Guidelines for sedation and/or analgesia by non-anaesthesiology doctors

Knape, J. T. A.; Adriaensen, H.; Aken, Hugo Van; Blunnie, W. P.; Carlsson, Christer; Dupont, M.; Pasch, Thomas

doi:10.1017/s0265021506002092

Cited by 112 publications

(49 citation statements)

References 2 publications

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“…Moderate sedation has also been claimed to be an alternative to general anesthesia. 3,4 American 5 and European guidelines 6 give specified recommendations for the use of propofol by doctors who are not anesthetists. However, the use of propofol increases the risk of over-sedation and cardio respiratory instability.…”

Section: Introductionmentioning

confidence: 99%

Alfentanil and patient‐controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events

Nilsson

Ustaal

et al. 2012

Acta Anaesthesiol Scand

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BackgroundWidespread use of patient‐controlled sedation (PCS) demands simplicity and a predictable outcome. We evaluated patients’ safety and ease of use of PCS for gynaecological outpatient procedures.MethodsIn a prospective double‐blind study, 165 patients were randomized to use propofol or propofol with alfentanil as PCS combined with local anaesthetic for pain control. Data on cardiopulmonary function, consciousness, and need for interventions were collected at baseline and every fifth minute. The surgeons’ evaluation of the ease and the duration of the procedure were recorded.ResultsOne hundred and fifty‐five patients used PCS for the entire procedure, 76 patients propofol, and 79 patients propofol/alfentanil. Fifteen procedures in the propofol group were limited or could not be done, compared with four in the propofol/alfentanil group (P = 0.02). The duration of surgery was not affected. The addition of alfentanil affected respiratory function compared with the propofol group: five patients compared with none were manually ventilated (P = 0.03), and two thirds, compared with a quarter, were given supplementary oxygen as their saturation decreased below 90% (P < 0.001). Overall cardiovascular stability was maintained. The propofol group had deeper conscious sedation as measured by the bispectral index (P = 0.03), but all patients could be roused. In the propofol/alfentanil group, five patients became apnoeic and could not be roused.ConclusionsPCS using propofol alone supports patients’ safety, as the addition of alfentanil increased the need for specific interventions to maintain respiratory stability. However, alfentanil increases the feasibility of the procedure, as complementary doses of propofol were not required.

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Section: Introductionmentioning

confidence: 99%

Alfentanil and patient‐controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events

Nilsson

Ustaal

et al. 2012

Acta Anaesthesiol Scand

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“…El nivel buscado es determinado primero por el tipo de procedimiento a realizar, pero también por factores inherentes al paciente (1,18). En el nivel ligero a moderado de sedación (sedación consciente en este trabajo) el paciente puede responder a órdenes verbales o táctiles suaves y simples para aumentar la frecuencia o profundidad de su respiración, suprimir su deglución o mantener inmóviles sus miembros (19), manteniendo su función cardiorrespiratoria y sus reflejos de protección, que suprime las náuseas y mejora la cooperación del paciente (4).…”

Section: Seguridadunclassified

Seguridad y eficiencia de sedación balanceada con propofol y remifentanil en endoscopia digestiva alta diagnóstica. Una experiencia exitosa

Avellaneda¹,

García²,

Avellaneda³

et al. 2017

Rev. Colomb. Gastroenterol.

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La sedación es una técnica anestésica de amplia utilización en los procedimientos endoscópicos digestivos actuales dado su claro beneficio en la tolerancia y comodidad para el paciente y el endoscopista. El medicamento de mayor uso en la actualidad para utilizarse como monosedación es el Propofol, pero los esquemas balanceados utilizando más de un medicamento ahora son ampliamente usados en endoscopia diagnóstica o terapéutica. La sedación balanceada utilizando Propofol y Remifentanil permite la potenciación sinérgica de un sedante con un opioide de ultra corta acción, lo que a su vez favorece la disminución respectiva de cada dosis. Se presenta una serie de 1148 pacientes llevados a endoscopia digestiva alta diagnóstica con dosis promedio de Remifentanil de 0,9 mcg/kg de peso, y de Propofol de 0,47mg/kg de peso, sin eventos adversos graves, con excelente satisfacción para el endoscopista y con muy bajo costo de la dosis por medicamento, con lo que se infiere ser un esquema seguro y eficiente.

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“…This was a retrospective study conducted on 380 patients from 3 Med & Health 2016;11(1): 2-10 Procedural sedation is commonly used for outpatient medical procedures and done by non-anesthesiology physicians (Knape et al 2007). The use of midazolam in the ED is unique in terms that the location possess different issues and risks to the physician.…”

Section: Introductionmentioning

confidence: 99%

“…Procedural sedation is commonly used for outpatient medical procedures and done by non-anesthesiology physicians (Knape et al 2007).…”

mentioning

confidence: 99%

Adverse Drug Reaction with Midazolam Use in Emergency Department

Muhamad¹

2016

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ABSTRAK Midazolam adalah salah satu ubat yang paling biasa digunakan sebagai ubat pelali di Jabatan Kecemasan (ED). Ini adalah satu kajian retrospektif yang dijalankan ke atas 380 pesakit dari Disember 2012 hingga Mei 2014 di ED, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM). ABSTRACTMidazolam is one of the most commonly used drugs for sedation in Emergency Department (ED). This was a retrospective study conducted on 380 patients from 3 Med & Health 2016;11(1): 2-10 Procedural sedation is commonly used for outpatient medical procedures and done by non-anesthesiology physicians (Knape et al. 2007). The use of midazolam in the ED is unique in terms that the location possess different issues and risks to the physician. Among issues that is different to normal outpatient clinic is the occurrence which is unpredictable, the timing is time dependent and sometimes emergent, gastric state is variable (either fasted or not). Patients are unselected and may have underlying systemic disease (Godwin et al. 2005). Hence, even though the adverse effects of midazolam was extensively studied in various clinical locations, the data for midazolam use in ED especially throughout Malaysia, is still lacking. Midazolam Use in Emergency DepartmentAdverse reactions from midazolam use include urinary retention, nausea, vomiting and excessive somnolence December 2012 to May 2014 in ED of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). The objective was to elicit the frequency of side effects and correlation to various factors i.e. socio-demography, co-morbidities, age groups and underlying illnesses. Out of 380 patients, 35 patients experienced side effects (20 patients with midazolam alone, 15 patients with combination of drugs). The average age was 42 years and the average dose of midazolam was 3.5mg. The most common other drug combined was fentanyl. The overall complication rate for midazolam was 5.3%. The most common side effect recorded was excessive somnolence (1.6%). Other side effects included local skin reactions (1.1%), vomiting (0.8%), headache (0.8%) and hypotension (0.5%). There was no significant association between the socio-demographic factors and drugs combination with the side effects of midazolam on patients. It was concluded that midazolam was a safe drug due to absence of any life-threatening side effects. There are possibilities that most side effects recorded could be caused by other comfounding factors e.g. underlying injuries or disease and combination with other drugs.

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Guidelines for sedation and/or analgesia by non-anaesthesiology doctors

Abstract: Ondansetron, in this study of 90 children, was not very effective in preventing nausea and vomiting after neurosurgical operations.

Cited by 112 publications

References 2 publications

Alfentanil and patient‐controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events

Alfentanil and patient‐controlled propofol sedation – facilitate gynaecological outpatient surgery with increased risk of respiratory events

Seguridad y eficiencia de sedación balanceada con propofol y remifentanil en endoscopia digestiva alta diagnóstica. Una experiencia exitosa

Adverse Drug Reaction with Midazolam Use in Emergency Department

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