The guideline "Sedation for gastrointestinal endoscopy" (AWMF-register-no. 021/014) was published initially in 2008. Because of new and developing evidence, the guideline was updated in 2015. The aim of the guideline is to define the necessary structural, equipment and personnel requirements that contribute to minimizing the risk of sedation for endoscopy. In view of the high and increasing significance of gastrointestinal endoscopy, the guideline will remain highly relevant in the future. Essential aspects are the selection of sedatives/hypnotics, structural requirements, personnel requirements with regard to number, availability and training, management of complications and quality assurance. In this article, the development and evaluation of the evidence and its influence on the practical implementation, in particular for anaesthesia, are highlighted.
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http://dx.doi.org/10.1055/a-1017-9138 | DOI Listing |
Pediatr Qual Saf
December 2024
From the Division of Neonatology, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, Pa.
Introduction: Although associated with respiratory morbidity, elective endotracheal intubation (ETI) for laser photocoagulation for retinopathy of prematurity (ROP) is the standard practice at our institution, with 100% of patients undergoing preoperation ETI. To mitigate this risk, we strove to reduce the percentage of infants intubated for laser photocoagulation by 30% by June 2022.
Methods: We assembled a multidisciplinary team and implemented a deep sedation guideline utilizing dexmedetomidine, fentanyl, and midazolam with noninvasive ventilation support for laser photocoagulation in January 2020.
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.
BMJ
December 2024
Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA.
Advances in our approach to treating pain and sedation when caring for patients in the intensive care unit (ICU) have been propelled by decades of robust trial data, knowledge gained from patient experiences, and our evolving understanding of how pain and sedation strategies affect patient survival and long term outcomes. These data contribute to current practice guidelines prioritizing analgesia-first sedation strategies (analgosedation) that target light sedation when possible, use of short acting sedatives, and avoidance of benzodiazepines. Together, these strategies allow the patient to be more awake and able to participate in early mobilization and family interactions.
View Article and Find Full Text PDFCureus
December 2024
Emergency Medicine and Pediatric Emergency Medicine, Buckinghamshire Healthcare NHS Trust, Buckingham, GBR.
In pediatric emergency medicine, sedation is crucial for performing some therapeutic procedures in children. Ketamine is still not widely used, despite being the preferred agent due to its effectiveness and safety profile. Implementing a guideline for intravenous ketamine in emergencies requiring procedural sedation in children, as well as training and evaluating staff competencies in performing this procedure, are the aims of this study.
View Article and Find Full Text PDFAir Med J
December 2024
Dartmouth-Hitchcock Medical Center, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH. Electronic address:
Objective: Deep sedation of mechanically ventilated patients is associated with poorer outcomes, including longer hospital length of stay and more ventilator days. In contrast, light sedation is associated with decreased hospital and intensive care unit length of stay, lower ventilator days, and decreased mortality. This study sought to decrease the use of unindicated deep sedation and benzodiazepine use in mechanically ventilated patients during critical care transport.
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