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At least 325 records · Page 18Linked to original sources
PubMed2004

Nitrous oxide analgesia for minor pediatric surgical procedures: an effective alternative to conscious sedation?

BACKGROUND/PURPOSE: Minor surgical procedures in children, while usually not requiring general anesthesia, need effective control of pain, anxiety, and motion. Certain techniques of conscious sedation may result in loss of protective airway reflexes. Nitrous oxide, however, when inhaled at levels below 50% maintains protective reflexes and does not require fasting or postprocedure monitoring. This study prospectively examines the efficacy of nitrous oxide analgesia in children undergoing outpatient surgical procedures. METHODS: Over a 2-year period (2000 to 2002), 150 consecutive children were given nitrous oxide analgesia as an alternative to a general anesthetic, sedation, or local anesthetic alone. Nitrous oxide (<50%) was administered by our practice's sedation-certified nurse practitioner without an anesthesiologist present. The children used the Wong-Baker Faces Scale (0-5) to score pain at different intervals (preprocedure, at injection, during procedure, and postprocedure) and event memories were tabulated. RESULTS: Of 150 children, 5 were uncooperative and could not participate. One hundred forty-five children, ages 1 to 20 years (Mean, 9.83 +/- 4.92 years) successfully underwent procedures (58 cyst/nevus excisions, 49 abscess drainages, 38 other) using nitrous. Two patients were too young to score pain. Pre- and postprocedure pain scores were significantly higher in the abscess group (P <.0001); during the procedures, however, all groups reported pain scores less than 1, with parents citing 100% satisfaction with the technique. Of 128 children receiving local anesthesia, 107 (84%) had no recall of the injection. Complications were limited to 4 patients; 2 experienced nausea, and 2 vomited. All resolved without interrupting the procedure. CONCLUSIONS: Nitrous oxide analgesia is a cost-effective and efficacious alternative to conscious sedation or general anesthesia for minor pediatric surgical procedures. In the office or outpatient setting, the technique provides for almost pain/anxiety-free surgery, no postoperative monitoring, and a high degree of satisfaction for patients, parents, and staff.

Adolescent↗
PubMed2006

Flexible sigmoidoscopy and colonoscopy during pregnancy.

More than 6000 pregnant women each year have an indication that warrants a flexible sigmoidoscopy or colonoscopy. In addition to the potential complications inherent in the risk of sedation and the procedures themselves, the endoscopist who performs these procedures in pregnant women must be aware of the potential to do harm to the fetus. This article reviews the existing literature as it pertains to flexible sigmoidoscopies and colonoscopies performed during pregnancy, including indications and diagnostic usefulness, safety, use of medications, and therapeutic interventions.

Colonoscopy↗
PubMed2003

Anaesthesia for awake craniotomy--evolution of a technique that facilitates awake neurological testing.

BACKGROUND: There is an increasing trend towards performing craniotomy awake. The challenge for the anaesthetist is to provide adequate analgesia and sedation, haemodynamic stability, and a safe airway, with an awake, cooperative patient for neurological testing. METHODS: The records of all patients who had awake craniotomy at our institution were reviewed. Patients were divided into three groups according to anaesthetic technique. Patients in Group 1 were sedated throughout the procedure. Patients in Groups 2 and 3 had an asleep-awake-asleep technique. Those in Group 2 were anaesthetized with a propofol infusion and fentanyl, and breathed spontaneously through a laryngeal mask airway (LMA). Patients in Group 3 had total i.v. anaesthesia with propofol and remifentanil, and ventilation was controlled using an LMA. We noted the incidence of complications in each group. RESULTS: There were 99 procedures carried out between 1989 and 2002. Group 3 had the fewest complications. No patients in Group 3 developed hypercapnia (E'(CO(2)) >6 kPa), compared with all of the patients in Group 2. Patients in Group 1 had no E'(CO(2)) monitoring, but 7% developed airway obstruction. No patients in Group 3 required additional analgesia for pain, compared with 70% of patients in Group 2. CONCLUSIONS: We have developed a technique for craniotomy, which facilitates awake neurological testing, is safe, and has good patient satisfaction.

Adolescent↗
PubMed1990

Monitoring--the gastroenterologist's view.

Better training standards and widespread adoption of monitoring equipment has resulted in a considerable drop in anaesthetic-related deaths. This fall, however, has not been reflected in the field of endoscopy, in which over 50% of the complications and deaths appear to be due to cardiopulmonary problems, suggesting the involvement of sedative drugs. Improvements in monitoring could substantially reduce these problems. Staff should be fully trained in endoscopic, sedative, and resuscitation procedures; equipment and drugs for resuscitation should be immediately to hand; any risk factors in patients who are to undergo endoscopy should be identified, and, when necessary, additional monitoring and safety procedures should be followed. Pulse oximeters can detect oxygen desaturation very early and should be used where risk factors have been identified. Use of oximetry and continuous ECG monitoring will improve the sensitivity of clinical monitoring and may reduce the number of adverse events encountered in endoscopy. Use of supplemental oxygen should be considered.

Procedural Sedation↗
PubMed1994

Sedative efficacy of droperidol and diazepam in the rat.

Droperidol and diazepam were evaluated for sedative properties in 12 male Sprague Dawley rats (Rattus norvegicus). Over a period of several weeks, each rat was treated subcutaneously with 0.5 mg droperidol/kg, 2.0 mg droperidol/kg, 5.0 mg diazepam/kg, 15.0 mg diazepam/kg, and physiologic saline according to a randomized schedule. After each treatment, the animals were evaluated for their response to a series of four common clinical manipulations (tail-vein bleeding, orbital bleeding, teeth clipping, and toenail bleeding) at five time points over the 90 min following the injection. Rats were scored on the basis of their responses to each manipulation. Response to cardiac puncture was assessed once in each animal immediately prior to euthanasia. Histologic lesions associated with subcutaneous and intramuscular administration of these drugs were evaluated in a separate group of animals. Results indicate that both droperidol and diazepam (at either dose) allow easier manipulation for toenail bleeding and teeth clipping when compared with saline control. There was no advantage in using these sedatives for tail-vein bleeding. Orbital bleeding could not be performed humanely with either drug. Diazepam at a dose of 15.0 mg/kg allowed humane cardiac puncture. Subcutaneous injection of diazepam or 2.0 mg droperidol/kg resulted in various degrees of inflammation revealed by histologic examination, although no clinical signs were associated with these lesions. Subcutaneous administration of droperidol at a dose of 0.5 mg/kg is recommended for nonpainful, noninvasive manipulations as it provides adequate sedation for most procedures without inducing the subcutaneous inflammation observed with diazepam or 2.0 mg droperidol/kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Animal Welfare↗
PubMed2003

High-dose rectal midazolam for pediatric procedures: a randomized trial of sedative efficacy and agitation.

OBJECTIVES: To compare 2 doses of rectal midazolam, used for pediatric emergency department sedation, with regard to sedative efficacy and frequency of paradoxical agitation. METHODS: Children <or=48 months old undergoing cutaneous procedures received midazolam by rectum, randomized in double-blind fashion to standard (0.5 mg/kg, SDM) or high (1 mg/kg, HDM) doses. Behaviors were scored on a 5-point sedation scale before and during procedures. Proportions manifesting successful sedation and postprocedure agitation were compared between the 2 doses. RESULTS: Sixty-five patients (32 SDM, 33 HDM) underwent sedated procedures (repair of lacerations, 97%). Behavior scores improved for both groups following medication administration and at best sedation during procedure. HDM produced better sedation at time of first suture (successful sedation: 70%, SDM vs. 91%, HDM; intergroup difference = 21%; 95% confidence interval [CI] = 2, 41) and at best point during the procedure (72%, SDM vs. 97%, HDM; Delta = 25%; 95% CI = 8, 43). However, sedative efficacy declined such that only 50% and 73% of the SDM and HDM groups, respectively, had successful sedation at the worst point during the procedures. Postprocedure agitation occurred in 17% of patients (6%, SDM vs. 27%, HDM; Delta = 21%; 95% CI = 3, 39). CONCLUSIONS: Rectal midazolam improved sedation scores over preprocedure levels and was more effective with a dose of 1 mg/kg than with 0.5 mg/kg. However, inadequate sedation in 27-50% of patients and prolonged agitation in 27% of patients at higher doses counter the advantages of rectal midazolam.

Administration, Rectal↗
PubMed1995

Sedation for outpatient dental procedures.

Pain and anxiety in the dental setting prevent many patients from seeking needed treatment. As a result, various techniques of anesthesia or sedation have been developed over the last 150 years to overcome this problem. Both the historic evolution of sedation and the use of several currently popular techniques are described in this article. Also discussed is the balance between individual patient responses to drugs, dosages, and rate of administration. Currently used definitions of pharmacologic depression of consciousness are detailed, as are contemporaneous training requirements. Finally, unexpected, rare, and catastrophic events that can occur with sedation are briefly discussed.

Administration, Intranasal↗
PubMed1999

Acceptance and side effects of nitrous oxide oxygen sedation for oral surgical procedures.

Two hundred and forty-one treatment sessions with nitrous oxide oxygen sedation were performed in 194 patients undergoing ambulatory oral surgery procedures. Removal of mesiodentes and tooth transplants were the most frequent procedures in age groups under 13 years, while removal of impacted teeth was predominant in older age groups. Local anesthesia was used in addition to inhalation sedation in 238 sessions. Median gas volume rate was 10 l/min, median concentration 50% and median duration of procedures 31 min. In 10 sessions (4.1%) sedation was not accepted, while in 25 (10.4%) sessions the procedure could be completed with some difficulty. No potentially dangerous complications were noted. Side effects occurred in 18 sessions in 16 patients. All side effects were minor and easily handled. Logistic regression analysis revealed that failure, defined as poor acceptance and/or presence of side effects, was associated with ASA class 2 and general apprehension, especially based on previous negative experience with medical or dental treatment. Nitrous oxide oxygen sedation is a reliable, efficient and safe adjunct to local anesthesia in both healthy children and adults undergoing ambulatory oral surgery procedures.

Adolescent↗
PubMed1995

Sedation and monitoring of patients undergoing gastrointestinal endoscopic procedures. American Society for Gastrointestinal Endoscopy.

Every available means to insure the safety of patients during endoscopic procedures is mandatory. This begins with a fully trained and knowledgeable endoscopist, thorough preparation of the unit to handle endoscopic procedures and potential adverse outcomes, appropriate patient preparation, skilled assistants, and monitoring of the patient's well-being before, during and after the procedure. The relative risks involved can be estimated from patient and procedural factors and should be determined for each procedure. The level and type of monitoring during endoscopic procedures is dependent upon a thorough understanding and assessment of the risk to the patient. Monitoring of patients undergoing endoscopic procedures is mandatory and prudent. The ultimate responsibility for protecting patients lies with the endoscopist and cannot be assigned to an assistant or electronic monitoring device. However, both may greatly improve the ability to detect patient distress at a time when intervention will prevent an otherwise adverse outcome.

Procedural Sedation↗
PubMed1996

Comparative review of the adverse effects of sedatives used in children undergoing outpatient procedures.

Children often fear medical procedures and interventions. Sedative agents enhance the care of these children who undergo outpatient procedures by decreasing anxiety, increasing cooperativity, and providing amnesia. Although higher dosages and intravenous administration of sedatives often produce improved sedation, adverse effects and complications are more frequent. The goals of therapeutic efficacy and safety must be balanced in all patients. The presence or anticipation of anxiety and pain helps in deciding whether to use a sedative alone, or a regimen also providing analgesia. The patient's clinical cardiorespiratory or neurological status, other relative contraindications, the duration of the intended procedure, and the presence or absence of an intravenous line will help in choosing specific drugs. Drug complications are a common cause of adverse events in patients. The combination of a sedative and analgesic, especially a benzodiazepine and an opioid given intravenously, is associated with a higher risk of serious complications. The practitioner responsible for the administration of a sedative to a child must be competent in its use and have the ability to detect and manage complications. Patients who are deeply sedated should be continuously monitored and observed by an individual dedicated to this task. Vital signs and oxygen saturation should be documented at frequent intervals and the patient should be appropriately monitored until discharge criteria have been met. The risk of serious complications with these agents may be reduced with vigorous monitoring and a judicious choice of dosage.

Ambulatory Care↗
PubMed2002

Cost analysis of adjunct hypnosis with sedation during outpatient interventional radiologic procedures.

PURPOSE: To compare the cost of standard intravenous conscious sedation with that of sedation with adjunct self-hypnotic relaxation during outpatient interventional radiologic procedures. MATERIALS AND METHODS: Data were reviewed from a prospective randomized study in which patients undergoing vascular and renal interventional procedures underwent either standard sedation (n = 79) or sedation with adjunct hypnosis (n = 82). These data were used to construct a decision analysis model to compare the cost of standard sedation with the cost of sedation with adjunct hypnosis. Multiple sensitivity analyses were performed to assess the applicability of these results to other institutions with different cost structures with respect to the following variables: cost of the hypnosis provider, cost of room time for interventional radiologic procedure, hours of observation after the procedure, and frequency and cost of complications associated with over- or undersedation. RESULTS: According to data from this experience, the cost associated with standard sedation during a procedure was $638, compared with $300 for sedation with adjunct hypnosis, which resulted in a savings of $338 per case with hypnosis. Although hypnosis was known to reduce room time, hypnosis remained more cost-effective even if it added an additional 58.2 minutes to the room time. CONCLUSION: Use of adjunct hypnosis with sedation reduces cost during interventional radiologic procedures.

Adolescent↗