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Results for “Procedural Sedation”

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At least 163 records · Page 9Linked to original sources
PubMed2003

Ventilatory response during dissociative sedation in children-a pilot study.

OBJECTIVES: It is unclear whether ketamine induces subclinical respiratory depression when administered in dissociative doses intravenously (IV). The authors report a pilot study of capnography in emergency department (ED) pediatric patients receiving ketamine alone for procedural sedation, and describe serial measures of ventilatory response [end-tidal carbon dioxide (EtCO(2)), respiratory rate, pulse oximetry]. METHODS: The authors performed continuous capnography on a convenience sample of 20 ED pediatric patients who received ketamine 1.5 mg/kg IV for procedural sedation. RESULTS: Continuous EtCO(2) and pulse oximetry remained essentially unchanged following ketamine injection, and no EtCO(2) levels > 47 mm Hg were noted at any point throughout sedation. CONCLUSIONS: No hypoventilation was observed in 20 ED pediatric patients receiving ketamine 1.5 mg/kg administered IV over 1 minute. The authors found no evidence of respiratory depressant properties for this dissociative agent.

Anesthetics, Dissociative↗
PubMed1997

Comparison of three different automatic defibrillator implantation approaches: pectoral implantation using conscious sedation reduces procedure times and cost.

Recent technological advances in implantable defibrillator systems (ICD) have changed implantation approaches. The aim of this study was to investigate the influence of these improvements on procedure times, implant-related charges, patient recovery, and morbidity. Ninety-six consecutive patients undergoing implantation of a nonthoracotomy ICD were studied. Implantation was performed under general anesthesia with the generator placed abdominally in 22 patients (group I) and pectorally in 40 patients (group II). Thirty-four patients underwent pectoral implantation using conscious sedation (group III). Groups were comparable with respect to clinical variables. Implantation duration and total procedure duration were shorter in group III (67 +/- 21 minutes and 117 +/- 30 minutes) when compared with group I (100 +/- 25 minutes and 157 +/- 39 minutes) and group II (86 +/- 24 minutes and 153 +/- 34 minutes, P < 0.05). Patients in group III did not require admission to the Post-Anesthesia Care Unit. In contrast, patients in groups I and II spent 92 +/- 28 minutes and 91 +/- 31 minutes in the Post-Anesthesia Care Unit. Implantation-related charges were reduced in patients having pectoral implantation using conscious sedation ($1451 +/- 217 vs. $2354 +/- 550 and $2796 +/- 384, P < 0.05). Patients in group III had a lower frequency of postoperative oral analgesic use (3.2 +/- 2.7 doses, P < 0.05) and a shortened post-operative length of stay (1.9 +/- 1.6 days, P < 0.05) when compared with groups I (5.7 +/- 4.0 doses and 3.3 +/- 1.4 days) and II (5.2 +/- 3.5 doses and 2.6 +/- 1.1 days). The overall complication rate was low (6.3%), with no differences between groups. Advances in ICD technology have simplified implantation, leading to shorter, less painful, and less expensive procedures.

Abdomen↗
PubMed2006

Effects of initial pain treatment on sedation recovery time in pediatric emergency care.

OBJECTIVE: The purpose of this study is to compare the sedation recovery times of children receiving ketamine/midazolam (K/M) versus K/M and initial pain treatment (morphine or meperidine) in pediatric emergency care. METHODS: Study method was a retrospective cross-sectional study of children receiving K/M for procedural sedation analgesia in an urban children's hospital pediatric emergency department (ED). A uniform data collection form was completed for each child. RESULTS: During an 18-month period, 116 children received K/M for procedural sedation analgesia in the ED. For this study, 80 children met inclusion criteria: 33 patients received K/M only; 32 received K/M and morphine, and 15 received K/M and meperidine. In comparing the K/M only group with the K/M morphine and K/M meperidine groups, the mean ketamine and midazolam doses (mg/kg) were not significantly different. In comparing the recovery times (minutes) for the K/M only group (29.7; SD, 15.7) with the K/M morphine (41.1; SD, 22.4) and K/M meperidine (50.1; SD, 24.9) groups, there was a significant difference for both comparisons (95% confidence interval for difference between 2 means, -20.9 to -1.76 and -32.2 to -8.4, respectively). CONCLUSION: Sedation (K/M) recovery time is significantly greater for children receiving initial pain treatment (morphine or meperidine). Children receiving meperidine had the longest recovery time. Considering this prolonged recovery time and the unique adverse effects of meperidine compared with morphine, we recommend meperidine not be used for initial ED pain treatment of children.

Adolescent↗
PubMedDate not supplied

Capnography in the gastroenterology lab.

This article provides the reader with information and education regarding the use of capnography for both adult and pediatric patients undergoing procedural sedation during endoscopy by: reviewing the basics of capnography, in addition to the physiology of ventilation and oxygenation; illustrating how capnography may provide an earlier warning of hypoxemia than does pulse oximetry; briefly discussing current guidelines for procedural sedation and the potential role of capnography; and reviewing clinical situations causing changes in the capnogram waveforms and the nursing interventions that should be made in response to such changes.

Analgesia↗
PubMed2005

Pediatric sedation outside the operating room: the year in review.

PURPOSE OF REVIEW: This review is a survey of the recent literature concerning issues and trends in the rapidly changing field of pediatric sedation. RECENT FINDINGS: Clinical guidelines for the safe provision of sedation to children continue to be developed and revised. Systems for providing sedation are evolving, and the most successful models emerging are those that involve a dedicated team, either mobile or stationary, of physicians and nurses. A variety of drugs is used, and potent drugs that were designed as anesthetics, such as propofol and ketamine, are being administered outside the operating room by anesthesiologists and non-anesthesiologists. The safety of this practice continues to be debated. The reported incidence of adverse events is different in various settings and systems; however, outcome data are difficult to compare because of differences in study design and outcome definition. There is agreement that sedation is a continuum, and evidence that the depth of sedation attained during procedural sedation in children is often consistent with general anesthesia. Capnography and processed electroencephalogram monitoring have been described in sedation studies, may enhance safety during pediatric sedation, and should be investigated further. SUMMARY: The evolution of systems, drugs, and monitors for the provision of pediatric sedation is continuing. An accurate assessment of safety and other outcomes will be enhanced through the establishment of multicenter collaborative databases.

Journal Article↗