Old Is (Not) Gold: Midazolam Monotherapy versus Midazolam Plus Fentanyl for Sedation during Cardiac Catheterization

Objective. We aimed to study the differences in perception of pain during cardiac catheterization with midazolam monotherapy compared to the current standard of midazolam plus fentanyl. Background. Procedural sedation is important to ensure comfort and safety in patients undergoing left heart catheterization. Despite the widespread use of midazolam and fentanyl for procedural sedation, the effectiveness of this dual agent approach to sedation has never been studied in comparison to midazolam monotherapy. Methods. A total of 129 patients undergoing sedation for outpatient elective cardiac catheterization were randomly assigned to either midazolam monotherapy (n = 69) or combination of midazolam and fentanyl (n = 60). The primary outcome was assessment of pain perception prior to discharge by patient completion of a pain questionnaire. Participants were asked if they experienced any pain during their procedure (yes/no) and, if yes, asked to rate their overall pain level using a 10-point Likert scale that ranged from 1 (minimal pain) to 10 (worst pain imaginable). Results. Most patients (n = 94, 73%) reported no pain during their procedure. Patients sedated with midazolam monotherapy reported similar average pain scores compared to patients sedated with the combination of midazolam and fentanyl (1.1 vs. 1.1, p = 0.95 ). Conclusions. Among patients undergoing elective cardiac catheterization, no significant differences in pain scores were noted between sedation with midazolam alone compared to midazolam and fentanyl. Due to fentanyl’s unfavorable interaction with P2Y12 agents, increased costs, and addiction potential, it is imperative that cardiologists revisit the role of effective procedural sedation with a single agent and avoid the use of fentanyl.

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Unmasking Occult Left Ventricular Diastolic Dysfunction In Scleroderma PH Patients - Role Of Left Heart Catheterization And Fluid Challenge

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a4089 ◽

2012 ◽

Author(s):

Benjamin D. Fox ◽

David Langleben ◽

Andrew Hirsch ◽

Robert Schlesinger ◽

Mark Eisenberg ◽

...

Keyword(s):

Diastolic Dysfunction ◽

Fluid Challenge ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Heart Catheterization ◽

Left Heart ◽

Left Heart Catheterization ◽

Ventricular Diastolic Dysfunction

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Regular use of a verbal pain scale improves the understanding of oncology inpatient pain intensity.

Journal of Clinical Oncology ◽

10.1200/jco.1994.12.12.2751 ◽

1994 ◽

Vol 12 (12) ◽

pp. 2751-2755 ◽

Cited By ~ 60

Author(s):

E Au ◽

C L Loprinzi ◽

M Dhodapkar ◽

T Nelson ◽

P Novotny ◽

...

Keyword(s):

Primary Care Physicians ◽

Pain Perception ◽

Assessment Tool ◽

Pain Scale ◽

Oncology Patients ◽

Educational Effort ◽

Pain Scores ◽

Pain Status ◽

Average Pain ◽

Average Pain Score

PURPOSE This study was undertaken to determine if the daily use of a verbal pain scale could improve the correlation of pain perception between hospitalized oncology patients and their caregivers. PATIENTS AND METHODS Hospitalized oncology patients were asked to rate verbally their average pain over the past 24 hours on a scale ranging from 0 to 10. The patients' primary-care physicians and nurses were asked the same question on the same morning after they had evaluated their patients. RESULTS During a baseline study, only 64% of caregivers' pain scores were within two points of the respective patient's score. Caregivers tended to underestimate patients' pain scores. Caregivers were alerted to these poor results and then requested to ask each patient daily for the average pain score and record this score on the patient's medical record. Nonetheless, correlation between patients' and caregivers' pain scores remained poor (68% within two points of each other) during a second study. The major reason for the poor results appeared to be because caregivers did not routinely ask patients for pain scores. Subsequently, a renewed, more intensive educational effort was undertaken and a third study was conducted. During the third study, 85% of caregivers' and patients' pain scores were within two points of each other (P = .001 when compared with baseline). CONCLUSION The enforced use of a simple verbal pain assessment tool appears to improve caregiver's understanding of the pain status of hospitalized oncology patients.

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Novel therapeutic agents for B-cell lymphoma: developing rational combinations

Blood ◽

10.1182/blood-2010-06-255067 ◽

2011 ◽

Vol 117 (5) ◽

pp. 1453-1462 ◽

Cited By ~ 32

Author(s):

Craig B. Reeder ◽

Stephen M. Ansell

Keyword(s):

Hodgkin Lymphoma ◽

Potential Role ◽

Single Agent ◽

B Cell Lymphoma ◽

Current Standard ◽

New Agents ◽

Surface Receptors ◽

Non Hodgkin Lymphoma ◽

Current Standard Treatment

AbstractSeveral novel targeted therapies have recently emerged as active in the treatment of non-Hodgkin lymphoma, including small molecules that inhibit critical signaling pathways, promote apoptotic mechanisms, or modulate the tumor microenvironment. Other new agents target novel cell surface receptors or promote DNA damage. Although most of these drugs have single-agent activity, none have sufficient activity to be used alone. This article reviews the utility and potential role of these new agents in the treatment of non-Hodgkin lymphoma with a specific focus on data that highlight how these agents may be incorporated into current standard treatment approaches.

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Left ventricular dysfunction in patients with suspected pulmonary arterial hypertension

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132014000600004 ◽

2014 ◽

Vol 40 (6) ◽

pp. 609-616 ◽

Cited By ~ 11

Author(s):

Francisca Gavilanes ◽

José Leonidas Alves Jr ◽

Caio Fernandes ◽

Luis Felipe Lopes Prada ◽

Carlos Viana Poyares Jardim ◽

...

Keyword(s):

Pulmonary Arterial Hypertension ◽

Arterial Hypertension ◽

Cardiac Catheterization ◽

Ventricular Dysfunction ◽

Right Heart Catheterization ◽

Left Ventricular ◽

Heart Catheterization ◽

Right Heart ◽

Pulmonary Arterial

OBJECTIVE: To evaluate the role of right heart catheterization in the diagnosis of pulmonary arterial hypertension (PAH). METHODS: We evaluated clinical, functional, and hemodynamic data from all patients who underwent right heart catheterization because of diagnostic suspicion of PAH-in the absence of severe left ventricular dysfunction (LVD), significant changes in pulmonary function tests, and ventilation/perfusion lung scintigraphy findings consistent with chronic pulmonary thromboembolism-between 2008 and 2013 at our facility. RESULTS: During the study period, 384 patients underwent diagnostic cardiac catheterization at our facility. Pulmonary hypertension (PH) was confirmed in 302 patients (78.6%). The mean age of those patients was 48.7 years. The patients without PH showed better hemodynamic profiles and lower levels of B-type natriuretic peptide. Nevertheless, 13.8% of the patients without PH were categorized as New York Heart Association functional class III or IV. Of the 218 patients who met the inclusion criteria, 40 (18.3%) and 178 (81.7%) were diagnosed with PH associated with LVD (PH-LVD) and with PAH, respectively. The patients in the HP-LVD group were significantly older than were those in the PAH group (p < 0.0001). CONCLUSIONS: The proportional difference between the PAH and PH-LVD groups was quite significant, considering the absence of echocardiographic signs suggestive of severe LVD during the pre-catheterization investigation. Our results highlight the fundamental role of cardiac catheterization in the diagnosis of PAH, especially in older patients, in whom the prevalence of LVD that has gone undiagnosed by non-invasive tests is particularly relevant.

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Interventional cardiology for coronary heart disease

Oxford Handbook of Cardiac Nursing ◽

10.1093/med/9780198832447.003.0008 ◽

2020 ◽

pp. 159-182

Keyword(s):

Cardiac Catheterization ◽

Nursing Care ◽

Heart Valves ◽

Interventional Cardiology ◽

Coronary Intervention ◽

Heart Catheterization ◽

Left Heart Catheterization ◽

Generic Term ◽

Percutaneous Coronary ◽

Diagnostic Angiography

The purpose of this chapter is to give an overview of interventional cardiology. Diagnostic angiography and percutaneous coronary intervention (PCI) are discussed, in addition to related issues (e.g. achieving haemostasis, pharmacological adjuncts, and complications). The principles of nursing care for both angiography and PCI are similar and will, ∴, be discussed together; any differences will be clarified. Although coronary angiography is the focus of this chapter, it is worth noting that cardiac catheterization is the passage of a catheter into the left and/or right heart to provide diagnostic information about the heart and blood vessels. Cardiac catheterization is a generic term that refers to a variety of procedures including angiography, ventriculography, and right or left heart catheterization. ∴ abnormalities of the heart valves, heart muscle, and coronary arteries can be identified by these procedures.

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Cardiac Catheterization: Right- and Left-Heart Catheterization

Contemporary Cardiology - Cardiovascular Hemodynamics ◽

10.1007/978-3-030-19131-3_14 ◽

2019 ◽

pp. 221-234

Author(s):

Michael D. Faulx ◽

Khaled M. Ziada

Keyword(s):

Cardiac Catheterization ◽

Heart Catheterization ◽

Left Heart ◽

Left Heart Catheterization

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Cardiac Catheterization: Right and Left Heart Catheterization

Cardiovascular Hemodynamics ◽

10.1007/978-1-60761-195-0_8 ◽

2012 ◽

pp. 155-177

Author(s):

Praneet Kumar ◽

Michael D. Faulx

Keyword(s):

Cardiac Catheterization ◽

Heart Catheterization ◽

Left Heart ◽

Left Heart Catheterization

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Chronic Pain: Fundamental Scientific Considerations, Specifically for Legal Claims

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2013.janfeb01 ◽

2013 ◽

Vol 18 (1) ◽

pp. 1-18 ◽

Cited By ~ 1

Author(s):

Robert J. Barth

Keyword(s):

Health Outcomes ◽

Pain Perception ◽

Driving Forces ◽

Psychological Treatment ◽

Dominant Role ◽

Meta Analysis ◽

General Medicine ◽

Pain Syndrome ◽

Problematic Relationship

Abstract Scientific findings have indicated that psychological and social factors are the driving forces behind most chronic benign pain presentations, especially in a claim context, and are relevant to at least three of the AMA Guides publications: AMA Guides to Evaluation of Disease and Injury Causation, AMA Guides to Work Ability and Return to Work, and AMA Guides to the Evaluation of Permanent Impairment. The author reviews and summarizes studies that have identified the dominant role of financial, psychological, and other non–general medicine factors in patients who report low back pain. For example, one meta-analysis found that compensation results in an increase in pain perception and a reduction in the ability to benefit from medical and psychological treatment. Other studies have found a correlation between the level of compensation and health outcomes (greater compensation is associated with worse outcomes), and legal systems that discourage compensation for pain produce better health outcomes. One study found that, among persons with carpal tunnel syndrome, claimants had worse outcomes than nonclaimants despite receiving more treatment; another examined the problematic relationship between complex regional pain syndrome (CRPS) and compensation and found that cases of CRPS are dominated by legal claims, a disparity that highlights the dominant role of compensation. Workers’ compensation claimants are almost never evaluated for personality disorders or mental illness. The article concludes with recommendations that evaluators can consider in individual cases.

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