Tu1047 PROPOFOL VERSUS MIDAZOLAM FOR CONSCIOUS SEDATION ADMINISTERED BY THE NURSE UNDER ENDOSCOPIST’S SUPERVISION IN PATIENTS UNDERGOING ELECTIVE ESOPHAGOGASTRODUODENOSCOPY: THE IMPACT ON ENDOSCOPY UNIT EFFICIENCY

Introduction Anxiety and fear in relation to dentistry are long-standing problems and the incidence of dental fear does not appear to be decreasing. It can result in poor dental health and wastage of clinical time. Conscious sedation is one method of allaying anxiety in dental patients and enables such patients to accept dental treatment. Aims, Materials and Methods A questionnaire survey was undertaken among patients attending an emergency dental clinic. Its aims were to assess the levels of dental anxiety in these subjects, the impact on their attendance for dental treatment, and their knowledge of and desire to have conscious sedation, should it be available. Results The results indicated that in the 72 patients who responded, levels of anxiety regarding dental treatment were high, with 49 (68%) claiming some nervousness or worse. Thirty-one (43%) cited fear/nervousness as a reason for delaying making a dental appointment. Twenty-seven (38%) were not aware of the existence of conscious sedation for dental treatment, of whom half reported that they were in the highly anxious group. Forty (56%) respondents said they would like to have sedation if it were available. Twenty-five (35%) claimed to have received sedation for dental treatment in the past. Conclusion It was concluded that the availability of dental sedation was currently not matching the needs and demands of several patients who took part in the survey. Increased availability of dental sedation could remove a barrier to dental care for many highly anxious dental patients.

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A Patient Flow Analysis: Identification of Process Inefficiencies and Workflow Metrics at an Ambulatory Endoscopy Unit

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2016/2574076 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Rowena Almeida ◽

William G. Paterson ◽

Nancy Craig ◽

Lawrence Hookey

Keyword(s):

Care Delivery ◽

Patient Flow ◽

Qualitative Interviews ◽

Flow Analysis ◽

Related Factors ◽

Endoscopy Unit ◽

Time And Motion ◽

Operational Characteristics ◽

Increasing Demand ◽

The Impact

Background. The increasing demand for endoscopic procedures coincides with the paradigm shift in health care delivery that emphasizes efficient use of existing resources. However, there is limited literature on the range of endoscopy unit efficiencies.Methods. A time and motion analysis of patient flow through the Hotel-Dieu Hospital (Kingston, Ontario) endoscopy unit was followed by qualitative interviews. Procedures were directly observed in three segments: individual endoscopy room use, preprocedure/recovery room, and overall endoscopy unit utilization.Results. Data were collected for 137 procedures in the endoscopy room, 139 procedures in the preprocedure room, and 143 procedures for overall room utilization. The mean duration spent in the endoscopy room was 31.47 min for an esophagogastroduodenoscopy, 52.93 min for a colonoscopy, 30.47 min for a flexible sigmoidoscopy, and 66.88 min for a double procedure. The procedure itself accounted for 8.11 min, 34.24 min, 9.02 min, and 39.13 min for the above procedures, respectively. The focused interviews identified the scheduling template as a major area of operational inefficiency.Conclusions. Despite reasonable procedure times for all except colonoscopies, the endoscopy room durations exceed the allocated times, reflecting the impact of non-procedure-related factors and the need for a revised scheduling template. Endoscopy units have unique operational characteristics and identification of process inefficiencies can lead to targeted quality improvement initiatives.

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Tu1156 THE IMPACT OF ANESTHESIA PRACTICE MODELS ON THE EFFICIENCY OF AN ENDOSCOPY UNIT

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2020.03.3328 ◽

2020 ◽

Vol 91 (6) ◽

pp. AB570

Author(s):

Albert A. Civitarese ◽

Reza V. Milano ◽

M.S. McFarland ◽

Abby R. Sapp ◽

David S. Weinberg ◽

...

Keyword(s):

Anesthesia Practice ◽

Endoscopy Unit ◽

Practice Models ◽

The Impact

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A patient information video for treatment under intravenous conscious sedation: considerations, challenges and prospects

Dental Update ◽

10.12968/denu.2021.48.9.752 ◽

2021 ◽

Vol 48 (9) ◽

pp. 752-758

Author(s):

Harjit Tagar ◽

Omesh Modgill ◽

Jashme Patel ◽

Julie Edwards ◽

Olamide Obisesan

Keyword(s):

Patient Experience ◽

Patient Information ◽

Dental Care ◽

Conscious Sedation ◽

Dental Treatment ◽

Digital Health ◽

Related Information ◽

Health Related ◽

The Impact ◽

Insight Into

This article describes the use of a newly developed animation for the delivery of patient information pertinent to dental treatment performed under intravenous conscious sedation, and provides an understanding of how digital health-related information impacts upon the patient experience. This article provides insight into the rationale for using animation as a means to deliver healthcare-related information, the process undertaken to develop this animation and how the themes and imagery in the animation can be used more broadly to further enhance the patient experience in primary and secondary dental care settings. CPD/Clinical Relevance: This article outlines the process of developing an animation for patient information and the impact animation can have upon patient experience locally as an aid to delivering instructions.

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Abstract WP2: Anesthesia Technique and Outcomes of Mechanical Thrombectomy in Patients With Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.wp2 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Kimon Bekelis ◽

Symeon Missios ◽

Todd MacKenzie ◽

Stavropoula Tjoumakaris ◽

Pascal Jabbour

Keyword(s):

New York ◽

Ischemic Stroke ◽

General Anesthesia ◽

Acute Ischemic Stroke ◽

Instrumental Variable ◽

Mechanical Thrombectomy ◽

Conscious Sedation ◽

Case Fatality ◽

Anesthesia Technique ◽

The Impact

Background: The impact of anesthesia technique on the outcomes of mechanical thrombectomy for acute ischemic stroke remains an issue of debate, and has not been studied in clinical trials. We investigated the association of general anesthesia with outcomes in patients undergoing mechanical thrombectomy for ischemic stroke. Methods: We performed a cohort study involving patients undergoing mechanical thrombectomy for ischemic stroke from 2009-2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. An instrumental variable (hospital rate of general anesthesia) analysis was used to simulate the effects of randomization and investigate the association of anesthesia technique with case-fatality and length of stay (LOS). Results: Of the 1,308 patients undergoing mechanical thrombectomy for acute ischemic stroke, 492 (37.6%) underwent general anesthesia, and 816 (62.4%) underwent conscious sedation. Employing an instrumental variable analysis, we identified that general anesthesia was associated with a 6.4% increased case-fatality (95% CI, 1.9% to 11.0%), and 8.4 days longer LOS (95% CI, 2.9 to 14.0) in comparison to conscious sedation. This corresponded to 15 patients needing to be treated with conscious sedation to prevent one death. Our results were robust in a sensitivity analysis utilizing mixed effects regression, and propensity score adjusted regression models. Conclusions: Using a comprehensive all-payer cohort of acute ischemic stroke patients undergoing mechanical thrombectomy in New York State, we identified an association of general anesthesia with increased case fatality and LOS. These considerations should be taken into account when standardizing acute stroke care.

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Endoscopy Unit Efficiency and Patient Satisfaction Utilizing Propofol in Comparison to Combination Propofol and Conscious Sedation

Gastroenterology ◽

10.1016/s0016-5085(11)60065-6 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-17

Author(s):

John E. Poulos ◽

Jeff Caudle ◽

Peter Kalogerinis ◽

Vidhi Patel

Keyword(s):

Patient Satisfaction ◽

Conscious Sedation ◽

Endoscopy Unit

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GASS Trial study protocol: a multicentre, single-blind, randomised clinical trial comparing general anaesthesia and sedation during intra-arterial treatment for stroke

BMJ Open ◽

10.1136/bmjopen-2018-024249 ◽

2019 ◽

Vol 9 (5) ◽

pp. e024249 ◽

Cited By ~ 3

Author(s):

Axelle Maurice ◽

Jean-Christophe Ferré ◽

Thomas Ronzière ◽

Jean-Michel Devys ◽

Aurelie Subileau ◽

...

Keyword(s):

Multicentre Study ◽

General Anaesthesia ◽

Endovascular Therapy ◽

Conscious Sedation ◽

Randomised Clinical Trial ◽

Primary Outcome Measure ◽

Anterior Circulation ◽

Vessel Occlusion ◽

The Impact ◽

Single Blind

IntroductionTreatment of acute stroke has drastically changed in the last 10 years. Endovascular therapy is now the standard of care for patients with a stroke caused by a large vessel occlusion in the anterior circulation. The impact of the type of anaesthesia (general anaesthesia or conscious sedation) during endovascular therapy on the outcome of the patients is still a matter of debate. Previous studies are mostly retrospective and/or focused on the early postprocedure outcome and/or without blood pressure goals and/or single-centre small size studies. We therefore designed a multicentre study hypothesising that conscious sedation is associated with a better functional outcome 3 months after endovascular therapy for the treatment of stroke compared with general anaesthesia.Methods/analysisThe General Anesthesia vs Sedation for Stroke (GASS) Trial is a randomised, parallel, single-blind, multicentre study of 350 patients undergoing endovascular therapy for the treatment of stroke. Patients will be randomly allocated to receive either a general anaesthesia or a conscious sedation. The primary outcome measure is the modified Rankin score assessed 3 months after the treatment. Data will be analysed on the intention-to-treat principle.Ethics/disseminationThe GASS Trial has been approved by an independent ethics committee for all study centres. Participant recruitment begins in September 2016. Results will be published in international peer-reviewed medical journals.Trial registration numberNCT02822144.

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Effects of Video Information on Parental Preoperative Anxiety Level and Their Perception of Conscious Sedation vs. General Anesthesia for the Dental Treatment of Their Young Child

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.31.2.773784g75vq15w45 ◽

2007 ◽

Vol 31 (2) ◽

pp. 90-92 ◽

Cited By ~ 6

Author(s):

Ari Kupietzky

Keyword(s):

General Anesthesia ◽

Conscious Sedation ◽

Dental Treatment ◽

Treatment Options ◽

Young Patients ◽

Anxiety Level ◽

Preoperative Anxiety ◽

Video Information ◽

Significant Difference ◽

The Impact

Aim. To investigate the impact of video information on parental preoperative anxiety and perception and their preference of conscious sedation versus general anesthesia for the dental treatment of young patients. Method/materials. Parents were given a verbal explanation regarding the two treatment options and were then asked to fill out a prescreening questionnaire. Their preference for mode of treatment was obtained and their preoperative anxiety level was measured on a visual analog scale (VAS). A video film depicting two children under going dental treatment with conscious sedation (CS) and a third child undergoing general anesthesia (GA) for dental treatment was shown to the parent. Following the viewing of the video film a post-screening questionnaire was given. Parents' post screening anxiety was measured and they were asked if their perception and preference of the two modes of treatment remained the same or changed. Results. 40 parents were included and completed the trial. The prescreening anxiety level of parents was 2.79 (± 1.05, SD) and was not significantly different than the post screening anxiety level of 2.91 (± .99 SD, paired t- test p=0.432). The majority of parents preferred CS to GA for the treatment of their child prior to screening of the video. Among the few who chose GA (n=5) all but one changed their choice after viewing the video to CS. However, this difference was not found to be statistically significant due to the small number of subjects in this group (McNemar test, p = 0.125). Most parents voiced the opinion that the video film contributed to their knowledge and also considered GA as having more risks than CS. An interesting finding was that a statistically significant difference was found regarding parent's perception of the two procedures and what they actually saw in the video. The majority of parents stated that their initial perception of GA was not similar to their viewing experience, conversely, CS matched their expectations. Conclusion. Parents' anxiety regarding their child's dental treatment under GA or CS is not affected by the viewing of a video film depicting either method. Parent's perception of GA is different than the actual procedure and may affect their choice of treatment.

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