Serial monitoring of sedation scores in benzodiazepine overdose

Patients who undergo surgery of femur fracture suffer the excruciating pain. Dexmedetomidine (DEX) is a unique α2-adrenergic receptor agonist with sedative and analgesic properties, whose efficacy and safety are still unclear for surgery of femur fracture. Randomized controlled trials comparing the effects of addition of DEX to general or local anesthesia in surgery of femur fracture were searched from MEDLINE, EMBASE, and the Cochrane Library database. Patients who received DEX infusion had a significant longer time to rescue analgesia compared with those without DEX coadministration. DEX treatment seemed to reduce the visual analog score; however, the significance did not reach any statistical difference. DEX as an analgesic adjuvant did not reduce the onset of sensory block time, shorten the time to achieve maximum sensory block level, and provide a longer duration of sensory block. The difference in mean sedation scores between 2 groups was not statistically significant. As for adverse effects, DEX therapy significantly increased the rate of hypotension. In conclusion, dexmedetomidine as a local anesthetic adjuvant in femur fracture surgery had a longer duration of rescue analgesia. However, the incidence of hypotension was markedly increased in these patients. It was worth noting that the evidence was of low to moderate quality.

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Epidural Clonidine or Bupivacaine as the Sole Analgesic Agent during and after Abdominal Surgery

Anesthesiology ◽

10.1097/00000542-199905000-00020 ◽

1999 ◽

Vol 90 (5) ◽

pp. 1354-1362 ◽

Cited By ~ 35

Author(s):

Marc De Kock ◽

Philippe Gautier ◽

Athanassia Pavlopoulou ◽

Marc Jonniaux ◽

Patricia Lavand'homme

Keyword(s):

High Dose ◽

General Anesthetics ◽

Visual Analogue Pain ◽

Pain Scores ◽

Arterial Blood ◽

Sedation Scores ◽

Group 3 ◽

Group 2 ◽

High Doses ◽

Group 1

Background The rationale of this study was to compare high-dose epidural clonidine with a more commonly used agent, such as bupivacaine. This was performed to give a more objective idea of the relative analgesic potency of epidural clonidine. Methods Sixty patients undergoing intestinal surgery during propofol anesthesia were studied. At induction, the patients received epidurally a dose of 10 micrograms/kg [corrected] clonidine in 7 ml saline followed by an infusion of 6 micrograms [corrected] x kg(-1) x h(-1) (7 ml/h) (group 1, n = 20), a dose of 7 ml bupivacaine, 0.5%, followed by 7 ml/h bupivacaine, 0.25% (group 2, n = 20), or a dose of 7 ml bupivacaine, 0.25%, followed by 7 ml/h bupivacaine, 0.125% (group 3, n = 20). Intraoperatively, increases in arterial blood pressure or heart rate not responding to propofol (0.5 mg/kg) were treated with intravenous alfentanil (0.05 mg/kg). Additional doses of propofol were given to maintain an adequate bispectral index. The epidural infusions were maintained for 12 h. In cases of subjective visual analogue pain scores up to 5 cm at rest or up to 8 cm during coughing, the patients were given access to a patient-controlled analgesia device. Results During anesthesia, patients in group 1 required less propofol than those in groups 2 and 3 (78 [36-142] mg vs. 229 [184-252] mg and 362 [295-458] mg; P < 0.05) and less alfentanil than patients in group 3 (0 [0-0] mg vs. 11 [6-20] mg; P < 0.05). Analgesia lasted 380 min (range, 180-645 min) in group 1 versus 30 min (range, 25-40 min) in group 2 and 22 min (range, 12.5-42 min) in group 3 (P < 0.05). There was no suggestion of a hemodynamic difference among the three groups except for heart rates that were significantly reduced in patients in group 1. Sedation scores were significantly higher in this group during the first 2 h postoperatively. Conclusion Our results show that high doses of epidural clonidine potentiate general anesthetics and provide more efficient postoperative analgesia than the two bupivacaine dosage regimens investigated.

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Sedative effects of alfaxalone and hydromorphone with or without midazolam in cats: a pilot study

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x21996155 ◽

2021 ◽

pp. 1098612X2199615

Author(s):

Emily P Wheeler ◽

Amanda L Abelson ◽

Jane C Lindsey ◽

Lois A Wetmore

Keyword(s):

Pilot Study ◽

Significant Positive Correlation ◽

Time Correlation ◽

Catheter Placement ◽

Blinded Study ◽

Sedative Effects ◽

Sedation Scores ◽

Adult Cats ◽

To Receive

Objectives The aim of this pilot study was to compare the quality of sedation and ease of intravenous (IV) catheter placement following sedation using two intramuscular (IM) sedation protocols in cats: hydromorphone, alfaxalone and midazolam vs hydromorphone and alfaxalone. Methods This was a prospective, randomized and blinded study. Cats were randomly assigned to receive an IM injection of hydromorphone (0.1 mg/kg), alfaxalone (1.5 mg/kg) and midazolam (0.2 mg/kg; HAM group), or hydromorphone (0.1 mg/kg) and alfaxalone (1.5 mg/kg; HA group). Sedation scoring (0–9, where 9 indicated maximum sedation) was performed at 0, 5, 10, 15 and 20 mins from the time of injection. At 20 mins, an IV catheter placement score (0–10, where 10 indicated least resistance) was performed. Results Twenty-one client-owned adult cats were included in this study. Sedation and IV catheter placement scores were compared between groups using Wilcoxon rank sum tests. Peak sedation was significantly higher ( P = 0.002) in the HAM group (median 9; range 7–9) than in the HA group (median 7; range 3–9), and IV catheter placement scores were significantly higher ( P = 0.001) in the HAM group (median 9.5; range 7–10) compared with the HA group (median 7; range 4–9). Spearman correlations were calculated between IV catheter placement score and sedation scores. There was a significant positive correlation of average sedation over time (correlation 0.83; P <0.001) and sedation at 20 mins (correlation 0.76; P <0.001) with a higher, more favorable IV catheter placement score. Conclusions and relevance These preliminary results suggest that the addition of midazolam to IM alfaxalone and hydromorphone produced more profound sedation and greater ease of IV catheter placement than IM alfaxalone and hydromorphone alone.

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Electroencephalograph variables, drug concentrations and sedation scores in children emerging from propofol infusion anaesthesia

Pediatric Anesthesia ◽

10.1046/j.1460-9592.2003.01175.x ◽

2004 ◽

Vol 14 (2) ◽

pp. 143-151 ◽

Cited By ~ 16

Author(s):

Deirdre M. Murray ◽

Gareth C. Thorne ◽

Ann E. Rigby-Jones ◽

Daniella Tonucci ◽

Siobhan Grimes ◽

...

Keyword(s):

Drug Concentrations ◽

Sedation Scores

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Sedation in intensive care: An audit of the effect of airway and sedation choice on ward round sedation scores

European Journal of Anaesthesiology ◽

10.1097/00003643-201006121-00587 ◽

2010 ◽

Vol 27 ◽

pp. 183

Author(s):

P. McConnell ◽

C. MacNeil ◽

P. Docherty

Keyword(s):

Intensive Care ◽

Ward Round ◽

Sedation Scores

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SPECTRAL ENTROPY FOR ASSESSING THE PATIENT RESPONSIVENESS DURING PROPOFOL/FENTANYL SEDATION IN DAY CARE SURGERIES

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i9.571 ◽

2019 ◽

Vol 3 (9) ◽

Author(s):

Dr Shalendra Singh ◽

Dr Priya Taank

Keyword(s):

Day Care ◽

Objective Assessment ◽

Primary Objective ◽

Sedation Scale ◽

Depth Of Anaesthesia ◽

Anesthetic Care ◽

Mean Values ◽

Day Care Surgery ◽

Monitoring Of Sedation ◽

Care Surgery

Background: For day care surgery under monitored anesthetic care, precise monitoring of sedation depth facilitates optimization of dosage and prevents adverse complications from over sedation. Conventionally subjective sedation scales, such as the Modified observer’s assessment of alertness/ sedation scale (MOAA/S) have been widely utilized for sedation monitoring. The newer monitoring called entropy is considered to be beneficial for objective assessment with combined use of opioids and hypnotics if applied. The primary objective is to determine measurement of entropy as a marker for measuring depth of anaesthesia. Methods: Two groups P and PF ( with 25 patients each) received either propofol 1mg/kg followed by maintenance infusion of 250 mic/ kg/hr whereas “PF”group received additional single dose of fentanyl 2 mic/kg respectively. The values of response entropy (RE) and state entropy (SE) corresponding to each MOAA/S (5 to 0) were determined. Results: The patient’s demographic profile and clinical characteristics were comparable in both the groups. No difference observed in duration of anaesthesia and surgery in both groups. No difference observed in MOAA/S in both groups. The results shows a highly significant differences in the observed means of SE, RE, MAP and HR with considerably higher mean values in group P (p<0.0001). However other parameter such as SPO2, ETCO2 and RR were almost comparable in both groups. Conclusion: The mean value of SE and RE in group P and PF indicates that deeper plane of anaesthesia is observed in PF group. It is concluded that in assessing the level of hypnosis during intra-operative sedation in MAC, entropy corresponds to MOAA/S and increases or decreases proportionately depending upon increase or decrease level of sedation. Hence from these results it is proposed that entropy monitoring is a reliable monitoring index of anaesthesia depth in MAC. Keywords: Entropy, Propofol, Sedation, Day care surgery, Observer’s assessment of alertness/ sedation scale, Monitored anaesthesia Care

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Comparison of single-shot nebuliser protocol between dexmedetomidine and ketamine in children undergoing magnetic resonance imaging

Journal of Perioperative Practice ◽

10.1177/17504589211037461 ◽

2021 ◽

pp. 175045892110374

Author(s):

K Geetha ◽

Shibani Padhy ◽

K Karishma

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Deep Sedation ◽

Rapid Onset ◽

Single Shot ◽

Efficacy And Safety ◽

Resonance Imaging ◽

Sedation Scores ◽

To Receive ◽

Group D

Background Sedation for magnetic resonance imaging mandates deep sedation to ensure patient immobility. The nebulised route of drug delivery carries the advantage of good bioavailability and safety profile. We aimed to compare the efficacy and safety of nebulised dexmedetomidine and ketamine for sedation in children undergoing magnetic resonance imaging. Methods A total of 71 children, aged two to eight years scheduled for outpatient magnetic resonance imaging were randomly allocated to receive nebulised dexmedetomidine 2 μg/kg (group D) or nebulised ketamine 2 mg/kg (group K) 30min before magnetic resonance imaging. Results Nebulised dexmedetomidine (2 μg/kg) resulted in faster onset and significantly better sedation scores with rapid clear-headed recovery. Ketamine resulted in better venepuncture scores but was associated with more neuropsychological events at recovery. Conclusion Nebulised dexmedetomidine at 2 μg/kg provides rapid onset of satisfactory sedation, with good parental separation and a quicker and more clear-headed recovery, allowing for a smooth magnetic resonance imaging experience.

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Lack of Efficacy of Propofol in the Treatment of Early Postoperative Nausea and Vomiting

Anaesthesia and Intensive Care ◽

10.1177/0310057x9802600404 ◽

1998 ◽

Vol 26 (4) ◽

pp. 366-370 ◽

Cited By ~ 10

Author(s):

I. Harper ◽

E. Della-Marta ◽

H. Owen ◽

J. Plummer ◽

A. Ilsley

Keyword(s):

Low Dose ◽

Dose Range ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Test Drug ◽

Gynaecological Surgery ◽

Treatment Groups ◽

Sedation Scores ◽

To Receive ◽

Rescue Antiemetic

The anti-nauseant efficacy of low-dose propofol was investigated in a blinded, randomized trial. Patients who complained of nausea and/or vomiting following laparoscopic gynaecological surgery and who requested antiemetic were randomly assigned to receive placebo, propofol 3 mg, propofol 9 mg or propofol 27 mg by intravenous injection. Nausea, vomiting and sedation were recorded by a blinded observer for 90 minutes following administration of the test drug, prior to discharge, and 24 hours following surgery. Rescue antiemetic (droperidol 1.0 mg IV) was available from 10 minutes after administration of test drug. Propofol failed to reduce nausea scores and did not reduce the incidence of vomiting. Numbers of patients receiving rescue antiemetic were similar in the four treatment groups. In the first 10 minutes following test drug administration, sedation scores were increased by propofol in a dose-related manner. We conclude that, in the dose range studied, propofol is ineffective for the treatment of nausea and vomiting occurring soon after laparoscopic gynaecological surgery.

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