Children presenting to the emergency department (ED) often require sedation for brief procedures such as fracture and dislocation reductions, laceration repairs, and imaging procedures that are painful, anxiety provoking or both. This article presents three cases of paediatric patients who require sedation and/or analgesia, and summarizes important aspects of procedural sedation for the primary care practitioner in the emergency setting. Presedation assessment and monitoring equipment are detailed. Discussion of routes of administration and different agents including barbiturates, opiates, benzodiaxepines, the 'cardiac coctail', ketamine, propofol, nitrous oxide, and etomidate follow. Emphasis is placed on indications, contraindications, dosing, timing and advantages and disadvantages of each. Reversal agents are mentioned, and discharge criteria are outlined.
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http://dx.doi.org/10.1093/pch/8.8.503 | DOI Listing |
Cancer
February 2025
Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA.
Background: There is much concern that opioids administered as intravenous (iv) bolus for pain relief may inadvertently increase their risk for abuse. However, there is insufficient data to support this. The authors compared the abuse liability potential, analgesic efficacy, and adverse effect profile of fast (iv push) versus slow (iv piggyback) administration of iv hydromorphone among hospitalized patients requiring iv opioids for pain.
View Article and Find Full Text PDFClin Nutr ESPEN
January 2025
Coordinación de Nutrición Clínica, Departamento de Áreas Críticas, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico. Electronic address:
Background: Intensive care unit-acquired weakness (ICU-AW) is a complication characterized by decreased muscle mass and impairments in strength and physical function and is associated with poor quality of life and worse clinical outcomes. The primary objective of this study is to analyze the prevalence of ICU-AW, and secondary objectives were to assess risk factors and analyze the associations with clinical outcomes.
Methods: This is a prospective cohort study of patients on mechanical ventilation (MV).
Anaesth Crit Care Pain Med
January 2025
Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, Montréal, QC, Canada; Université de Montréal, Montréal, QC, Canada; Maisonneuve-Rosemont Hospital Research Center, Montreal, QC, Canada.
Background: Pharmacological sedation and analgesia are used to alleviate discomfort during awake medical procedures but can cause adverse effects like apnea and hypoxemia, increasing the need for airway management and prolonging recovery. Virtual reality (VR) has emerged as a non-pharmacological intervention to reduce the need for procedural sedatives and analgesics.
Methods: A systematic review and meta-analysis were conducted, assessing the impact of VR immersion on intraprocedural sedation and analgesia usage in adults (≥ 18 years).
J Clin Med
January 2025
Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy.
Thoracic outlet syndrome (TOS) is an uncommon condition defined by the compression of neurovascular structures within the thoracic outlet. When conservative management strategies fail to alleviate symptoms, surgical decompression becomes necessary. The purpose of this study is to evaluate and compare the efficacy and safety of regional anesthesia (RA) using spontaneous breathing in contrast to general anesthesia (GA) for patients undergoing surgical intervention for TOS.
View Article and Find Full Text PDFJ Clin Med
January 2025
Department of Thoracic Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy.
Rigid bronchoscopy (RB) is the gold standard for managing central airway obstruction (CAO), a life-threatening condition caused by both malignant and benign etiologies. Anesthetic management is challenging as it requires balancing deep sedation with maintaining spontaneous breathing to avoid airway collapse. There is no consensus on the optimal anesthetic approach, with options including general anesthesia with neuromuscular blockers or spontaneous assisted ventilation (SAV).
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