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1.
J Neurosci Nurs ; 52(5): 214-218, 2020 Oct.
Article in English | MEDLINE | ID: mdl-32649381

ABSTRACT

BACKGROUND: Electroencephalography (EEG) enables the precise evaluation of a neonate's condition. Three factors that determine the quality of care during this procedure are knowledge, experience, and attitude. The role of the nurse during EEG recordings was evaluated in this study, and the requirements for successfully performing neonatal EEGs, along with practical suggestions, are presented. METHODS: Evidence in the literature as well as clinical expertise forms the basis for this review. RESULTS: From our observations and practice during EEGs, we found that the following conditions must be met to successfully perform an EEG examination in a newborn: safety, a period of sleep and calm wakefulness of the neonate, good technical conditions, and no external interferences. Key conditions include the maintenance of safety rules and cooperation between nurses, EEG technicians, and parents. CONCLUSION: The EEG examinations in neonates weighing less than 1500 g or those requiring respiratory support should only be performed by a trained neonatal intensive care unit nurse.


Subject(s)
Electroencephalography/nursing , Guidelines as Topic , Infant, Very Low Birth Weight , Neuroscience Nursing , Patient Safety , Video Recording , Health Knowledge, Attitudes, Practice , Humans , Infant, Newborn , Poland , Sleep/physiology
2.
Rev Infirm ; 66(227): 42-43, 2017 Jan.
Article in French | MEDLINE | ID: mdl-28048996

ABSTRACT

Drug-resistant epilepsy has significant repercussions on the daily life of children. Surgery may represent a hope. The nurse and the electroencephalogram technician carry out important teamwork during pre-surgical assessment tests and notably the stereo-electroencephalography.


Subject(s)
Drug Resistant Epilepsy , Electroencephalography/methods , Patient Care Team/organization & administration , Child , Cooperative Behavior , Drug Resistant Epilepsy/diagnosis , Drug Resistant Epilepsy/nursing , Drug Resistant Epilepsy/physiopathology , Drug Resistant Epilepsy/surgery , Electroencephalography/nursing , Humans , Preoperative Care/methods , Preoperative Care/nursing
3.
Neonatal Netw ; 35(2): 78-86, 2016.
Article in English | MEDLINE | ID: mdl-27052982

ABSTRACT

Therapeutic hypothermia (TH) is now considered a standard in tertiary NICUs. Amplitude-integrated electroencephalography (aEEG) is an important adjunct to this therapy and is gaining acceptance for use on the neonatal population. It can be easily incorporated into practice with appropriate education and training. Current publications are lacking regarding nursing care of neonatal patients undergoing th with the use of aEEG. This article presents a broad educational program as well as novel teaching tool for neonatal nurses caring for this population.


Subject(s)
Education, Nursing/methods , Electroencephalography , Hypothermia, Induced , Hypoxia-Ischemia, Brain , Neurophysiological Monitoring , Teaching Materials , Electroencephalography/methods , Electroencephalography/nursing , Humans , Hypothermia, Induced/adverse effects , Hypothermia, Induced/methods , Hypoxia-Ischemia, Brain/diagnosis , Hypoxia-Ischemia, Brain/nursing , Hypoxia-Ischemia, Brain/therapy , Infant, Newborn , Neurophysiological Monitoring/methods , Neurophysiological Monitoring/nursing , Teaching
4.
Korean J Intern Med ; 31(2): 260-6, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26932401

ABSTRACT

BACKGROUND/AIMS: The efficacy of bispectral index (BIS) monitoring during colonoscopic sedation is debated. We aimed to determine whether BIS monitoring was useful for propofol dose titration, and to evaluate differences in sedative administration between expert and inexperienced medical personnel during colonoscopy procedures that required moderate sedation. METHODS: Between February 2012 and August 2013, 280 consecutive patients scheduled to undergo a screening colonoscopy participated in this study and were randomly allocated to the expert or inexperienced endoscopist group. Each group was further divided into either a BIS or a modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S) subgroup. Trained nurses administered combined propofol sedation and monitored sedation using either the BIS or MOAA/S scale. RESULTS: The mean BIS value throughout the procedure was 74.3 ± 6.7 for all 141 patients in the BIS group. The mean total propofol dose administered in the BIS group was higher than that in the MOAA/S group, independently of the endoscopists' experience level (36.9 ± 29.6 and 11.3 ± 20.7, respectively; p < 0.001). The total dose of propofol administered was not significantly different between the inexperienced endoscopist group and the expert endoscopist group, both with and without the use of BIS (p = 0.430 and p = 0.640, respectively). CONCLUSIONS: Compared with monitoring using the MOAA/S score alone, BIS monitoring was not effective for titrating the dose of propofol during colonoscopy, irrespective of colonoscopist experience.


Subject(s)
Anesthetics, Intravenous/administration & dosage , Clinical Competence , Colonoscopy , Conscious Sedation/nursing , Consciousness Monitors , Consciousness/drug effects , Electroencephalography/instrumentation , Electroencephalography/nursing , Nurse Anesthetists , Propofol/administration & dosage , Adult , Aged , Anesthetics, Intravenous/adverse effects , Conscious Sedation/adverse effects , Female , Humans , Male , Middle Aged , Predictive Value of Tests , Propofol/adverse effects , Prospective Studies , Republic of Korea
6.
World J Gastroenterol ; 18(43): 6284-9, 2012 Nov 21.
Article in English | MEDLINE | ID: mdl-23180950

ABSTRACT

AIM: To determine whether bispectral index (BIS) monitoring is useful for propofol administration for deep sedation during endoscopic retrograde cholangiopancreatography (ERCP). METHODS: Fifty-nine consecutive patients with a variety of reasons for ERCP who underwent the procedure at least twice between 1 July 2010 and 30 November 2010. This was a randomized cross-over study, in which each patient underwent ERCP twice, once with BIS monitoring and once with control monitoring. Whether BIS monitoring was done during the first or second ERCP procedure was random. Patients were intermittently administered a mixed regimen including midazolam, pethidine, and propofol by trained nurses. The nurse used a routine practice to monitor sedation using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale or the BIS monitoring. The total amount of midazolam and propofol used and serious side effects were compared between the BIS and control groups. RESULTS: The mean total propofol dose administered was 53.1 ± 32.2 mg in the BIS group and 54.9 ± 30.8 mg in the control group (P = 0.673). The individual propofol dose received per minute during the ERCP procedure was 2.90 ± 1.83 mg/min in the BIS group and 3.44 ± 2.04 mg in the control group (P = 0.103). The median value of the MOAA/S score during the maintenance phase of sedation was comparable for the two groups. The mean BIS values throughout the procedure (from insertion to removal of the endoscope) were 76.5 ± 8.7 for all 59 patients in using the BIS monitor. No significant differences in the frequency of < 80% oxygen saturation, hypotension (< 80 mmHg), or bradycardia (< 50 beats/min) were observed between the two study groups. Four cases of poor cooperation occurred, in which the procedure should be stopped to add the propofol dose. After adding the propofol, the procedure could be conducted successfully (one case in the BIS group, three cases in the control group). The endoscopist rated patient sedation as excellent for all patients in both groups. All patients in both groups rated their level of satisfaction as high (no discomfort). During the post-procedural follow-up in the recovery area, no cases of clinically significant hypoxic episodes were recorded in either group. No other postoperative side effects related to sedation were observed in either group. CONCLUSION: BIS monitoring trend to slighlty reduce the mean propofol dose. Nurse-administered propofol sedation under the supervision of a gastroenterologist may be considered an alternative under anesthesiologist.


Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Consciousness Monitors , Deep Sedation/nursing , Electroencephalography/nursing , Hypnotics and Sedatives/administration & dosage , Monitoring, Physiologic/nursing , Nurse Anesthetists , Propofol/administration & dosage , Chi-Square Distribution , Cross-Over Studies , Deep Sedation/adverse effects , Female , Humans , Hypnotics and Sedatives/adverse effects , Male , Monitoring, Physiologic/instrumentation , Predictive Value of Tests , Propofol/adverse effects , Prospective Studies , Republic of Korea , Wakefulness/drug effects
7.
J Neurosci Nurs ; 44(2): E1-5, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22367276

ABSTRACT

Approximately a third of patients in neuroscience intensive care units (ICUs) experience subclinical seizures and, as a result, are at higher risk for poor outcomes. The use of continuous electroencephalography (cEEG) monitoring can help nurses detect seizure activity and initiate early prevention. Nurse competency in the use of cEEG is important to facilitate effective bedside monitoring. The objective of this study was to evaluate the effectiveness of a staff educational program aimed at improving the knowledge of nurses in the use of cEEG monitoring in adults. A quasi-experimental pretest/posttest 1-group design was utilized. Neuroscience ICU registered nurses, whose experience ranged from 2 months to 24 years, participated in the study. Participants completed a pretest on seizure knowledge and the use of cEEG monitoring. Participants received a 4-hour educational session on the use of cEEG monitoring. Immediately after the program and again 1 month later, they completed a posttest. Test scores improved significantly from pretest to the first posttest (t = -15.093, p < .001). Although there was a slight decline in the mean score from the posttest to the 1-month follow-up, posttest scores were significantly better than the pretest score (t = -12.42, df = 44, p < .001). Whereas years of experience correlated positively to the pretest score, after the intervention, no such correlation was evident. The results demonstrated that an educational program improved the competency of nurses in the use of cEEG with adult patients in a neuroscience ICU and that this knowledge was sustained over time. Further research is needed to demonstrate the effectiveness of this intervention in other settings.


Subject(s)
Critical Care/methods , Electroencephalography/nursing , Monitoring, Physiologic/nursing , Nursing Staff, Hospital/education , Specialties, Nursing/education , Staff Development/methods , Adult , Brain Injuries/diagnosis , Brain Injuries/nursing , Brain Injuries/physiopathology , Humans , Intensive Care Units , Middle Aged , Nursing Evaluation Research , Specialties, Nursing/methods , Trauma Centers , Young Adult
10.
Nurs Stand ; 24(39): 48-56; quiz 58, 2010.
Article in English | MEDLINE | ID: mdl-20572555

ABSTRACT

Sedatives may be administered to patients in the hospital setting to provide comfort and reduce anxiety and pain. A variety of sedative agents can be used depending on the circumstances and the type of sedation required. This article provides an overview of the different levels of sedation, the most common pharmacological agents, used and the potential side effects and complications. The importance of patient assessment is emphasised.


Subject(s)
Conscious Sedation , Inpatients , Adult , Anesthetics/therapeutic use , Anxiety/etiology , Anxiety/prevention & control , Conscious Sedation/adverse effects , Conscious Sedation/methods , Conscious Sedation/nursing , Critical Illness/therapy , Diazepam/therapeutic use , Drug Monitoring/methods , Drug Monitoring/nursing , Electroencephalography/methods , Electroencephalography/nursing , Humans , Hypnotics and Sedatives/therapeutic use , Ketamine/therapeutic use , Lorazepam/therapeutic use , Midazolam/therapeutic use , Nursing Assessment , Pain/etiology , Pain/prevention & control , Propofol/therapeutic use , Psychomotor Agitation/drug therapy
11.
Clin Nurse Spec ; 24(3): 140-8, 2010.
Article in English | MEDLINE | ID: mdl-20404622

ABSTRACT

Frequently, intensive care nurses assume responsibility for extubating patients after undergoing cardiac surgery. Bispectral index (BIS) monitoring assesses level of mental arousal and awareness when sedated. This study was to determine if the BIS might facilitate earlier extubation of patients following cardiac surgery. A study was conducted comparing 25 stable patients returning to the intensive care unit with a BIS with 25 patients managed without the BIS (N = 50). Data collected included age, sex, surgery, pH, CO2, and temperature on arrival/extubation, total intravenous propofol and pain medication, and BIS scores. Student t tests determined that there were no differences between groups for age, amount of propofol and pain medication received, or time to extubation (P > .05). Regression analysis determined that total propofol, total hydromorphone, and age were significant predictors of time to extubation. In this study, the BIS monitor did not facilitate earlier extubation in the stable patient after cardiac surgery.


Subject(s)
Critical Care/methods , Electroencephalography/methods , Monitoring, Physiologic/methods , Postoperative Care/methods , Ventilator Weaning/methods , Attitude of Health Personnel , Cardiac Surgical Procedures/nursing , Chi-Square Distribution , Clinical Nursing Research , Conscious Sedation/nursing , Conscious Sedation/statistics & numerical data , Electroencephalography/nursing , Female , Humans , Male , Middle Aged , Monitoring, Physiologic/nursing , Nursing Assessment/methods , Nursing Methodology Research , Nursing Staff, Hospital/education , Nursing Staff, Hospital/organization & administration , Nursing Staff, Hospital/psychology , Pilot Projects , Postoperative Care/education , Postoperative Care/nursing , Prospective Studies , Regression Analysis , Time Factors , Ventilator Weaning/nursing
12.
Neonatal Netw ; 27(5): 329-37, 2008.
Article in English | MEDLINE | ID: mdl-18807413

ABSTRACT

Continuously monitoring brain ftinction at the bedside in the NICU for term infants at risk of brain injury has become part of routine clinical practice in many countries. These monitors offer invaluable information about the sick infant's neurologic status by providing real-time measurements of the brain's electrical activity and identifring or confirming seizure activity. With the increasing availability of bedside electroencephalogram technology, it is essential for neonatal intensive care nursing staff to understand the rationale for its use, as well as the fundamentals of application and interpretation of this new technology.


Subject(s)
Brain Diseases/prevention & control , Electroencephalography/nursing , Electroencephalography/instrumentation , Electroencephalography/methods , Humans , Hypoxia-Ischemia, Brain/diagnosis , Infant, Newborn , Intensive Care Units, Neonatal , Male , Point-of-Care Systems , Seizures/diagnosis
17.
Crit Care Nurs Clin North Am ; 18(2): 227-41, xi, 2006 Jun.
Article in English | MEDLINE | ID: mdl-16728309

ABSTRACT

In situations in which clinical assessment of sedation level is compromised, such as deep sedation/analgesia with and without neuromuscular blockade (NMB), electroencephalogram-based monitoring may potentially assist in achieving balance between inadequate and excessive levels of sedation. To validate the bispectral index (BIS) for use in clinical practice, correlation and possible differences in outcome using clinical assessment versus clinical assessment augmented by electroencephalogram-based monitoring were determined. BIS monitoring was decisive in ICU care in 9 of 15 patients in this series. The most significant potential benefit was obtained in the subset of patients receiving NMB.


Subject(s)
Conscious Sedation , Critical Care/methods , Drug Monitoring/methods , Electroencephalography/methods , Adult , Aged , Clinical Nursing Research , Conscious Sedation/adverse effects , Conscious Sedation/nursing , Critical Care/standards , Drug Monitoring/nursing , Drug Monitoring/standards , Electroencephalography/nursing , Electroencephalography/standards , Female , Humans , Linear Models , Male , Middle Aged , Neurologic Examination/methods , Neurologic Examination/nursing , Neurologic Examination/standards , Neuromuscular Blockade , Nursing Assessment/methods , Nursing Assessment/standards , Nursing Evaluation Research , Patient Selection , Respiration, Artificial/adverse effects , Signal Processing, Computer-Assisted , Treatment Outcome
19.
AACN Clin Issues ; 16(4): 526-41, 2005.
Article in English | MEDLINE | ID: mdl-16269897

ABSTRACT

Patients with severe traumatic brain injury resulting in increased intracranial pressure refractory to first-tier interventions challenge the critical care team. After exhausting these initial interventions, critical care practitioners may utilize barbiturate-induced coma in an attempt to reduce the intracranial pressure. Titrating appropriate levels of barbiturate is imperative. Underdosing the drug may fail to control the intracranial pressure, whereas overdosing may lead to untoward effects such as hypotension and cardiac compromise. Monitoring for a therapeutic level of barbiturate coma includes targeting drug levels and using continuous electroencephalogram monitoring, considered the gold standard. New technology, the Bispectral Index monitor, utilizes electroencephalogram principles to monitor the level of sedation and hypnosis in the critical care environment. This technology is now being considered for targeting appropriate levels of barbiturate coma.


Subject(s)
Brain Injuries/complications , Critical Care/methods , Drug Monitoring/methods , Electroencephalography/methods , Electromyography/methods , Hypnotics and Sedatives/therapeutic use , Intracranial Hypertension/prevention & control , Pentobarbital/therapeutic use , Adult , Algorithms , Brain Injuries/therapy , Clinical Protocols , Critical Care/standards , Decision Trees , Drug Monitoring/nursing , Drug Monitoring/standards , Electroencephalography/nursing , Electromyography/nursing , Evidence-Based Medicine , Humans , Intracranial Hypertension/diagnosis , Intracranial Hypertension/etiology , Male , Neurologic Examination/methods , Neurologic Examination/nursing , Nursing Assessment , Patient Selection , Practice Guidelines as Topic , Signal Processing, Computer-Assisted , Trauma Severity Indices , Treatment Outcome
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