Avoidance of reintubation by using sedation during noninvasive positive pressure ventilation in a 3-month-old infant with postoperative respiratory failure.
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Maintaining alertness during noninvasive positive pressure ventilation (NPPV) is important, but there are no established guidelines for the use of sedation. We report our first experience of an infant with post-surgical vocal cord paralysis, severe stridor and breathing difficulties, who was reintubated after NPPV treatment without sedation, but who avoided a third reintubation through the use of sedation with the second NPPV treatment. NPPV treatment with the proper sedation can improve blood gas data in those patients with severe dyspnea, which can occur during respiratory care in several situations, and can affect not only infants, but also adults including elderly patients. (+info)
Chloral hydrate to study auditory brainstem response.
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Breakdown of within- and between-network resting state functional magnetic resonance imaging connectivity during propofol-induced loss of consciousness.
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Time to wake up the patients in the ICU: a crazy idea or common sense?
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With the first generation of ventilators, it was often necessary to sedate patients to avoid dyssynchrony between patient and ventilator. The standard treatment of patients in need of mechanical ventilation has therefore traditionally included sedation. Modern ventilators are able to simulate the patients breathing efforts to a higher degree, and therefore, deep sedation is no longer necessary. In the last decade, support has grown for a reduction in the use of sedation. The focus has been placed on the correlation between the depth of sedation and the length of mechanical ventilation. It has been shown that a daily wake up trial reduced the time that patients were dependent on mechanical ventilation. Additionally, it has been shown that combining both a spontaneous breathing trial and a daily wake up trial reduced the mechanical ventilation time compared to a spontaneous breathing trial alone. We have recently shown in a randomized study that the use of no sedation, compared to the standard treatment with sedation and a daily wake up trial, reduced the time that patients required mechanical ventilation, the length of the patients' stay in the intensive care unit, and the total length of the hospital stay. All evidence indicates that the use of sedative drugs should be reduced, patients should be mobilized, and each patient's needs should be evaluated on a daily basis to optimize the care of each individual patient. (+info)
The ethical and legal aspects of palliative sedation in severely brain-injured patients: a French perspective.
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Dose requirement and complications of diluted and undiluted propofol for deep sedation in endoscopic retrograde cholangiopancreatography.
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BACKGROUND: In general, the dose requirement and complications of propofol are lower when used in the diluted form than in the undiluted form. The aim of this study was to determine the dose requirement and complications of diluted and undiluted propofol for deep sedation in endoscopic retrograde cholangiopancreatography. METHODS: Eighty-six patients were randomly assigned to either group D (diluted propofol) or U (undiluted propofol). All patients were sedated with 0.02-0.03 mg/kg midazolam (total dose /=70) and 0.5-1 mug/kg fentanyl (total dose /=70). Patients in group U (42) were sedated with standard undiluted propofol (10 mg/mL). Patients in group D (44) were sedated with diluted propofol (5 mg/mL). All patients in both groups were monitored for the depth of sedation using the Narcotrend system. The primary outcome variable was the total dose of propofol used during the procedure. The secondary outcome variables were complications during and immediately after the procedure, and recovery time. RESULTS: All endoscopies were completed successfully. Mean propofol doses per body weight and per body weight per hour in groups D and U were 3.0 mg/kg, 6.2 mg/kg per hour and 4.7 mg/kg, 8.0 mg/kg per hour, respectively. The mean dose of propofol, expressed as total dose, dose/kg or dose/kg per hour and the recovery time were not significantly different between the two groups. Sedation-related adverse events during and immediately after the procedure were higher in group U (42.9%) than in group D (18.2%) (P=0.013). CONCLUSIONS: Propofol requirement and recovery time in the diluted and undiluted propofol groups were comparable. However, the sedation-related hypotension was significantly lower in the diluted group than the undiluted group. (+info)