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The practice of sedation and analgesia is under increasing scrutiny by numerous regulatory agencies, with the aim of making these procedures safer and reducing the incidence of cardiopulmonary complications during GI endoscopy. As we move toward more evidence-based medicine, new technologies will have to be assessed in a manner that demonstrates their efficacy and utility in clinical practice. Although there have been no controlled studies examining whether more intensive monitoring during endoscopy improves outcomes, extended monitoring with capnography seems to offer an advantage over conventional monitoring in that, by providing a real-time indication of any change in adequate ventilation before oxygen desaturation occurs, it can detect early phases of respiratory depression, which can allow a more precise and safer titration of medications. There is a close agreement among experts that capnography may reduce the risk of adverse outcomes during deep sedation; therefore, its use should be required for patients undergoing advanced endoscopic procedures with the potential for deep sedation. Extended monitoring with capnography should also be endorsed whenever propofol is considered as an alternative to standard sedation with a benzodiazepine or narcotic. Our understanding of the clinical application of techniques for monitoring of depth of sedation is in its infancy, and its full contribution to the practice of endoscopy has yet to be determined. Their potential role in improving sedation practice during endoscopy needs to be confirmed by controlled trials. If we consider the lack of proven efficacy of these emerging monitoring techniques in reducing the adverse outcomes associated with sedation and analgesia, the importance of appropriate monitoring cannot be overemphasized. However, it is vital for the endoscopist to be thoroughly familiar with the type of sedation chosen, to be able to recognize the various levels of sedation, and, above all, to rescue patients should they unintentionally progress to a deeper level of sedation than intended.
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http://dx.doi.org/10.1016/j.giec.2004.01.008 | DOI Listing |
Arch Pediatr
December 2024
CHRU de Brest, service de pédiatrie, Brest, France; Laboratoire de Traitement de l'Information Médicale INSERM U1101, Brest, France. Electronic address:
Background: Sedation is often required for pediatric medical imaging procedures to ensure compliance and image quality. Recommendations for pediatric sedation exist, but there are currently no guidelines for the choice of the sedative drug.
Objective: To compare the efficacy and adverse events of per os pentobarbital with intravenous chlorpromazine in children undergoing diagnostic imaging procedures.
Crit Care Med
December 2024
Department of Neurology, Northwestern University, Chicago, IL.
Objectives: To determine whether cognitive impairments of important severity escape detection by guideline-recommended delirium and encephalopathy screening instruments in critically ill patients.
Design: Cross-sectional study with random patient sampling.
Setting: ICUs of a large referral hospital with protocols implementing the Society of Critical Care Medicine's ICU Liberation Bundle.
BMC Anesthesiol
December 2024
Department of Anesthesiology, Anqing Medical Center of Anhui Medical University, the Fifth Clinical Medical School of Anhui Medical University, No.87 Tianzhushan East Road, Anqing, 246003, Anhui, China.
Background: Postoperative pain usually occur in patients who have undergone functional endoscopic sinus surgery (FESS). Remimazolam and dexmedetomidine could enhance the quality of recovery (QoR) after surgery. The aim of this study was to compare the effects of remimazolam and dexmedetomidine with respect to the QoR-40 score of patients who have undergone FESS.
View Article and Find Full Text PDFEur J Emerg Med
December 2024
Emergency Department, Azienda Sanitaria Locale Torino 3 (ASL TO3) Ospedale E. Agnelli, Pinerolo.
Background And Importance: Effective and safe procedural sedation is pivotal for the quality of care in the emergency department (ED).
Objectives: The aim of this work is to evaluate the feasibility, effectiveness, and safety procedural sedation performed by emergency physicians in the ED setting in Italy.
Design/setting And Participants/intervention: Following a specific training of the staff and with the adoption of a standardized protocol, a registry of procedural sedations performed on adult patients in 10 Italian EDs was compiled from 2019 to 2022; the following basic data were recorded: demographic and clinical information, procedure's indication, administered drugs, predefined, and actual sedation level.
JAMA Cardiol
December 2024
Section for Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia.
Importance: Infrequent intraprocedural premature ventricular complexes (PVCs) limit the efficacy of catheter ablation. Intravascular stimulation of sympathetic nerves via vertebral veins (VVs) has been used to activate cardiac sympathetic tone and may promote PVCs.
Objective: To characterize the ability of direct electrical sympathetic stimulation via VVs to induce PVCs at the time of catheter ablation.
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