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de Mucha PV, Thomas S. Incidence of post-induction hypotension following emergency rapid sequence induction with ketamine: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med 2025; 33:71. [PMID: 40312726 PMCID: PMC12044812 DOI: 10.1186/s13049-025-01374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2025] [Accepted: 03/26/2025] [Indexed: 05/03/2025] Open
Abstract
INTRODUCTION Rapid sequence induction (RSI) is a potentially-life saving intervention in critically ill patients. An important adverse effect of this procedure is post-induction hypotension (PIH), which is associated with worsened patient outcomes. Choice of induction agent can affect incidence of PIH, although the optimal drug has yet to be determined. Ketamine is postulated to reduce PIH incidence in emergency RSI when used instead of alternative agents. AIMS This systematic review and meta-analysis aims to evaluate the effect on PIH incidence of inducing anaesthesia with ketamine during emergency RSI. METHODS A systematic search was conducted to identify a sample of studies fulfilling criteria for population (emergency RSI), intervention (ketamine), comparator (any alternative induction agent) and outcome (PIH). No single definition of PIH was required for eligibility. A random-effects model was used to produce a pooled effect size estimate from the extracted data. The study question was also tested in pre-specified subgroups, including by specific comparator induction agent and by indication for RSI (medical vs trauma). RESULTS 27 studies, including 6 randomised controlled trials, were eligible for inclusion, with total n = 31,956. There was considerable methodological heterogeneity. The pooled estimate of odds ratio (OR) of PIH when ketamine is used for emergency RSI is 1.10, with 95% confidence interval 0.78-1.56. Excluding data from the 6 studies (1 randomised and 5 observational) at greater risk of bias, the pooled OR is 0.99 (0.69-1.43). There was no significant difference between ketamine and comparators in any subgroup, although significance was approached when comparing ketamine to etomidate, with OR 1.38 (0.99-1.94) and p = 0.058. CONCLUSIONS Choice of ketamine to carry out emergency RSI did not affect the incidence of PIH incidence in this diverse sample of studies. Given the breadth of inclusion criteria, applicability of this result is not necessarily universal. It is likely that optimal choice of induction agent varies according to specific circumstances in a manner as yet incompletely understood.
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Affiliation(s)
| | - Stephen Thomas
- Blizard Institute, Queen Mary University of London, London, UK
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Arsanious J, Rowland A, Sorich MJ, Hopkins AM, Alfred S, Rowland A. Ritonavir May Prolong Sedation but is Unlikely to Increase the Risk of Respiratory Arrest in Patients Requiring Intravenous Midazolam for Procedural Sedation. J Clin Pharmacol 2025; 65:637-643. [PMID: 39604049 DOI: 10.1002/jcph.6171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 11/11/2024] [Indexed: 11/29/2024]
Abstract
Intravenous midazolam is frequently used for procedural sedation. Use of ritonavir containing antivirals in patients requiring procedural sedation with intravenous midazolam is postulated to increase the risk or prolong the consequences of exposure related adverse events. The primary objective of this study was to characterize interaction of ritonavir with IV midazolam. The secondary objective was to define the time course over with the interaction of ritonavir with IV midazolam resolves following cessation of ritonavir. Physiologically based pharmacokinetic modeling was used to conduct clinical trials with a parallel group design defining exposure to a single 5 mg IV dose of midazolam in the presence and absence of nirmatrelvir/ritonavir dosed twice daily for 5 days. Simulations comprised 50 virtual healthy subjects aged 20 to 50 years (50% female). Based on FDA criteria, a moderate/strong interaction between nirmatrelvir/ritonavir and intravenous midazolam (area under the curve [AUC] ratio >2) was observed when intravenous midazolam was administered up to 72 h following cessation of nirmatrelvir/ritonavir. The geometric mean (90% CI) midazolam AUC ratio was 9.21 (5.44 to 16.43) when coadministered on the final day of nirmatrelvir/ritonavir dosing. Importantly, there was no change in peak exposure; the geometric mean (90% CI) midazolam maximum concentration ratio was 0.99 (0.99 to 1.00). Use of ritonavir containing antivirals is unlikely to increase a patient's risk of experiencing an exposure related adverse event following administration of intravenous midazolam but may prolong complications in patients who experience an event. A meaningful interaction persists for 72 h following cessation of nirmatrelvir/ritonavir.
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Affiliation(s)
- Jason Arsanious
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Angela Rowland
- SA Toxinology and Toxicology Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Michael J Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Ashley M Hopkins
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sam Alfred
- SA Toxinology and Toxicology Service, Royal Adelaide Hospital, Adelaide, Australia
- Department of Emergency Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Andrew Rowland
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Islam MR, Chowdhury MT, Chowdhury MM, Khanam BH, Ali ML, Hasan MM, Hossain MK. Investigating the Secondary Metabolite Profile and Neuropharmacological Activities of Ipomoea purpurea: A Multi-Method Approach Using GC-MS, In Vivo, and In Silico Techniques. Chem Biodivers 2025:e202500560. [PMID: 40263108 DOI: 10.1002/cbdv.202500560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2025] [Revised: 04/06/2025] [Accepted: 04/22/2025] [Indexed: 04/24/2025]
Abstract
Ipomoea purpurea, a traditional medicinal plant native to Mexico and Central America, was evaluated for its neuropharmacological effects. The methanol extract of I. purpurea leaves (IPML) was analyzed through in vivo and in silico approaches. The extract's secondary metabolites were identified through qualitative and gas chromatography-mass spectrometry (GC-MS) analysis. Anxiolytic effects were assessed using the elevated plus maze (EPM) and hole-board test (HBT), whereas sedative activity was evaluated through the open-field test (OFT) and hole cross test (HCT). Antidepressant properties were analyzed via the tail suspension test (TST) and forced swimming test (FST), and muscle relaxant activity was tested using the rota-rod test. IPML at 200 and 400 mg/kg showed significant anxiolytic (p < 0.001), sedative (p < 0.0001), antidepressant (p < 0.001), and muscle relaxant (p < 0.0001) effects. GC-MS analysis identified 19 bioactive compounds, and in silico molecular docking and absorption, distribution, metabolism, excretion, and toxicity (ADME/T) analysis revealed strong binding affinities, favorable pharmacokinetics, and a safe toxicological profile. Findings suggest that IPML possesses significant neuropharmacological properties, supporting its role as a natural therapeutic agent. However, further research is needed to address key concerns, such as small sample sizes, limited replication, and the necessity for extensive dose-response studies across diverse animal models.
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Affiliation(s)
- Mohammad Rashedul Islam
- Department of Pharmacy, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
| | - Md Tanvir Chowdhury
- Department of Pharmacy, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
| | - Md Mustafiz Chowdhury
- Department of Pharmacy, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
| | - Bibi Humayra Khanam
- Department of Pharmacy, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
| | - Md Liakot Ali
- Department of Pharmacy, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
| | - Md Mahmudul Hasan
- Department of Pharmacy, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
| | - Mohammed Kamrul Hossain
- Department of Pharmacy, Faculty of Biological Sciences, University of Chittagong, Chittagong, Bangladesh
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Magaton IM, Nordin M, Siercks I, Popovici RM, Boogen E, Eisenhardt S, Huober-Zeeb C, Lanowski JS, Roumet M, von Wolff M. Oocyte retrieval of few follicles does not require analgesia: a large-scale multicentre pain analysis. Reprod Biomed Online 2025; 50:104696. [PMID: 40000363 DOI: 10.1016/j.rbmo.2024.104696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/01/2024] [Accepted: 06/05/2024] [Indexed: 02/27/2025]
Abstract
RESEARCH QUESTION What is the pain intensity of oocyte retrieval (OCR) without anaesthesia and analgesia in women with a low or medium number of follicles? DESIGN Multicentre observational study analysing IVF cycles without anaesthesia and analgesia in seven IVF centres in Germany and Switzerland between January 2022 and March 2023. In total, 2290 cycles of natural cycle IVF or minimal stimulation IVF from 1039 patients were recorded. Pain score was assessed using a VAS graded 0 to 10. A descriptive analysis was conducted, followed by a statistical evaluation using a linear mixed model to analyse the effect on the pain score of the number of oocytes retrieved and the number of repeated IVF cycles. RESULTS The number of oocytes retrieved varied from 0 to 16 (IQR 1-2). Pain score varied from 0 to 10, with a median pain score of 3.0 (IQR 2-4), defined as 'mild' pain. Compared with a reference value of aspirations with one oocyte, the pain score increased slightly by 0.5 points if no oocyte was retrieved, by 0.42 points if two to five oocytes were retrieved and by 1.14 points if six or more oocytes were retrieved, all with little clinical relevance. Pain decreased slightly with repeated aspirations (-0.05 points per cycle) (P = 0.028). The complication rate requiring hospitalization per aspiration was less than 0.1%. CONCLUSION Pain intensity during OCR of one or few follicles is mild. Therefore, OCR can be offered without anaesthesia and analgesia to reduce aspiration time and cost.
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Affiliation(s)
- Isotta M Magaton
- Division of Gynaecological Endocrinology and Reproductive Medicine, University Women`s Hospital, Inselspital, Friedbühlstrasse 19, 3010 Bern, Switzerland..
| | - Martina Nordin
- Fertility Centre Baden AG, Mellingerstrasse 207, 5405 Baden, Switzerland
| | - Ikbale Siercks
- Institute for Gynaecological Endocrinology and Reproductive Medicine, c/o fiore Praxis AG, Rorschacherstrasse 267, 9016 St Gallen, Switzerland
| | | | - Eva Boogen
- Fertility Centre Bonner Bogen, Joseph-Schumpeter-Allee 1, 53227 Bonn, Germany
| | - Stefan Eisenhardt
- Fertility Centre Frauenärzte, Heilbronnerstrasse 1, 74172 Neckarsulm/Heilbronn, Germany
| | - Cosima Huober-Zeeb
- Fertility Centre Villa Kinderwunsch, Wörthstrasse 13, 89077 Ulm, Germany
| | - Jan-Simon Lanowski
- Fertility Centre and Human Genetics, Gartenstrasse 18-20, 31141 Hildesheim, Germany
| | - Marie Roumet
- Department of Clinical Research, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Michael von Wolff
- Division of Gynaecological Endocrinology and Reproductive Medicine, University Women`s Hospital, Inselspital, Friedbühlstrasse 19, 3010 Bern, Switzerland
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Weant KA, Bailey AM. Dream of the Endless: Special Considerations in Procedural Sedation. Adv Emerg Nurs J 2025; 47:13-22. [PMID: 39591632 DOI: 10.1097/tme.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2024]
Abstract
Procedural sedation and analgesia (PSAA) is integral to facilitating painful and anxiety-inducing medical procedures in the emergency department (ED). Optimal PSAA enhances procedural success and improves both patient and provider satisfaction. The selection of appropriate sedative and analgesic agents, routes, and dosages, which depend on various patient- and procedure-specific factors is a complex process. Alternative routes of administration, such as intranasal, intramuscular, and oral, are all options, each with their own inherent benefits and limitations. It is important for providers to take into account patient-specific considerations, including age, medical history, body weight composition, and pregnancy, which can significantly impact PSAA effectiveness and safety. Implementation strategies targeted to minimize medication errors and optimize workflow are also important considerations in PSAA. By adopting a comprehensive and evidence-based approach, health care providers can navigate the intricacies of PSAA and ensure the best possible care for patients in the ED.
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Affiliation(s)
- Kyle A Weant
- Author Affiliations: Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina, Columbia, South Carolina (Dr. Weant) and College of Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky (Dr. Bailey)
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Jiang S, Xia X, Lin M, Wang L. Nursing Intervention Based on the Interactive Attainment Model. Nurs Sci Q 2025; 38:67-75. [PMID: 39658915 DOI: 10.1177/08943184241291563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2024]
Abstract
This study aimed to examine the effectiveness of nursing that was based on the interactive attainment model in alleviating anxiety and pain during colonoscopy. This retrospective study included 213 patients, divided into intervention and control groups. Both groups underwent normal or painless colonoscopy. Anxiety and pain were evaluated using the Self-Rating Anxiety Scale and the Visual Analog Scale (VAS), respectively. The intervention group reported significantly lower anxiety and VAS pain scores compared with the control group. The interactive attainment model of nursing effectively reduces patient anxiety and pain and lowers complication rates in patients undergoing colonoscopy.
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Affiliation(s)
- Shuyin Jiang
- Department of Gastroenterology, Hangzhou First People's Hospital, Affiliated to Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Xiaofeng Xia
- Department of Gastroenterology, Hangzhou First People's Hospital, Affiliated to Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Min Lin
- Department of Gastroenterology, Hangzhou First People's Hospital, Affiliated to Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Linfei Wang
- Gastrointestinal Surgery, Hangzhou First People's Hospital, Affiliated to Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
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Lauer KK, Zhang D, Lunar L, Landry C, Welter J, Flemming K, Franco R, Siclovan D, Avdeev J, Woodson BT, Szabo A, Truwit JD, Hainsworth KR. Quality improvement initiative: use of the STOP-BANG score and monitoring to reduce adverse events in hospitalised patients at risk of obstructive sleep apnoea. BMJ Open Qual 2024; 13:e002968. [PMID: 39608972 PMCID: PMC11603732 DOI: 10.1136/bmjoq-2024-002968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 11/03/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND Obstructive sleep apnoea increases risk of respiratory depression with administration of sedatives, narcotics or anxiolytics. To reduce adverse events during hospital admission, we implemented STOP-BANG screening to prompt respiratory monitoring for inpatients receiving these medications. This study reports on protocol development, implementation and an initial analysis over 5 years to evaluate implementation success and outcomes. INTERVENTION The STOP-BANG measure was embedded in the nurse navigator at admission. If the score was ≥3 and sedatives, narcotics and/or anxiolytics were ordered, the provider was prompted to monitor patients with continuous pulse oximetry and/or capnography. METHODS We assessed the impact of the intervention using a retrospective pre-post design. Preprotocol data from all adult inpatients over a 2.5-year period, and postprotocol data from all adult inpatients from over a 5-year period, were extracted from the electronic health record. Outcomes included use of monitoring; adverse events during hospitalisation were included to evaluate the effects of the intervention: mortality, rate of rapid response team events, reversal and/or rescue, intensive care unit admission and orders for positive airway pressure equipment. RESULTS The combined preprotocol and postprotocol sample included 254 121 patients. After protocol implementation, overall mortality for patients receiving sedatives, narcotics or anxiolytics decreased slightly from 2.1% to 1.9% (p<0.001). In the postprotocol cohort only (n=193 744), monitored patients had a higher probability of experiencing all adverse events. Among monitored patients, mortality was lowest in the high-risk group (STOP-BANG≥5). DISCUSSION Triaging by STOP-BANG coupled with monitoring appeared to be helpful for patients at highest risk of obstructive sleep apnoea. Given the complexity of obstructive sleep apnoea, further pursuit of subphenotypes is warranted.
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Affiliation(s)
- Kathryn K Lauer
- Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Donglin Zhang
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lauren Lunar
- Population Health and Clinical and Translational Science Institute Office, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Curtis Landry
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - Rose Franco
- Pulmonary Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | | | - B Tucker Woodson
- Otolaryngology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aniko Szabo
- Medical College of Wisconsin Institute for Health & Equity, Milwaukee, Wisconsin, USA
| | | | - Keri R Hainsworth
- Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Jane B. Pettit Pain and Headache Center, Children's Wisconsin, Milwaukee, Wisconsin, USA
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Liu Y, Xiao J, Chen T, Shi D, Qiao Y, Liao X. Comparative Efficacy and Safety of Anesthetic and Sedative Regimens for Endoscopic Retrograde Cholangiopancreatography: A Network Meta-Analysis. Dig Dis 2024; 43:84-95. [PMID: 39536718 PMCID: PMC11817864 DOI: 10.1159/000542380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024]
Abstract
INTRODUCTION This study evaluates the efficacy and safety of various anesthetic and sedative regimens for endoscopic retrograde cholangiopancreatography (ERCP) procedures. METHODS A systematic search was conducted across PubMed, Web of Science, Scopus, and Embase to identify randomized controlled trials (RCTs) published until March 2024. Primary outcomes included procedure time, patient satisfaction, oxygen saturation (SpO2), incidence of SpO2 below 90%, and adverse events. The analysis was performed using R software, analyzing continuous outcomes with mean differences and dichotomous outcomes with risk ratios. RESULTS 42 RCTs were included. Combination therapies such as remifentanil plus tramadol and propofol plus midazolam plus pethidine demonstrated significantly shorter procedure times. Propofol plus oxycodone yielded higher patient satisfaction. Oxygenation results indicated that propofol plus fentanyl, oxycodone, and ketamine improved SpO2. Propofol plus oxycodone (RR <0.01), dexmedetomidine plus fentanyl (RR <0.01), propofol plus nalbuphine (RR = 0.01), Mg sulfate plus propofol (RR = 0.01), and propofol plus fentanyl (RR = 0.02) showed a significant lower rate of patients with SpO2 below 90% compared to propofol. Midazolam plus pethidine plus dexmedetomidine (RR = 0.01), propofol plus oxycodone (RR = 0.09), and dexmedetomidine plus fentanyl (RR = 0.2) exhibited lower rates of adverse events compared to propofol. CONCLUSION This study provides comprehensive evidence to guide clinical decision-making and optimize anesthetic management for ERCP procedures. INTRODUCTION This study evaluates the efficacy and safety of various anesthetic and sedative regimens for endoscopic retrograde cholangiopancreatography (ERCP) procedures. METHODS A systematic search was conducted across PubMed, Web of Science, Scopus, and Embase to identify randomized controlled trials (RCTs) published until March 2024. Primary outcomes included procedure time, patient satisfaction, oxygen saturation (SpO2), incidence of SpO2 below 90%, and adverse events. The analysis was performed using R software, analyzing continuous outcomes with mean differences and dichotomous outcomes with risk ratios. RESULTS 42 RCTs were included. Combination therapies such as remifentanil plus tramadol and propofol plus midazolam plus pethidine demonstrated significantly shorter procedure times. Propofol plus oxycodone yielded higher patient satisfaction. Oxygenation results indicated that propofol plus fentanyl, oxycodone, and ketamine improved SpO2. Propofol plus oxycodone (RR <0.01), dexmedetomidine plus fentanyl (RR <0.01), propofol plus nalbuphine (RR = 0.01), Mg sulfate plus propofol (RR = 0.01), and propofol plus fentanyl (RR = 0.02) showed a significant lower rate of patients with SpO2 below 90% compared to propofol. Midazolam plus pethidine plus dexmedetomidine (RR = 0.01), propofol plus oxycodone (RR = 0.09), and dexmedetomidine plus fentanyl (RR = 0.2) exhibited lower rates of adverse events compared to propofol. CONCLUSION This study provides comprehensive evidence to guide clinical decision-making and optimize anesthetic management for ERCP procedures.
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Affiliation(s)
- Yufang Liu
- Department of Anesthesiology, 904th Hospital of The Joint Logistics Support Force of the PLA, Wuxi, China
| | - Jifeng Xiao
- Department of Anesthesiology, 904th Hospital of The Joint Logistics Support Force of the PLA, Wuxi, China
| | - Tian Chen
- Department of Anesthesiology, 904th Hospital of The Joint Logistics Support Force of the PLA, Wuxi, China
| | - Dongdong Shi
- Department of Anesthesiology, 904th Hospital of The Joint Logistics Support Force of the PLA, Wuxi, China
| | - Yan Qiao
- Department of Anesthesiology, 904th Hospital of The Joint Logistics Support Force of the PLA, Wuxi, China
| | - Xingzhi Liao
- Department of Anesthesiology, 904th Hospital of The Joint Logistics Support Force of the PLA, Wuxi, China
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Zhao Q, Meng F, Han H, Han L. Meta-analysis study on anesthetic sedation recovery and onset times in pediatric and elderly patients undergoing CT and MRI. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024. [PMID: 39485116 DOI: 10.5507/bp.2024.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2024] Open
Abstract
Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are crucial diagnostic modalities that require patients to remain immobile for extended periods, with anesthesia sometimes used for comfort and image quality enhancement. The study compares dexmedetomidine and propofol in reducing recovery time and sedation onset in pediatric and elderly patients undergoing CT and MRI procedures. A meta-analysis of fifteen studies assessing recovery time, sedation onset, and failed sedation between dexmedetomidine and propofol in pediatric and elderly patients during CT and MRI was conducted. The study indicated that the administration of anaesthesia markedly improved patient compliance and reduced motion artefacts in both CT and MRI (P<0.00001, I2=94%). The meta-analysis indicated that the mean difference (MD) in the onset of sedation was significantly faster in the control group (P<0.00001, I2=96%). The study reveals that dexmedetomidine and propofol anesthesia can improve patient image quality during CT and MRI procedures by reducing motion artefacts. Dexmedetomidine sedated people more quickly than propofol, but no significant differences in sedation duration were observed.
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Affiliation(s)
- Qiong Zhao
- Department of Anesthesiology, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Jinan City, 250013 Jinan, P. R. China
| | - Fei Meng
- Department of Anesthesiology, Jinan Third People's Hospital, No. 1 Wangsheren North Street, Gongye North Road, Licheng District, Jinan City, Shandong Province, 250132, P. R. China
| | - Huimei Han
- Department of Anesthesiology, Jinan Third People's Hospital, No. 1 Wangsheren North Street, Gongye North Road, Licheng District, Jinan City, Shandong Province, 250132, P. R. China
| | - Lili Han
- Department of Anesthesiology, Central Hospital Affiliated to Shandong First Medical University, No. 105 Jiefang Road, Jinan City, 250013 Jinan, P. R. China
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ElKhatib AA, Ghoneim TAM, Dowidar KML, Wahba NA. Effect of Dexmedetomidine with or without Midazolam during procedural dental sedation in children: a randomized controlled clinical trial. BMC Oral Health 2024; 24:1298. [PMID: 39462365 PMCID: PMC11520047 DOI: 10.1186/s12903-024-04992-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 10/01/2024] [Indexed: 10/29/2024] Open
Abstract
BACKGROUND Dental anxiety is a global problem in the realm of pediatric dentistry. The use of procedural sedation is recommended to avoid substandard or unsafe dental treatment in preschoolers. This study aimed to compare the effect sedation with Dexmedetomidine with or without Midazolam in terms of sedation level, analgesic effect and ease of treatment completion in preschool children. METHODS A triple blind randomized controlled clinical trial comprised 72 healthy uncooperative children, 4-6 years old, were randomly allocated into three groups of 24 patients each: Group I patients were sedated with nebulized 5 μg/kg Dexmedetomidine (DEX), Group II with nebulized 3 μg/kg DEX followed by nebulized 0.3 mg/kg Midazolam (MID), and Group III with nebulized 0.5 mg/kg MID. Along the session, the three regimens were assessed and compared during the sedation level (children responsiveness) using the Modified Observer's Assessment of Alertness/Sedation Scale, the analgesic effect using the Face, Leg, Activity, Cry, Consolability scale and ease of treatment completion using a separate 5-point scale. Vital signs were recorded before and during sedation, until full recovery. RESULTS A significant difference was detected regarding children responsiveness during operative procedure in favour of DEX in comparison to MID and DEX/MID groups (P = 0.045). Within the DEX group, a significant difference was recorded regarding children responsiveness at optimum sedation and during the operative procedure (P = 0.04). Although, the analgesic effects of sedative drugs showed no statistically significant difference among the study groups (P = 0.20), the ease of treatment completion was statistically higher in the DEX than MID and DEX/MID groups (P = 0.03). CONCLUSION Dexmedetomidine provides a moderate level of sedation, that allowed better patient cooperation, and easy completion of performed dental procedures.
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Affiliation(s)
- Amira A ElKhatib
- Faculty of Oral and Dental Medicine, Kafrelsheikh University, Kafr El Sheikh, Egypt.
| | | | | | - Nadia A Wahba
- Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Ezzemani W, Altawalah H, Windisch M, Ouladlahsen A, Saile R, Kettani A, Ezzikouri S. Identification of Zika virus NS2B-NS3 protease and NS5 polymerase inhibitors by structure-based virtual screening of FDA-approved drugs. J Biomol Struct Dyn 2024; 42:8073-8088. [PMID: 37528667 DOI: 10.1080/07391102.2023.2242963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023]
Abstract
Zika virus (ZIKV) is a mosquito-borne human flavivirus responsible that causing emergency outbreaks in Brazil. ZIKV is suspected of causing Guillain-Barre syndrome in adults and microcephaly. The NS2B-NS3 protease and NS5 RNA-dependent RNA polymerase (RdRp), central to ZIKV multiplication, have been identified as attractive molecular targets for drugs. We performed a structure-based virtual screening of 2,659 FDA-approved small molecule drugs in the DrugBank database using AutoDock Vina in PyRx v0.8. Accordingly, 15 potential drugs were selected as ZIKV inhibitors because of their high values (binding affinity - binding energy) and we analyzed the molecular interactions between the active site amino acids and the compounds. Among these drugs, tamsulosin was found to interact most efficiently with NS2B/NS3 protease, as indicated by the lowest binding energy value (-8.27 kJ/mol), the highest binding affinity (-5.7 Kcal/mol), and formed H-bonds with amino acid residues TYRB130, SERB135, TYRB150. Furthermore, biotin was found to interact most efficiently with NS5 RdRp with a binding energy of -150.624 kJ/mol, a binding affinity of -5.6 Kcal/mol, and formed H-bonds with the amino acid residues ASPA665 and ASPA540. In vitro, in vivo, and clinical studies are needed to demonstrate anti-ZIKV safety and the efficacy of these FDA-approved drug candidates.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Wahiba Ezzemani
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
- Laboratoire de Biologie et Santé (URAC34), Départment de Biologie, Faculté des Sciences Ben Msik, Hassan II University of Casablanca, Morocco
| | - Haya Altawalah
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
- Virology Unit, Yacoub Behbehani Center, Sabah Hospital, Ministry of Health, Kuwait
| | - Marc Windisch
- Applied Molecular Virology Laboratory, Discovery Biology Department, Institut Pasteur Korea, Gyeonggi-do, South Korea
| | - Ahd Ouladlahsen
- Faculté de médecine et de pharmacie, Université Hassan II, Casablanca, Morocco
- Service des maladies Infectieuses, CHU Ibn Rochd, Casablanca, Morocco
| | - Rachid Saile
- Laboratoire de Biologie et Santé (URAC34), Départment de Biologie, Faculté des Sciences Ben Msik, Hassan II University of Casablanca, Morocco
| | - Anass Kettani
- Laboratoire de Biologie et Santé (URAC34), Départment de Biologie, Faculté des Sciences Ben Msik, Hassan II University of Casablanca, Morocco
| | - Sayeh Ezzikouri
- Virology Unit, Viral Hepatitis Laboratory, Institut Pasteur du Maroc, Casablanca, Morocco
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12
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Alsabri MAH, Abdelshafi A, Bostamy Elsnhory A, Selim NS, Elsnhory AB, Albelal D, Akram F, Elshanbary AA. Efficacy and Safety of Dexmedetomidine Compared to Other Needle-Free Pharmacological Sedation Methods in Pediatric Patients Undergoing Imaging Procedures. Pediatr Emerg Care 2024; 40:e233-e239. [PMID: 38713855 DOI: 10.1097/pec.0000000000003169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
BACKGROUND Pediatric patients often require sedation during magnetic resonance imaging (MRI) and computed tomography (CT) to ensure stillness and minimize stress. This meta-analysis compared the effectiveness and safety of 3 sedative agents-dexmedetomidine, midazolam, and chloral hydrate-for pediatric MRI/CT sedation. METHODS Six studies with a total of 633 patients were included in the analysis. Quality assessment revealed varying levels of bias risk. Dexmedetomidine exhibited a significantly higher successful sedation rate compared to midazolam (risk ratio [RR] = 0.43, 95% confidence interval [CI] [0.29-0.64]), but no statistically significant difference compared to chloral hydrate (RR = 0.94, 95% CI [0.60-1.45]). Chloral hydrate also showed a higher successful sedation rate compared to midazolam (RR = 0.46, 95% CI [0.25-0.83]). The onset of sedation time did not significantly differ between the 3 agents. RESULTS The dexmedetomidine group had a significantly higher incidence of bradycardia compared to the chloral hydrate group (RR = 0.17, 95% CI [0.05-0.59]), but no significant difference compared to the midazolam group (RR = 0.29, 95% CI [0.06-1.26]). No statistically significant differences were observed in the incidence of nausea and vomiting between the 3 groups. CONCLUSIONS Dexmedetomidine demonstrates effectiveness in pediatric MRI/CT sedation, offering advantages over midazolam and similar efficacy to chloral hydrate. Careful cardiovascular monitoring is essential during administration, particularly in patients with congenital heart disease. Sublingual and intranasal administration of dexmedetomidine is a viable option with high bioavailability. This meta-analysis contributes valuable insights into refining sedation protocols for pediatric imaging procedures, emphasizing efficacy and safety considerations.
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13
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Shah D, Sen J, Bawiskar D. Non-operating Room Anesthesia (NORA): A Comprehensive Review of Monitored Anesthesia Care. Cureus 2024; 16:e68024. [PMID: 39347359 PMCID: PMC11431130 DOI: 10.7759/cureus.68024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 08/28/2024] [Indexed: 10/01/2024] Open
Abstract
Monitored anesthesia care (MAC) is being increasingly employed in non-operative environments, particularly in the realms of endoscopy and magnetic resonance imaging (MRI) procedures. This in-depth analysis delves into the essential components of MAC within these specific contexts, with a primary focus on ensuring patient safety, evaluating efficacy, and assessing procedural outcomes. It is a common practice in endoscopic procedures to necessitate sedation for the purpose of alleviating discomfort and anxiety, ultimately ensuring patient cooperation and the successful completion of the procedure. MAC, which entails the administration of sedatives and analgesics under the close supervision of an anesthesia professional, offers a personalized approach that carefully balances the depth of sedation with maintaining optimal patient safety standards. Within the domain of MRI procedures, where challenges such as claustrophobia and motion artifacts can significantly impact the process, MAC plays a crucial role in providing a controlled setting that not only enhances image quality but also improves patient compliance throughout the procedure. The review extensively investigates the various pharmacological agents commonly utilized in these scenarios, including but not limited to midazolam and fentanyl, shedding light on their pharmacokinetic and pharmacodynamic properties specific to these contexts. Furthermore, the critical role of the anesthesia provider in effectively managing potential complications, such as respiratory depression, hemodynamic instability, and allergic reactions, is thoroughly examined and discussed. The analysis extends to the implementation of MAC protocols, encompassing pre-procedural assessments, continuous intra-procedural monitoring, and comprehensive post-procedural care, all aimed at ensuring the best possible outcomes for patients. Additionally, the review delves into the economic considerations associated with MAC, taking into account its impact on procedural efficiency, healthcare costs, and patient throughput within these settings. By exploring current guidelines and recommendations established by professional societies such as the American Society of Anesthesiologists (ASA), this review aims to provide a holistic understanding of the best practices in MAC for both endoscopy and MRI procedures. Through the synthesis of available evidence, the primary objective of this review is to contribute to informing clinical practices, enhancing patient safety measures, improving procedural success rates, and ultimately advocating for the broader adoption of monitored anesthesia care in diverse non-operative medical settings.
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Affiliation(s)
- Dhruv Shah
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jayshree Sen
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dushyant Bawiskar
- Sports Medicine, Abhinav Bindra Targeting Performance, Bangalore, IND
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14
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Khan MT, Khan AR, Rohail S, Raza FA, Ahmed S, Siddiqui A, Kumar J, Yasinzai AQK, Sohail AH, Goyal A. Safety of procedural sedation in emergency department settings among the adult population: a systematic review and meta-analysis of randomized controlled trials. Intern Emerg Med 2024; 19:1385-1403. [PMID: 39102153 DOI: 10.1007/s11739-024-03697-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/25/2024] [Indexed: 08/06/2024]
Abstract
Procedural sedation and analgesia (PSA) are a common practice in emergency departments (EDs), aiming to alleviate pain, anxiety, and discomfort during various medical procedures. We have undertaken a systematic review and meta-analysis with the aim of assessing the incidence of adverse events associated with PSA, including those related to individual drugs and various drug combinations. The study adhered to PRISMA guidelines for a systematic review and meta-analysis of adverse events in ED sedation. A comprehensive search strategy was employed across ten databases, supplemented by searches on clinicaltrials.gov and manual reviews of reference lists. Data extraction focused on medication administration and adverse events. The study considered four types of adverse events: cardiac, respiratory, gastrointestinal, and neurological. Only randomized controlled trials (RCTs) focusing on PSA administered to adult patients within the ED setting were included. The statistical analysis employed OpenMeta Analyst to conduct a one-arm meta-analysis, with findings presented alongside their corresponding 95% Confidence Intervals. Forest plots were constructed to combine and evaluate results, and sensitivity analyses were performed to identify sources of heterogeneity. From a literature search of 4246 records, 32 RCTs were deemed suitable for this meta-analysis. The analysis included 6377 procedural sedations. The most common adverse event was hypoxia, with an incidence rate of 78.5 per 1000 sedations (95% CI = 77.5-133.5). This was followed by apnea and hypotension, with incidence rates of 31 (95% CI = 19.5-41.8) and 28.1 (95% CI = 17.4-38.9) per 1,000 sedations, respectively. Agitation and vomiting each occurred in 15.6 per 1,000 sedations (95% CI = 8.7-22.6). Severe adverse events were rare, with bradycardia observed in 16.7 per 1,000 sedations, laryngospasm in 2.9 per 1,000 sedations (95% CI = - 0.1 to 6), intubation in 10.8 per 1,000 sedations (95% CI = 4-17), and aspiration in 2.7 per 1,000 sedations (95% CI = - 0.3 to 5.7). Ketamine is found to be the safest option in terms of respiratory adverse events, with the lowest rates of apnea and hypoxia, making it the least respiratory depressant among the evaluated drugs. Etomidate has the least occurrence of hypotension when used alone. Propofol has the highest incidence of hypotension when used alone and ranks second in hypoxia-related adverse events after midazolam. Using combinations of sedating agents, such as propofol and ketamine, has been found to offer several advantages over single drugs, especially in reducing adverse events like vomiting, intubation difficulty, hypotension, bradycardia, and laryngospasm. The combination significantly reduces the incidence of hypotension compared to using propofol or ketamine individually. Despite the regular use of procedural sedation, it can sometimes lead to serious adverse events. Respiratory issues like apnea and hypoxia, while not common, do occur more often than cardiovascular problems such as hypotension. However, the least frequent respiratory complications, which can also pose a threat to life, include laryngospasm, aspiration, and intubation. These incidents are extremely rare.
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Affiliation(s)
- Muhammad Taha Khan
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Ayesha Rahman Khan
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Samia Rohail
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Fatima Ali Raza
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Shahzaib Ahmed
- Department of Internal Medicine, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan
| | - Amna Siddiqui
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Jai Kumar
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | | | - Amir Humza Sohail
- Department of Surgery, University of New Mexico, Albuquerque, NM, USA
| | - Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India, 400012.
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15
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Yabrodi M, Abdel-Mageed S, Abulebda K, Murphy LD, Rodenbarger A, Bhai H, Lutfi R, Friedman ML. Deep Sedation in Pediatric Patients With Single Ventricle Physiology Outside of the Operating Room. World J Pediatr Congenit Heart Surg 2024; 15:488-493. [PMID: 38213105 DOI: 10.1177/21501351231211584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Background: Advancements in palliative surgery of patients with single ventricle physiology have led to an increase in the need for deep sedation protocols for painful procedures. However, positive pressure ventilation during anesthesia can result in unfavorable cardiopulmonary interactions. This patient population may benefit from sedation from these painful procedures. Methods: This study aims to demonstrate the safety and efficacy of deep sedation by pediatric intensivists outside the operating room for children with single ventricle physiology. This is a single-center, retrospective chart review on consecutive pediatric patients with single ventricle physiology who received deep sedation performed by pediatric intensivists between 2013 and 2020. Results: Thirty-three sedations were performed on 27 unique patients. The median age was 3.7 years (25th%-75th%: 2.1-15.6). The majority of the sedations, 88% (29/33), were done on children with Fontan physiology and 12% (4/33) were status-post superior cavopulmonary anastomosis. The primary cardiac defect was hypoplastic left heart in 63% (17/27) of all sedation procedures. There were 24 chest tube placements and 9 cardioversions. Ketamine alone [median dose 1.5 mg/kg (range 0.8-3.7)], ketamine [median dose 1 mg/kg (range 0.1-2.1)] with propofol [median dose 2.3 mg/kg (range 0.7-3.8)], and ketamine [median dose 1.5 mg/kg (range 0.4-3.0)] with morphine [median dose 0.06 mg/kg (range 0.03-0.20)] were the most common sedation regimens used. Adverse events (AEs) occurred in 4 patients (15%), three of which were transient AEs. All sedation encounters were successfully completed. Conclusion: Procedural deep sedation can be safely and effectively administered to single ventricle patients by intensivist-led sedation teams in selective case.
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Affiliation(s)
- Mouhammad Yabrodi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | | | - Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Lee D Murphy
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Andrew Rodenbarger
- Division of Pediatric Cardiology, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Hamza Bhai
- Marian University School of Medicine, Indianapolis, IN, USA
| | - Riad Lutfi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Matthew L Friedman
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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16
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Bailey AM, Weant KA. Dream of the Endless: Updates in Agents for Procedural Sedation. Adv Emerg Nurs J 2024; 46:195-206. [PMID: 39094079 DOI: 10.1097/tme.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Procedural sedation and analgesia is an essential activity in the emergency department for managing pain and anxiety during a variety of medical procedures. Various pharmacotherapy options, including opioid analgesics, antiemetics, anticholinergics, sedatives, and ketamine have been utilized, all with their unique efficacy and safety profiles. This review highlights the challenges associated with using certain agents and discusses emerging trends such as the use of newer synthetic opioids and the expanding use of dexmedetomidine. Overall, the selection of the optimal agents for procedural sedation and analgesia should be guided based on the unique characteristics of each agent tailored to the needs of the specific procedure, along with consideration for individual patient characteristics.
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Affiliation(s)
- Abby M Bailey
- Departments of Emergency Medicine Clinical Pharmacy, Emergency Medicine, and Pharmacy, University of Kentucky HealthCare, Lexington, Kentucky (Dr. Bailey); and Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina (Dr. Weant)
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17
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Elsaeidy AS, Ahmad AHM, Kohaf NA, Aboutaleb A, Kumar D, Elsaeidy KS, Mohamed OS, Kaye AD, Shehata IM. Efficacy and Safety of Ketamine-Dexmedetomidine Versus Ketamine-Propofol Combination for Periprocedural Sedation: A Systematic Review and Meta-analysis. Curr Pain Headache Rep 2024; 28:211-227. [PMID: 38214834 PMCID: PMC10940385 DOI: 10.1007/s11916-023-01208-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE OF REVIEW The combination of ketamine with propofol and dexmedetomidine has gained popularity for sedation and general anesthesia in different populations. In our meta-nalysis, we helped the anesthesiologists to know the efficiency and the efficacy of both combinations in adult and pediatric patients. METHODS We searched PubMed, CENTRAL, Web of Science, and Scopus from inception to August 1, 2023. Our outcome parameters for efficacy were recovery time, pain score, and physician satisfaction while for safety were the related cardiorespiratory, neurological, and gastrointestinal adverse events. RECENT FINDINGS Twenty-two trials were included with a total of 1429 patients. We found a significantly longer recovery time in the ketadex group of 7.59 min (95% CI, 4.92, 10.26; I2 = 94%) and a significantly less pain score of - 0.72 (95% CI, - 1.10, - 0.34; I2 = 0%). Adults had a significantly better physician satisfaction score with the ketofol group, odds ratio of 0.29 (95% CI, 0.12, 0.71; I2 = 0%). Recovery agitations were higher in the ketofol group with an odds ratio of 0.48 (95% CI, 0.24, 0.98; I2 = 36%). Furthermore, we found a significant difference between the combinations with a higher incidence in the ketadex group with pooled odds ratio of 1.75 (95% CI, 1.06, 2.88; I2 = 15%). Ketadex was associated with lower pain scores, hypoxic events and airway obstruction, and emergence agitation. At the same time, ketofol had much more clinician satisfaction which might be attributed to the shorter recovery time and lower incidence of nausea and vomiting. Therefore, we suppose that ketadex is the better combination in periprocedural sedation for both adult and pediatric patients who are not at greater risk for postoperative nausea and vomiting.
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Affiliation(s)
| | | | - Neveen A Kohaf
- Clinical Pharmacy, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo, Egypt
| | - Aya Aboutaleb
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Danisha Kumar
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Ola Saeed Mohamed
- Critical Care Medicine, Menofia University, Shibin El Kom, Menofia, Egypt
| | - Alan D Kaye
- Pharmacology, Toxicology, and Neurosciences, LSU School of Medicine, 1501 Kings Hwy, Shreveport, LA, 71103, USA
- Anesthesiology and Pharmacology, LSU School of Medicine, New Orleans, LA, USA
- Anesthesiology and Pharmacology, Tulane School of Medicine, New Orleans, LA, USA
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18
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Soliman SS, Mahmoud AM, Elghobashy MR, Zaazaa HE, Sedik GA. Eco-friendly electrochemical sensor for determination of conscious sedating drug "midazolam'' based on Au-NPs@Silica modified carbon paste electrode. Talanta 2024; 267:125238. [PMID: 37774450 DOI: 10.1016/j.talanta.2023.125238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/09/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
Benzodiazepines (BZDs) are a group of drugs prescribed for their sedating effect. Their misuse and addictive properties stipulate different authorities for developing simple, fast and accurate analytical methods for instantaneous detection. Differential pulse voltammetric technique (DPV) was utilized for the selective assay of midazolam hydrochloride (MDZ) in the pure, parenteral dosage forms and plasma samples. A chemically modified carbon paste electrode (CPE) was implemented during the study. The method depended on the electroreduction of MDZ on the surface of the electrode over a potential range of 0.0 V to -1.6 V. The electrode was fabricated using silica nanoparticles (Si-NPs) which were incorporated into the composition of the CPE and used to enhance the electrode performance. Then, to enhance the sensitivity of the method, a chronoamperometric modification step was applied for depositing gold nanoparticles (Au-NPs) on the carbon paste electrode surface. Modification with Au-NPs showed a higher reduction current peak for MDZ with well-defined peaks. Various parameters such as pH of the media and measurements scan rate were investigated and optimized to enhance the sensor sensitivity. The sensor showed a dynamic linear response over a concentration range of 4.0 × 10-7 M to 2.9 × 10-4 M of MDZ with a LOD of 2.24 × 10-8 M using 0.1 M acetate buffer (pH 5.6). The sensor was validated in accordance with the ICH guidelines regarding accuracy, precision and specificity for the selective assay of MDZ in the presence of excipients. A greenness evaluation was performed using three different assessment tools, namely, the "Green Analytical Procedure Index" (GAPI), the "Analytical Greenness metric" (AGREE) and the "Whiteness Analytical Chemistry tool" (WAC) using the RGB12 model.
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Affiliation(s)
- Shymaa S Soliman
- Analytical Chemistry Department, Faculty of Pharmacy, October 6 University, October 6 City, Giza, 12858, Egypt
| | - Amr M Mahmoud
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, El-Kasr-El Aini Street, Cairo, 11562, Egypt
| | - Mohamed R Elghobashy
- Analytical Chemistry Department, Faculty of Pharmacy, October 6 University, October 6 City, Giza, 12858, Egypt; Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, El-Kasr-El Aini Street, Cairo, 11562, Egypt
| | - Hala E Zaazaa
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, El-Kasr-El Aini Street, Cairo, 11562, Egypt
| | - Ghada A Sedik
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, El-Kasr-El Aini Street, Cairo, 11562, Egypt.
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19
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Thawkar VN, Taksande K. Advances in Anesthesia for Shoulder Surgery: A Comprehensive Review of Dexmedetomidine-Enhanced Interscalene Brachial Plexus Block. Cureus 2023; 15:e48827. [PMID: 38106768 PMCID: PMC10722345 DOI: 10.7759/cureus.48827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Surgical procedures on the shoulder pose distinctive challenges in managing pain during the perioperative period, underscoring the importance of exploring innovative anesthesia techniques. This comprehensive review article delves into integrating dexmedetomidine, an alpha-2 adrenergic agonist, within interscalene brachial plexus blocks for shoulder surgery. The review initiates by underscoring the pivotal role of effective anesthesia in shoulder surgery and elucidates the rationale behind investigating dexmedetomidine as an adjunct. It meticulously examines the anatomy and physiology of the brachial plexus, emphasizing its critical significance in shoulder surgery. Furthermore, the article expounds on dexmedetomidine's mechanisms of action and pharmacokinetics, encompassing its safety profile and potential side effects. The conventional interscalene brachial plexus block techniques, along with their limitations and challenges, are discussed, laying the foundation for the integration of dexmedetomidine. The review subsequently delves into exploring the role of dexmedetomidine in regional anesthesia, covering previous studies, mechanisms of action, and the potential advantages of incorporating it into nerve blocks. The review's core concentrates on the practical application of dexmedetomidine-enhanced interscalene brachial plexus blocks. This includes discussions on administration techniques, dosage guidelines, and compelling evidence supporting its utilization. Clinical scenarios where this approach proves most advantageous are thoroughly explored, comparing its effectiveness with traditional techniques in terms of pain control and patient outcomes. A comprehensive examination of relevant clinical trials and case studies highlights the evidence supporting its efficacy. The review also underscores safety considerations associated with dexmedetomidine. It proposes strategies for mitigating risks to ensure patient safety. Insights into future directions and research are provided, encompassing ongoing studies, areas necessitating further investigation, and potential refinements in technique. Finally, the article summarizes key findings, emphasizing the practicality of dexmedetomidine-enhanced interscalene brachial plexus blocks in shoulder surgery and its far-reaching implications for clinical practice and patient care.
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Affiliation(s)
- Varun N Thawkar
- Anesthesiology, Acharya Vinoba Bhave Rural Hospital, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Karuna Taksande
- Anesthesiology, Acharya Vinoba Bhave Rural Hospital, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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20
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Al-Husinat L, Jouryyeh B, Rawashdeh A, Alenaizat A, Abushehab M, Amir MW, Al Modanat Z, Battaglini D, Cinnella G. High-Flow Oxygen Therapy in the Perioperative Setting and Procedural Sedation: A Review of Current Evidence. J Clin Med 2023; 12:6685. [PMID: 37892823 PMCID: PMC10607541 DOI: 10.3390/jcm12206685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
High-flow oxygen therapy (HFOT) is a respiratory support system, through which high flows of humidified and heated gas are delivered to hypoxemic patients. Several mechanisms explain how HFOT improves arterial blood gases and enhances patients' comfort. Some mechanisms are well understood, but others are still unclear and under investigation. HFOT is an interesting oxygen-delivery modality in perioperative medicine that has many clinical applications in the intensive care unit (ICU) and the operating room (OR). The purpose of this article was to review the literature for a comprehensive understanding of HFOT in the perioperative period, as well as its uses in procedural sedation. This review will focus on the HFOT definition, its physiological benefits, and their mechanisms, its clinical uses in anesthesia, and when it is contraindicated.
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Affiliation(s)
- Lou’i Al-Husinat
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (L.A.-H.); (Z.A.M.)
| | - Basil Jouryyeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (B.J.); (A.R.); (A.A.)
| | - Ahlam Rawashdeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (B.J.); (A.R.); (A.A.)
| | - Abdelrahman Alenaizat
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (B.J.); (A.R.); (A.A.)
| | - Mohammad Abushehab
- Anesthesia and Intensive Care Unit, Salmanyeh Hospital, Manama 323, Bahrain;
| | - Mohammad Wasfi Amir
- Department of General Surgery and Anesthesia, Faculty of Medicine, Mutah University, Karak 61710, Jordan;
| | - Zaid Al Modanat
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (L.A.-H.); (Z.A.M.)
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Gilda Cinnella
- Department of Anesthesia and Intensive Care, University of Foggia, 71122 Foggia, Italy;
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21
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Eldawlatly AA, Delvi MB, Ahmad A. Procedural sedation analgesia in the elderly patient. Saudi J Anaesth 2023; 17:533-539. [PMID: 37779569 PMCID: PMC10540997 DOI: 10.4103/sja.sja_575_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 10/03/2023] Open
Abstract
Elderly patients are perceived as a high-risk group for procedural sedation. Procedural sedation analgesia (PSA) is generally safe in older adults. What is not acceptable is undertreating pain or inadequately sedating a stable patient. All the usual precautions should be taken. One should consider any comorbidities that could make the patient more at risk of adverse reactions or complications. Older patients may be at higher risk for oxygen desaturation, but they usually respond quickly to supplemental oxygen. Geriatric patients usually require lower doses of medications. They tend to be more sensitive to medications, with slower metabolism, less physiologic reserve to handle side effects, and a smaller volume of distribution. The use of drugs for sedation in elderly patients requires careful consideration of their age-related changes in physiology and pharmacokinetics. The choice of drug should be based on the patient's medical condition, comorbidities, and potential adverse effects. Moreover, the administration should be done by trained personnel with close monitoring of vital signs and level of consciousness to prevent complications such as respiratory depression.
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Affiliation(s)
| | - Mohamed Bilal Delvi
- Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulaziz Ahmad
- Department of Anesthesia, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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22
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Kenneally A, Cummins M, Bailey A, Yackey K, Jones L, Carter C, Dugan A, Baum RA. Intranasal Dexmedetomidine Use in Pediatric Patients for Anxiolysis in the Emergency Department. Pediatr Emerg Care 2023; 39:685-691. [PMID: 36728557 DOI: 10.1097/pec.0000000000002901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES In recent years, dexmedetomidine has gained traction as a treatment for anxiolysis in the emergency department (ED). When used with an atomizer, it may also be given intranasally for anxiolysis. The primary objective was to determine the level of ED provider satisfaction and comfort with intranasal (IN) dexmedetomidine for anxiolysis in pediatric patients with behavioral agitation and/or acute psychosis. The secondary objectives included determining safety, rates of therapy failure, and ED length of stay compared with oral midazolam. The efficacy of IN dexmedetomidine versus oral midazolam in patients with autism spectrum disorder (ASD) was also evaluated. METHODS This was a single-center, prospective study in a pediatric ED from March 1 to December 31, 2021. Patients were included in the study if the ED provider requested IN dexmedetomidine anxiolysis and completed a postadministration survey. Safety and efficacy outcomes were assessed by chart review and compared with patients who received oral midazolam during the same study period. Efficacy was defined as the rate of treatment failure, as the need for procedural termination, progression to procedural sedation, or the requirement of additional medications for anxiolysis. RESULTS Sixty-two patients received IN dexmedetomidine {median dose [interquartile range (IQR)] of 3.05 [2.04-4.00] μg/kg/dose} compared with 58 who received oral midazolam [median (IQR) dose of 0.29 (0.25-0.48) mg/kg/dose). Providers reported high comfort and satisfaction scores, with median (IQR) scores of 90 (75-100) and 88 (60-100) of 100. Twenty-nine percent of patients experienced treatment failure, most commonly because of the need for additional medications. Those who received IN dexmedetomidine had a longer ED length of stay (6.0 vs 4.4 hours, P = 0.010). Among the patients with ASD, those who received IN dexmedetomidine had a lower rate of treatment failure compared with oral midazolam (21.2% vs 66.7%, P = 0.039). CONCLUSIONS This study demonstrates that IN dexmedetomidine has high levels of provider comfort and satisfaction, moderately high success rate, and a promising safety profile. In addition, IN dexmedetomidine may be superior to oral midazolam in patients with ASD for anxiolysis, but additional studies are needed.
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Affiliation(s)
- Allison Kenneally
- From the Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Megan Cummins
- From the Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Abby Bailey
- From the Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
| | - Katelyn Yackey
- Department of Emergency Medicine, University of Kentucky HealthCare, Lexington, KY
| | - Landon Jones
- Department of Emergency Medicine, University of Kentucky HealthCare, Lexington, KY
| | - Craig Carter
- Department of Emergency Medicine, University of Kentucky HealthCare, Lexington, KY
| | - Adam Dugan
- Department of Biostatistics, University of Kentucky, Lexington, KY
| | - Regan A Baum
- From the Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
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23
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Aldosari N, Alrashid S, Alshareeda AH, Alenezi A, Alenezi MY, Almutairi A, Aldweesan Y, Almajed F, Alshakhri A, Alwahhabi F, Almehmadi SA, Albzea W, Alsakka MA, Alhajaji R. Dexmedetomidine in Patients Undergoing Transsphenoidal Resection of Pituitary Adenoma: An Updated Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Cureus 2023; 15:e44132. [PMID: 37641722 PMCID: PMC10460480 DOI: 10.7759/cureus.44132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 08/31/2023] Open
Abstract
Dexmedetomidine has been widely studied in many surgical settings, with possible benefits in lowering anesthetic requirements, improving perioperative hemodynamic stability, and improving postoperative outcomes. This systematic review aims to evaluate the effects of dexmedetomidine in patients undergoing transsphenoidal resection of pituitary adenoma, shedding light on its potential as an adjunctive agent in anesthesia for this specific surgical population. In this review, we searched PubMed, Cochrane Library, Scopus, Web of Science, and Google Scholar from inception to July 20, 2023. A total of six randomized clinical trials (RCTs) investigating the effects of dexmedetomidine versus placebo in patients undergoing transsphenoidal resection of pituitary adenoma were included in this review. The outcomes of interest were extracted from the included studies as mean difference (MD) and standard deviation (SD), then analyzed using the Review Manager (RevMan, RevMan International Inc., New York, USA) software. Our literature search process retrieved 274 records. Of them, six studies were included in the meta-analysis. There was a significant difference between the dexmedetomidine group compared to the placebo group in terms of heart rate at the end of the surgery (MD = -16.5; CI = [-25.36 to -7.64]; P value = 0.0003) and after extubation (MD = -16.81; CI = [-23.18 to -10.43]; P values < 0.00001). Furthermore, dexmedetomidine significantly reduced the mean arterial blood pressure (MAP) at after both intubation and extubation (MD = -9.11 and -21.5; CI = [-13.56 to -4.65] and [-30.93 to -12.06]; P values < 0.00001). This systematic review and meta-analysis demonstrated that dexmedetomidine appears to have several potential benefits in patients undergoing transsphenoidal resection of pituitary adenoma. The use of dexmedetomidine was associated with reductions in heart rate, mean arterial blood pressure, blood loss, and duration of surgery, while showing no significant difference in propofol dose or time to extubation of the trachea.
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Affiliation(s)
- Nasser Aldosari
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Shahad Alrashid
- Pediatrics, Alsabah Hospital, Ministry of Health, Kuwait City, KWT
| | - Anwar H Alshareeda
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Abdulaziz Alenezi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Mohammad Y Alenezi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Abdulrahman Almutairi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Yousef Aldweesan
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Fay Almajed
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Abdulrazzaq Alshakhri
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | - Fai Alwahhabi
- Medicine and Surgery, Kuwait Institute for Medical Specializations, Kuwait City, KWT
| | | | - Wardah Albzea
- Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, EGY
| | - Mahmoud A Alsakka
- Otorhinolaryngology and Facial Plastic Surgery, Canadian Medical Center, Kuwait City, KWT
| | - Raghad Alhajaji
- Family Medicine, Alhajj Primary Health Care, Ministry of Health, Makkah, SAU
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24
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Chang Y, Huang YT, Chi KY, Huang YT. Remimazolam versus propofol for procedural sedation: a meta-analysis of randomized controlled trials. PeerJ 2023; 11:e15495. [PMID: 37334113 PMCID: PMC10269568 DOI: 10.7717/peerj.15495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/11/2023] [Indexed: 06/20/2023] Open
Abstract
Background To improve patient tolerability and satisfaction as well as minimize complications, procedural sedation has been widely used. Propofol is the most widely used agent for induction of anesthesia and sedation by anesthesiologists. With a different mechanism compared to propofol, remimazolam is a new short-acting GABA-A receptor agonist. It is an ester-based benzodiazepine. This meta-analysis aims to clarify the efficacy and safety of remimazolam versus propofol for procedure sedation. Methods Electronic databases were searched for randomized controlled trials (RCTs) comparing efficacy or safety of remimazolam versus propofol. Meta-analysis were conducted using RStudio with "metafor" package with random-effects model. Results A total of twelve RCTs were included in the meta-analysis. The pooled results demonstrated that patients with remimazolam for procedural sedation had lower risk of bradycardia (OR 0.28, 95% CI [0.14-0.57]), hypotension (OR 0.26, 95% CI [0.22-0.32]), and respiratory depression (OR 0.22, 95% CI [0.14-0.36]). There was no difference in the risk of developing postoperative nausea and vomiting (PONV) (OR 0.65, 95% CI [0.15-2.79]) and dizziness (OR 0.93, 95% CI [0.53-1.61]) between the remimazolam and propofol groups. Using remimazolam for procedural sedation is significantly associated with less injection pain compared to propofol (OR 0.06, 95% CI [0.03-0.13]). Regarding the sedation efficacy, there was no difference in sedation success rate or time to loss of consciousness, recover and discharge between the remimazolam and the propofol groups. Conclusions Based on our meta-analysis, patients receiving procedural sedation with remimazolam had lower risk of bradycardia, hypotension, respiratory depression and injection pain compared with propofol. On the other hand, there was no difference in sedation success rate, risk of PONV, dizziness, time to LOC, recovery and discharge between these two sedatives. PROSPERO registration number CRD42022362950.
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Affiliation(s)
- Yu Chang
- Department of Surgery, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Yun-Ting Huang
- Department of Anesthesiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kuan-Yu Chi
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Education, Center for Evidence-Based Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
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25
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Keshavarz S, Nemati M, Saied Salehi M, Naseh M. The impact of anesthetic drugs on hemodynamic parameters and neurological outcomes following temporal middle cerebral artery occlusion in rats. Neuroreport 2023; 34:199-204. [PMID: 36789841 PMCID: PMC10516172 DOI: 10.1097/wnr.0000000000001863] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/21/2022] [Indexed: 02/16/2023]
Abstract
The induction of ischemic stroke in the experimental model requires general anesthesia. One of the factors that can be effective in the size of ischemic brain lesions and neurological outcomes is the type of anesthesia. So, the current study was designed to compare the impacts of the most important and widely used anesthetics including halothane, isoflurane, and chloral hydrate on the transient middle cerebral artery occlusion (MCAO) outcomes. Adult Male Sprague-Dawley rats were randomly divided into three groups as follows: (1) MCAO + halothane group, (2) MCAO + isoflurane group, and (3) MCAO + chloral hydrate group. After 24 h, the mortality rate, infarct size, tissue swelling, neurological function, hemodynamic, and arterial blood gas parameters were assessed. Our finding showed that 60 min MCAO rats anesthetized with chloral hydrate significantly increased mortality rate, infarct size, tissue swelling, and neurological deficits compared with halothane and isoflurane anesthetics after 24 h of MCAO. Also, chloral hydrate caused a significant decrease in mean arterial pressure and arterial pO2 compared to halothane and isoflurane anesthetics. On the basis of the current data, we concluded that chloral hydrate increased cerebral infarct volume and neurological outcomes and reduced hemodynamic and metabolic parameters compared with halothane and isoflurane-anesthetized rats temporal MCAO.
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Affiliation(s)
- Somaye Keshavarz
- Histomorphometry and Stereology Research Center
- Department of Physiology
| | | | - Mohammad Saied Salehi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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26
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Jo S, Chan Kye Y, Lee J, Jung E, Kang M, Kim B, Kim D, Park B. The effect of shoulder muscle succinylcholine injection on the foreleg raising power: Sion's local paralysis. Heliyon 2023; 9:e14468. [PMID: 37035370 PMCID: PMC10073639 DOI: 10.1016/j.heliyon.2023.e14468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Objective We examined the change in foreleg raising power after Sion's local paralysis (SLP) with succinylcholine in the shoulder muscle. Methods A randomized, double blind, placebo-controlled, porcine study was designed and performed at a research institution. Ten male Korean native pigs were randomized into an intervention group (n = 5) and a control group (n = 5). The injection points were in the middle of the left trapezius muscle and the middle of the left deltoid muscle. The control group received 2 ml normal saline (NS), 1 ml injected in each point. The intervention group received 0.4 mg/kg succinylcholine diluted to 2 ml in NS, and 1 ml was injected in each point. To represent the foreleg raising power, the height of the left forelegs from baseline (experiment table) was measured. We measured the foreleg height and oxygen saturation at -4, -2, 0, +2, +4, +6, +8, +10, +20, +30, and +60 min. Results After SLP, foreleg height immediately declined in the intervention group. It recovered slightly for a few minutes and declined from 4 to 8 min. In the control group, foreleg height was relatively similar throughout the study period. A repeated-measure analysis of variance revealed a significant group × time interaction (F10,80 = 2.37, P = 0.017), a significant main effect for group (F1,8 = 6.25, P = 0.037), and a significant main effect for time (F10,80 = 4.41, P < 0.001). Post hoc analysis demonstrated that the intervention group showed significantly less foreleg raising power than the control group at 0, 4, 6, 8, 20, and 30 min (P < 0.05). Conclusions Compared with the control group, the foreleg raising power in the intervention group immediately decreased significantly and persisted for a period after SLP, without hypoxia, in a pig model.
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27
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Kalsotra S, Khan S, McKee C, Tobias JD. Remimazolam as the Primary Agent for Sedation During Cardiac Catheterization in Three Patients With Comorbid Cardiac Conduction Abnormalities. Cardiol Res 2023; 14:86-90. [PMID: 36896227 PMCID: PMC9990540 DOI: 10.14740/cr1477] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023] Open
Abstract
General anesthesia or procedural sedation may be required to ensure immobility, facilitate completion of the procedure, and ensure patient comfort during diagnostic or therapeutic procedures in the cardiac catheterization suite. Although propofol and dexmedetomidine are two of the more commonly chosen agents, concerns regarding their impact on inotropic, chronotropic or dromotropic function may limit their applicability based on underlying patient comorbid conditions. We present three patients with comorbid conditions involving pacemaker (natural or implanted) function or cardiac conduction which impacted the choice of agent for procedural sedation during procedures in the cardiac catheterization suite. Remimazolam, a novel ester-metabolized benzodiazepine, was used as the primary agent for sedation in an effort to limit detrimental effects on chronotropic and dromotropic function which may be seen with propofol or dexmedetomidine. Remimazolam's potential utility in procedural sedation is discussed, previous reports of its use are reviewed, and dosing algorithms are presented.
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Affiliation(s)
- Sidhant Kalsotra
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Sarah Khan
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Christopher McKee
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
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28
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Thanikachalam P, Govindan DK. Pain Management during Ultrasound Guided Transvaginal Oocyte Retrieval - A Narrative Review. J Hum Reprod Sci 2023; 16:2-15. [PMID: 37305768 PMCID: PMC10256939 DOI: 10.4103/jhrs.jhrs_141_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/05/2023] [Accepted: 01/23/2023] [Indexed: 06/13/2023] Open
Abstract
Transvaginal oocyte retrieval (TVOR), done for the purpose of assisted reproduction can instigate enormous pain and therefore requires adequate analgesia with the least adverse effects. As the procedure involves retrieving oocytes for in vitro fertilisation, the effect of the anaesthetic drugs on the oocyte quality should also be considered. This review focuses on the various modes of anaesthesia and the anaesthetic drugs which can be administered safely to provide effective analgesia in normal and in special conditions such as women with pre-existing comorbidities. Medline, Embase, PubMed and Cochrane electronic databases were searched according to modified Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. According to this review, conscious sedation appears to be the most preferred mode of anaesthesia in women undergoing TVOR owing to fewer adverse effects, faster recovery, better patient and specialist comfort and the least effect on oocyte quality and embryo development. Combining it with paracervical block resulted in lesser consumption of the anaesthetic drug, which may have a beneficial effect on the oocyte quality.
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Affiliation(s)
- Puvithra Thanikachalam
- Department of Obstetrics and Gynaecology, Chettinad Fertility Services, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India
| | - Dilip Kumar Govindan
- Department of Anaesthesiology, Sri Sathya Sai Medical College and Research Institute, Balaji Vidyapeeth University, Kanchipuram, Tamil Nadu, India
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29
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Asiri S, Guilhermino M, Duff J. The effectiveness of using virtual reality technology for perioperative anxiety among adults undergoing elective surgery: a randomised controlled trial protocol. Trials 2022; 23:972. [PMID: 36461040 PMCID: PMC9716760 DOI: 10.1186/s13063-022-06908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND More than 2.5 million people are admitted for surgery in Australia each year, and between 40 to 80% will experience moderate to high preoperative anxiety. Elevated levels of preoperative anxiety can increase the risk of postoperative complications such as pain, delayed wound healing, infection, prolonged recovery, and longer hospitalisation. Limited previous research on Virtual Reality (VR) indicates a positive impact on surgery-related anxiety and suggests that the intervention potentially leads to reduce postoperative complications. OBJECTIVE To evaluate the effectiveness of using VR technology for perioperative anxiety among adults undergoing elective surgery. METHOD A two-group parallel randomised controlled trial (RCT) will be conducted, including 150 adult patients (aged 18 years and over) undergoing elective surgery and requiring an overnight stay at a major metropolitan hospital. Eligible participants will be screened for anxiety via the Amsterdam Preoperative Anxiety and Information score (APAIS). Those with moderate to severe anxiety will be randomly allocated to receive the VR session or usual care, in the preoperative holding area. Intervention participants will use a head-mounted VR device to watch and listen to a nature scene for 10 minutes. STUDY OUTCOMES The primary outcome is perioperative anxiety measured using the visual analogue scale for anxiety (VAS-A). Secondary outcomes include stress levels (measured by saliva cortisol level and heart rate), postoperative pain, patient satisfaction with perioperative care, hospital length of stay, and VR-associated adverse events. CONCLUSION This study will help evaluate if a brief preoperative VR session can reduce perioperative anxiety for adult elective surgical patients. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001350910.
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Affiliation(s)
- Salihah Asiri
- grid.412832.e0000 0000 9137 6644School of Nursing, Umm Al-Qura University, Makkah, Saudi Arabia ,grid.1024.70000000089150953School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia ,Australian College of Perioperative Nurses (ACORN), QLD, Australia ,grid.416100.20000 0001 0688 4634Nursing & Midwifery Research Centre, Centre for Clinical Nursing, Royal Brisbane & Women’s Hospital, Building 34, Level 5, Herston, QLD 4029 Australia
| | - Michelle Guilhermino
- grid.266842.c0000 0000 8831 109XSchool of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia ,grid.414724.00000 0004 0577 6676John Hunter Hospital – Intensive care Services, Newcastle, Australia
| | - Jed Duff
- grid.1024.70000000089150953School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia ,Australian College of Perioperative Nurses (ACORN), QLD, Australia
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30
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Muacevic A, Adler JR, Shariff MA, Epstein E, Umar Y, Leber M. Parent and Physician Preference for Anxiolytic Medication Prior to Laceration Repair in Young Children. Cureus 2022; 14:e32412. [PMID: 36644082 PMCID: PMC9833619 DOI: 10.7759/cureus.32412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives Pediatric laceration repair is a daunting process for parents and physicians. The repair could take place quickly if the child is calm and relaxed.This study aimeds to evaluate parental and physician preference for anxiolytic medication administration prior to laceration repair, with a pre-and post-repair survey on parents' and physicians' initial preference and follow-up perception. Methods Parents or guardians of children aged six months to five years who presented with simple lacerations and their physicians were asked to complete a survey on potential benefits and expectations of anxiolytic use before and after the laceration repair. Results Fifty parents/guardians completed the survey. Forty-three (86%) expressed their preference for anxiolytic medication use if it had been available, before laceration repair. Parents/guardians perceived reactions to laceration repair before and after the procedure were significant, ranging from "uncontrolled crying" to "continuous crying" (p=.032). The parents/guardians overwhelmingly preferred to take part in the decision-making process during the repair (not significant). Preference for anxiolytic use was high before repair at 54% and increased to 62% after witnessing the procedure (not significant). Physicians who completed the survey supported the use of anxiolytics 84% of the time. Forty (80%) physicians preferred the intranasal route, while parents/guardians preferred the oral route (58%). Conclusions Procedural sedation is critical for anxiety control and to minimize the difficulties related to treatment. In our study, parents and physicians supported the administration of an anxiolytic agent to help alleviate anxiety and achieve optimal outcomes.
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31
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Antiperovitch P, Mokhtar AT, Mian M, Yee R, Khan HR. A Novel Nerve Block Technique for a Patient Undergoing Cardiac Device Implantation. JACC Case Rep 2022; 4:101612. [PMID: 36684036 PMCID: PMC9847233 DOI: 10.1016/j.jaccas.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 08/11/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
A woman with type 1 myotonic dystrophy received an implantable cardioverter-defibrillator using a novel combination of ultrasound-guided supraclavicular nerve and pectoral nerve blocks. The entire procedure was completed without any procedural sedation or local anesthetic, and the patient did not experience any pain during or after the procedure. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Pavel Antiperovitch
- Department of Medicine, Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada,Address for correspondence: Dr Pavel Antiperovitch, Department of Medicine, Division of Cardiology, London Health Sciences Centre, Western University, 339 Windermere Road, Room C6-004, London N6A 5A5, Ontario, Canada.
| | - Ahmed T. Mokhtar
- Department of Medicine, Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada,Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muhtashim Mian
- Department of Medicine, Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Raymond Yee
- Department of Medicine, Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Habib Rehman Khan
- Department of Medicine, Division of Cardiology, London Health Sciences Centre, Western University, London, Ontario, Canada
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32
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Bermejo S, Covas B, Silva-Costa-Gomes T, Sánchez-Font A, Curull V, Pérez-Ramos À, Mases A, Gallart L. Moderate sedation with dexmedetomidine-remifentanil is safer than deep sedation with propofol-remifentanil for endobronchial ultrasound while providing comparable quality: a randomized double-blind trial. Expert Rev Respir Med 2022; 16:1237-1245. [PMID: 36351310 DOI: 10.1080/17476348.2022.2145949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We compared dexmedetomidine-remifentanil vs. propofol-remifentanil in terms of safety and quality during sedation for Endobronchial ultrasonography (EBUS). METHODS A randomized, double-blind trial. Outpatients undergoing EBUS randomly received 1 μg/kg/hour dexmedetomidine or a target concentration of 2.5 μg/mL propofol, both combined with remifentanil initially targeted at 1.5 ng/mL and subsequently titrated. Additional sedatives were restricted. The primary outcome was the need for airway rescue interventions to treat oxygen desaturation. RESULTS Twenty-eight patients received dexmedetomidine-remifentanil and 27 received propofol-remifentanil. Airway rescue interventions were fewer in the dexmedetomidine group vs. the propofol one (23 vs. 76% patients, relative risk 3.21 (95% CI 1.55-6.64, P < 0.002)). Desaturation in the dexmedetomidine group was always resolved by increasing nasal oxygen flow, whereas additional interventions were needed in 60% of patients receiving propofol. Hypotension was more frequent in the propofol group, while hypertension, bradycardia and coughing were similar in both. Bronchoscopists' and patients' satisfaction were similar, although in the dexmedetomidine group two patients needed additional sedatives and two patients would not repeat the sedation technique. CONCLUSION Moderate sedation with dexmedetomidine-remifentanil for EBUS is safer than deep sedation with propofol-remifentanil but it would occasionally need additional sedatives to ensure patient satisfaction.
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Affiliation(s)
- Silvia Bermejo
- Anesthesiology Department, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Begoña Covas
- Anesthesiology Department, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Teresa Silva-Costa-Gomes
- Anesthesiology Department, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Sánchez-Font
- Respiratory Endoscopy Section, Respiratory Medicine Department, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Universitat Autònoma de Barcelona, CIBERES, ISCIII, Barcelona, Spain
| | - Víctor Curull
- Respiratory Endoscopy Section, Respiratory Medicine Department, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Universitat Autònoma de Barcelona, CIBERES, ISCIII, Barcelona, Spain
| | - Àlex Pérez-Ramos
- Anesthesiology Department, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Mases
- Anesthesiology Department, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lluís Gallart
- Anesthesiology Department, Hospital del Mar. Institut Hospital del Mar d'Investigacions Mèdiques (IMIM). Universitat Autònoma de Barcelona, Barcelona, Spain
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Duerr B, Morrison S, Stanley E, Zona E, Mermigas J. Identification of Patient-Related and Procedure-Related Factors Contributing to Hypoxemia in Adult Outpatients Undergoing Esophagogastroduodenoscopy (EGD). J Perianesth Nurs 2022; 38:193-199. [PMID: 36967679 DOI: 10.1016/j.jopan.2022.05.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/07/2022] [Accepted: 05/25/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To assess which patient factors and procedure-related factors contribute to hypoxemia during esophagogastroduodenoscopy (EGD) and determine whether prophylactic oropharyngeal suctioning reduces the rate of hypoxemia when compared to oropharyngeal suctioning when clinically indicated by patient's coughing or secretions. DESIGN This was a single-site study taking place at a private practice, outpatient facility with no anesthesia trainees present. Patients were randomized to one of two groups based on birth month. After the administration of sedating medications but before the insertion of the endoscope, Group A was oropharyngeal suctioned by either the anesthesia provider or the proceduralist. Group B was oropharyngeal suctioned only when clinically indicated by coughing or visible copious secretions. METHODS Data were collected on a variety of patient and procedure-related factors. Associations between these factors and hypoxemia during esophagogastroduodenoscopy were analyzed using the statistical analysis system application JMP. After analysis and literature review, a protocol for prevention and treatment of hypoxemia during EGD was proposed. FINDINGS This study found that chronic obstructive pulmonary disease increases the risk for hypoxemia during esophagogastroduodenoscopy. There were no other statistically significant associations between other factors and hypoxemia. CONCLUSIONS This study highlights factors that should be evaluated in the future when considering the risk of hypoxemia during EGD. Although not statistically significant, this study's results indicated that prophylactic oropharyngeal suctioning may reduce rates of hypoxemia, as only 1 of 4 cases of hypoxemia occurred in Group A. Additionally, future studies on hypoxemia during monitored anesthesia care for EGD should include an evaluation of the impact of American Society of Anesthesiologists class, history of chronic obstructive pulmonary disease or asthma, body mass index, obstructive sleep apnea, and opioid administration on hypoxemia risk.
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Affiliation(s)
- Briana Duerr
- Staff CRNA, Duke University Medical System, Durham, NC
| | - Suzanne Morrison
- Adjunct Professor, University of Pittsburgh, School of Nursing, Nurse Anesthesia Program, Pittsburgh, PA; Chief CRNA, Three Rivers Endoscopy Center, Moon Township, PA.
| | - Ernest Stanley
- Gastroenterologist, Three Rivers Endoscopy Center, Moon Township, PA
| | - Elizabeth Zona
- Anesthesiologist, Three Rivers Endoscopy Center, Moon Township, PA
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Gergin ÖÖ, Pehlivan SS, Erkan İ, Bayram A, Aksu R, Biçer C, Yıldız K, Kahriman G. Clinical efficacy of ultrasound guided erector spinae plane block in patients undergoing microwave ablation. Saudi Med J 2022; 43:1027-1034. [PMID: 36104059 PMCID: PMC9987667 DOI: 10.15537/smj.2022.43.9.20220245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To compare the effect of pre-emptive erector spinae plane block (ESPB) applied before the procedure on opioid consumption during the procedure and analgesic demand and opioid consumption after the procedure. METHODS American Society of Anesthesiologists Physical Status Classification (ASA) I-II, 30 patients, with liver tumor and planned for microwave ablation (MWA) treatment were included in the interventional radiology clinic, Erciyes University, Kayseri, Turkey, Turkey between 2021 and 2022. Patients were randomized either to the ESPB or control group. Ultrasound-guided ESPB block with 20 mL of 0.25% bupivacaine was performed preoperatively in the ESPB group patients, and the patients who was not performed the ESPB the control group. All the patients were administered 1 µg/kg fentanyl, 1-2 mg/kg propofol, and 1 mg/kg ketamine for sedation during the MWA procedure after standard monitoring. Total opioid consumption and numeric rating scale (NRS) scores for pain were recorded at 0, 20, 40, and 60 minutes, and at 2, 4, 6, 12, and 24 hours after the procedure. RESULTS Total opioid consumption and total opioid amount during the procedure were statistically significantly lower in the ESPB group (p<0.001). Although all of the patients in the control group needed additional fentanyl throughout the procedure, only 5 patients in the ESPB group needed additional fentanyl (p<0.001). Post-procedure NRS score values were significantly lower in the ESPB group at 40 minutes, 60 minutes and 4 hours (p<0.05). Numeric rating scale values at other times were statistically similar (p>0.05) CONCLUSION: This study showed that ESPB provided effective preemptive analgesia during MWA procedures.
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Affiliation(s)
- Özlem Öz Gergin
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - Sibel Seçkin Pehlivan
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - İbrahim Erkan
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - Adnan Bayram
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - Recep Aksu
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - Cihangir Biçer
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - Karamehmet Yıldız
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
| | - Güven Kahriman
- From the Department of Anesthesiology and Reanimation (Gergin, Pehlivan, Erkan, Bayram, Aksu, Biçer, Yıldız), Medical Faculty, Erciyes University; and Department of Radiology (Kahriman), Medical Faculty, Erciyes University, Kayseri, Turkey.
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Razavi SS, Malekianzadeh B. The Efficacy and Complications of Deep Sedation in Pediatric Dental Patients: A Retrospective Cohort Study. Anesthesiol Res Pract 2022; 2022:5259283. [PMID: 35783546 PMCID: PMC9242812 DOI: 10.1155/2022/5259283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/28/2022] [Indexed: 11/27/2022] Open
Abstract
Background Dental anxiety in children is a common problem. Currently, many of dental procedures are performed under sedation. Different methods of sedation have been employed for this purpose. Compared to adults, children usually need a deeper sedation level. The aim of this retrospective study is to assess the efficacy and complication of deep sedation in pediatric dental patients. Method This study was performed on 250 ASA (American Society of Anesthesiologists) I, II children undergoing deep sedation during the dental procedures. After the administration of oral midazolam as premedication, the monitoring process started. The patients that received the sedation dose of propofol and oxygen through nasal cannula during the procedure were carefully monitored for the purpose of evaluating hemodynamic and respiratory complications. The mean procedure and recovery time, postoperative nausea and vomiting (PONV), and success rate were further studied. Result The average age of the patients was 3.7. 32% of the patients were females, and 68% of them were males. Laryngospasm that occurred in 5 cases was resolved immediately by using positive pressure ventilation. Mild hypoxia was observed in 17 cases which were immediately managed by a bag-valve-mask ventilation. No cases of hemodynamic complications and PONV were reported. The mean length of the procedure was 57 minutes, and the mean length of recovery was 16 minutes. The success rate of this method was estimated to be 99.6%. Conclusion Deep sedation with propofol is a suitable technique with a high success rate for dental procedures in children. It was also concluded that in pediatric dental procedures, the presence of a skilled anesthetist and the implementation of a close monitoring process are required.
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Affiliation(s)
- Seyed Sajad Razavi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Freriksen JJM, van der Zanden TM, Holsappel IGA, Molenbuur B, de Wildt SN. Best Evidence-Based Dosing Recommendations for Dexmedetomidine for Premedication and Procedural Sedation in Pediatrics: Outcome of a Risk-Benefit Analysis By the Dutch Pediatric Formulary. Paediatr Drugs 2022; 24:247-257. [PMID: 35344192 PMCID: PMC9068679 DOI: 10.1007/s40272-022-00498-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dexmedetomidine is currently off-label for use in pediatric clinical care worldwide. Nevertheless, it is frequently prescribed to pediatric patients as premedication prior to induction of anesthesia or for procedural sedation. There is ample literature on the pharmacokinetics, efficacy and safety of dexmedetomidine in this vulnerable patient population, but there is a general lack of consensus on dosing. In this project, we aimed to use the standardized workflow of the Dutch Pediatric Formulary to establish best evidence-based pediatric dosing guidelines for dexmedetomidine as premedication and for procedural sedation. METHOD The available literature on dexmedetomidine in pediatrics was reviewed in order to address the following three questions: (1) What is the right dose? (2) What is known about efficacy? (3) What is known about safety? Relevant literature was compiled into a risk-benefit analysis document. A team of clinical experts critically appraised the analysis and the proposed dosing recommendations. RESULTS Dexmedetomidine is most commonly administered via the intravenous or intranasal route. Clearance is age dependent, warranting higher doses in infants to reach similar exposure as in adults. Dexmedetomidine use results in satisfactory sedation at parent separation, adequate sedation and a favorable recovery profile. The safety profile is good and comparable to adults, with dose-related hemodynamic effects. CONCLUSION Following the structured approach of the Dutch Pediatric Formulary, best evidence-based dosing recommendations were proposed for dexmedetomidine, used as premedication prior to induction of anesthesia (intranasal dose) and for procedural sedation (intranasal and intravenous dose) in pediatric patients.
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Affiliation(s)
- Jolien J M Freriksen
- Department of Pharmacology and Toxicology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Tjitske M van der Zanden
- Department of Pharmacology and Toxicology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Intensive Care and Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Dutch Knowledge Center Pharmacotherapy for Children, Postbus 25270, 3001 HG, Rotterdam, The Netherlands
| | - Inge G A Holsappel
- Royal Dutch Pharmacists Association, Alexanderstraat 11, 2514 JL, The Hague, The Netherlands
| | - Bouwe Molenbuur
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Saskia N de Wildt
- Department of Pharmacology and Toxicology, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Intensive Care and Department of Pediatric Surgery, Erasmus MC, Sophia Children's Hospital, Dr Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Dutch Knowledge Center Pharmacotherapy for Children, Postbus 25270, 3001 HG, Rotterdam, The Netherlands
- Royal Dutch Pharmacists Association, Alexanderstraat 11, 2514 JL, The Hague, The Netherlands
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McPherson KL, Kovacic Scherrer NL, Hays WB, Greco AR, Garavaglia JM. A Review of Push-Dose Vasopressors in the Peri-operative and Critical Care Setting. J Pharm Pract 2022:8971900221096967. [PMID: 35459405 DOI: 10.1177/08971900221096967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
During hospitalization, the risk of hypotension and associated sequelae remain important considerations for patient outcomes. The use of push-dose vasopressors (PDP) outside of the operating room has increased in recent years to combat the negative effects of hypotension. This narrative review evaluates the utility of PDP in its traditional perioperative setting as well as in areas of increasing use such as the emergency department and intensive care unit. Articles evaluating PDP highlight successful increases in blood pressure with all agents but differ in rates of adverse events and most lack direct comparison of PDP agents in regard to safety and efficacy. Agents utilized as PDP, including epinephrine, phenylephrine, norepinephrine, vasopressin, and ephedrine vary in mechanism of action, onset of action, and duration of action. These variations in pharmacology along with published literature may lead to differences in the preferred PDP for various clinical scenarios. Many adverse events associated with PDP have been due to dosing errors highlighting the importance of education surrounding the use of these agents. Additional research is necessary to further elucidate the risks and benefits of PDP in clinical practice, and to determine which PDP is truly preferred. Careful consideration should be given when determining the appropriateness of this administration method of vasopressors in various clinical scenarios.
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Affiliation(s)
- Kaitlyn L McPherson
- Emergency Medicine Pharmacist, Department of Pharmacy, 20205Charleston Area Medical Center General Hospital, Charleston, WV, USA
| | | | - William B Hays
- Emergency Medicine Pharmacist, Department of Pharmacy, Indiana University Health West Hospital, Avon, IN, USA
| | - Alexandra R Greco
- Critical Care Pharmacist, Department of Pharmacy, WVU Medicine, Morgantown, WV, USA
| | - Jeffrey M Garavaglia
- Neurology Intensive Care Pharmacist, Department of Pharmacy, WVU Medicine, Morgantown, WV, USA
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Kim HY, Choi YH, Lee SJ. Effect of Sedation Anesthesia With Intravenous Propofol on Transrectal Ultrasound-Guided Prostate Biopsy Outcomes. J Korean Med Sci 2022; 37:e115. [PMID: 35437964 PMCID: PMC9015899 DOI: 10.3346/jkms.2022.37.e115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/21/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Sedation anesthesia during transrectal ultrasound (TRUS)-guided prostate biopsy is known to decrease patient pain and anxiety, but little is known whether it affects the procedure's prostate cancer detection and complication rates. This study aimed to determine the effect of sedation anesthesia with intravenous (IV) propofol on TRUS-guided prostate biopsy outcomes. METHODS A retrospective analysis of 2,119 patients who underwent TRUS-guided prostate biopsy between November 2009 and February 2019 was undertaken. The patients were divided into two groups: patients who underwent sedation anesthesia with IV propofol and patients who underwent local anesthesia with intrarectal lidocaine gel instillation. Cancer detection and complication rates were compared between the two groups. Univariate and multivariate binary logistic regression and multinomial logistic regression analyses were conducted to investigate the effects of sedation anesthesia with IV propofol on prostate cancer detection and complication rates. RESULTS The cancer detection rate of patients in the sedation group was 34.0%, whereas it was 29.2% in the local group (P = 0.024). Multivariate logistic regression analysis regarding factors associated with cancer detection rate after TRUS-guided prostate biopsy in patients with prostate specific antigen (PSA) < 10 showed that IV propofol usage, age, PSA density and core length were significant factors. Multivariate logistic regression analysis regarding factors associated with complications (voiding dysfunction, bleeding and infection) showed that IV propofol usage, age and prostate size were significant factors for voiding dysfunction. CONCLUSION Sedation anesthesia with IV propofol during TRUS-guided prostate biopsy was associated with a higher cancer detection rate than local anesthesia with intrarectal lidocaine gel instillation. Cancer detection rate could be an important factor to consider when selecting for the optimal anesthesia for TRUS-guided prostate biopsy.
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Affiliation(s)
- Hee Youn Kim
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Hyo Choi
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Ju Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Many YA, Berkenstadt H, Henkin Y. The safety and efficacy of a nurse-led sedation service using Chloral Hydrate for auditory brainstem response testing. J Pediatr Nurs 2022; 63:e143-e148. [PMID: 34620532 DOI: 10.1016/j.pedn.2021.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is a growing number of pediatric procedures requiring sedation outside the operating room. Among these are auditory brainstem response (ABR) tests, the gold standard for objective hearing evaluation in infants and toddlers. Recently, a nurse-led pediatric sedation service based on a structured protocol has been developed for ABR testing. OBJECTIVES To retrospectively analyze the safety and efficacy of the pediatric nurse-led sedation protocol (PNLSP) in a tertiary medical center using Chloral Hydrate (CH) in children undergoing ABR testing. METHODS Data from medical charts of children who underwent sedation for ABR testing between January 2014 and December 2017, were retrieved. Analysis of sedation success/failure rates, sleep induction time (SIT), sleep duration time (SDT), and adverse events (AE), was performed. FINDINGS 1348 children with a mean age of 13.4 months (range 3-42 months), classified by the American Society of Anesthesiologists Physical Status Classification System (ASA score) 1-3, were included in the analysis. All children received a fixed dose of 75 mg / kg CH orally or rectally. Sedation success rate was 98.7% and enabled completion of ABR testing. Failure to sedate was evident in 17 children (1.3%), all classified as ASA score 1-2. Median SIT and SDT were 25 and 100 min, respectively. Mild AE occurred in 9 children (0.67%), none of which required further intervention. CONCLUSIONS Findings support the use of a structured PNLSP using CH as safe and efficient. The suggested protocol is an effective alternative for general anesthesia (GA) for ABR testing in healthy young children.
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Affiliation(s)
- Yael Alfandary Many
- The Edmond and Lily Safra children's Hospital, Departments of Anesthesiology, Sheba Medical Center, Tel Hashomer, Derech Sheba 2, Ramat Gan, 5262000, Israel.
| | - Haim Berkenstadt
- Departments of Anesthesiology, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yael Henkin
- Hearing, Speech & Language Center, Sheba Medical Center, Tel Hashomer, Department of Communication Disorders, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Evaluation of Monitored Anesthesia Care Involving Sedation and Axillary Nerve Block for Day-Case Hand Surgery. Healthcare (Basel) 2022; 10:healthcare10020313. [PMID: 35206928 PMCID: PMC8872222 DOI: 10.3390/healthcare10020313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Ultrasound-guided axillary brachial plexus block (ABPB) is a technique of choice for regional anesthesia during hand and forearm surgery. Intravenous sedation may facilitate this procedure, particularly for those suffering from anxiety; however, it can also be associated with respiratory, cardiovascular, and neurological side effects. The objective of this study was to evaluate the effect of intravenous sedation on perioperative respiratory depression for patients undergoing day-case hand surgery under ABPB. Methods: A prospective, observational, single-center study was conducted between 1 May and 1 November 2016. Results: A total of 2318 patients were included, with 501 patients in the group with IV sedation and 1817 in the group without. A multivariable propensity-score matched analysis showed that the variables associated with the number of desaturation were: (i) sedation (aRR 1.534 [95% CI: 1.283 to 1.836]), (ii) age and sex, (iii) type of surgery, and iv) Body Mass Index (BMI). Conclusions: Supplementing ABPB with IV sedation was associated with an increased rate of respiratory depression (episodes of desaturation) compared to fully awakened patients. The rate of oxygen administration was also higher in sedated patients even though they had fewer cases of chronic respiratory diseases and fewer were active smokers than non-sedated patients. Future research should consider precisely evaluating patient satisfaction, as well as the differences between sedation and drug-free approaches.
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Zhuang Z, Chen Z, Chen H, Chen B, Zhou J, Liu A, Luo J. Using Local Anesthesia for Burr Hole Surgery of Chronic Subdural Hematoma Reduces Postoperative Complications, Length of Stay, and Hospitalization Cost: A Retrospective Cohort Study From a Single Center. Front Surg 2022; 9:783885. [PMID: 35433811 PMCID: PMC9010536 DOI: 10.3389/fsurg.2022.783885] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/11/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The purpose of the current study was to compare the effects of local anesthesia (LA) and general anesthesia (GA) on the surgical process and postoperative recovery of patients with unilateral chronic subdural hematoma (CSDH). PATIENTS AND METHODS A retrospective cohort study was conducted on patients with unilateral CSDH who underwent burr hole surgery between the years 2013 and 2018. Patients who received local anesthesia were allocated to the LA group, and the patients who received general anesthesia were allocated to the GA group. The clinical data, postoperative complication, length of stay, and hospitalization cost of these two groups were compared and analyzed. RESULTS Data from 105 patients was collected for this study. Fifty one patients were assigned to the LA group and 54 to GA group. The duration of anesthesia and operation of the LA group was 37.71 (10.55) min; while for the GA group the duration was 56.04 (8.37) min (p < 0.001). The time from operation to discharge in GA group was greatly longer than that in LA group [(8.51 (1.49) days vs. 10.46 (2.34) days, respectively; p < 0.001]. Hospitalization cost for LA group was 2,721.54 (504.66) USD, which was significantly lesser than that for GA patients [3,314.82 (493.52) USD; p < 0.001]. The total number of complications in LA patients was less than that in GA patients [6 vs. 29 cases, respectively; p < 0.001]. The number of patients with residual hematoma in the LA group was <that in the GA group (p = 0.014). CONCLUSION As compared to GA, LA might be a simpler, safer, and more effective method for burr hole surgery of CSDH to promote patients' recovery. However, further research is still required to confirm this conclusion.
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Affiliation(s)
- Zerui Zhuang
- Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Neurosurgery, Shantou Central Hospital, Shantou, China
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Zelin Chen
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Hui Chen
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Bin Chen
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Jianzhi Zhou
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, China
| | - Anmin Liu
- Department of Neurosurgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jianming Luo
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, China
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Abstract
With the increasing frequency of rabbits as veterinary patients, the expectation for high-quality, intensive veterinary care, and resultantly an understanding of anesthesia has been increasing. Sedation and general anesthesia are commonly required for many routine and emergency procedures in rabbits, and this results in the need for a strong awareness of anesthetic principles, knowledge of limitations of anesthesia, and maintenance of high standards of anesthesia.
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Biswas B, Singh PC. The enhanced dissociation and associated surface structure of the anesthetic propofol at the water interface: vibrational sum frequency generation study. Phys Chem Chem Phys 2021; 23:24646-24651. [PMID: 34704569 DOI: 10.1039/d1cp02838c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Propofol, the most administered drug for general anesthesia, affects the acid-base equilibrium at the interfacial region of arterial blood. Hence, the structure of propofol at the water interface under different pH conditions has been measured using the surface-selective vibrational sum frequency generation (VSFG) technique to understand the hydration as well as the dissociation of propofol at the water interface. Propofol remains in its neutral form at pH ≤ 5.8 in which the OH group of propofol forms a hydrogen bond with interfacial water molecules, where a few interfacial water molecules also interact with the π electron density of propofol. By contrast, propofol prefers to be in the deprotonated state at pH ≥ 7, due to which the surface of water becomes negatively charged and hence the interfacial water becomes oriented and the intensity of the OH stretch of water is enhanced. The pKa of propofol at the water interface is ∼three units lower than in the bulk medium indicating that the dissociation of propofol is notably enhanced at the water interface. These VSFG studies suggest that, unlike the bulk, propofol prefers to be in the charged state at the water interface under physiological conditions, which may be important in understanding its diffusion and acid-base equilibrium in the interfacial arterial blood region.
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Affiliation(s)
- Biswajit Biswas
- School of Chemical Sciences, Indian Association for the Cultivation of Sciences, Kolkata, West Bengal, 700032, India.
| | - Prashant Chandra Singh
- School of Chemical Sciences, Indian Association for the Cultivation of Sciences, Kolkata, West Bengal, 700032, India.
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Li HP, Liu KP, Yao L. Dexmedetomidine in combination with ketamine for pediatric procedural sedation or premedication: A meta-analysis. Am J Emerg Med 2021; 50:442-448. [PMID: 34492589 DOI: 10.1016/j.ajem.2021.08.073] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate effectiveness of combinational use of dexmedetomidine and ketamine (DEX-KET) for pediatric procedural sedation or premedication. METHODS Relevant studies were identified after a literature search in electronic databases and study selection was based on precise eligibility criteria. Meta-analyses of mean differences were performed to examine differences in sedation onset and recovery times between DEX-KET and comparators. Changes from baseline in heart rate (HR), respiratory rate, oxygen saturation, and mean arterial pressure (MAP), were pooled. Meta-analyses of proportions were performed to estimate incidence of adverse events. RESULTS 15 studies (1087 patients) were included. Onset of sedation was significantly shorter in DEX-KET than in DEX group. HR declined in DEX-KET group from start (-3.5 beats per minute (BPM) [95% CI: -5.1, -1.9]) through midpoint (-7.2 BPM [95% CI: -12.1, -2.3]) and at end of sedation (-8.7 BPM [95% CI: -13.1, -4.4]). Decrease in HR after DEX administration at start was -11.6 BPM [95% CI: -16.0, -7.1] and remained consistent afterward. There was no change in MAP during DEX-KET sedation. However, after DEX administration, MAP decreased by -6.9 [95% CI: -10.4, -3.3] at start, -7.8 [95% CI: -11.4, -4.2] at middle, and by -6.6 [95% CI: -14.4, 1.1] at end of sedation. Incidence of hypotension was 3% [95% CI: 0, 9] in DEX-KET, 7% [95% CI: 2, 14] in DEX, and 0% [95% CI: 0, 2] in KET groups. Incidence of bradycardia was 2% [95% CI: 0, 6] with DEX-KET and 12% [95% CI: 5, 20] with DEX. Incidence of oxygen desaturation was 3% [95% CI: 0, 8] in DEX-KET, 2% [95% CI: 0, 6] in DEX, 12% [95% CI: 5, 20] in KET, and 13% [95% CI: 6, 21] in PROP-KET groups. MIDA-KET sedation had 13% [95% CI: 4, 25] incidence of tachycardia. CONCLUSIONS DEX-KET for pediatric sedation results in better sedation outcomes than DEX or KET by shortening onset of sedation and recovery while maintaining hemodynamic and respiratory stability with low incidence of adverse events. DEX sedation was associated with higher incidence of bradycardia. Higher incidence of oxygen desaturation was observed with KET and PROP-KET whereas MIDA-KET was associated with higher incidence of tachycardia.
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Affiliation(s)
- Hong-Pei Li
- Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
| | - Kun-Peng Liu
- Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China
| | - Lan Yao
- Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China.
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Mekonnen GB, Debeb SG, Getaw NS, Kifle ZD. Self-Reported Sedative Drug Use Among Students Attending at University of Gondar, Gondar, Northwest, Ethiopia: A Cross-Sectional Study. Subst Abuse Rehabil 2021; 12:49-57. [PMID: 34429683 PMCID: PMC8378893 DOI: 10.2147/sar.s324098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Medical students experience significant psychological stress and are therefore at higher risk of using sedatives. There are currently no studies describing the prevalence of sedative drug use among medical students in Ethiopia. This study aimed to assess the prevalence and associated factors of self-reported sedative drug use among medical students attending the College of Medicine and Health Science (CMHS) students at the University of Gondar (UoG). Material and Methods A prospective cross-sectional study was conducted from May to July 2018 in CMHS at UoG. Data were collected using a pre-tested self-administered standard questionnaire. Data were collected, entered into a computer using Epi Info 7 software, and analyzed using SPSS version 20. Frequency, mean, and standard deviation were used to describe descriptive statistics, and binary and multiple logistic regression analyses were used to assess the association between different variables and sedative drug use; P <0.05 was used to declare association. Results Of the 422 students who returned questionnaires, 26 (6.2%) participants were reported sedative drug use at some time since enrollment. Of these, 61.54% participants used antihistamine drugs. Smoking status (AOR (95% CI), 0.046 (0.009–0.241) P = 0.0001), stimulant use (AOR (95% CI), 0.220 (0.062–0.780) P = 0.019), sleeping hour (AOR (95% CI), 9.931 (4.155–14.785) P = 0.001) and sleep disorder (AOR (95% CI), 0.149 (0.033–0.680) P = 0.014) were significantly associated with sedative drug use. Conclusion Self-reported sedative drug use among medical students at the University of Gondar is relatively low, and antihistamines are the most commonly used drugs. Smoking, stimulant use, sleeping hour, and the presence of sleep disorders were associated with sedative drug use.
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Affiliation(s)
- Gashaw Binega Mekonnen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Simachew Gidey Debeb
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nurahmed Seid Getaw
- Department of Pharmaceutical Analysis, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemene Demelash Kifle
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Comparative Safety Profiles of Sedatives Commonly Used in Clinical Practice: A 10-Year Nationwide Pharmacovigilance Study in Korea. Pharmaceuticals (Basel) 2021; 14:ph14080783. [PMID: 34451882 PMCID: PMC8399659 DOI: 10.3390/ph14080783] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 11/17/2022] Open
Abstract
This study aims to compare the prevalence and seriousness of adverse events (AEs) among sedatives used in critically ill patients or patients undergoing invasive procedures and to identify factors associated with serious AEs. Retrospective cross-sectional analysis of sedative-related AEs voluntarily reported to the Korea Adverse Event Reporting System from 2008 to 2017 was performed. All AEs were grouped using preferred terms and System Organ Classes per the World Health Organization-Adverse Reaction Terminology. Logistic regression was performed to identify factors associated with serious events. Among 95,188 AEs, including 3132 (3.3%) serious events, the most common etiologic sedative was fentanyl (58.8%), followed by pethidine (25.9%). Gastrointestinal disorders (54.2%) were the most frequent AEs. The most common serious AE was heart rate/rhythm disorders (33.1%). Serious AEs were significantly associated with male sex; pediatrics; etiologic sedative with etomidate at the highest risk, followed by dexmedetomidine, ketamine, and propofol; polypharmacy; combined sedative use; and concurrent use of corticosteroids, aspirin, neuromuscular blockers, and antihistamines (reporting odds ratio > 1, p < 0.001 for all). Sedative-induced AEs are most frequently reported with fentanyl, primarily manifesting as gastrointestinal disorders. Etomidate is associated with the highest risk of serious AEs, with the most common serious events being heart rate/rhythm disorders.
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Kim JN, Cho JE. Emergency drug usage during flight and airline safety management for passengers. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2021; 84:529-535. [PMID: 33761843 DOI: 10.1080/15287394.2021.1895013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
During flight, passengers may experience aviation-related symptoms such as headache, nausea, respiratory failure, and panic disorders. To treat patients with these symptoms, emergency drugs are prepared in the cabin and crews treat patients according taking into account usage and dose guidelines described on the drug containers. However, certain types of drugs are limited and not adequately prepared in the cabin. The aim of this study was to examine (1) emergency drugs used during flight and frequency of symptoms experienced in passengers and (2) cognizance of drug usage among crews was also determined in low-cost carriers. Most frequent symptoms recorded were headache (74.1%), abdominal pain (72.3%), nausea (70.5%), and ear pain (60.7%). Panic disorder (50.9%) is the fifth frequent syndrome in passengers, but emergency drugs are not available for this condition in the cabin. The cognizance survey showed that 21% of crews out of 112 who responded were not interested in usage guidelines of emergency drugs or simply ignored. Thirty-seven percent of crews failed to pay attention to drug expiration dates. Our findings suggest that crews need to be better trained for preparation and usage of emergency drugs in the cabin for passengers suffering from various symptoms. Further, it is recommended that airline companies need to consider to improve the emergency drug management system by requesting training from pharmacists and doctors for safe drug usage.
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Affiliation(s)
- Jeum-Nam Kim
- Department of Aviation-Tourism, Howon University, Gunsan-si, Jeolabuk-do, South Korea
| | - Ju-Eun Cho
- Department of Global Aviation Service Management, PaiChai University, Kwangyeoksi, South Korea
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Moderate and deep procedural sedation-the role of proper monitoring and safe techniques in clinical practice. Curr Opin Anaesthesiol 2021; 34:497-501. [PMID: 34039848 DOI: 10.1097/aco.0000000000001011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Interventional pain management procedures provide significant improvement to patient quality of life and functionality. In-office procedures are becoming an increasingly more common site of pain management intervention for patients with minimal risk of harm. RECENT FINDINGS Moderate and deep sedation techniques can be used in patients with high anxiety, complex pharmacotherapy, or a low pain threshold. Proper guidance and oversight by an attending anesthesiologist, in addition to appropriate monitoring, are key. Epidural steroid injection complications rates have been cited at 2.4%, with the most common complications noted as persistent pain and flushing. SUMMARY Serious complication errors can be avoided with proper supervision and monitoring. The adherence to published societal recommendations and guidelines for indications of when to use moderate to deep sedation techniques, and appropriate supervision and monitoring methods, can avoid errors in interventional pain management procedures.
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Ambler M, Springs S, Garcia D, Born C. Heterogeneity of outcomes for intraoperative music interventions: a scoping review and evidence map. BMJ Evid Based Med 2021; 26:116-117. [PMID: 32816900 DOI: 10.1136/bmjebm-2020-111382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Over the past 30 years, numerous studies have been performed that assess the efficacy of intraoperative music as an adjunctive means to regional and local anaesthesia to improve clinical outcomes. Despite an emerging body of evidence and growing adoption of music in surgical settings, the variety of interventions studied, and the heterogeneity of outcomes and outcome measurement tools applied makes difficult the task of aggregating evidence. OBJECTIVE This study assesses the state of the field of intraoperative musical interventions by documenting and visualising the breadth of outcomes measured in studies. DESIGN Scoping review and evidence map. METHODS Three electronic databases (PubMed, Embase and a music-focussed research database, RILM (International Music Literature Repository)) were searched for full-text articles published between January 1991 and July 2019. Results from these searches were screened and relevant data was extracted from full-text articles on type of music intervention and type of anaesthesia; outcomes measured were recorded in an evidence map in order to identify the current state of the field and assess for trends in outcome measurements. INTERVENTIONS Music administered to adult patients via headphones or speakers under regional or local sedation in during the intraoperative period. RESULTS Twenty-one studies with a total of 2283 patients were included. A total of 42 unique outcomes were measured across the 21 studies, with each measuring an average of 6.41±2.63 outcomes. Systolic blood pressure, diastolic blood pressure, heart rate, anxiety, pain, patient satisfaction, respiratory rate and sedation requirements were the most prevalent outcomes reported. Only 15 outcome measures (36%) were used in more than one study, while the remaining 27 outcome measures (64%) were identified in only one study in our review. CONCLUSIONS Our scoping review identifies that almost two-thirds of studies in this field used >1 outcome measure unique to that study (not also used in other studies), which hinders opportunities to aggregate data across studies and meta-analyse evidence. Future studies should provide clear documentation regarding the intervention and consider using valid and reliable outcome tools. Researchers should consider standardisation when appropriate and adopting the use of core outcome sets for conditions where these sets have been developed.
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Affiliation(s)
- Melanie Ambler
- Brown University Division of Biology and Medicine, Providence, Rhode Island, USA
- Diane Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Stacey Springs
- Center for Evidence Synthesis, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Dioscaris Garcia
- Diane Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Christopher Born
- Diane Weiss Center for Orthopaedic Trauma Research, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
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Joshi G, Kabra A, Goutam N, Sharma A. An Overview on Patient-Centered Clinical Services. BORNEO JOURNAL OF PHARMACY 2021. [DOI: 10.33084/bjop.v4i2.1978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Drug-related problems (DRPs) had often been a concern in the system that needed to be detected, avoided, and addressed as soon as possible. The need for a clinical pharmacist becomes even more important. He is the one who can not only share the load but also be an important part of the system by providing required advice. They fill out the patient's pharmacotherapy reporting form and notify the medical team's head off any drug-related issues. General practitioners register severe adverse drug reactions (ADRs) yearly. As a result of all of this, a clinical pharmacist working in and around the healthcare system is expected to advance the pharmacy industry. Its therapy and drugs can improve one's health quality of life by curing, preventing, or diagnosing a disease, sign, or symptom. The sideshows, on the other hand, do much harm. Because of the services they offer, clinical pharmacy has grown in popularity. To determine the overall effect and benefits of the emergency department (ED) clinical pharmacist, a systematic review of clinical practice and patient outcomes will be needed. A clinical pharmacist's anatomy, toxicology, pharmacology, and medicinal chemistry expertise significantly improves a patient's therapy enforcement. It is now important to examine the failure points of healthcare systems as well as the individuals involved.
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Affiliation(s)
- Gaurav Joshi
- University Institute of Pharma Sciences, Chandigarh University
| | - Atul Kabra
- University Institute of Pharma Sciences, Chandigarh University
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