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Freeman, Sarah L., and Gary C. W. England. "Comparison of sedative effects of romifidine following intravenous, intramuscular, and sublingual administration to horses." American Journal of Veterinary Research 60, no. 8 (1999): 954–64. http://dx.doi.org/10.2460/ajvr.1999.60.08.954.
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Abstract Objective To compare sedative effects of romifidine following IV, IM, or sublingual (SL) administration in horses. Animals 30 horses that required sedation for routine tooth rasping. Procedure Horses (n = 10/group) were given romifidine (120 μg/kg) IV, IM, or SL. Heart rate, respiratory rate, head height, distance between the ear tips, thickness of the upper lip, response to auditory stimulation, response to tactile stimulation, and degree of ataxia were recorded every 15 minutes for 180 minutes. Tooth rasping was performed 60 minutes after administration of romifidine, and overall adequacy of sedation was assessed. Results IV and IM administration of romifidine induced significant sedation, but SL administration did not induce significant sedative effects. Scores for overall adequacy of sedation after IV and IM sedation were not significantly different from each other but were significantly different from scores for horses given romifidine SL. Sedative and other effects varied among groups during the first 60 minutes after drug administration; thereafter, effects of IV and IM administration were similar. Conclusions and Clinical Relevance Onset of action was fastest and degree of sedation was greater after IV, compared with IM, administration of romifidine, but duration of action was longer after IM administration. Sublingual administration did not result in clinically important sedative effects. (Am J Vet Res 1999;60:954-959)
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Salman, Jasim M., Jasim N. Al-Asadi, Husham H. Abdul-Ra’aoof, Jawad H. Ahmed, and Ali H. Reshak. "COMPARISON OF INTRAMUSCULAR VERSUS INTRAVENOUS KETAMINE FOR SEDATION IN CHILDREN UNDERGOING MAGNETIC RESONANCE IMAGING EXAMINATION." Wiadomości Lekarskie 76, no. 1 (2023): 198–204. http://dx.doi.org/10.36740/wlek202301127.
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The aim: To compare efficacy of intramuscular (IM) versus intravenous (IV) ketamine for sedation in children undergoing brain MRI scanning in children. Materials and methods: Children who required elective brain MRI were selected for this study. They were randomly divided into two groups; group I received 1.5 mg/kg IV Ketamine and group II received 4 mg/kg IM ketamine. In each group supplementary 0.1 mg/kg midazolam intravenously before positioning on MRI table was given. Patients were monitored for pulse rate, SPO2, and respiratory wave. Results: Children who received IM ketamine had significantly shorter scan time and a greater success rate of sedation with first dose than the IV group. The proportions of scan interruption and scan repeat were significantly higher among the IV group than in the IM group. The scan time was longer among the IV group than in the IM group with significantly more scan interruption and repeat. Satisfaction with sedation as expressed by the technicians was significantly more in the IM group than in IV group (98.1% vs. 80.8%, P= 0.004). Conclusions: Intramuscular ketamine injection was predicted to have a better sedative success rate and takes less time to complete than intravenous admin¬istration. This makes IM ketamine more appealing in certain conditions.
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Barr, Juliana, Katayoun Zomorodi, Edward J. Bertaccini, Steven L. Shafer, and Eran Geller. "A Double-blind, Randomized Comparison of IV Lorazepam versus Midazolam for Sedation of ICU Patients via a Pharmacologic Model." Anesthesiology 95, no. 2 (2001): 286–98. http://dx.doi.org/10.1097/00000542-200108000-00007.
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Background Benzodiazepines, such as lorazepam and midazolam, are frequently administered to surgical intensive care unit (ICU) patients for postoperative sedation. To date, the pharmacology of lorazepam in critically ill patients has not been described. The aim of the current study was to characterize and compare the pharmacokinetics and pharmacodynamics of lorazepam and midazolam administered as continuous intravenous infusions for postoperative sedation of surgical ICU patients. Methods With Institutional Review Board approval, 24 consenting adult surgical patients were given either lorazepam or midazolam in a double-blind fashion (together with either intravenous fentanyl or epidural morphine for analgesia) through target-controlled intravenous infusions titrated to maintain a moderate level of sedation for 12-72 h postoperatively. Moderate sedation was defined as a Ramsay Sedation Scale score of 3 or 4. Sedation scores were measured, together with benzodiazepine plasma concentrations. Population pharmacokinetic and pharmacodynamic parameters were estimated using nonlinear mixed-effects modeling. Results A two-compartment model best described the pharmacokinetics of both lorazepam and midazolam. The pharmacodynamic model predicted depth of sedation for both midazolam and lorazepam with 76% accuracy. The estimated sedative potency of lorazepam was twice that of midazolam. The predicted C50,ss (plasma benzodiazepine concentrations where P(Sedation > or = ss) = 50%) values for midazolam (sedation score [SS] > or = n, where n = a Ramsay Sedation Score of 2, 3, ... 6) were 68, 101, 208, 304, and 375 ng/ml. The corresponding predicted C50,ss values for lorazepam were 34, 51, 104, 152, and 188 ng/ml, respectively. Age, fentanyl administration, and the resolving effects of surgery and anesthesia were significant covariates of benzodiazepine sedation. The relative amnestic potency of lorazepam to midazolam was 4 (observed). The predicted emergence times from sedation after a 72-h benzodiazepine infusion for light (SS = 3) and deep (SS = 5) sedation in a typical patient were 3.6 and 14.9 h for midazolam infusions and 11.9 and 31.1 h for lorazepam infusions, respectively. Conclusions The pharmacology of intravenous infusions of lorazepam differs significantly from that of midazolam in critically ill patients. This results in significant delays in emergence from sedation with lorazepam as compared with midazolam when administered for ICU sedation.
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Yen, Philip, Simon Prior, Cara Riley, William Johnston, Megann Smiley, and Sarat Thikkurissy. "A Comparison of Fospropofol to Midazolam for Moderate Sedation During Outpatient Dental Procedures." Anesthesia Progress 60, no. 4 (2013): 162–77. http://dx.doi.org/10.2344/0003-3006-60.4.162.
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Abstract Moderate intravenous (IV) sedation combined with local anesthesia is common for outpatient oral surgery procedures. An ideal sedative agent must be safe and well tolerated by patients and practitioners. This study evaluated fospropofol, a relatively new sedative/hypnotic, in comparison to midazolam, a commonly used benzodiazepine, for IV moderate sedation during oral and maxillofacial surgery. Sixty patients were randomly assigned to either the fospropofol or the midazolam group. Each participant received 1 μg/kg of fentanyl prior to administration of the selected sedative. Those in the fospropofol group received an initial dose of 6.5 mg/kg, with 1.6 mg/kg supplemental doses as needed. Those in the midazolam group received initial doses of 0.05 mg/kg, followed by 0.02 mg/kg supplemental doses. The quality of sedation in each patient was evaluated with regard to (a) onset of sedation, maintenance, and recovery profile; (b) patient and surgeon satisfaction; and (c) hemodynamic stability and adverse effects. The fospropofol group demonstrated shorter physical recovery times than midazolam patients, taking a mean of 11.6 minutes versus 18.4 minutes for physical recovery (P = .007). Cognitive recovery comparison did not find any difference with a mean of 7.5 minutes versus 8.8 minutes between the 2 drug groups (P = .123). The fospropofol group had a higher rate of local anesthetic injection recall (90.5 vs 44.4%, P = .004). Other parameters of recall were comparable. Two adverse effects demonstrated significance, with more patients in the midazolam group experiencing tachycardia (48.2 vs 9.4%, P = .001), and more patients in the fospropofol group experiencing perineal discomfort (40.6 vs 0, P < .001). No significant difference was found in any other measures of sedation safety, maintenance, or satisfaction. Fospropofol, when administered intravenously by a dentist anesthesiologist at the indicated dose in this study, appears to be a safe, well-tolerated alternative to midazolam for intravenous moderate sedation during minor oral surgery procedures.
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Abed, Hassan, Ali Al-Qarni, Shanon Patel, and Abdulaziz Bakhsh. "Clinical tips for safe and effective root canal treatment under intravenous sedation with midazolam." Dental Update 50, no. 8 (2023): 695–98. http://dx.doi.org/10.12968/denu.2023.50.8.695.
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Intravenous (IV) sedation with midazolam works as an anxiolytic and muscle relaxant agent and has proved successful in providing safe root canal treatment (RCT) for patients with dental anxiety or special care needs. However, before starting RCT under IV sedation with midazolam, clinicians should consider obtaining a thorough medical history and written, informed consent including any significant or unavoidable risks. A responsible adult escort should also accompany the patient to their appointment. The dental team should also ensure labelling the IV sedation drugs and irrigant solutions, and using a well-sealed rubber dam. CPD/Clinical Relevance: This article provides clinical recommendations to help provide safe RCT under IV sedation with midazolam.
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Martinez, Jose L., Kimberly A. Sutters, Steven Waite, et al. "A Comparison of Oral Diazepam Versus Midazolam, Administered With Intravenous Meperidine, as Premedication to Sedation for Pediatric Endoscopy." Journal of Pediatric Gastroenterology and Nutrition 35, no. 1 (2002): 51–58. http://dx.doi.org/10.1002/j.1536-4801.2002.tb07726.x.
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ABSTRACTObjectivesThis study was performed to compare the effects of oral midazolam and oral diazepam, administered with intravenous (IV) meperidine, on pre‐procedural, procedural, and post‐procedural sedation and recovery in children undergoing diagnostic upper endoscopy. The costs of pre‐procedure sedation were compared for the two benzodiazepines.MethodsA randomized, double‐blind study was conducted in 154 children (mean age 96.73 ± 59.34 months, 53% male) undergoing endoscopy. Oral midazolam (0.5 mg/kg, maximum dose of 20 mg) or oral diazepam (0.3 mg/kg, maximum dose of 10 mg) was given before IV insertion, and with IV meperidine (2 mg/kg, maximum dose of 100 mg) given to all patients just before upper endoscopy. Further “rescue” midazolam doses (to a maximum cumulative dose of 5 mg) were given as needed to achieve a pre‐procedure sedation score of ≥2. All patients received intravenous propofol for procedural sedation. Patients were evaluated for the efficacy and safety of pre‐procedural sedation, sedation during upper endoscopy, and recovery following completion of the procedure.ResultsThere were no significant differences between study groups for level of pre‐procedural sedation, need for midazolam rescue in endoscopy, effectiveness of procedural sedation, occurrence of adverse events, and recovery parameters.ConclusionsOral midazolam and diazepam, in conjunction with IV administration of meperidine, provide comparable, effective, and safe premedication for children undergoing upper endoscopy. The cost of midazolam was substantially higher than diazepam.
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McLaughlin, Kevin, Shannon Carabetta, Nicholas Hunt, et al. "Safety of Intravenous Push Lacosamide Compared With Intravenous Piggyback at a Tertiary Academic Medical Center." Annals of Pharmacotherapy 55, no. 2 (2020): 181–86. http://dx.doi.org/10.1177/1060028020943569.
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Background: There are limited data regarding the incidence of adverse events associated with administering lacosamide by intravenous push (IVP) compared with IV piggyback (IVPB). Objective: The objective of this analysis was to compare the safety profile, including cardiovascular effects, sedative effects, and IV site reactions of IVP and IVPB lacosamide administration. Methods: A retrospective pre/post cohort analysis comparing patients who received lacosamide via IVP and IVPB was conducted. Safety end points included hypotension, bradycardia, medication-related sedation, and IV site reactions. The relationship between patient characteristics and the incidence of safety end points was analyzed using the Student t-test and χ2 test as appropriate. Results: Bradycardia occurred after 0.19% of IVP administrations and 1.09% of IVPB administrations assessed ( P = 0.07). Hypotension was observed in 3.16% of IVP administrations compared to 1.59% in the IVPB cohort ( P = 0.12). Post lacosamide-related sedation was noted in 11.32% and 11.68% of the IVP and IVPB cohorts, respectively ( P = 0.87). Infusion site reaction rates of 1.80% and 0.84% were documented in the IVP and IVPB cohorts, respectively ( P = 0.33). Of note, only 1 adverse event required clinical intervention. One 200-mg dose in the IVP cohort required a fluid bolus postadministration. Conclusion and Relevance: IVP lacosamide was associated with a similar incidence of cardiovascular, neurological, and infusion site–related adverse events compared with IVPB, in which nearly every adverse event was deemed clinically insignificant. Lacosamide administered via IVP may be considered a safe alternative method of administration in the acute care setting.
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Costa, Giovanna L., Fabio Leonardi, Claudia Interlandi, et al. "Tramadol Administered Intravenously Either as a Bolus or a Slow Injection in Pain Management of Romifidine-Sedated Calves Undergoing Umbilical Hernia Repair." Animals 13, no. 7 (2023): 1145. http://dx.doi.org/10.3390/ani13071145.
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Umbilical hernias in calves occur with relative frequency. Most abdominal surgeries can be performed in cattle using standing sedation and local blocks. Romifidine is widely used in calves, alone or in combination with opioids. Tramadol administered as an intravenous slow injection provided better analgesia than an IV bolus in cows. The aim of the present study was to compare the response to surgical stimulus, and sedative effects of tramadol administered intravenously either as a bolus or a slow injection in romifidinesedated calves. Twenty Frisian calves undergoing umbilical hernia repair received romifidine (0.08 mg/kg IM; time 0) followed by tramadol (1 mg/kg IV) 5 min later either as a bolus (n = 10, B group) or a slow injection over 10 min (n = 10, SI group). Surgical area was infiltrated with lidocaine (4 mg/kg). Heart rate (HR), respiratory rate (RR), systolic, dyastolic and mean arterial pressure (SAP, DAP, MAP), sedation scores and response to surgical stimulus were recorded for up to 55 min. After the calves recovered a standing position, postoperative pain scores were assessed for up to 50 min. Sedation scores were significantly higher in the SI group than in the B group at 55 min (p < 0.05). HR, RR, SAP and response to surgical stimulus were significantly higher in the B group than in the SI group (p < 0.05). No significant differences were recorded in postoperative pain scores between groups (p > 0.05). Romifidine IM followed by intravenous tramadol, as a bolus or slow injection and local infiltration with lidocaine provided adequate sedation and analgesia in calves undergoing umbilical hernia repair.
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Olabi, Nassim F., James E. Jones, Mark A. Saxen, et al. "The Use of Office-Based Sedation and General Anesthesia by Board Certified Pediatric Dentists Practicing in the United States." Anesthesia Progress 59, no. 1 (2012): 12–17. http://dx.doi.org/10.2344/11-15.1.
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The purpose of this study is to explore the use of office-based sedation by board-certified pediatric dentists practicing in the United States. Pediatric dentists have traditionally relied upon self-administered sedation techniques to provide office-based sedation. The use of dentist anesthesiologists to provide office-based sedation is an emerging trend. This study examines and compares these two models of office-based sedations. A survey evaluating office-based sedation of diplomates of the American Board of Pediatric Dentistry (ABPD) based on gender, age, years in practice, practice types, regions, and years as a diplomate of the ABPD was completed by 494 active members. The results were summarized using frequencies and percentages. Relationships of dentist age, gender, and number of years in practice with the use of intravenous (IV) sedation was completed using two-way contingency tables and Mantel-Haenszel tests for ordered categorical data. Relationships of office-based sedation use and the type of one's practice were examined using Pearson chi-square tests. Of the 1917 surveys e-mailed, 494 completed the survey for a response rate of 26%. Over 70% of board-certified US pediatric dentists use some form of sedation in their offices. Less than 20% administer IV sedation, 20 to 40% use a dentist anesthesiologist, and 60 to 70% would use dentist anesthesiologists if one were available.
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Kurhekar, Pranjali, and J. Shesha dhiviya Krishna. "Randomized Double-Blind Trial Comparing Efficacy of Intravenous Nalbuphine vs Intrathecal Nalbuphine for Prevention of Intrathecal Morphine Induced Pruritus in Orthopaedic Surgeries." Sri Lankan Journal of Anaesthesiology 31, no. 2 (2023): 128–34. http://dx.doi.org/10.4038/slja.v31i2.9031.
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Intrathecal morphine provides excellent postoperative pain relief but results in pruritus in 30-60% of patients. Nalbuphine, an opioid agonist-antagonist prevents intrathecal morphine-induced itch when given by intravenous route. In this study, we compared efficacy of intrathecal and intravenous nalbuphine for the prevention of intrathecal morphine-induced pruritus. 90 patients were randomly divided into two groups. IT group received 100 mcg of morphine with 400 mcg of nalbuphine intrathecally. IV group received 100 mcg of morphine intrathecally and 400 mcg of nalbuphine intravenously. Incidence of itching, respiratory depression, hypotension, nausea, vomiting, sedation and analgesia were compared between the groups every 4th hourly for 24 hours. Data were analyzed with Chi-square test and Mann-Whitney test. Incidence of itching in 24 hours period was 11.6% (5 patients) in IV group and 4.8% (2 patients) in IT group which was comparable. (P= 0.250) Two patients in IV group had intractable itching requiring naloxone. Incidence of itching at all time intervals was comparable between the groups. Analgesia was prolonged in IV group (P=0.03) Incidence of nausea, vomiting, sedation and respiratory depression was comparable. We conclude that intrathecal nalbuphine and intravenous nalbuphine were equally effective in preventing intrathecal morphine induced pruritus. The duration of analgesia was more when nalbuphine was given by IV route as compared to IT route.
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Aseri, Zohair Al, Mariam Ali Alansari, Sara Ali Al-Shami, Bayan Alaskar, Dhuha Aljumaiah, and Alyaa Elhazmi. "The advantages of inhalational sedation using an anesthetic-conserving device versus intravenous sedatives in an intensive care unit setting: A systematic review." Annals of Thoracic Medicine 18, no. 4 (2023): 182–89. http://dx.doi.org/10.4103/atm.atm_89_23.
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Abstract: BACKGROUND: Sedation is fundamental to the management of patients in the intensive care unit (ICU). Its indications in the ICU are vast, including the facilitating of mechanical ventilation, permitting invasive procedures, and managing anxiety and agitation. Inhaled sedation with halogenated agents, such as isoflurane or sevoflurane, is now feasible in ICU patients using dedicated devices/systems. Its use may reduce adverse events and improve ICU outcomes compared to conventional intravenous (IV) sedation in the ICU. This review examined the effectiveness of inhalational sedation using the anesthetic conserving device (ACD) compared to standard IV sedation for adult patients in ICU and highlights the technical aspects of its functioning. METHODS: We searched the PubMed, Cochrane Central Register of Controlled Trials, The Cochrane Library, MEDLINE, Web of Science, and Sage Journals databases using the terms “anesthetic conserving device,” “Anaconda,” “sedation” and “intensive care unit” in randomized clinical studies that were performed between 2012 and 2022 and compared volatile sedation using an ACD with IV sedation in terms of time to extubation, duration of mechanical ventilation, and lengths of ICU and hospital stay. RESULTS: Nine trials were included. Volatile sedation (sevoflurane or isoflurane) administered through an ACD shortened the awakening time compared to IV sedation (midazolam or propofol). CONCLUSION: Compared to IV sedation, volatile sedation administered through an ACD in the ICU shortened the awakening and extubation times, ICU length of stay, and duration of mechanical ventilation. More clinical trials that assess additional clinical outcomes on a large scale are needed.
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Miyake, Kota, Hitoshi Higuchi, Saki Miyake, et al. "Evaluation of Sedation Levels Using SedLine During Intravenous Sedation for Dental Procedures: A Case-Series Study." Anesthesia Progress 70, no. 2 (2023): 85–87. http://dx.doi.org/10.2344/anpr-70-01-01.
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The Patient State Index (PSI) is the numerical value of anesthesia depth as measured using a SedLine Sedation Monitor (Masimo Corporation). In this pilot study, we evaluated PSI values captured during intravenous (IV) moderate sedation for dental treatment. During the dental treatment, a dental anesthesiologist maintained the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score at 3 to 4 by adjusting the administration of midazolam and propofol while PSI values were recorded. The mean (SD) and median (25th percentile, 75th percentile) PSI values during dental treatment under IV moderate sedation were 72.7 (13.6) and 75 (65, 85), respectively.
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Khadri, Syed Najeebullah, R. Shankar Anand, K. Soundarya Priyadharsini, and T. Krishna Prasad. "Comparison of postoperative analgesia by preemptive use of intravenous paracetamol and intravenous ketorolac in patients undergoing elective laparoscopic surgeries." Journal of Current Research in Scientific Medicine 10, no. 1 (2024): 38–43. http://dx.doi.org/10.4103/jcrsm.jcrsm_129_23.
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Abstract Background: Preemptive analgesia involves the introduction of an analgesic regimen before the onset of surgical stimuli. Paracetamol and ketorolac are effective in blunting postoperative pain scores and opioid consumption, but their comparison, when used preemptively, has been less studied. The study aim to compare the clinical efficacy of intravenous (IV) paracetamol and IV ketorolac given preemptively, to blunt the postoperative pain among patients undergoing laparoscopic surgeries. Materials and Methods: This was a double-blinded randomized control study conducted on 48 patients undergoing laparoscopic surgeries, and they were allotted into groups of 24 each. Patients in Group 1 received an IV paracetamol infusion of 1 g over 10–15 min, 1 h before surgery. Group 2 received IV ketorolac 30 mg in 100 mL NS over 10–15 min, 1 h before surgery. The primary aim of the study was to monitor postoperative pain using the Visual Analog Scale (VAS). The secondary aim was to monitor the rescue analgesia with the opioid. Hemodynamics and sedation score were monitored every 2 h till 12 h postsurgery. Results: The mean time to the first rescue drug among the paracetamol group was lower and statistically significant (P < 0.05) compared to the ketorolac group. The pulse rate, VAS, mean systolic blood pressure (SBP), Mean arterial pressure (MAP), and sedation score among the paracetamol group were insignificant compared to the ketorolac group at different time intervals. Conclusion: Postoperatively, sedation was not significantly different between the groups. The pain score was significantly lower and the time to first rescue was significantly higher among the ketorolac group compared to the paracetamol group. The preemptive use of IV ketorolac provided better postoperative analgesia compared with IV paracetamol in patients undergoing elective laparoscopic surgeries.
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Hussien, Rania Maher, Dalia Fahmy Emam, and Aktham Adel Shoukry. "Dexmedetomidine compared to ketofol for sedation in pediatric patients undergoing dental procedures: a double-blind, randomized clinical trial." Anaesthesia, Pain & Intensive Care 26, no. 5 (2022): 595–601. http://dx.doi.org/10.35975/apic.v26i5.2016.
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Background & objective: Hospital phobia and anxiety are still prevalent issues in the pediatric patients. Various sedative regimes have been in dental practice, but the evidence for safe and effective sedative drugs in this population is scarce. We compared the safety and efficacy of intravenous combination of ketamine plus propofol (ketofol) with dexmedetomidine (Dex) as a sedative premedication in anxious children undergoing dental pulp therapy.
 Methodology: This double-blind, randomized clinical study recruited 40 anxious children who were to undergo dental pulp therapy. The study participants were allocated into two groups (20 subjects each). Subjects in Group I received ketofol solution (ketamine/propofol mixture, each mL contains 2 mg of ketamine plus 4 mg of propofol). A loading dose of 0.3125 mL/kg was administered intravenously (IV) over 10 min, followed by maintenance infusion at a rate of 0.05-0.125 mL/kg/h. Subjects in Group II received the Dex solution (4 µg/mL). A loading dose of 2 µg/kg was administered IV over 10 min, followed by a maintenance infusion of 0.1-1 µg/kg/h. Non-invasive blood pressure, SpO2, heart rate (HR), and respiratory rate (RR) were assessed at baseline, at 2 min, and then at 5 min intervals till 60 min. Ramsay sedation score was assessed before, during, and after the procedure and Aldrete's recovery rating score was assessed at the end of the procedure.
 Results: Compared to the Dex group, the ketofol group showed a statistically significant shorter sedation onset (P = 0.017) but longer discharge time as well as higher rescue dose and a number of interruptions (P < 0.001). There was more stable respiration in Dex group, but with significantly more bradycardia. The mean arterial blood pressure showed some episodes of significant elevations with ketofol compared to Dex, while a biphasic response was observed in the Dex group.
 Conclusion: The use of Dex induced successful sedation of children who underwent tooth pulp therapy in terms of minimizing the number of interruptions during the procedure, the frequency of rescue drugs administration as well as the total procedure and discharge times. Dexmedetomidine showed no adverse respiratory effects but was associated with bradycardia and biphasic mean blood pressure alterations that require careful titration.
 Abbreviations: HR: heart rate; IV: Intravenous; RSS: NMDA: N-Methyl D-Aspartate PACU: Post Anesthesia Care Unit; Ramsay sedation score
 Citation: Hussien RM, Emam DF, Shoukry AA. Dexmedetomidine compared to ketofol for sedation in pediatric patients undergoing dental procedures: a double-blind, randomized clinical trial. Anaesth. pain intensive care 2022;26(5):595-601; DOI: 10.35975/apic.v26i5.2016
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Zec, Stephanie, Mark A. Mitchell, Kelly Rockwell, and Dana Lindemann. "Evaluating the Anesthetic and Physiologic Effects of Intramuscular and Intravenous Alfaxalone in Eastern Mud Turtles (Kinosternon subrubrum)." Animals 14, no. 3 (2024): 460. http://dx.doi.org/10.3390/ani14030460.
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Current sedation protocols for chelonians can pose a challenge to clinicians because of prolonged induction and recovery times, difficulties in gaining venous access, and natural species variation. This study evaluated the sedative and physiologic effects of intramuscular (IM) and intravenous (IV) alfaxalone in six wild-caught adult eastern mud turtles (Kinosternon subrubrum). The turtles received alfaxalone 10 mg/kg IM and IV in a randomized cross-over design. A 10-day washout period occurred between trials. Baseline parameters (heart rate, respiratory rate, temperature, and reflexes) were assessed prior to injection and every 5 min post-injection until recovery. Three venous blood gas samples were also collected and analyzed over the course of each trial (baseline, induction, and recovery). Intravenous alfaxalone resulted in a significantly faster induction (p = 0.016; median: 1.5 min, 25–75%: 1–7.5, minimum–maximum: 1–21) and a shorter total sedation time (p = 0.041; median: 52 min, 25–75%: 34.5–62.5, minimum–maximum: 33–87) when compared with IM alfaxalone (induction, median: 20 min, 25–75%: 15–22.5, minimum–maximum: 15–25; total, median: 70 min, 25–75%: 65–82.5, minimum–maximum: 65–90). Blood gas and physiologic parameters were not significantly different between groups; however, the pH (p = 0.009) and glucose (p = 0.0001) significantly increased, and partial pressure of carbon dioxide (p = 0.024) significantly decreased over time. This study demonstrated that alfaxalone 10 mg/kg IV or IM can be used to provide safe and effective sedation in eastern mud turtles.
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RAVIKUMAR, KAVIN, SIVASHANKAR RAMAKRISHNAN, PUSHKINRAJ HARIDOSS, and KANNAN THANDAVAN ARTHANARI. "Effects of intravenous xylazine versus dexmedetomidine premedication with ketamine-midazolam-isoflurane anaesthesia for castration in horses." Indian Journal of Animal Sciences 94, no. 2 (2024): 117–22. http://dx.doi.org/10.56093/ijans.v94i2.135343.
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The objectives of this research was to study the sedation and anaesthetic characteristics of intravenous xylazine and dexmedetomidine combined with ketamine-midazolam-isoflurane and to evaluate the cardiopulmonary effects during the anaesthetic period. Stallions were premedicated with xylazine (1.1 mg/kg IV) in Group 1 and dexmedetomidine (3.5 µg/kg IV) in Group 2. Sedation quality was evaluated and scored. General anaesthesia was achieved with ketamine (2.2 mg/kg IV) and midazolam (0.1 mg/kg IV) in both groups and anaesthesia was maintained with isoflurane inhalant in fresh oxygen gas flow (6-8 L/min). All the stallions underwent an orchiectomy by the half- closed method. Cardiovascular variables and pulmonary variables were recorded using multi gas vital sign monitor. Anaesthetic parameters, reflex status and quality of muscle relaxation were assessed. After the surgical procedure, recovery was monitored and scored on 6 point scale. Sedation score and quality was clinically better in Group 2. The difference in cardiopulmonary variables was statistically not significant. However, statistically significant changes were noticed between two groups with regard to some blood gas values during the intra-operative and at 15 min post anaesthetic period. Quality of muscle relaxation was better in group 2. Recovery was not significant. Overall quality of anaesthesia and recovery was almost similar in both the groups. In conclusion, both drug combinations produced satisfactory results for castration in the horses studied. In this study, dexmedetomidine at 3.5 µg/kg and xylazine at 1.1 mg/kg sedative doses did not result in much significant changes compared to one other.
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Sanchez, Antoine, Jan Chrusciel, Yann Cimino, et al. "Evaluation of Monitored Anesthesia Care Involving Sedation and Axillary Nerve Block for Day-Case Hand Surgery." Healthcare 10, no. 2 (2022): 313. http://dx.doi.org/10.3390/healthcare10020313.
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Background: Ultrasound-guided axillary brachial plexus block (ABPB) is a technique of choice for regional anesthesia during hand and forearm surgery. Intravenous sedation may facilitate this procedure, particularly for those suffering from anxiety; however, it can also be associated with respiratory, cardiovascular, and neurological side effects. The objective of this study was to evaluate the effect of intravenous sedation on perioperative respiratory depression for patients undergoing day-case hand surgery under ABPB. Methods: A prospective, observational, single-center study was conducted between 1 May and 1 November 2016. Results: A total of 2318 patients were included, with 501 patients in the group with IV sedation and 1817 in the group without. A multivariable propensity-score matched analysis showed that the variables associated with the number of desaturation were: (i) sedation (aRR 1.534 [95% CI: 1.283 to 1.836]), (ii) age and sex, (iii) type of surgery, and iv) Body Mass Index (BMI). Conclusions: Supplementing ABPB with IV sedation was associated with an increased rate of respiratory depression (episodes of desaturation) compared to fully awakened patients. The rate of oxygen administration was also higher in sedated patients even though they had fewer cases of chronic respiratory diseases and fewer were active smokers than non-sedated patients. Future research should consider precisely evaluating patient satisfaction, as well as the differences between sedation and drug-free approaches.
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Khorassani, Farah, and Maha Saad. "Intravenous Olanzapine for the Management of Agitation: Review of the Literature." Annals of Pharmacotherapy 53, no. 8 (2019): 853–59. http://dx.doi.org/10.1177/1060028019831634.
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Objective: The purpose of this review is to summarize the current evidence of the off-label use of intravenous (IV) olanzapine and discuss its risks versus benefits for the management of agitation. Data Sources: A literature search was conducted to gather relevant data regarding IV use of olanzapine for the management of acute agitation. PubMed, EMBASE, MEDLINE, and IPA were searched using the keywords and MESH terms: olanzapine, intravenous, IV, off-label, and agitation. Study Selection and Data Extraction: All case reports, and retrospective and prospective studies evaluating the efficacy and safety of IV olanzapine administration for agitation from January 2004 to December 2018 were analyzed. Data Synthesis: Doses from 2.5 to 10 mg given as an IV bolus (maximum dose of 30 mg/d) have been administered. Rescue medications such as droperidol or parenteral benzodiazepines are sometimes coadministered to assist with achieving adequate sedation. Prospective studies demonstrate efficacy similar to droperidol in achieving adequate sedation within 10 minutes and similar time to onset of sedation. Rates of respiratory depression and airway obstruction are low and similar to that of comparative agents, including intramuscular olanzapine. Relevance to Patient Care and Clinical Practice: This review evaluated the off-label use of IV olanzapine to manage agitation based on case reports, and retrospective and prospective data. Conclusions: The use of IV olanzapine remains controversial in the absence of clear evidence evaluating safety and efficacy. Future studies are warranted comparing IV olanzapine with more commonly utilized and Food and Drug Administration–approved treatment modalities for acute agitation in the emergency department and other settings.
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Nys, Margaux, Melisa Garip, Ruxandra Coropciuc, Jan Meeus, Paul Legrand, and Constantinus Politis. "Complications of Intravenous Midazolam–Fentanyl Sedation in Children and Adults Undergoing Oral Surgery: A Retrospective Study." Journal of Clinical Medicine 14, no. 12 (2025): 4096. https://doi.org/10.3390/jcm14124096.
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Objective: This study examines the incidence and predictors of complications following intravenous (IV) sedation in children and adults. Methods: A retrospective analysis of 1463 surgical procedures under IV sedation was conducted at the University Hospitals of Leuven (2018–2022). Patients aged 10–91 years were divided into pediatric (10–16 years, n = 731) and adult (17–91 years, n = 732) groups. Data were analyzed using multiple regression models (p < 0.05). Results: Side effects occurred more often during recovery (children: 20.1%, adults: 9.4%) than intraoperatively (children: 4.8%, adults: 2.7%). The most common side effects were nausea (children: 10.5%, adults: 8.4%) and prolonged sedation (children: 6.0%, adults: 1.8%). Younger children had higher risks of intraoperative side effects (p = 0.02), hypotension (p < 0.001), and longer recovery (p < 0.001). Ketamine increased nausea risk in children (p = 0.02). Females had a higher risk of prolonged sedation (p = 0.03) and nausea (p = 0.01). Older adults had fewer recovery-related side effects (p = 0.03) and shorter recovery times (p = 0.05). Conclusions: IV sedation is a safe alternative to general anesthesia in oral surgery when properly monitored. However, nausea and prolonged sedation remain concerns, particularly in younger children and females. Prophylactic anti-emetics and cautious Ketamine use may help mitigate risks.
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Sharma, Simran, Rutuja Gargote, Ms. Swarangi Marathe, Dr.Ashily Rajendran, and Dr. Akshay Meshram. "Pharmacotherapy in patient-controlled sedation techniques." International Journal of Advance and Applied Research 11, no. 6 (2024): 348–53. https://doi.org/10.5281/zenodo.13859337.
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Sedation is used to lessen discomfort, anxiety, and bad recollections of a surgery. Additionally, it can increase a procedure's efficacy. For example, being at ease may make it simpler to set a fractured bone. Procedural sedation is limited to simple, quick operations. All that is involved in patient controlled sedation is a painless process that the patient receives. Although local anesthetic is the most commonly utilized type of anesthesia, many patients are choosing the general anesthesia method since it provides them with a painless experience during the surgery. It is a drug-induced feeling of serenity, relaxation, or slumber. Sedation can be used to help manage extremely stressful situations or to help reduce anxiety during medical or surgical procedures. Since intravenous (IV) sedation is the safest and most predictable method, it is the preferred method for patient administration. Midazolam, propofol, and methohexitone were the drugs utilized, either alone or in conjunction with alfentanil or fentanyl. However, sedative usage has grown dramatically in recent years and will continue to rise steadily if not controlled. As a result, this essay explores strategies for cutting back on sedative usage and decreasing our reliance on them.
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Smith, Howard. "An Update of Evaluation of Intravenous Sedation on Diagnostic Spinal Injection Procedures." Pain Physician 2s;16, no. 2s;4 (2013): SE217—SE228. http://dx.doi.org/10.36076/ppj.2013/16/se217.
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Background: Intravenous (IV) sedation analgesia is often employed in patients with chronic spinal pain undergoing diagnostic spinal injection procedures. The drugs used for intravenous sedation analgesia produce varying degrees of sedation, amnesia, anxiolysis, muscle relaxation, and analgesia. The very nature of these pharmacologic effects in altering the patient’s level of consciousness, awareness, or response to a particular diagnostic stimulus invokes a sense of uncertainty about the results or response obtained from the diagnostic procedure. There is an ongoing controversy regarding the validity of controlled diagnostic blocks due to variability in sensitivity, specificity, and accuracy. Moreover, there is no consensus with regards to the use of sedation analgesic measures prior to controlled diagnostic blocks and their influence on the accuracy and validity of a diagnosis. Objective: To assess and update the clinically significant effects sedation analgesia procedures have on the diagnostic accuracy and validity of interventional spinal techniques. Methods: A comprehensive literature search using PubMed, EMBASE, and Cochrane Library review databases up to September 2012 was performed. The search included systematic and narrative review articles, prospective and retrospective studies, as well as cross-referencing of bibliographies from notable primary and review articles and abstracts from scientific meetings and peer-reviewed non-indexed journals. The search emphasized the effects of sedation analgesia on diagnostic spinal interventions. Conclusion: Based on a review of the available evidence, it appears that the administration of mild to moderate sedation does not confound the results or diagnostic validity of spinal injection procedures. Specifically, immediate pain relief after cervical and lumbar facet joint controlled nerve blocks is not enhanced by IV sedation with midazolam or fentanyl. This is especially true if stringent outcome criteria are employed, such as at least 75% pain relief combined with an increase in range of motion for pain limited movements. Key words: Conscious sedation, procedural sedation, intravenous sedation, analgesia, hypnotics, sedatives, anxiolytics, opioids, chronic spinal pain, spinal injections, epidural injections, controlled diagnostic nerve blocks, zygapophyseal or facet joint blocks, selective nerve root blocks, provocation discography, sacroiliac joint injections, outcomes
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Flores-Pérez, Carmen, Janett Flores-Pérez, Luis Alfonso Moreno-Rocha, et al. "Influence of Age and Sex on the Pharmacokinetics of Midazolam and the Depth of Sedation in Pediatric Patients Undergoing Minor Surgeries." Pharmaceutics 15, no. 2 (2023): 440. http://dx.doi.org/10.3390/pharmaceutics15020440.
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Whether age and sex influence the depth of sedation and the pharmacokinetics of midazolam is currently unknown. The influence of age and sex was investigated in 117 children (2 to 17 years) who required intravenous sedation for minor surgery (0.05 mg/kg). Plasma concentrations and sedation effects were simultaneously measured. The measured concentrations were analyzed using a two-compartment model with first-order elimination. Among the age ranges, significant differences were found (p < 0.05) between the volume of distribution (Vd) of the first compartment (V1) and that of the second (V2). With respect to sex, differences in V2 were found between age groups. At the administered dose, in patients younger than 6 years, a profound sedative effect (40–60 BIS) was observed for up to 120 min, while in older children, the effect lasted only half as long. The differences found in the Vd and bispectral index (BIS) in patients younger than 6 years compared to older patients may be due to immature CYP3A activity and body fat content; furthermore, the Vd varies with age due to changes in body composition and protein binding. Patients younger than 6 years require intravenous (IV) doses <0.05 mg/kg of midazolam for deep sedation. Dosage adjustments according to age group are suggested.
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Manu Dadhwal, Anupama Gupta, and Ajay Kurian. "A randomized controlled interventional study for analgesic effects of intrathecal versus intravenous dexmedetomidine on subarachnoid anesthesia with hyperbaric bupivacaine." Asian Journal of Medical Sciences 16, no. 2 (2025): 8–13. https://doi.org/10.71152/ajms.v16i2.4273.
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Background: Various pharmacologic agents such as opioids, benzodiazepines, ketamine, and alpha2 adrenergic agonists are commonly used to increase the duration of subarachnoid block. Alpha2 agonists have analgesia and sedative properties when used as adjuvant in regional anesthesia. Stable hemodynamics and decreased oxygen requirement due to enhanced sympathoadrenal stability make them very useful adjuvants. Aims and Objectives: To evaluate the effects of intrathecal versus intravenous (IV) dexmedetomidine on the block, characteristics, and sedation in patients receiving subarachnoid block with hyperbaric bupivacaine. Materials and Methods: In this prospective, randomized controlled, double-blind study total of 90 patients with the American Society of Anesthesiologists grade I and II were randomly allocated into three groups: Group A (n=30) received IV 20 mL 0.9% NaCl over 10 min followed by intrathecal 2.4 mL 0.5% hyperbaric bupivacaine+0.2 mL normal saline, group B (n=30) received IV 20 mL 0.9% NaCl over 10 min followed by intrathecal 2.4 mL 0.5% hyperbaric bupivacaine+0.2 mL (5 mcg) dexmedetomidine, and group C (n=30) received IV dexmedetomidine 1 mcg/kg in 20 mL 0.9% NaCl over 10 min followed by intrathecal 2.4 mL 0.5% hyperbaric bupivacaine+0.2 mL normal saline. Results: The mean time for two-segment regression in group A was 100.57±4.24 min, in group B it was 193.3±7.07 min, and in group C was 170.23±3.53 min. The duration of sensory and motor block was prolonged in groups B and C. The Visual analog scale scores were comparatively higher in group A than in groups B and C. The Sedation score in group C was significantly higher as compared to groups A and B. Conclusion: Both intrathecal and IV dexmedetomidine prolong the effect of intrathecal hyperbaric bupivacaine, improves post-operative analgesia, and provides arousable sedation without causing hemodynamic instability.
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Shionoya, Yoshiki, Kaoru Hirayama, Kaho Saito, et al. "Anesthetic Management of a Patient With Catecholaminergic Polymorphic Ventricular Tachycardia." Anesthesia Progress 69, no. 2 (2022): 24–29. http://dx.doi.org/10.2344/anpr-68-04-03.
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Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited arrhythmogenic disorder induced by adrenergic stress. Electrophysiologically, it is characterized by emotional stress- or exercise-induced bidirectional ventricular tachycardia that may result in cardiac arrest. Minimizing perioperative stress is critical as it can reduce fatal arrhythmias in patients with CPVT. Dexmedetomidine (DEX), a centrally acting sympatholytic anesthetic agent, was used in the successful intravenous (IV) moderate sedation of a 27-year-old female patient with CPVT, a history of cardiac events, and significant dental fear and anxiety scheduled to undergo mandibular left third molar extraction. Oral surgery was successfully performed under DEX-based IV sedation to reduce stress, and no arrhythmias were observed. IV sedation with DEX provided a sympatholytic effect with respiratory and cardiovascular stability in this patient with CPVT who underwent oral surgery.
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Sumaiya, Tahseen, S. Prabhakar, Krishnan Subi, and Sampath Arun. "A Comparative Study of Dexmedetomidine versus Midazolam with Fentanyl for Monitored Anaesthesia Care in Tympanoplasty under Local Anaesthesia." International Journal of Pharmaceutical and Clinical Research 15, no. 1 (2023): 739–46. https://doi.org/10.5281/zenodo.13143659.
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<strong>Background and Aims:</strong> Monitored anaesthesia care is a process in which several medicines are used to administer local anaesthesia and sedation. This comparative study was done to determine the safety and efficacy of Dexmedetomidine and midazolam with fentanyl for tympanoplasty under MAC. <strong>Methods:</strong> Sixty patients between the ages of 18 and 60 years who were scheduled for tympanoplasty under MAC were randomly divided into two groups. Group D (n = 30) patients were administered intravenous (IV) dexmedetomidine 1 mcg/kg as a bolus followed by 0.2 ml/kg/h normal saline infusion. Patients in Group MF (n =30) received intravenous administration of midazolam 0.05 mg/kg + fentanyl 1.5 mcg/kg as a bolus, followed by 0.2 ml/kg/h normal saline infusion. Intraoperatively, the heart rate (HR), mean arterial pressure (MAP), amount of sedation, and degree of analgesia were evaluated. Postoperatively, Pulse Rate (PR) and Mean Arterial Pressure (MAP) were evaluated. The data were analyzed using an unpaired t-test. <strong>Result:</strong> Dexmedetomidine produced significant decrease in heart rate and mean arterial pressure, improved sedation and analgesia during surgery, and a reduced need for rescue sedative and analgesic dosages. <strong>Conclusion:</strong> Dexmedetomidine is superior to midazolam and fentanyl for sedation and analgesia during tympanoplasty surgery under supervised anaesthetic care because it results in a better hemodynamic profile, sedation, and analgesia.
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Liew, Jonathan, and Michael Winston. "Retrospective audit of midazolam dose and intravenous sedation record keeping in a primary care oral surgery service." Primary Dental Journal 11, no. 1 (2022): 50–57. http://dx.doi.org/10.1177/20501684221085846.
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Regular and robust audit of conscious sedation practice is key to the delivery of safe and effective patient care in all clinical settings. Analysis of outcomes will help to highlight any necessary modifications to procedures and techniques. The Intercollegiate Advisory Committee for Sedation in Dentistry (IACSD) states that conscious sedation procedures must be the subject of robust and regular audit in which every member within the team takes part.1 This completed audit cycle highlighted the efficacy of intravenous (IV) midazolam in anxious patients undergoing oral surgical procedures and the suitability for its use in the primary care setting. No patient safety concerns or complications were recorded in this audit and midazolam was administered within the recommended dose range. By the conclusion of two audit cycles, all clinicians providing intravenous sedation within the service were aware of the missing elements in sedation record-keeping and were able to complete accurate contemporaneous records before, during and after conscious sedation, ensuring the continuous delivery of high-quality, safe, and patient-centred care.
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Peguero, Julio Antonio, Ahmed Ayad, Stacia Young-Wesenberg, Teresa Yang, Janine North, and Nancy Joseph-Ridge. "Optimizing chair time in infusion centers using intravenous cetirizine premedication for the prevention of hypersensitivity infusion reactions." Journal of Clinical Oncology 39, no. 15_suppl (2021): e13508-e13508. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e13508.
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e13508 Background: Oncology infusion centers are increasingly focused on improving operational efficiencies and patient satisfaction, while maintaining quality care. One key component is optimizing chair time, which has been especially important for patient safety during the COVID-19 pandemic to reduce risk of transmission. Many infusions require antihistamine premedication to reduce the risk of hypersensitivity infusion reactions (IRs). The two IV options are IV diphenhydramine and IV cetirizine, which have a quicker onset than oral options and can be administered IV push. In treating acute urticaria, IV cetirizine was shown to be comparable to IV diphenhydramine, with fewer side effects, and it may be effective for preventing IRs with improved chair time. Methods: A randomized, double-blind phase 2 study evaluating premedication with single dose IV cetirizine 10 mg versus IV diphenhydramine 50 mg was conducted in 34 patients receiving paclitaxel, rituximab, its biosimilar or obinutuzumab (first cycle, retreatment after 6 months or with persistent IRs). The primary objective was the incidence of IRs after premedication. Secondary endpoints included sedation due to antihistamines and time to readiness for discharge. Sedation was reported by patients on a scale of 0-4 (0 = none to 4 = extremely severe). No formal statistical analyses were planned given the exploratory nature of the study. Results: Adults primarily with cancer (n = 31 [91%]) were enrolled during the COVID-19 pandemic, from March 25 to November 23, 2020. The median age was 65 and 67 years in the IV cetirizine and diphenhydramine groups, respectively. The number of patients with IRs was 2/17 (11.8%) with IV cetirizine versus 3/17 (17.6%) with IV diphenhydramine. The mean sedation score in the IV cetirizine group compared to the IV diphenhydramine group was lower at all time points, including at discharge (0.1 vs 0.4, respectively). Mean time to discharge was 24 minutes less with IV cetirizine (4.3 hours [1.5]) versus IV diphenhydramine (4.7 hours [1.2]). This difference was greater (30 minutes less) in those ≥65 years of age (4.4 [1.3] vs 4.9 [1.0] hours). Regardless of whether patients received paclitaxel (n = 9) or an anti-CD20 (n = 25), patients had less chair time when premedicated with IV cetirizine. There were fewer treatment-related adverse events (AEs) with IV cetirizine (2 events) than with IV diphenhydramine (4 events). Conclusions: This was the first randomized, controlled trial evaluating IV antihistamine premedication for IRs and chair time. It was shown that IV cetirizine can prevent IRs, with less sedation, fewer related AEs and reduced chair time compared to IV diphenhydramine. This improves infusion center operations and patient experience. Clinical trial information: NCT04189588.
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Arghya Maity, Rajasree Biswas, Suchismita Mallick, Sujata Ghosh, and Sarbari Swaika. "Comparison between transdermal buprenorphine and intravenous paracetamol for post-operative analgesia after major plastic reconstructive surgery under general anesthesia – A randomized double-blind controlled trial." Asian Journal of Medical Sciences 14, no. 3 (2023): 33–38. https://doi.org/10.71152/ajms.v14i3.3764.
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Background: Adequate pain management is an essential entity in reconstructive surgery to prevent adverse physiological and psychological outcome. Transdermal buprenorphine has been mostly studied in chronic pain and cancer related pain but hardly studies in acute pain are available. Aims and Objectives: The aims of this study were to compare post-operative pain relief achieved by transdermal buprenorphine and IV paracetamol in terms of safety and efficacy. Sedation and adverse effects were also studied. Materials and Methods: This is a prospective, parallel group, double-blind, and randomized trial. After ethics, clearance and consent from 46 patients undergoing major reconstructive surgery were allotted into Group B, (n=23) who received transdermal buprenorphine and Group P (n=23) who received m IV paracetamol 6 hourly. IV Paracetamol was taken as active control. Standard institutional protocol for general anesthesia was followed. Visual analog scale (VAS) score was measured postoperatively for 48 h. Diclofenac sodium was the rescue analgesic. Sedation was assessed by Ramsay Sedation score. Results: Transdermal buprenorphine patch (TDB) gave superior pain relief in comparison to intravenous paracetamol 48 h postoperatively, P≤0.0.5 pin VAS score. The total amount of rescue analgesic required was high in Group P than Group B (P=0.034). Hemodynamic stability was better maintained with TDB with minimal sedation and side effect. Conclusion: TDB (20 μg/h; 20 mg) can be safely used for post-operative analgesia with greater efficacy and minimal side effects when compared to intravenous paracetamol.
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Arghya Maity, Rajasree Biswas, Suchismita Mallick, Sujata Ghosh, and Sarbari Swaika. "Comparison between transdermal buprenorphine and intravenous paracetamol for post-operative analgesia after major plastic reconstructive surgery under general anesthesia – A randomized double-blind controlled trial." Asian Journal of Medical Sciences 14, no. 3 (2023): 33–38. http://dx.doi.org/10.3126/ajms.v14i3.50054.
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Background: Adequate pain management is an essential entity in reconstructive surgery to prevent adverse physiological and psychological outcome. Transdermal buprenorphine has been mostly studied in chronic pain and cancer related pain but hardly studies in acute pain are available. Aims and Objectives: The aims of this study were to compare post-operative pain relief achieved by transdermal buprenorphine and IV paracetamol in terms of safety and efficacy. Sedation and adverse effects were also studied. Materials and Methods: This is a prospective, parallel group, double-blind, and randomized trial. After ethics, clearance and consent from 46 patients undergoing major reconstructive surgery were allotted into Group B, (n=23) who received transdermal buprenorphine and Group P (n=23) who received m IV paracetamol 6 hourly. IV Paracetamol was taken as active control. Standard institutional protocol for general anesthesia was followed. Visual analog scale (VAS) score was measured postoperatively for 48 h. Diclofenac sodium was the rescue analgesic. Sedation was assessed by Ramsay Sedation score. Results: Transdermal buprenorphine patch (TDB) gave superior pain relief in comparison to intravenous paracetamol 48 h postoperatively, P≤0.0.5 pin VAS score. The total amount of rescue analgesic required was high in Group P than Group B (P=0.034). Hemodynamic stability was better maintained with TDB with minimal sedation and side effect. Conclusion: TDB (20 μg/h; 20 mg) can be safely used for post-operative analgesia with greater efficacy and minimal side effects when compared to intravenous paracetamol.
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Tyagi, P., U. Dixit, S. Tyagi, and A. Jain. "Sedative Effects of Oral Midazolam, Intravenous Midazolam and Oral Diazepam." Journal of Clinical Pediatric Dentistry 36, no. 4 (2012): 383–88. http://dx.doi.org/10.17796/jcpd.36.4.t1j3625831144371.
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To evaluate and compare the behavioral changes and effect of sedative techniques in pediatric dental patients using Oral Midazolam, Intravenous Midazolam and Oral Diazepam as sedative agents. Materials and Methods: Triple blind randomized control trial with 40 patients aged between 2-10 years, exhibiting definitely negative behavior was considered. Patients were randomly assigned to one of the four treatment groups. Group I received midazolam 0.5mg/kg orally, Group II received 0.5mg/kg diazepam orally, Group III received 0.06mg/kg midazolam intravenously and Group IV received oral placebo. Behavioral changes (sleep, crying, movement, and overall behavior) and effect of sedative techniques on pediatric patients were assessed. Results: All the patients in group 3 were significantly better in post administrative behavior viz. sleep, crying and movement. Over all behavior scores for group 3 patients were significantly better than other three groups (p&lt;0.001). Positive behavior of patients in group 2 and 3 did not show significant difference but positive behavior in group 3 was significantly (p&lt;0.05) more than group 2. Placebo group showed the highest negative behavior. Conclusion: Sedative effects of oral midazolam and oral diazepam were comparable, where as intravenous midazolam produced more sedation. Anxiolysis was found to be more in both the midazolam groups than the diazepam group. Most number of positive changes were observed in midazolam groups as compared to diazepam group.
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Sakurai, Satoru, Atsuo Fukunaga, Tatsuya Ichinohe, and Yuzuru Kaneko. "IV ATP Potentiates Midazolam Sedation as Assessed by Bispectral Index." Anesthesia Progress 61, no. 3 (2014): 95–98. http://dx.doi.org/10.2344/0003-3006-61.3.95.
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Abstract In this study, by measuring bispectral index (BIS), we tested the hypothesis that intravenous adenosine 5′-triphosphate (ATP) infusion would deepen the level of midazolam-induced sedation. Ten healthy volunteers underwent 2 experiments with at least 2 weeks' interval: immediately after intravenous bolus administration of midazolam (0.04 mg/kg), they received continuous infusion of either ATP infusion (100 μg/kg/min) or placebo (saline) for 40 minutes in a double-blind, randomized, crossover manner. Changes in BIS values and responsiveness to verbal command as well as cardiorespiratory variables were observed throughout the study periods. Administration of midazolam alone reduced BIS value from control: 97 ± 1 to 68 ± 18 at 25 minutes, which was accompanied by significant cardiopulmonary depressant effects, while maintaining responsiveness to verbal command (consciousness) throughout the study period. Coadministration of ATP with midazolam further reduced BIS value to 51 ± 13, associated with complete loss of consciousness without adverse effect on the cardiorespiratory systems. We conclude that the addition of ATP infusion to midazolam significantly enhances midazolam sedation without disturbing cardiorespiratory functions.
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Goneppanavar, Umesh, Rahul Magazine, Bhavya Periyadka Janardhana, and Shreepathi Krishna Achar. "Intravenous Dexmedetomidine Provides Superior Patient Comfort and Tolerance Compared to Intravenous Midazolam in Patients Undergoing Flexible Bronchoscopy." Pulmonary Medicine 2015 (2015): 1–8. http://dx.doi.org/10.1155/2015/727530.
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Dexmedetomidine, anα2agonist, has demonstrated its effectiveness as a sedative during awake intubation, but its utility in fiberoptic bronchoscopy (FOB) is not clear. We evaluated the effects of midazolam and dexmedetomidine on patient’s response to FOB. The patients received either midazolam, 0.02 mg/kg (group M,n=27), or dexmedetomidine, 1 µg/kg (group D,n=27). A composite score of five different parameters and a numerical rating scale (NRS) for pain intensity and distress were used to assess patient response during FOB. Patients rated the quality of sedation and level of discomfort 24 h after the procedure. Ease of bronchoscopy, rescue medication requirement, and haemodynamic variables were noted. Ideal or acceptable composite score was observed in 15 and 26 patients, respectively, in group M (14.48 ± 3.65) and group D (9.41 ± 3.13),p<0.001. NRS showed that 11 patients in group M had severe pain and discomfort as compared to one patient with severe pain and two with severe discomfort in group D during the procedure,p<0.001. Rescue midazolam requirement was significantly higher in group M (p=0.023). We conclude that during FOB, under topical airway anaesthesia, IV dexmedetomidine (1 µg/kg) provides superior patient comfort and tolerance as compared to IV midazolam (0.02 mg/kg).
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Ko, Jeff C. H., Mark E. Payton, Alison G. White, David S. Galloway, and Tomohito Inoue. "Effects of Intravenous Diazepam or Microdose Medetomidine on Propofol-Induced Sedation in Dogs." Journal of the American Animal Hospital Association 42, no. 1 (2006): 18–27. http://dx.doi.org/10.5326/0420018.
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This crossover study tested the hypothesis that both diazepam and microdose medetomidine would comparably reduce the amount of propofol required to induce sedation. Four different medications, namely high-dose diazepam (0.4 mg/kg intravenously [IV]), low-dose diazepam (0.2 mg/kg IV), medetomidine (1 μg/kg IV), and placebo (0.5 mL physiological saline IV) were followed by propofol (8 mg/kg IV) titrated to a point where intubation could be performed. The effects of medetomidine were comparable to the effects of high-dose diazepam and significantly better than the effects of low-dose diazepam or placebo. Dogs in all treatment groups had transient hypoxemia, and induction and recovery qualities were similar.
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Lamireau, Thierry, Marc Dubreuil, and Manuel Daconceicao. "Oxygen Saturation during Esophagogastroduodenoscopy in Children: General Anesthesia versus Intravenous Sedation." Journal of Pediatric Gastroenterology and Nutrition 27, no. 2 (1998): 172–75. http://dx.doi.org/10.1002/j.1536-4801.1998.tb01129.x.
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ABSTRACTBackground:Hypoxia may occur in children undergoing upper digestive endoscopy under sedation. The purpose of this study was to compare the occurrence of desaturation during intravenous sedation with that which occurs during general anesthesia.Methods:Thirty‐six patients between 3 months and 6 years old underwent a diagnostic esophagogastroduodenoscopy under sedation (n = 18) or general anesthesia (n = 18). Oxygen pulse oximetry, heart rate, and mean arterial pressure were monitored throughout the procedure. At the end of the procedure, the operator gave the value of the endoscopy satisfaction score on a scale of I (very good conditions) to IV (impossible procedure).Results:The minimum oxygen pulse oximetry value was significantly lower in the sedation group compared with that in the general anesthesia group (89± 5 vs. 97 ± 1; p < 0.001). In the general anesthesia group, the oxygen pulse oximetry level declined to less than 95% in only one child; but in the sedation group, it declined to less than 95% in 16 patients (5.5% vs. 89%). Nine patients had a profound desaturation in sedation group (oxygen pulse oximetry <90%); no patients in the general anesthesia group had desaturation (50% vs. 0%). In the general anesthesia group, heart rate and mean arterial pressure remained stable during the whole procedure, whereas in the sedation group, heart rate and mean arterial pressure increased significantly during the procedure. The endoscopy satisfaction score was I in all 18 patients in the general anesthesia group, whereas in the sedation group, it was I in only 2 patients, II in 8 patients, and III in 10 patients.Conclusions:These results confirm that hypoxia during upper digestive endoscopy in patients under sedation is a frequent occurrence in children. When compared with sedation, general anesthesia is a safer technique that prevents hypoxia and allows the gastroenterologist to perform the endoscopy under better conditions.
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Bueno, Aloisio C., Janyce Cornick-Seahorn, Thomas L. Seahorn, Giselle Hosgood, and Rustin M. Moore. "Cardiopulmonary and sedative effects of intravenous administration of low doses of medetomidine and xylazine to adult horses." American Journal of Veterinary Research 60, no. 11 (1999): 1371–76. http://dx.doi.org/10.2460/ajvr.1999.60.11.1371.
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Abstract Objective To determine the cardiopulmonary and sedative effects of medetomidine hydrochloride in adult horses and to compare those effects with effects of an equipotent dose of xylazine hydrochloride. Animals 10 healthy adult female horses. Procedure 5 horses were given medetomidine (4 μg/kg of body weight, IV), and the other 5 were given xylazine (0.4 mg/kg, IV). Heart rate, respiratory rate, arterial blood pressures, pulmonary arterial blood pressures, and cardiac output were recorded, and sedation and ataxia scores were assigned before and every 5 minutes after drug administration for 60 minutes. Rectal temperature and blood gas partial pressures were measured every 15 minutes after drug administration. Results Arterial blood pressure was significantly decreased throughout the study among horses given medetomidine and was significantly decreased for 40 minutes among horses given xylazine. Compared with baseline values, cardiac output was significantly decreased 10, 20, and 40 minutes after administration of medetomidine and significantly increased 40 and 60 minutes after administration of xylazine. Despite the significant decrease in respiratory rate in both groups, results of blood gas analyses were not significantly changed over time. Ataxia and sedation scores were of similar magnitude for the 2 groups, but ataxia persisted slightly longer among horses given medetomidine. Horses resumed eating hay 10 to 55 minutes after drug administration. Conclusions and Clinical Relevance Results suggest that equipotent low doses of medetomidine and xylazine induce comparable levels of ataxia and sedation and similar cardiopulmonary changes in adult horses. (Am J Vet Res 1999;60:1371–1376)
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JIA, Dong-lin, Cheng NI, Ting XU, Li-ping ZHANG, and Xiang-yang GUO. "A small-dose naloxone infusion alleviates nausea and sedation without impacting analgesia via intravenous tramadol." Chinese Medical Journal 123, no. 13 (2010): 1695–98. http://dx.doi.org/10.3760/cma.j.issn.0366-6999.2010.13.015.
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Background Early studies showed that naloxone infusion decreases the incidence of morphine-related side effects from intravenous patient-controlled analgesia. This study aimed to determine whether naloxone preserved analgesia while minimizing side effects caused by intravenous tramadol administration. Methods Eighty patients undergoing general anesthesia for cervical vertebrae surgery were randomly divided into four groups. All patients received 1 mg/kg tramadol 30 minutes before the end of surgery, followed by a continuous infusion with 0.3 mg-kg-1h-1 tramadol with no naloxone (group I, n=20), 0.05 μg-kg-1-h-1 naloxone (group II, n=20), 0.1 μg-kg-1-h-1 naloxone (group III, n=20) and 0.2 μg-kg-1-h-1 naloxone (group IV, n=20). Visual analog scales (VAS) for pain during rest and cough, nausea five-point scale (NFPS) for nausea and vomiting, and ramsay sedation score (RSS) for sedation were assessed at 2, 6, 12, 24 and 48 hours postoperatively. Analgesia and side effects were evaluated by blinded observers. Results Seventy-eight patients were included in this study. The intravenous tramadol administration provided the satisfied analgesia. There was no significant difference in either resting or coughing VAS scores among naloxone groups and control group. Compared with control group, sedation was less in groups II, III, and IV at 6, 12, and 24 hours (P <0.05); nausea was less in groups II, III and IV than group I at 2, 6, 12, 24 and 48 hours postoperatively (P <0.05). The incidence of vomiting in the control group was 35% vs. 10% for the highest dose naloxone group (group IV) (P <0.01). Conclusion A small-dose naloxone infusion could reduce tramadol induced side effects without reversing its analgesic effects.
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Gandhi, Monika, Swati Singh, Arpit Agrawal, and Arora KK. "Comparative evaluation of the effectiveness of nebulized dexmedetomidine V/S intravenous dexmedetomidine in blunting hemodynamic response to intubation – A prospective and randomized study." Asian Journal of Medical Sciences 14, no. 7 (2023): 47–51. http://dx.doi.org/10.3126/ajms.v14i7.53081.
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Background: Endotracheal intubation stimulates sympathetic system causing transient increase in heart rate and blood pressure which may be detrimental in patients with cardiovascular and cerebrovascular comorbidities. Intravenous dexmedetomidine given preoperatively prevents these unfavorable changes caused by endotracheal intubation. Aims and Objectives: The aims of this study were to compare effectiveness of nebulized dexmedetomidine and intravenous dexmedetomidine given preoperatively in blunting hemodynamic response (HR) to intubation. Materials and Methods: One hundred and twenty ASA I and II patients (either gender between 18 and 60 years) undergoing elective surgeries under general anesthesia were randomized into two equal groups in this prospective and comparative study. Thirty minutes before induction, Group IV received dexmedetomidine 0.50 μg/kg (diluted with normal saline [NS] to 50 mL) as slow IV infusion and nebulization with 5 mL NS, while Group N received nebulization with dexmedetomidine 1 μg/kg mixed with NS up to 5 mL along with 50 mL NS given as slow IV infusion. HR and mean arterial pressure (MAP) were noted at different intervals until extubation. Sedation score using Ramsay Sedation Scale (post-administration of drug) and adverse effects were noted. Comparison of HR and MAP was done using unpaired “t” test (P=0.05). Results: IV dexmedetomidine and nebulized dexmedetomidine given pre-induction were comparable in reducing stress response to intubation. The sedation score in both groups was comparable post-administration of drug. The incidence of hypotension was significantly more in IV group. Conclusion: Nebulized dexmedetomidine was equally efficacious in blunting HR to intubation as IV dexmedetomidine with fewer side effects making its administration safer for maintaining hemodynamic stability.
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Jevdjic, Jasna, Maja Surbatovic, Svetlana Drakulic-Miletic, and Filip Zunic. "Deep sedation with midazolam and propofol in children undergoing ambulatory magnetic resonance imaging of the brain." Vojnosanitetski pregled 68, no. 10 (2011): 842–45. http://dx.doi.org/10.2298/vsp1110842j.
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Backround/Aim. Sedation is necessary in children undergoing magnetic resonance imaging (MRI) to ensure motionless. The success of sedation is typically measured by two factors: safety (lack of adverse events) and effectiveness of the procedure (successful completion of the diagnostic examination). Propofol is frequently used to induce deep sedation in children. However, increased doses of propofol may lead to oversedation and respiratory depression. The aim of the study was to investigate sedation in children using propofol with midazolam in regard to efficacy, adverse events and time to return to presedation functional status. Methods. We investigated 24 children prospectively. Sedation was introduced with a single bolus of intravenous (iv) midazolam 0.1 mg/kg followed by repeated small iv boluses of propofol until sufficient depth of sedation was obtained. The outcome of sedation was measured by the induction time, sedation time, need for additional sedation, respiratory events, cardiovascular events and sedation failure. Results. Median age of children was 4.72 ? 3.06 (1.1-12.3) years and their body weight was 21.3 ? 11.9 (11-60) kg. Average propofol bolus dose for induction was 1.76 ? 0.9 (0.5-4) mg/kg. The induction time was 8.88 ? 2.92 (5-15) min, and sedation time 28.39 ? 8.42 (20-50) min. Additional sedation was necessary in 3 (12.5%) patients. Unsucesfull sedation or significant adverse events were not observed. Conclusion. The presented sedation technique for children undergoing ambulatory MRI of the brain is safe and adequate. This sedation regiment provides short induction time, fast recovery, stable cardiorespiratory conditions and rarely demans additional sedation.
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Tyagi, P., S. Tyagi, and A. Jain. "Sedative effects of Oral Midazolam, Intravenous Midazolam and Oral Diazepam in the Dental Treatment of Children." Journal of Clinical Pediatric Dentistry 37, no. 3 (2013): 301–6. http://dx.doi.org/10.17796/jcpd.37.3.6u482603r0388558.
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Objective: To evaluate and compare the behavioral changes and effect of sedative techniques in pediatric dental patients using Oral Midazolam, Intravenous Midazolam and Oral Diazepam as sedative agents. Method: Triple blind randomized control trial with 40 patients aged between 2-10 years, exhibiting definitely negative behavior was considered. Patients were randomly assigned to one of the four treatment groups. Group I received midazolam 0.5mg/kg orally, Group II received 0.5mg/kg diazepam orally, Group III received 0.06mg/kg midazolam intravenously and Group IV received oral placebo. Behavioral changes (sleep, crying, movement, and overall behavior) and effect of sedative techniques on pediatric patients were assessed. Results: All the patients in group 3 were significantly better in post administrative behavior viz. sleep, crying and movement. Over all behavior scores for group 3 patients were significantly better than other three groups (p&lt;0.001). Positive behavior of patients in group 2 and 3 did not show significant difference but positive behavior in group 3 was significantly (p&lt;0.05) more than group 2. Placebo group showed the highest negative behavior. Conclusion: Sedative effects of oral midazolam and oral diazepam were comparable, where as intravenous midazolam produced more sedation. Anxiolysis was found to be more in both the midazolam groups than the diazepam group. Most number of positive changes were observed in midazolam groups as compared to diazepam group.
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Besi, E., C. Besi, R. Lees, A. Morrison, and N. O'Connor. "Comparison of fasting and non-fasting patients receiving intravenous (IV) sedation." Oral Surgery 11, no. 2 (2017): 98–104. http://dx.doi.org/10.1111/ors.12305.
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Edwards, Dave, Richard Ramsey, John Breeze, and Mark Dermont. "Exploring Dentist Opinions on the Provision of Intravenous Sedation in Primary Dental Care for UK Armed Forces Personnel." Military Medicine 185, no. 7-8 (2019): e1187-e1192. http://dx.doi.org/10.1093/milmed/usz451.
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Abstract Introduction: Anxiety toward dental treatment can lead to preventable morbidity, most notably oral pain and infection. This is of concern to the UK Armed Forces (UK AF), as dental care may not be immediately accessible during deployments and exercises, necessitating aeromedical evacuation. Current Defence Policy states that serving UK AF personnel requiring sedation to tolerate routine dental treatment are to have their Joint Medical Employment Standard (JMES) reviewed to restrict their deployability and employability. This article explores current sedation delivery, dentist opinion, and adherence to policy. Materials and Methods: The total number and type of intravenous (IV) sedation appointments over a 6-month period was assessed using surgical logbooks. Questionnaires were sent to all dentists in primary care responsible for treating military patients to ascertain their attitudes toward the requirement for sedation in support of recruitment and deployability. Ten-year retrospective data analyses were used to identify current trends in sedation use in the UK AF. Results: Responses were received from 117/137 (85%) dentists. All of the responding Civilian Dental Practitioners felt that there was a requirement for IV sedation in contrast to the Royal Navy (RN), where over a quarter (28%) disagreed. The majority, 48 (81%), of Army dentists felt that military patients unable to tolerate routine treatment under local anesthesia alone should not deploy on operations, compared with 7 (63%) of their civilian counterparts. Overall, 72 (62%) respondents felt that patients unable to tolerate routine treatment without sedation should not be recruited. Conclusions: Civilian Dental Practitioners in the sample indicated that they were less likely to recommend a patient for JMES review, less likely to prevent patients from deploying and less likely to believe that individuals requiring sedation for routine treatment should not be recruited into the UK AF. These attitudes are contrary to current Defence direction and could increase the risk of UK AF personnel experiencing morbidity on deployment requiring aeromedical evacuation. Over the longer term, civilianization of Defence dentistry is likely to reduce collective operational experience and Defence must ensure that clinicians understand the management of anxious patients in the military context and their responsibilities in relation to JMES. Furthermore, policy limiting the recruitment of personnel with significant dental anxiety is not being robustly adhered to. Based on the number of dental procedures undertaken under IV sedation in the UK AF, consistent application of this policy would not affect recruitment at an organizational level, but would limit the risk of deploying these personnel. Further work is required to understand dental anxiety within the UK Armed Forces so that the operational morbidity risks can be quantified and provision appropriately planned.
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Dutta, Debojyoti, Mukesh Godara, Shobha Purohit, Poonam Kalra, Satya Sharma, and Nitesh Gill. "Comparison of the effect of intravenous dexmedetomidine and lignocaine spray instilled into the endotracheal tube on extubation response in patients undergoing spine surgery." Journal of Neuroanaesthesiology and Critical Care 03, no. 03 (2016): 239–44. http://dx.doi.org/10.4103/2348-0548.190070.
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Abstract Background: In spine surgery rapid emergence and extubation with haemodynamic stability is crucial for early neurological examination. Here, we have studied the effect of α2 agonist – dexmedetomidine intravenous (IV) and lignocaine spray instilled into the endotracheal tube at the end of the procedure to attenuate the extubation responses. Methods: A total of 45 patients undergoing spine surgery were randomly allocated in three groups. After the return of spontaneous respiration, Group-D: Dexmedetomidine 0.3 mcg/kg IV, Group-L: 10% lignocaine spray 1.5 mg/kg through endotracheal route and Group-P: Normal saline IV given over 60 s. Haemodynamic responses (systolic blood pressure, diastolic blood pressure, mean arterial pressure [MAP], heart rate [HR] and SpO2) were recorded before and after administration of drugs and also duration of emergence, extubation, quality of extubation and post-operative sedation level were evaluated. Results: The increase in MAP and HR during extubation was significantly less in Group-D than Group-L and Group-P, 2 min after administration of the respective drugs (P < 0.05). There were no significant differences in the grade of a cough after extubation and post-operative sedation level. Conclusion: Dexmedetomidine (0.3 mcg/kg) attenuates haemodynamic response better than lignocaine spray (1.5 mg/kg) during emergence and extubation. It also provides smooth extubation and easy recovery without any post-operative sedative effect.
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El-Sesy, Mostafa Galal Mahrous, Amr E. Abdel Hameed, Abdelaziz A. Abdelaziz, Ibrahim M. Ahmed, and Ahmed M. Elhennawy. "A comparative study between intravenous and intraperitoneal magnesium sulphate for pain management in laparoscopic mini gastric bypass: a randomized clinical trial." Anaesthesia, Pain & Intensive Care 26, no. 4 (2022): 450–57. http://dx.doi.org/10.35975/apic.v26i4.1947.
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Abstract
 Background: Laparoscopic bariatric surgery has become a regular procedure, and it has largely replaced traditional open surgery. Patients experience postoperative pain even after laparoscopic surgery, although the intensity is low compared to open surgery. We compared the effectiveness of intravenous (IV) vs. intraperitoneal (IP) magnesium sulphate (MgSO4) injection in pain management in laparoscopic mini-gastric bypass surgery. 
 Methodology: We selected 100 patients based on convenient sampling and randomly divided into two groups; the IV group (50 patients) received MgSO4 50 mg/kg in 250 ml normal intravenously, and the IP group (50 patients) received MgSO4 50 mg/kg in 30 ml normal saline intraperitoneally. Nalbuphine was used as rescue analgesic and its total postoperative consumption during the first 24 h was recorded based on VAS score. Postoperative nausea and vomiting (PONV), sedation score and hemodynamic changes with pneumoperitoneum were also assessed.
 Results: Total nalbuphine consumption postoperatively was more in IV group than IP group (12 ± 3.03 mg vs. 8.3 ± 2.8 mg; P < 0.001). Postoperative pain score was significantly lower in IP group in comparison to IV group (P < 0.001). Intraoperative hypotension and bradycardia were significantly more (P = 0.03) in IV group (21% and 17% respectively) compared to IP group (10% and 7% respectively). Postoperative sedation and nausea and vomiting scores were reduced in IP group compared to IV group, the difference being highly significant (P < 0.001).
 Conclusion: Intraperitoneal MgSO4 instillation has better results than intravenous infusion in attenuation of postoperative pain and hemodynamic response associated with pneumoperitoneum, and results in less PONV when used in laparoscopic minigastric bypass patients.
 Key words: Analgesics / administration & dosage; Analgesics / pharmacology; Analgesics / therapeutic use; Bariatric; Magnesium Sulfate / administration & dosage; Magnesium Sulfate / pharmacokinetics; Magnesium Sulfate / therapeutic use; Mini-gastric bypass; Pain management; Pneumoperitoneum
 Citation: El-Sesy MG, Abdel Hameed AE, Abdelaziz AA, Ahmed IM, Elhennawy AM. A comparative study between intravenous and intraperitoneal magnesium sulphate for pain management in laparoscopic mini gastric bypass: a randomized clinical trial. Anaesth. pain intensive care 2022;26(4):450-457; DOI: 10.35975/apic.v26i4.1947
 Received: April 18, 2022; Reviewed: June 16, 2022; Accepted: July 10, 2022
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Dixon, C., A. Aspinall, S. Rolfe, and C. Stevens. "Acceptability of intravenous propofol sedation for adolescent dental care." European Archives of Paediatric Dentistry 21, no. 3 (2019): 295–302. http://dx.doi.org/10.1007/s40368-019-00482-0.
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Abstract Purpose Propofol is an intravenous anaesthetic agent commonly utilised in general anaesthesia, however in sub-anaesthetic concentrations can be utilised to provide sedation through automated dosing of target-controlled infusion (TCI). TCI has been shown to provide accurate and stable predicted plasma and effect-site concentrations of propofol. A four-part mixed-method prospective study was undertaken to evaluate the safety and patient acceptability of intravenous propofol sedation in adolescent patients requiring dental care. There is a paucity in the literature on patient-reported outcomes and patient safety in the management of adolescent patients for dental treatment. Methods Demographics were recorded including age, gender, ASA Classification and Children’s Fear Survey Schedule—Dental Subscale (CFSS-DS) completed pre-operatively. Behaviour ratings of the Frankl and Houpt scales were recorded followed by post-operative questionnaire and telephone consultation. Consultation was completed following the procedure to determine patient satisfaction, memory of the procedure and any reported side effects of treatment. Qualitative thematic analysis was utilised. Results 55 patients were recruited for the study, of which 49 (mean age 14.67 years) completed the sedation study and were treated safely with no post-operative complications. The mean lowest oxygen saturation was 98.12% SpO2 (SD 2.6). Thematic analysis demonstrated positive patient-reported outcomes to IV sedation. Conclusion Propofol TCI sedation is an effective treatment modality for the management of dentally anxious adolescents as a safe alternative to general anaesthesia, allowing the opportunity for increased provision of treatment per visit on those patients with a high dental need. Further randomised controlled trials comparing propofol TCI to other pharmacological managements are required.
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Tyler, PharmD, Timothy, Erik Stojanoff, PharmD, Joan Cannon, PharmD, MBA, et al. "Intravenous Cetirizine Premedication to Mitigate Infusion-Related Reactions." Journal of the Advanced Practitioner in Oncology 15, no. 2 (2024): 125–35. http://dx.doi.org/10.6004/jadpro.2024.15.2.5.
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Infusion-related reactions (IRRs) are a recognized concern for chemotherapy, biologic agents, and newer immunotherapies. Antihistamines are frequently recommended to prevent or manage these reactions. For over 60 years, diphenhydramine has been the only H1 antihistamine for intravenous (IV) administration. It has been considered the standard of care as part of premedication regimens to prevent IRRs associated with these therapies despite the lack of a US Food and Drug Administration (FDA)-approved indication and no evidence of efficacy data. Intravenous cetirizine was approved in 2019 for acute urticaria treatment, making it the only second-generation H1 antihistamine that can be administered intravenously. Compared with diphenhydramine, cetirizine has an improved safety profile with less sedation, fewer contraindications, lower incidence of anticholinergic side effects, and minimal risk of adverse events in elderly patients. A head-to-head study demonstrated that IV cetirizine is as effective as IV diphenhydramine in reducing IRRs and may decrease chair time, treatment center visits, and the need for rescue medication. Over the past 3 decades, the FDA has addressed the issue of IRRs by mandating language regarding the requirement or recommendation for premedication in the label of over 50 FDA-approved infusion products. As more therapeutics have premedication required or recommended, IV cetirizine should be considered an antihistamine for preventing and treating IRRs. In this article, we describe a patient whose IRR was successfully managed with IV cetirizine and discuss first- vs. second-generation H1 antihistamines and their use in treating and preventing IRRs.
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Das, Priti, Debasish Swain, Roopa Parida, and Lucy Das. "Intravenous Tramadol versus Nalbuphine in Perioperative Management of Pain and Stress - A Comparative Study." Journal of Evidence Based Medicine and Healthcare 8, no. 10 (2021): 527–31. http://dx.doi.org/10.18410/jebmh/2021/103.
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BACKGROUND Managing pain and stress during and after any surgical procedure is a real challenge and a matter of concern for both surgeons and anaesthesiologists. Various analgesics like tramadol and nalbuphine have been used as adjuncts to anaesthetic agents with different efficacy. We wanted to do a comparative assessment of efficacy between intravenous (IV) administration of tramadol and nalbuphine in managing perioperative pain and stress. METHODS This was a single blinded randomised control trial, which included 60 female adult patients in the age group of 30 - 50 years who were posted for surgical procedures like elective vaginal hysterectomy under spinal block. Patients with comorbidities like diabetes, obesity, hypertension, impaired pulmonary function, recent history of medication with selective serotonin reuptake inhibitors were excluded from the study. Study participants were divided into two groups - group tramadol (TR) and group nalbuphine (NA) with 30 patients in each group. Group TR was given tramadol 0.5 - 0.7 mg / Kg whereas group NA was given nalbuphine 0.1 - 0.2 mg / Kg after an hour of spinal block. Both drugs were administered intravenously. Midazolam 0.01 - 0.05 mg / Kg was administered intravenously within first hour of surgery for sedation. Pain, stress and sedation score, requirement of rescue analgesics and occurrence of adverse drug reactions (ADRs) over 12 hours postoperatively were compared. RESULTS Significant lowering of pain and stress scores and higher sedation score was observed in group NA in comparison to group TR. The requirement of rescue analgesic and occurrence of side effects like nausea and vomiting were less in group NA. CONCLUSIONS Intravenous administration of nalbuphine was found to be more effective in perioperative control of pain and stress and can be a better choice than intravenous tramadol. KEYWORDS Efficacy, Tramadol, Nalbuphine, Rescue Analgesia
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Javid, Mihan J., Mojgan Rahimi, and Amir Keshvari. "Dissociative Conscious Sedation, An Alternative to General Anesthesia for Laparoscopic Peritoneal Dialysis Catheter Implantation: A Randomized Trial Comparing Intravenous and Subcutaneous Ketamine." Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis 31, no. 3 (2011): 308–14. http://dx.doi.org/10.3747/pdi.2010.00110.
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Laparoscopy is an effective method of implantation for peritoneal dialysis (PD) catheters. Use of the laparoscopic technique is increasing because of its potential advantages over other techniques. In most patients, selection for PD is based on negative criteria, and because of the need for general anesthesia, the laparoscopic technique can be life-threatening in these patients. On the other hand, local anesthesia is insufficient for laparoscopic catheter implantation. To avoid the need for general anesthesia and to achieve patient safety and satisfaction, we designed a type of conscious sedation (dissociative conscious sedation) and compared the efficacy of subcutaneous (SC) and intravenous (IV) ketamine added to narcotics in patients scheduled for laparoscopic implantation of a PD catheter.MethodsOur prospective randomized double-blind study enrolled 60 adult patients with chronic renal failure who were scheduled for laparoscopic implantation of a PD catheter. Patients were randomly assigned to one of two groups: one receiving IV ketamine, and the other receiving SC ketamine. In both groups, patients were premedicated with IV midazolam 0.015 mg/kg, fentanyl 1–2 μg/kg, and lidocaine 1.5 mg/kg. Patients then received 0.6 mg/kg ketamine either intravenously (IV group) or by subcutaneous injection at the anterior aspect of the forearm (SC group). If systolic blood pressure (BP) increased more than 20% from baseline or exceeded 170 mmHg, IV nitroglycerine (TNG) 50 μg was administered incrementally (repeated 50-μg doses). After a desirable level of conscious sedation was achieved, local anesthesia and nitrous oxide pneumoperitoneum were applied, and the PD catheter was implanted under laparoscopic guidance. Heart rate and BP were measured throughout the procedure. Adverse effects and recovery events were recorded.ResultsAll patients tolerated the procedure well. Administration of TNG was significantly more frequent in the IV ketamine group. Pain intensity during the surgery was similar in both groups. Both groups were comparable with regard to heart rate, but patients in the SC ketamine group had a significantly lower systolic BP at the 2nd measurement and a lower rate–pressure product at the 2nd, 4th, and 5th measurements. All patients in the SC ketamine group were cooperative during surgery and experienced uneventful recoveries; mild hallucinations were observed in 5 patients in the IV ketamine group. In the IV ketamine group, 3 patients lost the ability to cooperate during surgery. All catheters were successfully placed.ConclusionsDissociative conscious sedation is an acceptable alternative to general anesthesia in laparoscopic implantation of the PD catheter. Ketamine by the SC route is as effective as, but safer than, IV ketamine.
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Manandhar, Sujita, and Kishor Manandhar. "Efficacy of intravenous Tramadol in prevention of catheter-related bladder discomfort in upper urinary tract surgery." Journal of Patan Academy of Health Sciences 6, no. 2 (2019): 45–50. http://dx.doi.org/10.3126/jpahs.v6i2.27229.
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Introductions: Catheter-related bladder discomfort (CRBD) is common in patients with urinary catheterization. Centrally acting intravenous opioid like Tramadol inhibits detrusor activity and incidence of CRBD. Present study aims to analyze efficacy of intravenous (IV) Tramadol in prevention of CRBD in patients undergoing upper urinary tract surgery. 
 Methods: Adult patients undergoing elective open upper urinary tract surgeries at Bir Hospital, National Academy of Medical Sciences (NAMS), Nepal, over a period of six months, requiring urinary catheterization were randomly divided into Control (C) and Tramadol (T) groups. After general anesthesia, patients in T-group received IV Tramadol 1.0 mg/kg and C-group received normal saline 30 minutes before extubation. In post-operative ward, CRBD was graded as mild, moderate or severe at 0, 1, 2 and 6 hours. Post-operative Ramsay sedation score and nausea vomiting were compared in two groups. 
 Results: There were total 70 patients, 35 in each of groups-T and C. Incidence of CRBD in T-group was significantly low compared to the C-group at all points of evaluation (p<0.05). Postoperative sedation score, analgesic requirement and nausea vomiting were not significantly different in two groups. 
 Conclusions: Intravenous Tramadol administered before extubation in upper urinary tract surgery reduces the incidence of CRBD.
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Chalmers, Brian P., Enrique Goytizolo, Mithun D. Mishu, and Geoffrey H. Westrich. "Manipulation under anaesthesia after primary total knee arthroplasty." Bone & Joint Journal 103-B, no. 6 Supple A (2021): 126–30. http://dx.doi.org/10.1302/0301-620x.103b6.bjj-2020-1950.r1.
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Aims Manipulation under anaesthesia (MUA) remains an effective intervention to address restricted range of motion (ROM) after total knee arthroplasty (TKA) and occurs in 2% to 3% of primary TKAs at our institution. Since there are few data on the outcomes of MUA with different anaesthetic methods, we sought to compare the outcomes of patients undergoing MUA with intravenous (IV) sedation and neuraxial anaesthesia. Methods We identified 548 MUAs after primary TKA (136 IV sedation, 412 neuraxial anaesthesia plus IV sedation) from March 2016 to July 2019. The mean age of this cohort was 62 years (35 to 88) with a mean body mass index of 31 kg/m2 (18 to 49). The mean time from primary TKA to MUA was 10.2 weeks (6.2 to 24.3). Pre-MUA ROM was similar between groups; overall mean pre-MUA extension was 4.2° (p = 0.452) and mean pre-MUA flexion was 77° (p = 0.372). We compared orthopaedic complications, visual analogue scale (VAS) pain scores, length of stay (LOS), and immediate and three-month follow-up knee ROM between these groups. Results Following MUA, patients with IV sedation had higher mean VAS pain scores of 5.2 (SD 1.8) compared to 4.1 (SD = 1.5) in the neuraxial group (p < 0.001). The mean LOS was shorter in patients that received IV sedation (9.5 hours (4 to 31)) compared to neuraxial anaesthesia (11.9 hours (4 to 51)) (p = 0.009), but an unexpected overnight stay was similar in each group (8.6%). Immediate-post MUA ROM was 1° to 121° in the IV sedation group and 0.9° to 123° in the neuraxial group (p = 0.313). Three-month follow-up ROM was 2° to 108° in the IV sedation group and 1.9° to 110° in the neuraxial anaesthesia group (p = 0.325) with a mean loss of 13° (ranging from 5° gain to 60° loss), in both groups by three months. No patients in either group sustained a complication. Conclusion IV sedation alone and neuraxial anaesthesia are both effective anaesthetic methods for MUA after primary TKA. Surgeons and anaesthetists should offer these anaesthetic techniques to match patient-specific needs as the orthopaedic outcomes are similar. Also, patients should be counselled that ROM following MUA may decrease over time. Cite this article: Bone Joint J 2021;103-B(6 Supple A):126–130.
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Stevanovic, Predrag. "Midazolam (dormicum®): Clinical practice guidelines." Medical review 59, no. 1-2 (2006): 89–94. http://dx.doi.org/10.2298/mpns0602089s.
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Introduction. Three benzodiazepines are available for IV injection and are commonly used in anesthesia practice: diazepam, lorazepam, and midazolam. The last is the most frequently used in anaesthesia practice. Benzodiazepines induce amnesia and sedation secondary to potentiation of the inhibitory neurotransmitter gamma amino-butyric acid (GABA). Although sleep inducing doses of midazolam (0,2-0,4 mg/kg) may produce unconsciousness in one to three minutes it is commonly used for sedation and to ensure amnesia and premedication. The effects of midazolam on the cardiovascular system are minimal. Mild decreases in blood pressure and heart rate are indicative of its sedative effect. There have been reports of respiratory depression with diazepam, however this response is dose dependent and can be marked if concomitant doses of narcotics are used. Because of its potential for depressing respiration, especially if given with narcotics, the respiratory response of these patients needs to be monitored. Intravenous midazolam should be titrated to effect and the benzodiazepine antagonist flumazenil should be immediately available. .