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Ann Emerg Med 2022 Jun 22. Epub 2022 Jun 22.

Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.

Study Objective: Laryngospasm is a rare but potentially life-threatening complication of sedation. The objective of this study was to perform a predictor analysis of biologically plausible predictors and the interventions and outcomes associated with laryngospasm.

Methods: Secondary analysis of prospectively collected data from consecutively sedated patients, less than or equal to 22 years of age, at multiple locations at 64 member institutions of the Pediatric Sedation Research Consortium. Read More

J Clin Med 2022 Jun 17;11(12). Epub 2022 Jun 17.

Department of Anaesthesia, NHS Grampian, Aberdeen AB25 2ZD, UK.

The use of total intravenous anaesthesia (TIVA) has been well established as an anaesthetic technique over the last few decades. Significant variation in practice exists however, and volatile agents are still commonly used. This study aims to determine the motivations and barriers for using TIVA over the use of volatile agents by analysing the opinion of several international anaesthetists with specific expertise or interests. Read More

Children (Basel) 2022 May 25;9(6). Epub 2022 May 25.

Department of Pediatrics, University Hospitals UZ Leuven, 3000 Leuven, Belgium.

The hospital can be a stressful environment for a child. To address the increase in demands for pediatric procedural sedation, the PROSA team initiative was started in the Leuven University Hospitals in 2014. In this study, we assessed the efficacy and safety of this project since its initiation. Read More

Pathophysiology 2022 May 28;29(2):223-232. Epub 2022 May 28.

School of Medicine, LSU Health Sciences, Shreveport, LA 71130, USA.

Legalization/decriminalization of cannabis will increase the numbers of patients who have had recent exposure to recreational or medical cannabis. Currently, little has been reported about potential interactions between cannabis use and Propofol anesthesia e.g. Read More

Eur J Pediatr 2022 Jun 22. Epub 2022 Jun 22.

Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy.

Ileocolic intussusception is a common cause of bowel obstruction. When spontaneous reduction does not occur, non-operative management through enema reduction is necessary. Despite the evidence indicating that sedatives favor success in the reduction, their use is still not a common practice. Read More

S D Med 2022 Mar;75(3):109-113

University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.

Introduction: The use of minimal and moderate sedation in the pediatric population allows for the successful completion of many procedures in both hospital and outpatient settings without the risks involved with general anesthesia. Sanford Children's outpatient sedation clinic had been using oral midazolam for minimal sedation but began using inhaled nitrous oxide in January 2019. The current study examines patient experience and parent/guardian satisfaction with use of inhaled nitrous oxide for minimal sedation. Read More

Pharmacotherapy 2022 Jun 16. Epub 2022 Jun 16.

Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

The bispectral index (BIS) is an attractive approach for monitoring level of consciousness in critically ill patients, particularly during paralysis, when commonly used sedation scales cannot be used. As a first step towards establishing the utility of BIS during paralysis, this review examines the strength of correlation between BIS and clinical sedation scales in a broad population of non-paralyzed, critically ill adults. We included studies evaluating the strength of correlation between concurrent assessments of BIS and Richmond Agitation Sedation Scale (RASS), Ramsay Sedation Scale (RSS), or Sedation Agitation Scale (SAS) in critically ill adult patients. Read More

JMIR Res Protoc 2022 Jun 13;11(6):e30616. Epub 2022 Jun 13.

Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île de Montréal, Montreal, QC, Canada.

Background: It is known that magnetic resonance imaging (MRI) procedures generate fear and anxiety. Children may become restless during scanning, which results in movement artifacts requiring the MRI procedure to be repeated with sedation. Few studies seem to have looked at the effect of immersive virtual reality (IVR) on anxiety in children scheduled for MRI scans and how to identify which children are more responsive. Read More

Plast Reconstr Surg Glob Open 2022 Jun 10;10(6):e4402. Epub 2022 Jun 10.

Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.

Evidence-based protocols identifying COVID-19 cases in pediatric preoperative settings are lacking. With COVID-19 positioned to remain a threat to children, this study examines effectiveness of preoperative COVID-19 symptom screening in pediatric patients.

Methods: This retrospective cohort study included hospital billing/medical record queries of (1) procedures performed under conscious sedation/general anesthesia and (2) laboratory-confirmed COVID-19 (+) cases from April 6, 2020, to June 15, 2020. Read More

Am J Emerg Med 2022 May 6;58:159-174. Epub 2022 May 6.

Department of Emergency Medicine, UHS Southern California Medical Education Consortium, Temecula, CA 92592, USA.

Introduction: Pericardial tamponade requires timely diagnosis and management. It carries a high mortality rate.

Objective: This review incorporates available evidence to clarify misconceptions regarding the clinical presentation, while provifing an in-depth expert guide on bedside echocardiography. Read More

J Am Dent Assoc 2022 Jun 9. Epub 2022 Jun 9.

Background: Tooth extractions account for most opioid prescriptions from dentists, but specific characteristics that influence likelihood are less established. Improving understanding can facilitate development of tailored interventions to reduce unnecessary opioid prescribing.

Methods: The authors performed a retrospective review of patients 12 years and older undergoing tooth extraction at the College of Dentistry at the University of Kentucky from 2013 through 2020. Read More

J Emerg Med 2022 Jun 8. Epub 2022 Jun 8.

Department of Pharmacy, Department of Emergency Medicine, Valleywise Health Medical Center, Phoenix, Arizona.

Background: The use of sedative and analgesic agents is required for procedural sedation in the emergency department (ED). Agents such as ketamine and propofol are commonly used for procedural sedation. This is likely due to clinical experience with these agents, as well as optimal pharmacologic properties when used in combination with one another. Read More

Gastrointest Endosc 2022 Jun 8. Epub 2022 Jun 8.

Department of Gastroenterology and Hepatology, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia.

Background And Aims: General anesthesia (GA) or monitored anesthesia care (MAC) is increasingly used to perform endoscopic retrograde cholangiopancreatography (ERCP). The definitive choice between the two sedative types remains to be established. This study compared the outcome of GA with MAC in ERCP performed in patients at average risk for sedation-related adverse events. Read More

BMC Anesthesiol 2022 Jun 10;22(1):180. Epub 2022 Jun 10.

Department of Anaesthesiology, The Fourth Affiliated Hospital, Zhejiang University, School of Medicine, Yiwu, 322000, Zhejiang, China.

Background: Remimazolam tosilate (HR7056, RT), a novel ultrashort-acting benzodiazepine, can be used for procedural sedation and general anaesthesia. However, few studies have focused on the sedative effect of RT during gastrointestinal endoscopy in elderly patients. The purpose of this study is to compare the sedative effect of RT and propofol for gastrointestinal endoscopy in elderly patients. Read More

Pediatr Emerg Care 2022 Jun 9. Epub 2022 Jun 9.

From the Division of Emergency Medicine.

Objective: Fractures are common childhood injuries that result in emergency department (ED) visits. National trends in pediatric fracture epidemiology and resource utilization are not well described. Our objective is to analyze national trends in pediatric fracture epidemiology, ED disposition, and ED resource utilization from 2010 to 2015. Read More

J Clin Med 2022 May 31;11(11). Epub 2022 May 31.

Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel-Hashomer 5262000, Israel.

Background: Conscious sedation (CS) has been used successfully to treat patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) and as such is considered the standard anesthesia method. The local anesthesia (LA) only approach may be feasible and safe thanks to improvements in operators' experience.

Objective: To evaluate differences between LA only versus CS approaches on short- and long-term outcomes among patients undergoing TAVI. Read More

J Clin Med 2022 May 25;11(11). Epub 2022 May 25.

Department of Anesthesiology and Intensive Care, Medical School, University of Pecs, 7624 Pecs, Hungary.

Background: Several factors affect the efficacy of endovascular thrombectomy (EVT); however, the anesthesia-related factors have not been fully explored. We aimed to identify independent predictors of outcome by analyzing procedural factors based on a multicentric stroke registry.

Methods: Data of consecutive patients with acute ischemic stroke (AIS) were extracted from the prospective STAY ALIVE stroke registry. Read More

Jpn Dent Sci Rev 2022 Nov 4;58:179-182. Epub 2022 Jun 4.

Division of Clinical Physiology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.

Structured Summary: Rationale: Nasal high-flow (NHF), a new method for respiratory management during procedural sedation, has greater advantages than conventional nasal therapy with oxygen. However, its clinical relevance for patients undergoing oral maxillofacial surgery and/or dental treatment remains uncertain and controversial, due to a paucity of studies. This scoping review compared and evaluated NHF and conventional nasal therapy with oxygen in patients undergoing oral maxillofacial surgery and/or dental treatment. Read More

OTO Open 2022 Apr-Jun;6(2):2473974X221101025. Epub 2022 May 30.

Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA.

Objective: Tracheostomies have been performed in patients with prolonged intubation due to COVID-19. Understanding outcomes in different populations is crucial to tackle future epidemics.

Study Design: Prospective cohort study. Read More

Neuroradiology 2022 May 31. Epub 2022 May 31.

Department of Diagnostic and Interventional Radiology, Nice University Hospital, Hôpital Pasteur 2, Nice, France.

Purpose: To evaluate clinical and radiological outcomes of a series of patients treated with a removable percutaneous interspinous process spacer (IPS) (LobsterProject® Techlamed®) for symptomatic degenerative lumbar spinal stenosis (DLSS).

Methods: All patients treated in two centres with this IPS during 2019 were retrospectively reviewed. Procedures were performed under deep sedation or general anaesthesia by two interventional radiologists. Read More

World J Surg 2022 Aug 31;46(8):1826-1843. Epub 2022 May 31.

School of Medical Sciences, Department of Surgery, Örebro University, 701 85, Örebro, Sweden.

Background: This is the first Enhanced Recovery After Surgery (ERAS®) Society guideline for primary and secondary hospitals in low-middle-income countries (LMIC's) for elective abdominal and gynecologic care.

Methods: The ERAS LMIC Guidelines group was established by the ERAS® Society in collaboration with different representatives of perioperative care from LMIC's. The group consisted of seven members from the ERAS® Society and eight members from LMIC's. Read More

BMJ Case Rep 2022 May 31;15(5). Epub 2022 May 31.

Cardiovascular Institute of Buenos Aires, Buenos Aires, Argentina.

The trigeminocardiac reflex (TCR) is an established brainstem reflex leading to parasympathetic dysrhythmias-including haemodynamic irregularities, apnoea and gastric hypermotility-during stimulation of any sensory branches of the trigeminal nerve. Most of the clinical knowledge about TCR was gathered from general anaesthesia observations, not from procedural sedation.We present a case of a 6-month-old premature baby experiencing the reflex twice under dexmedetomidine-propofol-sedation while undergoing ophthalmic and ear examination. Read More

Cureus 2022 Apr 25;14(4):e24466. Epub 2022 Apr 25.

Department of Diagnostic Radiology, National Cancer Center Hospital East, Chiba, JPN.

An 83-year-old man underwent cervical esophagectomy and developed a chylothorax as a postoperative complication. We decided to perform lymphangiography and thoracic duct embolization for chylous leakage, but it was expected to be challenging to maintain bed rest. Therefore, dexmedetomidine was administered for procedural sedation. Read More

Am J Emerg Med 2022 May 25;58:79-83. Epub 2022 May 25.

Pharmacy Department, IU Health Bloomington Hospital, 2651 E. Discovery Parkway, Bloomington, IN 47408, United States. Electronic address:

Background: Procedural sedation for electrical cardioversion is a common practice in the emergency department (ED). Ideal sedative properties for this procedure are a short half-life and minimal hemodynamic effects. There is limited literature examining methohexital for this use. Read More

Complement Ther Clin Pract 2022 May 21;48:101605. Epub 2022 May 21.

Volterra Research Foundation, ONLUS, Volterra, Pisa, Italy; Departement of Clinical and Experimental Medicine, Messina University, Italy.

Background And Purpose: This study aimed to determine the effect of Binaural Beats(BB)on feeling of pain, and patient comfort during colonoscopy without sedation.

Materials And Methods: It is a randomized, controlled, double-blind procedural study of 115 patients that underwent colonoscopy without sedation. The patients were randomly assigned into the experimental group (n = 42) and the control group (n = 48) that were given BB starting 5 min before and continuing until the end of the colonoscopy procedure without any intervention other than routine nursing care. Read More

Circ Arrhythm Electrophysiol 2022 Jun 26;15(6):e010817. Epub 2022 May 26.

Cardioangiologisches Centrum Bethanien (B.S., S.B., S.T., S.C., F.B., L.U., F.P., M.E., K.R.J.C.), Frankfurt, Germany.

Background: Pulsed field ablation represents an energy source specific for ablation of cardiac arrhythmias including atrial fibrillation. The aim of the study was to describe the adoption and the process of streamlining procedures with a new ablation technology.

Methods: All-comer atrial fibrillation patients (n=191; mean age 69±12 years) underwent catheter ablation with a pulsed field ablation ablation device exclusively using analog-sedation. Read More

Emerg Med Pract 2022 Jun 1;24(6):1-24. Epub 2022 Jun 1.

Assistant Professor, Department of Emergency Medicine, University of Texas-Southwestern, Dallas, TX.

Procedural sedation is a common procedure performed in the emergency department and is a fundamental skill for emergency clinicians. With a wide variety of procedures and patient populations, procedural sedation can be systematically tailored to individual patients' needs, in order to optimize safety and efficacy. This evidence-based review distinguishes the various levels of sedation, provides insight on which patients are appropriate for procedural sedation, lists adjuncts that should be used, and reviews considerations for special populations. Read More

Dig Endosc 2022 May 25. Epub 2022 May 25.

Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.

Objectives: Remimazolam, an ultra-short-acting benzodiazepine, has been used for procedural sedation in the United States. We conducted an investigator-initiated clinical trial to determine the appropriate dose of remimazolam required for sedation during gastrointestinal endoscopy in Japanese subjects.

Methods: In this single-center, open-label, uncontrolled, phase II trial, a three-stage cohort investigated the appropriate initial and additional doses of remimazolam required for gastrointestinal endoscopy. Read More

Pediatr Emerg Care 2022 May 17. Epub 2022 May 17.

From the Departments of Emergency Medicine.

Objectives: Our objectives were to quantify pain experienced by young children undergoing facial laceration repair and identify factors associated with low procedural pain scores.

Methods: We conducted a prospective cohort study of children's distress among a convenience sample of children aged 1 to 5 years undergoing facial or scalp laceration repair in 2 pediatric emergency departments. We reviewed video recordings and documented pain scores at 15-second intervals using the Face, Leg, Activity, Cry, Consolability-Revised (FLACC-r) scale. Read More

Front Med (Lausanne) 2022 6;9:867536. Epub 2022 May 6.

Department of Anaesthesia, Cambridge University Hospital National Health Service Trust, Cambridge, United Kingdom.

Background: Capnography has been associated with a reduced incidence of events related to respiratory compromise during procedural sedation.

Methods: A prospective service evaluation was conducted at a large United Kingdom (UK) teaching hospital to assess the impact of capnography on patient safety within four speciality services: bronchoscopy, endoscopy, interventional cardiology, and interventional radiology. Events were defined as provided by the World Society of Intravenous Anaesthesia. Read More