39,124 results match your criteria Sedation


Pediatric tracheostomy first tube change: When is it safe?

Int J Pediatr Otorhinolaryngol 2019 Feb 8;120:78-81. Epub 2019 Feb 8.

Department of Pediatric Otorhinolaryngology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.

Objectives: The first tracheostomy tube change is typically performed on days 5-7 post-operatively, however recent international consensus guidelines suggested that, with maturation sutures, days 3-5 is appropriate. We evaluate whether a first tube change on day 2 post-operatively is safe and effective.

Methods: We carried out a retrospective review of all patients undergoing tracheostomy between 2009 and 2018. Read More

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http://dx.doi.org/10.1016/j.ijporl.2019.02.017DOI Listing
February 2019

Using anxiolytics in a pediatric otolaryngology clinic to avoid the operating room.

Int J Pediatr Otorhinolaryngol 2019 Feb 5;120:73-77. Epub 2019 Feb 5.

Division of Otolaryngology, Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA. Electronic address:

Introduction: There is increasing concern regarding the risks associated with the use of general anesthesia in pediatric patients. Many otolaryngologic procedures performed under general anesthesia can also be performed in clinic. We hypothesize that anxiolytics can aid in performing common procedures in clinic thus avoiding the need to undergo general anesthesia in the OR. Read More

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http://dx.doi.org/10.1016/j.ijporl.2019.02.014DOI Listing
February 2019

Depression, anxiety-like behavior, and memory impairment in mice exposed to chitosan-coated zein nanoparticles.

Environ Sci Pollut Res Int 2019 Feb 15. Epub 2019 Feb 15.

Post-graduation Program in Cerrado Natural Resource Conservation and Biological Research Laboratory, Instituto Federal Goiano-Urutaí Campus, Urutai, GO, Brazil.

The advent of biotechnology provided the synthesis of nanoproducts with diverse applications in the field of medicine, agriculture, food, among others. However, the toxicity of many nanoparticles (NP) currently used, which can penetrate natural systems and impact organisms, is not known. Thus, in this study, we evaluated whether the short exposure (5 days) to low concentrations of chitosan-coated zein nanoparticles (ZNP-CS) (0. Read More

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http://dx.doi.org/10.1007/s11356-019-04536-0DOI Listing
February 2019

An audit of propofol administration in the intensive care unit: Infusion pump-recorded versus electronically documented amounts.

Aust Crit Care 2019 Feb 12. Epub 2019 Feb 12.

Departments of Anaesthesia and Intensive Care, Western Health, Melbourne, Australia; Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia. Electronic address:

Background: Although propofol is widely used for sedation in intensive care units around Australia, evaluation of bedside nursing practices of the administration of propofol have been limited. We investigated whether there was a discrepancy between the amount of propofol delivered by the infusion pump and that recorded electronically and consequently patient exposure to avoidable harms.

Aims: The aim of this research was to compare the total amount of propofol administered to intensive care patients via a programmable infusion pump with that documented in the electronic medical record (EMR). Read More

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http://dx.doi.org/10.1016/j.aucc.2018.12.005DOI Listing
February 2019

MP1104, a mixed kappa-delta opioid receptor agonist has anti-cocaine properties with reduced side-effects in rats.

Neuropharmacology 2019 Feb 12. Epub 2019 Feb 12.

School of Biological Sciences, Centre for Biodiscovery, Victoria University of Wellington, Wellington, New Zealand. Electronic address:

Kappa opioid receptor (KOPr) agonists have preclinical anti-cocaine and antinociceptive effects. However, adverse effects including dysphoria, aversion, sedation, anxiety and depression limit their clinical development. MP1104, an analogue of 3-iodobenzoyl naltrexamine, is a potent dual agonist at KOPr and delta opioid receptor (DOPr), with full agonist efficacy at both these receptors. Read More

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http://dx.doi.org/10.1016/j.neuropharm.2019.02.010DOI Listing
February 2019

Early Developmental Exposure to Repetitive Long Duration of Midazolam Sedation Causes Behavioral and Synaptic Alterations in a Rodent Model of Neurodevelopment.

J Neurosurg Anesthesiol 2019 Jan;31(1):151-162

Department of Anesthesiology and Critical Care Medicine, the Johns Hopkins University School of Medicine, Baltimore, MD.

There is a large body of preclinical literature suggesting that exposure to general anesthetic agents during early life may have harmful effects on brain development. Patients in intensive care settings are often treated for prolonged periods with sedative medications, many of which have mechanisms of action that are similar to general anesthetics. Using in vivo studies of the mouse hippocampus and an in vitro rat cortical neuron model we asked whether there is evidence that repeated, long duration exposure to midazolam, a commonly used sedative in pediatric intensive care practice, has the potential to cause lasting harm to the developing brain. Read More

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http://dx.doi.org/10.1097/ANA.0000000000000541DOI Listing
January 2019

Engaging Stakeholders to Promote Safe Anesthesia and Sedation Care in Young Children.

J Neurosurg Anesthesiol 2019 Jan;31(1):125-128

Department of Anesthesiology and Perioperative Medicine, Neurology, and Psychiatry, University of Rochester Medical Center, Rochester, NY.

An important aspect of any research endeavor is engaging various stakeholders to work toward the common goal of pushing knowledge forward about the question at hand. Research into pediatric anesthetic neurotoxicity could benefit greatly from interventions designed to improve the efforts and dedication of government agencies, pharmaceutical companies, research communities, and most importantly, patients. The Pediatric Anesthesia Neurodevelopment Assessment (PANDA) symposium is a biennial meeting where updates in research in the field are presented, and issues relevant to the community are discussed in round table discussions. Read More

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http://dx.doi.org/10.1097/ANA.0000000000000547DOI Listing
January 2019

Dose related effects of oral clonidine pre-medication on bupivacaine spinal anaesthesia.

Afr Health Sci 2018 Dec;18(4):1283-1291

Department of Anaesthesia, Faculty of Clinical Sciences, College of Health Sciences, University of Ilorin/ University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Introduction: The duration of action of sub-arachnoid block is short, and one of the ways to overcome this is the use of oral clonidine.

Methods: 108 patients of ASA I and II, aged 18 to 65 years undergoing lower abdominal surgeries under spinal anaesthesia were randomized into three groups.. Read More

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http://dx.doi.org/10.4314/ahs.v18i4.49DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354890PMC
December 2018

A comparison of risk of hypotension using standard doses of remifentanil versus dexmedetomidine infusions in adult patients undergoing surgery under general anaesthesia at the Aga Khan University Hospital, Nairobi.

Afr Health Sci 2018 Dec;18(4):1267-1282

Department of Anaesthesia, Aga Khan University, East Africa.

Background: Remifentanil and dexmedetomidine are common agents used in general anaesthesia, monitored anaesthesia care and critical care. When combined with inhaled or intravenous anaesthetic agents intra-operatively, they provide analgesia, lower general anaesthetic requirements and provide sedation and analgesia in the peri-operative period if indicated. Pharmacodynamically, they cause hypotension and bradycardia which are reversible if well managed. Read More

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http://dx.doi.org/10.4314/ahs.v18i4.48DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354876PMC
December 2018

Upper-Extremity Venous Access for Children and Adults in Pediatric Cardiac Catheterization Laboratory.

J Invasive Cardiol 2019 Feb 15. Epub 2019 Feb 15.

Texas Children's Hospital, 6651 Main Street, E1920, Houston, TX 77030 USA.

Background: Traditional approaches to pediatric cardiac catheterization have relied on femoral venous access. Upper- extremity venous access may enable cardiac catheterization procedures to be performed safely for diagnostic and interventional catheterizations. The objective of this multicenter study was to demonstrate the feasibility and safety of upper-extremity venous access in a pediatric cardiac catheterization laboratory. Read More

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February 2019

Design and methods of the 'monitoring outcomes of psychiatric pharmacotherapy' (MOPHAR) monitoring program - a study protocol.

BMC Health Serv Res 2019 Feb 14;19(1):125. Epub 2019 Feb 14.

Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, The Netherlands.

Background: At many outpatient departments for psychiatry worldwide, standardized monitoring of the safety of prescribed psychotropic drugs is not routinely performed in daily clinical practice. Therefore it is unclear to which extent the drugs used by psychiatric outpatients are prescribed effectively and safely. These issues warrant structured monitoring of medication use, (pre-existing) co-morbidities, effectiveness and side effects during psychiatric outpatient treatment. Read More

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http://dx.doi.org/10.1186/s12913-019-3951-2DOI Listing
February 2019

Sevoflurane enhanced the clearance of Aβ1-40 in hippocampus under surgery via up-regulating AQP-4 expression in astrocyte.

Life Sci 2019 Feb 11. Epub 2019 Feb 11.

Department of Anesthesiology, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China. Electronic address:

The neurotoxicity of anesthetics on developing brain has been a focused issue for years. However, controversy exists between human and animal studies and surgery may be a potential reason for this. The discovery of glymphatic system, a pathway eliminating soluble substance from central nervous system (CNS), together with recent evidence that surgery-induced Aβ increase contributes to cognition dysfunction made us rethink about the influence of anesthetics on cognitive function. Read More

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http://dx.doi.org/10.1016/j.lfs.2019.02.024DOI Listing
February 2019

Reevaluating a Standardized Sedation Weaning Protocol for Pediatric Laryngotracheal Reconstruction for Continuous Quality Improvement.

JAMA Otolaryngol Head Neck Surg 2019 Feb 14. Epub 2019 Feb 14.

Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye & Ear Infirmary, Boston, Masschusetts.

Importance: Health care organizations are complex and evolving systems. To date, longitudinal evaluation to ensure the sustainability of quality improvement (QI) initiatives has been missing from the otolaryngology literature. We sought to reassess perioperative management of laryngotracheal reconstruction, which requires adequate sedation. Read More

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http://dx.doi.org/10.1001/jamaoto.2018.4348DOI Listing
February 2019

Symptom Burden and End-of-Life Palliative Treatments during the Last Two Weeks of Life in Patients with Advanced Musculoskeletal Sarcoma.

J Palliat Med 2019 Feb 14. Epub 2019 Feb 14.

1 Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

Background: Musculoskeletal sarcomas (MSSs) are rare cancers and often aggressive tumors that originate from mesenchymal tissue. Patients with advanced MSS often report difficulties with symptom burden, which can reduce their health-related quality-of-life.

Objective: The aim of this study was to describe the patterns of the physical symptoms of MSS patients in the palliative setting and to detail the palliative treatment used in the last two weeks of life. Read More

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http://dx.doi.org/10.1089/jpm.2018.0415DOI Listing
February 2019

Safety and efficacy of a propofol and ketamine based procedural sedation protocol in children with cerebral palsy undergoing botulinum toxin A injections.

PM R 2019 Feb 13. Epub 2019 Feb 13.

Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.

Background: Pediatric patients with cerebral palsy (CP) often undergo intramuscular botulinum toxin (BoNT-A) injections. These injections can be painful and may require procedural sedation. An ideal sedation protocol has yet to be elucidated. Read More

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http://dx.doi.org/10.1002/pmrj.12146DOI Listing
February 2019

Volumetric Assessment of Pediatric Vascular Malformations Using a Rapid, Hand-Held Three-Dimensional Imaging System.

J Digit Imaging 2019 Jan 31. Epub 2019 Jan 31.

George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.

The effect of percutaneous, surgical, and medical therapies for vascular malformations (VMs) is often difficult to quantify volumetrically using cross-sectional imaging. Volumetric measurement is often estimated with serial, expensive MRI examinations which may require sedation or anesthesia. We aim to explore whether a portable 3D scanning device is capable of rapid, accurate volumetric analysis of pediatric VMs. Read More

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http://link.springer.com/10.1007/s10278-019-00183-6
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http://dx.doi.org/10.1007/s10278-019-00183-6DOI Listing
January 2019
1 Read

Anaesthetist-controlled versus patient-maintained effect-site targeted propofol sedation during elective primary lower-limb arthroplasty performed under spinal anaesthesia (ACCEPTS): study protocol for a parallel-group randomised comparison trial.

Trials 2019 Feb 13;20(1):129. Epub 2019 Feb 13.

Department of Anaesthesia and Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.

Background: The clinical efficacy of effect-site targeted patient-maintained propofol sedation (PMPS) compared to anaesthetist-controlled propofol sedation (ACPS) for patients undergoing awake joint replacement surgery is currently unknown. There is no commercially available medical device capable of delivering PMPS so we have designed and built such a device. We plan a clinical trial to compare PMPS to ACPS and to collect data relating to the safety of our prototype device in delivering sedation. Read More

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http://dx.doi.org/10.1186/s13063-019-3228-4DOI Listing
February 2019
2 Reads

Premedication with intranasal dexmedetomidine decreases barbiturate requirement in pediatric patients sedated for magnetic resonance imaging: a retrospective study.

BMC Anesthesiol 2019 Feb 13;19(1):22. Epub 2019 Feb 13.

Department of Anaesthesiology and Intensive Care, University of Turku, P.O. Box 51, Kiinamyllynkatu 4-8, FI-20521, Turku, Finland.

Background: Barbiturates are commonly used in ambulatory sedation of pediatric patients. However, use of barbiturates involve risks of respiratory complications. Dexmedetomidine, a highly selective α-adrenoceptor agonist, is increasingly used for pediatric sedation. Read More

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http://dx.doi.org/10.1186/s12871-019-0690-1DOI Listing
February 2019

Cerebral Autoregulation-Guided Optimal Blood Pressure in Sepsis-Associated Encephalopathy: A Case Series.

J Intensive Care Med 2019 Feb 13:885066619828293. Epub 2019 Feb 13.

1 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Background:: Impaired cerebral autoregulation and cerebral hypoperfusion may play a critical role in the high morbidity and mortality in patients with sepsis-associated encephalopathy (SAE). Bedside assessment of cerebral autoregulation may help individualize hemodynamic targets that optimize brain perfusion. We hypothesize that near-infrared spectroscopy (NIRS)-derived cerebral oximetry can identify blood pressure ranges that enhance autoregulation in patients with SAE and that disturbances in autoregulation are associated with severity of encephalopathy. Read More

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http://dx.doi.org/10.1177/0885066619828293DOI Listing
February 2019
1 Read

Lung Volume Reduction Under Spontaneous Ventilation in a Patient with Severe Emphysema.

Am J Case Rep 2019 Jan 30;20:125-130. Epub 2019 Jan 30.

Department of Anesthesiology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China (mainland).

BACKGROUND One-lung ventilation under general anesthesia is necessary for most thoracic surgical procedures. However, adverse effects may derive from mechanical ventilation in emphysema patients. At present, lung volume reduction surgery under spontaneous ventilation may attenuate these adverse effects. Read More

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http://dx.doi.org/10.12659/AJCR.912822DOI Listing
January 2019

Intravenous Olanzapine for the Management of Agitation: Review of the Literature.

Ann Pharmacother 2019 Feb 13:1060028019831634. Epub 2019 Feb 13.

1 St John's University College of Pharmacy and Health Sciences, Queens, NY, USA.

Objective: The purpose of this review is to summarize the current evidence of the off-label use of intravenous (IV) olanzapine and discuss its risks versus benefits for the management of agitation.

Data Sources: A literature search was conducted to gather relevant data regarding IV use of olanzapine for the management of acute agitation. PubMed, EMBASE, MEDLINE, and IPA were searched using the keywords and MESH terms: olanzapine, intravenous, IV, off-label, and agitation. Read More

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http://dx.doi.org/10.1177/1060028019831634DOI Listing
February 2019

The Use of Palliative Sedation to Treat Existential Suffering: A Scoping Review on Practices, Ethical Considerations, and Guidelines.

J Palliat Care 2019 Feb 13:825859719827585. Epub 2019 Feb 13.

2 Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.

Context:: Though palliative sedation has been recognized as an acceptable practice in Canada for many years now, there is a lack of clinical research and guidelines pertaining to its use as a treatment of existential refractory symptoms in the terminally ill.

Objectives:: This scoping review aimed to survey the literature surrounding palliative sedation and existential suffering and to inform research, policy, and practice.

Methods:: To address the main research question: Is palliative sedation an acceptable intervention to treat existential refractory symptoms in adults aged 65 and older? a scoping review following Arksey and O'Malley's framework was performed, spanning electronic databases of the peer reviewed and grey literature. Read More

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http://dx.doi.org/10.1177/0825859719827585DOI Listing
February 2019

Safety and Efficacy of Nonanesthesiologist-Administrated Propofol during Endoscopic Submucosal Dissection of Gastric Epithelial Tumors.

Gastroenterol Res Pract 2019 10;2019:5937426. Epub 2019 Jan 10.

Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan.

Objective: There is no consensus regarding administration of propofol for performing endoscopic submucosal dissection (ESD) in patients with comorbidities. The aim of this study was to evaluate the safety and efficacy of propofol-induced sedation administered by nonanesthesiologists during ESD of gastric cancer in patients with comorbidities classified according to the American Society of Anesthesiologists (ASA) physical status.

Methods: Five hundred and twenty-two patients who underwent ESD for gastric epithelial tumors under sedation by nonanesthesiologist-administrated propofol between April 2011 and October 2017 at Dokkyo Medical University Hospital were enrolled in this study. Read More

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http://dx.doi.org/10.1155/2019/5937426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348925PMC
January 2019

Natural and Synthetic Cannabinoids for Agitation and Aggression in Alzheimer's Disease: A Meta-Analysis.

J Clin Psychiatry 2019 Jan 29;80(2). Epub 2019 Jan 29.

Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Ste FG08, Toronto, Ontario, Canada, M4N 3M5.

Objective: This meta-analysis investigated the efficacy of cannabinoids on agitation and aggression in patients with Alzheimer's disease (AD).

Data Sources: Electronic records up to August 2018 were searched from MEDLINE, EMBASE, and PsycINFO. Search terms included Alzheimer's disease, agitation, aggression, and cannabinoids. Read More

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http://dx.doi.org/10.4088/JCP.18r12617DOI Listing
January 2019

Introducing a new sedation policy in a large district general hospital: before and after cohort analysis.

Anaesthesiol Intensive Ther 2019 Feb 12. Epub 2019 Feb 12.

Department of Anaesthesia, Intensive Care and Pain Medicine, Cardiff University, Cardiff, Wales, United Kingdom.

Background: The management of pain, agitation and sedation for ventilated patients who are admitted to intensive care is an essential part of their care. The introduction of sedation protocols is associated with improved patient outcomes.

Methods: We conducted an observational cohort study among mechanically ventilated patients in a 16-bed ICU over a two-year period. Read More

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http://dx.doi.org/10.5603/AIT.a2019.0004DOI Listing
February 2019
1 Read

Postinjection Delirium/Sedation Syndrome After 31st Long-Acting Olanzapine Depot Injection.

Clin Neuropharmacol 2019 Feb 8. Epub 2019 Feb 8.

Department of Psychiatry, Central Institute of Psychiatry, Ranchi, India.

Objective: Long-acting depot preparations of antipsychotics are the mainstay of treatment for patients with schizophrenia who show nonadherence to their medications. Olanzapine pamoate is one of the recently approved long-acting depot psychotropic preparations that have shown its efficacy both in clinical trials and in clinical uses against the illness. However, emerging literature indicates toward a cluster of adverse effects known as postinjection delirium/sedation syndrome (PDSS). Read More

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http://dx.doi.org/10.1097/WNF.0000000000000329DOI Listing
February 2019
2 Reads
1.836 Impact Factor

First-Line Diagnostic Evaluation with MRI of Children Suspected of Having Acute Appendicitis.

Radiology 2019 Feb 12:181959. Epub 2019 Feb 12.

From the Departments of Medical Imaging (R.M., S.M.D., F.M., D.G., S.V., B.K., D.R.M., U.K.U.), Pediatrics (G.G.), and Pediatric Emergency Medicine (A.L.), University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724.

Background Advances in abdominal MRI have enabled rapid, free-breathing imaging without the need for intravenous or oral contrast material. The use of MRI as the primary imaging modality for suspected appendicitis has not been previously studied. Purpose To determine the diagnostic performance of MRI as the initial imaging modality in children suspected of having acute appendicitis. Read More

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http://dx.doi.org/10.1148/radiol.2019181959DOI Listing
February 2019
1 Read

Palliative care specialists in hospice and hospital/community teams predominantly use low doses of sedative medication at the end of life for patient comfort rather than sedation: Findings from focus groups and patient records for I-CAN-CARE.

Palliat Med 2019 Feb 12:269216319826007. Epub 2019 Feb 12.

Division of Psychiatry, UCL, London, UK.

Background:: Little research has explored the detail of practice when using sedative medications at the end of life. One work package of the I-CAN-CARE research programme investigates this in UK palliative care.

Aims:: To investigate current practices when using sedative medication at the end of life in London, UK, by (1) qualitatively exploring the understandings of palliative care clinicians, (2) examining documented sedative use in patient records and (3) comparing findings from both investigations. Read More

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http://dx.doi.org/10.1177/0269216319826007DOI Listing
February 2019

Continuous Infusion Ketamine for Adjunctive Analgosedation in Mechanically Ventilated, Critically Ill Patients.

Pharmacotherapy 2019 Feb 11. Epub 2019 Feb 11.

Adjunct Assistant Professor of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 234 Goodman Street, Cincinnati, OH, 45219.

Objective: Ketamine is an N-methyl-D-aspartate (NMDA) antagonist with emerging evidence assessing its use as a continuous infusion agent to provide concomitant analgesia and sedation. The role of ketamine as adjunctive therapy in mechanically ventilated patients is unclear. This study sought to investigate the impact of adjunctive continuous infusion ketamine on concomitant analgesic and sedative dosing while providing goal comfort in mechanically ventilated patients. Read More

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http://dx.doi.org/10.1002/phar.2223DOI Listing
February 2019
2 Reads

Rescue Sedation When Treating Acute Agitation in the Emergency Department With Intramuscular Antipsychotics.

J Emerg Med 2019 Feb 8. Epub 2019 Feb 8.

Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.

Background: Rapid treatment of agitation in the emergency department (ED) is critical to avoid injury to patients and providers. Treatment with intramuscular antipsychotics is often utilized, but there is a paucity of comparative effectiveness evidence available.

Objective: The purpose of this investigation was to compare the effectiveness of droperidol, olanzapine, and haloperidol for treating agitation in the ED. Read More

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http://dx.doi.org/10.1016/j.jemermed.2018.12.036DOI Listing
February 2019
1 Read

Sedative and physiologic effects of tiletamine-zolazepam following buccal administration in cats.

J Feline Med Surg 2019 Feb 12:1098612X19827116. Epub 2019 Feb 12.

7 Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, USA.

Objectives: The aim of this study was to describe the sedative and some physiological effects of tiletamine-zolazepam following buccal administration (BA) in cats.

Methods: Seven healthy spayed European Shorthair cats (three males, four female) were studied twice in this randomized, blinded, crossover study. Each cat received two doses of tiletamine-zolazepam by BA: the low-dose (LD) consisted of 5 mg/kg of each drug, and the high dose (HD) consisted of 7. Read More

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http://dx.doi.org/10.1177/1098612X19827116DOI Listing
February 2019

Safety of Deep Sedation in Patients Undergoing Full-Thickness Skin Graft Harvesting and Skin Graft Reconstruction for Limb Salvage .

J Am Podiatr Med Assoc 2018 Nov;108(6):487-493

Background:: Studies on obtaining donor skin graft using intravenous sedation for patients undergoing major foot surgeries in the same operating room visit have not previously been reported. The objective of this retrospective study is to demonstrate that intravenous sedation in this setting is both adequate and safe in patients undergoing skin graft reconstruction of the lower extremities in which donor skin graft is harvested from the same patient in one operating room visit.

Methods:: Medical records of 79 patients who underwent skin graft reconstruction of the lower extremities by one surgeon at the Yale New Haven Health System between November 1, 2008, and July 31, 2014, were reviewed. Read More

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http://dx.doi.org/10.7547/17-042DOI Listing
November 2018

Evaluation of the Brief Alcohol Withdrawal Scale Protocol at an Academic Medical Center.

J Addict Med 2019 Feb 6. Epub 2019 Feb 6.

Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD (BKL, VTG, RMK, ASJ); Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (AAHA, TN); Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (ESC); Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD (PM, KP); Center for Chemical Dependence, Johns Hopkins Bayview Medical Center, Baltimore, MD (DAR); Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD (SY).

Objectives: The standard of care for treatment of alcohol withdrawal is symptom-triggered dosing of benzodiazepines using a withdrawal scale. Abbreviated scales are desired for clinician efficiency. The objective of this study was to evaluate the use of the 5-item Brief Alcohol Withdrawal Scale (BAWS) protocol. Read More

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http://dx.doi.org/10.1097/ADM.0000000000000510DOI Listing
February 2019
3 Reads

Effect of esmolol and lidocaine on agitation in awake phase of anesthesia among children: a double-blind, randomized clinical consort study.

Chin Med J (Engl) 2019 Feb 5. Epub 2019 Feb 5.

Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Cheonan, 31, Soonchunhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do 330-721, Republic of Korea.

Background: Sevoflurane is widely used to anesthetize children because of its rapid action with minimal irritation of the airways. However, there is a high risk of agitation after emergence from anesthesia. Strabismus surgery, in particular, can trigger agitation because patients have their eyes covered in the postoperative period. Read More

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http://dx.doi.org/10.1097/CM9.0000000000000141DOI Listing
February 2019

Probing the happy place.

Authors:
Kelly A Mills

J Clin Invest 2019 Feb 11. Epub 2019 Feb 11.

A variety of neurological procedures, including deep brain stimulation and craniotomies that require tissue removal near elegant cortices, require patients to remain awake and responsive in order to monitor function. Such procedures can produce anxiety and are poorly tolerated in some subjects. In this issue of the JCI, Bijanki and colleagues demonstrate that electrical stimulation of the left dorsal anterior cingulum bundle promoted a positive (mirthful) effect and reduced anxiety, without sedation, in three patients with epilepsy undergoing intracranial electrode monitoring. Read More

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http://dx.doi.org/10.1172/JCI126683DOI Listing
February 2019
1 Read

Pure Isolated Dorsal Hamatometacarpal Dislocation in a Rider: A Case Report and Review of Literature.

J Orthop Case Rep 2018 Sep-Oct;8(5):29-31

Department of Orthopedic Surgery and Traumatology, Military Hospital Mohamed V (HMIMV), BP 10100 Rabat, Morocco.

Introduction: Pure isolated dislocations of the fifth carpometacarpal joint are extremely rare. To the best of our knowledge, the case, we present here, is among the extremely rare cases report of an unstable hamatometacarpal dislocation(HMD)injury successfully treated by a well-molded cast.

Case Report: A 30-year-old rider fell from his horse, causing swelling of the wrist and the fifth finger was rotated with minimal active motion. Read More

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http://dx.doi.org/10.13107/jocr.2250-0685.1196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367302PMC
February 2019
1 Read

Dexmedetomidine versus Magnesium as Adjuvants to Bupivacaine-Induced Caudal Block in Children: A Randomized, Double-Blinded, Placebo-Controlled, Trial.

Open Access Maced J Med Sci 2019 Jan 12;7(1):73-76. Epub 2019 Jan 12.

Anesthesia and Critical Care, Cairo University, Cairo, Egypt.

Background: Caudal block remains fundamental in pediatric anaesthetic practice. It is very useful in a wide range of surgical procedures and has proved to have a remarkable safety record, But one of the major limitations of the single-injection technique is the relatively short duration of postoperative analgesia. Prolongation of caudal analgesia using single-shot technique has been achieved by the addition of various adjuvant. Read More

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http://dx.doi.org/10.3889/oamjms.2019.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352475PMC
January 2019
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Inhaled methoxyflurane for the reduction of acute anterior shoulder dislocation in the emergency department.

CJEM 2019 Feb 11:1-5. Epub 2019 Feb 11.

*Department of Emergency Medicine,University Hospital Galway,Galway,Ireland.

CLINICIAN'S CAPSULEWhat is known about the topic?Methoxyflurane is an inhalation analgesic with minimal sedative properties.What did this study ask?What is the success rate of methoxyflurane for acute anterior shoulder dislocation reduction and its impact on emergency department (ED) patient flow, as compared with propofol?What did this study find?Successful reduction was achieved in 80% of patients administered methoxyflurane; recovery time and ED length of stay was shorter, as compared with propofol sedation.Why does this study matter to clinicians?Methoxyflurane can be used for acute anterior shoulder dislocation reduction prior to considering deep sedation and may improve ED patient flow. Read More

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http://dx.doi.org/10.1017/cem.2018.493DOI Listing
February 2019
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Current status of diagnostic and therapeutic bronchoscopy in Japan: 2016 national survey of bronchoscopy.

Respir Investig 2019 Feb 6. Epub 2019 Feb 6.

Kagawa Kenritsu Chuo Hospital, Kagawa 760-8557, Japan. Electronic address:

Background: The safety management committee of the Japan Society for Respiratory Endoscopy (JSRE) conducted national surveys to clarify the state of diagnostic and therapeutic bronchoscopy in 2016.

Methods: Questionnaire forms were mailed to 532 JSRE-accredited facilities throughout Japan. We surveyed the actual condition of clinical practice and cases of bronchoscopy during 2016. Read More

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http://dx.doi.org/10.1016/j.resinv.2018.12.007DOI Listing
February 2019

Preoperative Assessment of Obstructive Sleep Apnea in the Ambulatory Anesthesia Patient: A Survey of Oral and Maxillofacial Surgery Providers.

J Oral Maxillofac Surg 2019 Jan 15. Epub 2019 Jan 15.

Director of Resident Research, Oral and Maxillofacial Surgery, Yale New Haven Hospital, New Haven, CT.

Purpose: Oral and maxillofacial surgeons often treat patients with both diagnosed and undiagnosed obstructive sleep apnea (OSA). Patients with OSA are at substantial risk of perioperative and postoperative complications after receiving intravenous sedation, general anesthesia, or postoperative opiate analgesia. The purpose of this study was to determine whether oral and maxillofacial surgery (OMS) providers are screening patients for perioperative and postoperative risks related to OSA before office-based ambulatory anesthesia. Read More

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http://dx.doi.org/10.1016/j.joms.2018.12.036DOI Listing
January 2019
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Caring for non-sedated mechanically ventilated patients in ICU: A qualitative study comparing perspectives of expert and competent nurses.

Intensive Crit Care Nurs 2019 Feb 5. Epub 2019 Feb 5.

Intensive Care Unit 4131, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark. Electronic address:

Background: Sedation practice has evolved from deep to lighter or no sedation in mechanically ventilated patients in the intensive care unit (ICU). The care of conscious intubated patients constitutes a change in the nurse-patient interaction.

Objective: We aimed to compare the perspectives of expert and competent nurses regarding their interaction with non-sedated mechanically ventilated ICU patients. Read More

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http://dx.doi.org/10.1016/j.iccn.2019.01.004DOI Listing
February 2019

Optimal adaptive control of drug dosing using integral reinforcement learning.

Math Biosci 2019 Feb 5;309:131-142. Epub 2019 Feb 5.

School of Aerospace Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0150, USA. Electronic address:

In this paper, a reinforcement learning (RL)-based optimal adaptive control approach is proposed for the continuous infusion of a sedative drug to maintain a required level of sedation. To illustrate the proposed method, we use the common anesthetic drug propofol used in intensive care units (ICUs). The proposed online integral reinforcement learning (IRL) algorithm is designed to provide optimal drug dosing for a given performance measure that iteratively updates the control solution with respect to the pharmacology of the patient while guaranteeing convergence to the optimal solution. Read More

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http://dx.doi.org/10.1016/j.mbs.2019.01.012DOI Listing
February 2019

Proportional Assist Ventilation feasibility in the early stage of respiratory failure: a prospective randomized multicenter trial.

Minerva Anestesiol 2019 Feb 7. Epub 2019 Feb 7.

Intensive Care Unit, Hospital Sant Joan de Deu, Althaia Xarxa Assistencial, Manresa, Spain.

Background: Proportional assist ventilation (PAV+) is an assisted ventilator mode usually applied during weaning. We aimed to determine the feasibility of using PAV+ in the early phase of acute respiratory failure compared to volume-assist control ventilation (V-ACV) in order to shorten the length of mechanical ventilation (MV).

Methods: We conducted a prospective randomized trial comparing high-assistance PAV+ (gain 80%) vs. Read More

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http://dx.doi.org/10.23736/S0375-9393.19.12618-1DOI Listing
February 2019
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Effect of fentanyl nasal packing treatment on patients with acute postoperative pain after closed reduction of nasal bone fracture: a randomized double-blind controlled trial.

J Plast Surg Hand Surg 2019 Feb 8:1-6. Epub 2019 Feb 8.

c Department of Anesthesiology and Pain Medicine, Gangneung Asan Medical Center , University of Ulsan College of Medicine , Seoul , Korea.

Purpose: Nasal bone fracture reduction surgery is normally followed by nasal packing to control bleeding. Yet, patients suffer from pain and require further analgesic treatments following nasal packing and removal. This study aimed to evaluate the effect of fentanyl-soaked packing as a method of controlling pain after nasal surgeries in a prospective, randomized, double-blind controlled trial. Read More

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http://dx.doi.org/10.1080/2000656X.2019.1566738DOI Listing
February 2019
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Can Therapeutic Hypothermia Diminish the Impact of Traumatic Brain Injury in ?

J Exp Neurosci 2019 21;13:1179069518824852. Epub 2019 Jan 21.

Jefferson Underclassman Multidisciplinary Laboratory (JUMP Lab), Thomas Jefferson High School for Science and Technology, Alexandria, VA, USA.

Background/main Objectives: No effective strategy exists to treat the well-recognized, devastating impact of traumatic brain injury (TBI) and chronic traumatic encephalopathy (CTE), which is the brain degeneration likely caused by repeated head trauma. The goals of this project were (1) to study the effects of single and recurrent TBI (rTBI) on (a) life span, (b) response to sedatives, and (c) behavioral responses to light and gravity and (2) to determine whether therapeutic hypothermia can mitigate the deleterious effects of TBI.

Methods: Five experimental groups were created: (1) control, (2) single TBI or concussion; (3) concussion + hypothermia, (4) rTBI, and (5) rTBI + hypothermia. Read More

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http://dx.doi.org/10.1177/1179069518824852DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343440PMC
January 2019
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Intranasal Low-Dose Dexmedetomidine Reduces Postoperative Opioid Requirement in Patients Undergoing Hip Arthroplasty Under General Anesthesia.

J Arthroplasty 2019 Jan 7. Epub 2019 Jan 7.

Department of Anaesthesiology and Intensive Care, University of Turku, Turku, Finland; Division of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, Turku, Finland.

Background: Patients undergoing total hip arthroplasty (THA) need substantial amount of opioids for postoperative pain management, which necessitates opioid-sparing modalities. Dexmedetomidine is a novel alpha-2-adrenoceptor-activating drug for procedural sedation. In addition to its sedative effect, dexmedetomidine has analgesic and antiemetic effects. Read More

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http://dx.doi.org/10.1016/j.arth.2018.12.036DOI Listing
January 2019
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Clinical Practice Guideline for Emergency Department Procedural Sedation With Propofol: 2018 Update.

Ann Emerg Med 2019 Feb 4. Epub 2019 Feb 4.

Division of Emergency Medicine, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, MA.

We update an evidence-based clinical practice guideline for the administration of propofol for emergency department procedural sedation. Both the unique considerations of using this drug in the pediatric population and the substantial new research warrant revision of the 2007 advisory. We discuss the indications, contraindications, personnel requirements, monitoring, dosing, coadministered medications, and adverse events for propofol sedation. Read More

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http://dx.doi.org/10.1016/j.annemergmed.2018.12.012DOI Listing
February 2019
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Case studies in physiology: oxygenation during general anesthesia and thoracic surgery in a patient with Titusville low-oxygen affinity hemoglobin.

J Appl Physiol (1985) 2019 Feb 7. Epub 2019 Feb 7.

Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca'Granda - Ospedale Maggiore Policlinico, Italy.

The purpose of this case study is to describe the physiologic characteristics of a patient with the low-oxygen affinity Titusville hemoglobin variant. A 46-year-old man with exertional dyspnea was diagnosed with a mediastinal lymphadenopathy of unknown origin and, to obtain definitive diagnosis by biopsy, underwent endobronchial ultrasound-guided transbronchial needle aspirate under sedation and video-assisted thoracoscopy under general anesthesia. High inspired fraction of oxygen (FIO) was used to guarantee adequate oxygenation even during the one-lung ventilation needed for thoracoscopy. Read More

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http://dx.doi.org/10.1152/japplphysiol.00860.2018DOI Listing
February 2019

Determining Interrater Reliability of the Cornell Assessment of Pediatric Delirium Screening Tool Among PICU Nurses.

Pediatr Crit Care Med 2019 Feb 5. Epub 2019 Feb 5.

Children's Core for Biomedical Statistics, Center for Clinical and Translational Research Seattle Children's Research Institute, Seattle, WA.

Objectives: To determine the interrater reliability of the Cornell Assessment of Pediatric Delirium Screening Tool amount PICU nurses.

Design: The design was setup as a cross-sectional study and conducted over the course of a year.

Setting: This study setting was a PICU and a pediatric cardiac ICU at Seattle Children's Hospital, a tertiary freestanding university-affiliated hospital in Seattle, Washington. Read More

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http://dx.doi.org/10.1097/PCC.0000000000001896DOI Listing
February 2019
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Effect of early and focused benzodiazepine therapy on length of stay in severe alcohol withdrawal syndrome.

Clin Toxicol (Phila) 2019 Feb 7:1-4. Epub 2019 Feb 7.

b Department of Surgery , University of California, Davis Medical Center , Sacramento , CA, USA.

Objective: Current evidence supports symptom-triggered therapy for alcohol withdrawal syndrome (AWS). Early, escalating therapy with benzodiazepines (BZD) appears to decrease ICU length of stay (LOS); however, the effect on hospital LOS remains unknown. The hypothesis of this study is that focused BZD treatment in the first 24 h will decrease hospital LOS. Read More

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http://dx.doi.org/10.1080/15563650.2018.1542701DOI Listing
February 2019
1 Read