Terms Of Sedation Research Articles

Comparative Evaluation of Two Different Doses of Dexmedetomidine for Intra Operative Moderate Sedation During Spinal Anesthesia

Background: Intravenous (IV) sedation is often used to relieve anxiety or stress during surgery under regional anesthesia. Subarachnoid block is a widely followed regional anaesthesia technique, especially in lower abdominal and lower limb surgeries. Intense sensory and motor block, continuous supine position and the inability to move the body also brings a feeling of discomfort and phobia in many patients. Sedation has been shown to increase patient satisfaction during regional anaesthesia. Dexmedetomidine is well suited for conscious sedation as patient can be quickly aroused and oriented on demand. Aim of this study was to compare infusion doses of 0.3μg/kg/hr and 0.5μg/kg/hr, after loading dose of 1μg/kg of injection (inj).dexmedetomidine in order to obtain a better regimen for patients undergoing procedures under spinal anaesthesia in terms of sedation and hemodynamic stability.
 Objective: To compare efficacy of dexmedetomidine for intraoperative sedation and hemodynamic stability at doses of 0.3μg/kg/hr and 0.5μg/kg/hr after loading dose of 1 μg/kg in patients operated under spinal anaesthesia.
 Methods: Adult 80 Patients were randomly divided into two groups, (Group D-0.3) and (Group D-0.5). They were given spinal anaesthesia with 0.5% hyperbaric bupivacaine and initial dose of inj.dexmedetomidine 1 μg/kg was infused over 10 minutes. Group D-0.3 received maintenance dose of inj.dexmedetomidine of 0.3μg/kg/hr and Group D-0.5 received maintenance dose of 0.5μg/kg/hr. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), respiratory rate (RR), spO2 and sedation using observer’s assessment of alertness/sedation (OASS) were recorded at baseline, after loading dose, before spinal anesthesia, after spinal anesthesia at every 5 minutes upto 30 minutes, followed by every 15 minutes till the end of surgery and every 5 minutes upto 15 minutes after surgery. Data were compared using chi-square and unpaired t test. 
 Results: The mean age for Group D-0.3 is 43.9+11 and for Group D-0.5 is 35.3+20. There is no statistically significant difference in demographic profile between two groups. It was also observed that there is no statistically significant difference in HR, SBP, DBP, MAP, RR and SpO2 in all point of time (p>0.05). According to sedation score in group D-0.3 72% patients were sleeping comfortably but easily arousable and 8% patients were in deep sleep, while in group D-0.5 70% were sleeping comfortably but easily arousable and 15% in deep sleep.
 Conclusion: After a loading dose of 1 μg/kg intravenously, an iv infusion of dexmedetomidine at a lower rate, i.e. 0.3μg/kg/hr is equally effective in providing sedation for patients undergoing surgeries under spinal anesthesia as 0.5μg/kg/hr.

Comparison of the Sedative Effects of Intravenous Midazolam with Intravenous Dexmedetomidine and Duration of Spinal Anesthesia with Bupivacaine During Cesarean Section: A Randomized Double-Blinded Trial

Background: Caesarean section (CS) is a common procedure, and spinal anesthesia is a safe method for inducing anesthesia during this procedure. The disadvantages of this technique are intraoperative pain sensation, the patient’s fear of injection, and remembering surgery. Objectives: The purpose of this study was to compare the effects of intravenous midazolam with intravenous dexmedetomidine on sedation and duration of spinal anesthesia during CS. Methods: In this study, 70 parturients with ASA II were randomly divided into two groups of 35. All parturients underwent spinal anesthesia. One of the groups (i.e., group D) received intravenous dexmedetomidine, and for the other group (i.e., group M), midazolam was injected intravenously. The parturients were compared in terms of the pain score measured by visual pain scoring (VAS), duration of anesthesia, sedation, and hemodynamic stability. Results: The mean pain score in group M was significantly higher than in group D (P < 0.001). The time to the first rescue analgesia was significantly higher in group D than in group M (P < 0.001). Also, the dose of the analgesic used in the postoperative period was significantly lower in group D (P < 0.001). No significant difference was found between the two groups in terms of sedation and hemodynamic status. Conclusions: The use of dexmedetomidine in comparison with midazolam resulted in longer bupivacaine-induced spinal anesthesia and duration of analgesia during and after CS, suggesting this method as an appropriate strategy for establishing an appropriate level of intraoperative sedation in parturients undergoing CS. Neither dexmedetomidine nor midazolam caused significant hemodynamic changes.

A Comparative Study of Intramuscular Ketamine and a Combination of Intramuscular Dexmedetomidine and Ketamine as Premedication in Paediatric Anesthesia

Introduction: Preoperative anxiety is an issue of concern in paediatric anaesthesia practice. Forceful transfer of children into the operating room can cause long-term psychological trauma. This clinical study compares intramuscular ketamine and a combination of intramuscular dexmedetomidine and ketamine as anaesthetic premedicants in terms of +anxiolysis, sedation and ease of IV cannulation.
 Objectives: To compare the level of preoperative anxiety, sedation and ease of cannulation following premedication between intramuscular ketamine and a combination of intramuscular dexmedetomidine and ketamine.
 Methods: Total of 60 patients belonging to American Society of Anaesthesiologists physical status I-II, in the age group of two to ten years, scheduled for elective surgery under general anaesthesia were included in the study; Group A patients received ketamine 3mg/kg body weight while Group B patients received ketamine 2mg/kg body weight and dexmedetomidine 1mcg/kg body weight intramuscular. The outcome variables were sedation score (Richmond Agitation Sedation Scale), IV cannula acceptance (IV cannula Acceptance Score), and parental separation (Separation Score).
 Results: The groups were comparable in patient characteristics and hemodynamic parameters between the groups. Median (IQR) sedation score at 10 min were -1 (-2—0) and 0(-1—1) (p< 0.001); mean parental separation scores were 3.76± 0.43 and 3.36±0.55 (p< 0.001); IV cannula acceptance score were 3.73±0.44 and 4.53±7.27 (p= 0.001) in Group A and Group B respectively.
 Conclusion: Combination of dexmedetomidine and ketamine is superior to ketamine alone in terms of sedation at 15 min and ease of IV cannulation but comparable in terms of anxiolysis.

Efficacy of Hematoma Block VS Conscious Sedation in Terms of Pain Relief for Manipulation and Reduction of Distal Radius Fracture

Objective: To compare the efficacy of hematoma block versus conscious sedation for closed reduction of distal radius fractures. Study Design and Setting: This was a Randomized Control Trial was conducted at Dr. Ziauddin University Hospital between 1st July 2018 and 31st July 2020. Methodology: A total of 158 patients underwent closed reduction of distal radius fractures in emergency department; these patients were divided in two groups of 79 each. Hematoma block was used as an analgesic in group A whereas conscious sedation was used on the patients in group B. Both groups were then compared for effectiveness in terms of pain reduction and SPSS software version 25 was used for data analysis. Results: Median age in group A was 44 years (IQR=37-48.5 years) and 40 years (IQR=30-47.50 years) in group B. The median pain score in group A [3 (IQR=2-5)] was significantly lesser than group B [5 (IQR=3-6)] with p=0.001. In group A effectiveness was achieved in patients was 69.6% and in group B effectiveness was achieved in patients was 35.44%. Statistically there was significant difference observed in proportion of efficacy between groups with p=0.001. Conclusion: This study show that hematoma block is more effective than conscious sedation in closed manual reduction of distal radius fractures in terms of pain relief.

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.

Halogenated anesthetics vs intravenous hypnotics for short and long term sedation in the intensive care unit: A meta-analysis

To comprehensively assess peer-reviewed studies using volatile (VA) or intravenous (i/v) anesthetics for sedation in intensive care units (ICUs), with the hypothesis that the type of sedation may have an impact on survival and other clinically relevant outcomes. Systematic review and meta-analysis of randomized and non-randomized trials. ICUs. Critically ill and postoperative patients. None. Studies comparing VA versus i/v anesthetics used in the ICU settings were independently systematically searched. Finally, 15 studies (1520 patients of predominantly surgical profile needed VA sedation for less than 96 h) were included. VA had no impact on all-cause mortality (very low quality of evidence, Odds Ratio = 0.82 [0.60–1.12], p = 0.20). However, VA were associated with a reduction in duration of mechanical ventilation ( p = 0.03) and increase in ventilator-free days ( p < 0.001). VA also reduced postoperative levels of cardiac troponin (24 h), time to extubation ( p < 0.001) and awakening ( p = 0.04). In this meta-analysis, volatile sedation vs propofol caused the increase in ventilator-free days, the reduction in the duration of mechanical ventilation, time to extubation and the troponin release in medical or surgical ICU patients, while in surgical ICU patients the time to awakening was shortened. Evaluar exhaustivamente los estudios revisados por pares que utilizan anestésicos volátiles (AV) o intravenosos (iv) para sedación en unidades de cuidados intensivos (UCI), con la hipótesis de que el tipo de sedación puede tener un impacto en la supervivencia y otros resultados clínicamente relevantes. Revisión sistemática y metaanálisis de ensayos aleatorizados y no aleatorizados. UCI. Se incluyeron críticamente enfermos y postoperatorios. Ninguna. Los estudios que comparaban los AV vs. los anestésicos iv utilizados en la UCI se buscaron de forma independiente y sistemática. Finalmente, se incluyeron 15 estudios (1.520 pacientes de perfil predominantemente quirúrgico necesitaron sedación de AV durante menos de 96 h). El AV no tuvo impacto en la mortalidad por cualquier causa (calidad de los datos probatorios muy baja, Odds Ratio = 0,82 [0,60-1,12], p = 0,20). Sin embargo, el AV se asoció con una reducción de la duración de la ventilación mecánica ( p = 0,03) y aumento de los días sin ventilación mecánica ( p < 0,001). La AV también redujo los niveles postoperatorios de troponina cardíaca (24 horas), el tiempo hasta la extubación ( p < 0,001) y el despertar ( p = 0,04). En este metaanálisis, la sedación volátil vs. propofol causó el aumento de los días sin ventilación, la reducción de la duración de la ventilación mecánica, el tiempo hasta la extubación y la liberación de troponina en pacientes de la UCI médica o quirúrgica, mientras que en pacientes de la UCI quirúrgica el tiempo hasta el despertar se acortó.

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.

The advantages of inhalational sedation using an anesthetic-conserving device versus intravenous sedatives in an intensive care unit setting: A systematic review.

Sedation is fundamental to the management of patients in the intensive care unit (ICU). Its indications in the ICU are vast, including the facilitating of mechanical ventilation, permitting invasive procedures, and managing anxiety and agitation. Inhaled sedation with halogenated agents, such as isoflurane or sevoflurane, is now feasible in ICU patients using dedicated devices/systems. Its use may reduce adverse events and improve ICU outcomes compared to conventional intravenous (IV) sedation in the ICU. This review examined the effectiveness of inhalational sedation using the anesthetic conserving device (ACD) compared to standard IV sedation for adult patients in ICU and highlights the technical aspects of its functioning. We searched the PubMed, Cochrane Central Register of Controlled Trials, The Cochrane Library, MEDLINE, Web of Science, and Sage Journals databases using the terms "anesthetic conserving device," "Anaconda," "sedation" and "intensive care unit" in randomized clinical studies that were performed between 2012 and 2022 and compared volatile sedation using an ACD with IV sedation in terms of time to extubation, duration of mechanical ventilation, and lengths of ICU and hospital stay. Nine trials were included. Volatile sedation (sevoflurane or isoflurane) administered through an ACD shortened the awakening time compared to IV sedation (midazolam or propofol). Compared to IV sedation, volatile sedation administered through an ACD in the ICU shortened the awakening and extubation times, ICU length of stay, and duration of mechanical ventilation. More clinical trials that assess additional clinical outcomes on a large scale are needed.

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

1015: COMPARISON OF DEXMEDETOMIDINE HIGH AND LOW MAXIMUM DOSE STRATEGIES IN A LARGE HEALTH SYSTEM

Introduction: Different maximum doses of dexmedetomidine are utilized in various studies, with some evidence that higher doses (>0.7 mcg/kg/hr) are not more effective. Our large health system utilizes two different dexmedetomidine order sets in different regions; with different high (up to 1.5 mcg/kg/hr) and low (0.7 mcg/kg/hr) maximum doses and duration limits in place (48hr and 24hr) to encourage use for short term sedation. We hypothesize that there will be no improvement in time to/spent in RASS goal with the high dose (HD) vs. low dose (LD) regimen. Methods: This retrospective evaluation compared adult ICU patients who utilized the HD or LD dexmedetomidine order sets in April-May 2021. Patients on ECMO, in the OR, or with pre-existing bradycardia (HR < 50 bpm) were excluded. Objective was to determine impact on time in/to RASS goal, and secondary outcomes of concomitant sedative use, ICU length of stay, adverse events (hypotension, bradycardia), and therapy duration. Results: 198 patients were reviewed (100 LD, 98 HD). Patients achieved goal sedation (targeted RASS goal) earlier in the LD vs. HD group with time to goal of 1.63 hr and 5.85 hr. Percent of time in goal was also greater (74.5% vs. 66.1%). For secondary outcomes, LD had a similar number of patients using concomitant continuous sedation compared to HD (37% vs. 30%) and utilized more PRN sedative doses (64% vs. 35%). The LD and HD groups experienced similar amounts of hypotension (53% and 46%), but there was more bradycardia with LD (40% vs. 21%), possibly due to overall higher illness acuity indicated by a median ICU length of stay of 12 days (LD) and 6.5 days (HD). Despite different automatic order expiration dates (48 hr vs. 24 hr), duration of therapy for all patients who received dexmedetomidine was similar [median 17.8 hr (LD) and 20.5 hr (HD)]. Within the HD group, < 10% of patients required median doses > 1.2 mcg/kg/hr. Conclusions: A higher maximum dexmedetomidine dose order set did not lead to superior outcomes of time to RASS goal or percentage of time at goal. The order renewal requirement difference of 24 vs 48 hours did not significantly impact overall median duration. The health system will adopt the LD strategy with a default maximum dose of 0.7 mcg/kg/hr and 48-hour order duration limit across all hospitals.

Halogenated anesthetics vs intravenous hypnotics for short and long term sedation in the intensive care unit: A meta-analysis

ObjectiveTo comprehensively assess peer-reviewed studies using volatile (VA) or intravenous (i/v) anesthetics for sedation in intensive care units (ICUs), with the hypothesis that the type of sedation may have an impact on survival and other clinically relevant outcomes. DesignSystematic review and meta-analysis of randomized and non-randomized trials. SettingICUs. ParticipantsCritically ill and postoperative patients. InterventionsNone. Measurements and main resultsStudies comparing VA versus i/v anesthetics used in the ICU settings were independently systematically searched. Finally, 15 studies (1520 patients of predominantly surgical profile needed VA sedation for less than 96h) were included. VA had no impact on all-cause mortality (very low quality of evidence, Odds Ratio=0.82 [0.60–1.12], p=0.20). However, VA were associated with a reduction in duration of mechanical ventilation (p=0.03) and increase in ventilator-free days (p<0.001). VA also reduced postoperative levels of cardiac troponin (24h), time to extubation (p<0.001) and awakening (p=0.04). ConclusionsIn this meta-analysis, volatile sedation vs propofol caused the increase in ventilator-free days, the reduction in the duration of mechanical ventilation, time to extubation and the troponin release in medical or surgical ICU patients, while in surgical ICU patients the time to awakening was shortened.

Comparative Study of Intranasal Dexmedetomidine Versus Intranasal Ketamine as Premedicant in Children.

Background: Pre-operative anxiety in children not only makes induction difficult but it is also associated with an increase in the requirement of analgesics, the incidence of post-operative nausea and vomiting (PONV), emergence delirium (ED), and postoperative maladaptive behavioral changes. It can be reduced effectively by pharmacological interventions. In a quest to find the ideal premedicant and non-invasive way of its administration, we decided to compare intranasal (IN) dexmedetomidine with IN ketamine as a premedicant in pediatric patients.Aims and objectives: To compare sedation score, mask acceptance score (MAS) during induction, the incidence of ED, and other adverse events in both groups.Material and methods: Some 60 children, between 1 and 8 years of age of either sex undergoing surgical procedures were included in this study and randomly divided into two groups (Group D and Group K). Thirty minutes prior to induction of anesthesia, patients of Group D received dexmedetomidine 1 mcg kg-1 in 1 mL of 0.9% saline intranasally and patients of Group K received ketamine 5 mg kg-1 in 1 mL of 0.9% saline intranasally through calibrated dropper (0.5 mL in each nostril) in a recumbent position. Incidences of sneezing or coughing after IN administration of study drugs were recorded. The subsequent sedation scores were assessed using MOASS at 15 min, then at 30 min following premedication at the time of parental separation. After shifting patients to operation theater inhalation induction was done. MAS at induction and any adverse effects were recorded.Results: Children in Group K were found to be significantly more sedated at 30 min after administration of premedication and mask acceptance was also better (p value < 0.0001 with a confidence interval, CI=95%). But the incidence of ED and PONV was high.Conclusion: Intranasal dexmedetomidine (1 mcg kg-1) is clinically less effective as a premedicant in terms of sedation and mask acceptance in older children as compared to ketamine (5 mg kg-1), but associated with fewer incidence of ED and PONV. We recommend the usage of IN dexmedetomidine in a higher dose (1.5-2 mcg kg-1), through nebulization/atomizer for the desired level of sedation and mask acceptance.

Long-term efficacy and safety of repeated botulinum toxin a applications based on function and anesthesia type in children with cerebral palsy

PurposeThis study evaluates the motor development of patients undergoing three or more repeated Botulinum toxin A (BoNT-A) applications in a tertiary pediatric hospital as well as the safety of three different types of anesthesia. MethodsSeventy-five children who underwent BoNT-A applications at least three consecutive times at six-month intervals and a total of 320 procedures were examined. Gross Motor Function Classification System (GMFCS) was employed in motor development evaluation. The three anesthesia methods (sedation analgesia, anesthesia with larengeal mask [LMA] and inhalation mask) were compared in terms of sedation, procedure, recovery, and total operation room time. ResultsFollowing the procedures, significant motor development was observed in 60 (80%) patients. In sedation analgesia group during the first three procedures, the recovery time was seen to be significantly shorter, while there was no difference between the anesthesia methods of any procedures following the fourth. Regardless of the type of anesthesia, the recovery times of those having undergone six or more procedures were longer than those with less than six procedures. ConclusionsAs repeated BoNT-A application provides motor step progress, it can be applied safely and effectively under anesthesia. Sedation analgesia provides an easier recovery compared to LMA and mask only within the first three applications. However, recovery time increases with four or more repeated applications, specifically increasing as the number of applications increases. Level of evidenceIII.

Comparison of the Analgesic Effects of Ultrasound Guided Pectoral Nerve Block Type II and Erector Spinae Plane Block in Breast Cancer Surgery

Objectives: To compare the effect of ultrasound guided Pectoral Nerve Block 2 (PECs 2) and Erector Spinae Plane Block (ESP) for post op analgesia in patients undergoing Breast cancer surgery Methods: This observationally planned study included 40 patients over the age of ages of 18 who are of American Society of Anesthesiologists (ASA) I-III and scheduled for elective surgery due to breast malignancy were included in the study. PECs 2 block was applied to the patients after the induction of general anesthesia in Group 1 and ESP block was applied to the patients after the induction of general anesthesia in Group 2. In the postoperative period, visual analog scale (VAS) values, nausea, vomiting and sedation score values and analgesic doses used by all patients in the post-operative period were recorded. Results: Intraoperative and postoperative opioid consumption was statistically significantly lower in the PECs block group than in the ESP group. Postoperative analgesia time was longer in the PECs group. The number of patients requiring rescue opioid in the post-operative period was statistically significantly lower in the PECs group. There was no difference between the groups in terms of complications, mobilization time, time of discharge, postoperative nausea-vomiting (PONV) and terms of sedation. Conclusions: In patients who underwent breast surgery for malignancy, we found that the ultrasound (US) guided PECs 2 block achieved more effective postoperative analgesia compared to ESP block.

Patient satisfaction with deep versus light/moderate sedation for non-surgical procedures: A systematic review and meta-analysis.

Background:Deep sedation relieves a patient's anxiety and stress during the procedure by inducing patient unconsciousness. However, it remains unclear whether deep sedation actually improves patient satisfaction with the procedure. Therefore, we performed a systematic review and meta-analysis to compare the satisfaction of patients undergoing deep sedation with that of those undergoing light/moderate sedation during non-surgical procedures.Methods:A comprehensive literature search was performed using electronic databases (search until September 2020). The primary outcome was whether patient satisfaction was higher after deep sedation or light/moderate sedation. The secondary outcome was the relative safety of deep sedation compared with light/moderate sedation in terms of oxygen saturation, systolic blood pressure, and heart rate. The tertiary outcomes were the relative procedure and recovery times for deep versus light/moderate sedation.Data from each of the trials were combined, and calculations were made using DerSimonian and Laird random effects models. The pooled effect estimates for patient satisfaction were evaluated using relative risk (RR) with the 95% confidence interval (CI). The pooled effect estimates for continuous data are expressed as weighted mean difference with the 95% CI. We assessed heterogeneity with the Cochrane Q statistic and the I2 statistic. The risk of bias assessment and Grading of Recommendations Assessment, Development and Evaluation approach were used as the quality assessment method.Results:After removing unrelated studies and applying the exclusion criterion, 5 articles satisfied the inclusion criteria. Patient satisfaction was significantly higher in those who received deep sedation compared with light/moderate sedation (relative risk = 1.12; 95% CI, 1.04–1.20; P = .003; Cochrane Q = 25.0; I2 = 76%).There was no significant difference in oxygen saturation, systolic blood pressure, heart rate, and procedure times according to whether the procedures were performed under deep or light/moderate sedation. However, the recovery time was significantly prolonged in patients under deep sedation.Conclusions:Our meta-analysis suggests that deep sedation resulted in improved patient satisfaction compared with light/moderate sedation. Deep sedation is recommended for patients undergoing procedures because it improves patient satisfaction. However, respiration and circulation should be carefully monitored both intra-operatively and postoperatively.

Comparison of the effect of oral diphenhydramine and midazolam on sedation of children

Objectives: The aim of this study was to compare the effect of diphenhydramine and midazolam on sedation of children. Methods: This clinical trial was performed on children aged 1 to 7 years who referred to the emergency department for diagnostic radiology. Patients were randomly divided into two groups of midazolam and diphenhydramine. Then, 30 minutes before the start of the procedure, 0.5 mg /kg was given to the midazolam group and 0.5 cc /kg to the diphenhydramine group. If sedation occurred, the child was separated from the parents and transferred to a diagnostic procedure. After performing the intended diagnostic procedure, the information sheet was completed and the patient's vital signs were checked again. The data were then analyzed by SPSS version 19 software. Results: A total of 74 patients were included in the study. There was no significant difference between the two groups in terms of age and gender (P = 0.89; P = 0.32). The mean sedation in the midazolam and diphenhydramine groups was 1.02 and 1.59 years, respectively. A significant difference was found between the two groups in terms of sedation (P = 0.04), where a greater effect of diphenhydramine on sedation was observed. Conclusion: The findings showed that the use of diphenhydramine resulted in effective sedation for children. Due to the fact that the main problem with midazolam is its bitter taste, which makes children reluctant to eat it, the use of diphenhydramine can be recommended.

A comparison of administration of oral chloral hydrate with intranasal dexmedetomidine in sedation of children to perform electroencephalography

Background: Electroencephalography is a record of the electrical activity of the brain that is used to diagnose brain dysfunction and to determine the location of brain injury and to determine seizure activity. There is. The sedative medication used should not only have an effect on the brain’s electrical activity, but it also calms the baby. Since there have been no studies to compare the effects of intranasal oral hydrate and dexmedetomidine on sedation in children for electroencephalography, this study aimed to compare the effects of intranasal intravenous dexmedetomidine with intramuscular dexmedetomidine on electroencephalography in children. Methods: This clinical trial study was performed on 62 children candidates for electroencephalography in Imam Hossein Pediatric Hospital in Isfahan. Age, weight, and clinical data including sedation score, mean arterial pressure, respiratory rate, arterial oxygen saturation, and heart rate at pre-medication times, 15, 30, 45, and 60 minutes after drug administration. And analyzed. Results: The mean age of the children candidates for electroencephalography was 16.90 ± 1.32, out of which 35 (56.5%) were male. The results showed no significant difference between the two groups in terms of sedation, mean arterial pressure, respiratory rate, and percentage of arterial oxygen saturation (p&gt; 0.05). But the difference between the two groups was statistically significant for the variable heart rate. Heart rate was significantly lower in group B (dexmedetomidine group) than in group A (oral chlorate hydrate group) (p-value = 0.032), and time as an influencing factor in changing mean sedimentation, mean arterial pressure, respiratory rate, and heart rate (p-value &lt;0.05). But there was no significant effect on the change in arterial oxygen saturation percentage (p = 0.478). Conclusion: Chloral hydrate administration was more effective than intranasal dexmedetomidine treatment in maintaining heart rate but overall the results showed no significant difference between the two groups in terms of clinical data and child sedation score in the two groups. Was.

Washout and Awakening Times after Inhaled Sedation of Critically Ill Patients: Desflurane Versus Isoflurane

In recent years, inhaled sedation has been increasingly used in the intensive care unit (ICU). The aim of this prospective, controlled trial was to compare washout and awakening times after long term sedation with desflurane and isoflurane both administered with the Mirus™ system (TIM GmbH, Koblenz, Germany). Twenty-one consecutive critically ill patients were alternately allocated to the two study groups, obtaining inhaled sedation with either desflurane or isoflurane. After 24 h study sedation, anesthetic washout curves were recorded, and a standardized wake-up test was performed. The primary outcome measure was the time required to decrease the endtidal concentration to 50% (T50%). Secondary outcome measures were T80% and awakening times (all extremities moved, RASS −2). Decrement times (min) (desflurane versus isoflurane, median (1st quartile—3rd quartile)) (T50%: 0.3 (0.3–0.4) vs. 1.3 (0.4–2.3), log-rank test P = 0.002; P80%: 2.5 (2–5.9) vs. 12.1 (5.1–20.2), P = 0.022) and awakening times (to RASS −2: 7.5 (5.5–8.8) vs. 41.0 (24.5–43.0), P = 0.007; all extremities moved: 5.0 (4.0–8.5) vs. 13.0 (8.0–41.25), P = 0.037) were significantly shorter after desflurane compared to isoflurane. The use of desflurane with the Mirus™ system significantly shortens the washout times and leads to faster awakening after sedation of critically ill patients.

Comparative analysis of oral cavity sanation in children under general anesthesia and inhalation anesthesia with nitrogen oxide

The aim of this study was to carry out a comparative analysis of the volume of dental intervention under conditions of combined endotracheal anesthesia and inhalation anesthesia of nitrous oxide in pediatric dentistry.Materials and methods. Within the framework of this study, the results of oral cavity sanitation were analyzed in 300 patients aged 2 to 5 years. The median age was 3.7 years. The participants were divided into 2 equal samples: 150 patients underwent sanitation under general anesthesia (anesthesia group), 150 under conditions of inhalation anesthesia of nitrous oxide (sedation group). In the sedation group, there were 83 (55.3%) boys and 67 (44.7%) girls, in the anesthesia group – 89 participants (59.3%) were male, and 61 (40.7%) were female. The patients included in this study had comparable dental status. Also, when performing dental interventions in both groups, according to indications, local anesthesia was performed: children under 4 years old – lidocaine, children over 4 years old – articaine.Results. Based on the results of the analysis of the data obtained, it was found that the number of visits required for full-fledged dental treatment was statistically significantly lower in the anesthesia group compared to the sedation group: thus, all patients who underwent combined endotracheal anesthesia required only one visit to the clinic for necessary treatment. But it was also found that the total time of dental treatment differed depending on the anesthetic aid used: in the anesthesia group, it usually took from 1 to 2 hours (in 98% of patients), during this time a complete sanitation of the oral cavity was carried out, and in the sedation group varied more widely, with half of the patients in the range from 30 minutes to 1 hour (14% and 36.7% of children, respectively), but the number of visits for complete oral cavity sanitation increased to 8.Conclusions. In the present work, it was revealed that dental treatment under general anesthesia in children was more effective than the same treatment under conditions of inhalation anesthesia of nitrous oxide with preserved consciousness. The use of combined endotracheal anesthesia allows to reduce the number of visits to the clinic and avoid refusals from further dental treatment. General anesthesia was also more effective than sedation in terms of the number of cured teeth with caries, chronic pulpitis and extracted teeth. Nitrous oxide inhalation anesthesia provides partial retention of consciousness, is more manageable and better tolerated by children.

Intraoperative sedation during regional anaesthesia (Caudal epidural anaesthesia) in paediatric patients: Role of intravenous dexemedetomidine

Introduction: To avoid adverse effects of general anaesthesia, regional anaesthesia (RA) techniques are increasingly being practiced in children for different surgeries. These RA techniques are often combined with moderate degree of sedation to remain child calm and immobile. With limited literature available, we planned a prospective study to evaluate the effectiveness of dexemedetomidine as an intraoperative sedative agent with RA considering its short term sedation and least respiratory depression property. Materials and Methods: Fifty children of 1-8 year of age, ASA grade 1&2 undergoing below umbilical surgery under RA (caudal epidural anaesthesia) were selected and studied. After giving Inj. Ketamine (1mg/kg) intravenously, RA was performed with Inj. Bupivacaine. Then inj. Dexemedetomidine (1mcg/kg) IV was administered as bolus over 10 min followed by continuous infusion (0.4 mcg/kg/hr) till completion of surgery. Perioperative sedation score, vital parameters, peripheral oxygen saturation, respiratory rate and surgeon's satisfaction were observed. The Study was considered complete till stay of patient in PACU for 2hrs. Recovery time and any complications were noted. Results: The quality of sedation and surgeon's satisfaction were good in all children except three children who needed extra dose of sedative. The only adverse effects reported were bradycardia and hypotension in 3 patients which were well managed by reducing the infusion rate. Conclusion: Dexemedetomidine offers an adequate level of sedation in most of the children without haemodynamic or respiratory side effects when used intraoperatively with RA. Keywords: Dexemedetomidine, Ketamine, Regional anaesthesia, Caudal epidural anaesthesia.