Erratum to: Nasotracheal Fiberoptic Intubation: Patient Comfort, Intubating Conditions and Hemodynamic Stability During Conscious Sedation with Different Doses of Dexmedetomidine

Background- Awake nasal or oral flexible fiberoptic intubation (AFOI) is technique of choice in known or anticipated difficult airway . The main aim was to have calm and cooperative patient who can follow verbal commands while maintaining adequate oxygenation . In our study, we compared the analgesic and sedative effects of fentanyl and midazolam with nalbuphine and midazolam in patients undergoing awake fiberoptic intubationmore tolerable and comfortable for the patient but also to ensure optimal intubating conditions. Material and Methodsâ€“ A prospective, randomized comparison study among patients between the age of 18 and 60yrs of either sex, with anticipated difficult airway . We compared the analgesic and sedative effects of fentanyl and midazolam with nalbuphine and midazolam in patients undergoing awake fiberoptic intubation. The primary objectives of our study were to observe the level of sedation, intubation score and OAS score after completion of procedure. The secondary objectives included assessment of patient comfort, intubation time, hemodynamic changes and complications. Results â€“ We found that comfort score and intubation time were significant lesser in Group which received fentanyl and midazolam than Group which received nalbuphine and midazolam . (p<0.05). The intubation attempt was similar in both groups (P>0.05). Conclusionâ€“ we concluded that both regimens used in this study provided comparable intubating conditions, better sedation and analgesia was observed in group fentanyl for airway procedure events. Our study concluded fentanyl to be the drug of choice for blunting of pressor response in such patients.

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Continuous, transcutaneous carbon-dioxide monitoring to avoid hypercapnia in complex catheter ablations under conscious sedation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0448 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Weinmann ◽

A Lenz ◽

R Heudorfer ◽

D Aktolga ◽

M Rattka ◽

...

Keyword(s):

Carbon Dioxide ◽

Conscious Sedation ◽

Venous Blood ◽

Patient Comfort ◽

Carbon Dioxide Partial Pressure ◽

Close Monitoring ◽

Blood Gas ◽

Transcutaneous Carbon Dioxide ◽

The Difference ◽

Venous Blood Gas

Abstract Background Ablation of complex cardiac arrhythmias requires an immobilized patient. For a successful and safe intervention and for patient comfort, this can be achieved by conscious sedation. Administered sedatives and analgesics have respiratory depressant side effects and require close monitoring. Purpose We investigated the feasibility and accuracy of an additional, continuous transcutaneous carbon-dioxide partial pressure (tpCO2) measurement during conscious sedation in complex electrophysiological catheter ablation procedures. Methods We evaluated the accuracy and additional value of tpCO2 detection by application of a Severinghaus electrode in comparison to arterial and venous blood gas analyses. Results We included 110 patients in this prospective observational study. Arterial pCO2 (paCO2) and tpCO2 showed good correlation throughout the procedures (r=0.60–0.87, p<0.005). Venous pCO2 (pvCO2) were also well correlated to transcutaneous values (r=0.65–0.85, p<0.0001). Analyses of the difference of pvCO2 and tpCO2 measurements showed a tolerance within <10mmHg in up to 96–98% of patients. Hypercapnia (pCO2<70mmHg) was detected more likely and earlier by continuous tpCO2 monitoring compared to half-hourly pvCO2 measurements. Conclusion Continuous tpCO2 monitoring is feasible and precise with good correlation to arterial and venous blood gas carbon-dioxide analysis during complex catheter ablations under conscious sedation and may contribute to additional safety. Funding Acknowledgement Type of funding source: None

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Efficacy of different doses of atracurium on intubating conditions of burned patients

Egyptian Journal of Anaesthesia ◽

10.1016/j.egja.2012.03.001 ◽

2012 ◽

Vol 28 (3) ◽

pp. 205-209 ◽

Cited By ~ 1

Author(s):

Ayman A. Mohamed ◽

Gehan A. Tarbeeh ◽

Omar Shouman

Keyword(s):

Intubating Conditions ◽

Different Doses

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Comparative Study Between Dexmedetomidine and Fentanyl as Sedatives in Awake Fiberoptic Intubation in Cervical Spine Surgeries

QJM ◽

10.1093/qjmed/hcab086.033 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Waleed Mohamed Abd El Mageed ◽

Ahmad Kamal Mohamed Ali ◽

Eeman Aboubakr ElSiddik Ahmed Bayoumi ◽

Haitham Sabry Mahmoud Omar

Keyword(s):

Cervical Spine ◽

Sedation Score ◽

Fiberoptic Intubation ◽

Intubation Time ◽

Hemodynamic Stability ◽

Double Blind ◽

Hemodynamic Variables ◽

Group A ◽

Group B ◽

Awake Fiberoptic Intubation

Abstract Background Various drugs are used for providing favorable intubation conditions during awake fiberoptic intubation (AFOI). However, most of them have various side effects. Aim The aim of this study was to compare the effects of dexmedetomedine and fentanyl as regards sedative effects, hemodynamic stability, intubation time and intubation attempts success during awake fiberoptic intubation. Material and Methods A randomized double-blind prospective study was conducted on a total of 40 patients scheduled for elective cervical spine surgeries who were randomly allocated into two equal groups (n 20): (group A) patients received a bolus dose of dexmedetomidine of 1 mcg/kg over 10 min followed by a continuous infusion of dexmedetomidine at 0.5 mcg/kg/h. and fentanyl group (group B) received dose of 1 μg/kg over 10 min followed by 0.5 μg/kg/hr. Sedation score (Ramsy sedation score), hemodynamic variables, oxygen saturation, intubation time and intubation attempts were noted and compared between the two groups. Results Ramsy Sedation Score was significantly favorable (P < 0.001) in group A in comparison to group B, moreover better hemodynamic stability during intubation (P < 0.05) and less intubation attempts were observed in group A in comparison to group B. Conclusion The results of our study showed that dexmedetomidine provides optimum sedation without compromising airway or hemodynamic stability and with favorable intubation time and less intubation attempts during AFOI in comparison to fentanyl.

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Gastroscopy Should Come Before Colonoscopy Using CO2 Insufflation in Same Day Bidirectional Endoscopies: A Randomized Controlled Trial

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwy074 ◽

2019 ◽

Vol 3 (3) ◽

pp. 120-126

Author(s):

Fahd Jowhari ◽

Lawrence Hookey

Keyword(s):

Carbon Dioxide ◽

Randomized Controlled Trial ◽

Primary Outcome ◽

Conscious Sedation ◽

Controlled Trial ◽

Patient Comfort ◽

Clinical Indication ◽

Randomized Controlled ◽

Co2 Insufflation ◽

Carbon Dioxide Co2

Abstract Background and Aims Same day bidirectional endoscopies (esophagogastroduodenoscopies [EGD]s and colonoscopies) are routinely performed. However, the best sequence of procedures is unknown, as is whether the use of carbon dioxide (CO2) affects the preferred sequence of procedures. This study aims to determine the preferred sequence of procedures and choice of insufflation gas (air or CO2) in patients undergoing same day bidirectional endoscopies. Methods Two hundred adults with a clinical indication for same day bidirectional endoscopies were randomized equally into four groups: A1 (EGD first, CO2 as insufflator); A2 (EGD first, air as insufflator); B1 (colonoscopy first, CO2 as insufflator); and B2 (colonoscopy first, air as insufflator). All procedures were performed with conscious sedation (Midazolam/Fentanyl). The primary outcome was patients’ overall comfort/satisfaction with the procedures and sedation received, as assessed by questionnaires and validated scoring scales (Nurse-Assessed Patient Comfort Score [NAPCOMS], La Crosse [WI]) collected during the procedures, before discharge, and on day 7 postprocedure. Results Two hundred patients were randomized, with data available for 186. Mean Midazolam dose between groups was significantly less in the EGD first groups (P=0.01). During the procedures, no differences were found in patients’ comfort as per the nurse reported NAPCOMS scores (P=0.19) or the Lacrosse (WI) endoscopy scores (P=0.05). On postprocedure days 0 and 7, no differences were found in the patients’ reported Lacrosse (WI) scores, nausea, sore throat, dizziness, satisfaction with sedation or overall level of procedural satisfaction (P>0.05 for each). However, bloating and discomfort were significantly lower in the CO2 arms (P<0.001). Conclusions This randomized controlled trial using validated patient comfort scoring assessments for same day bidirectional endoscopies demonstrated that the sequence of procedures affects the sedation used but does not affect overall patient comfort or satisfaction. Lesser sedation is needed in the EGD first group, and less postprocedural abdominal pain/discomfort and bloating is seen with CO2 insufflation.

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TRANSTHORACIC ECHOCARDIOGRAPHIC EVALUATION OF LEFT VENTRICULAR FUNCTION DURING CONSCIOUS SEDATION FOR TRANSESOPHAGEAL ECHOCARDIOGRAPHY. A COMPARISON OF MIDAZOLAM AND PROPOFOL FOR PATIENT COMFORT AND SAFETY

Anesthesiology ◽

10.1097/00000542-199809220-00019 ◽

1998 ◽

Vol 89 (Supplement) ◽

pp. 1347A

Author(s):

A. Bhatia ◽

S. C. Smart ◽

K. Sagar

Keyword(s):

Left Ventricular Function ◽

Transesophageal Echocardiography ◽

Ventricular Function ◽

Conscious Sedation ◽

Left Ventricular ◽

Patient Comfort ◽

Echocardiographic Evaluation

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Awake Nasotracheal Fiberoptic Intubation With Different Conscious Sedation Techniques

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000001929 ◽

2015 ◽

Vol 26 (6) ◽

pp. 2029-2030

Author(s):

RP Li ◽

Fu Shan Xue ◽

Gao Pu Liu ◽

Chao Sun

Keyword(s):

Conscious Sedation ◽

Fiberoptic Intubation

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Tailored sedation in critically ill COVID-19 patients based on lung damage, and pharmacokinetic and pharmacodynamic proﬁles

10.22514/sv.2021.115 ◽

2021 ◽

Keyword(s):

Critically Ill ◽

Positive Airway Pressure ◽

Deep Sedation ◽

Lung Damage ◽

Patient Comfort ◽

Invasive Ventilation ◽

Hemodynamic Stability ◽

Non Invasive ◽

Non Invasive Ventilation ◽

Light Sedation

In critically ill COVID-19 patients, proper management of sedation is an important issue. Therefore, for this purpose, several strategies and protocols have been proposed. In this paper, we illustrate an approach focused on lung damage, and both the pharmacokinetic and pharmacodynamic profiles of drugs used. In line with this, during high flow nasal (HFN), continuous positive airway pressure, or non-invasive ventilation, dexmedetomidine-based light sedation can be helpful for maintaining the respiratory driving and improving the patient comfort. A worsening in the respiratory clinical picture with mechanical ventilation may require deep sedation with the use of clonidine. The latter may reduce the hypnotic doses, allowing improved hemodynamic stability. When respiratory performance improves, dexmedetomidine can replace clonidine to reduce the time to extubation.

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