PubMed · 10777381
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N C Fisher. 2000-04-20. Endoscopy.. https://doi.org/10.1056/nejm200004203421616
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BACKGROUND: An increase in the number of patients undergoing sedation for imaging procedures has led to many changes in practice over the past 10 years. OBJECTIVE: The purpose of this study was to compare and evaluate sedation practice changes in a pediatric radiology department during the last 5 years. MATERIALS AND METHODS: The radiology computer database and corresponding minutes of the Radiology Sedation Committee were reviewed to identify changes in sedation policy. Data from three blocks of time were analyzed to determine time to sedation, time to discharge, drug frequency, rates of adverse events, sedation failure, and paradoxical reaction. RESULTS: Specific practice changes undertaken over the 5-year period include: (1) increased speed of administration of IV pentobarbital, (2) alternating pentobarbital and fentanyl, (3) presedation with midazolam, and (4) administering oral pentobarbital to children under and (5) over 12 months of age. Based on data analysis, changes 1 and 4 were incorporated into the sedation policy, while changes 2, 3, and 5 were abandoned. Comparison of data from the three time segments revealed improvement in the time to sedation, sedation failure, adverse event, and paradoxical reaction rates. CONCLUSION: There is improvement in all aspects of patient outcomes with sedation, as a result of several changes in sedation practice.
INTRODUCTION: The most proper examination for the morphological changes of the upper gastrointestinal tract is endoscopy. The standard oro-gastric route is carried out under conscious sedation, but the drugs used might have cardiopulmonary side effects. Furthermore there are a few conditions when this routine endoscopy is technically impossible. AIMS: Could these failures be avoided with an endoscope led through the nose? Are there advantages of the use of ultrathin endoscopes for transnasal oesophago-gastro-duodenoscopy? PATIENTS/METHODS: Own experiences with transnasal therapeutic endoscopies on patients with cancer in the head and neck region compared with data from the literature. RESULTS: Based on literature and on own experiences, transnasal oesophago-gastro-duodenoscopy may be advised in cases with trismus, stenosis of the upper aero-digestive tract, oropharyngeal dysphagia, cricopharyngeal achalasia, in several neurosurgical conditions and on severely ill ventilated patients. I.v. premedication is not always necessary for transnasal oesophago-gastro-duodenoscopy done with ultrathin endoscopes. CONCLUSIONS: The oesophagus might be accessed also via the nose, but it must be emphasized that transnasal oesophago-gastro-duodenoscopy is only advised when the standard way of upper gastrointestinal tract endoscopy is impossible.
Terminally ill patients want assurance that their symptoms will be controlled as death approaches. Most patients can have a peaceful death with standard palliative care. Some patients approaching death, however, have refractory symptoms such as pain, dyspnea, nausea, and agitated delirium. Palliative sedation (PS), the use of medications to induce sedation in order to control refractory symptoms near death, is a therapeutic option for these patients. The reported frequency of PS use varies greatly, ranging from 5% to 52% of the terminally ill. One concern with PS is its effect on survival. Data suggest that PS does not lead to immediate death, with the median time to death after initiating PS being greater than 1 to 5 days. A number of medications have been used for PS, but midazolam is most commonly reported. PS is distinct from euthanasia because the intent of PS is relief from suffering without death as a required outcome.