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    Specialized Imaging and Procedures in Pediatric Pancreatology: A North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Clinical Report.
    J Pediatr Gastroenterol Nutr 2017 Mar;64(3):472-484
    *Cincinnati Children's Hospital Medical Center, Cincinnati, OH †University of Texas Southwestern Medical School, Dallas, TX ‡Levine Children's Hospital, Charlotte, NC §Boston Children's Hospital, Boston, MA ||Baylor College of Medicine, Houston, TX ¶Montreal Children's Hospital, McGill University, Montreal, QC, Canada.
    Objectives: An increasing number of children are being diagnosed with pancreatitis and other pancreatic abnormalities. Dissemination of the information regarding existing imaging techniques and endoscopic modalities to diagnose and manage pancreatic disorders in children is sorely needed.

    Methods: We conducted a review of the medical literature on the use of the following imaging and procedural modalities in pediatric pancreatology: transabdominal ultrasonography (TUS), computed tomography (CT), magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Read More

    Ultrasound-Guided Femoral Nerve Blockage in A Patellar Dislocation: An Effective Technique for Emergency Physicians.
    J Emerg Med 2017 Feb 19. Epub 2017 Feb 19.
    Department of Orthopedics and Traumatology, Sirnak Military Hospital, Sirnak, Turkey.
    Background: Patellar dislocation is an orthopedic emergency and its reduction can be painful. The aim of this case is to show that the ultrasound-guided femoral nerve blockage can be effectively used in the pain management of patellar reduction in the emergency department (ED).

    Case Report: A 21-year-old man was admitted to our ED after suffering a fall down a flight of stairs. Read More

    Outcome of patients undergoing TAVR with and without the attendance of an anesthesiologist.
    Int J Cardiol 2017 Feb 9. Epub 2017 Feb 9.
    Department of Cardiology, Tel-Aviv Medical Center, Tel-Aviv, Israel; The Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
    Background: During the last few years there is a shift from performing Transcatheter Aortic Valve Replacement (TAVR) under general anesthesia towards conscious sedation and local anesthesia only. In the vast majority of centers, sedation is guided by a qualified anesthesiologist. In our center, all TAVR procedures are being performed under local anesthesia and mild sedation, however, since September 2014, a large portion of TAVR procedures are being performed under local anesthesia without the presence of an anesthesiologist. Read More

    Comparison of procedural sequences in same-day painless bidirectional endoscopy: a single-center, prospective, randomized study.
    Dig Endosc 2017 Feb 17. Epub 2017 Feb 17.
    Department of Gastroenterology, Daping Hospital, The Third Military Medical University, Chongqing, China.
    Aims: To compare the efficacy and safety of esophagogastroduodenoscopy (EGD)-colonoscopy and colonoscopy-EGD sequences for patients subjected to same-day bidirectional endoscopy under remifentanil and propofol sedation.

    Method: A total of 209 eligible outpatients scheduled for diagnostic same-day bidirectional endoscopy between February 16, 2016 and April 30, 2016 were randomly assigned to the EGD-colonoscopy (n=106) and colonoscopy-EGD (n=103) sequence groups. The primary endpoint was the total dose of propofol required for the procedure. Read More

    Assessing the safety of physician-directed nurse-administered propofol sedation in low-risk patients undergoing endoscopy and colonoscopy.
    Endosc Int Open 2017 Feb;5(2):E110-E115
    Lyell McEwin Hospital - Gastroenterology, Adelaide, South Australia.
    Background and study aims Physician-directed nurse-administered balanced propofol sedation (PhD NAPS) in patients undergoing endoscopy and/or colonoscopy is being increasingly utilized worldwide. However, this method of sedation is not universally employed in Australian hospitals due to concerns surrounding its safety. The aim of this study was to assess the safety of PhD NAPS in low-risk patients undergoing endoscopy and/or colonoscopy. Read More

    Moderate-to-deep sedation technique, using propofol and ketamine, allowing synchronised breathing for magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids: a pilot study.
    J Ther Ultrasound 2017 9;5. Epub 2017 Feb 9.
    0000000090126352grid.7692.aDivision of Anaesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Heidelberglaan 100, Huispostnr.: F 04.5.16, 3584 CX Utrecht, The Netherlands.
    Background: Magnetic resonance high-intensity focused ultrasound (MR-HIFU) treatment for uterine fibroids is rapidly gaining popularity as a treatment modality. This procedure is generally uncomfortable, painful, and requires minimal or absence of movement and an MR-HIFU synchronised breathing pattern of the patient. Procedural sedation and analgesia protocols have become the standard practice in interventional radiology departments worldwide. Read More

    Intranasal fentanyl and inhaled nitrous oxide for fracture reduction: The FAN observational study.
    Am J Emerg Med 2017 Jan 5. Epub 2017 Jan 5.
    Emergency Department, Royal Children's Hospital, University of Melbourne, Australia; Murdoch Children's Research Institute, Australia; University of Melbourne, Australia.
    Introduction: Procedural sedation and analgesia (PSA) are frequently used for fracture reduction in pediatric emergency departments (ED). Combining intranasal (IN) fentanyl with inhalation of nitrous oxide (N2O) allow for short recovery time and obviates painful and time-consuming IV access insertions.

    Methods: We performed a bicentric, prospective, observational cohort study. Read More

    Ultrasound-guided dorsal penile nerve block performed in a case of zipper entrapment injury.
    J Clin Ultrasound 2017 Feb 10. Epub 2017 Feb 10.
    Mount Sinai St. Luke's Mount Sinai West Hospitals, Department of Emergency Medicine, 1000 10th Avenue, New York, NY.
    Injury to the penis resulting from zipper entrapment is a painful condition that presents a unique anesthetic challenge to the emergency physician and may even require procedural sedation for removal. In this case report, we describe successful removal of zipper entrapment from the penis of a 34-year-old patient after the application of an ultrasound-guided dorsal penile nerve block. We discuss the anatomy, sonographic features, and steps required for the nerve block procedure. Read More

    Initial Experience of a Second-Generation Self-Expanding Transcatheter Aortic Valve: The UK & Ireland Evolut R Implanters' Registry.
    JACC Cardiovasc Interv 2017 Feb;10(3):276-282
    Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust & St. George's University of London, London, United Kingdom. Electronic address:
    Objectives: The authors present the UK and Irish real-world learning curve experience of the Evolut R transcatheter heart valve.

    Background: The Evolut R is a self-expanding, repositionable, and fully recapturable second-generation transcatheter heart valve with several novel design features to improve outcomes and reduce complications.

    Methods: Clinical, procedural, and 30-day outcome data were prospectively collected for the first 264 patients to receive the Evolut R valve in the United Kingdom and Ireland. Read More

    Procedural moderate sedation with ketamine in pediatric critical care unit.
    Avicenna J Med 2017 Jan-Mar;7(1):7-11
    Department of Pediatrics, Pediatric Intensive Care Unit, King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
    Objective: To evaluate the safety and efficacy of moderate sedation in the Pediatric Intensive Care Unit (PICU) settings according to moderate sedation protocol using ketamine and midazolam and to determine areas for the improvement in our clinical practice.

    Settings And Design: A retrospective study was conducted in the PICU.

    Materials And Methods: Retrospective chart review was performed for patients who had received moderate sedation between January and the end of December 2011 and who are eligible to inclusion criteria. Read More

    General anesthesia with a native airway for patients with mucopolysaccharidosis type III.
    Paediatr Anaesth 2017 Feb 8. Epub 2017 Feb 8.
    Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
    Background: Mucopolysaccharidosis type III is a progressive disease with worsening airway, pulmonary, and cardiac involvement that may complicate anesthetic care.

    Aim: To prospectively evaluate the incidence of airway issues and complications during magnetic resonance imaging (MRI) and lumbar puncture (LP) during general anesthesia with a native airway for patients with mucopolysaccharidosis type III.

    Method: The study was a part of the natural history study. Read More

    The influence of parents' voice on the consumption of propofol for pediatric procedural sedation-a randomized controlled trial.
    Paediatr Anaesth 2017 Feb 8. Epub 2017 Feb 8.
    Department of Pediatrics 1, University Hospital Essen, Essen, Germany.
    Background: In pediatric patients, invasive procedures such as the insertion of a central venous catheter or gastroscopy require deep sedation. It is unknown whether listening to parental voice during deep sedation in children can reduce sedative doses.

    Aim: The aim of this prospective study was to determine the effect of listening to a parent's voice during deep sedation on consumption of sedatives in children. Read More

    Implementation strategies for procedural sedation and analgesia in the emergency department.
    Int J Emerg Med 2017 Dec 3;10(1). Epub 2017 Feb 3.
    Department of Emergency Medicine, Summa Akron City Hospital, Northeastern Ohio Medical University, Akron, USA.
    Implementing procedural sedation and analgesia in the emergency department is still is a challenge on an international scale. Here, we describe the Dutch setting of emergency medicine and explain the strategies that were successful for the implementation of safe and effective procedural sedation and analgesia by emergency physicians. We describe strategies on how to bridge the gap of knowledge and skills and how to deal with a resistance to change. Read More

    Editorial: Endoscopic Sedation: Who, Which, When?
    Am J Gastroenterol 2017 Feb;112(2):303-305
    University of Washington, Department of Medicine, Seattle, Washington, USA.
    The costs of medical care are rising and media has focused attention on the costs of colonoscopy as a potential cause. A major component of procedural costs is the sedation, which is a combination of the drugs used and who administers them. An analysis of advanced endoscopic procedures revealed that the rate of sedation failure was significantly lower among patients administered sedation by anesthesia compared with patients who received moderate sedation administered by endoscopy staff. Read More

    How Do Observational Scales Correlate the Ratings of Children's Behavior during Pediatric Procedural Sedation?
    Biomed Res Int 2016 28;2016:5248271. Epub 2016 Dec 28.
    Faculty of Dentistry, Faculdade de Odontologia, UFG, Goiânia, GO, Brazil.
    Background. There is little information regarding the ability of observational scales to properly assess children's behavior during procedural sedation. Aim. Read More

    Deep sedation Vs. general anesthesia in 232 patients undergoing percutaneous mitral valve repair using the MitraClip(®) system.
    Catheter Cardiovasc Interv 2017 Jan 23. Epub 2017 Jan 23.
    Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany.
    Objectives: To investigate in a series of 232 patients whether the MitraClip(®) procedure can be performed safely using deep sedation (DS) without general anesthesia (GA).

    Background: Transcatheter mitral valve repair using the MitraClip(®) system is a safe and effective therapy for severe mitral regurgitation (MR) in patients who are at high operative risk or are unsuitable for surgery. For these patients, avoidance of GA might be beneficial. Read More

    Dexmedetomidine versus Midazolam in Procedural Sedation. A Systematic Review of Efficacy and Safety.
    PLoS One 2017 20;12(1):e0169525. Epub 2017 Jan 20.
    Department of oral and maxillofacial surgery, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
    Objectives: To systematically review the literature comparing the efficacy and safety of dexmedetomidine and midazolam when used for procedural sedation.

    Materials And Methods: We searched MEDLINE, EMBASE and COCHRANE for clinical trials comparing dexmedetomidine and midazolam for procedural sedation up to June 20, 2016. Inclusion criteria: clinical trial, human subjects, adult subjects (≥18 years), article written in English, German, French or Dutch, use of study medication for conscious sedation and at least one group receiving dexmedetomidine and one group receiving midazolam. Read More

    Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine.
    Clin Pharmacokinet 2017 Jan 19. Epub 2017 Jan 19.
    Department of Anesthesiology, University of Groningen, University Medical Center Groningen, P.O. Box 30001, 9700 RB, Groningen, The Netherlands.
    Dexmedetomidine is an α2-adrenoceptor agonist with sedative, anxiolytic, sympatholytic, and analgesic-sparing effects, and minimal depression of respiratory function. It is potent and highly selective for α2-receptors with an α2:α1 ratio of 1620:1. Hemodynamic effects, which include transient hypertension, bradycardia, and hypotension, result from the drug's peripheral vasoconstrictive and sympatholytic properties. Read More

    A risk stratifying tool to facilitate safe late-stage percutaneous endoscopic gastrostomy in ALS.
    Amyotroph Lateral Scler Frontotemporal Degener 2017 Jan 19:1-6. Epub 2017 Jan 19.
    a Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK.
    Background: The safety of percutaneous endoscopic gastrostomy (PEG) insertion in amyotrophic lateral sclerosis (ALS) patients with significant respiratory compromise has been questioned.

    Objectives: To review the characteristics of an ALS clinic patient cohort undergoing PEG, and the introduction of a risk stratification tool with procedural adaptations for higher-risk individuals.

    Methods: Patients undergoing PEG insertion were analysed (n = 107). Read More

    Anesthesia Practices for Interventional Radiology in Europe.
    Cardiovasc Intervent Radiol 2017 Jan 17. Epub 2017 Jan 17.
    Chef de Pôle, Imagerie, Les Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France.
    Purpose: The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) prompted an initiative to frame the current European status of anesthetic practices for interventional radiology, in consideration of the current variability of IR suite settings, staffing and anesthetic practices reported in the literature and of the growing debate on sedation administered by non-anesthesiologists, in Europe.

    Methods: Anonymous online survey available to all European CIRSE members to assess IR setting, demographics, peri-procedural care, anesthetic management, resources and staffing, pain management, data collection, safety, management of emergencies and personal opinions on the role CIRSE should have in promoting anesthetic care for interventional radiology.

    Results: Predictable differences between countries and national regulations were confirmed, showing how significantly many "local" factors (type and size of centers, the availability of dedicated inpatient bed, availability of anesthesia staff) can affect the routine practice and the expansion of IR as a subspecialty. Read More

    Aspiration thrombectomy in clinical routine interventional stroke treatment : Is this the end of the stent retriever era?
    Clin Neuroradiol 2017 Jan 12. Epub 2017 Jan 12.
    Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
    Purpose: The aim of our study was the technical evaluation of a first pass approach of primary thrombus aspiration (AST) in patients with emergency large intracerebral vessel occlusions (ELVO) under routine clinical conditions.

    Materials And Methods: We collected procedural and clinical data of 104 patients who underwent mechanical thrombectomy due to ELVO between June 2014 and January 2016 with intentional first-line thrombus aspiration. Procedures were conducted due to occlusions of the distal internal carotid artery, middle cerebral artery, anterior cerebral artery, basilar artery and posterior cerebral artery and were performed with the patient under either conscious sedation or general anesthesia. Read More

    Propofol versus midazolam for procedural sedation in the emergency department: A study on efficacy and safety.
    Am J Emerg Med 2017 Jan 3. Epub 2017 Jan 3.
    Department of Emergency Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands. Electronic address:
    Background: Procedural sedation for painful procedures in the emergency department (ED) can be accomplished with various pharmacological agents. The choice of the sedative used is highly dependent on procedure- and patient characteristics and on personal- or local preferences.

    Methods: We conducted a multicenter retrospective cohort study of procedural sedations performed in the EDs of 5 hospitals in the Netherlands over a 4year period to evaluate the efficacy- (success rate of the intended procedure) and safety (incidence of sedation (adverse) events) of propofol sedations compared to midazolam sedations. Read More

    Identification of factors associated with sedation tolerance in 5000 patients undergoing outpatient colonoscopy: Canadian tertiary center experience.
    World J Gastrointest Endosc 2016 Dec;8(20):770-776
    Alexandra Shingina, Department of Gastroenterology, Faculty of Medicine, University of Toronto, Toronto General Hospital, Ontario M5G 2C4, Canada.
    Aim: To develop a prediction model aimed at identifying patients that may require higher than usual sedation doses during colonoscopy.

    Methods: A retrospective chart review on 5000 patients who underwent an outpatient colonoscopy at St. Paul's Hospital from 2009 to 2010 was conducted in order to develop a model for identifying patients who will require increased doses of sedatives. Read More

    Incidence of bradycardia in pediatric patients receiving dexmedetomidine anesthesia: a meta-analysis.
    Int J Clin Pharm 2017 Feb 31;39(1):139-147. Epub 2016 Dec 31.
    Anesthesia and Operation Center, Chinese General Hospital of PLA, No. 28, Fuxing Road, Haidian District, Beijing, 100853, China.
    Background Dexmedetomidine, an α2-receptor agonist, provides potent sedation, analgesia, and anxiolysis without respiratory depression and is used in a variety of surgical and procedural situations. Aim of the review The aim of this study was to estimate the incidence of bradycardia in pediatric patients who received dexmedetomidine as a sole agent for any procedural, intensive care or surgical sedation. Method Literature was searched in electronic databases and studies were selected by following pre-determined eligibility criteria. Read More

    Using continuous quantitative capnography for emergency department procedural sedation: a systematic review and cost-effectiveness analysis.
    Intern Emerg Med 2016 Dec 28. Epub 2016 Dec 28.
    Department of Health Management and Policy, University of Iowa College of Public Health, 145 N. Riverside Drive, Iowa City, IA, 52246, USA.
    End-tidal CO2 has been advocated to improve safety of emergency department (ED) procedural sedation by decreasing hypoxia and catastrophic outcomes. This study aimed to estimate the cost-effectiveness of routine use of continuous waveform quantitative end-tidal CO2 monitoring for ED procedural sedation in prevention of catastrophic events. Markov modeling was used to perform cost-effectiveness analysis to estimate societal costs per prevented catastrophic event (death or hypoxic brain injury) during routine ED procedural sedation. Read More

    Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement: A Single Institution Experience and Outcomes to 30 Days and Beyond.
    J Gastrointest Surg 2017 Mar 19;21(3):446-452. Epub 2016 Dec 19.
    Digestive Disease and Surgery Institute, Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
    Introduction: Patients with prior foregut surgery requiring long-term enteral access typically undergo operative jejunostomy tube placement; however, direct percutaneous endoscopic jejunostomy (DPEJ) is a viable alternative.

    Methods: All de novo DPEJ procedures performed by surgical and advanced endoscopists from May 2003 to June 2015 were retrospectively reviewed following approval by the Institutional Review Board. There were 59 cases identified. Read More

    Intravenous Recombinant Tissue Plasminogen Activator Therapy for Acute Basilar Artery Ischemic Stroke Following Transfemoral Transcatheter Aortic Valve Implantation.
    J Heart Valve Dis 2016 Jan;25(1):14-17
    Royal Adelaide Hospital, Adelaide, South Australia, Australia.
    Transcatheter aortic valve implantation (TAVI) can now be considered a standard of care for inoperable and high-risk surgical patients with severe aortic stenosis, and its uptake worldwide is rapidly increasing. Indeed, many centers performing the procedure have now moved towards treating intermediate-risk patients with TAVI rather than referring them for surgical aortic valve replacement. Although the incidence of peri-procedural acute and subacute stroke following TAVI has fallen to 2-5%, its occurrence can be life-threatening and life-changing, and every effort must be made to improve patient outcome should stroke occur. Read More

    Changes in blood pressure and heart rate during sedation with ketamine in the pediatric ED.
    Am J Emerg Med 2017 Feb 11;35(2):322-325. Epub 2016 Oct 11.
    Department of Pediatrics, University of Louisville, Louisville, KY.
    Background: Ketamine is commonly used in the emergency department for short, painful procedures. We describe changes in blood pressure (BP) and heart rate (HR) during procedural sedation with ketamine, as these changes have not been well described in children.

    Methods: We performed a secondary analysis of a prospective, observational study involving children aged 8 to 18 years who received procedural sedation with ketamine in a pediatric emergency department. Read More

    Predictors of emesis in children undergoing procedural sedation with intramuscular ketamine in a paediatric emergency department.
    Singapore Med J 2016 Dec 9. Epub 2016 Dec 9.
    Duke-NUS Medical School, Singapore.
    Introduction: Emesis is one of the most common adverse events associated with ketamine sedation. However, the predictors of emesis have not been clearly studied among Asian children. This study aimed to determine the incidence and predictors of emesis in local children undergoing intramuscular (IM) ketamine sedation in the emergency department (ED), and identify high-risk groups(s), so that antiemetics may be administered prophylactically. Read More

    Low-dose Spinal Block With Continuous Epidural Infusion for Renal Transplantation in a Patient With Alport Syndrome: A Case Report.
    Transplant Proc 2016 Nov;48(9):3067-3069
    Department of Anesthesia and Intensive Care, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Surgical Sciences, University of Turin, Turin, Italy. Electronic address:
    Objective: We aim to describe management of a patient receiving renal transplantation for chronic renal failure due to Alport syndrome with low dose of intrathecal bupivacaine and continuous epidural infusion of local anesthetic.

    Case Report: A 38-years-old man with chronic renal failure secondary to Alport syndrome underwent kidney transplantation. Because of a high risk of respiratory and cardiovascular complications related to the patient's baseline lung disease and abnormalities in heart conduction, we selected combined spinal-epidural anesthesia. Read More

    Comparison Effect of Intravenous Ketamine with Pethidine for Analgesia and Sedation during Bone Marrow Procedures in Oncologic Children: A Randomized, Double-Blinded, Crossover Trial.
    Int J Hematol Oncol Stem Cell Res 2016 Oct;10(4):206-211
    Fellowship of Hematology-Oncology Department of Pediatrics, Amir Oncology Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
    Background: Children suffering from cancer always require pain relief and reduce anxiety when undergoing painful procedures. The aim of this study is to compare the effect of pethedine and ketamine administration in cancer-diagnosed children undergoing bone marrow aspiration and biopsy procedures. Subjects and Methods: A randomized, double-blinded, crossover trial was carried out on 57 children undergoing painful procedures (bone marrow aspiration/biopsy). Read More

    Dexmedetomidine for sedation in pediatric patients who received more than 20 sessions of radiation therapy: two cases report.
    Korean J Anesthesiol 2016 Dec 8;69(6):627-631. Epub 2016 Sep 8.
    Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
    Dexmedetomidine is a highly selective α2-adrenoceptor agonist that demonstrates anxiolytic and analgesic properties without inducing respiratory compromise, which makes it a suitable agent for procedural sedation and imaging studies. In our current case reports, intravenous dexmedetomidine infusion was used to provide sedation to 2 pediatric patients over more than 20 sessions of radiation therapy. On both occasions, dexmedetomidine provided adequate sedation without respiratory depression. Read More

    Reduced Length of Stay and Adverse Events Using Bier Block for Forearm Fracture Reduction in the Pediatric Emergency Department.
    Pediatr Emerg Care 2016 Jan 1. Epub 2016 Jan 1.
    From the *Department of Pediatric Emergency Medicine, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec; and †Section of Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
    Objectives: Forearm fractures are among the most common pediatric injuries. Procedural sedation is frequently used for analgesia during fracture reduction but requires a prolonged recovery period and can be associated with adverse events. Bier block is a safe alternative for fracture reduction analgesia. Read More

    Risk factors for unsuccessful lumbar puncture in children.
    S Afr Med J 2016 Dec 1;106(12):1230-1235. Epub 2016 Dec 1.
    Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, South Africa.
    Background: This descriptive study provides the first information on an association between the use of sedation and a reduction in the prevalence of unsuccessful lumbar puncture (LP) in African children of all races.

    Objective: Our hypothesis was that children who do not receive any procedural sedation are more likely to have unsuccessful LPs.

    Methods: A cross-sectional observational study examined LPs performed from February to April 2013, including details of the procedure, sedation or analgesia used, and techniques. Read More

    Mother-child interactions and young child behavior during procedural conscious sedation.
    BMC Pediatr 2016 Dec 3;16(1):201. Epub 2016 Dec 3.
    Faculty of Dentistry, Faculdade de Odontologia, Universidade Federal de Goiás, Primeira Avenida, Setor Universitário, CEP 74605-220, Goiânia, Goiás, Brazil.
    Background: As many preschoolers are not able to cooperate with health-related invasive procedures, sedation can help with the child's comfort and allow the intervention to be done. It is scarcely known how parents affect children's behavior during dental treatment under conscious sedation. The aim of this exploratory study was to analyze the association between mother-child interactions in day-to-day family life and preschool children's behavior during dental treatment under conscious sedation. Read More

    Sonographic identification of peripheral nerves in the forearm.
    J Emerg Trauma Shock 2016 Oct-Dec;9(4):146-150
    Gulfcoast Ultrasound Institute, St. Pete Beach, Florida.
    Background: With the growing utilization of ultrasonography in emergency medicine combined with the concern over adequate pain management in the emergency department (ED), ultrasound guidance for peripheral nerve blockade in ED is an area of increasing interest. The medical literature has multiple reports supporting the use of ultrasound guidance in peripheral nerve blocks. However, to perform a peripheral nerve block, one must first be able to reliably identify the specific nerve before the procedure. Read More

    Safety Analysis of Bariatric Patients Undergoing Outpatient Upper Endoscopy with Non-Anesthesia Administered Propofol Sedation.
    Obes Surg 2016 Nov 24. Epub 2016 Nov 24.
    Division of General Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.
    Background: Non-anesthesia administered propofol (NAAP) has been shown to be a safe and effective method of sedation for patients undergoing gastrointestinal endoscopy. Bariatric surgery patients are potentially at a higher risk for sedation-related complications due to co-morbidities including obstructive sleep apnea. The outcomes of NAAP in bariatric patients have not been previously reported. Read More

    Simulation and Web-based learning increases utilization of Bier block for forearm fracture reduction in the pediatric emergency department.
    CJEM 2016 Nov 21:1-7. Epub 2016 Nov 21.
    *Division of Pediatric of Pediatric Emergency Medicine,The Montreal Children's Hospital,McGill University Health Centre,Montreal,QC.
    Objectives: Bier block (BB) is a safe and effective alternative to procedural sedation for analgesia during forearm fracture reductions, yet remains infrequently used in the pediatric emergency department (PED). No standardized methods of BB training have previously been described. The objective of this study was to determine whether a multimodal instructional course increases comfort with BB and translates to increased use of this technique. Read More

    Comparison of Postoperative Complications Associated With Anesthetic Choice for Surgery of the Hand.
    J Hand Surg Am 2017 Jan 14;42(1):1-8.e5. Epub 2016 Nov 14.
    Department of Orthopedics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ; Center for Orthopedic Research and Education, Phoenix, AZ.
    Purpose: There is a recent trend toward performing most hand surgery procedures under local and/or regional anesthesia without sedation. However, little evidence exists regarding the postoperative complications associated with local/regional anesthesia without sedation, especially compared with local/regional anesthesia with sedation or general anesthesia.

    Methods: Patients who underwent hand procedures as part of the American College of Surgeons National Surgical Quality Improvement Program were identified. Read More

    Efficacy and safety of carbon dioxide insufflation versus air insufflation for endoscopic retrograde cholangiopancreatography: A meta-analysis update.
    Clin Res Hepatol Gastroenterol 2016 Nov 10. Epub 2016 Nov 10.
    School Renji Clinical Medical, Wenzhou Medical University, Advanced Education Park, Wenzhou, China.
    Background And Objective: Endoscopic retrograde cholangiopancreatography (ERCP) is essential for visualising the biliary tree and pancreatic ducts, and carbon dioxide (CO2) insufflation during ERCP is considered an alternative technique to air insufflation for relieving post-procedural abdominal discomfort (abdominal pain and distension). The aim of the present study was to evaluate the effect of CO2 insufflation on the remission of abdominal discomfort and the potential side effects by conducting a meta-analysis.

    Methods: The method recommended by the Cochrane Collaboration was employed to conduct a meta-analysis of randomised controlled trials (RCTs) of CO2 insufflation versus air insufflation during ERCP. Read More

    Optimal Volume of Administration of Intranasal Midazolam in Children: A Randomized Clinical Trial.
    Ann Emerg Med 2016 Nov 4. Epub 2016 Nov 4.
    Department of Pediatrics, Division of Pediatric Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
    Study Objective: The optimal intranasal volume of administration for achieving timely and effective sedation in children is unclear. We aimed to compare clinical outcomes relevant to procedural sedation associated with using escalating volumes of administration to administer intranasal midazolam.

    Methods: We conducted a randomized, single-blinded, 3-arm, superiority clinical trial. Read More

    The role of sedation in endobronchial ultrasound-guided transbronchial needle aspiration: Systematic review.
    Endosc Ultrasound 2016 Sep-Oct;5(5):300-306
    Tulane University Health Sciences Center, Section of Pulmonary Diseases, Critical Care and Environmental Medicine, New Orleans, Louisiana, USA.
    Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure that has become an important tool in diagnosis and staging of mediastinal lymph node (LN) lesions in lung cancer. Adequate sedation is an important part of the procedure since it provides patient's comfort and potentially increases diagnostic yield. We aimed to compare deep sedation (DS) versus moderate sedation (MS) in patients undergoing EBUS-TBNA procedure. Read More

    Comparing Two Different Doses of Intravenous Midazolam in Pediatric Sedation and Analgesia.
    Emerg (Tehran) 2016 Nov;4(4):192-195
    Department of EmergencyMedicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University ofMedical Sciences, Ahvaz, Iran.
    Introduction: Midazolam has turned into a common drug for pediatric procedural sedation and analgesia. However, there is not much data regarding its proper dose and potential side effects in the Iranian children population. Therefore, the present study was done to compare 2 doses of IV midazolam in this regard. Read More

    Procedural sedation in the emergency department by Dutch emergency physicians: a prospective multicentre observational study of 1711 adults.
    Emerg Med J 2016 Oct 21. Epub 2016 Oct 21.
    Department of Anaesthesiology, Intensive Care and Pain Catharina Hospital, Eindhoven, The Netherlands.
    Objective: To describe our experience performing ED procedural sedation in a country where emergency medicine (EM) is a relatively new specialty.

    Methods: This is a prospective observational study of adult patients undergoing procedural sedation by emergency physicians (EPs) or EM residents in eight hospitals in the Netherlands. Data were collected on a standardised form, including patient characteristics, sedative and analgesic used, procedural success, adverse events (classified according to World SIVA) and rescue interventions. Read More

    Physician Assistants Improve Efficiency and Decrease Costs in Outpatient Oral and Maxillofacial Surgery.
    J Oral Maxillofac Surg 2016 Nov 22;74(11):2128-2135. Epub 2016 Jul 22.
    Associate Professor, Harvard School of Dental Medicine; Oral Surgeon in Chief, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
    Purpose: To determine the effects on time, cost, and complication rates of integrating physician assistants (PAs) into the procedural components of an outpatient oral and maxillofacial surgery practice.

    Materials And Methods: This is a prospective cohort study of patients from the Department of Plastic and Oral Surgery at Boston Children's Hospital who underwent removal of 4 impacted third molars with intravenous sedation in our outpatient facility. Patients were separated into the "no PA group" and PA group. Read More

    Temporal trends in transcatheter aortic valve implantation, 2008-2014: patient characteristics, procedural issues, and clinical outcome.
    Clin Cardiol 2016 Oct 26. Epub 2016 Oct 26.
    Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
    Background: About a decade past the first transcatheter aortic valve implantation (TAVI), data are limited regarding temporal trends accompanying its evolution from novel technology to mainstream therapy. We evaluated these trends in a large multicenter TAVI registry.

    Hypothesis: TAVI is changing and improving with time. Read More

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