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Latest & greatest articles for sedation
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AnaConDa-S for sedation with volatile anaesthetics in intensive care AnaConDa-S for sedation with volatile anaesthetics in intensive care Medtech innovation briefing Published: 6 October 2020 www.nice.org.uk/guidance/mib229 pathways Summary Summary • The technology technology described in this briefing is AnaConDa-S. It is a volatile anaesthetic delivery system for use with ventilators to allow people to be sedated using inhaled anaesthetics (isoflurane or sevoflurane). • The innovative aspects (...) innovative aspects are that it enables sedation to be done using inhaled anaesthetics with standard ventilators in intensive care settings, instead of needing intravenous (IV) anaesthesia. • The intended place in therapy place in therapy would be as an alternative to IV sedation of people who need invasive ventilation in an intensive care setting. • The main points from the evidence main points from the evidence summarised in this briefing are from 5 studies, including 1 meta-analysis, with a total
Anaesthesia and sedation in breastfeeding women Guidelines Anaesthesia and sedation in breastfeeding women 2020 June 2020Guidelines Guidelineonanaesthesiaandsedationinbreastfeeding women2020 GuidelinefromtheAssociationofAnaesthetists J.Mitchell, 1 W.Jones, 2 E.Winkley 3 andS.M.Kinsella 4 1Consultant,DepartmentofAnaesthesia,UniversityHospitalAyr,Ayr,UK 2SpecialistPharmacist,BreastfeedingandMedication,Portsmouth,UK 3Consultant,DepartmentofAnaesthesia,NorthumbriaNHSFoundationTrust,UK 4Consultant (...) ,DepartmentofAnaesthesia,StMichael’sHospital,Bristol,UK Summary Breastfeedinghasmanyhealthbene?tsforthemotherandinfant.Womenwhoarebreastfeedingmayrequire anaesthesia or sedation. Concerns regarding the passage of drugs into breast milk may lead to inconsistent advicefromprofessionals.Thiscansometimesresultintheinterruptionoffeedingfor24 hoursorlongerafter anaesthesia, or expressing and discarding (‘pumping and dumping’) breast milk; this may contribute to early cessationofbreastfeeding.However
Remimazolam (Byfavo) - For sedation Drug Approval Package: BYFAVO U.S. Department of Health and Human Services Search FDA Submit search Drug Approval Package: BYFAVO Company: Cosmo Technologies, Ltd. Application Number: 212295 Approval Date: 07/02/2020 Persons with disabilities having problems accessing the PDF files below may call (301) 796-3634 for assistance. FDA Approval Letter and Labeling (PDF) (PDF) FDA Application Review Files (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF) (PDF
Capnography for Moderate Sedation in Non-Anesthesia Settings Management Briefs eBrief-no172 -- Capnography for Moderate Sedation in Non-Anesthesia Settings Talk to the Veterans Crisis Line now An official website of the United States government Here's how you know The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. The https:// ensures that you're connecting (...) to the official website and that any information you provide is encrypted and sent securely. Search Search the ORD website Button to search HSRD Contact us TTY: 711 × We're here anytime, day or night — 24/7 If you are a Veteran in crisis or concerned about one, connect with our caring, qualified responders for confidential help. Many of them are Veterans themselves. Get more resources at . » » » Management Briefs eBrief-no172 -- Capnography for Moderate Sedation in Non-Anesthesia Settings Health Services
CIRSE Standards of Practice on Analgesia and Sedation for Interventional Radiology in Adults CIRSE Standards of Practice on Analgesia and Sedation for Interventional Radiology in Adults | SpringerLink Search Search SpringerLink Search CIRSE Standards of Practice on Analgesia and Sedation for Interventional Radiology in Adults , , , , , , , , & ( 2020 ) 136 Accesses Abstract This CIRSE Standards of Practice document provides best practices for the safe administration of procedural sedation (...) and analgesia for interventional radiology procedures in adults. The document is aimed at health professionals involved in the provision of sedation and analgesia during interventional radiology procedures. The document has been developed by a writing group consisting of physicians with internationally recognised expertise in interventional radiology, and analgesia and sedation. This is a preview of subscription content, to check access. Access options References 1. Green SM, Krauss B. Procedural sedation
Evidence Brief: Capnography for Moderate Sedation in Non-Anesthesia Settings ? June 2020 Evidence Brief: Capnography for Moderate Sedation in Non-Anesthesia Settings Prepared for: Department of Veterans Affairs Veterans Health Administration Health Services Research & Development Service Washington, DC 20420 Prepared by: Evidence Synthesis Program (ESP) Coordinating Center Portland VA Health Care System Portland, OR Mark Helfand, MD, MPH, MS, Director Authors: Stephanie Veazie, MPH Kathryn Vela (...) , MLIS Katherine Mackey, MD, MPP Evidence Synthesis Program Evidence Brief: Capnography for Moderate Sedation Evidence Synthesis Program i PREFACE The VA Evidence Synthesis Program (ESP) was established in 2007 to provide timely and accurate syntheses of targeted healthcare topics of importance to clinicians, managers, and policymakers as they work to improve the health and healthcare of Veterans. These reports help: • Develop clinical policies informed by evidence; • Implement effective services
COVID-19: Sedation-Ventilation Liberation of COVID Patients COVID-19: SEDATION-VENTILATION LIBERATION OF COVID+ PATIENTS A Rapid Guidance Summary from the Penn Medicine Center for Evidence-based Practice Last updated May 6, 2020 12:00 pm All links rechecked April 27 th unless otherwise noted. Key questions answered in this summary • How should sedatives be dosed? • What fluid resuscitation approach should be taken with ventilated patients? • How often should spontaneous breathing tests (...) be attempted? • What are the criteria to begin a spontaneous breathing test? • What is the protocol for a spontaneous breathing test? Summary of major recommendations • Minimizing continuous sedation and instead favoring bolused sedation to targeted endpoints reduces number of days of mechanical ventilation. • Patients with ARDS should receive minimal fluid resuscitation. • Ventilator weaning tests should be attempted daily upon improvement of respiratory status. • Ventilator weaning protocol should follow
Evaluation of the safety of using propofol for paediatric procedural sedation: A systematic review and meta-analysis. Propofol is one of the most widely used drugs for paediatric procedural sedation owing to its known advantages, but some concerns remain regarding respiratory and/or cardiac complications in patients receiving propofol. Although a considerable number of randomised controlled clinical trials (RCTs) have been conducted to compare it with other sedative agents or opioids (...) that propofol sedation had advantages in recovery time when compared with other drugs, without excessive concerns for cardiovascular or respiratory adverse events. Its safety profile regarding coughing, nausea or vomiting, and emergence delirium was also similar to that of other drugs. The overall evidence suggests that propofol sedation for paediatric procedures should be considered more positively in the context of regulatory decisions.
Non-pharmacological strategies to obtain usable magnetic resonance images in non-sedated infants: Systematic review and meta-analysis. Although the use of sedation is commonly practiced to keep infants still while receiving magnetic resonance imaging, non-pharmacological strategies are a potential alternative.The purpose of this study was to determine the success rate of obtaining usable magnetic resonance images in infants with the sole use of non-pharmacological strategies.Systematic (...) literature review and meta-analysis SETTING: A search was conducted in PubMed, CINAHL and Cochrane Library.Human infants from birth to 24 months of age who did not receive any sedation or anesthesia during magnetic resonance imaging METHOD: Articles that reported the success rate of obtaining usable images were included.Of the 521 non-duplicate articles found, 58 articles were included in the systematic review with sample sizes ranging from 2-457, an average success rate of 87.8%, and an average scan
Propofol versus midazolam with or without short-acting opioids for sedation in colonoscopy: a systematic review and meta-analysis of safety, satisfaction, and efficiency outcomes. Propofol is increasingly being used for sedation in colonoscopy; however, its benefits over midazolam (± short-acting opioids) are not well quantified. The objective of this study was to compare safety, satisfaction, and efficiency outcomes of propofol versus midazolam (± short-acting opioids) in patients undergoing (...) criteria. There were no significant differences in cardiorespiratory outcomes (hypotension, hypoxia, bradycardia) between sedative groups. Patient satisfaction was high in both groups, with most patients reporting willingness to undergo a future colonoscopy with the same sedative regimen. In the meta-analysis, patients sedated with propofol had greater satisfaction than those sedated with midazolam (± short-acting opioids) (SMD, .54; 95% confidence interval [CI], .30-.79); however
Efficacy of chloral hydrate oral solution for sedation in pediatrics: a systematic review and meta-analysis. Chloral hydrate (CH), as a sedation agent, is widely used in children for diagnostic or therapeutic procedures. However, it has not come into the market and is currently only used as hospital preparation in China. This review aims to systematically evaluate the efficacy of CH in children of all age groups for sedation before medical procedures.Seven electronic databases and three (...) clinical trial registry platforms were searched and the deadline was September 2018. Randomized controlled trials (RCTs) evaluating the efficacy of CH for sedation in children were included by two reviewers. The extracted information included success rate of sedation, sedation latency and sedation duration. The Cochrane risk of bias tool was applied to assess the risk of bias. The outcomes were analyzed by Review Manager 5.3 software and expressed as relative risks (RR) or Mean Difference (MD) with 95
Comparing sedation vs. general anaesthesia in transoesophageal echocardiography-guided percutaneous transcatheter mitral valve repair: a meta-analysis. Transoesophageal echocardiography-guided percutaneous transcatheter mitral valve repair (TOE-guided PMVR) using edge-to-edge leaflet plication is typically performed under general anaesthesia (GA). Increasing evidence supports the efficacy and safety of PMVR performed under conscious sedation (CS) or deep sedation (DS). We performed a meta
General Anesthesia Versus Conscious Sedation for Intracranial Mechanical Thrombectomy: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Background Endovascular therapy is the standard of care for severe acute ischemic stroke caused by large-vessel occlusion in the anterior circulation, but there is uncertainty regarding the optimal anesthetic approach during this therapy. Meta-analyses of observational studies suggest that general anesthesia increases morbidity and mortality (...) compared with conscious sedation. We performed a systematic review and meta-analysis of randomized clinical trials to examine the effect of anesthetic strategy during endovascular treatment for acute ischemic stroke. Methods and Results Systematic review and meta-analysis according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines has been registered with the PROSPERO (International Prospective Register of Ongoing Systematic Reviews) ( CRD 42018103684). Medline
Moral identity and palliative sedation: A systematic review of normative nursing literature. In the last two decades, nursing authors have published ethical analyses of palliative sedation-an end-of-life care practice that also receives significant attention in the broader medical and bioethics literature. This nursing literature is important, because it contributes to disciplinary understandings about nursing values and responsibilities in end-of-life care.The purpose of this project (...) is to review existing nursing ethics literature about palliative sedation, and to analyze how nurses' moral identities are portrayed within this literature.We reviewed discussion papers, written by nurses about the ethics of palliative sedation, which were cited in MEDLINE, CINAHL, Nursing and Allied Health, or Philosopher's Index (search date March 2018). Twenty-one papers met selection criteria. We performed a comprehensive review and analysis (using the Qualitative Analysis Guide of Leuven
Efficacy of oral midazolam for minimal and moderate sedation in pediatric patients: A systematic review. One of the most widely used options for minimal/moderate sedation in pediatric patients is oral midazolam, as it presents an alternative to less well-accepted routes of administration (eg, intravenous or intranasal) of this well-known efficacious and well-tolerated short-acting benzodiazepine. A systematic review of the literature was conducted in order to identify clinical studies (...) evaluating the effectiveness of oral midazolam for sedation in pediatric patients in the context of premedication before anesthesia or during diagnostic/treatment procedures. The percentage of responders (response rate) after single administration of oral midazolam was evaluated and compared versus placebo in a subset of placebo-controlled studies. The range of oral midazolam doses providing effective sedation in the different pediatric age subsets was analyzed in order to assess optimum dosing
Ketamine Procedural Sedation for Children in EDs The Royal College of Emergency Medicine Best Practice Guideline KETAMINE PROCEDURAL SEDATION FOR CHILDREN IN THE EMERGENCY DEPARTMENT Revised: February 2020 Ketamine Procedural Sedation for Children in The Emergency Department (Feb 2020) 15 Summary of recommendations 1. Ketamine sedation may be appropriate for a procedure that is painful, or frightening after all other options have been considered. 2. Ketamine should not be used for sedation (...) in the Emergency Department for children under the age of 1 year. Ketamine should be only be used by clinicians with significant relevant experience in the use of ketamine when performing procedural sedation in children aged between 2-5 years. 3. Ketamine sedation should take place in an area with full resuscitation facilities immediately available. 4. Safe sedation requires adequate senior medical and nursing cover in the Emergency Department when any sedation takes place. 5. Ketamine sedation requires
Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients. In critically ill, mechanically ventilated patients, daily interruption of sedation has been shown to reduce the time on ventilation and the length of stay in the intensive care unit (ICU). Data on whether a plan of no sedation, as compared with a plan of light sedation, has an effect on mortality are lacking.In a multicenter, randomized, controlled trial, we assigned, in a 1:1 ratio, mechanically ventilated ICU (...) patients to a plan of no sedation (nonsedation group) or to a plan of light sedation (i.e., to a level at which the patient was arousable, defined as a score of -2 to -3 on the Richmond Agitation and Sedation Scale [RASS], on which scores range from -5 [unresponsive] to +4 [combative]) (sedation group) with daily interruption. The primary outcome was mortality at 90 days. Secondary outcomes were the number of major thromboembolic events, the number of days free from coma or delirium, acute kidney
Ketamine sedation in mechanically ventilated patients: A systematic review and meta-analysis. Ketamine use as a sedative agent in mechanically ventilated patients is increasing. This systematic review and meta-analysis collates existing literature and quantifies the impact of ketamine in mechanically ventilated patients.EMBASE, MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, conference proceedings, and reference lists were searched. Randomized (...) and nonrandomized studies were included, and two reviewers independently screened abstracts of identified studies for eligibility.Fifteen studies (n = 892 patients) were included. Random effects meta-analytic models revealed that ketamine was associated with a reduction in propofol infusion rate (mean difference in dose, -699 μg/min; 95% CI -1169 to -230, p = .003), but had no impact on fentanyl or midazolam. Ketamine was not associated with mortality, on-target sedation, vasopressor dependence, or hospital
Intranasal dexmedetomidine versus oral chloral hydrate for diagnostic procedures sedation in infants and toddlers: A systematic review and meta-analysis. Intranasal dexmedetomidine is a relatively new way to sedate young children undergoing nonpainful diagnostic procedures. We performed a meta-analysis to compare the efficacy and safety of intranasal dexmedetomidine in young children with those of oral chloral hydrate, which has been a commonly used method for decades.We searched PubMed, Embase (...) , and the Cochrane Library for all randomized controlled trials that compared intranasal dexmedetomidine with oral chloral hydrate in children undergoing diagnostic procedures. Data on success rate of sedation, onset time, recovery time, and adverse effects were extracted and respectively analyzed.Five studies with a total of 720 patients met the inclusion criteria. Intranasal dexmedetomidine provided significant higher success rate of sedation (relative risk [RR], 1.12; 95% confidence interval [CI], 1.02