ABSTRACT
Background: Patients undergoing an interventional radiology procedure report some degree of anxiety. Therefore, procedure-related anxiety needs to be managed. The aim of our study was to investigate patient satisfaction with monitored anesthesia care (MAC) for uterine artery embolization (UAE)-related procedural anxiety in symptomatic uterine fibroids or adenomyosis. Method(s): Between May 2021 and June 2022, 36 patients with symptomatic fibroids or adenomyosis underwent UAE with MAC. Follow-up evaluations consisted of clinical symptoms, degree of satisfaction with MAC in UAE, and complications. Result(s): MAC in UAE was successfully performed in all patients. UAE significantly reduced patients' complaints such as bleeding and pain: the scores for bleeding and pain were significantly reduced after 3 months of UAE compared with those before UAE, indicating the effectiveness of UAE. The mean score of satisfaction with MAC in UAE was 4.3 points, meaning that 94.4% of women were satisfied or very satisfied. No major complications were observed. Conclusion(s): MAC in UAE for symptomatic uterine fibroids or adenomyosis can be emotionally effective and safe for patients who are anxious about the procedure.Copyright © 2023 The Author(s).
ABSTRACT
Introduction: The bispectral index monitors the unawareness component of balanced anaesthesia and gives us the depth of Anesthesia.It reflects the response of the brain to a variety of hypnotic and inhaled anaesthesia agents. The aim of this study was to see the effect of different MAC values of isoflurane on the bispectral index and hemodynamic variations at different MAC values. Material(s) and Method(s): This prospective study was conducted on 20 patients at tertiary care center for 6 months. After induction of Anesthesia, following parameters were recorded: noninvasive blood pressure measurement, heart rate, oxygen saturation, ETCo2 and BIS values. The BIS was continuously monitored and when the MAC values of isoflurane were 0.5, 0.7, 1, 1.2 and 1.5 corresponding BIS values and all the other haemodynamic parameters were noted. Result(s): In 11 patients out of 20 patients satisfactory BIS of 40-60 was achieved at MAC 0.5. In 16 out of 20 patients satisfactory BIS 40-60 was achieved at 0.7 MAC. In all the 20 patients satisfactory BIS was achieved at 1 MAC.In 2 out of 20 patients we couldn't proceed beyond 1.0 MAC because of the fall in MAP to <65mm of Hg. In 4 out of 20 patients we couldn't proceed beyond 1.2MAC because of the fall in MAP to <65mm of Hg. Conclusion(s): Isoflurane produced satisfactory BIS of 40-60 in 16 patients at 0.7 MAC and in all the 20 patients at 1 MAC.Use of BIS in our study helped in better titration of Isoflurane according to patient's individual needs thereby we avoided light plane of anaesthesia or deep hypnosis and the adverse effects associated with it. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
INTRODUCTION: During the COVID-19 pandemic, continuous infusion neuromuscular blocking agents (NMBA) were frequently utilized. International guidelines for NMBA use in critically ill patients recommend patients achieve deep sedation using a continuous sedative and analgesic prior to and during neuromuscular blockade, and documentation is essential to confirm adequate sedation. The aim of this evaluation was to assess the use of sedation and analgesia in paralyzed patients. METHODS: A retrospective multi-center study was performed on fifty adult patients randomly selected from five hospitals across the health system based on the proportion of patients on NMBA at each delivery network. Patients were included if they received a continuous infusion NMBA between March 24 and May 8, 2020. The primary outcome was documentation of adequate sedation and analgesia prior to NMBA initiation, defined as a Richmond Agitation- Sedation Scale (RASS) -4 to -5 while receiving both sedative and analgesic infusions. Secondary outcomes included RASS documentation within 2 hours prior to and bispectral index (BIS) 2 hours after NMBA initiation, and incidence of medication orders updated with appropriate sedation goal. RESULTS: We identified 21 (42%) patients with documentation of adequate sedation and analgesia prior to NMBA initiation. Adequate sedation was documented in 22 (44%) patients, with 24 (48%) not at goal, 3 (6%) not documented, and 1 (2%) without a continuous sedative order. Adequate analgesia was documented in 39 (78%) patients, with 8 (16%) having as-needed intravenous (IV) push opiates orders and 3 (6%) without analgesia orders. Medication orders were updated with appropriate sedation goal in 2 (4%) patients. Documentation of sedation was completed within 2 hours of NMBA initiation in 25 (50%) patients and in 18 (36%) 2 hours after initiation. CONCLUSIONS: Electronic health records should be optimized to facilitate ordering appropriate sedation and analgesia with appropriate titration parameters, and to ensure that an appropriate level of sedation is documented prior to NMBA initiation. Adequate documentation may have been limited due to BIS monitor availability and medication orders with outdated titration parameters.