Procedural Sedation and Analgesia

Burbulys, David B.; Kiai, Kianusch

doi:10.1016/b978-0-323-05472-0.00187-0

Cited by 2 publications

(5 citation statements)

References 190 publications

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“…Normal ranges for the haemodynamic parameters were accepted as; mean arterial pressure (MAP): 70-110 mmHg, heart rate (HR): 60-100 bpm, respiratory rate (RR): 12-20/minutes, O 2 saturations (SpO 2 ): >94%, and end-tidal CO 2 (ETCO 2 ): 32-42 mmHg. 3,4 Respiratory compromise was defined as apnoea for more than 30 seconds or a SpO 2 of less than 90% requiring any clinical inter vention like air way manoeuvres, bag-valve mask ventilation or intubation. 12 Two groups of patients were defined and the patients were randomly allocated to one of them: 1) Group A patients received first intravenous fentanyl 1.5 mcg/ kg with 50 ml normal saline in 2 minutes and additional doses if needed for pain control.…”

Section: Methodsmentioning

confidence: 99%

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Anterior Shoulder Dislocation Reduction Managed Either with Midazolam or Propofol in Combination with Fentanyl

Ozturk¹,

Güneysel

Akoğlu

2014

Hong Kong Journal of Emergency Medicine

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Objective: Procedural Sedation and Analgesia is used in managing emergency painful procedures. The aim of this study is to compare the effects of propofol and midazolam on haemodynamic parameters when used in combination with fentanyl in isolated anterior shoulder dislocations and to measure the patient and physician satisfactions. Methods: The study is a randomised single blind prospective trial. All procedural sedations were performed by emergency medicine specialists and the shoulder reductions were performed by orthopaedic surgeons. Two groups were defined. Group A received intravenous fentanyl and midazolam and Group B received intravenous fentanyl and propofol. The orthopaedic surgeons were not informed about the drugs. The emergency medicine specialist observed the patients. The patients and the orthopaedic surgeons were asked for a satisfaction scoring. Results: Midazolam group consisted of 37 patients and propofol group consisted of 38 patients. Both groups were similar in demographic characteristics and pre-procedural vital signs. There was only one statistically significant difference at one time and it was the 5th minutes SpO 2 levels between groups. There were statistically significant changes in the measurements of vital parameters in both groups when compared with the baseline levels. However none of them was clinically important. In midazolam and propofol group, 10.8% and 10.5% respectively had respiratory compromise. Patient and physician satisfactions were similar in both groups. Conclusions: Midazolam and propofol are both relatively safe drugs using in combination with fentanyl in anterior shoulder dislocations. Patients and physicians can be highly satisfied with the two groups of drugs. (Hong Kong j.emerg.med. 2014;21:346-353) 目的：程序鎮靜和止痛常使用在處理急診中引起痛楚的手術程序。本研究的目的是在孤立的前肩脫位使用芬太尼時，比較異丙酚和咪達唑崙對血液動力學參數的影響，並測量患者和醫生的滿意度。方法：本研究是一項隨機單盲前瞻性研究。所有的鎮靜程序都由急診專科醫生負責，肩關節復位由骨科醫生進行。患者分為兩組。 A 組接受靜脈注射芬太尼和咪達唑崙， B 組靜脈注射芬太尼和丙泊酚。骨科醫生沒有被告知使用的藥物。急診專科醫生負責觀察患者。病人和骨科醫生會被詢問有關滿意度得分。結果：咪達唑崙組有 37 例，丙泊酚組有 38 例。兩組患者的人口統計學特徵和進行程序前的生命體徵相似。只有第 5 分鐘的血氧飽和度，兩組之間有一個統計上顯著差異。與基線水平相比，兩組的生命體徵參數測量到有統計學上的顯著變化。但是他們臨床上都不是重要的。在咪達唑崙和異丙酚組，分別有 10.8% 和

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Section: Methodsmentioning

confidence: 99%

“…It has been widely used in different groups of patients for the purpose of PSA. 3,4 In recent years propofol is becoming an agent of choice for PSA in emergency room because of its efficacy and safety profile. [5][6][7] It has antiemetic effect but no amnestic and analgesic effect.…”

Section: Introductionmentioning

confidence: 99%

Anterior Shoulder Dislocation Reduction Managed Either with Midazolam or Propofol in Combination with Fentanyl

Ozturk¹,

Güneysel

Akoğlu

2014

Hong Kong Journal of Emergency Medicine

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“…Emergency physicians develop the skills to carry out procedures such as resuscitation, vascular access, cardioversion, and advanced airway management, which require sedation and analgesia [ 1 ]. Moreover, sedation and analgesia lead to improved patient care and satisfaction, which, ultimately, facilitates diagnostic and therapeutic procedures [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…There are numerous intravenous drugs available for inducing sedation and analgesia prior to cardioversion, including Etomidate, fentanyl, midazolam, Propofol, Thiopental, and Methohexital [ 4 ]. In high pain and high anxiety procedures such as cardioversion, the best choice for sedation and analgesia is intravenous midazolam-fentanyl in adults [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…This mixture spreads rapidly in the alveoli and it has a rapid and predictable onset time of about 1 to 2 minutes, with a rapid clearance time of about 3 to 5 minutes. This gas is used in different ratios (30% to 70%) with oxygen and administered through a mask or a unilateral oral piece held by the patient [ 2 ]. The amount of gas inhaled is controlled by the patient.…”

Section: Introductionmentioning

confidence: 99%

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Sedative and Analgesic Effects of Entonox Gas Compared with Midazolam and Fentanyl in Synchronized Cardioversion

Masoumi

Forouzan

Saghari

et al. 2015

Critical Care Research and Practice

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The purpose of this study was to determine if the Entonox gas could cause adequate analgesic and sedative effects in patients who need cardioversion. In this randomized not blinded clinical trial, the sedative and analgesic effects of midazolam and fentanyl were compared with Entonox. Eligible patients who need synchronized cardioversion because of dysrhythmia were randomly divided into two groups. The first group received intravenous midazolam and fentanyl; the second group received Entonox through a blower-dependent mask. Onset and end of sedation, sedation level, and pain score were recorded. There were nonsignificant differences between the two groups (22 patients in each group) regarding age, gender, weight, sedation level, and frequency and level of shock. The pain score recorded in the first group was 5.05 ± 1.32, and 3.9 ± 0.7 in the second group (P = 0.002). Furthermore, sedation duration and time to full recovery consciousness were shorter in the second group (P < 0.001). In the first group, seven patients needed additional doses to induce and maintain sedation. In addition, as a result of apnoea, four patients required airway support. None of them occurred in the second group. Entonox is a suitable medication in rapid cardioversion, as it has minimal side effects and adequate analgesic and sedative effects.

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Procedural Sedation and Analgesia

Cited by 2 publications

References 190 publications

Anterior Shoulder Dislocation Reduction Managed Either with Midazolam or Propofol in Combination with Fentanyl

Anterior Shoulder Dislocation Reduction Managed Either with Midazolam or Propofol in Combination with Fentanyl

Sedative and Analgesic Effects of Entonox Gas Compared with Midazolam and Fentanyl in Synchronized Cardioversion

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