Xenon analgesia in children with extensive wounds

Purpose. To assess the effectiveness of sub-narcotic concentrations of xenon in the local treatment of extensive wounds in children with severe injuries.Material and methods. 14 patients (average age 9.3 ± 4.0 years) with extensive wounds were taken into the trial. 67 dressings in them were done with 30 % xenon and oxygen. Pain intensity was assessed by the numerical rating scale of pain (NRSp) (1–10 points); sedation depth – by Ramsay scale (1–6 points) and BIS index.Results. Inhalations of 30 % xenon with oxygen during wound dressings reduced the intensity of pain from Me 3.67 (1.2; 6.0) to Me 2.0 (1.0; 3.3) points by NRSp scale (p < 0.05); after sedanalgesia, it increased again to Me 3.0 (1.0; 5.3). Analgesia with 30 % xenon was effective in 55 (82.0 %) dressings; in 8 (11.9 %) patients with trauma, xenon concentration was increased to 50 %, and in 4 (5.9 %) cases 50 % xenon was added with Fentanyl 1–2 mcg/kg. The depth of sedation assessed by the Ramsay scale decreased (p < 0.05) from 6.0 (5.6; 6.0) to 3.1 (2.2; 4.5) points; after sedanalgesia it increased to Me 5.0 (4.5; 5.4) points. At the same time, the mean value of BIS index decreased (p < 0.05) from 97.5 ± 1.5 to 86.5 ± 5.0 U; after dressing, it rapidly increased to 93.0 ± 2.1 U. During dressings, 82 % of children were calm, had contact with a doctor. Afterwards, their sleep was restored, their mood improved.Conclusion. Sedanalgesia with xenon in sub-narcotic concentrations is an effective technique to relieve pain during treatment of extensive wounds in children.

Perspectives on Sedation Assessment in Critical Care

Multiple studies have been undertaken to show that neurofunction monitors can correlate to objective sedation assessments. Showing a correlation between these 2 patient assessments tools may not be the correct approach for validation of neurofunction monitors. Two different methods of assessing 2 different modes of the patient’s response to sedation should not be expected to precisely correlate unless the desire is to replace one method with the other. We provide a brief summary of several sedation scales, physiologic measures and neurofunction monitoring tools, and correlations literature for bispectral index monitoring, and the Ramsay Scale and the Sedation Agitation Scale. Neurofunction monitors provide near continuous information about a different domain of the sedation response than intermittent observational assessments. Further research should focus on contributions from this technology to the improvement of patient outcomes when neurofunction monitoring is used as a complement, not a replacement, for observational methods of sedation assessment.

Midazolam-sirupus, formulation and pharmacodynamic efficacy

Due to its pharmacokinetic and pharmacodynamic properties (sedation, amnesia and relief of anxiety) Midazolam has become a commonly used agent for conscious sedation of children before diagnostic or therapeutic procedure or before induction of anesthesia. Considering the advantage of oral administration to avoid the additional trauma of starting an IV in the child, and the fact that there is no adequate dosage form (Midazolam - Syrupus) on the drug market in our country, the aim of the presented work was to formulate syrupus using syrupus base/aqueous solution of viscosity enhancer - HPMC, in combination with suitable sweetener, flavor, and preservatives, and to evaluate its quality and stability. The pharmacodynamic efficacy/sedative effect of Midazolam HCl - Syrupus formulation was evaluated in 33 pediatric patients comparing this with the efficacy of intramuscularly administered Midazolam HCl (35 pediatric patients) in accordance with the Ramsay scale for analgosedation. The formulation manifested good quality in respect to physical properties, physico-chemical parameters (pH value, relative density, drug content, ingredients content) antimicrobial efficacy and microbiological quality according to Ph Eur 3. In the conditions characteristic of the second (II) climate zone, the dosage form was stable for four months. The sedative effect of orally administered Midazolam was manifested in a period necessary for surgical premedication (30 - 45 min). The majority of patients (71%) entered the second phase on the Ramsay scale, when Midazolam was administered in a dose of 0.40 mg/kg.