Progress of takotsubo mediated by sympathetic nervous in children with intensive nervous system disease / 中国小儿急救医学

The incidence of intensive nervous system disease in children is high, and there will be more or less long-term sequelae.In addition, due to age, long-term treatment costs are high, causing a great burden to society.When intensive nervous system disease occurs, the body can show an increase in sympathetic activity and catecholamine, which leads to the occurrence of takotsubo.After the occurrence of takotsubo, it can reduce the supplement of intracranial oxygen, thus aggravate the intensive nervous system disease and aggravate the adverse clinical outcome of children.Sedation and analgesia to reduce sympathetic activity can achieve the purpose of treating intensive nervous system diseases and takotsubo.

Influence and clinical application of acupuncture therapy on weaning from mechanical ventilation / 国际中医中药杂志

The use of mechanical ventilation is more common in the diagnosis and treatment of clinical critically ill patients. However, in the process of mechanical ventilation, it may be difficult to withdraw from the machine due to various factors other than the primary disease. Among them, intra-abdominal hypertension, accumulation of analgesic and sedative drugs, and weakness of diaphragmatic function are common causes of difficulty in weaning. Acupuncture has obvious efficacy in regulating gastrointestinal function, exerting analgesic and sedative effect and improving muscle weakness. Acupuncture intervention can optimize the scheme of mechanical ventilation weaning, and improve the success rate by correcting different concurrent factors.

Application of remifentanil in postoperative ICU sedation and analgesia in patients with severe craniocerebral trauma / 中国临床药理学与治疗学

AIM: To investigate the effect of remifentanil in the management of sedation and analgesia after severe traumatic brain injury and its influence on the incidence of inflammatory stress. METHODS: From January 2017 to April 2020, 92 patients with severe head trauma surgery in our hospital were selected as the research objects, randomly divided into groups, each with 46 cases. Both groups received postoperative sedation and analgesia management, the control group received dexmedetomidine + 0.9% sodium chloride injection, and the observation group received dexmedetomidine combined with remifentanil. The effects of sedation and analgesia, vital signs, and inflammatory stimuli C reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10)related indicators, serum cortisol, β-endorphin, and the incidence of adverse reactions in the two groups were observed and counted. RESULTS: The scores of sedation and analgesia in the observation group were lower than control group at 2 h, 4 h, and 12 h after administration (P 0.05). CONCLUSION: Remifentanil is used in the management of sedation and analgesia after severe traumatic brain injury, which can effectively improve the effect of sedation and analgesia, reduce inflammatory stimulation, regulate the levels of cortisol, and β-endorphin It is worthy of clinical application.

Availability and quality of procedural sedation and analgesia in emergency departments without emergency physicians: A national survey in the Netherlands / 世界急诊医学杂志（英文）

BACKGROUND@# Emergency physicians have been successful in implementing procedural sedation and analgesia (PSA) to treat emergency department (ED) patients who need to undergo painful procedures. However, 25% of the EDs in the Netherlands are not staffed by emergency physicians. The aim of this study was to investigate PSA availability and quality in EDs without emergency physicians.@*METHODS@# We performed an exploratory cross-sectional study amongst ED nurses and physicians in all 13 EDs without emergency physicians in the Netherlands. Data were gathered using a standardized questionnaire.@*RESULTS@# The response rate was 34.3% (148/432). Of the respondents, 84/148 (56.8%) provided adult PSA and 30/148 (20.3%) provided paediatric PSA. Main reasons for not providing PSA were insufficient numbers of trained staff to support PSA in the ED and insufficient training and exposure. The providers agreed significantly stronger when reflecting their PSA competencies in adults compared to paediatric patients.@*CONCLUSION@# The key to improve pain management in the ED-setting may lay in investing in continuous training of ED health care professionals and/or acquiring professionals who are both qualified in PSA and available in the ED.

Effect of dexmedetomidine hydrochloride on senile patients with hypertension during cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the effect of dexmedetomidine hydrochloride on hemodynamics, sedation and analgesia effect during cataract surgery for senile patients with hypertension.METHODS: Totally 90 senile patients with hypertension receiving cataract surgery were randomly divided into two groups, 45 cases in study group during the surgery by intravenous infusion of dexmedetomidine hydrochloride, 45 cases in control group were given normal saline for intravenous infusion.Blood flow dynamics index level were detected in two groups at five time points of before surgery (T0), beginning of the surgery (T1), 10 min after beginning (T2), 20 min after beginning (T3), the end of surgery (T4).Analgesia and sedation scores were compared in two groups, the incidence of adverse reactions and complications were recorded in two groups.RESULTS: Heart rate (HR), diastolic blood pressure (DBP), systolic blood pressure (SBP) increased significantly at the time points of T1, T2, T3, T4 compared with T0 time point in the control group (P0.05).Sedation scores in the study group were significantly higher than that of the control group at the same time (P<0.05).The incidence of adverse reactions and complications in the study group was significantly lower than that of the control group (P<0.05).CONCLUSION: Application of dexmedetomidine hydrochloride to monitoring anesthesia during senile cataract patients with hypertension surgery, can stabilize the hemodynamics and has obvious sedation and analgesia effect.

End-tidal capnometry during emergency department procedural sedation and analgesia: a randomized, controlled study / 世界急诊医学杂志（英文）

@#BACKGROUND:This prospective, randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry (ETC) to pulse oximetry (PO) in patients undergoing procedural sedation and analgesia (PSA) in the emergency department (ED). METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of care. Primary endpoints included respiratory adverse events, with secondary endpoints of level of sedation, hypotension, other PSA-related adverse events and patient satisfaction. RESULTS:Of 986 patients, 501 were randomized to usual care and 485 to additional ETC monitoring. In this series, 48％ of the patients were female, with a mean age of 46 years. Orthopedic manipulations (71％), cardioversion (12％) and abscess incision and drainage (12％) were the most common procedures, and propofol and fentanyl were the sedative/analgesic combination used for most patients. There was no difference in patients experiencing de-saturation (SaO2<90％) between the two groups; however, patients in the ETC group were more likely to require airway repositioning (12.9％ vs. 9.3％,P=0.003). Hypotension (SBP<100 mmHg or <85 mmHg if baseline <100 mmHg) was observed in 16 (3.3％) patients in the ETC group and 7 (1.4％) in the control group (P=0.048). CONCLUSIONS:The addition of ETC does not appear to change any clinically significant outcomes. We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used. We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.