scholarly journals Sedation and analgesia during manipulation in children

2020 ◽  
Vol 10 (1) ◽  
pp. 103-112
Author(s):  
Yuriy S. Aleksandrovich ◽  
Konstantin V. Pshenisnov ◽  
Irina V. Aleksandrovich
Keyword(s):  
Initial Level ◽  
Deep Sedation ◽  
Adequate Ventilation ◽  
Normal Airway ◽  
Vital Functions ◽  
Ensure Patient Safety ◽  
Level Of Consciousness ◽  
Sedation And Analgesia ◽  
To Receive ◽  
Recovery Of Consciousness

The article provides an overview of modern methods of sedation and analgesia during therapeutic and diagnostic manipulations in children, indicates indications and contraindications. Special attention is paid to the assessment of sedation and anaesthesia effectiveness, scales used for this purpose in children of different ages are described, criteria of sedation depth are given, equipment and measures necessary to ensure patient safety during manipulation are described. It has been noted that BIS index values correlate with sedation scales in children and adults, but values that determine deep sedation in children are currently not clearly defined, which requires further research. Drugs for sedation, their main characteristics and limitations for use are presented. The differences between sedation and monitored anesthesiology care (MAC), which can be provided only by a qualified anesthesiologist, are described in detail. It has been demonstrated that monitored anesthesiologic care implies deep sedation with control of vital functions, control of breathing and hemodynamics during manipulation, and it is noted that capnography is a mandatory element of monitoring in this type of anesthesiologic care in order to detect apnea as early as possible. Criteria for recovery of consciousness after completion of sedation are specified, which include normal airway, adequate ventilation, stability of hemodynamic, restoration of initial level of consciousness, motor activity and possibility to receive liquids through mouth in absence of vomiting. It is noted that the average time from the end of procedural sedation to the restoration of the original state is about 2 hours.

scholarly journals Cardioprotective Therapy in the Practice of an Anaesthesiologist

2020 ◽  
Author(s):  
Arina Viacheslavovna Balan
Keyword(s):  
Neurological Status ◽  
Underlying Disease ◽  
Research Papers ◽  
Vital Functions ◽  
Level Of Consciousness ◽  
Life Threatening ◽  
Published Research ◽  
The Brain ◽  
Careful Assessment

All components of anaesthesia have a direct or indirect depressing effect on the myocardium and functional activity of the brain. Given the initial failure of the coronary blood flow, life-threatening disorders of the heart are possible. The higher the severity of the underlying disease, the greater the risk of transient neurological deficit, stroke. Extended continuous monitoring of vital functions, careful assessment of the neurological status of the patient with special attention to the level of consciousness, the presence or absence of symptoms of increased ICP is necessary. The purpose of this study is to evaluate the beneficial effect of cardioprotectors Mexicor, Meldonium in the fight against ischemia in patients with CHD, GB in the department of surgical profile. The following methods have been used: review of literature, previously published research papers. Results: this article discusses the main drugs with cardioprotective properties, describes the positive experience of using them by specialists, and proves the effectiveness of using drugs in the long term.

The treatment of spontaneous intracerebral hemorrhage

1989 ◽  
Vol 70 (5) ◽  
pp. 755-758 ◽  
Author(s):  
Seppo Juvela ◽  
Olli Heiskanen ◽  
Antti Poranen ◽  
Simo Valtonen ◽  
Timo Kuurne ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Conservative Treatment ◽  
Intracerebral Hematoma ◽  
Content Type ◽  
Conservative Group ◽  
Level Of Consciousness ◽  
A Prospective Study ◽  
To Receive ◽  
Surgical Group

✓ In a prospective study, 52 patients with a spontaneous supratentorial intracerebral hematoma (ICH) were randomly assigned to receive emergency surgery or conservative treatment within 48 hours after the bleed. Patients with a decreased level of consciousness and/or a severe neurological deficit were admitted to the study. The overall mortality rate at 6 months was 42%: 10 (38%) of the 26 patients in the conservative group and 12 (46%) of the 26 in the surgical group. Six (20%) of the 30 survivors at 6 months were able to conduct their activities of daily living independently: five (31%) of the 16 patients in the conservative group and one (7%) of the 14 in the operative group. These differences are not statistically significant. The mortality rate of semicomatose or stuporous patients (Glasgow Coma Scale score 7 to 10) was statistically significantly lower in the surgical group (none of the four patients) than in the conservative group (four of five patients) (p < 0.05); however, all surviving patients in this subgroup were severely disabled. The study suggests that surgical treatment of this category of patients with ICH does not offer any definite advantage over conservative treatment. In semicomatose or stuporous patients, surgery may improve the length of survival, but the quality of life remains poor.

Comparison of single-shot nebuliser protocol between dexmedetomidine and ketamine in children undergoing magnetic resonance imaging

2021 ◽  
pp. 175045892110374
Author(s):  
K Geetha ◽  
Shibani Padhy ◽  
K Karishma
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Deep Sedation ◽  
Rapid Onset ◽  
Single Shot ◽  
Efficacy And Safety ◽  
Resonance Imaging ◽  
Sedation Scores ◽  
To Receive ◽  
Group D

Background Sedation for magnetic resonance imaging mandates deep sedation to ensure patient immobility. The nebulised route of drug delivery carries the advantage of good bioavailability and safety profile. We aimed to compare the efficacy and safety of nebulised dexmedetomidine and ketamine for sedation in children undergoing magnetic resonance imaging. Methods A total of 71 children, aged two to eight years scheduled for outpatient magnetic resonance imaging were randomly allocated to receive nebulised dexmedetomidine 2 μg/kg (group D) or nebulised ketamine 2 mg/kg (group K) 30min before magnetic resonance imaging. Results Nebulised dexmedetomidine (2 μg/kg) resulted in faster onset and significantly better sedation scores with rapid clear-headed recovery. Ketamine resulted in better venepuncture scores but was associated with more neuropsychological events at recovery. Conclusion Nebulised dexmedetomidine at 2 μg/kg provides rapid onset of satisfactory sedation, with good parental separation and a quicker and more clear-headed recovery, allowing for a smooth magnetic resonance imaging experience.

Solid Organ Biopsies

2018 ◽  
pp. 246-249
Author(s):  
Jennifer Biber ◽  
Jenna Wheeler
Keyword(s):  
Adverse Events ◽  
General Anesthesia ◽  
Operating Room ◽  
Local Anesthesia ◽  
Deep Sedation ◽  
Recovery Period ◽  
Contingency Planning ◽  
Solid Organ ◽  
Sedation And Analgesia ◽  
Pediatric Sedation

While solid organ biopsies are routinely done on adults with only local anesthesia or minimal sedation, children frequently require deep sedation or general anesthesia to achieve acceptable conditions (stillness, anxiolysis, analgesia) to facilitate these procedures. This is more frequently being done with pediatric sedation/anesthesia outside the operating room. Issues unique to sedation for these procedures are pain, the need for relative patient immobility (both during the procedure and following it), and the nonstandard positioning required during the procedure. Regardless of the medications chosen, adequate monitoring should occur during the procedure as well as during the recovery period. With a good sedation plan for both sedation and analgesia, adequate monitoring, and contingency planning for adverse events, this can safely be performed in institutions with highly motivated and organized sedation services.

Influence of the initial level of consciousness on early, goal-directed mobilization: a post hoc analysis

2019 ◽  
Vol 45 (2) ◽  
pp. 201-210 ◽  
Author(s):  
Stefan J. Schaller ◽  
Flora T. Scheffenbichler ◽  
Somnath Bose ◽  
Nicole Mazwi ◽  
Hao Deng ◽  
...  
Keyword(s):  
Initial Level ◽  
Post Hoc Analysis ◽  
Level Of Consciousness ◽  
Post Hoc

Lessons for Health Service: the Chernobyl Accident and the COVID-19 Pandemic

2020 ◽  
Vol 65 (3) ◽  
pp. 79-84
Author(s):  
A. Bushmanov ◽  
I. Galstyan ◽  
V. Solov'ev ◽  
M. Konchalovsky
Keyword(s):  
Chernobyl Accident ◽  
Large Scale ◽  
Medical Personnel ◽  
The Body ◽  
Key Factors ◽  
Vital Functions ◽  
Medical Institutions ◽  
Emergency Drugs ◽  
To Receive

Purpose: The article is devoted to the analysis of organizational measures to overcome the medical consequences of two large-scale events: the Chernobyl accident on 26.04.1986 and the COVID-19 pandemic. Results: A comparison of the causes, key factors, numbers affected and involved in these events persons, and the availability of the source of knowledge about the clinical picture, diagnosis, prevention and treatment of diseases, developing as a result of radiation exposure and the virus SARS-Cov-2. The article considers the availability of special medical institutions, the infectability of medical workers, the presence of long-term consequences for the health of victims and for the economy. Conclusions: In the development of such catastrophic events, an important role should be played by 1) Timely and adequate information to the population. 2) It is necessary to have a sufficient number of beds that can be repurposed in accordance with the needs and provided with appropriate equipment to support the vital functions of the body. 3) Planned training of qualified medical personnel should be carried out. 4) It is necessary to have stocks of emergency drugs close to the institutions where it is possible to receive victims.

scholarly journals RECOVERY OF CONSCIOUSNESS: OPPORTUNITIES FOR NEUROPSYCHOLOGICAL ASSESSMENT AND REHABILITATION

2021 ◽  
pp. 102-128
Author(s):  
Ekaterina V. Fufaeva ◽  
Yuri V. Mikadze ◽  
Anastasiia N. Cherkasova ◽  
Maria S. Kovyazina ◽  
Maria E. Baulina ◽  
...  
Keyword(s):  
Neuropsychological Assessment ◽  
Brain Lesions ◽  
Disorders Of Consciousness ◽  
Diagnostic Tools ◽  
Clinical Psychologist ◽  
Neuropsychological Rehabilitation ◽  
Rehabilitation System ◽  
Level Of Consciousness ◽  
Practical Guidelines ◽  
Recovery Of Consciousness

Relevance. Neuropsychological rehabilitation and assessment are the priority tasks in practice of a clinical psychologist. The modern rehabilitation system can be considered as a partnership between patients, their families and different specialists participating in the rehabilitation process. The existing approaches to neurorehabilitation are aimed at the earliest possible intervention. It`s of particular importance for patients with disorders of consciousness, whose number has been increasing in connection with the development of medicine in recent decades. This leads to the need to develop tools for specialized neuropsychological assessment and methods of neuropsychological rehabilitation of patients in the early stages of recovery of consciousness. Objective. To summarize neuropsychological diagnostic and rehabilitation experience of working with patients with disorders of consciousness after brain lesions. Methods. We analyze practical guidelines, applied research and our own hands-on experience of working with patients with disorders of consciousness after brain lesions. Results. Based on the analysis, the recommended diagnostic tools are formulated that can be used to identify the current level of consciousness and to assess various parameters of psychic activity of patients with disorders of consciousness. In addition, the main directions and neuropsychological methods of rehabilitation work recommended for recovery of consciousness and continuing to be developed now are highlighted. Conclusion. A new diagnostic and rehabilitation material is presented, which is recommended for use in neuropsychological practice by practicing clinical psychologists with patients with disorders of consciousness after brain lesions.

scholarly journals Potential use of dexmedetomidine for different levels of sedation, analgesia and anaesthesia in dogs

2013 ◽  
Vol 58 (No. 2) ◽  
pp. 87-95 ◽  
Author(s):  
Amarpal ◽  
RA Ahmad ◽  
P. Kinjavdekar ◽  
HP Aithal ◽  
AM Pawde ◽  
...  
Keyword(s):  
Heart Rate ◽  
Recovery Time ◽  
Deep Sedation ◽  
Muscle Relaxation ◽  
Complete Recovery ◽  
Group Iii ◽  
Group I ◽  
Righting Reflex ◽  
Sedation And Analgesia ◽  
Different Levels

A combination of drugs may be preferred over the use of a single agent to induce deep sedation. A synergistic interaction between the drugs reduces the dose requirements of the drugs thereby minimising the unwanted side effects associated with each drug and improving recovery. The present study was undertaken to evaluate the suitability of dexmedetomidine and dexmedetomidine in combination with midazolam-fentanyl or midazolam-fentanyl-ketamine for different levels of sedation, analgesia and anaesthesia in dogs. In a prospective, blinded, randomised clinical trial, 12 mixed breed dogs were divided into three groups. Animals of Group I were injected with dexmedetomidine 20 &mu;g/kg. Animals of Group II received 20 &mu;g/kg dexmedetomidine + 0.2 mg/kg midazolam + 4 &mu;g/kg fentanyl and animals of Group III were administered with 20 &mu;g/kg dexmedetomidine + 0.2 mg/kg midazolam + 4 &mu;g/kg fentanyl + 10 mg/kgketamine. All the drugs were given simultaneously via the intramuscular route. Jaw relaxation, palpebral reflex, pedal reflex and response to intubation were recorded and graded on a numerical scale. Values of heart rate, respiratory rate, rectal temperature and mean arterial pressure were recorded at baseline and then at predetermined intervals up to 120 min. Onset of sedation time, onset of recumbency time, time to return of righting reflex, standing recovery time and complete recovery time were recorded. Maximal muscle relaxation, sedation and analgesia were observed in animals of Group III, which was followed in decreasing order by Groups II and I. Heart rate decreased significantly (P &lt; 0.05) after administration of drugs in Groups I and II but a significant (P &lt; 0.05) increase was recorded in Group III. Respiratory rate decreased significantly (P &lt; 0.05) in all the groups. Rectal temperature decreased non-significantly in all the groups. Mean arterial pressure initially increased significantly (P &lt; 0.01) in Groups I and III followed by a decrease in Group I, but in Group III it remained above the base line. In Group II, MAP decreased throughout the study period. Onset of sedation time and onset of recumbency time were significantly (P &lt; 0.05) shorter in Group III as compared to Group I. Time to return of righting reflex, standing recovery time and complete recovery time did not differ significantly between the groups. It is concluded that dexmedetomidine provides a reliable moderate sedation and analgesia. Addition of midazolam and fentanyl enhances sedation, analgesia and muscle relaxation induced by dexmedetomidine. Addition of ketamine produced deep sedation and complete anaesthesia with lesser cardiopulmonary depression. Thus, dexmedetomidine can be used safely in combination with midazolam, fentanyl and ketamine for different levels of sedation, analgesia and anaesthesia in dogs. &nbsp;

Guidelines for the Elective Use of Conscious Sedation, Deep Sedation, and General Anesthesia in Pediatric Patients

PEDIATRICS ◽  
1985 ◽  
Vol 76 (2) ◽  
pp. 317-321
Author(s):  
◽  
Keyword(s):  
General Anesthesia ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Deep Sedation ◽  
Loss Of Consciousness ◽  
Physical Stimulation ◽  
Verbal Command ◽  
Patent Airway ◽  
Level Of Consciousness ◽  
Definition Of

The goals of sedation and general anesthesia in the ambulatory patient are: (1) patient welfare; (2) control of patient behavior; (3) production of positive psychological response to treatment; and (4) return to pretreatment level of consciousness by time of discharge. DEFINITION OF TERMS Terms used in this document are defined as follows: Pediatric patients: Includes all patients who are infants, children, and adolescents less than age of majority. Must or shall: Indicates an imperative need and/or duty; as essential or indispensable; mandatory. Should: Indicates the recommended manner of obtaining the standard; highly desirable. May or could: Indicates freedom or liberty to follow a suggested or reasonable alternative. Conscious sedation: Conscious sedation is a minimally depressed level of consciousness that retains the patient's ability to maintain a patent airway independently and continuously, and respond appropriately to physical stimulation and/or verbal command, eg, "Open your eyes." For the very young or handicapped individual, incapable of the usually expected verbal responses, a minimally depressed level of consciousness for that individual should be maintained. The caveat that loss of consciousness should be unlikely is a particularly important part of the definition of conscious sedation, and the drugs and techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Deep sedation: Deep sedation is a controlled state of depressed consciousness or unconsciousness from which the patient is not easily aroused, which may be accompanied by a partial or complete loss of protective reflexes, including the ability to maintain a patent airway independently and respond purposefully to physical stimulation or verbal command.

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