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Results for “Procedural Sedation”

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At least 145 records · Page 8Linked to original sources

PubMed2001

Etomidate for pediatric sedation prior to fracture reduction.

OBJECTIVE: While etomidate is reported as a procedural sedative in adults, its use in children has not been extensively reported. The authors describe their experience with etomidate for procedural sedation in children with extremity fractures and major joint dislocations. METHODS: This was a retrospective descriptive chart review. The setting was a university-based emergency department (ED) that follows national guidelines for procedural sedation. Subjects were children less than 18 years old who received etomidate prior to fracture reduction or major joint dislocations. Standardized data were abstracted from the medical records, including patient demographics, diagnosis, weight, types and doses of sedative and analgesic agents used, number of boluses of etomidate, attempts at reduction, complications encountered, vitals signs before, during, and after the reduction, disposition, and the time from procedure to discharge. Descriptive statistics calculated included means and proportions with 95% confidence intervals. RESULTS: Fifty-three children received etomidate for fracture reduction. Their mean age was 9.7; 41.5% were females. Indications for reduction included forearm fractures (38), ankle fractures (12), upper arm fractures (2), and hip dislocations (1). In most cases (83%) reduction was successful after one attempt only. The mean initial and total doses of etomidate were 0.20 mg/kg (range, 0.1 to 0.4) and 0.24 mg/kg (range, 0.13 to 0.52), respectively. Thirteen patients required a second bolus of etomidate or midazolam. Thirty-four patients (64%) were discharged from the ED after a mean observation of 94 minutes (range, 35 to 255). There were no major adverse events (95% CI = 0% to 5.7%). One patient reported nausea and one required a fluid bolus for hypotension. One patient receiving multiple sedatives and opioid analgesics was admitted for observation due to prolonged sedation. No patient required assisted ventilation or intubation. CONCLUSIONS: These results suggest that etomidate is a safe and effective agent for procedural sedation in children requiring fracture and major joint reductions.

Child↗

PubMed2006

Deep sedation with propofol for upper gastrointestinal endoscopy in children, administered by specially trained pediatricians: a prospective case series with emphasis on side effects.

BACKGROUND AND STUDY AIMS: The need to administer procedural sedation to children has increased in recent years, as has experience in this field among nonanesthesiologists. Using propofol makes it easier to achieve sufficiently deep sedation. There is a considerable literature on the administration of propofol by nonanesthesiologists for gastroscopy in adults, but very few data are available on this issue in children. The aim of the present study was to assess the safety and efficacy of procedural sedation with propofol for gastroscopy in a pediatric ward with trained personnel and monitoring facilities. PATIENTS AND METHODS: A training protocol was developed to educate nurses and residents. Children requiring gastroscopy were included in the study prospectively and underwent procedural sedation with propofol administered by nonanesthesiologists. RESULTS: A total of 811 upper gastrointestinal endoscopies were carried out with procedural sedation. Sedation was achieved in all procedures, and all but three (0.4%) were conducted successfully. None of the patients required intubation. Stridor with signs of upper airway obstruction occurred in 14 of the 811 procedures (1.7%). Laryngoscopy was required to manage difficulties in introducing the gastroscope in 16 of the 811 procedures (2.0%). Major desaturation requiring a short course of ventilation occurred in six procedures (0.7%), and transient desaturation that resolved spontaneously occurred in 97 of the procedures (12%). CONCLUSIONS: Administration of propofol by nonanesthesiologists for gastroscopy examinations in children was successful in this study, but was associated with a small risk of potentially severe complications. Although the residents were generally able to administer procedural sedation alone, constant and immediate availability of anesthesiological support continues to be mandatory.

Adolescent↗

PubMed1990

The use of midazolam and flumazenil in cardiovascular diagnostic and therapeutic procedures.

Sedation is sometimes required for cardiovascular diagnostic or therapeutic procedures. Midazolam may be proposed in these situations because of its duration of action and because of its moderate haemodynamic effects. However, the use of midazolam implies that the standards of safety required for all anaesthetic techniques have been applied. The changes in haemodynamic data induced by the administration of midazolam must be taken into account in interpretation of the catheterisation report. At the end of investigation, flumazenil can be administered safely to reverse residual sedative effects of midazolam but its use does not exempt from normal monitoring during the recovery period.

Cardiovascular Diseases↗

PubMed2006

Successful implementation of a radiology sedation service staffed exclusively by pediatric emergency physicians.

OBJECTIVE: As the number of diagnostic imaging studies performed has increased, the demand for sedation in support of these radiologic tests has also increased. Our objectives were to (1) assess the safety and efficacy of a radiology sedation service that is staffed exclusively by pediatric emergency medicine (PEM) physicians, (2) determine the frequency and the type of commonly performed pediatric imaging studies that require procedural sedation, and (3) assess the average duration of procedural sedation for commonly performed radiologic studies. METHODS: We conducted a retrospective observational study of patient encounters in 2004 involving procedural sedation to facilitate diagnostic imaging. We are a university-affiliated group of PEM physicians that provide a radiology sedation service during weekdays at a freestanding urban children's hospital. RESULTS: The sedation service participated in 1285 patient encounters during the study period. Deep sedation was provided to 1027 patients. Moderate sedation was administered to 258 patients. Procedural sedation times for the most frequently performed imaging studies ranged from 5 to 183 minutes. Agents that were used to provide deep sedation were pentobarbital (with midazolam, fentanyl, or both) in 65% of cases, propofol in 31%, and ketamine (with or without midazolam) in 4%. Moderate sedation was achieved with chloral hydrate in 86% and oral diazepam in 14% of the cases. A total of 99.1% of the imaging studies were completed successfully. Six imaging studies were aborted because of failed sedation or occurrence of adverse event. Five patients who were deemed high risk on their presedation evaluation were referred electively for general anesthesia. CONCLUSIONS: Our data suggest that a dedicated sedation team in support of diagnostic imaging services, staffed exclusively by PEM physicians, can be a successful clinical enterprise. The service consumes significant resources and physician time.

Child↗

PubMed2006

Comparative study of intranasal midazolam and intravenous diazepam sedation for procedures and seizures.

OBJECTIVE: To evaluate the safety and efficacy of intranasal midazolam for seizures and various procedures. METHODS: Prospective randomized study. Total 125 children of all ages of either sex, for seizure episode (n-76) and various invasive and non-invasive procedures (n-49) received either intranasal midazolam (0.2 mg/Kg) or intravenous diazepam (0.3 mg/Kg). RESULTS. Mean time from arrival at hospital to starting treatment was significantly shorter in midazolam group compared to diazepam group [2.34+/-0.90; minute vs 4.61+/-1.08 minute p< 0.001]. Mean time to control seizures after arrival in hospital was significantly shorter in midazolam group compared to diazepam group [5.25+/-0.86 minute vs 6.51+/-1.06 minute p. CONCLUSION: Midazolam by the intranasal route provides safe and equally effective non-invasive method of sedation for procedures and seizures.

Administration, Intranasal↗

PubMedDate not supplied

Anxiolysis in dental practice: a report of three cases.

While general dentists have used many modalities to reduce fear and anxiety in the dental office, including iatrosedation (calming words), distraction techniques, conditioning techniques, and empathy, there still are patients who need pharmacologic management of fear and anxiety to receive dental care. Anxiolysis, the lightest level of sedation, can be employed by all dentists and is safe and effective when used properly. This article presents three cases to introduce the anxiolysis technique as an in-office sedation procedure that can be used by all general dentists.

Adult↗

PubMed1993

The safe practice of intravenous sedation in dentistry.

All clinicians who administer intravenous sedation should undergo appropriate training according to recognised guidelines. Such guidelines are now established in New Zealand through the joint endeavours of the New Zealand Dental Association, Royal Australasian College of Dental Surgeons, and the Australian and New Zealand College of Anaesthetists. It is essential that there be acceptable staff training and experience, that physical facilities and arrangements for emergency care are adequate, and that parameters for patient selection are adhered to. Adequate knowledge of pharmacology and the therapeutic indications for specific sedative drugs is necessary, and sedation procedures must be undertaken with appropriate monitoring. There are significant medico-legal aspects to this area of dental practice and these should be well recognised by all practitioners.

Adolescent↗

PubMed1999

What is the optimal dose of intramuscular ketamine for pediatric sedation?

OBJECTIVE: The optimal dose of i.m. ketamine for ED procedural sedation in children is not known. The authors wished to quantify the dose-response of ketamine with respect to sedation adequacy, time to discharge, and adverse effects in order to identify an optimal dose. METHODS: The study was a consecutive case series of 1,022 children < or = 15 years of age given i.m. ketamine in the EDs of a university medical center and an affiliated county hospital over a nine-year period. Adequacy of sedation, time to discharge, and adverse effects were compared with dose administered. RESULTS: Doses in the sample averaged 3.96+/-0.69 mg/kg, with a range of 0.48 to 9.09 mg/kg. Children judged to be adequately sedated received higher doses compared with those inadequately sedated (3.94+/-0.44 mg/kg vs 3.77+/-0.49 mg/kg, p=0.041), and a nonsignificant trend was noted toward uniformly adequate sedation with increasing dose (< or =91% at <4.00 mg/kg, 93% at 4.00-4.49 mg/kg, and 100% at > or = 4.50 mg/kg). No significant difference or trend in time to discharge or adverse effects was noted between the children receiving <4.00 mg/kg and those receiving > or = 4.00 mg/kg of ketamine, and the study had power (alpha=0.05, beta=0.20) to detect a 9-minute difference in times to discharge, a 3.3% difference in rates of airway complications, a 5.6% difference in rates of emesis, and a 12.3% difference in rates of recovery agitation. CONCLUSION: Ketamine doses of 4 to 5 mg/kg i.m. produced adequate sedation in 93%-100% of children, suggesting that this dosing range may be optimal for ED procedural sedation. No difference in time to discharge or adverse effects was observed for lower or higher doses.

Anesthetics, Dissociative↗

PubMed2005

Sedation for pediatric CT scanning: is radiology becoming a drug-free zone?

INTRODUCTION: Cooperation for a diagnostic study is a frequent indication for pediatric procedural sedation. This study examines the continued need for sedation in the era of fast helical computerized tomography (CT) scanners. METHODS: Medical records of children younger than 72 months undergoing CT scans were systematically reviewed to identify the use of procedural sedation to complete their diagnostic studies. Statistical analysis was through ANOVA and regression modeling. RESULTS: A total of 104 patients underwent 122 CT studies. Requests originated from 3 sources: 59.8% ED (n = 73), 38.5% Neonatal Intensive Care Unit (n = 47), and 1.6% Pediatric Ward (n = 2). Studies performed included: 79.5% head/facial (n = 97), 15.6% abdomen/pelvis (n = 19), and 5.9% other (n = 6). The mean ages of all study patients was 23.4 (+/-2.4) months with a median of 14 months. Only 8.6% patients (n = 9) received any sedation. The mean age of sedated patients was 18.8 (+/-2.7) months with a median of 21 months. With the exception of one 4-month-old, all other sedated children were between 12 and 30 months. Sedative use occurred in 36.4% of patients in this age group, which was significantly greater than the remainder of the study group (OR 56.5, 95% CI 9-1091, P < 0.001) Sedative agents used included: diphenhydramine (4), pentobarbital (1), propofol (1), ketamine (1), midazolam (1), diphenhydramine/pentobarbital (1). CONCLUSIONS: Procedural sedation is infrequently used in infants and young children undergoing helical CT studies.

Child, Preschool↗

PubMed2004

Practice patterns of pediatric versus general emergency physicians for pain management of fractures in pediatric patients.

OBJECTIVE: To determine if there are actual differences between pediatric emergency medicine (PEM) physicians and general emergency medicine (GEM) physicians in the management of pain in pediatric patients with fractured extremities. METHOD: Retrospective chart review of children seen with a forearm or lower extremity fracture over a 2-year period at 3 emergency departments (1 staffed by PEM physicians and 2 staffed by GEM physicians). A severe fracture was defined as a closed fracture with the presence of angulation or displacement. Procedural sedation was defined as the administration of medicine (sedative, analgesic, or dissociative anesthetic) at the time of reduction and/or immobilization of a fracture. RESULTS: Of the 718 charts reviewed, PEM physicians managed 428 patients, and GEM physicians managed 290 patients. There were no significant differences between the patients managed by PEM physicians and GEM physicians with regard to age, sex, site of fracture, and proportion of severe fractures. There were no differences in the administration of analgesic-related medicines between PEM physicians and GEM physicians in the management of all fractures [40% (95% CI 35-45%) vs. 43% (95% CI 37-49%)] or severe fractures [58% (95% CI 51-64%) vs. 66% (95% CI 58-73%)]. In the management of all fractures, procedural sedation was used by PEM physicians in 100 [23% (95% CI 19-27%)] patients and by GEM physicians in 52 [18% (95% CI 14-23%)] patients. When procedural sedation was used, PEM physicians were more likely to use a sedative agent than GEM physicians [94% (95% CI 88-97%) vs. 46% (95% CI 33-59%)], fentanyl as opposed to morphine or meperidine [62% (95% CI 52-71%) vs. 19% (95% CI 33-59%)] and a combination of sedative and analgesic [90% (95% CI 83-94%) vs. 44% (95% CI 31-57%)]. For all fractures, GEM physicians documented recommending pain medications on discharge more often than PEM physicians [66% (95% CI 60-71%) vs. 45% (95% CI 40-50%)], and they prescribed significantly more prescription analgesics than PEM physicians [13% (95% CI 10-17%) vs. 2% (95% CI 1-4%)]. CONCLUSIONS: In our study, most children with an extremity fracture and greater than one-third of children with a severe fracture did not receive pain medications in the emergency department. Overall, both PEM physicians and GEM physicians have similar practices of analgesic administration for fracture reduction, with a notable exception in the types of agents used during procedural sedation. GEM physicians documented discharge pain medications and prescribed prescription analgesics more often than PEM physicians.

Adult↗

PubMed2005

Propofol-induced seizure-like phenomena.

Procedural sedation is a common practice in Emergency Medicine. Propofol has supplanted benzodiazepines in many centers as the drug of choice for procedural sedation. This article reports a case of seizure-like activity in an elderly man undergoing procedural sedation for a fracture reduction. The seizure-like activity was attributed to propofol. A review of the literature is discussed. When using propofol for sedation one should be aware of the risk of seizure-like activity.

Aged↗

PubMed2001

Ensuring safety of patients receiving sedation for procedures: evaluation of clinical practice guidelines.

BACKGROUND: In 1995 The Johns Hopkins Hospital in Baltimore convened an interdisciplinary task force to evaluate sedation practices, create a comprehensive set of sedation guidelines, and evaluate patient safety outcomes following guideline implementation. METHODOLOGY: Baseline data were collected on all procedures in which sedation was administered by a nonanesthesiologist for a 6-month period, using scanning technology to automate data entry. Sedation practices were reviewed, and four critical events were examined: unresponsiveness, obstructed airway, airway placement, and cardiopulmonary resuscitation (CPR). In 1998 data collection procedures were repeated to evaluate the impact of the guidelines on sedation practices and patient safety outcomes. RESULTS: In 1995 sedation practices varied, and one or more critical events occurred in 45 (1.4%) of 3,255 procedures. Steps taken included development and dissemination of a clinical sedation guideline, including monitoring criteria to guide nonanesthesiologists, and evaluation planning. In 1998 sedation practices were more consistent. One or more critical events occurred in 50 (1.6%) of 3,134 procedures, representing a small increase in critical events from 1995. More events of unresponsiveness were identified, and no event required CPR. Although not statistically significant, this trend suggests that critical events were being identified earlier, preventing patients from progressing to a more serious event requiring CPR. Steps taken included further refinement of clinical practice guidelines and establishment of ongoing monitoring. CONCLUSIONS: Standardization of sedation practices is a complex and resource-intensive activity, requiring ongoing oversight and monitoring. Commitment from medical staff, nursing staff, and administration is essential to successful implementation of sedation guidelines.

Academic Medical Centers↗

PubMed2005

Preliminary experience with oral dexmedetomidine for procedural and anesthetic premedication.

BACKGROUND: Oral premedication is often required in children to provide anxiolysis and lessen the psychological impact of hospitalization and/or procedures. We present our experience with dexmedetomidine as an oral premedicant prior to procedural sedation or anesthetic induction. METHODS: We undertook a retrospective review of the anesthesia or sedation service records of patients who received oral dexmedetomidine. RESULTS: The cohort for the study included 13 patients ranging in age from 4 to 14 years. Oral dexmedetomidine (mean dose: 2.6 +/- 0.83 microg.kg(-1); range 1.0-4.2 microg.kg(-1)) was used as premedication prior to anesthesia induction in four patients and prior to intravenous (IV) cannula placement for procedural sedation in nine patients with neurobehavioral problems. Effective sedation was achieved in 11 of 13 patients. The one patient in whom anxiolysis was not achieved received the lowest dose of dexmedetomidine (1 microg.kg(-1)) prior to anesthesia induction. In the other three patients, parental separation and acceptance of the mask was achieved at 20-30 min with a dose of 2.5 microg.kg(-1). When used for procedural sedation, placement of an IV cannula was accomplished without difficulty in seven of eight patients with neurobehavioral disorders and with only mild resistance in the other. No complications were noted and parental satisfaction with the sedation experience was high. CONCLUSIONS: These preliminary data suggest that dexmedetomidine may be an effective oral premedicant prior to anesthesia induction or procedural sedation. We found that it was effective even in patients with neurobehavioral disorders in whom previous attempts at sedation had failed.

Administration, Oral↗

PubMed2007

Sedation and analgesia for brief diagnostic and therapeutic procedures in children.

The number of diagnostic and therapeutic procedures done outside of the operating room and the intensive care unit has increased substantially in recent years. In parallel, the management of acute pain and anxiety in children undergoing therapeutic and diagnostic procedures has developed considerably in the past two decades. The primary goal of procedural sedation and analgesia is the safe and efficacious control of emotional distress and pain. The availability of non-invasive monitoring, short-acting opioids and sedatives has broadened the possibilities of sedation and analgesia in children in diverse settings. While most of these procedures themselves pose little risk to the child, the administration of sedation or analgesia may add substantial risk to the patient. This article reviews the current status of sedation and analgesia for invasive and non-invasive procedures in children providing an evidence-based approach to several topics of importance, including patient assessment, personnel requirements, equipment, monitoring, and drugs.

Analgesia↗

PubMed2006

Interdisciplinary approach to endodontic therapy for uncooperative children in a dental school environment.

The aim of this study was to describe an interdisciplinary approach for endodontic therapy of behavior-challenging children and to report the efficacy of sedation techniques for these procedures. Sedation records of thirty-two patients who received root canal treatment were reviewed. Age at treatment in months, gender, year of treatment, tooth type, status of root maturation (open or closed apex), etiological factor(s), sedation protocol, and outcome were the variables analyzed. The collected information was entered into a computerized flowchart and the data analyzed using descriptive statistics. Midazolam in combination with meperidine or hydroxyzine were the most common protocols used (46 percent and 40 percent of the cases, respectively). Only two (6 percent) treatments were aborted due to uncontrolled behavior during sedation. We conclude that cooperation between pediatric dentists and endodontists is fundamental to achieving success when providing root canal treatment for uncooperative child patients.

Anesthesia, Dental↗

PubMed2006

Adverse events in pediatric ketamine sedations with or without morphine pretreatment.

OBJECTIVE: To assess outcomes between 2 groups of patients receiving ketamine for procedural sedations in our pediatric emergency department. Our hypothesis is that there is no difference in the number of adverse events in ketamine sedations with and without morphine pretreatment. METHODS: This was a retrospective cohort study of all ketamine sedation records over 15 months. The number and types of adverse events between patients with and without morphine pretreatment were examined. The numbers of adverse events in each group were compared using a z test. We also examined the possible influence of midazolam coadministration. P values were calculated using Pearson chi2 or Fisher exact tests. RESULTS: A set of 858 sedations were reviewed. Age, weight, and medication dosages were similar in each group. Twenty-one adverse events were recorded in the group of patients without morphine pretreatment. There were 13 adverse events in the group with morphine pretreatment. No significant differences were found for the number or types of events. There was no difference in the frequency of midazolam coadministration, Pearson chi2, P = 0.994, nor for the number of adverse events in each group, Fisher exact test, P = 0.465. The mean time from morphine administration to procedural sedation was 114.7 minutes. One adverse event occurred in the 15-minute or less time interval. CONCLUSIONS: We found no increase in the number of adverse events with morphine pretreatment in ketamine sedations for children. Prospective studies to validate these findings, including an effect of timing of analgesia administration, are warranted.

Child↗

PubMedDate not supplied

Educating patients after conscious sedation for gastrointestinal procedures.

Medication for conscious sedation during gastrointestinal (GI) diagnostic procedures causes amnesia, thereby preventing patients from recalling postprocedure instructions or follow-up appointments. A serious complication after GI diagnostic procedures is bleeding, which can occur if patients take aspirin or nonsteroidal anti-inflammatory agents after the procedure. Past research revealed that 73% of patients did not remember instructions. The purpose of this randomized controlled trial was: (1) to determine if patients with wrist bands remember to read their postprocedure instructions, and (2) to determine what patient demographics are associated with failure to read postprocedure instructions. Sixty-one GI clinic outpatients participated in this Veterans Affairs Medical Center study, received routine written instructions before and after GI diagnostic procedures, and were randomly assigned to one of two groups: control group (standard care plus next-day phone call) or intervention group (wrist band plus standard care plus next-day phone call). A memory test evaluated patients' knowledge of procedure results, date of follow-up appointment, and medications. Results indicated no significant differences in the memory test between the groups (t = 0.9, p = .36). Patients 65 years of age and older had scores indicating memory problems, regardless of the wrist band (r = 0.19, p = .06). The wrist band was ineffective as a reminder to read instructions; rather, the next-day phone call served as the reminder.

Adult↗

PubMedDate not supplied

Conscious sedation for procedures under local or topical anesthesia.

For many surgical procedures in otolaryngology general anesthesia is not required, but it is difficult to block completely all noxious sensations with local or topical anesthesia. Intravenously administered antianxiety and analgesic drugs can make the procedure more tolerable for the patient. A technique of conscious sedation based upon titrating diazepam to specific eye signs and fentanyl to specific end points is described. Safety is maintained by ensuring that the patient is always in verbal contact with the surgeon. The rationale for administering the sedative before the narcotic is presented along with the treatment of side effects and untoward responses to the drugs.

Administration, Topical↗