Safety degree assessment of drugs used in conscious sedation for colonoscopy in patients that develop respiratory depression

Dilatation and curettage (D and C) is an essential and common minor surgery in obstetrics and gynecology. Sedation, hypnosis and analgesia are used in combination for such short procedures. These days conscious sedation is provided to patients for day care surgeries which includes analgesia, sedation and anxiolysis while rapid recovery is ensured without side effects. Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis and conscious sedation without respiratory depression. It was to study the effect of dexemedetomidine with fentanyl versus Pentazocine with promethazine on hemodynamic stability and recovery during sedation in dilatation and curettage procedure. The comparison included the hemodynamic data and recovery time. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done. In our study, 50 patients were randomly divided into 2 equal groups; group DF received dexmedetomidine loading dose 1 μg/kg over 10 min and followed by 0.5 μg/kg/hr infusion till completion of surgery and group PP received pentazocine 0.5 mg/kg (max 30mg) and Promethazine 12.5 mg slow intravenous Bolus. Dexmedetomidine is a safe drug which provides good hemodynamics and less recovery time. It also exerts sedative and analgesic effects without respiratory depression unlike most analgesic/sedative drugs, such as ketamine, pentazocine and benzodiazepines. This study demonstrates that dexmedetomidine is a safe drug with good hemodynamic and recovery profile. Dexmedetomidine administration showed better preservation of MAP and SpO2.

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Risk of respiratory depression at use of nitrous oxide on individuals with cerebral palsy: a clinical trial

Research Society and Development ◽

10.33448/rsd-v10i13.20774 ◽

2021 ◽

Vol 10 (13) ◽

pp. e198101320774

Author(s):

Fernando Martins Baeder ◽

Daniel Furtado Silva ◽

Ana Carolina Lyra de Albuquerque ◽

Dênis Clay Lopes dos Santos ◽

Andrea Pavanello ◽

...

Keyword(s):

Nitrous Oxide ◽

Cerebral Palsy ◽

Respiratory Depression ◽

Dental Care ◽

Conscious Sedation ◽

Dental Treatment ◽

Outpatient Setting ◽

Significance Level ◽

Significant Difference ◽

N2o Titration

The dental care for individuals with cerebral palsy (CP) often result in the referral of patients for general anesthesia. Conscious sedation with nitrous oxide (N2O) could be an alternative resource, from a behavioral and physiological point of view, and could favor dental care in an outpatient setting. This study aimed to evaluate the influence of conscious sedation with N2O on respiratory rate (RR) and oxygen saturation (SpO2) in the dental treatment of individuals with CP. Seventy-seven patients with CP, over 3 years old, regardless of gender and ethnicity, were evaluated with the measurement of N2O titration, RR and SpO2 in four moments: initial, 5 minutes after sedation, 10 minutes after anesthesia and 5 minutes after removal of the N2O. Student's t test and ANOVA F were used, with a significance level of 5%. The variation in N2O titration did not generate significant variation in RR (p = 0.122). There was a significant difference in SpO2 between T1 and other times. It can be said that conscious sedation is not influenced by N2O titration, does not cause respiratory depression or any clinically significant change in SpO2, confirming the safety of use in an outpatient setting.

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Can liver cirrhosis patients benefit from target controlled infusion of propofol for conscious sedation during endoscopic variceal ligation?

International Surgery Journal ◽

10.18203/2349-2902.isj20173869 ◽

2017 ◽

Vol 4 (9) ◽

pp. 2907

Author(s):

Jun-Xiang Li ◽

Jun-Chao Wu ◽

Wei-Wei Lin ◽

Xiao Wang

Keyword(s):

Liver Cirrhosis ◽

Respiratory Depression ◽

Recovery Time ◽

Conscious Sedation ◽

Demographic Data ◽

Endoscopic Variceal Ligation ◽

Target Controlled Infusion ◽

Scale Scores ◽

Degree Of Satisfaction ◽

Sedation Group

Background: The aim of the present study was to evaluate the feasibility of conscious sedation using target controlled infusion of propofol combined with a single dose of fentanyl during endoscopic variceal ligation in patients with liver cirrhosis.Methods: Forty-eight patients with liver cirrhosis scheduled for endoscopic variceal ligation were randomly assigned to deep sedation group (DS group) with intravenous bolus of propofol and conscious sedation group (CS group) with target controlled infusion of propofol, 1 μg/kg fentanyl was intravenously injected in each patient before administration of propofol. Cardiorespiratory parameters were monitored, and the side-effects were recorded. The depth of sedation was assessed by both of the sale of observer′s assessment of alertness/sedation (OAA/S) and the bispectral index (BIS). The quality of sedation/analgesia was evaluated by the endoscopist and patients using Visual Analog Scores (VAS). The recovery level was evaluated with the Aldrete scales.Results: No significant differences were found on demographic data and initial parameters in the two groups. Compared with the CS group, the changes of mean arterial pressure (MAP) and heart rate (HR) and the signs of respiratory depression were significant in the DS group (p<0.05). The recovery time in DS group (16.7±2.7 minutes) was much longer than that in the CS group (9.3±3.0 minutes, p<0.01). There was no difference in Visual Analogue Scale scores for endoscopist’s satisfaction between the two groups (9.2±0.6 versus 9.0±0.6, p>0.05), but a higher degree of satisfaction for patient was found in the DS group (9.3±0.6 versus 7.9±0.7, p<0.01).Conclusions: Conscious sedation with target controlled infusion of propofol combined with a single bolus of fentanyl for endoscopic variceal ligation in patients with liver cirrhosis had better hemodynamic stability, less respiratory depression and shorter recovery time.

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Squamous Papilloma Causing Airway Obstruction During Conscious Sedation

Anesthesia Progress ◽

10.2344/anpr-64-03-07 ◽

2017 ◽

Vol 64 (3) ◽

pp. 168-170

Author(s):

Paul Brady ◽

Christine McCreary ◽

Ken D. O'Halloran ◽

Catherine Gallagher

Keyword(s):

Carbon Dioxide ◽

Oxygen Saturation ◽

Airway Obstruction ◽

Respiratory Rate ◽

Respiratory Depression ◽

Conscious Sedation ◽

Monitoring Tool ◽

Squamous Papilloma ◽

End Tidal Carbon Dioxide ◽

End Tidal

Monitoring for respiratory depression is essential during conscious sedation. We report a case of a squamous papilloma as an unusual cause of intermittent partial airway obstruction in a 43-year-old man undergoing intravenous conscious sedation with midazolam. The Integrated Pulmonary Index (IPI) is an algorithm included in some commercially available monitors that constitutes a representation of 4 parameters: end-tidal carbon dioxide, respiratory rate, oxygen saturation, and pulse rate. We discuss the potential of the IPI as a monitoring tool during sedation.

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Comparative evaluation of hemodynamic stability and recovery during conscious sedation by dexmedetomidine with fentanyl versus ketamine with fentanyl dilatation and curettage

QJM ◽

10.1093/qjmed/hcaa039.050 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Cited By ~ 1

Author(s):

G F Kamel ◽

R M Ali ◽

A E A Ismail ◽

B E A Hanna

Keyword(s):

Respiratory Depression ◽

Recovery Time ◽

Conscious Sedation ◽

Diagnostic Procedures ◽

Locus Ceruleus ◽

Hemodynamic Stability ◽

Analgesic Effects ◽

Dilatation And Curettage ◽

Recovery Profile ◽

Sedative Drugs

Abstract Background Conscious sedation is a technique of providing analgesia, sedation and anxiolysis while ensuring rapid recovery without side effects. Conscious sedation is administered with the dual goals of rapidly and safely establishing satisfactory procedural condition for the performance of therapeutic or diagnostic procedures while ensuring rapid, predictable recovery with minimal post-operative sequels. Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis and cooperative sedation without respiratory depression. it inhibits the release of norepinephrine via actions on the alpha2A (α-2A) adrenoceptors located in the locus ceruleus and the spinal cord, resulting in sedation and analgesia via sympatholysis. Objective It was to study the effect of dexemdetornidine with fentanyl versus ketamine with fentanyl on hemodynamic stability and recovery during conscious sedation in dilatation and curettage procedure. The comparison included the vital data and recovery time. The effect of the drugs on hemodynamics and monitoring the occurrence of any complication were also done. Patients and Methods In our study, 50 patients were randomly divided into 2 equal groups; group DF received dexmedtomidine loading dose 1 πg/kg over 10 min and followed by 0.5 πg/kg/hr infusion till completion of surgery and group KF received ketamine 0.5 mg/kg slow intravenous Bolus. Results Dexmedetomidine is a safe drug with good hemodynamic and recovery time, also exerts sedative and analgesic effects without respiratory depression, unlike most analgesic/sedative drugs, such as ketamine, opioids, benzodiazepines and propofol. Conclusion This study demonstrates that dexrnedetomidine is a safe drug with good hemodynamic and recovery profile. Dexmedetomidine better preserved MBP and SpO2.

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Dexmedetomidine-assisted drug interviews: an observation in psychiatric setting

BMJ Case Reports ◽

10.1136/bcr-2018-227195 ◽

2018 ◽

Vol 11 (1) ◽

pp. e227195 ◽

Cited By ~ 1

Author(s):

Devalina Goswami ◽

Harshit Garg ◽

Hamsenandinie Carounagarane ◽

Koushik Sinha Deb

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Adverse Events ◽

Respiratory Depression ◽

Conscious Sedation ◽

Psychological Interventions ◽

Psychiatric Illnesses ◽

Psychiatric Setting ◽

Anaesthesia Practice ◽

Long Time

Drug-assisted interviews are an effective tool in the management of various psychiatric illnesses where psychopharmacological, as well as routine psychological interventions, do not prove beneficial. These have most commonly been done by using barbiturates and benzodiazepines that have given favourable results for a long time. However, they carry the risk of respiratory depression and difficulty in maintaining the plane of sedation where the patient is amenable to interviewing. In our experience of drug-assisted interviews with two patients we used intravenous dexmedetomidine, which is being used in anaesthesia practice for conscious sedation or sedation in the intensive care unit. We found dexmedetomidine to be superior to thiopentone in achieving a level of conscious sedation where the patients were amenable for an interview, with no significant adverse events and faster post-anaesthetic recovery.

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Efficacy of combination therapy with dexmedetomidine for benzodiazepines-induced disinhibition during endoscopic retrograde cholangiopancreatography

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820911822 ◽

2020 ◽

Vol 13 ◽

pp. 175628482091182

Author(s):

Yuki Ikeda ◽

Makoto Yoshida ◽

Kazuma Ishikawa ◽

Tomohiro Kubo ◽

Kazuyuki Murase ◽

...

Keyword(s):

Combination Therapy ◽

Respiratory Depression ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Conscious Sedation ◽

Sedative Effect ◽

Completion Rate ◽

Sedation Scale ◽

Endoscopic Retrograde ◽

Ramsay Sedation Scale ◽

Respiratory Dynamics

Background: Benzodiazepines (BZDs) and analgesics are widely used for conscious sedation during endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP). However, endoscopic procedures are sometimes discontinued because of BZD-induced disinhibitory reactions such as excessive movement. We evaluated the usefulness of dexmedetomidine (DEX) for BZD-induced disinhibition in ERCP. Methods: Between February 2018 and August 2019, 22 patients who underwent EUS or ERCP were enrolled. All patients showed BZD-induced excessive movement at the first examination (BZD group) and received DEX at the second examination (DEX group). The initial DEX dose was 6 μg/kg/h for a 10-min loading, followed by 0.4 μg/kg/h during the procedure. BZDs and analgesics were administered before scope insertion. An additional sedative was administered to achieve a Ramsay sedation scale (RSS) of 4–5. Sedative effect, procedure completion rate, and changes in circulatory and respiratory dynamics were evaluated. Results: Mean RSS scores were significantly higher ( p < 0.001) in the DEX (5.1 ± 0.5) compared with the BZD (4.0 ± 0.5) group. The movement score ( p < 0.001) and number of additional sedatives required ( p < 0.01) were lower in the DEX group. The procedure completion rate was significantly higher in the DEX (95.5%) compared with the BZD group (63.6%; p < 0.05). Significant differences in the frequency of hypotension ( p = 1.00), bradycardia ( p = 0.22), and respiratory depression ( p = 0.68) were not noted between groups. Conclusions: The addition of DEX to BZD therapy yielded better sedative efficacy, lower excessive movement, a reduction in BZDs used, and a higher procedure complete rate. DEX may be used as an alternative method for BZD-induced inhibition during ERCP.

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