ABSTRACT
Introducción: la odontología es un campo indispensable para el ser humano, de no existir, se complica la prevención y atención de las patologías orales, resultando en estructuras dentales y bucales enfermas. La cantidad de pacientes diagnosticados con trastorno del espectro autista (TEA) que acuden a consulta odontológica va en aumento, lo cual genera ansiedad en el cirujano dentista al no contar con la capacitación adecuada para la atención de estos pacientes. Existen técnicas que ayudan al manejo correcto del comportamiento de los pacientes con trastorno del espectro autista como decir-mostrar-hacer, sedación consciente, TEACCH y desensibilización. Objetivo: explicar las técnicas para la atención de pacientes con trastorno del espectro autista durante la consulta odontológica. Conclusiones: aprender a tratar a los pacientes con trastorno del espectro autista es de suma importancia, ya que para ellos una simple consulta inicial podría convertirse en una experiencia traumática. Es necesario que todos los odontólogos conozcan las técnicas de manejo de conducta para que traten con profesionalidad a pacientes con trastorno del espectro autista debido al aumento de la prevalencia de personas diagnosticadas con este padecimiento (AU)
Introduction: dentistry is an indispensable field for the human being, if it did not exist, the prevention and care of oral pathologies would be complicated, resulting in diseased dental and oral structures. The number of patients diagnosed with autism spectrum disorder (ASD) who come to a dental office is increasing, which generates anxiety in the dentist surgeon because they do not have adequate training to care for these patients. There are techniques that help to correctly manage the behavior of patients with autism spectrum disorder such as tell-show-do, conscious sedation, TEACCH and desensitization. Objectives: explain the techniques for the care of patients with autism spectrum disorder during the dental consultation. Conclusions: learning to treat patients with autism spectrum disorder is extremely important, since for them a simple initial consultation could become a traumatic experience. It is necessary that all dentists know behavior management techniques so that they treat patients with autism spectrum disorder professionally due to the increase in the prevalence of people diagnosed with this condition (AU)
Subject(s)
Dental Anxiety/therapy , Autism Spectrum Disorder/psychology , Autism Spectrum Disorder/therapy , Conscious Sedation/methods , Desensitization, Psychologic/methodsABSTRACT
@#Lung cancer is the leading cause of cancer death worldwide. It may present as airway obstruction in a patient with endobronchial masses. Endobronchial brachytherapy (EBBT) has been shown to provide palliative therapy. It is the insertion of a radioactive material near the mass to reduce tumor size, thereby improving airway obstruction. This is the first case of EBBT done in our institution during the COVID-19 pandemic. A 53-year-old male, 60 kg, ASA Physical Status 2 for hypertension, smoker, malignancy, and previous pulmonary tuberculosis patient, presented with a cough and dyspnea. An endobronchial mass almost obstructing the right mainstem bronchus was seen on a computed tomography (CT) scan. He was diagnosed with squamous cell carcinoma of the lung and underwent radiotherapy and erlotinib chemotherapy. On repeat CT scan, there was no noted decrease in the size of the mass. EBBT was suggested, and a multi-disciplinary team was formed for the planned procedure. Pulmonology, radiation oncology, and anesthesiology teams were identified, and thorough planning was done prior to the actual procedure. Three fractions of EBBT were done under sedation using midazolam, fentanyl, and dexmedetomidine infusion. Lidocaine spray and transtracheal block were also performed as adjuncts prior to sedation. The procedure went as planned, and points for improvement were discussed for subsequent fractions. Due to persistent cough and discomfort from the catheter, additional ipratropium nebulization for minimization of secretions, and oral dextromethorphan for cough suppression were incorporated. After each fraction, the patient was monitored post-procedure for any side effects both from the radiotherapy and anesthetic technique. Qualitative reduction in mass size was noted in subsequent fractions. The patient was able to complete 3 fractions and was advised to follow-up after a month. EBBT is an emerging palliative and treatment modality for lung cancer, especially for intraluminal masses. Anesthetic considerations will depend on each case’s characteristics such as airway anatomy, patient comfort and capacity, and procedural requirements. Conscious sedation with topical anesthesia is an adequate and appropriate anesthetic option, especially in cases where severe airway obstruction may compromise ventilation if airway reflexes are blunted. A multidisciplinary approach with different services and stakeholders is important for the proper planning, execution, and management of such patients.
Subject(s)
Lung Neoplasms , Conscious Sedation , Dexmedetomidine , Midazolam , Fentanyl , Lidocaine , DextromethorphanABSTRACT
ABSTRACT Objective: To analyse pharmacological overlap in patients with autism spectrum disorder (ASD) under conscious sedation in a dental office environment, identifying any potential risks and complications. Material and Methods: A critical review was conducted by selecting articles from online databases (Pubmed and Lilacs), using a search algorithm and eligibility criteria. The Medscape® platform was used to verify interactions between drugs commonly used by patients with ASD and medications used for sedation in paediatric dentistry. Results: Due to their polydrug use, children with ASD are at risk of complications, namely Serotonin Syndrome (SS), Neuroleptic Malignant Syndrome (NMS), increase or decrease of the QT interval (QTi) and Torsade de Pointes (TdP), due to pre-existence of metabolic syndrome, deepening the sedation level or even leading to a decrease in the sedative capacity of the drugs used. Conclusion: It is essential to assess better drug interaction in ASD patients submitted to sedation. The severity of the disorder and the need for sedation for dental treatment are directly proportional. However, increases in sedative doses tend to increase risks and complications in children with ASD.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Conscious Sedation/methods , Dental Anxiety/therapy , Desensitization, Psychologic/methods , Autism Spectrum Disorder/pathology , Child , Child DevelopmentABSTRACT
O confronto com o câncer de um filho e a percepção da sua morte como inevitável dão lugar a experiências parentais relevantes para a pesquisa científica. Este estudo teve como objetivo investigar, por meio da percepção dos profissionais hospitalares, o modo como os pais experienciam a fase terminal e fim de vida do filho com câncer para melhor compreender os processos psicoemocionais experienciados por esses pais diante da cronicidade da doença e da morte do filho. No sentido de alcançar esse objetivo, realizou-se um estudo qualitativo de tipo fenomenológico envolvendo 17 profissionais de dois hospitais portugueses de referência em oncologia pediátrica. Os dados foram recolhidos com recurso a um guia de entrevista semiestruturada. Na percepção dos profissionais hospitalares, os resultados evidenciam que esses pais experienciam múltiplas dificuldades e preocupações na fase terminal da doença do filho e no pós-morte, bem como um sofrimento extremo e desestruturação biopsicossocial e espiritual na família. O conhecimento aprofundado da fenomenologia desses processos é essencial para o desenho e a implementação de intervenções emocionais, cognitivas, comportamentais e sociais mais ajustadas às dificuldades e preocupações parentais vividas no fim de vida e pós-morte.(AU)
Coping with children's cancer and the perception of their inevitable death give rise to parental experiences that are important to study. This study aimed to investigate, based on hospital professionals' perspectives, how parents experience the terminal phase and end of life of their children suffering from cancer to better understand the psycho-emotional processes these parents experienced in face of the chronicity of the disease and their children's death. To achieve this objective, a qualitative phenomenological study was carried out involving 17 professionals of two Portuguese hospitals that are reference in pediatric oncology. Data were collected using a semi-structured interview guide. From the perspective of hospital professionals, results show that these parents experience multiple difficulties and concerns in the terminal phase of their children's disease and postmortem, as well as the extreme suffering and biopsychosocial and spiritual disruption of the family. A deeper understanding of the phenomenology of these processes is essential to design and implement better adjusted emotional, cognitive, behavioral, and social interventions aimed at the parental difficulties and concerns experienced at the end of life and after death.(AU)
El enfrentamiento del cáncer de un hijo y la percepción de su muerte como inevitable dan lugar a experiencias parentales importantes que deben ser estudiadas. Este estudio pretende identificar desde la percepción de los profesionales del hospital cómo los padres viven la fase terminal y el final de la vida de su hijo con cáncer con el fin de comprender mejor los procesos psicoemocionales que viven estos padres ante la cronicidad de la enfermedad y la muerte de su hijo. Para ello, se realizó un estudio cualitativo, con enfoque fenomenológico, en el que participaron 17 profesionales de dos hospitales portugueses de referencia en oncología pediátrica. Para recoger los datos se aplicó un guion de entrevista semiestructurada. En cuanto a la percepción de los profesionales del hospital, estos padres experimentaron múltiples dificultades y preocupaciones en la fase terminal de la enfermedad de su hijo y postmuerte, así como un sufrimiento extremo y una desestructuración biopsicosocial y espiritual en la familia. El conocimiento en profundidad de la fenomenología de estos procesos es esencial para elaborar e implementar intervenciones emocionales, cognitivas, conductuales y sociales más acordes a las dificultades y preocupaciones parentales que se experimentan al final de la vida y la postmuerte.(AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Parents , Pediatrics , Portugal , Expression of Concern , Neoplasms , Anxiety , Pain , Palliative Care , Parent-Child Relations , Patient Care Team , Philosophy , Psychology , Psychology, Medical , Psychophysiology , Quality of Health Care , Risk-Taking , Schools , Self Care , Sibling Relations , Speech , Stress Disorders, Post-Traumatic , Awareness , Survival , Terminal Care , Therapeutics , Vision, Ocular , Body Image , Right to Die , Activities of Daily Living , Bereavement , Leukemia , Attitude of Health Personnel , Attitude to Death , Divorce , Marriage , Patient Acceptance of Health Care , Central Nervous System , Homeopathic Cure , Child , Child Care , Psychology, Child , Child Rearing , Child Health , Family Health , Sampling Studies , Life Expectancy , Mortality , Conscious Sedation , Adolescent , Negotiating , Hospice Care , Caregivers , Health Personnel , Neoplasms, Post-Traumatic , Interview , Communication , Pain Clinics , Comprehensive Health Care , Conflict, Psychological , Crisis Intervention , Affect , Psychosocial Impact , Mind-Body Therapies , Withholding Treatment , Spirituality , Decision Making , Denial, Psychological , Depression , Diagnosis , Diet , Drug-Related Side Effects and Adverse Reactions , Dyspnea , Education, Nonprofessional , Emotions , Disease Prevention , Humanization of Assistance , User Embracement , Family Conflict , Family Relations , Early Detection of Cancer , Fatigue , Fear , Early Medical Intervention , Medicalization , Hope , Acceptance and Commitment Therapy , Courage , Optimism , Psychological Trauma , Psychiatric Rehabilitation , Psychosocial Support Systems , Psycho-Oncology , Frustration , Sadness , Respect , Emotional Regulation , Psychological Distress , Patient Care , Psychosocial Intervention , Family Support , Psychological Well-Being , Emotional Exhaustion , Health Promotion , Health Services , Hearing , Hospitalization , Anger , Leukocytes , Life Change Events , Life Support Care , Loneliness , Love , Nausea , Nursing CareABSTRACT
Objetivo: Avaliar fatores associados, percepção e prevalência do uso de óxido nitroso por cirurgiões-dentistas do Rio Grande do Sul, Brasil. Metodologia: Realizou-se um estudo transversal, de base eletrônica, com profissionais registrados no Rio Grande do Sul. A coleta de dados baseou-se no envio, por e-mails e campanhas no Instagram, de um questionário via plataforma Google Forms contendo 27 questões acerca do uso de óxido nitroso em atendimentos odontológicos, bem como o perfil e as percepções dos profissionais sobre a técnica. Resultados: Dos 220 participantes, apenas 12,3% utilizava o óxido nitroso em sua prática clínica, sendo as especialidades que mais utilizavam, cirurgia e odontopediatria. Dentre os que reportaram utilizar a técnica, 81,5% tinham mais de 29 anos (p<0,001) e possuíam curso de pós-graduação, sendo que destes, 55,6% realizou o curso de habilitação (p<0,01) e mais da metade (55,6%) relatou utilizar em pacientes adultos (p<0,001). O alto custo do equipamento, bem como a falta de interesse dos profissionais, foram as principais razões para o não uso da técnica. Conclusão: A técnica de sedação consciente com óxido nitroso é pouco usada pelos cirurgiões-dentistas no Estado do Rio Grande do Sul. É possível que a ampliação do conhecimento acerca da indicação e aplicação do óxido nitroso, ainda durante a graduação, possa expandir o uso e contribuir para uma melhor qualidade no atendimento de pacientes com medo e ansiedade odontológicos. (AU)
Objective: The aim of this study is to evaluate associated factors, perception and prevalence of nitrous oxide use by dental surgeons in Rio Grande do Sul, Brazil. Methodology: A cross-sectional, electronic-based study was carried out with professionals registered in Rio Grande do Sul. Data collection was based on sending, via emails and Instagram campaigns, a questionnaire via the Google Forms platform containing 27 questions about the use of nitrous oxide in dental care, as well as the profile and perceptions of professionals about the technique. Results: Of the 220 participants, only 12.3% used nitrous oxide in their clinical practice, the specialties they used most being surgery and pediatric dentistry. Among those who reported using the technique, 81.5% were over 29 years old (p<0.001) and had a postgraduate course, of which 55.6% completed the qualification course (p<0.01) and more than half (55.6%) reported using it in adult patients (p<0.001). The high cost of the equipment, as well as the lack of interest from professionals, were the main reasons for not using the technique. Conclusion: The conscious sedation technique with nitrous oxide is little used by dental surgeons in the State of Rio Grande do Sul. It is possible that expanding knowledge about the indication and application of nitrous oxide, even during graduation, can expand its use and contribute to a better quality of care for patients with dental fear and anxiety. (AU)
Subject(s)
Humans , Male , Female , Adult , Conscious Sedation/methods , Anesthetics, Inhalation , Practice Patterns, Dentists'/statistics & numerical data , Nitrous Oxide , Brazil , Cross-Sectional Studies , Surveys and Questionnaires , Dental AnxietyABSTRACT
Abstract Background: Conventional dental care is often impossible in patients with Autism Spectrum Disorder (ASD). Non-collaborative behaviors, sometimes associated with aggressiveness, are usual justifications for premedication in this population. Thereby, this research focuses on the effects of oral midazolam versus oral ketamine plus midazolam as preanesthetic medication in ASD. Methods: The sample included 64 persons with ASD, aged 2-59 years, scheduled for dental care under general anesthesia. The primary objective of this study was to compare degrees of sedation between two parallel, double-blinded, equally proportional groups randomized to receive oral midazolam (0.5 mg.kg−1, maximum 15 mg) or oral midazolam (0.5 mg.kg−1) associated with oral S(+)-ketamine (3 mg.kg−1, maximum 300 mg). The secondary outcomes were the need of physical stabilization to obtain intravenous line, awakening time, and occurrence of adverse events. Results: According to the dichotomous analysis of sedation level (Ramsay score 1 and 2 versus Ramsay ≥ 3), oral association of S(+)-ketamine and midazolam improved sedation, with increased probability of Ramsay ≥ 3, Relative Risk (RR) = 3.2 (95% Confidence Interval [95% CI] = 1.32 to 7.76) compared to midazolam alone. Combined treatment also made it easier to obtain venous access without physical stabilization, RR = 2.05 (95% CI = 1.14 to 3.68). There were no differences between groups regarding awakening time and the occurrence of adverse events. Conclusion: The association of oral S(+)-ketamine with midazolam provides better preanesthetic sedation rates than midazolam alone and facilitates intravenous line access in patients with autism.
Subject(s)
Humans , Autism Spectrum Disorder/chemically induced , Autism Spectrum Disorder/drug therapy , Ketamine , Preanesthetic Medication , Midazolam , Double-Blind Method , Conscious Sedation , Hypnotics and SedativesABSTRACT
Objetivo: compreender o conhecimento e a percepção de enfermeiros quanto à sedação paliativa em oncologia. Método: estudo qualitativo, exploratório e descritivo, com delineamento transversal. Participaram do estudo 16 enfermeiros atuantes na oncologia de um hospital de referência localizado ao norte do Rio Grande do Sul. A coleta de dados ocorreu por meio de entrevista gravada com duração de aproximadamente 10 minutos, sendo aplicado um roteiro de perguntas fechadas com a finalidade de caracterizar os enfermeiros participantes da pesquisa, e perguntas abertas e específicas para contemplar o objetivo do estudo. O método utilizado para o diagnóstico e verificação dos dados da pesquisa foi a análise de conteúdo de Bardin. Os dados foram analisados e codificados por meio do software NVivo 10, que gerou categorias de similaridade e correlações. Resultados: surgiram cinco categorias intituladas "Conhecimento sobre sedação paliativa; Percepção sobre sedação paliativa na oncologia; Sentimentos em relação à sedação paliativa aos pacientes oncológicos; Vivência em relação à sedação paliativa em pacientes oncológicos e Participação do enfermeiro no procedimento de sedação paliativa". Conclusão: o enfermeiro atua de forma efetiva e fundamental na prestação do cuidado e na avaliação do paciente em sedação paliativa, mas ainda encontram-se diversos obstáculos relacionados à participação na tomada de decisões. Evidencia-se a importância de novas pesquisas sobre a temática, como também a implementação de protocolos que subsidiem na indicação da sedação paliativa.(AU)
Objective: to understand the knowledge and perception of nurses dealing with palliative sedation in oncology. Method: this is a qualitative, exploratory, and descriptive study, with a cross-sectional design. The study included 16 nurses working in oncology at a reference hospital located in the north of Rio Grande do Sul. Data were collected through recorded interviews lasting approximately 10 minutes, with a script of closed questions being applied to characterize the nurses participating in the research, and open and specific questions, to contemplate the objective of the study. The method used for the diagnosis and verification of research data was Bardin's content analysis. Data were analyzed and coded using the NVivo 10 software, which generated categories of similarity and correlations. Results: five categories emerged: (i) Knowledge about palliative sedation; (ii) Perception of palliative sedation in oncology; (iii) Feelings regarding palliative sedation in cancer patients; (iv) Experience with palliative sedation in cancer patients; and (v) Participation of the nurse in the palliative sedation procedure. Conclusion: nurses act effectively and fundamentally in providing care and evaluating patients undergoing palliative sedation, but there are still several obstacles related to their participation in decision-making. The importance of new research on the subject is evident, as well as the implementation of protocols that support the indication of palliative sedation.(AU)
Objetivo: comprender el conocimiento y la percepción de los enfermeros sobre la sedación paliativa en oncología. Método: estudio cualitativo, exploratorio y descriptivo, con diseño transversal. El estudio abarcó 16 enfermeros que trabajaban en oncología en un hospital de referencia localizado en el norte de Rio Grande do Sul. La colecta de datos ocurrió por medio de entrevista grabada con duración aproximada de 10 minutos, siendo aplicado un guión de preguntas cerradas con la finalidad de caracterizar los enfermeros participantes de la investigación, y preguntas abiertas y específicas para contemplar el objetivo del estudio. El método utilizado para el diagnóstico y verificación de los datos de la investigación fue el análisis de contenido de Bardin. Los datos fueron analizados y codificados utilizando el software NVivo 10, que generó categorías de similitud y correlaciones. Resultados: surgieron cinco categorías tituladas "Conocimientos sobre sedación paliativa; Percepción de la sedación paliativa en oncología; Sentimientos con respecto a la sedación paliativa para pacientes con cáncer; Experiencia con sedación paliativa en pacientes oncológicos y participación de Enfermeros en el procedimiento de sedación paliativa". Conclusión: el enfermero actúa de forma eficaz y fundamental en la prestación del cuidado y en la evaluación del paciente en sedación paliativa, pero aún existen varios obstáculos relacionados con la participación en la toma de decisiones. Es evidente la importancia de seguir investigando sobre el tema, así como la implementación de protocolos que sustenten la indicación de la sedación paliativa.(AU)
Subject(s)
Humans , Male , Female , Adult , Oncology Nursing , Palliative Care , Conscious Sedation/nursing , Deep Sedation/nursing , Hospice and Palliative Care Nursing , Analgesia , Neoplasms/drug therapy , Surveys and Questionnaires , Clinical Decision-Making , Relational Autonomy , NursesABSTRACT
OBJECTIVE@#To study the effect of propofol used for painless gastroscopy and colonoscopy on psychomotility recovery.@*METHODS@#One hundred adult patients undergoing painless gastroscopy and colonoscopy were recruited, aged 18-72 years, with American Society of Anesthesiologist (ASA) physical status Ⅰ-Ⅱ. According to age, the patients were divided into youth group (20-39 years old, 27 cases), middle age group (40-54 years old, 37 cases), and elder group (55-64 years old, 36 cases). Propofol was continuously infused according to the patients' condition to mantain the bispectal index (BIS) score 55-64. All the patients received psychomotility assesment 30 min before the operations when the discharge criteria were met including number cancellation test, number connection test and board test. The heart rate, blood pressure, saturation of pulse oximetry, electrocardiograph and BIS were monitored during the operation. The operating time, recovery time, total volume of propofol and discharge time were recorded. If the results obtained were inferior to those before operation, a third assessment was taken 30 minutes later until the results recovered or being superior to the baseline levels.@*RESULTS@#All the patients completed the first and second assessments, and 25 patients had taken the third assessment. There was no statistically significant difference in the results of psychomotility assessment when the patients met the discharge standard. Furthermore, the results were analyzed by grouping with age, and there was no statistical difference in the test results of the youth and middle age groups compared with the preoperative group, among which, the efficiency of the number cancellation test was significantly better than that before operation in the youth group (P < 0.05). However, in the elderly patients the number cancellation efficiency, number connection test and board test were significantly inferior to that before operation (P < 0.05). There was no significant difference in the accuracy of number cancellation compared with that before operation. The patients who needed the third test in the elder group were significantly more than in the other groups (P < 0.05). Compared with the preoperative results, there was no statistical difference in the test results of those who completed the third test.@*CONCLUSION@#The psychomotility function of the patients who underwent painless gastroscopy and colonoscopy was recovered when they met discharge criteria. The elderly patients had a prolonged recovery period.
Subject(s)
Adult , Aged , Middle Aged , Adolescent , Humans , Young Adult , Propofol , Hypnotics and Sedatives , Gastroscopy/methods , Conscious Sedation/methods , Colonoscopy/methodsABSTRACT
ABSTRACT Objective: To evaluate the behaviour and stress of children undergoing restorative treatment with and without sedation. Material and Methods: Participants were 14 healthy children aged between 2.5 and 6 years and with a history of dental behavioural management problems. In the dental treatment visit, the child was treated with non-pharmacological techniques, and in the second, moderate sedation was added. The child received the same procedure performed by a paediatric dentist in both visits: composite resin restoration using local anaesthesia and rubber dam isolation. In both visits, saliva was collected at the children's arrival at the dental clinic, during local anaesthesia and at the end of treatment. The visits were filmed for later analysis of behaviour according to the Ohio State University Behavioural Rating Scale. Results: About 78.5% of children improved their behaviour from the first to the second visit. The salivary cortisol curve of the first visit was maintained in the second visit for 21.4% of children but varied in the remaining participants. Conclusion: Most children presented better behaviour and less stress when sedation was added to non-pharmacological techniques during dental care.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Midazolam/adverse effects , Conscious Sedation , Dental Anxiety/psychology , Dental Care for Children/psychologyABSTRACT
Abstract Background: Dexmedetomidine (DEX) is an α2-adrenergic receptor agonist used for its sedative, analgesic, and anxiolytic effects. Non-Operating Room Anesthesia (NORA) is a modality of anesthesia that can be done under general anesthesia or procedural sedation or/and analgesia. In this particular setting, a level-2 sedation, such as the one provided by DEX, is beneficial. We aimed to study the effects and safety of DEX in the different NORA settings in the adult population. Methods: A systematic review with meta-analysis of randomized controlled trials was conducted. Interventions using DEX only or DEX associated with other sedative agents, in adults (18 years old or more), were included. Procedures outside the NORA setting and/or without a control group without DEX were excluded. MEDLINE, ClinicalTrials.gov, Scopus, LILACS, and SciELO were searched. The primary outcome was time until full recovery. Secondary outcomes included hemodynamic and respiratory complications and other adverse events, among others. Results: A total of 97 studies were included with a total of 6,706 participants. The meta-analysis demonstrated that DEX had a higher time until full recovery (95% CI = [0.34, 3.13] minutes, a higher incidence of hypotension (OR = 1.95 [1.25, 3.05], p = 0.003, I2 = 39%) and bradycardia (OR = 3.60 [2.29, 5.67], p < 0.00001, I2 = 0%), and a lower incidence of desaturation (OR = 0.40 [0.25, 0.66], p = 0.0003, I2 = 60%). Conclusion: DEX in NORA procedures in adults was associated with a lower incidence of amnesia and respiratory effects but had a long time to recovery and more hemodynamic complications..
Subject(s)
Conscious Sedation , Dexmedetomidine , Anesthesia , Patient Safety , Hypnotics and Sedatives , AnesthesiologyABSTRACT
Abstract he innate immune response plays an important role in the pathophysiology of acute respiratory distress syndrome (ARDS); however, no drug has been proven to be beneficial in the management of ARDS. Therefore, the aim of this study was to investigate the effects of using combined sedatives on systemic inflammatory responses in patients with ARDS. A total of 90 patients with ARDS and an intubation time of > 120 h were randomly divided into the propofol group (group P), midazolam group (group M), and combined sedation group (group U). Patients in groups P and M were sedated with propofol and midazolam, respectively, whereas patients in group U were sedated with a combination of propofol, midazolam, and dexmedetomidine. The dosage of sedatives and vasoactive drugs, duration of mechanical ventilation, and incidence of sedative adverse reactions were documented. The dosage of sedatives and vasoactive drugs, as well as the incidence of sedative adverse reactions in group U, was significantly lower than those in groups P and M. Similarly, the duration of mechanical ventilation in group U was significantly shorter than that in groups P and M. Hence, inducing sedation through a combination of multiple drugs can significantly reduce their adverse effects, improve their sedative effect, inhibit systemic inflammatory responses, and improve oxygenation in patients with ARDS
Subject(s)
Humans , Male , Female , Adult , Patients/classification , Respiratory Distress Syndrome, Newborn/diagnosis , Pharmaceutical Preparations/analysis , Conscious Sedation/adverse effects , Midazolam/agonists , Propofol/agonists , Cytokines/administration & dosage , Dexmedetomidine/agonistsABSTRACT
RESUMEN: ANTECEDENTES: La valvuloplastía aórtica es un procedimiento paliativo o como puente al reemplazo aórtico percutáneo o quirúrgico. Nuestro abordaje incluye una técnica minimalista y la utilización de balones de mayor tamaño que lo estándar. OBJETIVO: Evaluar los resultados clínicos inmediatos y alejados de pacientes tratados mediante esta técnica modificada. MÉTODOS: Se incluyó a todos los pacientes sometidos a balonplastía aórtica entre Julio del 2012 y Agosto del 2019 en nuestro centro. El procedimiento se realizó bajo sedación consciente mediante un único acceso femoral y sin instalación de un marcapasos transitorio. El éxito de la intervención se definió como caída de gradiente basal en 50% o más en ausencia de complicación mayor. RESULTADOS: Se realizaron un total de 52 procedimientos en 49 pacientes. La edad promedio fue 76 ± 9,9 años. Un tercio de los pacientes tenía una fracción de eyección del ventrículo izquierdo ≤35% y similar proporción tenía un perfil de riesgo STS score > 10 puntos. La duración total promedio fue de 31,1 + 10,0 min. Se utilizó un balón #28 en el 84.6% de los casos. El éxito del procedimiento se alcanzó en 94,2% de los casos. Ocurrieron 2 muertes intraoperatorias (3,9%), ambas en pacientes de muy alto riesgo y 2 (3,9%) complicaciones vasculares mayores. La sobreviva en el seguimiento alejado fue 32,7%. CONCLUSIÓN: La valvuloplastia aórtica percutánea con técnica modificada, utilizando balones de mayor tamaño que lo habitual, es una técnica segura que logra óptimos resultados hemodinámicos.
ABSTRACT: Aortic balloon valvuloplasty (ABV) is a palliative procedure or a bridge to percutaneous or surgical aortic valve replacement. Our group proposes a minimalist approach that reduces the use of resources and also stands out for using larger balloons. AIM: To assess the safety and the immediate results of patients undergoing aortic balloon valvuloplasty using a minimally invasive procedure. METHODS: All patients who underwent ballon aortic valvuloplasty (BAV) between July 2012 and Au- gust 2019 were included. The procedure was performed under conscious sedation using a single femoral access and without the installation of a temporary pacemaker. Success was defined as a 50% drop in the mean aortic gradient plus the absence of major complications. RESULTS: 52 procedures in 49 patients were performed; the average age was 76 ± 9,9 years. A third of patients included had a left ventricular ejection fraction ≤35% and a similar proportion had a high risk profile with an STS score> 10 points. A 28 mm balloon was used in 84.6% of cases. The procedure was successful in 94,2% of cases. There were 2 (3,85%) intraoperative deaths in very high-risk patients and 2 (3,85%) major vascular complications. The survival rate at late follow up was 32,7%. CONCLUSION: Aortic balloon valvuloplasty with a minimally invasive technique using larger than usual balloons is a safe technique that achieves optimal hemodynamic results.
Subject(s)
Humans , Female , Aged , Aortic Valve/physiopathology , Aortic Valve/diagnostic imaging , Balloon Valvuloplasty/methods , Retrospective Studies , Conscious Sedation/methods , Balloon Valvuloplasty/adverse effects , Contraindications, ProcedureABSTRACT
COVID-19 pandemic generated multiple challenges for the health system. Cardiovascular disease is associated with a worse prognosis of infections. Moreover, most hospital resources and operative rooms were destined to patients with COVID-19 infection, deferring the treatment of most valvular patients requiring surgery. We report seven patients with symptomatic severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) with conscious sedation and early discharge. No patient required intensive care unit admission or mechanical ventilation. After a 90-day follow-up, there were no complications or unplanned readmissions.
Subject(s)
Humans , Aortic Valve Stenosis/surgery , Aortic Valve Stenosis/etiology , Transcatheter Aortic Valve Replacement/adverse effects , COVID-19 , Patient Discharge , Risk Factors , Conscious Sedation/adverse effects , Treatment Outcome , PandemicsABSTRACT
INTRODUCTION@#Although ketamine is one of the commonest medications used in procedural sedation of children, to our knowledge, there is currently no published report on predictors of respiratory adverse events during ketamine sedation in Asian children. We aimed to determine the incidence of and factors associated with respiratory adverse events in children undergoing procedural sedation with intramuscular (IM) ketamine in a paediatric emergency department (ED) in Singapore.@*METHODS@#A retrospective analysis was conducted of all children who underwent procedural sedation with IM ketamine in the paediatric ED between 1 April 2013 and 31 October 2017. Demographics and epidemiological data, including any adverse events and interventions, were extracted electronically from the prospective paediatric sedation database. The site of procedure was determined through reviewing medical records. Descriptive statistics were used for incidence and baseline characteristics. Univariate and multivariate logistic regression analyses were performed to determine significant predictors.@*RESULTS@#Among 5,476 children, 102 (1.9%) developed respiratory adverse events. None required intubation or cardiopulmonary resuscitation. Only one required bag-valve-mask ventilation. The incidence rate was higher in children aged less than three years, at 3.6% compared to 1.0% in older children (odds ratio [OR] 3.524, 95% confidence interval [CI] 2.354-5.276; p < 0.001). Higher initial ketamine dose (adjusted OR 2.061, 95% CI 1.371-3.100; p = 0.001) and the type of procedure (adjusted OR 0.190 (95% CI 0.038-0.953; p = 0.044) were significant independent predictors.@*CONCLUSION@#The overall incidence of respiratory adverse events was 1.9%. Age, initial dose of IM ketamine and type of procedure were significant predictors.
Subject(s)
Child , Humans , Conscious Sedation/methods , Emergency Service, Hospital , Incidence , Ketamine/adverse effects , Prospective Studies , Retrospective StudiesABSTRACT
INTRODUCTION@#In Singapore, non-anaesthesiologists generally administer sedation during gastrointestinal endoscopy. The drugs used for sedation in hospital endoscopy centres now include propofol in addition to benzodiazepines and opiates. The requirements for peri-procedural monitoring and discharge protocols have also evolved. There is a need to develop an evidence-based clinical guideline on the safe and effective use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting.@*METHODS@#The Academy of Medicine, Singapore appointed an expert workgroup comprising 18 gastroenterologists, general surgeons and anaesthesiologists to develop guidelines on the use of sedation during gastrointestinal endoscopy. The workgroup formulated clinical questions related to different aspects of endoscopic sedation, conducted a relevant literature search, adopted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology and developed recommendations by consensus using a modified Delphi process.@*RESULTS@#The workgroup made 16 recommendations encompassing 7 areas: (1) purpose of sedation, benefits and disadvantages of sedation during gastrointestinal endoscopy; (2) pre-procedural assessment, preparation and consent taking for sedation; (3) Efficacy and safety of drugs used in sedation; (4) the role of anaesthesiologist administered sedation during gastrointestinal endoscopy; (5) performance of sedation; (6) post-sedation care and discharge after sedation; and (7) training in sedation for gastrointestinal endoscopy for non-anaesthesiologists.@*CONCLUSION@#These recommendations serve to guide clinical practice during sedation for gastrointestinal endoscopy by non-anaesthesiologists in the hospital setting.
Subject(s)
Humans , Conscious Sedation , Endoscopy, Gastrointestinal , Hospitals , Hypnotics and Sedatives , SingaporeABSTRACT
The use of nitrous oxide-oxygen inhalation sedation to relieve anxiety and pain in dental outpatient treatment has been a very mature and safe technique in the world. This technology has been introduced into China for nearly 20 years, and many clinical cases have proved its safety, practicability and effectiveness, which can meet the clinical needs of patients. To further standardize and popularize this technique, the Society of Sedation and Analgesia, Chinese Stomatological Association formed the recommended application guidelines after many discussions and revisions on the basis of widely soliciting opinions and referring to relevant literatures. It covers indications, contraindications, standardized operation procedures, occupational protection, identification and treatment of adverse reactions, training and other aspects. This guideline can be used as a reference for the use of nitrous oxide-oxygen inhalation sedation techniques in the outpatient setting of dentistry.
Subject(s)
Humans , Anesthesia, Dental , Anesthetics, Inhalation/adverse effects , Conscious Sedation/methods , Dental Anxiety/prevention & control , Nitrous Oxide/adverse effects , Outpatients , OxygenABSTRACT
We present the case report of one of the co-authors for the closure of her atrial septal defect under neuraxial anesthesia. The influence of the Cardiovascular Anesthesiologist on the response to perioperative stress in the context of cardiac surgery with the choice and application of the best anesthetic technique adjusted to a high-risk patient, has a positive impact on the main objectives of high-value care in the critical area of medicine and in the immediate postoperative evolution after a heart surgery. The safety of neuraxial anesthesia in cardiac surgery is a subject in wide debate in Mexico, even in hospitals with high volume of cardiac surgery it is a controversial subject, we present the first clinical case in Mexico of a 21-year-old female patient under- going closure of Atrial septal defect (ASD) via median sternotomy with extracorporeal circulation under neuraxial anesthesia and sedoanalgesia without orotracheal intubation.
Presentamos el reporte de caso de una de las coautoras para el cierre de su comunicación interatrial bajo anestesia neuroaxial. La influencia del Anestesiologo Cardiovascular en la respuesta al estres perioperatorio en el contexto de cirugía cardíaca con la elección y aplicación de la mejor tecnica anestesica ajustada a un paciente de alto riesgo, tiene un impacto positivo en los principales obejtivos del cuidado de alto valor en el área de la medicina critica y en la evolución posoperatoria inmediata tras una cirugía caridaca. La seguridad de la anestesia neuroaxial en cirugía cardíaca es un tema en amplio debate en México, aun en hospitales con alto volumen de cirugía cardíaca es un tema controversial. Presentamos el primer caso clínico en México de una paciente femenino de 21 años sometida a cierre de comunicación interauricular (CIA) vía esternotomia media con circulación extracorporea bajo anestesia neuroaxial y sedoanalgesia sin intubación orotraqueal.
Subject(s)
Humans , Female , Young Adult , Conscious Sedation/methods , Thoracic Surgical Procedures/methods , Heart Septal Defects, Atrial/surgery , Anesthesia, Conduction/methods , Extracorporeal Circulation , Sternotomy , Anesthesia, Epidural , Anesthesia, SpinalABSTRACT
RESUMEN Introducción: el SARS-CoV-2 es un nuevo coronavirus descrito por primera vez en China y con alta capacidad de propagación. Su presentación clínica más frecuente son los síntomas respiratorios, aunque se han descrito otros como los gastrointestinales. La transmisión ocurre por gotas, aerosoles, vía fecal oral, conjuntiva, fómites y por contacto directo con fluidos corporales del paciente. En este sentido, los procedimientos realizados en las salas de endoscopia deben considerarse de alto riesgo. Objetivo: describir y analizar las medidas de prevención frente al SARS-CoV-2 para la práctica endoscópica-anestésica u otros procedimientos que requieran sedación, con el fin de disminuir la exposición y así minimizar el contagio del personal de salud. Resultados: la respuesta global se ha enfocado en la utilización de elementos de protección personal para tratar de disminuir el riesgo al que se encuentra expuesto el personal de salud. Sin embargo, debido a la prontitud de la emergencia, no se han podido generar evidencias de alta calidad que permitan dar recomendaciones definitivas. Reflexión: el personal de salud debe tomar todas las medidas de protección que puedan ser consideradas como efectivas, además deconstruir protocolos y fomentar la adherencia a los mismos.
SUMMARY Introduction: SARS-CoV-2 is a new coronavirus described for the first time in China, with high capacity of propagation. Its most frequent clinical presentation is respiratory symptoms; however, others have been described as gastrointestinal. Transmission occurs by droplets, aerosols, oral fecal route, conjunctiva, fomites and by direct contact with body fluids of the patient. In this sense, the procedures performed in endoscopy rooms should be considered high risk. Objective: To describe and analyze preventive measures against SARS-CoV-2 for endoscopic-anesthesia practice or other procedures that require sedation, in order to reduce exposure and thus minimize contagion of health personnel. Results: The global response has focused on the use of personal protective equipment to try to reduce the risk to which health care personnel are exposed, but due to the urgency of the emergency, it has not been possible to generate high quality evidence to give definitive recommendations. Reflection: Health personnel should take all protective measures that can be considered effective, and also deconstruct protocols and encourage adherence to them.
Subject(s)
Humans , Coronavirus , Personal Protection , Endoscopy , Conscious Sedation , AnesthesiaSubject(s)
Humans , Respiration, Artificial , Hypnotics and Sedatives , Conscious Sedation , Intensive Care UnitsABSTRACT
Dentes supranumerários são caracterizados como um excesso no número de dentes da série normal. Os mesiodentes, definidos pela sua localização mediana aos incisivos centrais superiores, referem-se ao tipo de dente supranumerário mais comumente encontrado na cavidade oral, normalmente intraósseo e assintomático. A presença desses dentes pode ocasionar alterações na dentição permanente, mas a abordagem cirúrgica na fase da dentição mista mostra resultados satisfatórios no alinhamento dental espontâneo. Em pacientes pediátricos, a sedação consciente com óxido nitroso tem demonstrado ser uma alternativa segura e eficaz no controle do medo e da ansiedade. Objetivo: relatar um procedimento cirúrgico de remoção de dois mesiodentes em paciente pediátrico sob anestesia local associada à sedação com óxido nitroso. Relato de caso: paciente do sexo feminino, 11 anos de idade, necessitava de remoção cirúrgica de dois dentes supranumerários localizados em região anterior de maxila. Com a avaliação da tomografia computadorizada, pôde-se observar a posição em que ambos se encontravam. Realizou-se também a exodontia do elemento dentário 14, como solicitado pela ortodontista, para posterior continuidade do tratamento ortodôntico. Devido à complexidade cirúrgica e ao tempo operatório, considerando a idade da paciente e o possível aumento nos níveis de ansiedade, optou-se pela realização de sedação consciente com óxido nitroso. Conclusão: clinicamente, dentes supranumerários podem causar danos locais. O tratamento cirúrgico associado à sedação consciente mostrou-se bastante seguro e efetivo no controle comportamental, além de poder ser implementado na rotina ambulatorial.(AU)
Supernumerary teeth are defined as those in addition to the normal series. The mesiodens, is the most common supernumerary tooth and it is present in the midline between the two central incisors. It is usually intraosseous and asymptomatic. The presence of these teeth may cause changes in permanent dentition and the surgical approach in the mixed dentition phase shows satisfactory results in spontaneous dental alignment. In pediatric patients, conscious sedation with nitrous oxide has been shown to be a safe and effective alternative in controlling fear and anxiety. Objective. To report a surgical procedure for the removal of two mesiodens in a pediatric patient under local anesthesia associated with nitrous oxide sedation. Case report. 11-year-old female patient required surgical removal of two upper mesiodens. The computed tomography images assisted to indicate their exact position. The extraction of the upper right premolar (tooth #14) was also performed as requested by the orthodontist. Considering the patient's age and the possible increase in anxiety levels, along with surgical complexity and operative time, the conscious sedation with nitrous oxide was selected. Conclusion. Clinically, supernumerary teeth cause local damage and surgical treatment associated with conscious sedation has proved to be quite safe and effective in the behavioral control besides being able to be implemented in the outpatient routine.(AU)