scholarly journals Painful Recall in Elective Electrical Cardioversion with Propofol and the Need for Additional Analgesia

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
D. F. M. van Winden ◽  
A. Westra ◽  
P. J. W. Dennesen ◽  
S. H. J. Monnink ◽  
B. C. Verdouw ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Muscle Pain ◽  
Severe Pain ◽  
Rating Scale ◽  
Electrical Cardioversion ◽  
Secondary Outcome ◽  
Prospective Multicenter Study ◽  
Mild Pain ◽  
Sole Agent ◽  
Electrical Shocks

Introduction. Electrical cardioversion (ECV) is a short but painful procedure for treating cardiac dysrhythmias. There is a wide variation regarding the medication strategy to facilitate this procedure. Many different sedative techniques for ECV are described. Currently, the optimal medication strategy to prevent pain in ECV has yet to be established. The role for additional analgesic agents to prevent pain during the procedure remains controversial, and evidence is limited. Methods. We conducted a prospective multicenter study to determine the incidence of painful recall in ECV with propofol as a sole agent for sedation, in order to assess the indication for additional opioids. In all patients, sedation was induced with propofol titrated till loss of eyelash reflex and nonresponsiveness to stimuli, corresponding to Ramsay Sedation Score level 5-6. ECV was performed with extracardiac biphasic electrical shocks. The primary outcome was painful recall of the procedure, defined as numeric pain rating scale (NRS) ≥ 1. NRS ≥ 4 is considered inadequately treated pain. Secondary outcome parameters were pain at the side of the defipads and muscle pain after ECV. Results. A total of 232 patients were enrolled in this study. Six patients were excluded due to missing data or violation of study protocol. Three patients reported recall of the procedure, and one patient (0.4%) reported recall of severe pain during the procedure with NRS 7. Two patients (0.9%) reported recall of mild pain with NRS 1–3. Complete amnesia was observed in 223 patients (98.7%), with NRS 0. The mean of the total dose of propofol was 1.1 mg/kg. Fifteen patients (6.6%) experienced pain at the side of the defipads, and six patients (2.7%) complained of muscle pain after the procedure. Conclusions. In this prospective multicenter study, propofol as a sole agent provided good conditions for ECV with a low incidence of recall. Effective sedation and complete amnesia was achieved in 98.7% of the patients, 0.4% of patients reported recall of severe pain during the procedure, and 0.9% of patients experienced mild pain during the ECV.

Assessment of acute pain in trauma—A retrospective prehospital evaluation

2016 ◽  
Vol 12 (5) ◽  
pp. 347 ◽  
Author(s):  
Stine Hebsgaard, MD ◽  
Anne Mannering, MD ◽  
Stine T. Zwisler, MD, PhD
Keyword(s):  
Endotracheal Intubation ◽  
Severe Pain ◽  
Rating Scale ◽  
Pain Treatment ◽  
Opioid Analgesics ◽  
Multiple Injuries ◽  
Pharmacological Intervention ◽  
Mild Pain ◽  
Trauma Population ◽  
Opioid Administration

Objective: To elucidate pain treatment with analgesics in a prehospital trauma population.Design: Retrospective database study.Setting: Prehospital data from the anesthesiologist-manned Mobile Emergency Care Unit (MECU) in Odense, Denmark, were extracted and subjected to analysis.Patients: During the period of January 1, 2013 to December 31, 2014, patients with the diagnoses “unspecified multiple injuries,” “examination and observation following traffic accident,” “examination and observation following other accident,” and “commotio cerebri” were included in the analysis.Main Outcome Measures: Evaluation of the application of the pain scale Numeric Rating Scale (NRS). Furthermore, the authors performed a characterization of the patients with mild pain and severe pain according to specific parameters such as pharmacological interventions, opioid consumption, intubation, and others.Results: Nine hundred eighty-five cases were analyzed. NRS was documented only in one case. In all, 787 patients experienced no pain or mild pain (no pain, n = 242; mild pain, n = 545) and 168 patients severe pain or worse (severe pain, n = 155; intolerable pain, n = 13). In the severe pain group, 138 were treated with opioid analgesics or S-ketamine, while no pharmacological intervention was documented in 30 cases. Eight of the 138 cases with severe pain needed endotracheal intubation, whereas nine cases in the patients with mild or no pain needed endotracheal intubation; odds ratio (OR) 4.3 (p = 0.003).Conclusions: Effect was only documented in one patient after administering opioids in a patient with trauma population, where approximately 17 percent of patients experienced severe pain. Severe pain was correlated to male gender, respiratory intervention, opioid administration, and the diagnosis unspecified multiple injuries.

scholarly journals ASSOCIATIONS OF PAIN INTENSITY WITH SEDENTARY BEHAVIOR AND PHYSICAL ACTIVITY IN OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S20-S21
Author(s):  
Kushang Patel ◽  
Andrea LaCroix ◽  
Paul Crane ◽  
Rod L Walker ◽  
KatieRose Richmire ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Pain Intensity ◽  
Sedentary Behavior ◽  
Severe Pain ◽  
Rating Scale ◽  
Future Research ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Mild Pain

Abstract Exercise is recommended for several painful, age-associated conditions; however, relationships between pain intensity and objectively measured sedentary behavior and physical activity have not been investigated in older adults. Accordingly, we analyzed cross-sectional data on 936 older adults in the ACT Study who self-reported their pain intensity on a 0-10 rating scale (0=no pain; 1-3=mild pain; and 4-10=moderate/severe pain) and wore an activPAL accelerometer. A total of 181 (19.3%) reported no pain, while 564 (60.3%) and 191 (20.4%) reported mild and moderate/severe pain, respectively. Linear regression models adjusted for age and sex estimated that compared to those with no pain, participants with moderate/severe pain walked significantly fewer steps/day (b-coefficient=-778 [95%CI: -1377, -179]) and had fewer sit-to-stand transitions/day (b-coefficient=-2.9 [95%CI: -5.6, -0.1]). In contrast, there were no significant differences in these outcomes comparing no pain versus mild pain. Future research will examine effects of pain treatments (opioids) and diagnoses on accelerometer-measured outcomes.

scholarly journals Steroid Antibiotic Pack Versus 10% Ichthammol Glycerol Pack in Management of Acute Otitis Externa: A Comparative Study

2021 ◽  
Vol 12 (1) ◽  
pp. 192-198
Author(s):  
Akshaya Thrinetrapriya N ◽  
Nandhini R ◽  
Shoba K
Keyword(s):  
Severe Pain ◽  
Otitis Externa ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Randomised Clinical Trial ◽  
Rapid Onset ◽  
Moderate Pain ◽  
Predisposing Factor ◽  
Mild Pain ◽  
Institutional Review

Acute otitis externa is a common clinical condition that presents with rapid onset of otalgia, fullness, otorrhea and canal oedema. Moisture in-ear canal appears to be an important predisposing factor. The most common etiological agents include Pseudomonas aeruginosa and Staphylococcus aureus. Management includes control of otalgia and elimination of infection from the ear. Precipitating factors should be avoided. The main objective of this study is to compare the efficacy of 10% ichthammol glycerol ear pack with steroid antibiotic ear pack in the treatment of acute otitis externa. Institutional Review Board (IRB) clearance was obtained, and a prospective randomised clinical trial was conducted in the ENT outpatient department of Saveetha Medical College & Hospital, Thandalam, from January 2020 to March 2020. Patients were explained about the study in detail, and consent was obtained. The patients were randomised, and 10% ichthammol glycerol pack and steroid antibiotic pack were used in alternate turns for aural packing. Pain rating was done using Numerical rating scale (NRS) before and 48 hours post-treatment and also in each subsequent hospital visit till complete subsidence of symptoms. Among the 85 patients included in the study, 42 (49.4%) were males, and 43 (50.6%) were females. Most of them belonged to the age group 31-40 years (41.2%). Tragal tenderness and external auditory canal oedema were the most common ear findings noted. In the patients treated with steroid antibiotic pack, only 2.3% of the patients had severe pain, whereas 14% had moderate pain and 83.7% had only mild pain. Whereas among those treated with 10% ichthammol glycerol pack, 9.5% of the patients had severe pain, whereas 35.7% had moderate pain and 54.8% had mild pain. On analysis, the results were statistically significant, and there was considerable pain relief with steroid antibiotic pack. Therefore, our study showed that steroid antibiotic pack is more effective in relieving the symptoms, thereby reducing the number of hospital visits when compared to 10% ichthammol glycerol pack.

EFFECTIVENESS AND TOLERABILITY OF VERY LOW VOLUME PREPARATION FOR COLONOSCOPY: A PROSPECTIVE, MULTICENTER STUDY

2019 ◽  
Author(s):  
M Maida ◽  
G Morreale ◽  
E Sinagra ◽  
M Manganaro ◽  
D Schillaci ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Prospective Multicenter Study ◽  
Low Volume

Role of pulse oximetric monitoring during gastrointestinal endoscopy. Prospective multicenter study of the Gastroenterological Working Group of the Veszprém Regional Committee of the Hungarian Academy of Sciences (VEAB)

2013 ◽  
Vol 154 (21) ◽  
pp. 825-833
Author(s):  
Zoltán Döbrönte ◽  
Mária Szenes ◽  
Beáta Gasztonyi ◽  
Lajos Csermely ◽  
Márta Kovács ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multicenter Study ◽  
Hungarian Academy ◽  
Prospective Multicenter Study ◽  
Standard Requirement ◽  
Long Duration ◽  
Related Risk ◽  
American Society ◽  
Academy Of Sciences ◽  
Endoscopic Investigation

Introduction: Recent guidelines recommend routine pulse oximetric monitoring during endoscopy, however, this has not been the common practice yet in the majority of the local endoscopic units. Aims: To draw attention to the importance of the routine use of pulse oximetric recording during endoscopy. Method: A prospective multicenter study was performed with the participation of 11 gastrointestinal endoscopic units. Data of pulse oximetric monitoring of 1249 endoscopic investigations were evaluated, of which 1183 were carried out with and 66 without sedation. Results: Oxygen saturation less than 90% was observed in 239 cases corresponding to 19.1% of all cases. It occurred most often during endoscopic retrograde cholangiopancreatography (31.2%) and proximal enteroscopy (20%). Procedure-related risk factors proved to be the long duration of the investigation, premedication with pethidine (31.3%), and combined sedoanalgesia with pethidine and midazolam (34.38%). The age over 60 years, obesity, consumption of hypnotics or sedatives, severe cardiopulmonary state, and risk factor scores III and IV of the American Society of Anestwere found as patient-related risk factors. Conclusion: To increase the safety of patients undergoing endoscopic investigation, pulse oximeter and oxygen supplementation should be the standard requirement in all of the endoscopic investigation rooms. Pulse oximetric monitoring is advised routinely during endoscopy with special regard to the risk factors of hypoxemia. Orv. Hetil., 2013, 154, 825–833.

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