The combined use of propofol and fentanyl for outpatient intravenous conscious sedation

An Extension Study Using Hypnotic Suggestion as an Adjunct to Intravenous Sedation

The effects of hypnosis/therapeutic suggestion in connection with intravenous sedation and surgery have been described in many clinical publications; however, few randomized, controlled, and blind studies have been performed in the outpatient area. The original study published in 2010 aimed to evaluate the use of hypnosis/therapeutic suggestion as an adjunct to intravenous sedation in patients having third molar removal in an outpatient setting. The patients were randomly assigned to a treatment or control group. The treatment group listened to a rapid conversational induction and therapeutic suggestions via headphones throughout the entire surgical procedure along with a standard sedation dose of intravenous anesthetic. The control group received intravenous anesthesia but listened to only music without any hypnotic intervention. The current replication study addressed several of the limitations of the original. Sample size was increased and selection of participants from a different geographic area in Pennsylvania. Intra-operative propofol administration, patient post-operative pain ratings, and post-operative prescription pain reliever consumption were all significantly reduced in the treatment compared to the control group. Implications of these results are discussed.

Effects of hypnosis as an adjunct to intravenous sedation for third molar extraction: a randomized, blind, controlled study

The effects of hypnosis/therapeutic suggestion in connection with intravenous sedation and surgery have been described in many clinical publications; however, few randomized, controlled, and blind studies have been performed in the outpatient area. This study aimed to evaluate the use of hypnosis/therapeutic suggestion as an adjunct to intravenous (IV) sedation in patients having 3rd molar removal in an outpatient setting. The patients were randomly assigned to a treatment (n = 46) or control (n = 54) group. The treatment group listened to a rapid conversational induction and therapeutic suggestions via headphones throughout the entire surgical procedure along with a standard sedation dose of intravenous anesthetic. The control group listened to only music without any hypnotic intervention. Intraoperative Propofol administration, patient postoperative pain ratings, and postoperative prescription pain reliever consumption were all significantly reduced in the treatment compared to the control group. Implications of these results are discussed.

Propofol for Sedation in the Endoscopy Setting

Intravenous sedation is routinely administered for endoscopic examinations to help alleviate patient anxiety and discomfort. The goal of moderate sedation is to provide patient comfort to facilitate the completion of the procedure. Nurse administration of intravenous meperidine and midazolam under the direct supervision of the gastroenterologist is the traditional method for achieving this outcome. More recently, physicians have been requesting monitored anesthesia care for the administration of propofol when performing procedures expected to be technically difficult. Propofol is a rapid acting sedative-hypnotic that produces the desired level of consciousness without the residual sedative effect that often persists with the use of benzodiazepines and analgesics. This article reviews current literature regarding the use of propofol for sedation of patients in the endoscopy setting, and highlights the trends in research that may impact future nursing practice.

Anterior face-lift for correction of middle face aging utilizing a minimally invasive technique

OBJECTIVE

A minimally invasive face-lifting approach aimed at rejuvenation of the midface was examined, for patients with concerns limited to midfacial aging.

METHODS

An incision in the preauricular area and then minor undermining to lift superfical musculo apponeurotic system (SMAS), followed by SMAS plication and removal of skin laxity in the midface, results in excellent superolateral reversal of inferomedial displacement of the aging vector.

RESULTS AND CONCLUSION

A minimally invasive procedure was performed easily under local anesthesia in an office/ambulatory surgery center setting.

Propofol sedation by emergency physicians for elective pediatric outpatient procedures

STUDY OBJECTIVE

We describe the efficacy of propofol sedation administered by pediatric emergency physicians to facilitate painful outpatient procedures.

METHODS

By using a protocol for patients receiving propofol sedation in an emergency department-affiliated short-stay unit, a prospective, consecutive case series was performed from January to September 2000. Patients were prescheduled, underwent a medical evaluation, and met fasting requirements. A sedation team was present throughout the procedure. All patients received supplemental oxygen. Sedation depth and vital signs were monitored while propofol was manually titrated to the desired level of sedation.

RESULTS

There were 291 separate sedation events in 87 patients. No patient had more than 1 sedation event per day. Median patient age was 6 years; 57% were male patients and 72% were oncology patients. Many children required more than 1 procedure per encounter. Most commonly performed procedures included lumbar puncture (43%), intrathecal chemotherapy administration (31%), bone marrow aspiration (19%), and bone biopsy (3%). Median total propofol dose was 3.5 mg/kg. Median systolic and diastolic blood pressures were lowered 22 mm Hg (range 0 to 65 mm Hg) and 21 mm Hg (range 0 to 62 mm Hg), respectively. Partial airway obstruction requiring brief jaw-thrust maneuver was noted for 4% of patient sedations, whereas transient apnea requiring bag-valve-mask ventilation occurred in 1% of patient sedations. All procedures were successfully completed. Median procedure duration was 13 minutes, median sedation duration was 22 minutes, and median total time in the short stay unit was 40 minutes.

CONCLUSION

Propofol sedation administered by emergency physicians safely facilitated short painful procedures in children under conditions studied, with rapid recovery.

Propofol for procedural sedation in children in the emergency department

STUDY OBJECTIVE

We determine the safety and efficacy of propofol sedation for painful procedures in the emergency department (ED).

METHODS

A consecutive case series of propofol sedations for painful procedures in the ED of a tertiary care pediatric hospital from July 2000 to July 2002 was performed. A sedation protocol was followed. Propofol was administered in a bolus of 1 mg/kg, followed by additional doses of 0.5 mg/kg. Narcotics were administered 1 minute before propofol administration. Adverse events were documented, as were the sedation duration, recovery time from sedation, and total time in the ED.

RESULTS

Three hundred ninety-three discrete sedation events with propofol were analyzed. Procedures consisted of the following: fracture reductions (94%), reduction of joint dislocations (4%), spica cast placement (2%), and ocular examination after an ocular burn (0.3%). The median propofol dose was 2.7 mg/kg. Ninety-two percent of patients had a transient (<or=2 minutes) decrease in systolic blood pressure without clinical signs of poor perfusion. Nineteen (5%) patients had hypoxia, 11 (3%) patients required airway repositioning or jaw-thrust maneuvers, and 3 (0.8%) patients required bag-valve-mask ventilation. No patient required endotracheal intubation.

CONCLUSION

Propofol sedation is efficacious and can be used safely in the ED setting under the guidance of a protocol. Transient cardiopulmonary depression occurs, which requires vigilant monitoring by highly skilled practitioners. Propofol is well suited for short, painful procedures in the ED setting.

Resuspension of mild to moderate jawline laxity using a minimally invasive technique

BACKGROUND

A practical approach for superficial musculoapponeurotic system plication and neck lift is indicated for early aging changes of jawline.

METHODS

A single or series of small punches or single incisions at the earlobe and then minor undermining to lift the superficial musculoapponeurotic system followed by removal of skin laxity in neck and jowl result in a seamless scar via a simple V to Y closure.

RESULTS AND CONCLUSION

A minimally invasive procedure was performed easily under local anesthesia in an office/ambulatory surgery center setting.

The Webster-type face and neck lift: an extensive cervico-facial rhytidectomy employing a minimally invasive technique

BACKGROUND

Facelifting has incorporated a wide range of new techniques and developments over the past few decades. Many techniques employ a more aggressive surgical approach that may be advocated for seeming advantage, yet upon closer review may be unwarranted for the average patient seeking facial rejuvenation. The Webster-type face and neck lift utilizes a minimally invasive approach to thoroughly resupport the face and neck substructure and skin. This approach affords the patient excellent results while limiting untoward complications.

OBJECTIVE

To evaluate the efficacy of the Webster-type face and neck lift.

METHODS

The Webster-type face and neck lift was utilized in 200 facelift patients. We reviewed these cases for aesthetic results and associated complications.

RESULTS

The great majority of patients have been uniformly pleased with the aesthetic restoration via the Webster-type lift. Postoperative courses have been routinely uneventful and major complications have been avoided.

CONCLUSION

The evolution of more invasive approaches to cervicofacial rhytidectomy has not been shown to produce consistently better or longer-lasting results. Many of these aggressive techniques have extended the operating time, heightened the potential morbidity of the operation, and prolonged the duration of convalescence. The Webster-type lift is a proven, modern approach that provides comparable and lasting results while limiting risk and avoiding serious complications.