Use Of Sedation Research Articles

The WALANT Technique in Osteotomy and Bone Elongation for Brachymetatarsia: A Case Report

Introduction: Brachydactyly (BD) is considered a genetic malformation that can cause disproportionately short fingers and toes. The incidence ranges from 0.0% up to 0.05%, with a predilection for females. On the other hand, the Walant anesthetic technique is safe and effective and uses epinephrine, lidocaine, and sodium bicarbonate. Case presentation: A 50-year-old female diagnosed with BD was scheduled for an elective osteotomy with a bone elongator. During the procedure, we used the Walant technique, which does not require intravenous sedation or supplementary oxygen. Clinical discussion: Hand surgery is one of the most common procedures and usually requires the use of a tourniquet for hemostatic control, creates pain and makes the use of sedation necessary. In this case, we explained how the Walant technique can be beneficial in cases with BD. Conclusion: The Walant technique proves anesthesia and avoids the use of tourniquet and sedation, decreasing surgical times, optimizing surgical supplies, and decreasing costs and post-anesthetic recovery. It can be used as a first-line anesthetic option in selected procedures, including tendon repairs and carpal tunnel release.

Nationwide trends in diagnosed sedative, hypnotic or anxiolytic use disorders in adolescents and young adults enrolled in Medicaid: 2001-2019.

Sedative, hypnotic or anxiolytic use disorders (SHA-UD) are defined by significant impairment or distress caused by recurrent sedative, hypnotic or anxiolytic use. This study aimed to measure trends in the prevalence of SHA-UD diagnoses in adolescent and young adult US Medicaid enrollees from 2001 to 2019. Annual, cross-sectional study, 2001-2019. Medicaid Analytic eXtracts (MAX) and Transformed Medicaid Analytic Files (TAF) from 42 US states with complete data. Adolescents (13-17 years) and young adults (18-29 years) with ≥10months Medicaid enrollment in the calendar year; analytic sample contained 5.7 (2001) to 13.2 (2019) million persons per year. Annual prevalence of SHA-UD in adolescent and young adult Medicaid enrollees [defined as an inpatient or outpatient ICD code (304.1x, 305.4x, F13.1x, F13.2x) in the calendar year] was stratified by sex, race/ethnicity, receipt of a benzodiazepine, z-hypnotic or barbiturate prescription, and selected mental health diagnoses. Absolute and relative percent-changes from 2001 vs. 2019 were summarized. Secondary analyses were restricted to states with more consistent data capture. The prevalence of SHA-UD diagnoses statistically significantly increased for adolescents (0.01% to 0.04%) and young adults (0.05% to 0.24%) from 2001 to 2019. Increasing trends were observed in sex and race/ethnicity subgroups, with greatest relative increases among Non-Hispanic Black (624%) and Hispanic (529%) young adults. The trend increased among those with and without a benzodiazepine, z-hypnotic or barbiturate prescription; i.e. young adults with (2001 = 0.39% to 2019 = 1.77%) and without (2001 = 0.03% to 2019 = 0.18%) a prescription. Most adolescents (76%) and young adults (91%) with a SHA-UD diagnosis in 2019 had a comorbid substance use disorder. Sedative, hypnotic or anxiolytic use disorders (SHA-UD) diagnoses increased 3- to 5-fold between 2001 and 2019 for adolescent and young adult US Medicaid enrollees, with prevalence remaining low in adolescents. The increase over two decades may be attributed to changes in the availability, use and misuse of sedative, hypnotic and anxiolytic medications and to increased detection, awareness and diagnosing of SHA-UD.

Gender and substance use : men exposed, women vulnerable

The use of psychoactive substances affects more men than women, with a prevalence that is 1.3 to 2 times higher, except for the use of sedatives. Men are also more affected by accidents, injuries, and acts of violence. As for women, they are more vulnerable to the consequences of substance use for metabolic, hormonal, and cerebral reasons. At the same time, they suffer more psychological problems, somatic complications, and exposure to violence. Sociocultural representations may prevent them from expressing their difficulties and delay their entry into care. It is essential to understand these gender differences in order to take action to reduce the prevalence of substance use among men and to facilitate early detection and treatment among women, particularly around the time of pregnancy.

P1278 The use of pain and sedative medications among individuals with a diagnosis of Inflammatory Bowel Disease

Abstract Background Individuals with inflammatory bowel disease (IBD) frequently experience pain, poor sleep and anxiety even when disease activity is well controlled. A nationwide UK study showed that 42% individuals with IBD want help with pain and 56% want help with fatigue.(1) Unfortunately, pharmacological management of these symptoms is often inadequate and frequently associated with significant side effects, particularly when pain medications and sedatives are prescribed chronically or concurrently. Despite the risks, there is a lack of evidence regarding the trend in use of these medications in European IBD populations. Methods An extract of over 80,000 individuals with IBD was obtained from the general practice database "Clinical Practice Research Datalink" (CPRD) including details of prescriptions, diagnoses and demographics. Data from 1st January 2010 to 31st December 2019 was analysed to assess prescribing trends for opioids, gabapentinoids, benzodiazepines, and Z-drugs. We examined overall, chronic, and concurrent prescribing patterns. Chronic prescribing was defined as continuous use of opioids for more than 3 months, or Z-drugs and benzodiazepines for more than 4 weeks, in accordance with national guidelines.(2–4) Concurrent prescribing, assessed in 2-year intervals, was defined as overlapping prescriptions of opioids, gabapentinoids, Z-drugs, or benzodiazepines. Data were analysed using Stata 18 and R. Results Over the study period, the annual prevalence of gabapentinoids, and Z-drug use increased (2.5% to 5.5% and 3.3% to 3.4% respectively) while strong opioid (9.2%-8.5%), weak opioid (12.1%-9.9%) and benzodiazepine use (6.1%-5.6%) decreased (see Figure 1). The annual prevalence of chronically prescribed medications in 2019 were 2.5% strong opioids, 3.4% weak opioids, 2.4% benzodiazepines and 1.8% Z-drugs. Over 1 in 5 gabapentinoid prescriptions were concurrent with another pain or sedative medication; 17% with strong opioids, 6% benzodiazepines and 4% Z-drugs, while 18% of strong opioids, 18% Z-drugs and 18% benzodiazepines were concurrently prescribed with another pain medication or sedative (see Table 1). Conclusion Overall, prescribing rates of pain medications and sedatives in individuals with IBD remain concerning. While opioid use has dropped and sedative use is stable, gabapentinoid use has increased, and all are often co-prescribed. Chronic prescribing of these medications provides no clear benefit and poses significant risks. Future efforts should prioritise reducing chronic and concurrent prescribing of pain and sedative medications

Use of Local Anesthetic Agents and Conscious Sedation in Intrauterine Device Insertion: A Systematic Review

Intrauterine devices (IUDs) are highly effective long-acting contraceptives. However, pain associated with insertion deters some women and impacts satisfaction. This systematic review critically evaluates the effectiveness of local anesthetics, misoprostol, nonsteroidal anti-inflammatory drugs (NSAIDs), and conscious sedation for managing pain associated with IUD insertion. A comprehensive database search including PubMed, Web of Science, Google Scholar, ClinicalTrials.gov, and ProQuest was conducted from inception to July 2023 for randomized controlled trials (RCTs). RCTs assessing interventions for IUD insertion pain were included. Case reports, non-randomized studies, and non-English papers were excluded. Two independent reviewers extracted data on pain outcomes and adverse effects. The risk of bias was assessed using Cochrane tools. Thirty-nine RCTs (n = 12,345 women) met the inclusion criteria. Topical lidocaine effectively reduced pain on consistent findings across multiple high-quality RCTs. Misoprostol pretreatment facilitated easier insertions through cervical ripening. However, evidence for NSAIDs was inconclusive, with some RCTs finding no additional benefits versus placebo. Results also remained unclear for nitrous oxide conscious sedation due to variability in protocols. Nulliparity predicted higher reported pain consistently. Lidocaine and misoprostol show promise for minimizing IUD insertion pain and difficulty. Further optimization is required to standardize conscious sedation and fully evaluate NSAIDs. Improving pain management may increase favorable experiences and uptake of this reliable method.

The Effect of Opioid-Free Anaesthesia in an Apert Syndrome Child: A Case Series

Apert syndrome is an autosomal dominant inherited syndrome that presents with craniosynostosis, mid-face hypoplasia, and symmetrical syndactyly of limbs. These patients undergo different types of surgery and are challenging to the anaesthesiologist in terms of a difficult airway, causing difficulty in bag-mask ventilation and an increased incidence of postoperative airway obstruction. Apert syndrome is a congenital anomaly that is associated with a difficult airway, so we avoid opioids to decrease complications like sedation and respiratory depression and use dexmedetomidine to facilitate early postoperative recovery. We report the perioperative management of a case series of six patients with Apert syndrome with opioid-free anaesthesia.

"Clinical outcomes and healthcare costs in status epilepticus: A multivariable analysis from a tertiary center in a resource-limited setting".

As a debilitating and severe repercussion, the clinical and economic impact of Status epilepticus (SE) has not been thoroughly explored in various regions around the world, especially those with limited resources. Therefore, we aimed to identify the predictors of mortality and healthcare costs associated with SE in one tertiary care center with limited resources. This retrospective single-center cohort study, carried out at Namazi Hospital, Shiraz, Iran, included 130 SE cases from March 21, 2021, to March 20, 2022. Patient data were extracted from medical records, including demographics, clinical presentations, hospital course, treatment modalities, and costs. Multivariable regression models were used to identify factors associated with mortality and hospital stay costs. Patients were aged 1month to 92years (mean 20.36years, median 7), with a male predominance of 59.23%. Pre-existing epilepsy was found to be associated with lower mortality (p<0.05), while cardiovascular complications (p<0.05) and cerebrovascular disease (p<0.001) were significantly associated with increased mortality risks. In addition, Intensive Care Unit (ICU) admission, necessitated by complex treatment regimens, was linked to significantly higher healthcare costs (p<0.001). Older age and the use of sedatives were also associated with higher costs, while psychiatric disorders were linked to lower costs. SE imposes a substantial clinical and economic burden in resource-limited settings, as limited availability of ICU beds is common. Thus, screening SE cases based on clinical characteristics (e.g., comorbidities) is paramount. Therefore, targeted strategies are essential for optimizing care and reducing costs.

Procedural sedative effect of remimazolam in ICU patients on invasive mechanical ventilation: a randomised, prospective study

BackgroundInvasive procedures and environmental factors in the intensive care unit (ICU) may cause anxiety and discomfort in patients, who often require sedation therapy. The aim of this study was to assess the safety of remimazolam tosilate for procedural sedation in ICU patients receiving mechanical ventilation following endotracheal intubation. Eighty patients from a single centre were randomly assigned to either the propofol group or the remimazolam group. Blood tests were conducted to evaluate changes in lactate, blood lipids, liver and kidney function, and inflammatory markers, and patients’ vital signs were observed over several periods. This study compared the incidence of delirium, the impact on liver and kidney function, circulatory effects, and changes in blood lipids between the two groups. These findings have optimised the selection of medications, providing ICU patients with more options for sedation therapy.MethodsIn this single-centre randomised controlled trial, intubated patients were randomly assigned to the remimazolam group or the propofol group. Under the same analgesic regimen, the two groups received remimazolam and propofol for procedural sedation.ResultsOur primary outcome was the mean arterial pressure (MAP), which significantly differed on Days 4 and 7 (P = 0.021, control group vs. experimental group = 85.23 ± 11.24 vs. 94.36 ± 13.18, P = 0.023, 83.55 ± 8.94 vs. 92.66 ± 7.02). With respect to liver and kidney function, the ∆AST value in the remimazolam group was significantly lower than that in the control group on Day 7 (P = 0.023). There were significant differences in triglyceride (TG) levels on Days 4 and 7 (P = 0.020) and in the ∆LDL on Day 7 (P = 0.027). Furthermore, the rates of dyslipidaemia and delirium in the remimazolam group were lower than those in the propofol group (85.0%, n = 40 vs. 90.0%, n = 40; 27.5%, n = 40 vs. 55%, n = 40).ConclusionRemimazolam is a novel benzodiazepine that has demonstrated promising applications in general anaesthesia and procedural sedation; however, its use in ICU sedation is still in the early stages of research. Current evidence suggests that remimazolam is a safe sedative that is particularly well suited for patients with haemodynamic instability. Large sample-size randomised clinical trials are warranted.

A Survey of Sedation Practices for Adolescents and Young Adults With Acute Lymphoblastic Leukemia Undergoing Lumbar Puncture.

Lumbar puncture is a frequently performed procedure for patients undergoing treatment for acute lymphoblastic leukemia. This brief procedure is frequently performed with sedation in young patients but with only local anesthesia in adults. Adolescent and young adult patients may be cared for by physicians with different training backgrounds and sedation preferences, making the utilization of sedation for lumbar punctures variable among providers. The benefits of sedation for young adults with leukemia undergoing lumbar puncture (analgesia, anxiolysis, safety) must be weighed against the obligate fasting interval, hospital cost, and resource allocation that is required. We conducted a survey of pediatric and medical oncologists who care for patients with acute lymphoblastic leukemia to assess their use of sedation for adolescents and young adults undergoing lumbar punctures as part of their cancer therapy. (see Supplemental Digital Content 1, http://links.lww.com/JPHO/A723). Twenty-six percent of pediatric oncologists and 28% of medical oncologists completed the survey. Pediatric oncologists were more likely to perform lumbar punctures under sedation as compared with medical oncologists. This pattern remained consistent across all patient age ranges surveyed, despite no significant difference in the expected cumulative number of lumbar punctures that a patient was to undergo. Medical oncologists reported topicalization with local anesthetics before lumbar puncture more often than pediatric oncologists. Sedation practices for lumbar puncture during acute lymphoblastic leukemia treatment varies by specialty of treating oncologist.

Postintubation Sedation of Pediatric Patients in the Emergency Department: A Systematic Review and Meta-Analysis.

Postintubation sedation is a critical intervention for patients undergoing mechanical ventilation. Research in the intensive care unit (ICU) and adult emergency department (ED) demonstrates that appropriate postintubation sedation has a significant impact on patient outcomes. There are minimal published data regarding postintubation sedation for pediatric ED patients. To identify, describe, and critique published literature on postintubation sedation in pediatric ED patients. Embase, Ovid Medline, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.Gov. Studies describing postintubation sedation in the ED for pediatric patients (<18 years of age) intubated in the ED via rapid sequence intubation (RSI) were included. Studies reporting intubation outside the ED, intubation not by RSI, or nonpediatric patients were excluded, as were studies not reporting novel human clinical research. Data were abstracted by 2 authors using a standardized worksheet. Data included study design & setting, demographics, medications for RSI and postintubation sedation, administration of any or appropriately timed postintubation sedation, and predictive factors for postintubation sedation-related outcomes. A total of 10 studies were included, all of which were nonrandomized; there was significant heterogeneity and many key variables and outcomes were not consistently reported. Meta-analysis of eligible studies demonstrated pooled estimates of 77.3% (95% confidence interval [CI]: 62.5-92.0) for proportion of patients receiving any postintubation sedation, 43.5% (95% CI: 29.3-57.6) for proportion of patients receiving appropriately timed postintubation sedation, and 18.6 minutes (95% CI: 12.5-24.7) for median time to postintubation sedation, all with significant heterogeneity. Data on postintubation sedation in pediatric ED patients are limited. Administration of postintubation sedation is inconsistent and may be substantially delayed. Further high-quality research into the use of postintubation sedation in this setting is needed, and appropriate postintubation sedation should be a target for quality improvement.

Study on the sedative effect and safety of oral midazolam combined with dexmedetomidine nasal drops in children during magnetic resonance imaging examination.

Magnetic resonance imaging (MRI) is a crucial non-invasive diagnostic tool for pediatric diseases, requiring patients to remain still, often with the use of sedatives. Midazolam and dexmedetomidine are commonly used for sedation in children, but their combined effect needs further study. This study aims to evaluate the safety and effectiveness of combining intranasal dexmedetomidine (ID) with oral midazolam (OM) in children undergoing MRI, and assess its clinical feasibility. A prospective, randomized controlled trial was conducted with 196 pediatric patients undergoing MRI from January 2022 to December 2023. Patients were randomly assigned to a control group (OM alone) or an observation group (OM + ID), with 98 cases each. Total sedation time, wake-up time, onset time, and adverse reactions were evaluated. Sedation effectiveness was assessed using the Ramsay Sedation Score. The observation group had significantly longer total sedation time (P = 0.039) and higher one-time sedation success rate (P = 0.038) compared to the control group. The Ramsay score indicated better sedation effects in the observation group (P < 0.05). Adverse events were similar between groups and resolved with rest. Combining ID with OM provides effective sedation for pediatric MRI, with an acceptable safety profile, supporting its use in clinical practice.

Comparison of sedation and general anesthesia protocols for 18F-FDG-PET/CT studies in dogs and cats: Musculoskeletal uptake and radiation dose to workers.

In veterinary medicine, PET/CT scans are generally performed with the patient under general anesthesia. The aim of this prospective crossover study was to compare the musculoskeletal uptake of 18F-FDG and radiation doses to workers during PET/CT studies of healthy dogs and cats between sedation and general anesthesia. Volume and maximal standard uptake values (SUVmax) values of abnormal 18F-FDG uptake in the skeletal musculature, presence of misregistration artifact, and radiation doses to workers for each PET/CT study were recorded. Sedation was associated with increased volume of 18F-FDG uptake in the musculature of the thoracic limbs (p=.01), cervical (p=.02), and thoracic (p=.03) spine. Increased volume and SUVmax of the musculature assessed altogether were associated with the lighter degree of sedation (p=.04 for both). A significant decrease in the odds of misregistration artifact was observed for anesthetized animals in comparison with sedated (OR: 0.0, 95% CI: 0.0-0.0, p=.01). Radiation doses to workers were significantly higher for sedation compared with general anesthesia (p=.01) and for the anesthesia technician compared with the nuclear medicine technologist (p=.01). Use of sedation for PET/CT studies in dogs and cats is feasible. However, it is associated with increased physiologic musculoskeletal uptake of 18F-FDG in the thoracic limbs, cervical, and thoracic spine, with increased frequency of misregistration artifact, and with increased radiation doses to workers. These limitations can be overcome by recognition of the uptake pattern and monitoring/rotation of the involved staff at institutions where a high caseload is expected.

Application of automated face coding (AFC) in older adults: A pilot study.

The study aimed to assess the prevalence and nature of emotional expressions in care-dependent older adults, using an automated face coding (AFC) software. By examining the seven fundamental emotions, the study sought to understand how these emotions manifest and their potential implications for dental care in this population. Fifty care-dependent older adults' (mean-age: 78.90 ± 10.83 years; n = 50, men = 25, women = 25) emotional expressions were analyzed using an AFC software. The study measured the prevalence of the seven fundamental emotions including neutral, happy, sad, angry, surprised, scared, and disgusted. Correlations were explored between these expressions and demographic variables such as sex, age, Mini-Mental State Examination (MMSE) scores, as well as the use of sedation. Descriptive statistics, non-parametric tests and Spearman's rho correlations were applied for statistical analysis (p < 0.05). Neutral expression was the most common emotion (0.732 ± 0.23), with other emotions largely inactive. A trace of happiness was detected in women (0.110 ± 0.23), though not statistically significant (p = 0.061). Significant correlations were found between happy expressions and left eye opening (p = 0.021), and a negative correlation was observed between mouth opening and sad expressions (p = 0.049). No significant associations were found with age, MMSE scores, or sedation use. This study found that AFC software can detect and quantify emotions from facial expressions of dependent older adults and that they predominantly exhibited neutral expressions, with few signs of other emotions. Future research should explore these influences to inform personalized care approaches.

A Scoping Review of Factors Associated with Delayed Extubation in Post Cardiac Surgery Patients.

Delayed extubation (DE) after cardiac surgery is associated with high morbidity, mortality, increased length of stay in the intensive care unit, and hospital costs. Various studies have identified factors that influence the occurrence of DE in patients after cardiac surgery, but no review has systematically synthesized the results. This review aimed to identify the influencing factors and the leading causes of DE in patients after cardiac surgery. This scoping review uses the framework developed by Arksey and O'Malley (2005). Literature was searched through four databases: PubMed, Scopus, Science Direct, and CINAHL, and two search engines, Sage and Google Scholar, accessed on October 20, 2024. The articles analyzed met the inclusion criteria, such as full-text articles in English, published from 2014-2024, with case-control, cross-sectional, longitudinal, and cohort study designs and had good quality as assessed using the Joanna Briggs Institute critical appraisal checklist. Data was synthesized using thematic analysis. Eight articles with a total of 13801 participants were included in this review. The prevalence of DE after cardiac surgery ranged from 13.6% to 91.9%. The factors affecting DE were categorized into preoperative, intraoperative and postoperative. The factors most commonly reported to influence ED include preoperative factors (age ≥ 60 and EF < 50%), intraoperative factors (duration of surgery ≥7hours, use of IABP and sedatives), and postoperative factors (BNP≥806 pg/mL). The leading causes of DE after cardiac surgery are hemodynamic instability requiring increased inotropes (33.51%), reduced level of consciousness or drowsiness (31.91%), and postoperative bleeding (20.74%). The process of extubation is a crucial phase in postoperative care. By comprehending the elements that impact DE, healthcare providers can effectively allocate medical resources to enhance the success of weaning, extubation, and recovery following cardiac surgery. Consequently, further research focusing on DE is essential, particularly in patients who have undergone cardiac surgery.

Effect of mild sedation and analgesia on radial artery cannulation in novice residents: a prospective, randomized controlled trial

BackgroundRadial artery cannulation can be challenging, particularly for inexperienced providers. This study aimed to compare the success rates of resident physicians performing radial artery cannulation with mild sedation and analgesia versus without.Materials and methodsThis study was a prospective, single-center, double-blind randomized controlled trial. Twelve anesthesiology residents performed radial artery insertions on 96 patients. The procedures were conducted with either mild sedation and analgesia (treatment group) or an equivalent volume of 0.9%Nacl (control group), in a random order. The primary outcome was the success rate of radial artery cannulation within 10 min for each group. Secondary outcomes included the first-attempt success rate, visual analogue scale (VAS) scores, and self-reported patient discomfort scores (0 corresponding to “no anxious”, 1 corresponding to “mildly anxious”, 2 corresponding to “moderately anxious” and 3 corresponding to “very anxious”).ResultsThe success rate of radial artery cannulation within 10 min was 75.0% (36/48) in the treatment group and 54.2% (26/48) in the control group, respectively (difference 20.8%; P = 0.033, OR: 1.38, 95%CI: 1.02–1.88). The first-attempt success rate was 68.8% (33/48) in the treatment group, compared to 52.1% (25/48) in the control group (difference 16.7%; P = 0.095, OR: 1.32, 95%CI: 0.95–1.84). The VAS scores and self-reported patient discomfort scores were significantly lower in the treatment group than in the control group (2.0 [2.0, 2.0] vs. 3.0 [2.0, 4.0], P = 0.005; 1.0 [0.0, 2.0] vs. 2.0 [2.0, 2.0], P<0.001, respectively).ConclusionsThe success rate of radial artery cannulation within 10 min significantly increased for anesthesiology residents with the use of mild sedation and analgesia. Additionally, these medications resulted in a notable reduction in procedure-related pain and patient discomfort.Trial registrationThe study was registered at ClinicalTrials.gov (NCT05863455), with Qing-he Zhou as the principal investigator, on May 16, 2023.

Brain volumes, cognitive, and adaptive skills in school-age children with Down syndrome

BackgroundDown syndrome (DS) is the most common congenital neurodevelopmental disorder, present in about 1 in every 700 live births. Despite its prevalence, literature exploring the neurobiology underlying DS and how this neurobiology is related to behavior is limited. This study fills this gap by examining cortical volumes and behavioral correlates in school-age children with DS.MethodsSchool-age children (mean = 9.7 years ± 1.1) underwent comprehensive assessments, including cognitive and adaptive assessments, as well as an MRI scan without the use of sedation. Children with DS (n = 35) were compared to available samples of typically developing (TD; n = 80) and ASD children (n = 29). ANOVAs were conducted to compare groups on cognitive and adaptive assessments. ANCOVAs (covarying for age, sex, and total cerebral volume; TCV) compared cortical brain volumes between groups. Correlations between behavioral metrics and cortical and cerebellar volumes (separately for gray (GM) and white matter (WM)) were conducted separately by group.ResultsAs expected, children with DS had significantly lower cognitive skills compared to ASD and TD children. Daily Living adaptive skills were comparable between ASD children and children with DS, and both groups scored lower than TD children. Children with DS exhibited a smaller TCV compared to ASD and TD children. Additionally, when controlling for TCV, age, and sex, children with DS had significantly smaller total GM and tissue volumes. Cerebellum volumes were significantly correlated with Daily Living adaptive behaviors in the DS group only.ConclusionsDespite children with DS exhibiting lower cognitive skills and smaller brain volume overall than children with ASD, their deficits in Socialization and Daily Living adaptive skills are comparable. Differences in lobar volumes (e.g., Right Frontal GM/WM, Left Frontal WM, and Left and Right Temporal WM) were observed above and beyond overall differences in total volume. The correlation between cerebellum volumes and Daily Living adaptive behaviors in the DS group provides a novel area to explore in future research.

Comparing Cisgender and Trans-spectrum Postsecondary Student Alcohol and Substance Use: Results From the Arkansas Collegiate Substance Use Assessment.

Examine self-reported substance use of cisgender and trans-spectrum students. Observational Study, cross-sectional design. Arkansas post-secondary institutions. Active students enrolled in 2021, sample responses n = 3659. 9 Demographics, 13 recent substance use outcomes, 1 weekly alcohol use outcome, and 1 COVID-related substance use outcome. Demographic and geospatial descriptives; t test/Cohen's d effect size; X2 Test for Independence/Cramer's V effect size; OLS Regression/Standardized Beta coefficients/Adjusted R2 effect sizes; level of significance = .05. Trans-spectrum students are 1.8% of the sampled responses (n = 3315) with geographical variation. Weekly alcohol consumption is greater with trans-spectrum (MD = 0.74, d = .102), along with frequency of recent use of marijuana (V = .113), cocaine (V = .097), sedatives (V = .098), hallucinogens (V = .127), designer drugs (V = .087), and meth (V = .151). Suicidal thoughts (V = .112) and attempted suicide (V = .118) are greater and COVID increased use of substances (29.3% for trans-spectrum v 13.7% for cisgender, V = .073). Gender (B = .099), family history (B = .092), and campus policies (B = .084) impact weekly alcohol consumption (P < .001, R2 = .024). Trans-spectrum students report higher usage rates, suicidal thoughts, and COVID impacts on usage. Family history and campus policies also show impact on weekly alcohol use. Future postsecondary substance use assessments should include trans-spectrum demographic categories.

Comorbidity of problematic substance use and other addictive behaviors and anxiety, depression, and post-traumatic stress disorder: a network analysis.

Among those with common mental health disorders (e.g. mood, anxiety, and stress disorders), comorbidity of substance and other addictive disorders is prevalent. To simplify the seemingly complex relationships underlying such comorbidity, methods that include multiple measures to distill which specific addictions are uniquely associated with specific mental health disorders rather than due to the co-occurrence of other related addictions or mental health disorders can be used. In a general population sample of Jewish adults in Israel (N = 4002), network analysis methods were used to create partial correlation networks of continuous measures of problematic substance (non-medical use of alcohol, tobacco, cannabis, and prescription sedatives, stimulants, and opioid painkillers) and behavioral (gambling, electronic gaming, sexual behavior, pornography, internet, social media, and smartphone) addictions and common mental health problems (depression, anxiety, and post-traumatic stress disorder [PTSD]), adjusted for all variables in the model. Strongest associations were observed within these clusters: (1) PTSD, anxiety, and depression; (2) problematic substance use and gambling; (3) technology-based addictive behaviors; and (4) problematic sexual behavior and pornography. In terms of comorbidity, the strongest unique associations were observed for PTSD and problematic technology-based behaviors (social media, smartphone), and sedatives and stimulants use; depression and problematic technology-based behaviors (gaming, internet) and sedatives and cannabis use; and anxiety and problematic smartphone use. Network analysis isolated unique relationships underlying the observed comorbidity between common mental health problems and addictions, such as associations between mental health problems and technology-based behaviors, which is informative for more focused interventions.

Dexmedetomidine Is Associated with Reduced In-Hospital Mortality Risk of Subarachnoid Hemorrhage Patients undergoing surgery

BackgroundSubarachnoid hemorrhage (SAH) is a severe neurological event with high mortality. The choice of sedatives in SAH management may influence patient outcomes. This study aimed to investigate the association between sedatives and in-hospital mortality among SAH patients. MethodsThis study analyzed data from the MIMIC-IV database, and in-hospital mortality was the primary outcome. Key variables collected included sedatives, demographics, comorbidities, vital signs, laboratory tests, and severity scores. Univariate and multivariate logistic regression analyses were used to assess associations between sedative use and in-hospital mortality, with adjustments for confounding factors. Further stratified analyses explored the effects of dexmedetomidine across different patient subgroups, and mediation analysis evaluated creatinine's role in the relationship between dexmedetomidine and mortality. ResultsA total of 527 patients were included in this study, with 301 males. Compared to propofol and midazolam, the use of dexmedetomidine was significantly related to the reduction of in-hospital mortality in SAH patients (OR = 0.369, 95% CI: 0.237-0.574, p < 0.001). After adjusting for variables such as demographics, comorbidities, and laboratory tests, dexmedetomidine remained associated with lower in-hospital mortality. Additionally, our findings indicated that dexmedetomidine use was associated with a reduced risk of in-hospital mortality regardless of the presence of cerebrovascular disease. Importantly, we discovered that creatinine acted as a mediator in the protective effect of dexmedetomidine on in-hospital mortality. ConclusionDexmedetomidine is associated with significantly lower in-hospital mortality in SAH patients. These findings underscore the importance of sedative choice for SAH patients, suggesting that dexmedetomidine could enhance patient outcomes.

Guideline on the Use of Intravenous Ketamine for Procedural Sedation in the Children's Emergency Department: A Quality Improvement Project.

In pediatric emergency medicine, sedation is crucial for performing some therapeutic procedures in children. Ketamine is still not widely used, despite being the preferred agent due to its effectiveness and safety profile. Implementing a guideline for intravenous ketamine in emergencies requiring procedural sedation in children, as well as training and evaluating staff competencies in performing this procedure, are the aims of this study. Senior and mid-level physicians, including pediatric nurses working in the children's emergency department (ED), have easy access to this concise repository for carrying out this procedure safely and effectively. The main objective was to implement a policy (guideline) for sedation in the children's ED. The secondary objectives were to determine whether the introduction of this policy increased the overall satisfaction rating of procedural sedation as a service offered in the Trust, to close skillgaps among staff through targeted training, and to assess the degree of recommendation for this ongoing standard of practice, in line with the current best evidence. A retrospective review of pediatric sedation cases with fractures in the children's ED of Buckinghamshire Healthcare National Health Service (NHS) Trust was conducted between June 2022 and August 2023. Surveys were sent out to assess attitudes, sedation skills, and compliance with the Royal College of Emergency Medicine (RCEM) guidelines. A policy for pediatric sedation with intravenous ketamine was later created and put into effect. Pre- and post-intervention data were compared to assess changes in sedation competency, compliance, and confidence. Out of the 103 pediatric fracture cases reviewed, 16 were identified as needing reduction upon initial evaluation, based on the child's condition at presentation. However, only one (6%) was treated with ketamine sedation in the children's ED, whereas nine cases (56%) were reduced under general anesthesia. The remainder was treated with varying use of nitrous oxide gas (Entonox) and diamorphine. Significant progress had been made after a clinical guideline for intravenous ketamine-assisted sedation in children was put into practice. Physicians reported improved knowledge of sedation techniques, knowledge of airway control, and safety in administering ketamine sedation. The percentage of respondents supporting the guidelines increased from 61% before the intervention (nValue=11) to 94% after (nValue​=17), using various metrics. These results demonstrated how well evidence-based policies and training can improve performance, competence, and safety. The use of procedural sedation in the children's EDincreased and the need for general anesthesia was significantly reduced after a uniform pediatric ketamine sedation policy was implemented. Targeted training to address skillgaps increased employee confidence and adherence to best practices.