ARDS and non-COVID-19 ARDS (non-C-ARDS) on veno-venous extracorporeal membrane oxygenation (VV-ECMO). Data were collected from the electronic medical records of all adult patients treated with C-ARDS in our Department of Intensive Care Medicine between March 2020 and April 2022. The control group included patients treated with non-C-ARDS between the years 2009 and 2020. A sedation sum score was created in order to describe the overall analgosedation needs. A total of 115 (31.5%) patients with C-ARDS and 250 (68.5%) with non-C-ARDS requiring VV-ECMO therapy were included in the study. The sedation sum score was significantly higher in the C-ARDS group (p < 0.001). COVID-19 was significantly associated with analgosedation in the univariable analysis. By contrast, the multivariable model did not show a significant association between COVID-19 and the sum score. The year of VV-ECMO support, BMI, SAPS II and prone positioning were significantly associated with sedation needs. The potential impact of COVID-19 remains unclear, and further studies are warranted in order to evaluate specific disease characteristics linked with analgesia and sedation.

An observational study to compare the effect of intravenous dexmedetomidine versus intravenous magnesium sulphate pretreatment on characteristics of spinal anaesthesia

The study was conducted to assess &amp; compare the effect of pretreatment with intravenous Dexmedetomidine and Magnesium sulphate on characteristics of SAB with hyperbaric bupivacaine. 80 ASA grade I and II patients (age: 18-60 years) scheduled for infraumblical surgery under spinal anesthesia were included &amp; randomly divided into group-D (dexmedetomidine 1μ gm/kg) and group-M (magnesium sulfate 50 mg/kg). patients were given prefixed doses of either intravenous dexmedetomidine or Magnesium sulfate 15 mins before SAB. Incidence of hypotension, highest level &amp; duration of sensory &amp; motor blockage, duration of analgesia, vasopressor requirement and incidence of sedation, nausea &amp; vomiting were compared. highest upper level of sensory block after SAB was higher in group-D (p value &amp;#60; 0.001) than group-M. onset of sensory &amp; motor block was earlier &amp; duration of sensory and motor block, time of rescue analgesia was longer in group-D (p value &amp;#60; 0.001). Depth of sedation was higher in group-D though oxygen saturation and respiratory rate was comparable in both groups. Postoperative VAS score (p value &amp;#60; 0.001) was lower in dexmedetomidine group.Study suggests that Intravenous dexmedetomidine at a dose of 1μg/kg is a better adjuvant to 0.5% hyperbaric bupivacaine than MgSo at a dose of 50 mg/kg in infra-umbilical surgeries, with complications of hypotension and bradycardia occurring at acceptable incidences.

"This Won't Hurt a Bit": Is There a Role for Music in Bedside Procedures?

Music has played a long and storied role in clinical healing. However, the integration of music into clinical practice has been slow to gain traction, despite a recent meta-analysis demonstrating association of music interventions with clinically meaningful improvements in health-related quality of life. There is growing evidence that music has an active role in reducing patient pain and anxiety as well as affecting physiologic parameters, such as heart rate and blood pressure, in an ICU setting. Past studies have shown that incorporation of music into procedures in the operating room, radiology suites, and catheterization labs has reduced concurrent pharmacologic sedation requirements. In the age of patient-centered personalized medicine, we propose a call to action to implement an easily accessible, attainable checklist item offering a personal choice of music for patients during standardized bedside procedural training, to reduce anxiety, pain, and pharmacologic sedation and potentially improve clinical outcomes.

Fentanyl-Propofol Versus Ketamine-Propofol Combination for Sedation and Recovery in ERCP: A Double-Blinded Randomized Clinical Trial

Objective: The main goal of this study was to investigate the groups receiving fentanyl-propofol (fentP) against ketamine-propofol (ketP) in ERCP in terms of sedation, rescue sedation requirement, and recovery scores. Additionally, evaluated were the procedure's hemodynamic changes, postoperative pain score, complications, and endoscopist satisfaction. Methodology: A double-blinded randomized clinical trial was undertaken at the Dr. Ruth K.M. Pfau Civil Hospital Karachi's endoscopic room (DUHS) for six months. By using OPEN EPI sample size calculator, sample size was calculated. A total of 124 patients for elective ERCP were randomized into two groups by SNOSE protocol. Groups A and B, fentanyl-propofol (fentP) and ketamine-propofol (ketP), respectively, each contain 62 patients. All patients were given a loading dose of propofol 0.5 mg/kg, followed by a 75 ug/kg/minute infusion. The group fentP received fentanyl 1ml/kg (1 ug/kg) and the group ketP received ketamine 1ml/kg (0.5mg/kg). Ramsay sedation scores, the necessity for rescue sedation, and the Aldrete score post-operatively were noted. Hemodynamics during surgery and complications were also noted. Results: Sedation began noticeably earlier than usual in the group B at 0, 2 and 4 minutes (p-value &lt;0.05), whereas sedation scores were higher in the group A at 8,10, and 15 minutes (p-value &lt;0.05). Early sedation in the group B led to less consumption of rescue sedation doses (p-value &lt;0.01). However, recovery scores were comparable in each groups (p-value &gt;0.05). Conclusion: We were able to conclude that during ERCP, ketP had a significantly faster sedative onset than fentP, with less complication and a quicker recovery. Keywords: Propofol, KetP, FentP, ketamine, fentanyl, Sedation, Analgesia, ERCP, Monitored Anesthesia care.

Inhaled volatile anesthetics in the intensive care unit.

The discovery and utilization of volatile anesthetics has significantly transformed surgical practices since their inception in the mid-19th century. Recently, a paradigm shift is observed as volatile anesthetics extend beyond traditional confines of the operating theatres, finding diverse applications in intensive care settings. In the dynamic landscape of intensive care, volatile anesthetics emerge as a promising avenue for addressing complex sedation requirements, managing refractory lung pathologies including acute respiratory distress syndrome and status asthmaticus, conditions of high sedative requirements including burns, high opioid or alcohol use and neurological conditions such as status epilepticus. Volatile anesthetics can be administered through either inhaled route via anesthetic machines/devices or through extracorporeal membrane oxygenation circuitry, providing intensivists with multiple options to tailor therapy. Furthermore, their unique pharmacokinetic profiles render them titratable and empower clinicians to individualize management with heightened accuracy, mitigating risks associated with conventional sedation modalities. Despite the amounting enthusiasm for the use of these therapies, barriers to widespread utilization include expanding equipment availability, staff familiarity and training of safe use. This article delves into the realm of applying inhaled volatile anesthetics in the intensive care unit through discussing their pharmacology, administration considerations in intensive care settings, complication considerations, and listing indications and evidence of the use of volatile anesthetics in the critically ill patient population.

Does Pre-procedural Anxiety Affect the Consumption of Sedatives During Colonoscopy?

Anxiety is an unpleasant emotional stat with systemic effects. The anxiety level of the patients may increase the requirements for sedation during colonoscopy. The aim of the study was to evaluate the effect of pre-procedural anxiety on the dose of propofol. After ethical approval and informed consent, a total of 75 patients undergoing colonoscopy were enrolled in the study. Patients were informed about the procedure and the anxiety levels were assessed. The level of sedation was defined as a Bispectral Index (BIS) of 60 and was achieved by target-controlled infusion of propofol. Patients' characteristics, hemodynamic profiles, anxiety levels, the propofol dosage and complications were recorded. The procedure duration, difficulty score for colonoscopy assessed by the surgeon, and the patient's and surgeon's satisfaction with sedation instrument scores were recorded. A total of 66 patients were studied.Demographic and procedural data were similar among groups. The anxiety scores were not correlated with the total propofol dosage, hemodynamic parameters, the time needed to reach a BIS value of 60, surgeon and patient satisfaction and the time needed to regain consciousness. No complications were observed. In patients receiving deep sedation for elective colonoscopies, the pre-procedural anxiety level is not related to sedative requirement, post-procedural recovery, or surgeon and patient satisfaction.

Quetiapine for the Treatment of Pediatric Delirium.

Delirium is a common complication of critical illness, with a prevalence of 25% among pediatric intensive care unit (ICU) patients. Pharmacological treatment options for ICU delirium are limited to off-label use of antipsychotics, but their benefit remains uncertain. The purpose of this study was to evaluate quetiapine effectiveness for the treatment of delirium in critically ill pediatric patients and to describe the safety profile of quetiapine. A single-center, retrospective review of patients aged ≤ 18 years who screened positive for delirium via the Cornell Assessment of Pediatric Delirium (CAPD ≥ 9) and received ≥ 48 hours of quetiapine therapy was conducted. The relationship between quetiapine and deliriogenic medication doses was evaluated. This study included 37 patients who received quetiapine for the treatment of delirium. The change in sedation requirements before quetiapine initiation to 48 hours after the highest quetiapine dose demonstrated a downward trend; 68% of patients had a decrease in opioid requirements and 43% of patients had a decrease in benzodiazepine requirements. The median CAPD score at baseline was 17 and the median CAPD score at 48 hours after the highest dose was 16. Three patients experienced QTc prolongation (defined as a QTc ≥ 500), although none developed dysrhythmias. Quetiapine did not have a statistically significant impact on deliriogenic medication doses. There were minimal changes in QTc and dysrhythmias were not identified. Therefore, quetiapine can be safe to use in our pediatric patients but further studies are needed to find an effective dose.

Comparison of Sedation and Analgesia Requirements in Patients With SARS-CoV-2 Versus Non-SARS-CoV-2 Acute Respiratory Distress Syndrome on Veno-Venous ECMO.

Increased analgosedation requirements have been described in patients with acute respiratory distress syndrome (ARDS) on extracorporeal membrane oxygenation (ECMO) support due to unique pharmacokinetic challenges. There is a paucity of data comparing sedation requirements in patients on ECMO for ARDS secondary to SARS-CoV-2 versus other etiologies of respiratory failure. To compare sedation and analgesia requirements in adult patients with SARS-CoV-2 versus non-SARS-CoV-2 ARDS requiring veno-venous (VV) ECMO support. We performed a retrospective cohort study of adult patients receiving sedation and analgesia on VV-ECMO support. Patients were excluded if cannulated at an outside hospital for greater than 24 hours, expired within 48 hours of ECMO cannulation, or received neuromuscular blocking agents for greater than 7 consecutive days following ECMO cannulation. We evaluated 108 patients on VV-ECMO support, including 44 with non-SARS-CoV-2 ARDS and 64 with SARS-CoV-2 ARDS. The median daily dexmedetomidine requirements were significantly higher in the SARS-CoV-2 cohort (16.7 vs 13.4 mcg/kg/day, P = 0.03), while the median propofol daily requirements were significantly higher in the non-SARS-CoV-2 cohort (40.3 vs 53.5 mg/kg/day, P < 0.01). There was no difference in daily requirements of opioids, benzodiazepines, and ketamine between groups. Use of adjunct agents to facilitate weaning was significantly higher in the SARS-CoV-2 cohort (78.1% vs 43.2%, P < 0.01). Patients with ARDS on VV-ECMO support require multiple analgosedative agents with concomitant use of nonparenteral adjunct agents. Further studies are needed to evaluate optimal analgosedation strategies in patients on ECMO support.

The effect of playing music and mother's voice to children on sedation level and requirement during pediatric magnetic resonance imaging

BackgroundMagnetic resonance imaging examinations frequently cause anxiety and fear in children. The objective of this study was to investigate the effects of listening to music sound, the mother's voice, and sound isolation on the depth of sedation and need for sedatives in pediatric patients who would undergo MRI. MethodsNinety pediatric patients aged 3 to 12 years who were planned for imaging in the MRI unit were randomly assigned to isolation group (Group I), musical sound group (Group II), and mother's voice group (Group III). We evaluated patients' anxiety and sedation levels via the Observer's Assessment of Alertness/Sedation (OAA/S) ResultsHeart rate, oxygen saturation, OAA/S, and Ramsey scores during the procedure were not significantly different among the groups (p>0.05). The mean amount of propofol and total propofol consumption was statistically lower in the mother's voice group than in the isolation and music sound groups (p<0.001). Mean propofol amount and total propofol consumption were not significantly different in isolation and music sound groups (p>0.05). No difference was found between the groups regarding the time it took for the patients' Modified Aldrete score to reach 9 (p>0.05). ConclusionsIn pediatric patients, listening to the mother's voice during MRI decreased the total sedative requirement consumed without increasing the depth of sedation.

Popliteal sciatic nerve block in the endovascular management of critical limb ischaemia: a UK single-centre experience

Objective: This study aims to assess the safety and efficacy of the use of popliteal nerve block (PNB) in the endovascular management of patients with critical limb threatening ischaemia. Design: Single-centre retrospective observational study. Methods: All patients with rest pain who received PNB from March 2018 to August 2021 were included. Pain scores were recorded before and after block using a visual analogue scale (VAS). Requirements for analgesia or sedation, complications related to nerve block, and level of intervention were recorded. Results were compared with a historical cohort of patients prior to implementation of nerve blocks. Results: 68 nerve blocks were performed in 63 patients (M:F 46:17) of mean age 71.7 years (range 43–91). All patients were Fontaine classification III–IV. Sonographically, all nerve blocks were technically successful. The mean VAS pain score was 8.2 pre-block, reducing to 0.3 (p&lt;0.0001) post-block. There were no complications related to the block. Four patients required supplementary analgesia for breakthrough ischaemic pain. Compared with the historical comparison group of patients (n=62), there was a statistically significant reduction in the requirement for conscious sedation (p=0.004) and no procedures were abandoned due to pain compared with three in the historical comparison group (p=0.034). Conclusion: Popliteal sciatic nerve block is safe and effective in patients with critical limb threatening ischaemia undergoing lower limb endovascular intervention, significantly reducing the need for conscious sedation and risk of procedural abandonment.